CHILDHOOD
TUBERCULOSIS IN CHINA
Jiang Zaifang
Beijing Children¡¯s
Hospital, Beijing, China
Before
1950, tuberculosis was the most prevalent infectious disease and the
leading killer in China. Tuberculosis morbidity in Beijing was 5000/100,000
and the mortality rate was 230/10,000. Since 1950¡¯s, BCG vaccination has
been started and antituberculosis chemotherapy has been initiated. Although
tuberculosis has declined since 1960¡¯s, it still represents one of the
major health problems. So up to now, China is still among the high TB
prevalence countries, characterized by high morbidity (523/100,000), high
mortality (20.9/100,000) and low annual decrease rate (2.8%).
Childhood
tuberculosis has declined ever since 1960¡¯s. The TB infection rate in
children (0-14 years) was 8.8% in 1979 and 7.5% in 1990. The prevalence of
pulmonary TB (1/100,000) in age group 0-14 years was 241.65 in 1979 and
172.1 in 1990. The incidence of TB meningitis in 0-14 years children was
1.4/100,000 in 1989 and 0.4/100,000 in 1997. In Beijing the BCG coverage
rate in children reached 86% in 1955 and remained above 95% in recent 3
decades. In 0-14 years children the TB morbidity had decreased from
68/100,000 in 1974 to 2/100,000 in 1997. The peak of TB mortality in 0-4
years children disappeared: 296/100,000 in 1949 and almost no death in 1990¡¯s.
Beijing¡¯s experience proved the practical effect of BCG vaccination on
infant life-threatening TB and TB mortality.
DOTS was
first initiated in Beijing in 1979 and was spread to the whole country
since 1990. China initiated two TB control programs in 1991 and 1993. They
covered population of 0.9 billion and DOTS was implemented. Case detection
and treatment have all remarkably improved since. In 1998 the cure rate of
new smear positive TB cases was 96.3%.
Our DOTS
program for childhood TB: 1), pulmonary TB, usually INH+RFP 6m; in severe
cases: SM (or PZA) + INH +RFP 2m, then INH+RFP 4-6m. 2), Miliary TB and TBM:
SM +INH+RFP+PZA 3m, then HR 3-6m and H 3m.