Vietnam is the first country in the world to routinely use an innovative method to diagnose tuberculosis (TB) using stool. The Simple One-Step Stool Method, developed by KNCV Tuberculosis Foundation, is implemented in 10 healthcare facilities across the country. ,,This simple and painless test is an important development for diagnosing TB in children under the age of five and people living with HIV. This can save many lives and reduce suffering”, says Prof. Dr. Nguyen Viet Nhung, Director of the National Lung Hospital and Head of the Vietnam National Tuberculosis Control Program (NTP).
In Vietnam 170,000 people get ill and 11,400 people die of TB every year, according to WHO estimates. Although all new born babies are vaccinated against TB, some of them still acquire TB. And even though TB is a curable disease, still many adults and children lose their lives.
,,The early diagnosis of child tuberculosis for treatment only accounts for 10% of the total cases of child tuberculosis”, says Prof. Dr. Nguyen Viet Nhung. “Child tuberculosis is a difficult disease. Its symptoms are hard to find especially with the under 5-year-old children and acquiring a diagnosis faces many difficulties.”
To raise the number of children being diagnosed and treated in time, the NTP decided to start an implementation pilot – financed by the Global Fund – with the KNCV Simple One-Step (SOS) Stool Method. This turned out to be very successful and made the NTP decide to continue working with the SOS Stool Method routinely.
The WHO has very recently recommended the use of stool as a primary sample for TB diagnoses in children. The Pediatric TB Operational Sustainability Expertise Exchange (POSEE) Taskforce also describes the benefits of using stool to diagnose TB. As the SOS Stool Method is published in the peer reviewed Journal of Clinical Microbiology, many other countries are expected to follow Vietnams example and use this method.
SOS Stool Method: Painless and simple diagnosis
Worldwide, sputum from the lungs is currently mainly used as a sample to diagnose TB. However, it can be very difficult for many people living with HIV and children to cough up sputum. For very young children it is completely impossible on command. For that reason, an invasive and painful procedure is necessary – for example a tube passed through the child’s nose to the stomach – to collect a sputum sample.
“These invasive methods are often traumatizing for the children, parents and healthcare workers. Materials for these procedures are not available everywhere and sometimes it is only done when the child is already very ill. This results in many children worldwide not being diagnosed or being diagnosed too late”, explains Mustapha Gidado, executive director of KNCV Tuberculosis Foundation (KNCV). “This is one of the main reasons why 170.000 children die of TB every year. Unnecessary, because with a timely diagnosis and good treatment, TB can be cured.”
A stool sample is painless and easy to obtain from children. KNCV laboratory experts dove into the matter and developed the SOS Stool Method, that was first presented during the Union World Conference in 2018. Extended research – such as head-to-head comparisons with other stool processing methods (FIND and TB Speed study) and the cost effectiveness of the SOS Stool Method (SOS-TBIM study) – have since be done. The results and scientific publications will follow this fall 2021, as well as presentations at the Union World Conference 2021.
Training and implementation
KNCV Tuberculosis Foundation provides online training courses for laboratory staff, so that all countries can start using this method for diagnosing TB in children and people living with HIV. Vietnam sets an example of how this can be done successfully on all levels.
Dr. Nguyen Thien Huong, KNCV Country Representative in Vietnam: “The same machine that is used to examine sputum – the GeneXpert – is used in the SOS Stool Method and no other materials are needed. In Vietnam, the GeneXpert systems are equipped nationwide from central to provincial and district levels. To train staff on how to use it for stool samples is a small step. While the difference for the lives of the affected children and people living with HIV, their families and the communities is immense.”
SOS Stool Method: no more suffering for baby Dang
Vietnamese Thao, mother of the baby boy Dang (pictured above), knows from her own experience how big the difference between the painful sputum method and the painless KNCV SOS Stool Method is. Her son was only three months old, when he underwent both procedures. “In the first hospital where he was tested, they only used the sputum test. Witnessing how the doctors collected sputum from him was really painful. They had to push a tube through his mouth to his stomach.” They tested the boy three times, but all results were negative. Eventually he was referred to the National Lung Hospital, where a sputum and stool test were done. Both tests turned out positive for TB. It made Thao and her husband cry to hear the diagnosis, but their boy is now under treatment and recovering well. Thao: The SOS Stool Method made my son’s diagnosis and treatment much more accurate and easier. Read the full story of baby boy Dang here.