Infectious Disease Screening

Infectious disease screening is neither a "universal disease prevention item that must be done for annual physical examinations" nor a "shaming examination that only high-risk groups need to do." Its core value is a precise prevention and control method for specific exposure risks and specific scenarios - low-risk groups do not need excessive screening to add unnecessary psychological and economic burdens, and people who meet high-risk indications are screened regularly according to regulations. It is currently the most cost-effective early diagnosis and early treatment plan for infectious diseases.

Last week, I met a 22-year-old young man in the infectious disease clinic. He had just made a new relationship, and asked him to get a full set of tests for hepatitis B, hepatitis C, AIDS, and syphilis, as well as a tuberculosis T-SPOT. The question he asked was, "The Internet says there are more people infected now. "Don't worry." It turned out that neither of them had any high-risk behavior. In the end, I only prescribed two and a half doses of hepatitis B. It was found that one of them had insufficient antibody titer. I just gave him a shot of the vaccine and that was it. Not only did I save a thousand check-up fees, but I also didn't need to worry about that unnecessary worry.

Nowadays, everyone’s understanding of infectious disease screening has indeed gone to two extremes. Friends who work in public health often complain that free HIV screening stalls are set up in the community. After sitting there all afternoon, few people came and asked, “I didn’t do anything random. People thought there was something wrong with me when I checked this.””； On the other hand, I meet several people in the outpatient clinic every week. Even a roommate who shares a flat with a cold has to come to check for tuberculosis. If there is no high-risk behavior, he will be prescribed a full package. The euphemistically called "taking responsibility for oneself".

There are several types of screening that are not controversial, such as the "four pre-operative items" (hepatitis B, hepatitis C, AIDS, and syphilis) before surgery, blood transfusion, and blood donation, as well as screening for Toxoplasma gondii, hepatitis B, syphilis, and AIDS during pregnancy, as well as screening for specific infectious diseases required for entry and exit. These are all clearly regulated and required. Just do what you need to do, and there is nothing to discuss.

As for the people who are proactively screened, there are actually very clear indications: those who have engaged in high-risk behaviors such as unprotected unsafe sex, sharing needles, and occupational exposure are recommended to be screened regularly during the window period regardless of whether they have symptoms or not.； If you have close contacts with hepatitis B, hepatitis C, or open tuberculosis patients at home, it is also necessary to conduct corresponding screening every year. ； There are also occupations such as medical care, disease control, and nursing home staff who often come into contact with susceptible people. It is also the industry's default norm to include relevant items in routine physical examinations.

The most controversial issue now is "should ordinary people's physical examinations include routine screening for infectious diseases?" Many clinical experts suggest that HIV and syphilis should be included in routine physical examination packages. After all, the proportion of sexual transmission of these two diseases now exceeds 90%. Many people have been infected for several years without symptoms. By the time they are discovered, they have already combined with immune damage. The treatment is expensive and harmful to the body. Moreover, the two items combined only cost a few dozen yuan, which is extremely cost-effective.； However, there are also many public health experts who object. They feel that although the probability of false positive screening for low-risk groups is only a few thousandths, once it is encountered, the follow-up review and psychological pressure will be very great. There have been real cases before where a young man was found to be falsely positive for HIV and his marriage almost ended. Both statements are reasonable. In fact, there is no need to argue about right or wrong. If you have had uncertain exposure experiences, it is perfectly fine to add a project for peace of mind. If your life circle is very stable and there are no high-risk behaviors, there is really no need to add it specially.

What impressed me deeply was a 42-year-old patient I met last year. His brother’s physical examination showed hepatitis B positive. He thought that the two brothers had shared a fever-reducing needle when he was a child, so he stopped by to check. The result was also hepatitis B minor positive. The transaminase had risen to three times the normal level. He might have progressed to cirrhosis in two or three years. After taking antiviral drugs in time, he was now under good control. He said that he had never thought of checking for this before. He always felt that hepatitis B was far away from him. This is the meaning of screening.

Of course, there is really no need to over-screen. Last month, after a girl kissed her boyfriend, she posted on the Internet that hepatitis B could be transmitted through saliva. She was so frightened that she checked for hepatitis B twice in a row. In fact, her own antibody titer was sufficient and she would not be infected at all. The test cost several hundred, and she was so anxious that she didn't sleep well for half a month. It was simply not worth the gain.

In fact, to put it bluntly, infectious disease screening is essentially a health tool. It is the same as bringing an umbrella when it rains and putting on clothes when it is cold. If you run outside every day and come into contact with many people, it is definitely right to bring an umbrella. If you stay in the office every day and have a fixed commuting route, there is no need to carry an umbrella every day and occupy space. When you are really not sure whether you should get checked out, call the infectious disease department or dermatology department and explain your situation clearly to the doctor. They can give you an accurate answer in three to five minutes, which is much better than searching on the Internet until you are half scared to death.