Bill Gates plans to spend most of the next 20 years fighting tuberculosis, malaria and polio.
He mentioned in last year’s year-end summary that [we have been lagging behind in the research on TB treatment. TB has always been a major cause of human death. Unfortunately, the current treatment plan is not perfect-especially drug-resistant TB. In recent decades, it has been stagnant.]
The Gates Foundation has invested billions of dollars in the prevention and treatment of tuberculosis worldwide.
This ancient disease has long occupied the top spot in the incidence of human infectious diseases. It is called “white plague” in the West and “nine tuberculosis in ten people” in ancient China.
To return in a swirl of dust?
With the progress of economy and the development of modern medicine, tuberculosis seems to have withdrawn from the public’s view and is no longer horrible. However, in fact, the epidemic situation is still grim. In previous reports, tuberculosis is likely to make a comeback.
In 2013, 9 million people worldwide suffered from tuberculosis and 1.5 million people died of the disease. In China, there is one tuberculosis patient for every 1,000 people, and 1 million new tuberculosis patients occur every year.
More than 95 percent of tuberculosis deaths occur in low-and middle-income countries, and it is one of the three leading causes of death among women aged 15 to 44. It is also the leading cause of death among people living with HIV, accounting for one fifth of all deaths.
A new study in the Lancet pointed out that 18.8% of the people in China are latent infected with Mycobacterium tuberculosis. Of course, it is not just carrying Mycobacterium tuberculosis that will develop tuberculosis.
The onset of tuberculosis is closely related to human immunity. According to previous studies, 5%-10% of these latent infections will develop tuberculosis in their lifetime.
Tuberculosis can infect many parts of the body, except hair and nails, every part of the human body may be the territory of tuberculosis, but the most common is tuberculosis, because tuberculosis is infectious, so it is the enemy of human beings.
The other side of the severe epidemic is the slow progress in tuberculosis prevention and control.
For a long time, tuberculosis was considered [a disease of the poor], so that in the second half of the 20th century, few companies were willing to invest in the research and development of drugs and vaccines for this purpose.
Since rifampicin, a specific anti-tuberculosis drug, was invented in 1965, no new anti-tuberculosis drug has appeared for more than 50 years.
On April 23, 1993, at the 46th World Health Assembly held in London, WHO declared [a state of emergency for tuberculosis worldwide].
In particular, the emergence of drug-resistant tuberculosis has added setbacks to the human war against this disease.
In 2013, about 480,000 people worldwide suffered from MDR-TB, with more than half of the cases occurring in India, China and the Russian Federation.
The so-called drug-resistant tuberculosis refers to the drug resistance of tuberculosis bacteria to drugs, which can not be killed by common drugs.
Drug-resistant pulmonary tuberculosis patients need to switch to expensive or side-effect drugs, the treatment cost will be significantly increased, even reaching 100 times of the treatment cost of common pulmonary tuberculosis, the treatment course will be significantly lengthened, it takes 18-24 months, and the success rate of treatment will be significantly reduced.
Is it really just the disease of the poor?
The main route of transmission of tuberculosis is air transmission. TB patients who can expel bacteria, When sneezing or coughing, a large number of droplet nuclei will be produced. Tuberculosis bacteria are very small, only 1-4 microns in diameter (about 1/60 of human hair). Small tuberculosis bacteria float into the air and wander in the wind on the droplet nuclei. Untreated tuberculosis patients can infect an average of 10 to 15 healthy people.
The reason why there is a saying of diseases of the poor is mainly because the onset of tuberculosis is related to human immunity, while poor people are more prone to tuberculosis due to malnutrition and poor living conditions.
However, this statement is not scientific. People with low immunity, such as HIV infected persons, end-stage renal disease and organ transplant patients, have higher risk of onset.
Diabetes patients and malnourished people will also have a significant increase in the incidence rate. Among them, about 20% of tuberculosis in the world is caused by respiratory tract immunity reduction caused by smoking.
Therefore, tuberculosis does not matter occupation or income, the key is whether there is contact with patients and their own immunity.
Don’t ignore it any more
The onset of tuberculosis is slow, the early symptoms are not serious, the patient often looks pale, the zygomatic flushes, occasionally coughs a few times, with some morbid beauty, European upper-class society once became fashionable to get tuberculosis. Famous poet Shelley is a tuberculosis patient, his good friend Byron envied extremely, also wrote in the letter to the friend that he also wants to get tuberculosis.
We can’t learn from Byron. If you live with patients with tuberculosis, you must pay attention to living in relative isolation from the elderly and children. It is better to let patients wear masks, keep indoor ventilation and disinfect sputum. You can spit sputum in a closed container containing 75% alcohol and then pour it out uniformly.
Close contacts with tuberculosis can go to the hospital for relevant examinations. If infected with tuberculosis bacteria, they can take anti-tuberculosis drugs preventatively. If symptoms such as persistent cough, expectoration or fever occur for more than two weeks, they need to go to the hospital for screening for tuberculosis.
The treatment principle of tuberculosis is early, combined, moderate, regular and full-course. At least 6 months of combined medication must be adhered to, and the treatment course must be completed according to the prescribed plan to ensure the curative effect.
In the past few decades, due to various problems, the investment in tuberculosis prevention and control field has been insufficient and the progress has been slow. However, with the increasingly severe tuberculosis epidemic, more funds and talents have been invested in this field. Now, two new drugs are about to come out.
However, there is still a long way to go before human beings can eliminate tuberculosis, which requires the attention of the whole society.
Responsible Editor: Xiao Xi