Tuberculosis in China

Key facts

  • Tuberculosis (TB) is an infectious disease that spreads through the air.
  • Only people who are sick with TB in their lungs (pulmonary TB) are infectious.
  • When infectious people cough, sneeze, talk or spit, they propel TB germs (bacilli), into the air.
  • One third of the world's population is currently infected with the TB bacillus, but only 5%-10% of people infected will become sick with the disease in their lifetime.
  • Tuberculosis mostly affects young adults in their most productive years.
  • The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant in the body for years.
  • When someone's immune system is weakened, the chances of becoming sick are greater.
  • Left untreated, each person with active TB disease will infect on average of between 10 and 15 people every year.
  • People with HIV are much more likely to develop TB after infection due to their weakened immune systems.

The situation

  • China has an estimated 1 million new cases of tuberculosis every year, more than any country except India.
  • In recent years, the Government has made great progress in TB control and prevention, resulting in a significant decline in the burden of TB.
  • TB prevalence: the estimated overall prevalence rate per 100,000 population fell from 215 in 1990, to 108 in 2010. The rate of decline was 2.2% per year between 1990 and 2000, and 4.7% per year between 2000 and 2010.
  • TB mortality: TB mortality in China has declined rapidly, at an average rate of 8.6% per year between 1990 and 2010.
  • TB incidence: TB incidence rate was estimated to have declined by 3.4% per year since 1990.

Multidrug-resistant TB

  • MDR-TB is a particularly dangerous form of drug-resistant TB. It is defined as when TB bacilli are resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
  • In China it is estimated there are 63,000 new multidrug-resistant tuberculosis (MDR-TB) cases among the 1 million notified new cases of TB every year. China contributes approximately one third of the world's MDR-TB.
  • Based on 2007-08 National Drug Resistant Survey, the rate of MDR-TB among new TB cases was 5.7%, and 25.6% among previously treated TB cases.
  • MDR-TB is treatable, but requires extensive chemotherapy (up to two years of treatment) with second-line anti-TB drugs.
  • Second-line drugs are more costly than first-line drugs, and can cause adverse reactions that are more severe, though manageable.

TB and HIV

  • WHO estimated that China had 13,000 HIV positive TB cases in 2011.
  • Among 911,884 notified TB patients in 2011, 23% were tested for HIV and 2.3% of tested TB patients were HIV positive.
  • The Ministry of Health issued the National Framework on TB/HIV Collaboration in 2005, and the National Implementation Protocol for TB/HIV Co-infection Control in 2010.

Key achievements on TB control

  • By 2004, the Ministry of Health had established a nationwide TB control network based on the China CDC system that successfully implemented the WHO-recommended DOTS strategy and standardized the diagnosis and treatment of TB.
  • In 2005, China achieved the global TB control target set by WHO – one of only a few countries to do so. Since 2005, the national TB control program has been diagnosing at least 80% of the highly infectious TB patients and successfully treating more than 90% of them.
  • In 2010, China achieved the TB control targets of the United Nation’s Millennium Development Goals, which is 5 years ahead of the target date set by the UN. This means, over the past 20 years, China has reduced the TB prevalence and mortality rates by half.

WHO's response

WHO's pursues six core functions in addressing TB.

  • Providing global leadership on matters critical to TB;
  • Developing evidence-based policies, strategies and standards for TB prevention, care and control, and monitoring their implementation;
  • Providing technical support to Member States, catalyzeingchange, and building sustainable capacity;
  • Monitoring the global TB situation, and measuring progress in TB care, control, and financing;
  • Shaping the TB research agenda and stimulating the production, translation and dissemination of valuable knowledge;
  • Facilitating and engage in partnerships for TB action.

The WHO’s Stop TB Strategy, which is recommended for implementation by all countries and partners, aims to dramatically reduce TB by public and private actions at national and local levels. The aim is to:

  • Pursue high-quality DOTS expansion and enhancement. DOTS is a five-point package to:
    • Secure political commitment, with adequate and sustained financing;
    • Ensure early case detection, and diagnosis through quality-assured bacteriology;
    • Provide standardized treatment with supervision and patient support;
    • Ensure effective drug supply and management;
    • Monitor and evaluate performance and impact.
  • Address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations;
  • Contribute to health system strengthening based on primary health care;
  • Engage all care providers;
  • Empower people with TB, and communities through partnership;
  • Enable and promote research.