Traditional Chinese medicine: empowering tuberculosis prevention and control

Dear Editor,Tuberculosis(TB)is an airborne chronic infectious disease,posing long-lasting challenges and causing extensive health crises and deaths to humanity throughout history,despite existing prevention and treatment methods.The latest TB statistics report released by the World Health Organization in 2023 pointed out that,in 2022,the world recorded approximately 10.6 million new confirmed cases of TB.Among them,China accounted for about 748,000,around 7.1%of the total[1].

Occupation-related airborne diseases: Management and prevention of tuberculosis among nurses working in Ekiti State University Teaching Hospital

Objective:More health workers die from infectious diseases such as tuberculosis(TB)than from any other infectious agent,so the current study is designed to assess TB treatment and preventive measures as they relate to nursing care practice.Materials and Methods:A cross-sectional study was conducted among 82 nurses from December 2022 to January 2023.The data were collected through a self-developed questionnaire and analyzed by frequency table and analysis of variance(ANOVA)statistics.Results:The researchers found that nurses have sufficient knowledge on Infection Prevention and Control(IPC)policy,but not all nurses follow this management protocol,and the reason for their action is addressed in this study.The management and preventive measures used by the participants were identified as:proper cough etiquette/hygiene,working in a well-ventilated area,use of mask,appropriate disposal of used items and so on was reported.Moreover,this study also discovered that there is a positive correlation between nurses who had received training in IPC policy and their use of airborne preventive measures for TB patients(F=1.87,P=0.002)as well as a positive correlation between the availability of resources and their adherence to the proper use of airborne preventive measures when caring for TB patients(F=1.96,P˂0.001).Conclusion:We proposed infection and control training for nurses and adequate equipment supplies to the TB ward which are required in quick TB diagnosis,and must be carried out on a regular basis by health-care personnel,for efficient nursing practice.Ensuring proper safety equipment and isolation units should be available and assessable for nurses or other health workers showing sign or symptoms of TB.Similarly,it is necessary for government to put in place the control and regulations that will safeguard nurses and mandate them to adopt TB prevention protocols,which will aid in lowering the prevalence of TB among nurses.

Scenario of Infection Prevention and Control Measures for Tuberculosis in Tuberculosis Inpatient and Outpatient Department in Tertiary Care Hospital

Tuberculosis is one of the most important infectious diseases in our country. Also nosocomial infection by tuberculosis can occur, which can be prevented by implementing simple, effective and affordable tuberculosis infection control measures in health care facilities. To evaluate the effectiveness of infection control measures, such study was planned. Questionnaires were administered to all doctors, healthcare workers and servants working in outdoor and indoor department of tuberculosis at tertiary care hospital to assess the knowledge, attitudes and practices on prevention and control of Tuberculosis infection. A scoring system was devised to grade them. One-time audit was also done in outpatient and inpatient department. The analysis showed scoring of poor for doctors, good for nurses and poor forward aids. There is a need to develop strategies for training of health care workers on regular basis in order to reduce the incidence of nosocomial infections. Audit result shows a good level of environmental control measures. Better knowledge, attitude and practices are helpful for the prevention and control of tuberculosis. Also environmental control measures are helpful to prevent infection.

The Impact of Directly Observed Therapy on Preventive Treatment for Latent Tuberculosis Infection among Students in Dalian, China

Preventive treatment has an essential effect on latent tuberculosis infection(LTBI)[purified protein derivative(PPD)induration≥15 mm].Between2010 and 2013,there were 6 tuberculosis(TB)outbreaks in the universities in Dalian,China.So far,in Dalian,the directly observed therapy(DOT)and

An Unexpected Presentation of Tuberculosis in the Surgical Field with a Preventable Disease Transmission

Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass and without fever, chills or cough. Bacterial and Fungal cultures were sent during the initial visit and were negative throughout the entire management of his care. After several months of surgical interventions, the patient appeared positive for TB;however a staff member contracted the disease. The patient was managed successfully with the four-drug regimen of Isoniazid, Rifampin, Pyrazinamide and Ethambutol and recovered well from his surgeries.

