Table of Content

30 September 2013, Volume 2 Issue 3

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Expert Forum

Global tuberculosis control: then and now

Emilio Dirlikov, LIU Yu-hong, Catharina Van Weezenbeek, Mario Ra-viglione, Fabio Scano

Journal of Tuberculosis and Lung Health. 2013, 2(3):  143-149.  doi:10.3969/j.issn.2095-3755.2013.03.002

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In this article, we review the progress made in the global fight against tuberculosis. We detail current challenges to control efforts, including MDR-tuberculosis and HIV/tuberculosis co-infection. We finish by highlighting developments in the WHO End TB strategy 2016—2035. A search for English articles was conducted on two electronic databases: PubMed and Science Direct. Articles were searched under the keywords “tuberculosis,” “global,” “control,” and “policy,” for 2007 to May 23, 2013. PubMed returned 145 articles, and Science Direct returned 68. Articles were further excluded if they focused on an individual country or region, or exclusively on clinical research. A final 70 articles were reviewed. Additional background information was assembled from information provided by WHO headquarters, and through discussions with relevant tuberculosis experts.

The current status and development idea of basic medical and health institution in TB control

LIU Xiao-qiu,WANG Li-xia

Journal of Tuberculosis and Lung Health. 2013, 2(3):  150-152.  doi:10.3969/j.issn.2095-3755.2013.03.003

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Basic medical and health institution is an important part of tuberculosis (TB) service system in China. It has the exceptional position to refer TB suspects, supervise TB patients and conduct health education activities to the public. Aiming to improve TB control in China, we describe the effect of basic medical and health institution in TB control, analyze the current challenges and constraints and suggest making fully use of the national basic public health services.

Original Articles

The estimation of required funds for diagnosis and treatment of pulmonary tuberculosis patients

LI Jun, LIU Xiao-qiu, ZHAO Jin, ZHANG Hui, JIANG Shi-wen, WANG Li-xia

Journal of Tuberculosis and Lung Health. 2013, 2(3):  153-158.  doi:10.3969/j.issn.2095-3755.2013.03.004

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Objective To estimate the required funds for diagnosis and treatment of pulmonary tuberculosis (PTB) patients and to provide reference for implementing National Tuberculosis Control Program(NTP) and improving financing mechanism.Methods Based on the estimation unit of one prefecture, the annual diagnosis and treatment fund demand per capita and per case of common TB patient and MDR-TB patient were calculated respectively, the fund demand nationwide from 2011—2015 were estimated. In accordance with the sixth national census, central government transfer payment program for TB control and the extension plan of programmatic management of MDR-TB from 2011—2015, 334 prefectures nationwide implementing TB control program and basic parameters for one prefecture (3.895 million population, 8 counties and 127 towns/communities) were determined. In terms of the final evaluation report of NTP (2001—2010) and the baseline survey result of drug resistance from 2007—2008 nationwide, the number of patients diagnosed and reported annually in one prefecture was estimated.Results 17630000 yuan was required for patient diagnosis and treatment in one prefecture on average in one year, with 4.53 yuan per capita, in which common TB patients required 13000000 yuan (74%), with 3.34 yuan per capita, while MDR-TB required 4630000 yuan (26%), with 1.19 yuan per capita. On average, the required fund of one common TB patient for diagnosis, treatment and patient care was 4151 yuan, while one MDR-TB patient required 42129 yuan. In accordance with the NTP (2011—2015) and MDR-TB management tentative expansion plan, a total of 5.02 billion yuan, 5.12 billion yuan and 5.27 billion yuan were required during 2013 to 2015 nationwide respectively.Conclusion The method and result of estimation will act as a scientific base for estimating financing of TB diagnosis and treatment, and also provide reference for estimating local required funds and improving financing mechanism.

