World Tuberculosis Day is celebrated annually on 24 March. It was established in 1982 by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease and received official UN support in 1998. The date of March 24 was chosen due to the fact that on this day in 1882 the German microbiologist Robert Koch first described the causative agent of tuberculosis – Mycobacterium tuberculosis (Koch's bacillus) in his lecture for the Physiological Society of Berlin. The discovery made it possible to diagnose and treat the disease.
In 2021 World Tuberculosis Day will be celebrated under the slogan "Time is ticking, let’s eliminate tuberculosis".
About the disease
Tuberculosis is an infectious disease of humans and animals. Tuberculosis is still one of the top 10 causes of death in the world. Every day almost 4,500 people die from this preventable and curable disease, and almost 30,000 people get sick. Most often, Koch's bacillus affects the lungs, but sometimes the nervous, urinary, bone, digestive systems, brain, skin, eyes. Common symptoms of pulmonary tuberculosis are:
- cough lasting more than 3 weeks, chest pain.
- a slight increase in temperature 37-37,50°C for a long period.
- rapid fatigue, the appearance of weakness, causeless fatigue.
- decrease or lack of appetite, weight loss of 5-10 kg or more.
- profuse sweating for no apparent reason, especially at night.
If you have such complaints, it is necessary to consult a physician or a phthisiatrician for diagnostic tests.
The disease is transmitted by airborne droplets and proceeds, as a rule, in a latent form, but in some cases, it acquires an open, active form. The risk of developing tuberculosis in infected people is 5-15%. However, it is significantly higher in people with weakened immunity, diabetes, malnutrition and in smokers. Thus, the likelihood of developing an active form of tuberculosis in HIV-infected people is 20-30 times higher. The COVID-19 pandemic is in its second year now, and, unfortunately, it is taking away more and more medical resources and attention from providing essential life-saving diagnoses, medicines and care to people suffering from tuberculosis.
Fight against tuberculosis
Since 1995, WHO has been monitoring cases of infection and treatment outcomes on the national level and worldwide. Since 1997, the organization annually has been publishing the Global Tuberculosis Report with estimates of morbidity and mortality.
In 2014, the World Health Assembly (the highest governing body of WHO) approved the Strategy to End Tuberculosis 2016-2035. It set the task for this time to eliminate the global tuberculosis epidemic – to reduce the incidence rate by 90%.
Following the Sustainable Development Goals (SDGs) for the period up to 2030 (including the fight against tuberculosis) adopted by the United Nations in 2015, WHO has approved 20 areas of its work to help countries achieve these goals. Health ministers and representatives from 120 countries pledged to accelerate the fight against tuberculosis at the Global Ministerial Conference on the disease held in Moscow in November 2017.
The epidemic situation for tuberculosis in Belarus began to deteriorate in the early 90s of the last century, and the dynamics of its spread qualifies the situation as unfavorable. Currently, tuberculosis has taken the leading position among all causes of death from infectious diseases. The injury of the respiratory system prevails in the structure of all forms of active tuberculosis.
Taking into account the high prevalence of multidrug-resistant and extensively drug-resistant tuberculosis among patients in the Republic of Belarus and the insufficient number of successful treatment cases for these patients, WHO requires new strategies and approaches to eliminate the tuberculosis epidemic.
Using the slogan “Working Together to End TB,” WHO calls on governments of all countries to engage in dialogue and collaboration that bring people and communities together to find new ways to end the tuberculosis epidemic.
The main strategies and directions for the fight against tuberculosis in the world are:
"Together we will tackle the problem of tuberculosis by ending poverty";
"Together we can better diagnose, treat and heal";
"Together we will end stigma and discrimination"
"Together we will drive new research and innovation".
In May 2014, The World Health Assembly that is convened annually by WHO at the Palais des Nations in Geneva adopted a resolution that fully endorses the new Global Tuberculosis Strategy with its ambitious post-2015 End TB Strategy.
The strategy aims to end the global tuberculosis epidemic and has the goals of reducing deaths by 95% and reducing new cases by 90% between 2015 and 2035, and ensuring that no family spends catastrophic costs because of tuberculosis. Interim targets are set for 2020, 2025 and 2030.
Modern trends in the treatment of tuberculosis always resonate with the TB service of the republic. The approaches to the provision of medical care to patients with tuberculosis have been updated via the organizational and methodological support of the Ministry of Health of the Republic of Belarus. The main measures to combat tuberculosis in Belarus are aimed at strengthening the regulatory, organizational, methodological, information base of healthcare organizations providing anti-tuberculosis assistance to the population, introducing modern effective and economically justified technologies for combating tuberculosis into practice.
The situation with tuberculosis is under the control of the government of the Republic of Belarus and the Ministry of Health. A new State Program "Tuberculosis" for 2021-2026 has been developed and approved by the Council of Ministers of the Republic of Belarus. The program primarily provides for the solution of problems related to the prevention of the emergence and spread of resistant forms of tuberculosis.
Currently, new anti-tuberculosis drugs are widely used, new treatment regimens for patients with extensive drug resistance of the causative agent and new approaches to the diagnosis of tuberculosis in children have been introduced. Social support (food packages) at the outpatient stage of treatment was introduced at the expense of budget funding. New methods for diagnosing tuberculosis, which make it possible to obtain the results of a study for the presence of the disease within one day and diagnose a resistance model within a week, have been provided in each region of our country. Innovative technologies are used in the organization of treatment in order to create comfortable psychological and living conditions. Video controlled treatment of tuberculosis – taking anti-tuberculosis drugs with video recording on a mobile phone – has been introduced in the republic. Patients have the opportunity to lead their usual way of life via the smartphone, which is given free of charge, and specially created software. In addition, preparatory work to change the financing model for anti-tuberculosis measures and the possibility of reallocating funds in a way to provide the most comfortable conditions for the patient both at the inpatient stage of treatment and outpatient is underway.
