Press Interpreter

Highly infective -- in one year a single person can infect 15 others; even more frightening is that many TB sufferers still socialize

04/08/08 -- Yesterday, the Jiangsu Province Department of Health published the March 2008 provincial report on infectious disease as mandated by law. The report indicated that tuberculosis (TB) is still the leading cause of new infections and of death from infection [in the province]. In the course of interviews [for this story], this reporter found out that some individuals who know that they have tuberculosis take buses without wearing masks, continue to eat at restaurants as usual, and certainly will not publicly reveal their infection status. Some patients do not comply with treatment once they are diagnosed with TB. Experts say that behind these problems is the current legal vacuum for supervision of those with TB.

Assessing the Current Situation

Continuing to ride the bus and eat at restaurants after diagnosis

"Some TB patients throw away the boxes from their medications in the hospital trashcans right after filling their prescriptions, taking the medicines themselves home hidden in their bags. The patients are afraid that if they take the packaging for the medicines home, others will find out about their TB status, affecting their work and personal relationships." Experts at the Nanjing Chest Hospital say that some portion of those with TB are not emotionally stable. They don't tell their workplace, coworkers, or friends about their TB status, continuing to work, take the bus, and eat as though everything is normal. Although doctors emphasize that these patients should wear masks in public so as not to infect others, they are afraid and feel that to do so would attract too much attention--with one look people would know that they were sick. Some patients even disappear after they are diagnosed with TB and don't return to the hospital for treatment.

In order to help TB patients receive standard care, the [local] disease control center staff will deliver the medications to the patient's homes, but many patients do not cooperate. Often, when the staff member visits the patients, they stringently deny that they are sick. "Some people are afraid that they will be discriminated against by their coworkers or friends, so they put down false information when filling out their names and addresses. When staff from the disease control center or from the local medical community try to track down patients and treat them as required by regulations, they inevitably find out that there are no such persons." People involved in this process say that this has led to some TB patients 'evaporating'.

Community danger

Every year patients infect an average of 15 others

Some people infected with TB think that their disease status is something personal and that no one else needs to know. Experts disagree. Although tuberculosis is not a fulminating infectious disease, active pulmonary tuberculosis can still spread. Research shows that one highly infectious individual with TB can infect an average of 15 others every year. The infectious nature of TB is also somewhat different than other diseases in that TB has a strong social dimension. Evasive behavior will not only lead to chronic TB for the patient and increased financial burden for the patient's family, but will endanger society.

Experts say that in general nearly everyone is susceptible to TB infection. Some people, once infected, develop disease within a few months. Others do not develop disease for years. Most people (about 90%) won't develop the disease for their entire lives.* When individuals infected with TB are discovered, standard and reasonable treatment will eliminate the possibility of spreading the infection. Tuberculosis treatment requires at least 6-9 months time. If a patient does not complete the treatment regimen or interrupts treatment, it can lead to antibiotic-resistant strains of tuberculosis and thereby lower the efficacy of treatment.

The Difficulty of Treatment

No legal requirement for quarantine

Experts recommend that in order to maintain the efficacy of TB medications, those discovered to have TB should receive treatment under the supervision of health professionals until the infection is cured. In reality, this type of treatment regime is difficult to maintain. Experts indicate that there are currently no explicit regulations that compel TB sufferers to receive treatment and that no current laws require TB patients to be treated under quarantine. This is a big headache for the hospitals and departments involved; once [the hospitals or doctors] come into contact with these patients, no amount of cajoling can convince the patients to take their medication. Experts say that the main avenue for resolving the problem of infective-TB patients who continue to carry on normal social interactions is to rely on the self-discipline of the patients themselves.

[Full Text]

* The distinction that the author is drawing here is between those merely infected with Mycobacterium tuberculosis, the organism that causes TB, and those who are not only infected with the organism but show pathological signs of the disease tuberculosis. The symptoms of pulmonary tuberculosis (tuberculosis that affects the lungs) are as follows: an intractable cough that produces mucus and possibly blood, weight loss, and eventually respiratory failure.

As noted in the article, the vast majority of people who acquire a TB infection never present with clinical symptoms of the disease--they never actually 'get' tuberculosis. One study published in 1980 that supports the claim made in the article that 90% of those that get infected don't get the disease is found in the journal Advances in Tuberculosis Research (which discontinued publication in 1985). The study shows that only about 10% of those who test positive for tuberculosis infection progress to active tuberculosis disease. Of those that do get the disease, 54% manifest it in the first year after testing positive and 78% manifest within 2 years (Styblo, K. Recent advances in epidemiological research in tuberculosis. Adv Tuberc Res 20:1-63, 1980). Thus, only one out of ten TB infections actually progresses to full-blown tuberculosis, but the disease is still the most deadly infectious disease in Jiangsu province.

By Zhang Xing

--Translated by D. Owen Young

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