A Modeling Study Recurrent Tuberculosis Towards End TB Strategy — China, 2025–2035

Tao Li^1,2,3,4; Xin Du²; Zhongwei Jia^4,5,6#; Yanlin Zhao^2,3#

¹ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.

² Chinese Center for Disease Control and Prevention, Beijing, China.

³ National Key Laboratory of Intelligent Tracking and Forecasting for infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.

⁴ Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.

⁵ Department of Global Health, School of Public Health, Peking University, Beijing, China.

⁶ Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China.

^# Corresponding authors: Zhongwei Jia, urchinjj@163.com; Yanlin Zhao, zhaoyl@chinacdc.cn.

The global challenge of TB recurrence after successful treatment persists, despite national TB programs primarily focusing on patient detection and management of treatment. These programs often overlook the need for follow-up and intervention post-treatment. Although the incidence of TB in China has been steadily declining, significant efforts are still required to achieve the END-TB targets. This study utilizes a transmission dynamic model to evaluate the impact of various control strategies on accelerating TB elimination in China. Under the current strategies, TB incidence rates in China are projected to decrease to 44.9 per 100,000 by 2030 and to 40.4 per 100,000 by 2035. Introducing post-recovery interventions to prevent recurrence, along with providing TB preventive treatment (TPT) to 30% of individuals with latent TB infection (LTBI) starting in 2025, and increasing LTBI TPT coverage to 90% beginning in 2031, will contribute to achieving the milestones of the End TB Strategy by 2030 and the 2035 target.

迈向“终结结核病战略”的结核病复发模型研究 — 中国，2025–2035年

李涛^1,2,3,4；杜昕²；贾忠伟^4,5,6#；赵雁林^2,3#;

1北京大学公共卫生学院流行病与卫生统计系，北京，中国；

2中国疾病预防控制中心，北京，中国；

3中国疾病预防控制中心传染病溯源预警与智能决策全国重点实验室项目，北京，中国；

4北京大学人工智能研究院智慧公众健康研究中心，北京，中国；

5北京大学公共卫生学院全球卫生系，北京，中国；

6北京大学健康医疗大数据国家研究院药物滥用防控中心，北京，中国。

#通讯作者：贾仲伟，urchinjj@163.com；赵雁林，zhaoyl@chinacdc.cn。

国家结核病规划主要侧重于患者发现和治疗管理，成功治疗后结核病复发的全球挑战持续存在。这些规划往往忽视了治疗后随访和干预的必要性。尽管中国的结核发病率一直在稳步下降，但仍需要做出重大努力来实现END-TB目标。本研究利用传播动态模型评估了各种防控策略对加快中国结核病消除的影响。根据目前的策略措施，到2030年，中国的结核发病率预计将降至44.9/10万，到2035年将降至40.4/10万。如果引入康复后干预措施以预防复发，加上从2025年开始为30%的结核病潜伏感染者提供结核预防性治疗，并且从2031年开始将潜伏感染预防性治疗的覆盖率提高到90%，将有助于到2030年和2035年分别实现“终结结核病战略”的里程碑和最终目标。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.189

Effectiveness of C-Reactive Protein as a Tuberculosis Screening Test Among HIV-Infected Individuals — Shanghai, China, 2021–2023

Lixin Rao¹; Zheyuan Wu¹; Jing Chen¹; Zhen Ning¹; Xin Shen^1#

1. Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China

^# Corresponding author: Xin Shen, shenxin@scdc.sh.cn.

The World Health Organization (WHO) has recommended the inclusion of the C-reactive protein (CRP) test in active tuberculosis (ATB) screening algorithms among human immunodeficiency virus (HIV)-infected individuals. The performance of the CRP test in African regions has been well-documented. This study analyzed data from a big data platform of Shanghai medical records together with infectious disease surveillance systems. We simulated a screening and plotted a receiver operating characteristic (ROC) curve comparing all participants and people living with HIV (PLHIV) which gives the optimal cut-off value of 11.115 mg/L, with sensitivity of 0.784 and specificity of 0.723 in PLHIV. We obtained a promising perspective on screening for tuberculosis in PLHIV using the CRP test in Shanghai. Our study offers an original standpoint for following research.

