Guest
Shen Xin and Li Tao
Interview Background
This episode focuses on the prevention and control of tuberculosis. The host from the Jing'an District Media Convergence Center, along with two experts, will engage in an interactive discussion to provide the public with scientific knowledge and answers regarding tuberculosis prevention and treatment. The program aims to share and exchange valuable information with the audience.
Host:
Centered on the topic of tuberculosis prevention and control, we are honored to have two esteemed guests with us today to share their expertise and engage in insightful discussions. I am pleased to introduce Dr. Shen Xin beside me. Dr. Shen is the Director of the Tuberculosis and AIDS Prevention and Control Institute at the Shanghai Municipal Center for Disease Control & Prevention. Additionally, he serves as a Chief Physician and a Master's Supervisor. Welcome, Dr. Shen.
Shen Xin:
Hello, host.
Host:
Now, we present Dr. Li Tao, the Director of the Clinical Diagnosis and Treatment Department for Mycobacterium at the National Center for Infectious Diseases and a Chief Physician from Huashan Hospital of Fudan University. Welcome, Director Li.
Li Tao:
Hello, host.
Host:
As we commence our program, I would like to inquire: how long have humans been battling tuberculosis? What is the precise nature of its evolutionary trajectory from a medical research perspective? Why does it continue to endure to the present day?
Shen Xin:
Tuberculosis is a disease of great antiquity, with origins traceable to the dawn of human existence. Numerous archaeological findings, including human skeletal remains, provide substantial evidence of its longstanding presence. Since the mid-20th century, the advent and extensive use of anti-tuberculosis medications have marked a significant triumph in our fight against tuberculosis. This has led to marked reductions in the incidence, prevalence, and mortality rates of tuberculosis worldwide. To date, tuberculosis has not been entirely eradicated on a global scale. It continues to be prevalent and to spread in various regions around the world. At present, the incidence of tuberculosis in Shanghai is among the lowest in the nation, representing roughly 15% of the global average. While the global average incidence rate stands at 130 cases per 100,000 people, Shanghai's rate is approximately 20 cases per 100,000, indicating a significantly low prevalence of the disease. However, in Shanghai, pulmonary tuberculosis ranks as the third most frequently reported infectious disease among those classified under Categories A and B.
Host:
We will now have a discussion with Director Li. Director Li, could you please provide an in-depth overview of tuberculosis, including the nature of the disease and the characteristics of the causative bacterium?
Li Tao:
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Upon infection, it predominantly targets the lungs, leading to conditions that affect lung tissues, the trachea, bronchi, and even the pleura. This manifestation of the disease, characterized by pathological changes resulting from Mycobacterium tuberculosis infection, is referred to as pulmonary tuberculosis.
Host:
Could you two please clarify whether tuberculosis and pulmonary tuberculosis can be considered equivalent?
Li Tao:
Pulmonary tuberculosis is a form of the disease tuberculosis, which can impact multiple organ systems within the body. Simply put, aside from hair and nails, any part of the body is susceptible to tuberculosis. The disease is named according to the area it affects, for instance, skin tuberculosis, bone tuberculosis, intestinal tuberculosis, renal tuberculosis, or pelvic tuberculosis which causes infertility.
Shen Xin:
Tuberculosis treatment in China is provided at designated medical institutions. Diagnosis is made through comprehensive evaluations that include imaging tests, pathogenic examinations, and various clinical indicators. Treatment is centralized at designated hospitals, adhering to a structured system. In Shanghai, every district has at least one designated hospital for tuberculosis. Jing'an, for instance, has Shibei Hospital, a district-level institution, and Huashan Hospital, which serves at the municipal level. This system ensures convenient access to tuberculosis treatment for all residents of Shanghai.
Host:
Director Li, based on your observations, could you please describe the standard procedure followed from the onset of symptoms to the definitive diagnosis of tuberculosis? What treatment protocols are typically administered to our conventional tuberculosis patients upon confirmation of the diagnosis?
Li Tao:
The optimal procedure is to seek consultation at a designated tuberculosis hospital upon suspecting tuberculosis. Following this, employ our state-of-the-art diagnostic and treatment methods. This approach ensures maximum efficiency and convenience.
Host:
What are the standard treatment protocols for tuberculosis from a clinical perspective?
Shen Xin:
Conventional tuberculosis that is not drug-resistant is considered drug-sensitive tuberculosis. The standard treatment involves a lengthy regimen of four oral anti-tuberculosis medications, typically lasting at least six months. In contrast, treating drug-resistant tuberculosis requires an even longer duration under traditional protocols. Nevertheless, recent advances in scientific research are driving global efforts to shorten the treatment periods. Drug-resistant tuberculosis remains relatively common today. The extensive use of anti-tuberculosis medications has led to bacteria developing sophisticated mechanisms to evade eradication. These bacteria undergo frequent genetic mutations, which confer drug resistance. To counteract this, it is essential to undertake a dual approach: Firstly, ensure patients are fully cured to prevent transmission; Secondly, once diagnosed with tuberculosis, patients must adhere strictly to the prescribed treatment regimen as directed by medical professionals to prevent sensitive bacteria from developing resistance.
Host:
Could you please inform us, Director Li, about the criteria used to ascertain a patient's recovery? What are the commonly established criteria?
Li Tao:
Firstly, it is imperative to complete the treatment course as stipulated by national health regulations. Typically, the regimen for tuberculosis involves an initial two-month phase of intensive treatment with three to four effective first-line anti-tuberculosis medications. This is followed by a consolidation phase consisting of an additional four months of treatment with two medications. Throughout the treatment period, our protocol includes regular assessments to determine whether the tuberculosis mycobacteria in the patient's sputum has converted to a negative status. Additionally, we will perform routine chest imaging examinations to monitor for any changes, absorption, or calcification in previously affected areas. Paramount to the treatment's success is the noticeable improvement of the patient's symptoms.