Modelling the preventive treatment under media impact on tuberculosis:A comparison in four regions of China

Preventive treatment for people with latent Tuberculosis infection(LTBI)has aroused our great interest.In this paper,we propose and analyze a novel mathematical model of TB considering preventive treatment with media impact.The basic reproduction number R_(0)is defined by the next generation matrix method.In the case without media impact,we prove that the disease-free equilibrium is globally asymptotically stable(unstable)if R_(0)<1(R_(0)>1).Furthermore,we obtain that a unique endemic equilibrium exists when R_(0)>1,which is globally asymptotically stable in the case of permanent immunity and no media impact.We fit the model to the newly reported TB cases data from 2009 to 2019 of four regions in China and estimate the parameters.And we estimatedR_(0)=0.5013<1 in Hubei indicating that TB in Hubei will be eliminated in the future.However,the estimatedR_(0)=1.015>1 in Henan,R_(0)=1.282>1 in Jiangxi andR_(0)=1.930>1 in Xinjiang imply that TB will continue to persist in these three regions without further prevention and control measures.Besides,sensitivity analysis is carried out to illustrate the role of model parameters for TB control.Our finding reveals that appropriately improving the rate of timely treatment for actively infected people and increasing the rate of individuals with LTBI seeking preventive treatment could achieve the goal of TB elimination.In addition,another interesting finding shows that media impact can only reduce the number of active infections to a limited extent,but cannot change the prevalence of TB.

Candidate Vaccines against Tuberculosis and the Future of Novel TB Vaccine Research

Introduction: Tuberculosis (TB) continues to be a global health challenge and currently only one licensed vaccine is available. For nearly 100 years, the Bacillus Calmette-Guérin (BCG) vaccine has been in use. While it provides protection against disseminated TB in infants, its protection against adult and adolescent pulmonary tuberculosis (PTB) is variable. This literature review will provide an overview of the clinical status of candidate TB vaccines and discuss the challenges and future development trends of novel TB vaccine research, in combination with a general overview of the Tuberculosis (TB) disease and Mycobacterium tuberculosis itself. Methods: Bibliographic searches were carried out on medical journal databases, publishers, and aggregators. The most used databases were PubMed, NCBI and MDPI. Publications in English on these and other databases relating to novel TB vaccines were included in this review. Results: Currently, there are 12 main vaccine candidates in various phases of clinical trials, they include four protein or adjuvant vaccines, three viral-vectored vaccines, three mycobacterial whole cells or extract vaccines, and one each of the recombinant life and the attenuated Mycobacterium tuberculosis vaccine. Currently, the most likely candidate vaccines are the M72 + AS01E and Vaccae vaccines. M72 + AS01E is a recombinant fusion protein vaccine candidate, clinical trials showed that administering two doses of M72/AS01E was successful in reducing the development of active TB disease with 50% efficacy. Studies have also proven the efficacy of Vaccae (which is currently in phase III clinical trials) as an adjunctive therapy, with it being curative in conjunction with current therapy. Conclusion: Given the morbidity and mortality suffered globally by M. tuberculosis, it is time to realize the seriousness of the situation and accelerate our commitment and investment to the eradication of this infectious disease. With the number of vaccine candidates currently in clinical trials having promising results, it is imperative to continue these studies and accelerate towards phase III licensure trials if we are to achieve the milestone of “End TB Strategy” by 2035. Today, we are witnessing immense progress in both preclinical and clinical TB vaccine research despite disappointing results from some of the clinical efficacy trials like that of MVA85A. We can revisit the design of vaccines and learn from them. It is important not only to recognize and give credit to those that have tested well in human trials, such as M72 + AS01E, but to expedite and improve its efficacy through funding of its research.

