Table of Content

10 April 2024, Volume 46 Issue 4

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Interpretation of Standards

Interpretation of social organization standard of Specification for Pathological Diagnosis of Tuberculosis

Zhao Yanli, Che Nanying

Chinese Journal of Antituberculosis. 2024, 46(4):  371-374.  doi:10.19982/j.issn.1000-6621.20240074

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The social organization standard Specification for Pathological Diagnosis of Tuberculosis (T/CRHA 029—2023) was officially released on the national group standard platform on December 25, 2023, and was implemented from January 1, 2024. This article interprets the core points of the standard, aiming to assist pathologists at all levels of medical institutions nationwide in mastering the basis of pathological diagnosis of tuberculosis and improving their diagnostic proficiency in this area.

Original Articles

Investigation on the status of tuberculosis infection among household student close contacts of pulmonary tuberculosis patients

Xu Chenyi, Chen Hui, Zhong Jiyuan, Ding Xiaoyan, Yang Rui, Xu Xiangchao, Zhang Canyou, Cheng Jun, Li Tao

Chinese Journal of Antituberculosis. 2024, 46(4):  375-382.  doi:10.19982/j.issn.1000-6621.20230434

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Objective: To analyze tuberculosis (TB) infection and influencing factors in household close contacts of active pulmonary TB patients who studies in local schools (HCCSs). Methods: All HCCSs registered in Baoying County and Zhangjiagang City in Jiangsu Province, Yidu City in Hubei Province, Pengshui County in Chongqing City, and Zhaoyang District of Zhaotong City in Yunnan Province from January 1 to December 31 in 2021 were included into this investigation. Tuberculin skin test (TST) was carried out and demographic characteristics were collected for every participant, and demographic and diagnostic information of their index cases were also collected from Chinese Tuberculosis Information Management System (TBIMS), by which factors associated with TB infection among HCCSs were analyzed. Results: Totally 686 HCCSs were included for 477 active pulmonary TB patients. Overall acceptance rate of TST for these HCCSs was 92.27% (633/686).The differences of TST acceptance rates between counties/districts were statistically significant (χ²=57.781, P<0.001), with the highest rate in Baoying County (100.00%, 35/35). The overall TB infection rate and strong positive rate of TST among HCCSs were 14.85% (94/633; 95%CI: 11.85%-17.85%) and 5.06% (32/633), respectively, with statistically significant differences between counties/districts (χ²=35.800, P<0.001;Fisher exact probability method,P=0.029). The results of univariate analysis showed that HCCS aged 15 years old and above ((23.47% (23/98); 95%CI:13.88%-33.06%)), studying in high schools and colleges ((26.09% (18/69); 95%CI:14.04%-38.14%)), living in Yidu City ((33.33% (28/84); 95%CI:20.99%-45.68%)), and contacting with TB patients with diagnosis delay ((18.37% (52/283); 95%CI:13.38%-23.37%)) had a higher prevalence rate of TB infection. In multifactorial logistic regression, diagnosis delay of index cases was founded to be associated with TB infection of HCCSs. After adjusting confounding factors, HCCSs contacted with TB patients with diagnosis delay had a higher TB infection risk than those contacted with TB patients without diagnosis delay, with OR (95%CI) being 1.586 (1.016-2.476). Conclusion: High TB infection rate exists in HCCSs, especially those contacted with active pulmonary TB patients with diagnosis delay. Our study showed timely screening and following intervention is necessary for HCCSs.

Prevalence and influencing factors of latent tuberculosis infection among elderly rural residents in Changshan County, Zhejiang Province

Chen Ruiqi, Zhang Mingwu, Wang Wei, Chen Songhua, Liu Zhengwei, Chen Bin

Chinese Journal of Antituberculosis. 2024, 46(4):  383-389.  doi:10.19982/j.issn.1000-6621.20230399

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Objective: To investigate the status of latent tuberculosis infection (LTBI) among elderly rural residents in Changshan County, Zhejiang Province, and its related influencing factors, so as to provide scientific basis for formulating targeted intervention measures. Methods: In the “Tuberculosis Management Information System”, a subsystem of the “China Disease Control Information System”, the towns were sorted by the reported incidence of tuberculosis in the past five years from 2017 to 2021, all the permanent elderly rural residents were selected as the investigation objects in the three villages with the highest reported incidence in Changshan County, Quzhou City, Zhejiang Province, and a total of 909 people were included. Demographic information, smoking history and drinking history were collected. LTBI was detected by interferon gamma-induced protein 10 (IP-10) mRNA release test, and its influencing factors were analyzed by multivariate logistic regression. Results: Among the 909 study subjects, 375 tested positive for LTBI (41.25%) and 534 tested negative (58.75%). Multivariable logistic regression analysis showed that male participants (OR=1.676,95%CI: 1.170-2.401) had a higher risk of LTBI than female participants, while those with higher levels of serum high-density lipoprotein (OR=0.607,95%CI: 0.433-0.852) had a relatively lower risk of LTBI. Conclusion: Elderly rural residents in Changshan County, Zhejiang Province have a high prevalence of LTBI, with particular attention should be paid to males and those with lower levels of high-density lipoprotein.

