Vietnam Faces Challenges in TB Control Due to Undetected Latent Infections

As the world strives to eradicate tuberculosis by 2030, a significant challenge in Vietnam and many other countries lies in the overlooked latent tuberculosis infections, where individuals carry the bacteria without symptoms. This oversight delays early detection and treatment, contributing to community spread. At the "Media and Policy Forum on Diagnostics," held as part of the APAC-IRIDS 2026 International Conference on Infectious Diseases in Thailand, experts highlighted tuberculosis as one of the world's greatest public health challenges. In 2024, approximately 10.7 million new TB cases were recorded globally, with the Asia-Pacific region bearing 6.6 million cases, or 61% of the global burden. An estimated 1.1 million people died, and 2.4 million cases went undiagnosed or unreported. Dr. Rugaiya W. Calapis from the Department of Health, Philippines, noted that the primary challenge is not a lack of treatment drugs but the late detection of patients. Many individuals visit multiple healthcare facilities for repeated examinations before a diagnosis is made, during which time they continue to infect family and community members. The use of outdated testing methods also leads to missed cases of drug-resistant TB, underscoring the need for expanded molecular testing and rapid diagnostic techniques. Furthermore, a significant gap in current TB control programs is their focus on detecting active disease, while an estimated one-quarter of the global population harbors latent TB bacteria. Dr. Razia Kaniz Fatima of the International Union Against Tuberculosis and Lung Disease stated that this "reactive" approach intervenes only when symptoms like prolonged cough, fever, or weight loss appear. To meet the 2030 eradication goal, a shift from control to prevention is crucial. Dr. Razia recommended expanding screening and preventive treatment for high-risk groups, including household contacts of TB patients, children under five, individuals with HIV, the immunocompromised, or those with diabetes. Early detection allows for preventive therapy before the disease progresses to active TB. Professor Erlina Burhan from the University of Indonesia explained that many individuals with latent TB remain perfectly healthy, asymptomatic, and have normal chest X-rays, unaware of their infection. A major deficit in TB strategy is the low rate of preventive treatment in high-burden countries due to the inability to identify infected individuals. She emphasized that the health sector must invest adequately in detecting both active and latent TB to achieve elimination goals. Beyond technical factors, living conditions significantly impact TB transmission. Poverty, malnutrition, crowded housing, poor ventilation, and smoking are cited as factors that sustain the spread, with healthcare addressing only part of the problem. Climate change also poses new challenges; for instance, floods in Pakistan have disrupted patient access to healthcare, necessitating mobile testing units. Dr. Sergio Carmona, Chief Medical Officer for Infectious Diseases at Roche and former WHO and FIND expert, advocated for a transition from disease-specific diagnostic models to integrated approaches. Patients presenting for care should be screened simultaneously for TB, HIV, Hepatitis C, or diabetes during a single healthcare encounter, enabling earlier detection and reducing missed cases. Experts believe new technologies like molecular biological tests, IGRA blood tests, AI-assisted chest X-ray reading, and integrated multi-disease testing models can significantly shorten diagnostic times. However, widespread implementation faces substantial hurdles related to resources, infrastructure, and human capital.