Human resources survey and assessment of tuberculosis prevention and control in Heilongjiang province

ZHENG Gui-lan, WEI Song-ting, ZHANG Jing-lin, YAN Xing-lu, LI Fa-bin, HAN Xue

Journal of Tuberculosis and Lung Health. 2013, 2(3):  159-163.  doi:10.3969/j.issn.2095-3755.2013.03.005

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Objective To learn the currant human resource status for tuberculosis(TB) control and prevention in Heilongjiang province, and to provide evidence for improving human resources development.Methods According to the annual report of the TB Information Management System of Heilongjiang province in 2012, there were 1520 TB control staff in Heilongjiang province. The reported data were collected and analyzed. χ² test was used to compare the difference of rate among groups. P<0.05 was statistically significant. For multiple comparison among several groups, P<0.0125 was statistically significant.Results The proportion of TB control staff with undergraduate degree or above accounted for 66.67% (36/54) at provincial level, 42.99% (92/214) at prefecture level and 18.29%(229/1252) at county level. The proportion at province level was much higher than that at prefecture level (χ²=9.69, P<0.01), which was significantly higher than county level (χ²=65.20, P<0.01). The proportion of senior TB control staff accounted for 18.52% (10/54) at provincial level, 26.64% (57/214) at prefecture level and 12.70% (159/1252) at county level. The proportion at prefecture level was much higher than county level (χ²=28.25, P<0.01). The proportion of TB control staff in training, health education and statistics analysis was less than 10% (9.14%,139/1520). The Gini coefficient of TB control staff were 0.18 by population and 0.41 by area.Conclusion TB control staff with high education was insufficient. The distribution of TB control staff according to service area is higher than the alarm value. Therefore the human resource for TB control needs to be strengthened urgently.

The value of gene chip on rapidly detecting isoniazid-resistant Mycobacterium tuberculosis clinical isolates in Suzhou city of China

SHI Mei-hua, TANG Pei-jun, YE Zhi-jian, SHEN Xing-hua, WANG Xia-fang, XIAO Yu-mei, WU Mei-ying

Journal of Tuberculosis and Lung Health. 2013, 2(3):  164-168.  doi:10.3969/j.issn.2095-3755.2013.03.006

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Objective To evaluate the clinical value of gene chip on rapidly detecting isoniazid (INH)-resis-tant Mycobacterium tuberculosis (Mtb) clinical isolates in Suzhou city.Methods The sputum samples were collected from TB patients in the Affiliated Hospital of Infectious Diseases of Soochow University. Mtb isolates were performed the conventional drug susceptibility testing on the Lwenstein-Jensen culture medium. 21 INH-resistant and 21 INH-sensitive strains were randomly selected, and then detected genes katG315 and inhA-15 by gene chip. The PCR fragments of katG gene including katG315 from 18 samples tested by gene chip were sequencing. The results of DNA chip were respectively compared with traditional drug susceptibility test and DNA sequencing.Results Using the traditional drug susceptibility testing and DNA sequencing as the controls, the accurate rates of gene chip for detecting INH resistance and katG 315 point mutation were 73.8% (31/42) and 88.9% (16/18), respectively.Conclusion INH resistance in Mtb was mainly induced by gene mutations at katG 315 and inhA-15 in Suzhou city. It can be rapidly, accurately detected by gene chip.

Application of percutaneous puncture catheter interventional treatment in spinal tuberculosis in elderly

CHENG Jie, ZHANG Xiao-wei

Journal of Tuberculosis and Lung Health. 2013, 2(3):  169-171.  doi:10.3969/j.issn.2095-3755.2013.03.007

