Management of latent tuberculosis infection in China: Exploring solutions suitable for high-burden countries

Abstract

China is one of the countries with a high burden of tuberculosis (TB) and latent tuberculosis infection (LTBI). It was recently estimated that China had the highest LTBI burden in the world, with approximately 350 million persons living with the infection. The prevalence of LTBI in China is overestimated by tuberculin skin test (TST) as compared to interferon-gamma release assay (IGRA). A population-based study found that IGRA positivity rates ranged between 13.5% and 19.8%. The annual TB infection rate in the rural population was 1.5% based on persistent positive IGRA results in converters. The development of active TB from LTBI in the general rural population was 0.87 per 100 person-years in the first 2 years among individuals who newly converted to IGRA-positive. TB control in students has been paid more attention by the government, which also improved LTBI management among students in close contact with active TB patients. A 3-month regimen of twice-weekly rifapentine plus isoniazid (3H 2 P 2 , both with a maximum dose of 600 mg) has been practiced for LTBI treatment in China for years. With respect to LTBI management in populations using immune inhibitors, an expert consensus on TB prevention and management in tumor necrosis factor antagonist application was published in 2013 in China. In order to achieve the global goals of the End TB Strategy, China needs innovative ideas and technologies to reduce the TB incidence by management of LTBI, such as the identification of populations for LTBI testing and treatment, selecting and developing reliable LTBI tests, exploring safe and effective preventive treatment tools, and establishing a set of optimized LTBI management systems.

The effect of anti-cancer and anti-tuberculosis treatments in lung cancer patients with active tuberculosis: a retrospective analysis

“…and 20% in a population-based study [19]. Due to large size of latent TB population, latent TB treatment is not systemically adopted in national guideline, but restricted to patients with diverse immune de ciencies, such as HIV, silicosis, receiving anti-tumour necrosis factor treatment, receiving dialysis, organ or hematologic transplantation [20,21]. Because of simpler treatment regimen for latent TB compared with active TB, preventive chemotherapy of latent TB may be preferable in lung cancer patients.…”

Tuberculosis registration rates analysis and prediction based on exponential smoothing model: could tuberculosis control milestones be achieved in 2020, 2025 in Henan province, China?

“…So, to achieve the second WHO milestone, new measures must be taken. In order to improve the diagnosis [32][33][34][35], treatment [36,37] and TB prevention services [38][39][40], a lot of research have been carried out around the world. A study from Nepal found that active case nding could reduce catastrophic costs [41].…”

Time series analysis of tuberculosis registration rates from 2007 to 2019 and prediction: could tuberculosis control milestones be achieved in 2020 and 2025 in Henan Province, China?

“…So, to achieve the second WHO milestone, new measures must be taken. In order to improve the diagnosis [27][28][29][30], treatment [31,32] and TB prevention services [33][34][35], a lot of research have been carried out around the world. A study from Nepal found that active case finding could reduce catastrophic costs [36].…”