Coughing, fever, wearing a mask... Mention these sensitive words, and your first reaction may be to new crown pneumonia.
But there is an infectious disease, much more common than the new crown, which alone has taken the lives of hundreds of millions of people around the world, and it is the tuberculosis known as the "white plague".
According to the latest WHO data, around 1.5 million people died from TB globally in 2020[1], on par with COVID-19 (about 1.8 million in 2020[2]).
An even more frightening fact is that the number of deaths from tuberculosis has increased for the first time in a decade.
(Source: WHO website)
In the mainland, the number of new cases of tuberculosis in 2020 was 842,000 [3], and the cumulative number of confirmed cases of COVID-19 in the mainland was 87,071 [4]. That is to say, the number of new patients with tuberculosis in 2020, which is also a respiratory infectious disease, is about 10 times that of the number of confirmed cases of new crown pneumonia.
Today (March 24) is World TB Day, let's take a look at why this infectious disease that has been lurking around us for thousands of years can always "kill people invisibly"?
2021 is known as the most difficult graduation season in history. But Kobayashi (not his real name) still found a good job before graduation and was already preparing to go to the company for an internship for several months in advance.
However, it all ends with the induction check-up.
The doctor informed Kobayashi that the chest x-ray test resulted in suspected tuberculosis and recommended further CT testing. In a series of subsequent examinations, the disease was confirmed: tuberculosis infection had formed a 2 cm cavity in the lungs. Then he began a long course of treatment.
Recalling the whole thing, Kobayashi initially thought that it was just a seasonal cold that aggravated chronic pharyngitis, so he coughed incessantly, but he did not expect that tuberculosis bacteria had been lurking in the body for a long time.
Xiaolin wrote out the medical experience, posted on the Internet, actually received more than 100 messages, many netizens replied to similar experiences: "Last year, the university graduated from the university and entered the medical examination chest X-ray suspected of tuberculosis, and the hospitalization examination was confirmed" "The third year of high school was diagnosed, it was very desperate at the time, and it was only discharged the day before the college entrance examination"...
(Kobayashi shared his physical examination experience on a website)
But thankfully, as long as the five basic principles of "early, joint, appropriate, regular, and full" are followed, after 6 to 8 months of standardized treatment, the vast majority of ordinary tuberculosis patients can be cured.
After Kobayashi was cured of tuberculosis, he found a new job. Only from the large number of comments on the Internet, he still vaguely felt that it was not uncommon for people who had the same encounters with him.
Tuberculosis, known as the "White Plague", seems to be milder than severe infectious diseases such as pneumonic plague, but more than 4,000 people die of tuberculosis every day[1], taking hundreds of millions of lives in human history.
Tuberculosis is mainly transmitted through droplets and the respiratory tract. Tuberculosis patients generally gradually become emaciated, pale, cough from time to time, life is pressed to accelerate the key, but do not die in a short time.
In the 19th century, tuberculosis was even treated as a romantic, elegant fashion, and the poet Shelley joked in a letter to the poet Keats in 1820: "You still have the appearance of a tuberculosis patient." This appearance became a sign of nineteenth-century etiquette.
For this morbid fashion, Lu Xun described it like this: "Autumn twilight, vomiting half a mouthful of blood, two waiters supporting, intimidating to the front of the steps to see the begonias." ”
However, seemingly mild tuberculosis is harmful to the human world, lurking for a long time, waiting for an opportunity.
On March 24, 1882, German scientist Robert Koch announced that he had discovered Mycobacterium tuberculosis, and at this point, humans finally found the cause of tuberculosis. In the following decades, humans have successfully developed a vaccine that can prevent tuberculous meningitis and miliary pulmonary tuberculosis - BCG vaccine, as well as a variety of drugs that can kill Mycobacterium tuberculosis, such as streptomycin, rifampicin, isoniazid...
Humanity rejoices that a bright future of ending tuberculosis lies ahead, just as we once ended smallpox and controlled the plague.
But more than a century later, WHO's Global TB Report 2021 shows that in 2020, 9.87 million people will have new TB and 1.5 million people will die of TB worldwide, and TB remains the world's leading infectious disease killer.
Currently, on the mainland, the government provides free sputum smears and chest x-rays for confirmed TB patients, as well as free first-line treatment drugs.
After being diagnosed and registered, Kobayashi received a free "Golden Quadruple" drug at the designated hospital, namely oral fixed-dose compounds of isoniazid, rifampicin, ethylaminebutanol, and pyrazinamide.
From the perspective of mortality alone, the domestic tuberculosis mortality rate in 2020 is only about 2.1/100,000, which can be said to be very low.
