Occult transmission of asymptomatic tuberculosis and iterative renewal of prevention and control strategies

doi:10.19982/j.issn.1000-6621.20250305

Abstract

Abstract:

As a special target population in tuberculosis (TB) prevention and control, patients with asymptomatic tuberculosis (aTB) pose significant challenges to global TB control efforts due to the strong concealment of their condition and the difficulty in clinical diagnosis. Based on the latest definition by the World Health Organization and combined with relevant research progress and global epidemiological evidence on aTB, this paper constructs a logical framework of “problem definition-impact assessment-strategy innovation-challenge response” to systematically elaborate on the key role of aTB in the reconstruction of the disease spectrum, as well as its in-depth impacts on screening strategies, clinical diagnosis and treatment, and public health management. It is expected to provide theoretical basis and practical reference for optimizing aTB prevention and control strategies.

Key words: Tuberculosis, Asymptomatic tuberculosis, Communicable disease control, Disease management, Consensus development conference

CLC Number:

Gao Lei, Cheng Shiming, Jin Qi, Liu Jianjun. Occult transmission of asymptomatic tuberculosis and iterative renewal of prevention and control strategies[J]. Chinese Journal of Antituberculosis, 2025, 47(9): 1135-1139. doi: 10.19982/j.issn.1000-6621.20250305

References 29

[1]	World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization, 2024.
[2]	Frascella B, Richards AS, Sossen B, et al. Subclinical Tuberculosis Disease-A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology. Clin Infect Dis, 2021, 73(3): e830-e841. doi:10.1093/cid/ciaa1402. pmid: 32936877
[3]	全国结核病流行病学抽样调查技术指导组, 全国结核病流行病学抽样调查办公室. 2000年全国结核病流行病学抽样调查报告. 中国防痨杂志, 2002, 24(2): 65-108.
[4]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8): 485-508.
[5]	World Health Organization. Report of the WHO consultation on asymptomatic tuberculosis. Geneva: World Health Organization Geneva, 2024.
[6]	Emery JC, Dodd PJ, Banu S, et al. Estimating the contribution of subclinical tuberculosis disease to transmission: An individual patient data analysis from prevalence surveys. Elife, 2023, 12: e82469. doi:10.7554/eLife.82469.
[7]	Ku CC, MacPherson P, Khundi M, et al. Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data. BMC Med, 2021, 19(1): 298. doi:10.1186/s12916-021-02128-9.
[8]	Chen JO, Qiu YB, Rueda ZV, et al. Role of community-based active case finding in screening tuberculosis in Yunnan province of China. Infect Dis Poverty, 2019, 8(1): 92. doi:10.1186/s40249-019-0602-0.
[9]	World Health Organization. WHO standard: universal access to rapid tuberculosis diagnostics. Geneva: World Health Organization, 2023.
[10]	World Health Organization. WHO consolidated guidelines on tuberculosis. Module 2: screening-systematic screening for tuberculosis disease. Geneva: World Health Organization, 2021.
[11]	MacPherson P, Shanaube K, Phiri MD, et al. Community-based active-case finding for tuberculosis: navigating a complex minefield. BMC Glob Public Health, 2024, 2(1): 9. doi:10.1186/s44263-024-00042-9. pmid: 39681899
[12]	van Wyk SS, Blose N, Kapanda-Phiri L, et al. The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review. EClinicalMedicine, 2025, 79: 103010. doi:10.1016/j.eclinm.2024.103010.
[13]	Ge S, Liu K, Jiang X, et al. Prevalence, Progression, and Treatment of Asymptomatic Tuberculosis: A Prospective Cohort Study in Lanxi County, Zhejiang Province, China. Open Forum Infect Dis, 2025, 12(5): ofaf275. doi:10.1093/ofid/ofaf275.
[14]	World Health Organization. Use of computer-aided detection software for tuberculosis screening: WHO policy statement. Geneva: World Health Organization, 2025.
[15]	Xin H, Wang W, Wang X, et al. The performance of computer-aided detection for chest radiography in tuberculosis screening: a population-based retrospective cohort study. Emerg Microbes Infect, 2025, 14(1): 2470998. doi:10.1080/22221751.2025.2470998.
[16]	赵琰枫, 屠霞, 王嫩寒, 等. 三种检测方法在肺结核患者病原学阳性检出中的贡献分析. 中国防痨杂志, 2025, 47(6): 701-707. doi:10.19982/j.issn.1000-6621.20250005.
[17]	World Health Organization. WHO consolidated guidelines on tuberculosis. Module 3: diagnosis-rapid diagnostics for tuberculosis detection. 3rd ed. Geneva: World Health Organization, 2024.
[18]	Boehme CC, Nabeta P, Hillemann D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med, 2010, 363(11): 1005-1015. doi:10.1056/NEJMoa0907847.
[19]	Hu S, Li G, Li H, et al. Rapid detection of isoniazid resis-tance in Mycobacterium tuberculosis isolates by use of real-time-PCR-based melting curve analysis. J Clin Microbiol, 2014, 52(5): 1644-1652. doi:10.1128/JCM.03395-13.
[20]	Yu S, Liu N, Xie Z, et al. Nanopore sequencing for precise detection of Mycobacterium tuberculosis and drug resistance: a retrospective multicenter study in China. J Clin Microbiol, 2025, 63(4): e0181324. doi:10.1128/jcm.01813-24.
[21]	Chew N, Yun S, See KC. Diagnostic Accuracy of Breath Tests to Detect Pulmonary Tuberculosis: A Systematic Review. Lung, 2025, 203(1): 26. doi:10.1007/s00408-024-00779-y. pmid: 39841224
[22]	Wang Y, Cui J, Li Y, et al. Rapid quantitative PCR on tongue swabs for pulmonary tuberculosis in adults: a prospective multicentre study. Eur Respir J, 2025, 65(1): 2401493. doi:10.1183/13993003.01493-2024.
[23]	Wang Y, Ma Z, Liu Z, et al. Tongue swab-based molecular diagnostics for pulmonary tuberculosis and drug resistance in adults: A prospective multicenter diagnostic accuracy study. J Infect, 2025, 91(1): 106517. doi:10.1016/j.jinf.2025.106517.
[24]	张灿有, 陈彬, 叶建君, 等. 中国重点人群肺结核患病与发病调查分析. 中国防痨杂志, 2021, 43(12): 1260-1268. doi:10.3969/j.issn.1000-6621.2021.12.006.
[25]	张慧, 成君, 于艳玲, 等. 基于社区的重点人群肺结核主动发现干预效果评价:多中心前瞻性队列研究. 中国防痨杂志, 2021, 43(12): 1248-1259. doi:10.3969/j.issn.1000-6621.2021.12.005.
[26]	Dhana A, Gupta RK, Hamada Y, et al. Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis. Eur Respir Rev, 2023, 32(168): 230021. doi:10.1183/16000617.0021-2023.
[27]	Dheda K, Perumal T, Fox GJ. Asymptomatic tuberculosis: undetected and underestimated, but not unimportant. Lancet, 2025, 405(10492): 1797-1800. doi:10.1016/S0140-6736(25)00555-0.
[28]	Yoon SH, Goo JM, Yim JJ, et al. CT and ¹⁸F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray. Insights Imaging, 2022, 13(1): 112. doi:10.1186/s13244-022-01255-y.
[29]	Churchyard GJ, Houben RMGJ, Fielding K, et al. Implications of subclinical tuberculosis for vaccine trial design and global effect. Lancet Microbe, 2024, 5(10): 100895. doi:10.1016/S2666-5247(24)00127-7.