C-反应蛋白检测作为HIV感染者中结核筛查手段的效果评价 — 上海，中国，2021-2023年

饶立歆¹；吴哲渊¹；陈静¹；宁镇¹；沈鑫^1#

1.上海市疾病预防控制中心，上海，中国

#通讯作者：沈鑫，shenxin@scdc.sh.cn。

世界卫生组织（WHO）推荐将C-反应蛋白（CRP）检测纳入针对HIV感染人群的活动性肺结核筛查策略。CRP筛查结核病的效果已在非洲地区人群中获得充分验证。本研究利用上海市医疗卫生大数据平台和疾病监测数据，抽取并分析结核病患者、HIV感染者与TB/HIV双感患者治疗前CRP检查结果与结核发病的关系，模拟筛查的受试者工作特征（ROC）曲线并计算曲线下面积（AUC），得出在HIV感染者中利用CRP检测筛查活动性结核的效果优于一般人群，筛查最佳阈值为11.115mg/L，灵敏度为0.784，特异度为0.723。本研究结果将为后续研究提供基础。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.190

Evaluation of Latent Tuberculosis Infection Using the ESAT6-CFP10 Skin Test Among International Freshmen With Diverse Skin Tones at a University — Nanjing City, Jiangsu Province, China, September 2023

Peng Lu^1,2*, Rong Wang^3*, Jingjing Xu², Jianming Wang², Fangfang Du⁴, Guozhi Wang⁵, Shiming Cheng^4#, Limei Zhu^1#

1. Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing City, Jiangsu Province, China

2. Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, China

3. Nanjing City Center for Disease Control and Prevention, Nanjing City, Jiangsu Province, China

4. Chinese Antituberculosis Association, Beijing, China

5. National Institutes for Food and Drug Control, Beijing, China

*Joint first authors.

^#Corresponding author: Limei Zhu, lilyam0921@163.com; Shiming Cheng, smcheng@163.com.

Newer skin tests, including the ESAT6-CFP10 (EC) skin test, were recommended for diagnosing Mycobacterium tuberculosis (M. tb) infection. However, no data exist assessing the diagnostic performance of the EC skin test among foreign students with different skin tones. A cohort study at Nanjing Medical University screened incoming foreign freshmen. The EC skin test was used to assess for M. tb infection, and results were read at 24, 48, 72, and 96-hours post-administration. Among 96 participants, M. tb infection rates at 24, 48, 72, and 96-hours post-injection were 3.13%, 7.29%, 13.54%, and 9.38%, respectively. While infection rates were lower among individuals with darker skin tones, the difference was not statistically significant (P=0.186), and variations were consistent across different measurement times. Trajectory analysis revealed 5.3% in the continuous-increasing group, 86.5% in the low-stable group, and 5.2% in the elevated-decreasing group. Notably, participants in the elevated-decreasing group had lighter skin tones, with trajectory patterns consistent across different skin colors. The EC skin test is safe, and redness diameter is a more reliable indicator than induration. Results should be collected within 48 to 72 hours, with verification at 72 hours crucial if initial results are negative. Importantly, skin color does not affect EC skin test outcomes.

