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China Cuts Number of TB Cases in Half

  • Jessica Berman

Over the past 20 years, China has slashed its tuberculosis rate by more than 50 percent by broadly applying the World Health Organization's strategy for TB elimination. Experts say the outcome is proof tuberculosis can be vanquished through an aggressive treatment program.

China is a major contributor to the world's tuberculosis pandemic, with an estimated one million new cases every year. Experts say its infection rate accounts for eleven percent of the global burden.

But by extending an aggressive TB elimination strategy from half the country in the 1990s to the entire population, China has dramatically cut the number of existing TB cases. In less than 15 years, they dropped from 170 to 59 people per hundred thousand. That's a 57 percent reduction in TB prevalence between 2000 and 2010.

The figure puts China significantly ahead of the WHO's global tuberculosis reduction target of 50 percent by 2015.

Giovanni Battista Migliori, director of the WHO Collaborative Center for Tuberculosis and Lung Diseases in Italy, is not surprised at China's success in reducing its TB prevalence.

"When a decision is taken [made] in China, it is more likely to be really applied than in Western countries, for example," he said. "So a policy is really applied when the government sends an order to do this."

Migliori also says TB is easier to control in China than in other countries because there is relatively little outside migration.

A nationwide expansion of the Directly Observed Therapy Strategy, or DOTS, program in China is credited for the dramatic reduction in the rate of TB.

Treatment for tuberculosis requires patients to take a number of drugs daily for six to nine months. Adherence to the regimen is difficult, and often uneven.

But with DOTS, health care workers visit patients in their homes every day, making sure they swallow each dose of the prescribed pills.

Migliori says China's commitment to eliminate TB can serve as a model for other countries with high prevalence rates.

The disease is often seen as a co-infection in HIV-positive patients. But even in countries battling a high incidence of AIDS, Migliori believes TB can be dramatically reduced with the proper commitment.

"The possibility to intervene with the antiretrovirals early is important and might allow [TB prevalence] to go in the same direction," he said.

An article on the reduction in China's tuberculosis rate is published in the journal Lancet, along with a commentary by Migliori.
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