Analysis of the incidence and influencing factors of household close contacts of pulmonary tuberculosis patients in Kashgar, Xinjiang Uygur Autonomous Region, 2018—2021

Fan Xiaolei, Maiwulajiang·Yimamu , Peng Xiaowang, Hu Pengyuan, Wang Yanjie, Alimire·Abulimiti , Mairihaba·Kamili , Wang Senlu, Xiang Yang

Chinese Journal of Antituberculosis. 2024, 46(4):  390-396.  doi:10.19982/j.issn.1000-6621.20230424

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Objective: To analyze the risk and influencing factors among household close contacts of pulmonary tuberculosis (PTB) patients in a high tuberculosis burden setting. Methods: From January 1, 2018 to December 31, 2021, patients diagnosed with PTB in 12 counties in Kashgar Prefecture of Xinjiang Uygur Autonomous Region were selected from the subsystem “Tuberculosis Management Information System” of the China Information System for Disease Control and Prevention as indicator cases. A family close contact cohort was established through contact screening, and the incidence was followed up and observed. Poisson regression model was used to analyze the etiological characteristics, treatment status, exposure, and previous history of PTB in close family contacts of the indicator cases. Results: As of December 31, 2021, a total of 40182 indicated cases of PTB and 57142 close contacts within the household had been investigated. During the 4-year follow-up period, the median (quartile) duration of follow-up was 3.2 (2.7, 3.3) years, 3585 close family contacts with secondary cases were identified, the secondary attack rate was 6.27%, total 180543 person-years of observation, with an average incidence density of 1985.68/100000 person-years. Among them, the highest incidence of PTB among close contacts within household was about 3317.62/100000 person-years in the first year after the diagnosis of the indicated case. Poisson regression analysis showed that smear-negative pathogenetic testing in the indicated cases, primary treatment, close contacts in the household being male, ≥55 years of age, previous exposure to PTB and history of PTB were all risk factors for the development of PTB in close contacts in the household (RR (95%CI) were 2.491 (2.347-2.562), 1.221 (1.102-1.354), 1.449 (1.306-1.607), 8.451 (6.388-11.179), 2.680 (2.314-3.104), 4.479 (3.852-5.207)). Conclusion: Close contacts within household are the high-risk group for the transmission of indicated cases of PTB, and screening and education of close contacts should be strengthened, especially the elderly, males, previous PTB patients or contacts of PTB patients; there is also a need to systematically scale up and strengthen household contact tracing and preventive treatment strategies for close contacts in high tuberculosis burden areas. It is also recommended to include all PTB patients for screening based on the current strategy, especially smear-negative and only positive molecular biological test patients.

Analysis of the epidemiological characteristics and prediction for the reported incidence of pulmonary tuberculosis in Dongcheng District, Beijing from 2013 to 2022

Teng Chong, Wang Yulan, Liu Liu, Zhang Fang, Huang Fei, Li Tao, Zhao Bing, Zhao Yanlin, Ou Xichao

Chinese Journal of Antituberculosis. 2024, 46(4):  397-402.  doi:10.19982/j.issn.1000-6621.20230420

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Objective: To analyze the epidemic characteristics and changing rules of tuberculosis reported in Dongcheng District of Beijing from 2013 to 2022. The reported incidence from January to June 2023 was predicted through modeling the previously reported data using the seasonal autoregressive integrated moving average (SARIMA), so as to provide reference for tuberculosis prevention and control measures in the district. Methods: The reported incidence data of pulmonary tuberculosis in Dongcheng District, Beijing from January 2013 to June 2023 was obtained through the “Infectious Disease Monitoring System” subsystem of the “China Disease Prevention and Control Information System”. The epidemic characteristics of reported pulmonary tuberculosis from 2013 to 2022 were analyzed. The SARIMA model was established using monthly reported incidence data from 2013 to 2022, and the model was applied to predict and verify the reported incidence data from January to June 2023. Results: A total of 2505 pulmonary tuberculosis patients were reported from 2013-2022 in Dongcheng, with an average annual reported incidence rate of 28.81/100000. The highest reported incidence rate was in 2013 (38.68/100000, 379 cases), and the lowest rate was in 2020 (23.30/100000, 185 cases). The annually reported incidence rate showed an decreasing trend ($χ^{2}_{trend}=25.371$, P<0.001), and the average annual decline rate was 5.26%. The highest detection rate of pathogenic positive pulmonary tuberculosis was in 2022 (57.74%, 97/168), and the lowest rate was in 2017 (30.71%, 74/241), showing an overall upward trend year by year ($χ^{2}_{trend}=29.945$, P<0.001). The annual average reported incidence rate of male tuberculosis was 36.85/100000 (1559 cases), significantly higher than that of female tuberculosis (21.20/100000, 946 cases; χ²=184.738, P<0.001; n_male:n_female=1.73∶1). The proportion of patients in the 20-29 age group (19.88%, 498/2505) and retirees (37.72%, 945/2505) was relatively high and the patients were mainly concentrated in Yongdingmenwai Street (11.38%, 285/2505). Seasonal analysis showed that the seasonal index ranged from 0.83 to 1.09, with periodic fluctuations, and the epidemic period mainly concentrated from March to August, as well as in December. The SARIMA (0,1,2) (1,2,1)₁₂ model fit well with the reported incidence trend (AIC=657.67), with an average relative error of -17.72% and high prediction accuracy (root mean square error of 5.188 and average absolute percentage error of 22.01%). Conclusion: From 2013 to 2022, the reported incidence of tuberculosis in Dongcheng District of Beijing showed a steady downward trend, and the patients were mainly male and retired population. Attention should be paid to the prevention and control of tuberculosis and propaganda and education of the elderly and young adults in spring and summer. The SARIMA (0,1,2) (1,2,1)₁₂ model can well fit the trend of reported incidence of pulmonary tuberculosis in this region and has good predictive effects.