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Objective To evaluate the curative effect of percutaneous catheter drainage combined with local chemotherapy for spine tuberculosis abscesses in elderly patients (≥65 years).Methods A retrospective analysis of 25 patients older than 65 years with paraspinal abscess and (or) psoas abscess from June 2005 to December 2011 was conducted. On the basis of systemic anti-tuberculosis chemotherapy, all patients received the combination treatment of CT-guided percutaneous catheter drainage and local chemotherapy. The best puncture point was selected with CT. The 18G puncture needle was put through the abscess cavity, double central venous catheter was left into the abscess cavity to take the pus. 500ml 0.9% sodium chloride solution with 0.3g isoniazid was used to rinse the lesion, than the solution by mixing 0.45g rifampin with 0.3g isoniazid was injected into the abscess cavity.Results Twenty-five patients had catheter placed smoothly under CT guidance. No puncture-related complications, such as nerve damage, bleeding, visceral injury and pneumothorax, were detected. During the follow-up period of 6 to 36 months, CT scans of 22 cases showed vertebral lesion absorption, bone density increased, lesions peripheral sclerosis, vertebral edge hyperplasia, paraspinal abscess and (or) psoas abscess disappearance. Erythrocyte sedimentation rate (ESR) was decreased from (58±19) mm/1h on admission to (13±10) mm/1h 6 months after surgery (t=37.557,P=0.000). Another 3 cases stopped taking anti-TB drugs due to severe liver damage during the follow-up. CT scan showed paraspinal abscess narrowed, but vertebral lesion absorption was not obvious, and there were still visible patchy or worm-eaten low-density lesions.Conclusion On the basis of systemic anti-tuberculosis chemotherapy, the combination treatment of CT-guided percutaneous catheter drainage and local chemotherapy was a safe and effective method for spinal tuberculosis in elderly patients (≥65 years).

The surgical procedures and clinical observation in patients with pulmonary tuberculosis hemoptysis

WANG Hai-jiang^*, SONG Yan-zheng, XIA Zhao-hua,CHEN Qi-fu, SONG Li-xia

Journal of Tuberculosis and Lung Health. 2013, 2(3):  172-174.  doi:10.3969/j.issn.2095-3755.2013.03.008

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Objective To explore the indication and procedures of surgical in treatment of pulmonary tuberculosis hemoptysis.Methods Retrospective analysis of clinical data was performed in 42 cases of pulmonary tuberculosis hemoptysis admitted in the Thoracic Surgery Department of our hospital from October 2008 to October 2012.Results Of 42 cases, underwent lobectomy in 30 cases, pneumonectomy in one case, pulmonary wedge resection in 11 cases. There were 5 cases of relapse,one reoperation due to postoperative pleural hemorrhage, postoperative atelectasis and pleural effusion in 4 cases, wound infection in 2 cases and bronchopleural fistula in 2 cases. The surgical complication rate was 21.4% (9/42) and the clinical cure rate was 88.1% (37/42).Conclusion Surgical procedures is more effective means for patients with hemoptysis of pulmonary tuberculosis and long-term repeated small or in the amount of hemoptysis in comprehensive treatment measures.The optimal surgical procedure is elective surgery lobectomy.

Analysis of 56 cases of primary pulmonary cryptococcosis

HUANG Jin-bao,LI Hong-yan,WENG Heng, LAN Chang-qing,WANG Jie,LIN Qing-hua,CHENG Li-zhu

Journal of Tuberculosis and Lung Health. 2013, 2(3):  175-180.  doi:10.3969/j.issn.2095-3755.2013.03.009

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Objective To investigate the clinical symptoms,radiology,laboratory data,diagnosis,different diagnosis,management and prognosis of pulmonary cryptococcosis.Methods A total of 56 cases of primary pulmonary cryptococcosis,confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2007 to February 2012,were studied.Results Thirty-two of 56 cases(57.14%) were under 50 years old and 37(66.07%) were male patients.Aged from 16 to 76 years. There were no underlying diseases in 36 cases. The main clinical manlfestations were cough(42 cases,75.00%) and cough up phlegm (39 cases,69.64%).Chest CT study showed that the majority of the lesions (51 cases) were close to the pleura. Lower lungs were often involved (24 cases). Pulmonary nodules and mass (34 cases,60.71%),either solitary nodules or multiple nodules,were the most common CT finding. Air bronchogram(22 cases,39.29%) and halo sign(12 cases,21.43%) were the common accompanying signs. Enhanced CT scanning was made in 13 patients and 10 cases(76.92%) showed uniform enhancement. The diagnosis was confirmed in all cases by pathological findings. Succeessful outcomes were achieved in the patients by surgical resection or treated with antifungal drug. Thirty-nine of 52 cases (75.00%)treated in our hospital were cured and 13 were improved(25.00%).Conclusion Although the clinical symptoms of primary pulmonary cryptococcosis were lack of specificity,the disease has some characteristics on radiology. Final diagnosis making depended on pathological examinations by lung biopsy. If diagnosis is timely and treatment is reasonable,majority of patients with the disease can be obtained satisfactory results.

