From ＂talking about the color change of tuberculosis＂ to ＂staying out of the area＂ in diagnosis and treatment, what has tuberculosis prevention and control experienced in the past 70 years？
Cctv news(Reporter Zhang Ke Yi) Tuberculosis, commonly known as "consumption disease", is a chronic respiratory infectious disease caused by the invasion of mycobacterium tuberculosis into human body. Mycobacterium tuberculosis may invade all organs of human body, and tuberculosis is the most common one. As an ancient disease, tuberculosis can be traced back to the Neolithic Age. Scientists used modern detection technology to find mycobacterium tuberculosis in Egyptian mummies in 3000 BC.
In A Dream of Red Mansions, one of Four Great Classical Novels’s well-known novels, Lin Daiyu, a sick beauty, actually got consumption. What is intriguing is that among the modern writers in China, there is a long list of those suffering from tuberculosis: Ba Jin, Qu Qiubai, Lu Xun, Yu Dafu, Ye Zi, Xiao Hong … … Tuberculosis is also involved in many of their literary works, such as Lu Xun’s short story Medicine, Yu Dafu’s Chi Guihua, Boundless Night, Ba Jin’s Home, Cold Night and so on. At that time, tuberculosis ranked first in the list of causes of death. "Ten diseases and nine tuberculosis" and "talk about tuberculosis" are not sensational.
Nowadays, tuberculosis is still one of the top ten deadly diseases in the world. More than 1.6 million people die of tuberculosis every year in the world, and there are about 10 million new tuberculosis patients every year, with an incidence rate of 1.33/100,000. In China, the epidemic situation of tuberculosis is declining year by year. According to the data of 2018, there are 823,000 cases of tuberculosis patients reported in China, with a reported incidence rate of 59.3/100,000. However, it is worth noting that the severity of tuberculosis drug resistance in China is higher than the global average. How to do a good job in drug-resistant prevention and treatment of tuberculosis and accelerate the process of ending tuberculosis has become a major public health problem for the government, medical institutions and even the whole society.
"Institute-linked remote diagnosis and treatment platform"
Explore a new model of tuberculosis diagnosis and treatment
Beijing tuberculosis therapy institute liandong remote consultation center
"Hello, Director Gao, I saw your number here today." On the morning of March 22, 2019, Xiao Zhang, a pulmonary tuberculosis patient who lives in Daxing District, Beijing, greeted Gao Mengqiu, the chief physician of Beijing Chest Hospital, 50 kilometers away, through the big screen at Daxing District Tuberculosis Control Center and started his visit. He also became the first online patient on the "hospital-linked remote diagnosis and treatment platform" for tuberculosis prevention and control in Beijing.
"I have seen the film you shot yesterday. The lesion has been absorbed and recovered quite well. You have been taking medicine for more than 2 months now, and the infectivity is gone. But you should stick to taking medicine and you will be cured in about 9 months." On the screen, Gao Mengqiu gave Xiao Zhang treatment advice. "Drink milk every day, eat eggs, and sleep before 10 o’clock to ensure your resistance. Do you know that you get this disease because you usually don’t pay attention to rest and your resistance drops? "
This remote diagnosis and treatment made Xiao Zhang excited. He admits that in the process of seeing a doctor, he once considered the examination in the local tuberculosis control center, but the concept of going to a big hospital drove him to choose the Beijing Chest Hospital in Tongzhou. "In fact, sometimes I understand that this is unnecessary, but I just feel that going to the top three hospitals is practical." He also said that he knew he shouldn’t go to public places, but in order to see a doctor, he had to squeeze the bus, take the subway and wear a mask, and he was afraid that others would treat him differently, so sometimes he didn’t bring it. He said: "But now, I can see the expert number of the top three hospitals at the CDC in front of my house, which is simply great."
Guan Yongchun, director of Beijing Daxing District Institute for Tuberculosis Control and Prevention, said at the remote consultation site: "This model is a supplement to medical technology for us, which is more convenient for us to manage patients." Beijing Changping District Tuberculosis and Prevention Institute and Daxing District Tuberculosis and Prevention Institute became the first members of the "hospital-linked remote diagnosis and treatment platform". It is understood that after the "new model" is officially completed, all district and county clinics in Beijing will establish remote clinics with Beijing Chest Hospital to provide services to district and county patients through face-to-face online video.
Li Liang, vice president of Beijing Chest Hospital and executive vice president of Beijing Tuberculosis Diagnosis and Treatment Technology Innovation Alliance, said: "The biggest change is to change the diagnosis and treatment of tuberculosis from patients seeking medical treatment everywhere to ’ Foot-out area ’ , the change of getting the high-quality service from the superior hospital at home; However, it has expanded the probability of infection from chariots and horses to the nearest place and reduced the spread; Referral from a number of hospitals, repeated medical treatment, timely detection and diagnosis, and timely standardization of treatment changes. "
Peer education for patients with multidrug-resistant tuberculosis
"I’m cured, so I decided to stay."