Analysis of the epidemiological characteristics and treatment outcomes of pulmonary tuberculosis aged ≥60 years old in Tongzhou District of Beijing, 2016—2022

Yang Chao, Wang Jing, Yang Chaohui, Gao Hanqing

Chinese Journal of Antituberculosis. 2024, 46(4):  403-410.  doi:10.19982/j.issn.1000-6621.20230416

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Objective: To analyze the epidemiological characteristics and treatment outcomes of pulmonary tuberculosis (PTB) in the elderly people (≥60 years old) in Tongzhou District of Beijing from 2016 to 2022, and provide reference for formulating prevention and control strategies in Tongzhou District. Methods: Data information of 4208 patients with active PTB in Tongzhou District of Beijing from 2016 to 2022 were collected from the subsystem “Tuberculosis Management Information System” of the China Information System for Disease Control and Prevention including medical records, diagnosis and treatment information, laboratory examination and so on. Descriptive statistics methods were used to analyze the patients’ characteristics, treatment and outcomes. The seasonal indexes were used to analyze the seasonal effects of time series. Results: From 2016 to 2022, a total of 963 elderly cases aged 60 and above were registered in Tongzhou District of Beijing, accounting for 22.88% (963/4208) of the total reported patients in the same period. The proportion increased from 22.75% (157/690) in 2016 to 28.06% (142/506) in 2022, showing an increasing trend year by year ($χ^{2}_{trend}=5.749$, P=0.016).The registration rate in the elderly people (53.18/100000 (963/1810800)) was significantly higher than that in the whole population (37.67/100000 (4208/11171400)). The registration rate of PTB patients in both the elderly people and the general population declined from 82.81/100000 (157/189600) and 50.07/100000 (690/1378000) in 2016 to 43.80/100000 (142/324200) and 27.45/100000 (506/1843100) in 2022, showing declining trends (elderly population $χ^{2}_{trend}=10.266$, P=0.001; whole population $χ^{2}_{trend}=52.560$, P<0.001). The etiological positive rate (53.27% (513/963)) and positive rate of 0-month sequence sputum smear (30.22% (291/963)) of elderly patients was significantly higher than that in non-elderly group (38.34% (1244/3245)) and (18.86% (612/3245)) (etiologically positive rate χ²=68.534, P<0.001; positive rate 0-month sequence sputum smear χ²=56.844, P<0.001). The elderly patients were mainly male (68.95% (664/963)), the majority were aged 60-69 years old (48.81% (470/963)), the sources were mainly passive finding (90.24% (869/963)), and among which the most were referral from general hospitals (81.83% (788/963)). The mean delay rate was 40.08% (386/963). The prevalence of PTB in the elderly people was from June to September per year, and the seasonal indexes were 127.15%, 103.47%, 134.63% and 102.22%, respectively. The overall treatment success rate was 84.29% (692/821), and showed a upward trend from 82.80% (130/157) in 2016 to 90.78% (128/141) in 2021 ($χ^{2}_{trend}=4.359$, P=0.026). The treatment success rate of female (88.45% (222/251)) was higher than that the male (82.46% (470/570))(χ²=4.721, P=0.030). The treatment successful rates of the young, middle and old groups (89.63% (363/405), 82.44% (216/262) and 73.38% (113/154)) were significantly different ($χ^{2}_{trend}=23.243$, P<0.001). Conclusion: The epidemic situation of PTB in the elderly people showed a downward trend in Tongzhou District of Beijing from 2016 to 2022. However, the proportion of elderly tuberculosis patients registered was still high and showed a upward trend, and the majority of elderly tuberculosis patients were 60-69 years old, male, non-urban, and referrals, and had the characteristics of high etiological positive rate, high delay rate, and unsatisfactory treatment outcome.Thus corresponding prevention and control strategies should be formulated according to these epidemic characteristics of PTB among elderly.

