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Tuberculosis remains one of the deadliest infectious diseases in the world, second only to Covid-19. These are data from the latest ECDC/WHO report on surveillance and monitoring of tuberculosis (TB) in Europe, which shows that there has been a sharp drop (24%) in reported tuberculosis cases between 2019 and 2020, probably due to the pandemic , which made detection and notification difficult.
The document also warns that drug-resistant strains of tuberculosis remain a major concern.
Unfortunately, the fight against tuberculosis has become even more difficult in the last two years. Due to the ongoing pandemic, notes ECDC Director Andrea Ammon, “we are seeing a sharp decline in reporting trends, which is due, at least in part, to a decline in data integrity.
Let’s not forget that this remains one of the deadliest infectious diseases in the world.”
“Thanks to a remarkable 25% reduction in the estimated number of TB cases in the WHO European Region between 2015 and 2020, countries in Europe and Central Asia achieved the regional action plan target and passed the End TB milestone. of a 20% drop over this 5-year period. This is testimony to the political commitment and advances in TB testing and treatment strategies that we have seen across the Region,” says Hans Henri P. Kluge, WHO Regional Director for Europe.
Experts acknowledge on World Tuberculosis Day 2022 that there is no room for complacency.
TB deaths plateaued for the first time in two decades between 2019 and 2020, when Covid-19 disrupted services, leaving people undiagnosed and untreated. To ensure that progress continues, the report highlights, more innovative and effective approaches in the diagnosis and treatment of TB and multidrug-resistant TB (MDR) must be introduced.
Historically, social and economic determinants have influenced. It should not be ignored that a lower socio-economic development is accompanied by a higher incidence of TB. During the post-civil war, the epidemiological situation was worse than that of other European countries. Hence, the Franco regime promoted the “National Plan for the Eradication of Tuberculosis”, which operated between 1966 and 1973.
Millions of radiophotoseriations, tuberculin tests and BCG vaccinations were carried out, but there were important failures in treatment and isolation. It cost the equivalent of 541 million euros and, unfortunately, the only thing that was eradicated was the aforementioned Plan.
Subsequently, in 2007 and 2019, new plans for the prevention and control of TB in Spain were drawn up, which were again cut short. The first for the 2009 pandemic flu and the second for COVID-19.
At the XXV International TB Conference in 2021, at the clinical level it was highlighted that TB health workers had to dedicate themselves to COVID-19, canceling or delaying many visits. For this reason, the patients who could be visited presented advanced lesions more frequently. Moreover, in a reference laboratory a large decrease in the number of samples processed was observed, but more positive sputum smears than usual.
Regarding the management of TB, it was highlighted that the 2020 patients had more extensive lesions than those of 2019, with an increase in latent tuberculosis infection (LTI) and TB in children who were contacts of tuberculosis cases. Likewise, the Barcelona TB Program observed a decline in TB of 19% in 2020 compared to 2019, with great limitations in the completion of epidemiological surveys, in contact studies that decreased to 35% and in the detection of outbreaks epidemic.
In relation to treatments, the frequent shortage of basic medicines for the treatment of TB was denounced, especially those that carry rifampicin, an essential drug, and the extreme difficulty in obtaining bedaquiline, fundamental in those cases with multi-resistant TB.
It is also a grievance for European patients that rifapentine is not available on this continent, a drug that simplifies the treatment of both TB and LTBI.
And the COVID-19 arrived
In just two years, the COVID-19 pandemic has caused more than 350 million cases and more than 5.5 million deaths worldwide, according to data from Johns Hopkins University. Although the actual figures are estimated to be much higher. In Spain, for example, on many days during the 6th wave of the epidemic, 120,000 daily cases have been exceeded.
This epidemiological situation has overwhelmed health systems even in developed countries. The impact of COVID-19 on TB and other infectious or chronic diseases is enormous, with the aggravating factor that it causes an economic crisis that especially affects social diseases such as TB.
In relation to TB, the WHO is currently concerned that the 5.7 million cases reported in the world in 2020 represent a decrease of 18% compared to the previous year. This decline is due, above all, to a lower access of patients to the health system. As a consequence, estimated deaths from TB have reached 1,514,000. Recently in Canada, during the pandemic, a decrease in LTBI treatments has been observed, which, according to the center, ranges between 30-66%, and in treatments of TB of 16-29%.
COVID-19 and tuberculosis
It seems clear that COVID-19 continues to hold back the elimination of TB in all countries of the world. At this stage of the pandemic, it would be convenient to prioritize the normalization of health services dedicated to the prevention and control of TB, as well as other infectious and chronic diseases.
And if we manage to better control the pandemic in the short term, the health services dedicated to TB – which have helped so much to control COVID-19 – should now take advantage of the resources and innovations developed to stop the pandemic.
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