24 March marks the 27th World TB Day. Experts said that although the tuberculosis epidemic is preventable and controllable, it is still a major infectious disease that seriously endangers the health of the people on the mainland, and early detection of patients and standardized treatment management are the core links of tuberculosis prevention and control. In addition, with the intensification of the aging process of the population, the challenge of tuberculosis prevention and control in the elderly has become increasingly prominent.
The situation of tuberculosis prevention and control remains grim
Tuberculosis is caused by infection with mycobacterium tuberculosis in humans and is mainly transmitted through the respiratory tract.
The picture shows the patient treated at Beijing Chest Hospital. (Courtesy of Beijing Chest Hospital)
According to experts, tuberculosis can occur in any organ except hair and nails, and about 80% of tuberculosis is tuberculosis. If patients with tuberculosis are not diagnosed and treated in time, lung lesions will repeatedly worsen and spread, forming cavities and fibrosis, causing serious damage to lung tissue and lung function, and even leading to death. Tuberculosis requires standardized treatment for more than 6 months, and once the treatment is irregular or incomplete, it is easy to develop into drug-resistant tuberculosis with a longer treatment course, low cure rate and high case fatality rate.
"The fight against drug resistance is huge for TB patients, and drug resistance makes people see no hope of recovery." Nie Wenjuan, deputy chief physician of the first ward of Beijing Chest Hospital, said that especially for some adolescents and young adults, they can only lie in their beds and endure symptoms such as persistent fever and cough and hemoptysis caused by drug-resistant tuberculosis.
The World Health Organization's Global Tuberculosis Report 2021 notes that TB still poses a serious threat to global public health, estimating that 9.87 million new cases of TB will be born globally and 1.5 million people will die of TB in 2020; the number of new TB cases on the mainland will be 842,000.
Experts said that the situation of tuberculosis prevention and control in the mainland is still grim, especially the incidence of drug-resistant tuberculosis is not optimistic. Because of its repeated illness, it not only brings patients physical and family economic burdens, but also has a great impact on the development of life.
The "alarm bell" for the prevention and control of tuberculosis in the elderly has sounded
The reporter learned from the interview that with the continuous intensification of the aging of the population, the "alarm bell" of tuberculosis prevention and control in the elderly has sounded. The reason is that the resistance of the elderly population is weak, the risk of tuberculosis is high, the incidence is hidden, and the symptoms are atypical, the treatment management is difficult, and the treatment outcome is not ideal.
Taking Beijing as an example, the Beijing Municipal Center for Disease Control and Prevention reported that of the 6717 tuberculosis patients in Beijing in 2021, the elderly over the age of 65 accounted for 27.6%. The Beijing Municipal Center for Disease Control and Prevention said that with the intensification of the aging of the population, the impact of tuberculosis in the elderly on the city's tuberculosis prevention and control work will become increasingly prominent.
Duan Hongfei, deputy director of the Third Department of Tuberculosis of Beijing Chest Hospital, said that the risk of tuberculosis in adults will gradually increase after the age of 40, and the prevalence of men aged 75 to 80 years old is about 5 times higher than that of the whole population, and the prevention and control of tuberculosis in the elderly needs to be highly concerned.
Duan Hongfei said that tuberculosis in the elderly is easy to be missed and misdiagnosed due to symptoms and imaging performance, and more comorbidities, thinking that it is chronic bronchitis, and ignoring tuberculosis screening. In this regard, experts remind the elderly to improve health awareness, strengthen their own health monitoring, regular physical examination every year, and attach importance to imaging examination of the chest.
Duan Hongfei said that the first stop for most elderly patients after the appearance of relevant symptoms is often a general hospital rather than a tuberculosis specialist hospital, which requires comprehensive medical institutions to have a sense of vigilance against tuberculosis when receiving treatment; at the same time, specialized hospitals should also strengthen their own comprehensive capacity building to provide more perfect medical services for elderly patients with chronic diseases and basic diseases.
Early detection and standardized treatment are key
According to the Beijing Municipal Center for Disease Control and Prevention, when patients with infectious tuberculosis cough, sneeze and speak loudly, they can spread droplets with tuberculosis bacteria into the air, and people around them may be infected by inhaling droplets with tuberculosis bacteria. In densely populated places such as homes, schools, and factories, there are clusters of TB outbreaks every year caused by the untimely detection of infectious tuberculosis patients.
Li Liang, executive deputy director of the Clinical Center for Tuberculosis Prevention and Control of the Chinese Center for Disease Control and Prevention and vice president of Beijing Chest Hospital, said that in the eyes of many people, the tuberculosis that was originally thought to have disappeared is still around, and one of the important reasons is that it is an infectious disease mainly transmitted by the respiratory tract, and it is very difficult to prevent and control; in addition, tuberculosis does not have a clear incubation period, and after infection with tuberculosis bacteria, it may be onset after 1 year, or it may be 5 years or even 20 years later, so that it is more difficult to find. At the same time, the population base of the mainland is large, and it is estimated that 15% to 20% of the population has tuberculosis bacteria in the body, which means that it is quite difficult to effectively suppress the incidence for a long time.
Experts said that at present, no measures have been found that can effectively block transmission and protect susceptible people, and the most effective prevention and control measures for tuberculosis are still the early detection of tuberculosis patients and scientific treatment management.
Li Liang and other interviewed experts believe that tuberculosis is also a class B infectious disease transmitted by the respiratory tract, patients in the infectious period have a strong infectivity, and the movement in the population will cause the spread of tuberculosis bacteria, especially drug-resistant tuberculosis patients, can learn from the experience of prevention and control of the new crown pneumonia epidemic, take early detection, early isolation measures, and try to hospitalize. "The resources of existing chest or tuberculosis hospitals can be fully utilized and utilized everywhere to stimulate their role and capacity." Li Liang said. (Reporter Mank)