Analysis of self-paid medical expenses and influencing factors for multidrug-resistant tuberculosis patients in Guangzhou City

Li Xueqiu, Kuang Haobin, Wang Ting, Min Fei, Tao Lan, Cao Xihui, Li Xiang, Liu Guobiao

Chinese Journal of Antituberculosis. 2024, 46(4):  411-417.  doi:10.19982/j.issn.1000-6621.20230448

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Objective: To investigate the current situation and influencing factors of the direct self-paid medical expenses of multidrug-resistant tuberculosis (MDR-TB) patients in Guangzhou City, providing a basis for optimizing medical reimbursement policies for MDR-TB patients. Methods: A self-designed questionnaire was used to conduct face-to-face or telephone interviews on factors related to MDR-TB in 284 patients who completed treatment receive treatment in the MDR-TB clinic of Guangzhou Chest Hospital from January 1, 2020 to December 31, 2022.The direct self-paid medical expenses and information of examinations of patients (including laboratory examination fees, anti-tuberculosis drug fees, non tuberculosis drug fees, hospitalization fees, etc.) were collected through the hospital information system. Descriptive statistical analysis, Chi square test, and other methods were used to analyze direct self-paid medical expenses of MDR-TB patients with different age, gender, family income, occupation, and education levels. Stepwise multiple linear regression was conducted to analyze the influencing factors of direct self-paid medical expenses (α=0.05). Results: The median (quartile) direct self-paid medical expenses of 284 MDR-TB patients was 99927.25 (40136.45, 202526.91) RMB yuan, the top three were anti-TB drug expenses, laboratory examination expenses, and non-anti-TB drug expenses, with median (quartile) of 46676.27 (5590.92, 150869.86) RMB yuan, 22130.59 (15609.23, 31417.06) RMB yuan, and 12751.68 (7977.07, 19418.64) RMB yuan, respectively.In the multi-factorial analysis model, the protective factors for self-paid medical expenses of MDR-TB patients were Guangzhou City household registration (OR (95%CI)=0.95 (0.84-0.99)), and full face-to-face medication management (OR (95%CI)=0.73 (0.65-0.87)), and the risk factors for self-paid medical expenses of MDR-TB patients were having adverse drug reactions (OR (95%CI)=1.33 (1.19-1.46)), using linezolid (OR (95%CI)=2.23 (1.92-2.59)), and having hospitalization (OR (95%CI)=1.57 (1.32-1.91)). Conclusion: The self-paid medical expenses of multidrug-resistant tuberculosis patients in Guangzhou are high, and the management of multidrug-resistant patients’ medication should be standardized to reduce adverse drug reactions and optimize medical reimbursement policies.

Evaluation of the implementation effect of the “Zero Burden” strategy for diagnosis and treatment of pulmonary tuberculosis in Longyou County, Zhejiang Province

Wang Liyan, Zhou Hui, Wu Qian, Hao Xiaogang, Lu Bingxin, Chen Bin

Chinese Journal of Antituberculosis. 2024, 46(4):  418-423.  doi:10.19982/j.issn.1000-6621.20230340

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Objective: To compare the changes in tuberculosis prevention and control indicators before and after the implementation of the “Zero Burden” strategy for tuberculosis diagnosis and treatment in Longyou County, Zhejiang Province, in order to provide scientific basis for formulating new tuberculosis prevention and control measures in a new stage. Methods: The reported incidence data of tuberculosis in all counties (cities, districts) of Quzhou City and counties bordering Longyou County (including Suichang County, Lanxi City, Wucheng District, and Jiande City) in Zhejiang Province from 2016 to 2022, as well as the admission rate and treatment outcome data of tuberculosis patients currently residing in Longyou County, were collected through the Tuberculosis Management Information System, a subsystem of China Disease Prevention and Control Information System. The number of permanent residents came from the local statistical yearbook. The data of diagnosis and treatment cost of pulmonary tuberculosis patients in Longyou County were from the information management system of Longyou County People’s Hospital. The interruption rate of treatment and policy satisfaction of pulmonary tuberculosis patients were mainly collected through surveys conducted by follow-up doctors in designated hospitals and community. Compare the diagnosis and treatment costs of tuberculosis patients, reported incidence rate of tuberculosis, admission rate of the county, treatment outcome and other indicators before (2016-2018) and after (2020-2022) the implementation of the “Zero Burden” strategy for tuberculosis diagnosis and treatment in Longyou County, and analyzed the implementation effect of the strategy. Results: Before the implementation of the “Zero Burden” strategy, the total personal payment expenses for tuberculosis patients were RMB 830322.45 yuan in 2016, RMB 833450.10 yuan in 2017, and RMB 792879.99 yuan in 2018. The personal payment expenses per tuberculosis patient were RMB 3075.27 yuan in 2016, RMB 3281.30 yuan in 2017 and RMB 3523.91 yuan in 2018. After the implementation of the “Zero Burden” strategy, the proportion of personal payment expenses for ordinary tuberculosis patients decreased to 0, and the county’s financial support expenses decreased year by year (RMB 492160.29 yuan, RMB 401349.56 yuan, and RMB 389319.42 yuan respectively from 2020 to 2022).The reported incidence rate of pulmonary tuberculosis in Longyou County was 74.17/10⁵ (270/364000) in 2016, and decreased to 47.21/10⁵ (169/358000) in 2022, the difference was statistically significant ($χ^{2}_{trend}=43.962$, P<0.001); the local admission rate of reported pulmonary tuberculosis patients had significantly increased from 74.81% (202/270) in 2016 to 93.49% (158/169) in 2022 ($χ^{2}_{trend}=64.483$, P<0.001); and the reported interruption rate of treatment for pulmonary tuberculosis patients significantly decreased from 6.30% (17/270) in 2016 to 1.18% (2/169) in 2022 ($χ^{2}_{trend}=17.965$, P=0.003). Conclusion: The implementation of the “Zero Burden” strategy for tuberculosis diagnosis and treatment in Longyou County, Zhejiang Province reduced the medical burden of tuberculosis patients, increased the local admission rate, reduced the rate of patients’ treatment interruption and the overall reported incidence rate of tuberculosis, and the implementation effect of the strategy has appeared tentatively.

