"Big bones withered, big flesh sinking down." The chest is full of breath, and it is inconvenient to breathe..." "Or because of alcohol and food, infection and disease, people's blood qi is weak, the Tibetan government is vain, because of the sense of evil, it becomes its disease..." This is the "Yellow Emperor's Inner Classic" and "Zhongzang Jing" record of "tuberculosis", which was called "tuberculosis" in ancient times, which is a chronic infectious disease caused by tuberculosis bacillus infection, tuberculosis bacteria may invade various organs throughout the human body, but mainly invade the lungs. To this day, TB remains the ninth most deadly disease in the world, a serious threat to human health, higher than AIDS.
In recent years, due to the impact of the new crown pneumonia epidemic, tuberculosis, an ancient infectious disease, has been ignored to varying degrees. According to the Global Tuberculosis Report 2021 released by the World Health Organization, the number of TB deaths has risen for the first time in more than a decade. At present, there are nearly 2 billion people with latent tuberculosis infections in the world, and the estimated number of new TB patients in mainland China in 2020 is 842 000. In layman's terms, about one in three people in life is a carrier of TB bacteria (about 5% to 10% of them eventually develop TB after infection with TB bacteria). Our province is a province with a more serious tuberculosis epidemic in the country, and the reported incidence of tuberculosis in 2020 ranks third in the country, and the number of tuberculosis patients ranks first in the number of reported class A and B respiratory infectious diseases in our province. When it comes to tuberculosis prevention and treatment, more people think of clinicians, and the driving force behind the discovery, diagnosis and treatment and management of tuberculosis patients should not be underestimated.
Carry out "active screening" based on "symptomatic medical treatment" to find the source of infection
The discovery of tuberculosis patients is generally "symptomatic consultation", the patient coughs, coughs up sputum for more than two weeks to the hospital for examination, but in fact, nearly half of the tuberculosis patients do not have any clinical symptoms, then these people are likely not to be found and there is a risk of transmission. At present, the diagnosis of tuberculosis in our province is mainly based on the treatment of the symptoms, and the patient discovery is expanded through close contact screening, active screening in high-epidemic areas, and screening of key populations. "The peak reported incidence of tuberculosis in our province reached 60,000 people, because of the particularity of latent tuberculosis infection and the limitations of personnel and technology, many tuberculosis patients were not detected in time. The reported incidence of tuberculosis in our province has dropped from the highest 18 per 18,000 to 85 per 100,000, which is inseparable from our active screening. Chen Huijuan, deputy director of the Institute of Tuberculosis Prevention and Control, introduced, "At present, drawing on the experience of new crown pneumonia prevention and control, in the prevention and control of tuberculosis in schools, our province should screen the student population as much as possible, and on the basis of strictly implementing the tuberculosis screening of new students in the province, the students enrolled in the spring and autumn should also carry out tuberculosis latent infection screening." By identifying latent infected people at an early stage and taking preventive anti-TUBERCULO treatment measures to reduce the risk of disease, the incidence of tuberculosis clusters in schools can be controlled. It is understood that at present, for high-risk groups, the elderly, agricultural workers and other groups, our province has also carried out multi-party linkage and timely active screening of tuberculosis.
Actively carry out the handling of tuberculosis epidemics in schools
Tuberculosis prevention and control health promotion into schools
"Combination of medical and prevention" 16 designated hospitals in the province focus on the diagnosis and treatment of tuberculosis patients
Respiratory transmission is the main mode of tuberculosis transmission, so centralized hospitalization management for patients with infectious and severe tuberculosis is an effective way to reduce social transmission and carry out treatment. Li Jinlan, director of the Provincial Center for Disease Control and Prevention, said, "At present, we are adopting a 'trinity' medical and prevention combination prevention and control management system in which disease control institutions are responsible for planning and coordination, designated hospitals are responsible for confirmed diagnosis and treatment, and community health centers are responsible for patient management." By the end of last year, we had established a comprehensive prevention and control management model with the centralized hospitalization of infectious and severe tuberculosis patients as the core in the province, and 16 designated hospitals have carried out centralized diagnosis and treatment. By controlling the source of infection through this measure, tuberculosis patients can be treated with a regular course of treatment, which can greatly reduce the infectivity and block the transmission to a certain extent. "It is worth mentioning that Guizhou is currently the first province in the country to carry out full coverage of tuberculosis clinical diagnosis and treatment quality assessment, which is of great significance for improving the accurate diagnosis of tuberculosis diagnosis and treatment in our province."
Designated hospitals carry out centralized diagnosis and treatment of tuberculosis
Explore the implementation of "drug-resistant" TB dynamic zeroing to provide medical protection for patients
In recent years, our province has reported about 500 cases of multidrug-resistant tuberculosis patients every year, compared with ordinary tuberculosis, the treatment of drug-resistant tuberculosis is difficult, the treatment course is about 18 months, and it costs 200,000-300,000 yuan... If patients with multidrug-resistant tuberculosis do not get effective treatment, they will not only fall into the dilemma of "poverty caused by illness and return to poverty", but also become the source of infection in social activities.
