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Video: A Completely Prosperous Person Can Also Get Sick With Tuberculosis
A completely prosperous person can also get sick with tuberculosis
This week is World Tuberculosis Day. The chief phthisiatrician of the Ministry of Health of the Russian Federation, director of the Research Institute of Phthisiopulmonology at the I. M. I. M. Sechenova, professor Irina Vasilyeva.
World Tuberculosis Day is celebrated on 24 March. The chief freelance specialist of the phthisiatrician of the Ministry of Health of the Russian Federation, director of the Research Institute of Phthisiopulmonology of the First Moscow State Medical University named after M. V. I. M. Sechenova, professor Irina Vasilyeva.
Irina Anatolyevna, many believe that tuberculosis is the lot of socially disadvantaged people, and this will never affect them. Who is the average TB patient? Can you paint a portrait of him?
- This is a completely wrong idea, a completely safe person, even with good immunity, can get sick with tuberculosis, if he met at an unfavorable moment in his life with an infectious patient. If we talk about a portrait, then most often it is a young man of 24-35 years old who leads an active lifestyle, and at the same time, possibly, overwork. He has the means to eat well, but he has no time for that. That is, he sleeps little and eats irregularly, plus stress at work. Also, of course, there must be an encounter with an infection that could have happened anytime, even 10 years ago. But this infection wakes up in the body when a person's immunity falls. For any reason: illness, overwork, stress.
But, of course, socially disadvantaged people are at risk. Their immunity is weakened by poor living conditions, alcoholism, drug addiction. The incidence of diseases in prisons is always higher - due to the deterioration of conditions, living in a common cell, overcrowding. Moreover, we are not talking about infection, but about the development of a disease that did not manifest itself under normal conditions. Infectious prisoners do not end up in shared cells - fluorographic examinations are mandatory at the entrance, and if tuberculosis is detected, the person is treated in the prison hospital.
What other risk groups are there?
- In the development of tuberculosis, not only social and behavioral factors, but also medical factors play a role. So, patients with diabetes mellitus, according to the WHO, get sick with tuberculosis 4-5 times more often. The likelihood of getting sick is increased in people with chronic diseases of the lungs, gastrointestinal tract, as well as in patients who receive drugs that suppress immunity. Such drugs are used in the treatment of cancer, rheumatological diseases, after transplantation.
The high-risk group includes people with HIV infection who do not have immune defenses. When a person with an infectious form of tuberculosis meets an HIV-infected person, they pick up Koch's bacillus, and this very quickly develops into a disease, which would not have happened in a person with good solid immunity. If the infection with tuberculosis occurred earlier than the infection with HIV, then the tuberculosis bacterium wakes up, provoking the disease. According to statistics, the likelihood of developing tuberculosis with HIV infection increases 30-40 times. And although in recent years, the total number of patients with tuberculosis in Russia has been decreasing, the proportion of such patients with HIV is growing.
And how does a meeting with an infection generally take place? Is it possible to get infected with tuberculosis in transport and other public places?
- It can happen anywhere - in transport, in supermarkets. It is not even necessary to meet directly with an infectious patient, it is enough just to inhale the air in which droplets of his sputum remain. This often happens in confined spaces with a lot of crowded people. But this does not mean that a healthy person with a normal immune system who has caught the infection will certainly get sick. In 9 cases out of 10, immunity works, but people whose bodies are weakened by something fall into the remaining 10%. Tuberculosis can be contracted at any age, and most often it occurs in youth. But the infection can dormant in the human body while it is calm and stable, and protected by the immune system, and wakes up when a failure occurs.
All sorts of social upheavals also contribute to the development of the disease - this affects the emotional background, and as a result, the body's defenses.
Is this what happened in our country after the collapse of the Soviet Union?
- In the 90s, the unstable situation in the country, disorder, migration processes seriously influenced the growth of morbidity. The growth of tuberculosis associated with social and economic upheavals in our country was noted in the late 90s - early 2000s. The fact is that tuberculosis is a disease that develops slowly and slowly recedes. According to statistics, the peak incidence was in 2002, and the peak in mortality was in 2005. That is, the development of the tuberculosis epidemic lasted 10 years, and now there is a gradual decline, but the echoes of that period are still felt.