Analysis of influencing factors of tuberculosis patients’ medical experience with the internet hospital platform

Zhou Shuang, Zong Di, Li Shixue, Du Jian

Chinese Journal of Antituberculosis. 2024, 46(4):  424-432.  doi:10.19982/j.issn.1000-6621.20230367

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Objective: To investigate and discuss the influencing factors of tuberculosis (TB) patients’ experience of visiting the Internet hospital platform, to improve their experience of “Internet plus” medical services and the service quality of the Internet hospital platform. Methods: Using the form of random number table to sample 175 TB patients who visited the Beijing Chest Hospital Internet Hospital online platform between January and May 2022 and met the enrollment requirements, for telephone interview. A self-developed questionnaire was used to collect the patients’ basic information, medical treatment, and satisfaction data, and the “Internet +” patient experience scale was used to evaluate the patient experience. One hundred and fifty valid questionnaires were collected, with an effective rate of 85.7% (150/175). t test, ANOVA and multiple linear regression analysis were used respectively for univariable analysis and multiple factor analysis. Results: The overall average score of the patient experience was (59.44±7.06), with the highest score (4.41±0.62) for the safety dimension and the lowest score (3.97±0.66) for the accessibility dimension. The results of the univariable analysis showed that patients’ age (F=8.477, P<0.01), residence (F=3.285, P<0.05), and occupation (F=3.158, P<0.01) were statistically related with patient experience; waiting time for consultation (t=-3.099, P<0.01), consultation time (t=3.725, P<0.01), and doctor’s professionalism (F=4.887, P<0.01) were statistically related with patient experience; satisfaction with the overall visit (F=16.134, P<0.01), with the consultation process (F=21.862, P<0.01), with the accessibility to medical resources (F=24.165, P<0.01), with doctors (F=20.458, P<0.01), and with the Beijing Chest Hospital (F=17.176, P<0.01) were statistically related with patient experience. In the multiple linear regression analysis, compared with the suburbs of Beijing, patients from Tianjin City or Hebei Province had better medical experience (t=2.386,P<0.05); Compared with retired people, staffs of government and public institutions, company employees, self-employed people, unemployed people all had better medical experience (t=2.585, P<0.05; t=2.626, P<0.05; t=2.839, P<0.01; t=2.424, P<0.05); Patients with waiting time ≥30 min, having enough time for consultation, having high satisfaction with ease of access to medical resources and satisfaction with doctors had better medical experience (t=3.402,P<0.01;t=-2.775,P<0.01;t=2.329,P<0.05;t=2.064,P<0.05). Conclusion: The overall experience of TB patients in the Internet hospital platform is good, and patients’ age, residence, occupation, waiting time for consultation, consultation time, and satisfaction with resource access and doctors affect the experience of TB patients. Improving the above aspects and paying more attention to key groups will improve patient experience and service quality of the Internet hospital platform.

Analysis of the influence of receiving health education on knowledge, belief and behavior of college students in four provinces in China

Ni Shuaihu, Wang Jia, Chen Gang, Dong Longyu, Wang Ni, Luo Xiaofeng, Qu Yan, ZhaoYanlin

Chinese Journal of Antituberculosis. 2024, 46(4):  433-439.  doi:10.19982/j.issn.1000-6621.20230369

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Objective: To analyze the effects of tuberculosis (TB) health education on the knowledge, belief and behavior of TB prevention and control among Chinese college students, and to provide evidence for further improving the effect of school health education on TB. Methods: Stratified cluster sampling method was used to sample college students, a self-designed questionnaire was used to investigate college students in the first and second grades. Univariable and multivariable logistic regression models were used to analyze differences in the acceptance rate of TB health education among college students. Results: A total of 18438 questionnaire were collected, and 17491 pieces of valid questionnaire were retrieved, with an effective rate of 94.86% (17491/18438). The total awareness rate of core knowledge of TB was 82.20% (115019/139928), and 82.99% (14516/17491) of the students had received health education on TB among whom the total awareness rate of the core knowledge of TB (83.62%, 97111/116128) was higher than that of the college students who had not received TB health education (75.24%, 17908/23800). However, among the college students who had received TB health education, the awareness rates of “TB is a chronic infectious disease”, “The vast majority of TB patients can be cured” and “Opening windows and ventilation are conducive to preventing the spread of TB bacteria” were generally low which were 54.59% (7924/14516), 76.77% (11144/14516) and 77.24% (11212/14516), respectively. The college students who had received TB health education had a better belief in TB prevention and control compared with those who had not. However, even for those who had received TB health education, the number of students who thought they might be at risk of TB was generally lower, accounting for only 48.44% (7032/14516). Compared with those who had not received TB health education, students who had received TB health education had better TB health behaviors, such as not smoking (95.12% (13807/14516) vs. 93.08% (2769/2975)), cough or sneeze with elbow/tissue covering nose and mouth ((98.73% (14332/14516) vs. 96.77% (2879/2975)), don’t stay up late (35.09% (5093/14516) vs. 25.92% (771/2975)). However, among them, students who often stayed up late and had insufficient sleep time were still common, accounting for 64.91% (9423/14516) and 54.99% (7983/14516) respectively. The acceptance of TB health education in college students was related to gender, major and contact history of TB patients. Female college students (OR=1.20, 95%CI: 1.10-1.30), medical college students (OR=1.57, 95%CI: 1.37-1.77) and college students who had no contact with TB patients (OR=1.33, 95%CI: 1.23-1.43) received TB health education better. Conclusion: TB health education can effectively improve the knowledge, belief and behavior of Chinese college students, but there are still shortcomings. It is necessary to further strengthen the targeted health education for male students and non-medical students.

