Tuberculosis control in China

The China Food and Drug Administration approved Vaccae in June 2021 for use in individuals with latent tuberculosis infection (LTBI). Vaccae is a heat-killed Mycobacterium vaccae (a non-tuberculosis mycobacterium closely related to M. obuense). For China’s aging population, where reactivation-driven tuberculosis (TB) poses a significant challenge, this new TB vaccine offers a promising intervention for TB control. A targeted vaccination strategy focusing on older adults could serve as a cost-effective epidemic control measure. While mass vaccination could yield greater impact, its high costs remain a barrier. Reducing vaccine prices is crucial to ensure the economic viability of future vaccination programs.[1] See also: https://lintblab.weebly.com/publications.html

Multidrug-resistant (MDR) tuberculosis in China arises primarily from person-to-person transmission rather than failed hospital treatments. While China successfully met earlier global targets by halving tuberculosis prevalence and mortality between 1990 and 2015—largely due to shifting treatment from hospitals to Chinese CDC public health centers—the current outlook is less optimistic. Future reductions in tuberculosis incidence and mortality are expected to be slower, with the most optimistic projections estimating only an 18% reduction in incidence and a 28% reduction in mortality between 2015 and 2025. Achieving the 2025 targets will likely require more proactive measures, such as enhanced surveillance systems, although their full benefits remain uncertain.[2]

Meeting the ambitious global tuberculosis targets for 2035—a 90% reduction in incidence and a 95% reduction in mortality—appears even more challenging under current strategies. Innovations such as a new vaccine or prophylactic treatments for latent infections will likely be essential. Addressing MDR tuberculosis will also require improved treatment for drug-susceptible cases and strengthened diagnostic and treatment capabilities for MDR cases. A combination of these approaches could have the most significant impact, potentially reducing MDR tuberculosis prevalence by up to 75% within a decade starting in 2015.[2]

References:

1. Mao, J.J., Zang, X., Yue, W.L., Zhai, P.Y., Zhang, Q., Li, C.H., Zhuang, X., Liu, M. and Qin, G., 2023. Population-level health and economic impacts of introducing Vaccae vaccination in China: a modelling study. BMJ global health, 8(5), p.e012306.

2. Lin, H.H., Wang, L., Zhang, H., Ruan, Y., Chin, D.P. and Dye, C., 2015. Tuberculosis control in China: use of modelling to develop targets and policies. Bulletin of the World Health Organization, 93, pp.790-798.