Tuberculosis and COVID-19 Screening at Health Facilities: A Cross-Sectional Survey of Health Care Workers in Nigeria during the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) incidence continues to rise in many parts of the world with increasing fatality. At the same time, tuberculosis (TB) has been identified as the leading cause of death amongst all infectious diseases globally. Routine screening of clients visiting health facilities can help to prevent the spread of these diseases. Aim: To assess the relationship between the practice of facility-based routine tuberculosis screening and routine screening for COVID-19. Methodology: Using a Snowball technique, a cross-sectional online survey was carried out during the national lockdown from 5 July to 5 August 2020. The target population for this survey was health care workers from the different health facilities across Nigeria. An online semi-structured questionnaire was used to interview healthcare workers to identify their knowledge, attitudes, and practices (KAP) towards COVID-19 and the practice of routine TB screening. Descriptive analysis, analysis of variance (ANOVA), and Pearson’s Chi-square test was used for statistical comparative analysis. Results: This shows that 53.9% of healthcare workers did not practice routine TB screening while 46.9% did not practice routine COVID-19 screening. Respondents who practiced routine TB screening were found to be more likely to practice routine COVID-19 screening (p < 0.001). Healthcare workers in primary healthcare centers were more likely to carry out routine screening for both diseases (p < 0.001) and among these, Community Healthcare Workers were more likely to carry out routine screening for both diseases than other cadres (p < 0.001). Conclusion/Recommendation: Routine screening for infectious diseases is still not institutionalized in the Nigerian health system, making the control of these diseases difficult. Continued sensitization on the need for routine screening for infectious diseases like TB and COVID-19 should be done for healthcare workers at the different levels in the health care system.

Knowledge and Practice on Tuberculosis among Prison Workers from Seremban Prison

Background: Prisons are always overcrowded, and congestion leads to close relationships, and subsequently, increases the likelihood of airborne illnesses including Tuberculosis (TB). The purpose of this study was to identify the level of knowledge of TB transmission, and TB preventive practices of prison workers in a Malaysian prison. Methods: A cross-sectional study was conducted with convenience sampling technique utilizing a validated questionnaire. 280 prison workers employed at the Seremban Prison were invited to participate in the study. The study period was from January 2019 to June 2019. Inclusion criteria included age above 18 years old and English literacy. The questionnaire was divided into 3 parts which were sociodemographic details, knowledge on TB transmission and TB preventive practices. The analysis was done in SPSS version 24.0 using appropriate statistical tests. Descriptive statistics was used to evaluate the knowledge level of TB transmission, and TB preventive practices of prison workers at Seremban prison. Results: Around 190 questionnaires were obtained usable registering a response rate of 68.5%. This study showed that around 66% of prison workers had moderate knowledge while around 26% had good knowledge of TB transmission. In terms of practice, around 93.7% of prison workers applied good TB prevention practice. Conclusion: This study showed that the majority of the respondents had moderate knowledge regarding TB transmission. However, their disease preventive practices were at acceptable levels which implied that existing prison standard operating procedures play an important on instilling these practices. Nonetheless, prison management should take important action by providing education and training to increase TB knowledge among prison workers to ensure that this practice is always upheld in both prison and community settings.

The strategic framework of tuberculosis control and prevention in the elderly:a scoping review towards End TB targets

With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.

Tuberculosis in Schools and Requirements for Prevention and Control in China

In recent years,although tuberculosis(TB)control in schools has achieved success to some extent,TB outbreaks still occur in schools from time to time.There are gaps in the response to TB outbreaks,which should be identified and addressed through a series of integrated measures that should be implemented and further strengthened.This article summarizes the circumstances of TB outbreaks in schools,their characteristics,and experiences and lessons that can be learned to improve TB prevention and control.

Identification and attribute analysis of key stakeholders who influence multidrug-resistant tuberculosis prevention and control in China