Investigation and analysis of social discrimination and awareness of pulmonary tuberculosis among junior college students in Zhejiang Province

Li Yang, Chen Bin, Peng Ying, Chen Xinyi, Jiang Jianmin

Chinese Journal of Antituberculosis. 2024, 46(4):  440-448.  doi:10.19982/j.issn.1000-6621.20230445

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Objective: To understand the current situation and its influencing factors of pulmonary tuberculosis (PTB) core knowledge awareness and discriminatory attitudes of first- and second-year college students towards PTB patients in Zhejiang Province, to provide a scientific basis for taking effective measures to reduce PTB discrimination in college. Methods: From May 1 to 20, 2022, an electronic questionnaire survey was conducted on junior students in 20 colleges in Zhejiang Province using stratified cluster random sampling. A total of 4427 pieces of questionnaire were sent out, and 4414 valid ones were retrieved to analyze the current situation and influencing factors of students’ awareness of core knowledge of PTB prevention and treatment and their discriminatory attitudes towards TB patients. Results: The total awareness rate of the core knowledge of TB prevention and control among the freshmen and sophomores of the 20 colleges was 81.6% (28804/35312). College students had the highest awareness rate (96.2%, 4248/4414) for the core knowledge of “Patients should go to TB designated medical institutions after getting TB”, while the lowest awareness rate of the core knowledge was for “TB is a chronic infectious disease” (51.0%, 2251/4414).Among all respondents, 641 (14.5%) had a discriminatory attitude towards TB patients and 3773 (85.5%) had a non-discriminatory attitude towards TB patients. The results of multivariable analysis showed that female students were less prone to discriminatory attitudes towards TB patients compared to male students (OR=0.606, 95%CI:0.497-0.739); Compared with students with an average monthly living expenses ≤500 yuan, students with average monthly living expenses of 501-1000 yuan (OR=0.514, 95%CI: 0.282-0.935), 1001-1500 yuan (OR=0.459, 95%CI: 0.267-0.789), 1501-2000 yuan (OR=0.436, 95%CI: 0.254-0.747), and >2000 yuan (OR=0.492, 95%CI: 0.283-0.857) had a lower discriminatory attitude towards TB patients; Students knowing messages of “TB is a chronic infectious disease” (OR=0.801, 95%CI: 0.671-0.956), “Coughing or expectoration for more than 2 weeks or having blood in sputum should be suspected for having TB” (OR=0.608, 95%CI: 0.448-0.825), “During staying in school, if having suspicious symptoms of PTB or being diagnosed with PTB, student should actively report this to the school authority, and do not conceal their illness or go to class with illness” (OR=0.405, 95%CI: 0.332-0.494), “Go to bed early and get up early, keep a balanced diet, exercise persistently can improve physical resistance” (OR=0.639, 95%CI: 0.503-0.811)had significantly lower discriminatory attitude towards TB patients than the rest of the survey participants. Conclusion: Freshmen and sophomores in colleges in Zhejiang Province have certain knowledge of TB prevention and control, but their understanding of TB is not comprehensive, and there are still discriminatory attitudes towards TB patients. Schools should further strengthen health education for male students and college students with low average monthly living expenses, and carry out theoretical and practical education from the beginning of enrollment to improve students’ attitudes towards TB patients.

Transcriptome study on peripheral blood mononuclear cells of latent tuberculosis infection individuals

Shang Xuetian, Dong Jing, Huang Mailing, Sun Qi, Jia Hongyan, Zhang Lanyue, Liu Qiuyue, Yao Mingxu, Wang Yingchao, Ji Xiuxiu, Du Boping, Xing Aiying, Pan Liping

Chinese Journal of Antituberculosis. 2024, 46(4):  449-460.  doi:10.19982/j.issn.1000-6621.20240005

