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Although the global battle against tuberculosis has largely been successful, the disease still poses a serious threat in China, especially for poor people, and will only be entirely eradicated through greater financial protection for patients and the elimination of social discrimination, according to experts speaking ahead of World Tuberculosis Day, which falls on March 24.

Medical staff from hospitals in Zhengzhou, Henan province, promote prevention and control of tuberculosis to local residents. China has made huge progress in the fight against TB, but the disease continues to pose a threat to public health. [Photo/Xinhua]

A report published by the World Health Organization said that in the past 20 years China has made great progress in the control and prevention of TB, which has resulted in a significant decline in the disease. Meanwhile, the National Health and Family Planning Commission, China's top health authority, said the number of new cases has declined steadily in the past two decades.

Last year, 889,381 new cases were reported on the Chinese mainland, a decline of 1.7 percent from 2013, and 2,240 people died, the commission said.

However, the commission's figures show that TB still ranks second on a list of highly infectious diseases in terms of the number of cases reported and resultant deaths.

"Tuberculosis remains the No 1 one public health threat from an infectious disease in China," Bernhard Schwartlander, WHO representative in China, said. "There are still an estimated 1 million new cases of TB in China every year. Disturbingly, the highest rate of tuberculosis infection is among the poor."

WHO statistics show that 9 million new cases of TB are reported globally every year, leading to about 1.5 million deaths.

As an airborne disease, TB can be transmitted by coughs, sneezes, contact with an infected person's saliva and even through conversation, which make prevention more difficult than for some other infectious diseases, Schwartlander said.

A disease of poverty

According to Fabio Scano, WHO coordinator for disease control, about 82 percent of TB patients in China earn less than the national average wage. "Tuberculosis in China is a disease of poverty. The high cost of treatment and the need to take medication over an extended period of time, in particular for patients with multi-drug resistant TB (usually called MDR-TB), makes treatment less viable for the poor."

MDR-TB, a particularly dangerous form of the disease, occurs when the bacilli grow resistant to Isoniazid and Rifampicin, the two most-powerful anti-TB drugs, which is usually the result of improper treatment during the early stage of the infection.

In 2011 just 3 percent of 100,000 new MDR-TB cases were diagnosed and reported, and only 2 percent of patients received the standard treatment, according to the Chinese Center for Disease Control and Prevention, which said, "MDR-TB poses a serious problem to TB prevention and control in China."

Chen Mingting, deputy head of the National Center for Tuberculosis Control and Prevention, said: "The proportion of MDR-TB patients that received standardized treatment rose to 7.7 percent last year." He added that rapid response is vital. "There are no effective vaccines for TB, so speedy diagnosis is especially important for the prevention and control of the disease," he said.

In recent years, China has intensified research into the diagnosis of MDR-TB, and has made good progress. New molecular testing methods for MDR-TB have reduced the time lag between the collection of "resistance test" specimens and the start of treatment by 90 percent, from an average 139 days to just 14, Chen said.

The new method, published in the journal Lancet Global Health last week, greatly facilitates testing for MDR-TB and will bring huge benefits to patients, he said.

"In addition to rapid diagnosis and standardized treatment, improved disease management is the key to curing patients with MDR-TB," he said.

According to Chen, the optimum treatment period for people with MDR-TB is 18 to 24 months, but many patients－especially migrant workers, one of the largest MDR-TB groups－fail to complete the course: "The patients receive standardized treatment at hospitals and are supposed to continue to take medication under the guidance of doctors after being discharged. But in reality they may not take the medication as required, and sometimes the doctors lose contact with patients because they have moved to other cities and regions."

The high cost is one of the reasons that very few MDR-TB patients receive standardized treatment, Chen said. A full course costs about 30,000 yuan ($4,800), according to the WHO, a sum that puts it out of the range of most migrant workers and others in low-paid jobs. To put that figure in context, per capita GDP in China was 47,000 yuan last year.

"Some patients have received treatment intermittently for more than 10 years, but still haven't been cured," Chen said. "Imagine how much they have paid for their treatment over the years."

He said the highly infectious nature of MDR-TB, coupled with the ease of transmission, mean that in some cases entire families have the disease. "We've seen this phenomenon in rural families living in extreme poverty," he said.

Free drugs and tests

To provide a larger number of patients with more financial support, the government classified MDR-TB as a major serious disease in 2012, which means the State will reimburse as much as 70 percent of each patient's medical bills, and basic drugs and tests are provided free of charge.

"We hope that in future the medical costs of all patients with financial difficulties will be covered 100 percent," Chen said. "That would not only benefit the patients, but also society as a whole."

Although TB is preventable and curable, many patients suffer discrimination, which not only has a severe psychological impact, but also makes the task of preventing and controlling the disease far more difficult.

As one of the oldest diseases in the world, and one of the most difficult to treat effectively, TB was once feared, but that fear is diminishing, according to Scano of the WHO.

"Now, there is rapid diagnosis and there is a cure. There is no reason whatsoever for TB to be stigmatized. If a disease is stigmatized, that stigma can kill more people than the disease itself, because some patients hide away and fail to get a diagnosis, or they hide from their families when they take the treatment," he said.

Yan Xiaodong, a former TB patient who was cured after a course of treatment that lasted two years, said: "Society still lacks tolerance of TB patients or those who have suffered from the disease."

Yan spends much of his time on an online forum, where current and former TB patients discuss the illness and exchange information and support. "I've discovered that many patients are less afraid of the disease than the discrimination they are likely to encounter when looking for work," he said, adding that many migrant workers and students are compelled to remain active, but silent, in the face of the disease.

"Some students told me that they won't be allowed to return to school, even if they are cured, and some migrant workers say they have considered getting treatment at unlicensed clinics instead of hospitals because they are worried the hospitals may notify their employers, who are likely to fire them because they have the disease," Yan said.

One of the people on the forum, a migrant worker who used the cyber name Yan Xia, or "Hot Summer", said he is still concerned about how colleagues and friends would if they discovered he once had TB, even though he was cured several years ago.

For the WHO's Scano, education and public awareness are crucial factors in China's battle against TB, because greater public acceptance would result in a more-open atmosphere and reduce the social pressures on patients. "The eradication of TB is not just a task for the government, but for the whole of society, so it's vitally important to educate the entire community," he said.

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