World Tuberculosis Day is an opportunity for the WHO, governments and others to raise awareness about TB. While TB is curable and preventable, it still kills 1.4 million people each year.
Every year, March 24 is World Tuberculosis Day. This date marks the day in 1882 when Dr. Robert Koch announced that he had discovered the mycobacterium that causes tuberculosis, thus paving the way for the diagnosis and treatment of this disease. According to World Health Organization (WHO) figures, 66 million lives have been saved since 2000 as a result of global efforts to eradicate Tuberculosis; while this progress has been steady, the COVID-19 pandemic has reversed years of global progress in the fight against Tuberculosis: this is the first time since 2005 that a year-on-year increase in the number of Tuberculosis deaths has been observed (WHO Global Report 2021). In 2020, 9.9 million people contracted the disease and 1.5 million people died from it.
Tuberculosis remains the leading cause of death among people living with HIV and is at the heart of the threat posed by antimicrobial resistance.
What is tuberculosis? Tuberculosis is a bacterial disease. There are two types:
On the one hand, the tuberculosis bacterium can remain in a resting state in the body, in which case it does not cause any disease. This is called latent tuberculosis infection. The bacteria are alive in the infected person, but they do not cause disease or symptoms and are not contagious. Latent TB infection can last for years or decades.
On the other hand, the bacteria can infest the body and tuberculosis then becomes contagious. It is transmitted through the airways and is manifested by :
- A cough with sputum sometimes containing blood
- From the fièvre
- General fatigue
- Weight loss
- Chest pain
There is an efficacious treatment for tuberculosis. When taken correctly, it cures the majority of cases. Without treatment, mortality from the disease is estimated at 50% of cases. The treatment consists of a combination of antibiotics to be taken over the long term (for at least 6 months).
The COVID-19 pandemic has reversed years of progress in Tuberculosis control and disease burden reduction.
Much work remains to be done to better understand and effectively manage this disease. In all disciplines, from basic research to human and social sciences, progress is needed to understand the persistence of Mycobacterium tuberculosis in the body, to develop new therapeutic approaches and more effective vaccination, or to improve surveillance by taking into account potential animal reservoirs in a One Health approach, for example.
At the agency’s Scientific Days, which took place on March 15 and 16, 2022, Claudia Denkinger (Heidelberg University Hospital) emphasized the need for sensitive, specific, easy-to-use and inexpensive diagnostic tools. This is indeed the first step to identify infected people and allow them to start treatment. She presented the avenues being developed to diversify the samples that can be analyzed (blood, stool, urine, etc.) in order to target the affected populations more effectively, particularly children. Alain Baulard (Inserm, Institut Pasteur, CIIL), for his part, addressed the phenomenon of resistance to anti-tuberculosis drugs, one of the major current research challenges. In particular, he presented innovative work that makes it possible to circumvent the resistance mechanisms developed by Mycobacterium tuberculosis against certain treatments.
Tuberculosis A deteriorated situation since the Covid-19 pandemic
While diagnostic and treatment strategies have saved 66 million lives since the 2000s, the Covid-19 pandemic has halted this progress. According to the WHO, for the first time in 10 years, the number of deaths due to tuberculosis is on the rise worldwide. In addition, it warns of the devastating effect of the current conflicts in Eastern Europe, Africa and the middle east.
The situation has deteriorated significantly, particularly for children and young adolescents. According to WHO estimates, in 2020, 63% of sick children and adolescents under 15 years of age did not benefit from diagnostic services or treatment. The situation is even more alarming for children under the age of 5. Indeed, 72% of them would not have benefited from diagnosis or treatment in 2020. In addition, two-thirds of those who qualify have not received preventive treatment for TB and thus remain at risk of contracting the disease. These alarming conditions are due to lack of access to care and reduced access to health follow-ups during the Covid-19 pandemic.
WHO recommendations in the face of this emergency situation
On World Tuberculosis Day, WHO is sounding the alarm for countries to restore access to Tuberculosis services for all patients, especially children and adolescents, as soon as possible. In response to this alarming situation, it is issuing guidelines for the management of the disease in children and adolescents. They include:
- Expansion of diagnostic tests with the inclusion of non-invasive tests
- The use of rapid molecular diagnosis as an initial test in children and adolescents
- The treatment of benign forms was reduced from 6 to 4 months. The treatment of tuberculous meningitis is reduced from 12 to 6 months
- Recommending the use of the two newest medications for the management of children and adolescents. This will allow a shift to an oral-only regimen
- Decentralization of care models afin order to increase access to preventive care and treatment.