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Objective: The aim of the study is to explore the tuberculosis (TB) antigen specific transcriptome profile of latent TB infection (LTBI) individuals and identify the critical gene modules and pathways that may play significant roles in LTBI occurrence and development, by comparing the transcriptome results of peripheral blood mononuclear cells (PBMC) stimulated by TB-specific antigen of healthy controls (HC) and LTBI. Methods: Microarray test was used to uncover the transcriptome profile of PBMC stimulated by TB antigens in 4 cases of LTBI and 4 HC from Beijing Chest Hospital, Capital Medical University in December 2009, and further validated with qPCR to confirm the microarray data. Weighted gene co-expression network analysis (WGCNA) was used to identify the critical gene modules that were associated with LTBI. Geneontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were carried out based on the genes in the two modules significantly associated with LTBI. At the same time, GSEA-based KEGG analysis was also used in order to fully understand the transcriptome changes of PBMC after TB-specific antigen stimulation in the two groups. Immune infiltration analysis was also used to further confirm the important immune cells involving in LTBI occurrence. Protein-Protein Interaction (PPI) network analysis based on the STRING database was used to draw the differential gene interaction network diagram in the two modules. Results: A total of 393 differentially expressed genes were found between LTBI group and healthy group (fold change >2 or <0.5, P<0.05), of which 112 were down-regulated and 281 were up-regulated. qPCR analysis of 10 differential genes confirmed that the gene expression pattern was consistent with that of the microarray data, and CAMK1G, IL2, SPINK1, SUCNR1, HCAR3, IL18BP, CHI3L1 and TNF were up-regulated, while RASGRP2 and TPM2 were down-regulated. According to the analysis of WGCNA, the blue module with positive correlation (cor=0.88, P=0.004) and the turquoise module with negative correlation (cor=―0.93, P=0.001) were the modules that most significantly associated with LTBI. The genes in the two modules were then subjected to KEGG enrichment analysis, meanwhile, GSEA analysis based on complete transcriptome was also performed. The results showed that chemokine signaling pathway (P<0.001) and apoptosis signaling pathway (P=0.003) were significantly enriched by both analyses. The PPI network diagram of the differential genes in the two modules was constructed through the STRING database, and the top 10 hub genes in each module were obtained through the built-in plug-in, including PTPRC, CD40, IL10, IRF8, CCR1, CD80, TLR8, CLEC7A, CD83 and CD274 in the blue module, and TNF, ICAM1, TNFRSF4, HAVCR2, CD276, CCL4, CD33, IL1RN, NCF1 and FGR in the turquoise module. Immune infiltration analysis showed that innate immune cells, such as M1 macrophage (P=0.029) and M2 macrophage (P=0.001), were significantly concentrated in LTBI population. Conclusion: Significant differences in transcriptome of PBMC stimulated by TB-specific antigen are identified between LTBI and HC. These differential genes are mainly enriched in apoptosis signal pathway and chemokine signal pathway. Meanwhile, macrophage-mediated immune response plays an important role. These results collectively reveal the important role of innate immune response in LTBI occurrence.

Evaluation of in vitro activity of fusidic acid against mycobacteria

Cheng Mengli, Jiang Guanglu, Huo Fengmin, Xue Yi, Yu Xia

Chinese Journal of Antituberculosis. 2024, 46(4):  461-466.  doi:10.19982/j.issn.1000-6621.20230458

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Objective: To evaluate the in vitro inhibitory activity of fusidic acid (FA) against mycobacteria. Methods: The standard strains and clinical isolates of mycobacteria stored in the strain bank of Beijing Chest Hospital, Capital Medical University were selected as the research strains. There were 45 standard strains of mycobacteria, including 26 rapidly growing mycobacteria (RGM) strains and 19 slowly growing mycobacteria (SGM) strains. A total of 129 clinical isolates of mycobacteria were isolated from Beijing Chest Hospital, Capital Medical University from January 2017 to December 2018, including 26 Mycobacterium tuberculosis (MTB) sensitive strains, 29 multidrug-resistant (MDR) strains, 30 extensive drug-resistant (XDR) strains, 23 Mycobacterium avium strains and 21 Mycobacterium gordon strains. Broth microdilution method was used to test the minimal inhibitory concentrations (MIC), MIC₅₀, MIC₉₀ and MIC₉₉ of mycobacteria strains against FA, and the strains with MIC ≤16μg/ml were defined as FA sensitive strains. The drug resistance of the strains to FA was analyzed. Results: The resistance rates of RGM and SGM standard strains to FA were 23.1% (6/26) and 21.1% (4/19), respectively. The MIC₅₀, MIC₉₀, and MIC₉₉ values of FA for MDR-MTB clinical isolates were 4, 16, and 16μg/ml, respectively. The resistance rate of MTB clinical isolates to FA was 3.5% (3/85), with the resistance rates of MTB drug sensitive strains, MDR-MTB, and XDR-MTB strains being 0, 0, and 10.0% (3/30), respectively. The resistance rates of clinical isolates of Mycobacterium avium and Mycobacterium gordon to FA were 17.4% (4/23) and 9.5% (2/21), respectively. The MIC₅₀, MIC₉₀, and MIC₉₉ values of FA for clinical isolates of mycobacterium were 4, 16, and >32μg/ml, respectively. The overall resistance rate of FA for clinical isolates of mycobacterium was 7.0% (9/129). Conclusion: FA has high antibacterial activity against mycobacterium species and has a good antibacterial effect on MTB clinical isolates.

