TBC 037: Challenges in Achieving Global Tuberculosis Targets

1. Vaccination Strategies for Tuberculosis Control

• Key Points: The China Food and Drug Administration approved Vaccae in 2021 for latent tuberculosis infection (LTBI).Vaccae, a heat-killed Mycobacterium vaccae, shows promise for TB control in aging populations where reactivation-driven TB is a challenge.Targeted vaccination for older adults offers a cost-effective control measure compared to mass vaccination.High vaccine costs remain a barrier to large-scale implementation.
• Feasible Suggestion: Subsidize vaccine production and distribution to reduce costs and improve accessibility, particularly for high-risk groups like the elderly. See also: Lin TB Lab

2. Challenges in Achieving Global Tuberculosis Targets

• Key Points: While China halved TB prevalence and mortality between 1990 and 2015, current progress is slower.Multidrug-resistant (MDR) TB in China is driven by person-to-person transmission rather than failed treatments.Meeting the 2025 and 2035 TB targets requires innovations such as new vaccines and enhanced surveillance.A combination of improved diagnostics, treatment strategies, and MDR TB management could significantly reduce prevalence.
• Feasible Suggestion: Establish nationwide digital TB surveillance systems to improve case tracking and response efficiency.

3. Impact of Diabetes Mellitus on Tuberculosis Progression

• Key Points: Type 2 diabetes mellitus (T2DM) increases susceptibility to TB and worsens outcomes, including higher MDR-TB risk.T2DM-induced immune dysregulation involves chronic inflammation, altered cytokine profiles, and oxidative stress.Poor glycemic control exacerbates TB progression and treatment challenges.Emerging therapies like metformin show potential in improving immune responses and TB outcomes.
• Feasible Suggestion: Integrate TB-DM management into primary care by screening TB patients for diabetes and ensuring optimized glycemic control.

4. Hypertension and Tuberculosis: An Overlooked Risk

• Key Points: Hypertension prevalence is higher in individuals with latent TB infection (TBI).TBI and HIV co-infection further elevate hypertension prevalence and cardiovascular risks.Hypertensive TB patients face higher mortality risks, especially during the first 9 months of treatment.Non-dihydropyridine calcium channel blockers (non-DHP-CCBs) improve TB treatment outcomes in hypertensive patients.
• Feasible Suggestion: Implement routine hypertension screening and management for TB patients to reduce mortality and improve outcomes.

5. Innovations and Biomarker Insights for TB Management

• Key Points: Specific biomarkers, including cytokine levels and chemokine profiles, aid in TB diagnosis and monitoring in T2DM patients.Unique immune profiles in TB-DM and TB-HIV patients highlight the need for tailored treatment strategies.Novel drugs like bedaquiline, enhanced by adjunctive therapies like verapamil, show promise in reducing bacillary load.High antigen-nil (Ag-NIL) values correlate with increased hypertension in TBI, suggesting potential biomarkers for risk stratification.
• Feasible Suggestion: Develop multiplex biomarker panels for integrated TB diagnostics, enabling simultaneous evaluation of infection, inflammation, and comorbidities.

References:

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