Positive dynamics of the epidemic situation concerning tuberculosis has been recorded in the Republic of Belarus for about 10 years. The morbidity rates of the population, the mortality rate decreased, and the death rate from tuberculosis of the population of working age decreased as well. Thanks to the anti-epidemic measures, early diagnostics and the introduction of effective treatment methods, it was possible to achieve isolated cases of tuberculosis in children and completely eliminate deaths from tuberculosis among the child population.
It should be remembered that the basis for the prevention of tuberculosis among the population is made up of measures aimed at increasing the body's defenses: adherence to the correct regime of work and rest, rational, complete and timely nutrition, quitting smoking, using psychoactive substances and alcoholic beverages, rational physical activity and adherence to a healthy lifestyle.
The application of new strategies in the prevention, dissemination, diagnosis and treatment of tuberculosis will improve treatment results, the quality of patients’ life and help to achieve a positive socio-economic effect, which, in turn, will contribute to the successful implementation of the indicators of Subprogram 4 "Tuberculosis" of the State Program "People's Health and Demographic Security in the Republic of Belarus" for 2021-2025.
Close cooperation of the Ministry of Health of the Republic of Belarus with WHO and the Global Fund within the framework of the implementation of the current grant, as well as cooperation with other international organizations working in the field of tuberculosis control, contributes to the implementation of measures that have a positive effect on the quality of anti-tuberculosis care and the improvement of the epidemic situation with tuberculosis in the republic.
The leading institution that coordinates the fight against tuberculosis in the republic is the State Institution "Republican Scientific and Practical Center for Pulmonology and Phthisiology". The center develops new technologies and tests advanced international approaches to the diagnosis and treatment of tuberculosis. There is a daily tuberculosis hotline (toll-free number 88011001313). Information on the fight against tuberculosis, on the provision of free and paid services to the population, is presented on the center's website http://www.rnpcpf.by.
The only way to detect the disease in the early stages of its development is fluorographic (or X-ray) and bacteriological examination. Annual fluorographic examinations are a reliable and safe method for detecting pulmonary tuberculosis and other diseases of the chest organs, especially in the presence of factors that reduce the body's resistance.
Different people are susceptible to infection to varying degrees, but people with weakened immune systems are more likely to get sick.
To get infected with tuberculosis does not mean to get sick. The probability of contracting active tuberculosis in a healthy person who has received Koch's bacillus is about 5-10% during his life. The disease does not occur immediately: it can take from several days to several months from the moment of infection to the development of the disease. As a rule, the disease occurs in case of sufficiently long contact with a person that has an active form of tuberculosis and against the background of weak defenses of the body.
Weakening of the immune system is caused by:
- inadequate or inadequate nutrition;
- consumption of toxic products (smoking, alcohol, narcotics);
- concomitant diseases (tuberculosis is especially susceptible to HIV-infected, patients with gastric ulcer and ulcer, diabetes, prolonged use of hormonal medications, etc.);
- stress. It has been proven that stress and depression negatively affect the state of the immune system.
How can you protect yourself from getting TB?
First of all, the basis for the prevention of tuberculosis among the entire population is measures aimed at increasing the body's defenses: adherence to the correct work regime; rational and timely nutrition; quitting smoking, drugs, alcohol abuse; taking multivitamins in the spring; hardening, physical training; adherence to a healthy lifestyle and measures aimed at improving the living and working environment (reducing crowding and dustiness in premises, ventilation improving).
Specific prophylaxis of tuberculosis – vaccination with BCG vaccine of newborns and revaccination of uninfected children at the age of 7 and 14 among groups of children with an increased risk of the disease – is carried out in our country.
Sanitary prevention, which includes the whole range of measures aimed at preventing the transmission of tuberculosis infection from sick to healthy, is very important. Medical workers have developed a whole range of measures that must be followed by every patient with tuberculosis and by any person if such a patient is next to him. Above all, it is the observance of personal hygiene. If it is possible, the patient should have a separate room, bed, dishes and a towel. It is necessary to ventilate the room several times a day, carry out systematic wet cleaning and general cleaning with a soap-alkaline solution at least once a month. The patient should be trained to use spittoon bowls to collect sputum and then decontaminate them.
Social prevention of tuberculosis can be effective only if the number of socially maladjusted people decreases, while the living standards of all segments of the population increase.
Tuberculosis bacteria are very tenacious. As soon as the intake of anti-tuberculosis drugs is interrupted or the dose is reduced, mycobacteria restore not only their vital activity but also acquire the resistance, which makes further treatment costly and unpromising.
International experience convincingly shows that a successful fight against tuberculosis is possible only when all the forces of society are united.
Knowledge of the characteristics of tuberculosis transmission and manifestation is necessary for every person and every family since the timely adoption of measures can prevent not only the transmission of infection but also the development of the disease.
Valeologist of the 4th City Clinical Hospital named after M. Saŭčanka U. Čarnoŭ
The material was prepared on the basis of information from WHO and open sources