Analysis of influencing factors on treatment interruption in 317 pulmonary tuberculosis patients

Zheng Hailun, Li Yamin, Sun Shanhua, He Xiaoxin

Chinese Journal of Antituberculosis. 2024, 46(4):  467-472.  doi:10.19982/j.issn.1000-6621.20240044

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Objective: To analyze the interruption of treatment and influencing factors in 317 patients with pulmonary tuberculosis,then propose countermeasures to provide basis for improving the management quality of tuberculosis patients. Methods: All of 2715 pulmonary tuberculosis patients were taken as the research objects, who were registered and managed in Tuberculosis Outpatient Department of Beijing Center for Disease Control and Prevention from 2012 to 2021. Basic demographic information and clinical data was collected from Tuberculosis Management Information System and medical records respectively. Univariate and multivariate logistic regression methods were used to analyze the influencing factors of treatment interruption. Results: Among 2715 pulmonary tuberculosis patients, 317 cases were interrupted treatment, with a rate of 11.68%. Univariate analysis showed that the interrupted treatment rate of female patients (10.11%, 109/1078) was lower than that of male patients (12.71%, 208/1637), and there was significant difference (χ²=4.244,P=0.039).The interrupted treatment rate of patients in 25-44 years old group (8.21%, 96/1170) was lower than that in <25 years old group (11.38%, 57/501), 45-64 years old group (14.75%, 86/583) and ≥65 years old group (16.92%, 78/461), and the difference was significant (χ²=31.349,P<0.01).In occupational classification, the interrupted treatment rate for tuberculosis patients with occupations as students/teachers/medical personnel/cadres (7.29%, 72/988) was lower than that of patients with occupations as farmers/migrant workers/workers (13.37%, 25/187), retired/housework and unemployed/other (14.65%, 194/1324), and commercial, catering service/public place waiters (12.04%, 26/206) and the difference was statistically significant (χ²=30.373,P<0.001).The interrupted treatment rate of initially treated pulmonary tuberculosis patients (11.05%, 274/2480) was lower than that in retreated pulmonary tuberculosis patients (18.30%, 43/235), and the difference was statistically significant (χ²=10.939,P<0.001). Multivariate analysis showed that comparing with patients aged 25-44 years, patients aged <25 years (OR=1.536, 95%CI: 1.082-2.180), patients aged 45-64 years (OR=1.538, 95%CI: 1.101-2.149) and patients aged ≥65 years (OR=1.596, 95%CI: 1.095-2.326) were more likely to interrupt treatment.Comparing with students/teachers/medical staff/cadres, commercial, catering service/public place waiters (OR=1.693, 95%CI: 1.050-2.731), farmers/migrant workers/workers (OR=1.681, 95%CI: 1.014-2.787), retired/housework and unemployed/other occupation (OR=1.776, 95%CI: 1.278-2.469) were more likely to interrupt treatment. Treatment interruption was more likely to occur in retreated patients than in initial patients (OR=1.487, 95%CI: 1.031-2.145).54.57% (173/317) of tuberculosis patients interrupted treatment within the first 2 months of treatment. Conclusion: Beijing should adopt more targeted supervision and health education for male, retired/housework and unemployed/other, older people ≥65 years old, and retreated patients with pulmonary tuberculosis. Management of the first two months of treatment should be strengthened to reduce the rate of treatment interruption.

Review Articles

Research progresses of interferon-induced protein 10 in the diagnosis and monitor of respiratory infectious diseases

Song Ruixue, Yao Mingxu, Pan Liping

Chinese Journal of Antituberculosis. 2024, 46(4):  473-478.  doi:10.19982/j.issn.1000-6621.20230400

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Interferon inducible protein 10 (IP-10) is a member of the Cys-X-Cys (CXC) chemokine family, and its receptor is CXCR3. IP-10 has multiple biological functions, such as CXCR3⁺ cells, including chemotactic T cells, monocytes and NK cells, play roles in the process of pro-inflammation or anti-inflammation. It was found that IP-10 is also associated with respiratory infectious diseases, it plays a certain role in the diagnosis of tuberculosis infection, as well as monitor the progress of acute and serious respiratory infectious diseases such as novel coronavirus infection and highly pathogenic avian influenza. Therefore, the progresses of IP-10 in the diagnosis and monitor of respiratory infectious diseases were reviewed in this article.

The role of CD4⁺ and CD8⁺T cells in the immune response to tuberculosis

Wen Shufang, Wei Rongrong, Li Haoran, Liu Yi

Chinese Journal of Antituberculosis. 2024, 46(4):  479-484.  doi:10.19982/j.issn.1000-6621.20230452

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Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) is the leading cause of death from a single infectious agent worldwide, and there has been a large number of individuals who remain in a long-term latent infection state after being infected. The clearance of MTB in the body primarily relies on specific immune responses, in which T lymphocytes, as the main cells involved in cellular immunity. Their proliferation and activation play a crucial role during the specific immune response in the body. This review discusses the functions of CD4⁺ T cells and CD8⁺ T cells, two subsets of T lymphocytes, in the immune response MTB infection, and summarizes the mechanisms of the immune response against MTB infection in the body. It aims to provide insights for further exploration of the adaptive immune network against MTB infection,diagnosis of TB, and the development of new vaccines in clinical research.