Analysis of pulmonary tuberculosis patients detection from health examination in Songjiang district

LU Li-ping, HONG Jian-jun, JIN Xiao-ping, SHEN Hong-ying

Journal of Tuberculosis and Lung Health. 2013, 2(3):  181-184.  doi:10.3969/j.issn.2095-3755.2013.03.010

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Objective To understand the characteristic of new pulmonary tuberculosis (PTB) patients detection from health examination in Songjiang district, in order to implement control and prevention measures in time.Methods The data of new registered patients with PTB in Songjiang from 2009 to 2011 were retrospectively analyzed. Demographic, clinical and bacteriological characteristics were compared between tuberculosis patients from health examination and others using Chi-square test.Results There were 176 new PTB cases (11.34%, 176/1552) detected from health examination who registered from 2009 to 2011 in Songjiang district. Among the 176 patients, there were mainly male cases (64.20%,113/176) and cases among floating population (75.00%,132/176). Patients aged 21-40 years old accounted for 67.05% (118/176). Compared to the patients detected from non-health examination (59.38%, 817/1376), 81.25% (143/176) of the health examination patients showed lesions in less than 2 lung fields, and the difference was statistically significant (χ²=31.661,P<0.05). Only 25.00% (44/176) of the patients detected from health examination was found with cavities, which was significantly lower than those from non-health examination (39.17%, 539/1376) (χ²=13.362,P<0.05). The positive sputum smear rate was 21.59%(38/176) and the positive sputum culture rate was 35.23% (62/176) for patients detected from health examination, both of which were significantly less than those in non-health examination (44.40%, 54.22%) (χ² values were 33.378 and 22.542 respectively, both P values were less than 0.05). Only 14.20% (25/176) of patients had delayed diagnosis, which was lower than that in non-health examination (42.01%, 578/1376) (χ²=50.765, P<0.05)Conclusion PTB cases can be detected from health examination at early stage. The new TB cases found in the health examination were mainly with mild symptoms and lower infectivity.

Analysis of mental health status of floating population with tuberculosis in Haizhu district of Guangzhou city

ZHANG Ke-xun, LI Pei-zhu, PENG Feng-ling, TAN Shou-yong, LIU Jian-xiong, HE Li-qian, LIN Yin, CHEN Qi-chen

Journal of Tuberculosis and Lung Health. 2013, 2(3):  185-188.  doi:10.3969/j.issn.2095-3755.2013.03.011

