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Tuberculosis in China: A Success Story for a Global Problem

By Roberta Attanasio

Sometimes called “The Silent Killer”, tuberculosis, or TB for short, is a huge worldwide public health problem — according to the World Health Organization (WHO), one-third of the human population is infected with Mycobacterium tuberculosis, the micro-organism that causes the disease. In 2012, an estimated 8.6 million people developed TB and 1.3 million died from it. The number of TB deaths is unacceptably large, given that most are preventable — indeed, a cure for TB, consisting of a six-month course of drugs, has been available for more than 50 years.

Mycobacterium tuberculosis culture
Photo credit: CDC/Dr. George Kubica

If treatment is incomplete, TB can come back, often in a form resistant to treatment. Years ago, the WHO developed a strategy known as “directly observed, short-course treatment”, or DOTS, to make sure that people with TB take their medicines. The strategy requires government support and is based on a standardized drug treatment monitored by health care workers.

Here is an explanation of how it works (in the words of the U.S. Centers for Disease Control and Prevention): “If you get DOT, you will meet with a health care worker every day or several times a week. You will meet at a place you both agree on. This can be the TB clinic, your home or work, or any other convenient location. You will take your medicines at this place while the health care worker watches. DOT helps in several ways. The health care worker can help you remember to take your medicines and complete your treatment. This means you will get well as soon as possible. With DOT, you may need to take medicines only 2 or 3 times each week instead of every day. The health care worker will make sure that the medicines are working as they should. This person will also watch for side effects and answer questions you have about TB.”

China accounts for a large portion of the global cases of TB. In 2010, China had an estimated 1 million new cases, accounting for 11% of global tuberculosis incidence. However, during the past two decades, China scaled up a DOTS-based control program for TB —  in the 1990s, the program covered half the population and, after 2000, the entire population.

Now, researchers from the Chinese Center for Disease Control and Prevention in Beijing show that this program has been very effective — in 20 years, China more than halved its tuberculosis prevalence, with cases decreasing from 170 per 100,000 in 1990, to 59 per 100,000 in 2010.

The researchers published their findings in the journal The Lancet on March 18, 2014. The findings suggest that, if the strategy is adopted worldwide, tuberculosis can be controlled. Dr, Yu Wang, one of the researchers involved in the study, said in a press release “One of the key global TB targets set by the Stop TB Partnership aims to reduce tuberculosis prevalence by 50% between 1990 and 2015. This study in China is the first to show the feasibility of achieving such a target, and China achieved this 5 years earlier than the target date,”

Aaron Oxley of Stop TB UK told BBC News Health “China has shown what is possible to achieve when attention and resources are brought to the fight against TB. But (globally) nearly 4,000 people still die from TB every day, and 3 million cases go undiagnosed each year. We still have a long way to go.”

Despite the “still long way to go” — good job, China!

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