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Measuring Progress in TB Control in China

Summary and Comment |
March 25, 2014

Measuring Progress in TB Control in China

  1. Mary E. Wilson, MD

Between 1990 and 2010, the prevalence of smear-positive tuberculosis decreased from 170 to 59 per 100,000 population.

  1. Mary E. Wilson, MD

In 2001, China issued a new national tuberculosis (TB) control program that expanded the directly observed treatment, short-course (DOTS) program covering half the country's population, implemented in the 1990s, to include the entire population by 2005. In a longitudinal analysis, investigators from the Chinese CDC compared results from national TB prevalence surveys done in 1990, 2000, and 2010.

For the 2010 survey, the researchers used stratified random sampling to choose >250,000 local residents aged ≥15 years from all mainland provinces for screening that included chest radiographs and additional testing (sputum smear, culture) based on clinical findings.

The prevalence of smear-positive TB was 59 per 100,000 in 2010, down from 170 per 100,000 in 1990 and 137/100,000 in 2000. Between 1990 and 2000, the TB prevalence in provinces that had not instituted the DOTS program showed little change (180 to 174/100,000). Prevalence of bacteriologically positive TB in 2010 (116/100,000 overall, down from 221/100,000 in 1990 and 178/100,000 in 2000) remained substantially higher in males than in females (183 vs. 64/100,000), in rural than in urban populations (163 vs. 73/100,000), and in western provinces than in central or eastern ones (212 vs. 124 or 66/100,000). Prevalence was highest in the oldest age group studied (346/100,000 among individuals aged ≥60) and lowest in the youngest (59/100,000 in those aged 15–29).

Comment

The authors credit the improvement in tuberculosis control to expansion of the directly observed treatment, short-course program to cover the entire country and expansion of free treatment to include all patients with active pulmonary TB (instead of only those with smear-positive infection). They note that improved socioeconomic conditions probably also contributed to the decrease in TB prevalence. They acknowledge the need for more attention to regions and groups — notably, western provinces and rural populations — with consistently higher rates of infection. As noted by editorialists, China had >900,000 TB cases notified in 2012, and as such was a major contributor to the global TB burden. This study confirms the feasibility of doing TB prevalence surveys, even in a country as large as China.

  • Disclosures for Mary E. Wilson, MD at time of publication Editorial boards Up to Date; Clinical Infectious Diseases; RSTMH International Health; Infectious Diseases in Clinical Practice; Travel Medicine and Infectious Diseases

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