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Objective To investigate the mental health status of floating population with tuberculosis in order to provide evidence-based psychological treatment and health education.Methods We investigated the mental health status of 173 cases of floating population with tuberculosis by the symptom checklist (SCL-90), and made comparison with 1388 cases of national norm. EpiData 3.0 software is used for setting up the database and data entry. PASW 18.0 is used for statistical analysis.Results SCL-90 shows the experimental group has lower scores in somatic(score 1.24±0.36), compulsive (score 1.40±0.36), depressed (score 1.36±0.33) and psychotic symptoms factor (1.15±0.26) compared to the domestic norm(scores respectively 1.37±0.48, 1.62±0.52, 1.50±0.59, 1.29±0.42). The differences are statistically significant (t values is －5.20, －8.71, －5.95, －7.83, P<0.01). Score in interpersonal sensitivity, anxiety, and hostile factor (respectively 1.71±0.48, 1.57±0.54, 1.56±0.54) is higher than domestic norm(respectively 1.65±0.61, 1.39±0.43, 1.46±0.55). The differences are statistically significant (t values is 2.24, 4.58, 2.73, P<0.01). By using multivariate analysis, we find that interpersonal sensitivity is related to annual income, patient category and with or without lung cavity (patients with annual incomes between 5000 to 10000 yuan, Wald χ²=20.916,P<0.001,OR=0.035,95%CI:0.008-0.147; patients with annual incomes of between 10000 to 15000 yuan, Wald χ²=1.146,P=0.284,OR=0.393,95%CI＝0.071-2.171; patients with annual incomes of 15000 to 20000 yuan, Wald χ²=0.317,P=0.573,OR=0.731,95%CI＝0.246-2.174; patients with annual incomes of more than 20000 yuan, Wald χ²=6.145,P=0.013,OR=0.247,95%CI＝0.081-0.746; for previously treated patients, Wald χ²=4.321,P=0.038,OR=0.248,95%CI＝0.067-0.924; for patients with lung cavities, Wald χ²=4.123,P=0.042,OR=2.321,95%CI＝1.030-5.232). The anxiety factor is related to annual income (annual income between 5000-10000 yuan, Wald χ²=14.047, P<0.001, OR=0.016,95%CI: 0.002-0.130; annual income of 15000-20000 yuan, Wald χ²=1.650, P=0.199, OR=2.083,95%CI＝0.680-6.370; annual income of more than 20000 yuan, Wald χ²=4.934, P=0.026, OR=0.253,95%CI＝0.075-0.850).Conclusion Migrant patients’ mental health status is relevant to patients’ illness condition, patient category and annual income. In general, the mental health status of floating population with tuberculosis is relatively low. Therefore, mental therapy should be provided.

Influencing factors of awareness rate of TB-related knowledge in rural areas of Yunnan province

CHEN Liu-ping, XU Lin, HOU Jing-long, CHEN Jin-ou

Journal of Tuberculosis and Lung Health. 2013, 2(3):  189-193.  doi:10.3969/j.issn.2095-3755.2013.03.012

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Objective To analyze the awareness rate of pulmonary tuberculosis (PTB) among the rural residents of Yunnan province and its influencing factors, and to provide scientific evidence for further improvement of tuberculosis (TB) prevention education and health promotion.Methods An awareness rate survey of 9305 residents who were over 15 years old in 6 sites of the fifth national tuberculosis epidemiological survey in Yunnan was conducted from April to June 2010. There were 4613 (49.6%) male and 4692 (50.4%) female. The contents of the survey covered the basic information of patients (gender, age and nationality) and 5 key TB messages. SPSS 17.0 statistical software was applied to analyze the score of awareness on key TB messages. Univariate analysis was used to analyze the score of awareness on key TB messages with different genders, ages, nationalities, histories of tuberculosis, per capita income of rural residents. Multiple linear regression analysis was conducted by taking key TB messages score as the dependent variable and taking gender, age, nationality, history of tuberculosis and the per capita income of rural residents as independent variables.Results The general awareness rate of all 5 key messages in the rural areas of Yunnan province was 43.45% (20217/46525). The average scores of awareness for male and female were (4.686±3.387) and (4.010±3.429) respectively, with the difference of statistical significance (t=9.567, P<0.05). The scores of 15-, 25-, 35-, 45-, 55- and 65- age groups were (5.421±3.246), (5.106±3.270), (4.737±3.399), (4.038±3.353), (3.962±3.350) and (2.666±3.234) respectively, and the difference was statistically significant (F=120.625, P<0.05). The scores of the Han nationality, the Zhuang nationality, the Yi nationality and others were (4.254±3.407), (4.102±3.277), (5.324±3.639) and (3.897±3.086), and the difference was statistically significant (F=36.518, P<0.05). The scores of those with TB history, without TB history and those had no idea were (5.952±3.124), (4.420±3.420) and (2.053±2.648), with statistical significance (F=102.111, P<0.05). The scores of those with different per capita net income of rural residents (less than 2000 yuan, 2000 yuan- and 3000 yuan) were (3.011±2.959), (3.944±3.125) and (5.905±3.475), the diffe-rence was statistically significant (F=663.706, P<0.05). Multivariate analysis showed that the factors influencing key TB messages score included rural per capita net income, age, gender, with TB history and the Han nationality (t values were 39.003, －28.161, －9.588, 9.381 and 4.361 respectively, P<0.05).Conclusion The awareness rate of key TB messages among the rural areas of Yunnan province is low, the influencing factors include rural per capita net income, gender, age, history of TB and the Han nationality.

