As the “wave” caused by the Covid-19 “tsunami” slowly recedes, health authorities in all countries begin the difficult task of damage control in terms of prevention and care of other diseases. And the case of tuberculosis in Argentina is a sad but faithful summary of what has happened in healthcare since the WHO declared the pandemic.
A report -published just a couple of weeks ago by the National Ministry of Health- confirms that “in Argentina, [la tuberculosis] continues to be a major health problem that compromises above all the lives of young people, their families and communities. Globally, the impact of the pandemic has created many difficulties in chronic diseases. Regarding tuberculosis (TB), the loss of follow-up of patients stands out, complications for people who suffered from both infections and the decrease in the notification of new cases, something that is manifested in late detections of people with serious and advanced disease, some times irreversible.
That same situation is what the doctors who treat these cases detect. “Although we manage similar numbers of patients to those treated before the pandemic, we now see an important difference: the cases we diagnose come to us with a much more advanced degree of disease,” he told NEWS the doctor Matias Scafati, head of the Pneumonology Inpatient Unit at Tornú Hospital. And he added: “the experience of the office is that there is a significant delay in diagnoses. That is why now they come with much more serious and advanced conditions than they did a few years ago. We are even detecting situations that were no longer seen, such as tuberculous meningitis.”
HISTORY
It is true that the incidence of tuberculosis usually goes hand in hand with the economic and social situation of the country. “In Argentina. Since 2000, the statistics indicate that the reported cases of TB have been falling year after year, at least until 2014,” he recalled for NEWS Dr. Laura Lagrutta, a pediatrician specializing in pediatric pulmonology who works at the Institute of Thisioneumonology “Prof. Dr. Raúl Vaccarezza”. But around that time the trend reversed and it began to slowly rise. The explanation of the experts is based on the fact that “the advance of TB is usually an indicator that closely mimics the evolution of poverty,” added Lagrutta, who is also a member of the Argentine Association of Respiratory Medicine (AAMR).
And what happened during the Covid-19 pandemic? “What was already happening complicated us. Despite the particular phenomenon that during 2020 notifications fell significantly, we believe that this decrease was due to many patients with TB simply not accessing the diagnosis and others did not sustain treatment ” added the expert.
The aforementioned Ministry of Health report details that “after the emergence of Covid-19, there were several waves of infections of varying magnitude and severity. And although the pandemic affected all areas of life, its impact has been profound in vulnerable groups, such as tuberculosis patients. The study -presented by Dr. Hugo Feraud, director of the Office in charge of Control of Communicable Diseases- details that “the notification of TB cases in 2020 had been reduced by 14% compared to 2019. But, according to the information provisional 2021, the notification increased by 13.8% over that of 2020”.
One point on which the professionals consulted agree is that -although historically it has been characterized as a classic disease associated with poverty, it is not exclusive to that social situation. “In fact”, highlighted Lagrutta, in recent years there has also been a resurgence of TB cases in the US and several countries in developed Europe“. This epidemiological phenomenon is due to a set of reasons: in part, to the migration of people from the geographical regions of greatest poverty who arrive already infected in the “first world”. But the demographic trends that explain many cases also play a role. of “rich” but elderly patients, and more and more cases of people with immunological problems (HIV), cancer and transplant patients whose defenses are low and that opens the door to the TB bacillus.
The central idea that emerges from this fact is that people with a certain symptomatology (cough for more than 15 days (can be with blood), weight loss, night sweats and loss of appetite and fever), they should consult and the professional should suspect TB and indicate specific tests to diagnose or rule it out.
In that sense, there is also a way to go. According to Lagrutta, “clinicians should be very vigilant: in hospitals specializing in infectious diseases, it is detected immediately, but sometimes referred patients come to us after their doctors have given them several treatments with various antibiotics without the infection getting better. It just wasn’t the right medication because they didn’t suspect TB“, explained the pulmonologist.
It is not exclusively a disease of poverty. In recent years there is a resurgence of cases in the US and developed countries in Europe.
What is the largest age group affected? Undoubtedly, the one between the ages of 20 and 44, a group that “remains” with 84% of the cases diagnosed among the population of productive age. But Scafati drew attention to a disturbing point: “there is also a high incidence in people under 20 years of age, who comprise 17% of TB cases and who correspond to children and adolescents. This is a particularly vulnerable group, above all, younger, because their immune systems are not fully developed and therefore if they suffer from tuberculosis, even if they are later treated, they can be left with disabling sequelae for life”.
Another one of the “you should” who have this ancient disease are the treatments. After diagnosis, a combination of four antibiotics is prescribed, which must be taken by the patient normally for a period of six months. The long time and some typical side effects of these drugs mean that there is a considerable lack of adherence and many people abandon them before finishing.
This phenomenon can also stimulate other complications: the increase in the presence of certain strains of the bacillus that are capable of resisting the attack of common antibiotics. “For now,” according to Lagrutta, “the percentage of new diagnoses of resistant bacilli to treatments is relatively low. In the world it is around 3.5% and in Argentina it is even lower, around 1.8% of cases.” But experts suspect that it is possible that there is an underreporting of patients with resistance. “Sometimes we consider that the person with TB it is not cured because it does not follow the treatment well. But it’s also possible that he does take the medication and it’s not working.”
Of course it would be ideal develop a preventive vaccine. Yes, there is -for many years now- the famous BCG. However, experts admit that its effectiveness is not the best. The data indicates that it reduces the risk of contracting the disease by 50% and minimizes death by 71%. That is why the WHO proposed in its latest document on this disease, that “it is necessary to catalyze investment and action to accelerate the development of new tools, especially new vaccines against tuberculosis”.
Enrique Garabetian
Twitter: @egarabet
Missing / More prevention
On March 24, a date that commemorates World Tuberculosis Day, the WHO issued a document where he summarized that -in 2020- for the first time in the last decade, deaths from TB increased in the world. “We cannot waver in our commitment to care for every person affected by this disease,” said Tereza Kasaeva, director of WHO’s Global Tuberculosis Programme. And he reviewed other data: “today TB is already the thirteenth cause of death and the second infectious cause of death after Covid-19. Every day more than 4,100 people die from TB and every year 1.1 million children get sick” . Globally, the increase in tuberculosis deaths grew, from 2019 to 2020, from 1.4 million to 1.5 million. And, oh chance, it happened in a context of drop in prevention funding: In that period, the diagnosis, treatment and prevention of TB went from US$5.8 billion to US$5.3 billion: “less than half of the 2022 goal of US$13 billion,” reported Kasaeva
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