In June 2021, the Notice of the Provincial Medical Insurance Bureau on Further Regulating the Outpatient Guarantee System for Chronic Special Diseases was issued, which solved the long-standing outstanding problem of heavy outpatient diagnosis and treatment burden for tuberculosis patients. "'Drug resistance' is included in the outpatient protection of chronic diseases, indicating that multidrug-resistant patients can also enjoy inpatient reimbursement in outpatient clinics, and most of the treatment costs of more than 100,000 yuan will be guaranteed." This is the director of the center Yang Guanghong led the team to visit tuberculosis patients, tuberculosis designated medical institutions, health administrative departments, medical insurance departments, through in-depth interviews, actual calculations, the actual needs of patients' treatment costs and the gap between medical security to conduct in-depth research, in order to provide a basis and suggestions for adjusting the medical security policy for tuberculosis patients. He Yuying said. In December 2021, Professor Zhang Wenhong's team of the National Center for Infectious Disease Medicine and the China Health Management Association signed and launched the implementation of the project to eliminate the harm of drug-resistant tuberculosis with the Guizhou Provincial Health Commission, the implementation of the project is expected to promote 90% of drug-resistant tuberculosis patients in Guizhou Province to receive treatment through four to five years, more than 90% of the found tuberculosis patients are tested for drug resistance, and finally reach an 80% treatment success rate, so that patients no longer have "catastrophic" expenditure on treatment. And let Guizhou take the lead in achieving the "dynamic clearance" of drug-resistant tuberculosis in the country, which is the embodiment of the sustainable innovation model of our province to explore the "government + enterprise + social welfare" of diversified financing to support the elimination of infectious diseases.
The scene of the signing ceremony of the Guizhou Province Eradication of Drug-Resistant Tuberculosis Hazard Promotion Project
The Provincial Center for Disease Control and Prevention went to Anshun to investigate the work of tuberculosis medical security policies
Establish a healthy Guizhou smart cloud platform to strengthen patient management in multiple dimensions
"Through field visits, I found that some tuberculosis patients are families, neighbors, and even villages, which shows that people's understanding of tuberculosis prevention and control is far from enough, coupled with the regional characteristics of our province, patients are inconvenient to receive medicines, village doctors can not do supervision and intervention at any time, and patients have poor adherence to medication." Chen Pu said. Health Guizhou smart cloud platform is based on the actual situation and needs of tuberculosis patient management in our province to establish an auxiliary system, Zhou Jian introduced, "This platform is currently in the trial operation stage, mainly including real-time prevention and early warning of tuberculosis epidemic in schools in the province, tuberculosis drug management (including drug access management, drug records, medication reminders, etc.), which is the embodiment of the application of the concept of smart medical care to tuberculosis management in our province, mainly for disease control personnel and county-level outpatient doctors, through remote supervision and intervention, It not only ensures the continuity, portability and privacy of guardianship, but also has low cost and popularity, frees grass-roots doctors and patients from complicated treatment and management processes, saves manpower and material resources and reduces the risk of tuberculosis transmission, and is conducive to promoting patients to take drugs regularly and effectively. ”
There is a long way to go and a long way to go, and pragmatically promote multi-party assistance in tuberculosis prevention and control
"Looking back at the establishment of the tuberculosis prevention and control matrix in our province, under the leadership of Director Yang Zhao, our earliest team, '18 Green Pines', ran through all counties and districts in the province in three years, constantly discovering, controlling and treating cases, this process is persistence and achievement, eliminating tuberculosis is not achieved overnight, it requires the efforts of one, two generations or even more generations." Li Yang, director of the former Junction Defense Institute, said. "To achieve the ultimate goal of ending tuberculosis by 2035 is still facing great pressure, tuberculosis prevention and control can not be separated from government leadership, departmental cooperation and the participation of the whole society, we can learn from the new crown prevention and control experience, early detection, early isolation, early treatment, publicity, increase investment, to further promote the standardized treatment, tracking management and quality control of tuberculosis patients in our province." Lei Shiguang, deputy director of the Provincial Center for Disease Control and Prevention, said. "Tuberculosis prevention and control is not an immediate effect, because active tuberculosis patients are only the tip of the iceberg of tuberculosis infected people, although after decades of efforts, the incidence of tuberculosis has been somewhat controlled, we must stick to the original intention, prevention and control steps can not be sluggish and can not stop." Chen Huijuan said. The task is heavy and the road is long, it is more necessary to spur the horse, the still water is deep, it should still be stable and far-reaching, tuberculosis prevention and control needs to be pragmatic and innovative, and it needs the attention and participation of everyone in society, I believe that through multi-party assistance, continuous weaving of a dense public health protection network, the road to healthy Guizhou construction will move towards a newer step.
Review: Yang Guanghong, Lei Shiguang, Huang Yan, Li Yafei
Written by: Huang Luqiu
END