Background There could be various stakeholders who influencing multidrug-resistant tuberculosis(MDR-TB)policy development and implementation,yet their attributes and roles remain unclear in practice.This study aimed to identify key stakeholders in the process of policy-making for MDR-TB control and prevention and to analyse the attributes and relationships of the stakeholders,providing evidence for further policy research on MDR-TB control.Methods This study was conducted from October 2018 to March 2019 and applied the stakeholder analysis guidelines and domestic stakeholder analysis.An initial candidate stakeholder list was developed by policy scanning.Ten experts were invited to identify these candidate stakeholders.The major attribute of these stakeholders were analysed using the Michell scoring method.Based on these results,the intertwined relationships among groups of stakeholders were analysed and mapped through a systematic scan of the policy and literature on MDR-TB control,as well as information obtained from the interviews.Results A list of 21 types of candidate stakeholders was developed after a literature review and policy scanning,of which 11 received 100%approval.After expert evaluation and identification(the total expert authority was 0.80),19 categories of stakeholders were approved and included in the stakeholder analysis.We categorized all of the stakeholders into three groups:(i)definitive stakeholders who are mainly involved in administrative departments and the Provincial Center for Disease Control and Prevention(CDC);(ii)expectant stakeholders who are mainly involved with MDR-TB patients,clinical departments of TB hospitals at different levels,community health care facilities,prefectural CDC and charity organizations;and(iii)latent stakeholders who mainly involved family members and neighbours of MDR-TB patients and TB related products manufacturers.Government departments and higher-level CDCs have strong decision-making power in developing MDR-TB control policies whereas the recommendations from service providers and the concerns of patients should be considered.Conclusions The MDR-TB prevention system was a multistakeholder cooperation system that was mainly led by government stakeholders.Enhancing communications with front-line service providers and patients on their unmet needs and evidence-based suggestions would highly benefit policy-making of MDR-TB prevention and control.

Tuberculosis infection prevention and control:why we need a whole systems approach

Infection prevention and control(IPC)measures to reduce transmission of drug-resistant and drug-sensitive tuberculosis(TB)in health facilities are well described but poorly implemented.The implementation of TB IPC has been assessed primarily through quantitative and structured approaches that treat administrative,environmental,and personal protective measures as discrete entities.We present an on-going project entitled Umoya omuhle(“good air”),conducted in two provinces of South Africa,that adopts an interdisciplinary,‘whole systems’approach to problem analysis and intervention development for reducing nosocomial transmission of Mycobacterium tuberculosis(Mtb)through improved IPC.We suggest that TB IPC represents a complex intervention that is delivered within a dynamic context shaped by policy guidelines,health facility space,infrastructure,organisation of care,and management culture.Methods drawn from epidemiology,anthropology,and health policy and systems research enable rich contextual analysis of how nosocomial Mtb transmission occurs,as well as opportunities to address the problem holistically.A‘whole systems’approach can identify leverage points within the health facility infrastructure and organisation of care that can inform the design of interventions to reduce the risk of nosocomial Mtb transmission.

Guidelines for the Prevention and Control of Tuberculosis in Schools:Recommendations from China CDC

China is still a high tuberculosis(TB)burden country,and the number of new cases of TB was 833,000 in 2019(1).School campuses are highlycrowded places with potential for close contact,which suggests that a few cases of TB may lead to a large outbreak.Thus,TB prevention and control in schools is an important disease control challenge for educational and health departments at all levels.

Achievements and challenges of the World Bank Loan/Department for International Development grant-assisted Tuberculosis Control Project in China

In March 2002,the government of China launched the World Bank Loan/ Department for International Development-supported Tuberculosis （TB） Control Project to reduce the prevalence and mortality of TB. The project generated promising results in policy development, strengthening of TB control systems, patient treatment success,funds management, and the introduction of legislation. In light of the global TB epidemic and control environment, it is useful to review the TB control priorities of the project, summarize the achievements and experiences around its implementation.

Rising challenge of multidrug-resistant tuberculosis in China:a predictive study using Markov modeling