Moreover, the state also provides first-line treatment drugs free of charge, and it is reasonable to say that the burden of disease should not be heavy for patients.
But this is not the case.
The two most serious challenges are co-infection and drug resistance.
For example, previous studies have shown that people with diabetes are 3 times more likely to develop tuberculosis than the average person. It has also been reported that diabetes may be an important factor threatening TB control in the future [5].
Tuberculosis is also one of the most common opportunistic infections among people living with HIV and is an important cause of death among PEOPLE living with AIDS.
Even if tuberculosis patients do not have these diseases, once the drug is stopped, it will form a serious drug resistance, and the time cost of treatment (18 to 24 months) and the cost of treatment will become uncontrollable.
In particular, once it becomes MDR-TB and XDR-TB, it means that isoniazid and rifampicin, the two most important first-line anti-TB drugs, are all ineffective!
Drug-resistant TB means that only more expensive second-line drugs or other new drugs can be used, and even the available treatment options cannot be combined, costing hundreds of thousands of dollars a year, which is undoubtedly worse for low-income patients.
About 20 percent of the population in China is infected with Mycobacterium tuberculosis and remains dormant for a long time, with nearly 300 million people, and the number of TB patients who develop the disease each year due to the reactivation of latent tuberculosis infection (LTBI) is extremely large [6].
Patients with immunodeficiency or other underlying diseases, such as diabetes, have a higher risk of exposure and development of tuberculosis due to the large number of infectious agents. If drug-resistant TB or MDR-TB are combined, not only will the burden of disease rise exponentially, but the prognosis of patients will be even less optimistic.
In 2014, the WHO ambitiously proposed the End TB Strategy: by 2035, TB deaths would be reduced by 95%, cases would be reduced by 90%, and families without TB patients would suffer catastrophic expenditures [6]. Finally, a world free of TB: the number of TB cases per 100 000 people will be reduced to 0.1 by 2050.
Achieving that goal will not be easy, especially now that COVID-19 is spreading.
But each of us can make a contribution to fighting TB, such as remembering these three things in our daily lives:
1. If you find suspected symptoms, see a doctor in time. If you or someone around you coughs, coughs up sputum for two weeks, and there is hemoptysis, low-grade fever, sweating, loss of appetite, etc., go to the hospital as soon as possible to check to avoid the spread of tuberculosis.
2. Do a good job of hygiene, open the window for ventilation. Do a good job of environmental cleaning, and ventilate the closed environment such as home and dormitory frequently.
3. Improve autoimmunity. There are a large number of tuberculosis bacteria in the environment, do not get sick, not rely on a healthy qi, but rely on immunity, rest well, do not stay up late, strengthen physical exercise, dietary balance, ensure nutrition, and enhance immunity to resist tuberculosis invasion.
Tuberculosis is preventable and treatable. I believe that in the near future, ending tuberculosis will not only be a vision, but a reality.
Reviewers:
Zhang Can has
Associate Researcher of tuberculosis Prevention and Control Center of Chinese Center for Disease Control and Prevention, Ph.D. of Peking University School of Medicine
Li Qian
Deputy Chief Physician of the Department of Epidemiological endemic disease prevention and control of Beijing Chaoyang District Center for Disease Control and Prevention
bibliography
1] Global Tuberculosis Report 2021, WHO
https://www.who.int/tb/publications/global_report/zh/
[2] The distribution data of the novel coronavirus pneumonia epidemic situation are http://2019ncov.chinacdc.cn/2019-nCoV/global.html on the official website of the Chinese Center for Disease Control and Prevention
[3] The Global Tuberculosis Report 2021 was released ---- authoritative interpretation of the key data in the report, the official website of the Chinese Center for Disease Control and Prevention
https://tb.chinacdc.cn/zxdt/tpdt/202110/t20211014_250299.htm
[4] The situation of statutory infectious diseases in China in 2020 is http://www.nhc.gov.cn/jkj/s3578/202103/f1a448b7df7d4760976fea6d55834966.shtml
[5] Tang Shenjie, Li Liang, Gao Wen, Xu Shaofa, et al.; China Tuberculosis Yearbook (2017), People's Medical Publishing House; January 1, 2018
[6] The Strategy to End Tuberculosis, WHO website https://www.who.int/tb/strategy/en/
Editors: Ye Zhengxing, Wu Jiaxiang, Zhang Jie
Proofreading: Wu Yihe | Typesetting: Li Yongmin
Operation: Han Ningning | Coordinator: Wu Wei