The increase in morbidity after the collapse of the Soviet Union was also associated with the loss of control over tuberculosis. Our anti-tuberculosis service was destabilized and destroyed, and there were problems with its financing. Tuberculosis is an infection that must be tightly controlled, otherwise the incidence immediately rises.
Has this control been restored now?
- Yes. And thanks to this, morbidity and mortality rates are decreasing in Russia, this has become especially pronounced in the last 3-4 years. As of today, we have preliminary data for 2016: the incidence rate was 53.3 cases per 100 thousand of the population, and the mortality rate was 7.8 per 100 thousand. That is, over the past year, mortality has decreased by 15%, and morbidity - by 7.7%. This is a very good trend; there have not been any examples of mortality reduction at such a high rate in history.
But Russia still remains on the list of countries with a high burden of tuberculosis formed by the World Health Organization - this is due to the absolute number of patients in our country. We have not yet reached the level of European countries, but WHO drew attention to the significant changes that have occurred in our country, and even suggests making the experience of Russia in the fight against tuberculosis an example for other countries. This year in Moscow, at the initiative of the Ministry of Health of the Russian Federation, supported by the World Health Organization and personally by WHO Director General Margaret Chen, the first in the world history global ministerial conference on the problem of tuberculosis will be held, consisting of ministerial delegations of 194 WHO member countries and 40 countries with high burden of tuberculosis, and Russia will act on it as the leader of the world movement for the elimination of tuberculosis.
What kind of experience can Russia share and with whom?
- First of all, Russia can share with countries with a high burden of tuberculosis its system of dispensary observation and early active detection of the disease. And now WHO recommends other countries, following our example, to actively search for patients. There is no such practice in any country in the world, there is only passive identification. That is, when a patient, worried about some symptoms, turns to the doctor, and during the examination he has tuberculosis. To detect tuberculosis, the Russian phthisiatric service conducts screening examinations of the healthy population. And this is the most reliable prevention of tuberculosis.
In adults, this is a fluorographic study that allows you to identify the disease at an early stage, when it has not managed to cause significant damage to the body, and is also not contagious, and the person does not pose a danger to others. In children, screenings are carried out using skin tests, which can reveal the fact of infection. This is necessary in order to catch the moment when the child has already come into contact with mycobacterium tuberculosis, and to take the necessary preventive measures, as well as to select children for in-depth diagnostics to identify the developed disease in its initial stage.
In recent years, Russia has developed and implemented new algorithms for the diagnosis and treatment of tuberculosis with an emphasis on a personalized approach to the most problematic drug-resistant forms of tuberculosis, which is not in the clinical guidelines of other countries. Russia is also famous for its actively developing phthisiology science and innovations; domestic diagnostic developments have been introduced into practice and are successfully applied, which are of interest to foreign colleagues.
In addition, WHO drew attention to the entire Russian system of control and dispensary observation. A person is observed by a phthisiatrician not only while he is sick, but also for some time after recovery, he undergoes preventive treatment courses. And, of course, vaccination. Many Western countries have already given up vaccination, and this is justified because they have a low incidence. But in countries with a high incidence, vaccination is very important - BCG vaccination does not completely protect against tuberculosis, but prevents the development of severe, fatal forms in children.
Why are these vaccinations not given to adults?
- Because adults, in general, already have a latent tuberculosis infection, that is, they are infected with mycobacterium tuberculosis. And in these cases, it is no longer possible to get vaccinated. We used to have a three-step vaccination: at birth, at 7, at 14 and at 21. First, the last revaccination was canceled, because by 20-21 all people are already infected, and there is no one to vaccinate. Now revaccination has already been canceled at the age of 14. But for an adult, there is little point in vaccination, since there is no such vaccine that would completely protect against tuberculosis.