Say "No" to Tuberculosis (Design: Liu Zhengqiang)
Xu Xinghua said: "All the medical staff who accompanied and cared for me all the way and ‘ 57 Heaven and Earth ’ My peers have asked me to stick to this job. Without them, I wouldn’t be here today. So when I was cured, I decided to stay. For the health of more patients, I am willing to be their ‘ Butler ’ 。”
One day in September 2013, Xu Xinghua went to a local hospital because of fever, cough and pain in his feet and joints. The doctor said that he had rheumatoid disease. After more than four months of treatment, Xu Xinghua was diagnosed with dermatomyositis. After treatment according to the doctor’s advice, he still had a fever repeatedly, once reaching 40 degrees, which lasted for another five months, and finally he was diagnosed with tuberculosis.
"At that time, when my friends came to see me, I would say that I had rheumatism. I was afraid that my friends would stay away from me if they knew that I had tuberculosis." Xu Xinghua said that in addition to being afraid of losing friends, he also faces a heavy economic burden. Xu Xinghua’s family is in the countryside. Before that, some savings were spent by him, and he even borrowed a loan. He wanted to give up treatment.
On July 1, 2014, Xu Xinghua was transferred to Yunnan Tuberculosis Clinical Treatment Center for hospitalization. During the treatment, the danger was constant. He had an extremely serious systemic rash. He was treated with second-line anti-tuberculosis drugs because of serious drug allergy. He suffered from liver failure for many times and complicated with bone tuberculosis. He was cured in October 2017 with the joint efforts of his family, patients and medical staff.
"Illness can destroy my body, but it can’t destroy my will", which is the impression Xu Xinghua left for his patients. In 2015, Xu Xinghua joined the "57 Tiandi" peer team of Yunnan Tuberculosis Clinical Treatment Center, which is a tuberculosis consultation and exchange network platform managed by tuberculosis patients. He hopes to guide and encourage other patients to adhere to scientific treatment through his own experience.
Due to the long course of treatment and many adverse reactions, the compliance of patients with multidrug-resistant tuberculosis has always been a difficult problem, and peer education plays a very important role in the compliance of patients with drugs. Yunnan Provincial Tuberculosis Clinical Treatment Center has been trying first. Since 2012, it has started patient-centered care work, recruiting peers to provide online and offline patient compliance support and care services for patients, which has been unanimously recognized by the tuberculosis community at home and abroad. In October 2018, this work was shared at the Union Tuberculosis Hague Conference.
Research and development of new anti-tuberculosis drugs
How to Solve the "Last Mile" Problem
A "street rat" with nowhere to hide (design: Sun Yaping)
Nowadays, tuberculosis can be cured. However, the four first-line drugs used for treatment take a long period of time, and conventional treatment takes six months. If you are infected with drug-resistant mycobacterium tuberculosis, it may take years of treatment, and the cost is also very high, which is a common problem facing the whole world.
"At present, among the 558,000 cases of MDR-TB in the world, only 25% of patients can get treatment for MDR-TB, and the success rate of treatment is only 55%." Dr. Chen Zhongdan, technical officer of HIV/AIDS/viral hepatitis/tuberculosis in the representative office of the World Health Organization in China, said.
Only Mycobacterium tuberculosis has super drug resistance? Actually, it is not. From the perspective of drug research and development, there are currently four first-line drugs for anti-knot. It is understood that these four drugs are "old drugs" that have been listed since the 1950 s and 1960 s. In the past 70 years, few first-line anti-knotting drugs have entered the public eye. In addition, due to the long treatment cycle, large side effects and heavy economic burden, the treatment compliance is not good. Therefore, it is reasonable for first-line drugs to develop drug resistance.
Dr. Lu Manchun, Chief Operating Officer of Global Health Drug R&D Center, said that we should realize that if new drugs with the same efficacy as first-line anti-tuberculosis drugs can enter the market and form new treatment schemes, the problem of tuberculosis drug resistance will be greatly alleviated. She further said that in shortening the research and development cycle of new drugs, through innovative technological breakthroughs, such as the artificial intelligence drug design technology developed by the R&D center, the research and development time of new drugs can be greatly shortened, expenses can be reduced and risks can be reduced.
There is something special about the drugs used to treat tuberculosis. At present, there must be at least three effective drugs in the simplest treatment scheme, and the three drugs need to be used together. Therefore, in the research and development of new drugs, the formulation of the best scheme of combined drug use can not be ignored. Huan Shitong, senior project officer of Bill & Melinda Gates Foundation, said that this is not a study of a drug, and the formulation of a combination drug plan is very important for each drug to enter the market. Once a drug has passed the pre-clinical safety test, it is necessary to consider how to include it in the future combination drug program for evaluation. This will reduce the risk and improve the cure rate of patients.
In short, on the one hand, we should strengthen and optimize the use of existing tools and methods to accelerate the decline of tuberculosis; On the other hand, in the face of "market failure", it is necessary to increase investment, strengthen all-round research and development, and pay attention to new drugs, vaccines, new prevention methods, and new combined treatment schemes. It is necessary to comprehensively use mechanisms such as financial input, medical insurance, civil support, poverty alleviation and social assistance to reduce the economic burden of patients, so that they can obtain and adhere to high-quality medical services. Only with the participation of the whole society can tuberculosis be better controlled and finally eliminated.