Tuberculosis in the context of the COVID-19 pandemic: what to expect and how to act?
Background. As of the end of December 2019, the list of priority areas of research and development of WHO included coronavirus of severe acute respiratory distress syndrome, coronavirus of the Middle East respiratory syndrome and mycobacterium tuberculosis (TB). In January, a new coronavirus SARS-CoV-2 was added to this list. The COVID-19 pandemic puts enormous pressure on the health systems of all countries, including those with a high TB burden, including Ukraine.
Objective. To describe the condition of TB care in the context of the COVID-19 pandemic and to analyze the prospects for the consequences of the interaction between COVID-19 and TB.
Materials and methods. Analysis of literature and statistics on this issue.
Results and discussion. As a result of social distancing and staying at home, it is difficult to provide quality TB care: the level of timely diagnosis decreases, treatment control deteriorates, the number of undetected side effects in outpatients increases, the proportion of patients with uncontrolled or interrupted TB treatment increases. These processes can have serious adverse consequences. A comparison of TB incidence, including relapses, found out that in Ukraine in the first half of 2020 the TB incidence decreased by 27.4 % compared to the same period in 2019. Unfortunately, this most likely does not indicate a true decrease in incidence, but the reduction of the TB detection due to quarantine measures. The largest difference between 2019 and 2020 is observed in Zhytomyr, Ivano-Frankivsk, Rivne, Ternopil and Chernivtsi regions, which roughly corresponds to the distribution map of COVID-19. The incidence of TB in combination with HIV/AIDS in 2020 is also lower than in 2019 (by 28.4 %). Advanced cases have started to be registered more and more often, and in the conditions of strict quarantine patients with active bacterial excretion pose a serious threat to contact persons, first of all, to risk groups for COVID-19. Coronavirus infection can accelerate the activation of latent TB. According to the WHO, latent TB affects a quarter of the world’s population, so if the activation is accelerated, the process can easily get out of control. All viral infections, including COVID-19, also have an immunosuppressive effect that promotes TB progression. In case of co-existence, COVID-19 and TB have a mutually reinforcing effect, which reduces the likelihood of favourable outcomes for the patient. The interruption of TB treatment on the background of COVID-19 is an additional danger. Patients with TB, COVID-19 and diabetes are the most difficult to treat. In a pandemic, the feasibility of using intravenous forms of anti-TB drugs, which can intensify treatment, dramatically increases. On the positive side, the response of the medical community to COVID-19 can help the long-term efforts to combat TB through infection prevention and control, the development of a contact control system, surveillance and monitoring. The WHO recommends continuing to vaccinate newborns with the BCG vaccine. Clinical trials of the BCG vaccine for the prevention of coronavirus infection are currently underway.
Conclusions. 1. The detection of TB in Ukraine in 2020 compared to 2019 decreased by 27.4 %, in children – by 34.5 %. 2. Coronavirus infection accelerates the activation of latent TB, has an immunosuppressive effect, promotes the progression of TB. 3. To improve TB treatment during a pandemic, electronic monitoring of drug circulation and treatment outcomes should be actively introduced. 4. TB treatment in people with and without coronavirus infection does not have any differences. 5. In a pandemic, the feasibility of using intravenous forms of anti-TB drugs is growing.
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