Pandemic aggravates cases of tuberculosis in younger people – 04/12/2023 – Health

The number of tuberculosis cases in Brazil has increased again, interrupting a sequence of two consecutive years of decline. With this, it approached the scenario observed in the pre-Covid pandemic period.

The increase is attributed to the damming of diagnoses that were no longer carried out in the first two years of the health crisis. And he worries due to the advance of the disease among children and adolescents.

An epidemiological bulletin from the Secretariat for Health and Environmental Surveillance, of the Ministry of Health, points out that in 2022, 2,703 cases were registered in children under 15 years of age, which corresponds to 3.5% of the total number of cases in the country, the highest proportion verified since 2012. Of these, 1,788 were in children under ten years old.

There was also an increase in the proportion of new diagnoses in children aged 0 to 4 years. Last year, this age group accounted for 37.5% of cases of children under 15 years of age, the largest share since 2012.

In all, the country accumulated last year 78,057 new cases of the disease (36.3 per 100,000 inhabitants), surpassing the 74,385 (34.9 per 100,000 inhabitants) and 70,554 (33.3 per 100,000 inhabitants) in 2021 and 2020, respectively.

The number for 2022 is still the highest since 2012, below only the more than 79,000 accounted for (almost 38 per 100,000 inhabitants) in both 2018 and 2019.

According to the bulletin, there was also an 11% increase in deaths from tuberculosis in 2021 compared to the previous year, from 4,569 deaths to 5,072.

For Pedro Campana, infectologist at Santa Casa de São Paulo, Hospital das Clínicas at USP and NuMa (Núcleo de Medicina Affectiva), younger people have, in general, a worse picture, with multiple involvement of organs and systems, not just lungs. “We have noticed an increase in the number of patients arriving at the hospital in serious condition.”

Tuberculosis is a contagious disease caused by the bacteria Mycobacterium tuberculosis. It is transmitted through the airways and spreads easily in areas with large crowds of people, high concentration of poverty, environments without sunlight and little air circulation.

He explains that the increase in the incidence of the disease is directly related to the worsening of social conditions in the country in recent years, especially in malnourished patients. In addition, new cases in children under five may have had a direct influence on the period of confinement caused by the Covid pandemic.

“Whenever we have a case of tuberculosis in a child aged five or less, we need to look for the adult who lives with that child and who probably transmitted the bacteria”, reinforces Campana.

One way to protect the severe form in children is with the BCG vaccine, widely offered in the National Immunization Program, but it does not prevent infection in adulthood.

“[A vacina] BCG prevents infection in childhood, but is less effective in adults, that is, immunity is lost with age. For this reason, today, efforts are being made to increase the duration of immunity or create reinforcement”, says Luciana Leite, senior researcher at the Vaccine Development Laboratory at the Butantan Institute, .

Leite is the coordinator of the research that seeks to develop a recombinant BCG vaccine comprising a strain of the bacteria modified to produce a protein from the bacteria E coli, which serves as an adjuvant (enhancer) of the immune response. This vaccine has completed the pre-clinical stages, in the laboratory, where it has been shown to induce greater protection and longer duration of the immune response in mice. Now, it is expected to move on to human trials.

The drop in BCG vaccination coverage may have caused an increase in new infections among children, says the researcher. “The country has always been very well placed in terms of vaccination in general, and BCG coverage had good rates, but with the pandemic coverage dropped a lot”, she says.

NORTH OF THE COUNTRY CONCENTRATES HIGH INCIDENCE

Although the incidence of tuberculosis in the country as a whole has grown from 2020 to 2022, the states that concentrate the highest incidence of the disease are Amazonas (84.1 cases per 100,000 inhabitants), Roraima (75.9), Acre (52) and Pará (49.4).

Among the other states in the North, Amapá (43.1) and Tocantins (13.6) already showed a growth trend before the pandemic, while Rondônia (26.9) is the only one in the region with a downward trend in the last four years.

Regarding ethnicities and skin color, the highest proportion of new cases of tuberculosis from 2012 to 2022 is concentrated in the black and brown population, but there was also an increase in incidence in yellow and indigenous people, while in whites it dropped.

For Campana, the data reinforce the situation of social vulnerability of indigenous people, who are already considered a higher risk group for tuberculosis. “I usually tell my students that a risk factor for tuberculosis is living in Brazil. Many people from the middle and upper classes have never had contact with the reality of tuberculosis, but it is widespread throughout the country, especially in the most vulnerable populations .”

In a note, the Ministry of Health said that the scenario of tuberculosis in the country was aggravated by the pandemic, and that it remains an infectious disease that, even with available prevention and treatment measures, still causes a high number of deaths in Brazil.

Regarding new cases in children, the folder said that they are often affected by being in contact with sick adults, and that one of the main forms of protection against serious cases is the BCG vaccine, offered right after birth. The current management stated that “it is fully committed to rescuing the high vaccination coverage in the country”.

EARLY DIAGNOSIS IN THE POPULATION WITH HIV

Among the populations most at risk are also people living with HIV and living on the streets, where the death rate is 15 to 21 times higher than in the general population.

In March, the Ministry of Health distributed 13,900 rapid tests to municipalities to expand the diagnosis of tuberculosis in the population living with HIV/AIDS.

Different from the traditional test, the new test, called LF-LAM (lateral flow for detection of lipoarabinomannan), has a much greater sensitivity in this population, which leads to a faster and more effective diagnosis, fundamental to identify the first symptoms of the disease and start treatment.

It is offered in all health services and uses urine samples, with a result in 25 minutes.