Break the Chain of Transmission to End TB
For World TB Day 2024, respiratory groups call for comprehensive TB screening in high-burden settings
March 21, 2024
GLENVIEW, IL - On World TB Day, March 24, 2024, the
Forum of International Respiratory Societies
(FIRS), of which the
American College of Chest Physicians
(CHEST) is a founding member, calls on all stakeholders, including
multilateral agencies, governments, national and local programs,
nongovernmental organizations, academics, activists and donors, to focus
on activities that will break the chain of transmission in high-burden
settings in order to end TB.
In high-burden settings, TB is endemic, meaning everyone is at risk, all
the time, through the unbroken chain of transmission. To break the
chain, it is critical that we screen everyone in high-burden settings
for TB so that we can find and treat all people with TB and prevent them
from infecting others. The latest evidence shows that in high-burden
settings, most people with infectious TB do not have symptoms (such as
cough or fever), and many are not members of high-risk groups. Hence, it
is vital that screening for TB is not limited to those with symptoms or
those who are members of high-risk groups.
During the height of the COVID-19 pandemic, before the availability of
vaccines, this approach of widespread testing was rolled out by
governments across the globe and proved to be highly effective in
controlling the spread of COVID-19.
Professor Guy Marks, President and Interim Executive Director of the
International Union Against Tuberculosis and Lung Disease
(The
Union), a member of FIRS, says, “We must be brave and recognize that
the current strategy to end TB in high-burden countries is not achieving
the results we hoped for. We need to change our approach if we are to
win the fight against this infectious disease.”
Professor Marks explains, “The incidence of TB in high-burden countries
is falling at a glacially slow pace. The simple reason for this is that
far too many people with TB remain undiagnosed and untreated, often
because they do not experience or recognise symptoms that lead to a
diagnosis. These people are infectious and can transmit the infection to
others in their households, workplaces and communities. So, the
transmission continues: More people are infected, and many of them
develop TB.”
It was the same with COVID-19, another airborne infection, where much of
the spread in the community occurred from people with infectious
COVID-19 who did not have symptoms.
Professor Marks adds, “The latest evidence suggests that in high-burden
settings, most people with TB have been recently infected (within the
last 2 years). This means that reducing the rate of new infections (or
reinfections) with TB can have a big impact on preventing people from
becoming sick with TB, and hence, breaking the chain of transmission and
ending TB.”
The standard approach to controlling TB has been to wait for people to
seek care, be correctly diagnosed and take medication. However, we now
know that many people with infectious TB do not have symptoms and, as a
result, do not visit health care facilities seeking care.
Additionally, those who do seek care often encounter hurdles in terms of
accessing diagnosis and treatment due to TB not being appropriately
prioritized by health care systems.
Professor Marks concludes, “These strategic and operational
modifications will not achieve an end to TB in isolation. They must be
accompanied by a change in public mindset and behavior toward TB.”
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global leader
in the prevention, diagnosis and treatment of chest diseases. Its
mission is to champion advanced clinical practice, education,
communication and research in chest medicine. It serves as an essential
connection to clinical knowledge and resources for its 22,000+ members
from around the world who provide patient care in pulmonary, critical
care and sleep medicine. For information about the American College of
Chest Physicians, and its flagship journal CHEST®,
visit chestnet.org.
About the Forum of International Respiratory Societies
The Forum of International Respiratory Societies
(FIRS) is an organization comprised of the world's leading international
respiratory societies working together to improve lung health
globally. The goal of FIRS is to unify and enhance efforts to improve
lung health through the combined work of its more than 70,000 members
globally.
FIRS comprises the American College of Chest Physicians (CHEST),
American Thoracic Society (ATS), the Asian Pacific Society of
Respirology (APSR), Asociación Latinoamericana de Tórax (ALAT), European
Respiratory Society (ERS), International Union Against Tuberculosis and
Lung Disease (The Union), Pan African Thoracic Society (PATS), the
Global Initiative for Asthma (GINA) and the Global Initiative for
Chronic Obstructive Lung Disease (GOLD).