Background:Multidrug-resistant tuberculosis(MDR-TB)is on the rise in China.This study used a dynamic Markov model to predict the longitudinal trends of MDR-TB in China by 2050 and to assess the effects of alternative control measures.Methods:Eight states of tuberculosis transmission were set up in the Markov model using a hypothetical cohort of 100000 people.The prevalence of MDR-TB and bacteriologically confirmed drug-susceptible tuberculosis(DS-TB+)were simulated and MDR-TB was stratified into whether the disease was treated with the recommended regimen or not.Results:Without any intervention changes to current conditions,the prevalence of DS-TB+was projected to decline 67.7%by 2050,decreasing to 20 per 100000 people,whereas that of MDR-TB was expected to triple to 58/100000.Furthermore,86.2%of the MDR-TB cases would be left untreated by the year of 2050.In the case where MDR-TB detection rate reaches 50%or 70%at 5%per year,the decline in prevalence of MDR-TB would be 25.9 and 36.2%respectively.In the case where treatment coverage was improved to 70%or 100%at 5%per year,MDR-TB prevalence in 2050 would decrease by 13.8 and 24.1%,respectively.If both detection rate and treatment coverage reach 70%,the prevalence of MDR-TB by 2050 would be reduced to 28/100000 by a 51.7%reduction.Conclusions:MDR-TB,especially untreated MDR-TB,would rise rapidly under China’s current MDR-TB control strategies.Interventions designed to promote effective detection and treatment of MDR-TB are imperative in the fights against MDR-TB epidemics.

Guiding Tuberculosis Control Through the Healthy China Initiative 2019−2030

Tuberculosis(TB)is a global public health problem,especially in China.China has the third largest TB burden in the world with nearly 0.9 million new TB cases emerging annually.Despite impressive achievements,China still faces many challenges in TB control that threaten further progress and the ability to meet the targets of the End TB strategy if not addressed.On July 15,2019,the State Council of China issued Healthy China Initiative 2019-2030,which proposed 15 special campaigns including the Tuberculosis Control Action to guide the way for China’s TB prevention and control.This article introduces the current status of TB in China,achievements reached so far,and challenges remaining and interprets the targets and strategies from the individual,society,and government level in the Tuberculosis Control Action.

Multichannel Financing Reduces Economic Burden and Improves the Medical Security Level for Tuberculosis Patients

Tuberculosis(TB)is one of the main infectious diseases to simultaneously cause poverty and be caused by poverty.Reducing the economic burden of TB patients in China is essential to improving patient compliance and reducing the impact of the TB epidemic.In accordance with the national reform of the medical and health system and the current status of the country’s TB prevention and treatment service system,representatives of the government proposed the concept of a multichannel financing mechanism.

Prevention

950429 Implementation of national tuberculosis con-trol programme(focus on registration,case-manage-ment and treatment).QIAN Yuanfu(钱元福),et al.Nation Tuberc Contr Center.Public Health Ministr,Beijing,101149.Chin J Tuberc & Respir Dis 1995;18(1):16-18.The results of three nationwide epidemiological sur-veys on tuberculosis showed that the declination in theincidence of tuberculosis from 1979 to 1990 was slowThe rates of case registration and new case registrationrates within ten years(1982～1991) were graduallyincreasing year by year and came to a climax in 1988.

Application of ARIMA model in predicting the incidence of tuberculosis in China from 2018 to 2019

Objective Autoregressive integrated moving average(ARIMA)model was used to predict the incidence of tuberculosis in China from 2018 to 2019,providing references for the prevention and control of pulmonary tuberculosis.Methods The monthly incidence data of tuberculosis in China were collected from January 2005 to December 2017.R 3.4.4 software was used to establish the ARIMA model,based on the monthly incidence data of tuberculosis from January 2005 to June 2017.Both predicted and actual data from July to December 2017 were compared to verify the effectiveness of this model,and the number of tuberculosis cases in 2018-2019 also predicted.Results From 2005 to 2017,a total of 13022675 cases of tuberculosis were reported,the number of pulmonary tuberculosis patients in 2017 was 33.68%lower than that in 2005,and the seasonal character was obvious,with the incidence in winter and spring was higher than that in other seasons.According to the incidence data from 2005 to 2017,we established the model of ARIMA(0,1,2)(0,1,0)12.The relative error between the predicted and actual values of July to December 2017 fitted by the model ranged from 1.67%to 6.80%,and the predicted number of patients in 2018 and 2019 were 789509 and 760165 respectively.Conclusion The ARIMA(0,1,2)(0,1,0)12 model well predicted the incidence of tuberculosis,thus can be used for short-term prediction and dynamic analysis of tuberculosis in China,with good application value.