Host:
During the preparation of this episode, we consulted our online followers for their opinions. A majority of them posed a very similar and straightforward query: Is tuberculosis curable?
Li Tao:
Tuberculosis is preventable and treatable.
Shen Xin:
With standardized treatment, most cases are curable. Nationally, the cure rate is at least 90%.
Host:
Today, we are honored to be joined remotely by Dr. Zhang Wenhong, a highly respected figure whom you all recognize. Up next, we will hear from Dr. Zhang, who will provide expert advice on the prevention and treatment of tuberculosis.
Zhang Wenhong:
During winter, a range of infectious diseases become prevalent, including mycoplasma pneumonia, influenza, and pneumonia caused by pneumococcus. Many individuals may experience persistent coughing throughout the season. Notably, there is a specific winter-related infectious disease that warrants attention. Following an acute phase, this disease can lead to a chronic and intermittent cough. In severe cases, symptoms may include minor blood in the sputum and even excessive sweating in the afternoon or upon waking at night. These symptoms are typical of a chronic infection. In such instances, we strongly advise individuals to seek medical attention at a hospital for a comprehensive examination to definitively exclude the possibility of tuberculosis. In daily life, individuals must be vigilant about the common symptoms of tuberculosis, which include fever, persistent coughing, mild blood in sputum, or significant weight loss. Most importantly, they must conduct a prompt and thorough screening for these symptoms.
Host:
For many viewers and online followers of this episode, a predominant concern is: How can one effectively prevent tuberculosis and protect oneself from infection?
Shen Xin:
Tuberculosis is transmitted via the respiratory tract, making it comparable to COVID-19. Therefore, the preventive measures effective against COVID-19 are equally applicable to tuberculosis control. For example, wearing a mask on public transportation, whether for preventing other infectious diseases or tuberculosis, can be effective and beneficial.
Host:
If a family member is diagnosed with tuberculosis, it is crucial that we care for them while also safeguarding our own health. What then are the appropriate protective measures that individuals should take?
Li Tao:
Firstly, any family member diagnosed with tuberculosis should immediately commence standardized treatment. Moreover, if secretions from an infected family member are present or if bed sheets and bedding are contaminated with Mycobacterium tuberculosis, it is imperative to ventilate the room daily by opening windows. This method is rather effective. If feasible, consider using ultraviolet light for disinfection or, on sunny days, place the contaminated items outside to sunbathe for a morning or afternoon. If the patient coughs up phlegm, it must be properly disposed of in a container and must not be expelled onto the ground. If a family member has been diagnosed with tuberculosis, individuals in close contact should promptly visit a designated medical facility for screening. This screening should determine if there has been any infection or if early symptoms of the disease are present. Following this, necessary preventive measures should be taken, appropriate treatments administered, and efforts made to improve nutrition and boost immune strength.
Host:
Many of our online followers have submitted topics and questions of interest. One such inquiry pertains to whether tuberculosis remains contagious throughout the entire duration of the illness.
Li Tao:
No. Following infection with tuberculosis, the latent infection phase indicates that although the body is definitively infected with Mycobacterium tuberculosis, the disease has not yet manifested, and there is no risk of transmission at this stage. When pulmonary lesions develop, and Mycobacterium tuberculosis is detected in the secretions, the disease becomes infectious. Nevertheless, with the implementation of a rigorous and effective anti-tuberculosis treatment regimen over a specified duration, the level of infectivity will be significantly diminished.
Host:
Could you please elaborate on the concept of the latency period?
Shen Xin:
The process of tuberculosis infection and disease manifestation is notably intricate. Typically, healthy individuals do not develop tuberculosis even after exposure to the bacteria. The disease generally occurs when the immune system is weakened or when the bacterial load is too substantial for the body to eliminate. Consequently, most individuals remain in a state of latent infection throughout their lives without advancing to active disease.
Host:
Consider the context of schools. For children who are in their developmental stages, what measures should we implement to effectively prevent and control tuberculosis?
Shen Xin:
As we said earlier, the protective efficacy of the BCG vaccine is limited. Typically, by the age of 12 or 13, the vaccine ceases to offer protection. Consequently, there is a marked increase in the incidence of tuberculosis in individuals beyond this age. This necessitates our continued and focused monitoring of students. We have encountered several cases of disease transmission within the student population, primarily due to the failure to detect tuberculosis during admission medical examinations. To prevent such occurrences, we consistently stress the importance of thorough and rigorous health screenings for all incoming students. Upon the identification of a tuberculosis case, we must require the affected student to take a leave of absence. The student may only resume regular academic activities on campus after successfully completing their treatment at home.
Host:
What measures has Shanghai implemented to ease the treatment burden for tuberculosis patients?
Shen Xin:
Tuberculosis is recognized as a major infectious disease. In China, including Shanghai, it falls under subsidized or complimentary treatment programs. Policies vary by region, but generally, through health insurance and government reimbursement schemes, patients are exempt from out-of-pocket expenses, thus alleviating their financial burden.
Host:
Today's discussion has greatly improved our understanding of tuberculosis prevention and control. This episode marks the conclusion of our in-depth exploration of this vital subject. We look forward to your continued interest and extend our sincere thanks to our two distinguished guests for their invaluable contributions and insights shared in the studio. Thank you.
Shen Xin:
You're welcome!
Li Tao:
My pleasure.