College students’ awareness rate of tuberculosis-related knowledge in Fujian province

HUANG Zhi-zhong^*, LAN Ya-yan, WEI Shu-zhen, CHEN Qiu-yang, LIN Shu-fang

Journal of Tuberculosis and Lung Health. 2013, 2(3):  194-196.  doi:10.3969/j.issn.2095-3755.2013.03.013

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Objective To understand the college students’ awareness level of tuberculosis (TB) messages in Fujian province, and to explore the method for improvement.Methods The cluster sampling method was used. The unite questionnaire was designed according to the key TB messages of Guidelines for implementing the national tuberculosis control program in China by the research group. After being trained, investigators issued questionnaire and supervised respondents completing questionnaire by themselves, 220 questionnaires were issued and 203 valid questionnaires were received, the collecting rate was 92.3%.Results The general awareness rate of key TB messages was 52.3% (849/1624), the awareness rate of 3 core information (symptom, institute for examination and treatment, free policies) were 39.1% (238/609). 69.5% (141/203) students didn’t discriminate against TB. They acquired the TB knowledge by many ways, by television was the highest (58.1%, 118/203), by video cassette, tape and optical disk was the lowest (13.8%, 28/203).Conclusion The publicity and education about TB control in colleges and universities should be enhanced, and the suitable media and channel should be chosen to strengthen the health education activities for college students.

Effect evaluation of tuberculosis health education program among primary school and middle school students in rural area of Anhui province

XU Xiao-min^*, SU Hong, XU Zhi-wei, WU Jia-ling, CHANG Wei-wei, SUN Ying

Journal of Tuberculosis and Lung Health. 2013, 2(3):  197-201.  doi:10.3969/j.issn.2095-3755.2013.03.014

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Objective To evaluate the perceptions and understanding of tuberculosis (TB) among the primary school and middle school students before and after a school-based TB health education program in rural China.Methods Stratified cluster sampling method was used to select 4 primary schools and 4 middle schools in 2 counties of Anhui province. A three-month health education program on TB was conducted in the eight schools. Questionnaire surveys were conducted before and after the program to evaluate the effectiveness of the health program, 5309 students were recruited in the study, 5017 valid questionnaires were received in the baseline survey (collecting rate 94.5%) and 5276 valid questionnaires were received from the survey after intervention (collecting rate 99.4%).Results The TB knowledge score of students increased from (2.92±1.57) before the program to (5.48±1.770) after the program, with statistical difference (t=－77.482, P=0.000). The channels getting TB knowledge in different gender were different. Girls acquired TB knowledge through magazines, newspapers and books(46.5%, 1100/2365), school teaching (34.4%, 813/2365), peer education (19.9%, 470/2365), all of which were higher than boys. While boys acquired TB knowledge from video and tape (7.8%, 207/2652) was higher than girls (5.2%, 124/2365).Conclusion Improved awareness rate of TB among students can be got through the school-based TB health education

Review Articles

The main influencing factors affecting tuberculosis incidence

CHENG Jun^*, LUO Ying-hui, ZHANG Can-you, ZHANG Hui

Journal of Tuberculosis and Lung Health. 2013, 2(3):  202-205.  doi:10.3969/j.issn.2095-3755.2013.03.015

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Based on results of published original article and systematic review, we summarize respectively the risk ratio and mechanism of main biological influencing factors and behavioral influencing factors including gender, age, genetic factor, HIV infection, diabetes mellitus, silicosis, cigarette smoking and alcoholism,and provide re-ference for further study on risk factors affecting tuberculosis incidence.