EC融合抗原在外籍留学生中诊断结核潜伏感染的应用价值研究 — 中国江苏省南京市，2023年9月

卢鹏^1,2*；王荣^3*；许晶晶²；王建明²；杜芳芳⁴；王国志⁵；成诗明^4#；竺丽梅^1#

¹江苏省疾病预防控制中心慢性传染病防制所，南京市，江苏省，中国；

²南京医科大学公共卫生学院，南京市，江苏省，中国；

³南京市疾病预防控制中心，南京市，江苏省，中国；

⁴中国防痨协会，北京，中国；

⁵国家食品药品监督管理局，北京，中国。

*共同第一作者。

#通讯作者：竺丽梅，lilyam0921@163.com；成诗明，smcheng@163.com。

ESAT6-CFP10 (EC) 皮肤测试是一种新型的皮肤试验，已被世界卫生组织推荐用于诊断结核分枝杆菌潜伏感染。然而，目前尚无关于该皮肤试验在不同肤色的外籍人群中的诊断价值研究。本研究是在南京医科大学进行，研究对象为参加南京医科大学新生入学筛查的外籍学生。通过EC皮肤试验评估外籍新生结核潜伏感染情况。分别在注射后24、48、72和96小时测量EC皮肤试验反应的硬结和红晕直径。研究共纳入96名外籍新生。注射后24、48、72和96小时的结核分枝杆菌感染率分别为3.13%、7.29%、13.54%和9.38%。与肤色较浅的外籍学生相比，深色皮肤外籍学生的感染率较低，但差异并无统计学意义（P=0.186）。轨迹分析显示，5.3%的参与者属于持续上升组，86.5%属于低稳定组，5.2%属于先升高后下降组。值得注意的是，先升高后下降组的外籍新生多肤色较浅，且不同肤色间EC反应的轨迹趋势一致。在外籍人群结核潜伏感染筛查中，EC皮肤试验是安全的，EC反应的红晕直径大于硬结直径。应在EC注射后48至72小时查看EC反应结果，尤其是在48小时结果为阴性时，应在72小时进行复看结果。同时，肤色不会影响EC皮肤试验的结果。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.191

The Implications of Artificial Intelligence on Infection Prevention and Control: Current Progress and Future Perspectives

Lin Yang¹, Shuya Lu¹, Lei Zhou^2#

1. School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China;

2. Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Lei Zhou, zhoulei@chinacdc.cn.

Artificial intelligence (AI) has significantly impacted infection prevention and control, particularly during the COVID-19 pandemic. AI techniques have enhanced disease surveillance, outbreak prediction, contact tracing, diagnosis, treatment, and pandemic response. Notable applications include the BlueDot AI system for forecasting infectious diseases, Bluetooth technology for contact tracing, AI-powered image analysis for diagnosing COVID-19 and other diseases, and the AlphaFold algorithm for decoding protein structures. AI has also been utilized for epidemic forecasting, resource management, and disseminating reliable information. However, the growing application of AI raises ethical and safety concerns related to data privacy, bias, equity, and the spread of misinformation. Addressing these challenges requires international collaboration, strict regulations, ethical oversight, and improved public information literacy to maximize the benefits of AI while mitigating associated risks.

人工智能在传染病防控中的应用：当前进展和未来展望

杨琳¹；卢姝亚¹；周蕾^2#

1. 香港理工大学护理学院，香港特别行政区，中国；

2. 中国疾病预防控制中心，北京，中国。

#通讯作者：周蕾, zhoulei@chinacdc.cn。

人工智能（AI）对传染病防控尤其在新冠大流行期间产生了重大影响。人工智能技术提升了疾病监测、暴发预测、密接追踪、疾病诊断、临床治疗以及大流行应对等方面的能力，一些新兴技术和应用软件也应运而生，如用于疫情预测的BlueDot人工智能系统、用于密接追踪的蓝牙技术、用于新冠等疾病诊断的人工智能图像分析系统、以及用于解码蛋白质结构的AlphaFold算法等。人工智能还被用于疫情预测、资源管理和信息传播。然而，人工智能应用的日益增长同时引发了人们对数据隐私、信息偏倚、公平性和信息误传等相关的道德和安全问题的担忧。应对这些挑战，需要从国际合作、严格监管、道德监督以及提高公共信息素养等方面着手，以最大限度地发挥人工智能的优势，同时降低相关风险。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.192