ABSTRACT
Background: The state of São Paulo reports the highest number of tuberculosis cases in Brazil. We aimed to analyze the SARS-CoV-2 pandemic's impact on tuberculosis notifications and identify factors associated with reduced notifications and tuberculosis deaths in 2020-2021. Methods: This retrospective cross-sectional study analyzed data from 126,649 patients with tuberculosis notified in São Paulo from 2016 to 2021. Interrupted time series analysis assessed the pandemic's impact on notifications. Descriptive statistics and logistic regressions identified factors associated with decreased tuberculosis notifications and deaths during the pandemic (2020-2021) compared to the pre-pandemic period (2019). Findings: Tuberculosis notifications decreased by 10% and 8% in 2020 and 2021, respectively, with declines 2-3 times higher among individuals with no education or deprived of liberty. Contrastingly, tuberculosis notifications increased 68% among corrections workers in 2021. Diagnostics and contact tracing were compromised. Individuals with HIV, drug addiction, or deprived of liberty had lower odds of notification during the pandemic. Black and Pardo individuals or those with diabetes, treatment interruption history, or treatment changes post-adverse events had higher odds of notification. However, adverse events and tuberculosis-diabetes cases have been increasing since 2016. During the pandemic, tuberculosis-related deaths rose 5.0%-12.7%. Risk factors for mortality remained similar to 2019, with Pardo ethnicity, drug addiction and re-treatment post-adverse events emerging as risk factors in 2020/2021. Interpretation: The pandemic affected tuberculosis notifications and deaths differently among populations, exacerbating inequalities. Treatment interruption, loss of follow-up, and challenges in accessing healthcare led to increased mortality. Funding: FAPESP, CNPq and CAPES, Brazil.
ABSTRACT
Background The state of São Paulo reports the highest number of tuberculosis cases in Brazil. We aimed to analyze the SARS-CoV-2 pandemic's impact on tuberculosis notifications and identify factors associated with reduced notifications and tuberculosis deaths in 20202021. Methods This retrospective cross-sectional study analyzed data from 126,649 patients with tuberculosis notified in São Paulo from 2016 to 2021. Interrupted time series analysis assessed the pandemic's impact on notifications. Descriptive statistics and logistic regressions identified factors associated with decreased tuberculosis notifications and deaths during the pandemic (20202021) compared to the pre-pandemic period (2019). Findings Tuberculosis notifications decreased by 10% and 8% in 2020 and 2021, espectively, with declines 23 times higher among individuals with no education or deprived of liberty. Contrastingly, tuberculosis notifications increased 68% among corrections workers in 2021. Diagnostics and contact tracing were compromised. Individuals with HIV, drug addiction, or deprived of liberty had lower odds of notification during the pandemic. Black and Pardo individuals or those with diabetes, treatment interruption history, or treatment changes post-adverse events had higher odds of notification. However, adverse events and tuberculosis-diabetes cases have been increasing since 2016. During the pandemic, tuberculosis-related deaths rose 5.0%12.7%. Risk factors for mortality remained similar to 2019, with Pardo ethnicity, drug addiction and re-treatment post-adverse events emerging as risk factors in 2020/2021. Interpretation The pandemic affected tuberculosis notifications and deaths differently among populations, exacerbating inequalities. Treatment interruption, loss of follow-up, and challenges in accessing healthcare led to increased mortality. (AU)
Subject(s)
Tuberculosis , Tuberculosis/mortality , Brazil , Disease Notification , Pandemics , SARS-CoV-2 , COVID-19ABSTRACT
The aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.
Subject(s)
Disease Notification/statistics & numerical data , Tuberculosis, Multidrug-Resistant/epidemiology , Adolescent , Adult , Aged , Brazil/epidemiology , Child , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Introdução: Tuberculose multidroga resistente é uma doença causada pelo Mycobacterium tuberculosis de cepas resistentes à rifampicina, hidrazida e a mais uma droga do esquema I, esquema IR e/ou esquema III; ou falência operacional ao esquema III, adotado no Brasil. Objetivo: Analisar o perfil epidemiológico e o resultado de tratamento dos pacientes submetidos ao tratamento da TBMDR. Método: Estudo dos casos de TBMDR notificados e tratados nas unidades de referência do Estado de São Paulo, no período entre novembro de 1999 e janeiro de 2004. Resultados: Análises dos 170 pacientes tratados com TBMDR obteve-se: 64,1 por cento do sexo masculino, faixa etária mais acometida foi de 30 a 39 anos, 17,6 por cento (30/170) eram alcoólicos, 8,2 por cento (14/170) eram diabéticos, 9,4 por cento (16/170) tinham AIDS e 11,2 por cento (19/170) eram soropositivo. Foram divididos em dois grupos conforme o esquema terapêutico utilizado: tratamento padrão - que seguiu o esquema padronizado pelo Ministério da Saúde, com administração de Amicacina, Ofloxacina, Terizidona, Clofazimina e Etambutol - e o tratamento não padrão, que seguiu esquema com uma ou mais drogas fora do esquema preconizado (Ciprofloxacina ou Metronidazol ou Talidominda). No tratamento padrão, aplicado em 100 pacientes, os resultados foram de: cura- 59,0 por cento; abandono- 6,0 por cento; óbito- TB 20,0 por cento; óbito não TB- 4,0 por cento; falência- 8 por cento; transferência para outro Estado - 3 por cento. No tratamento não padronizado em 70 pacientes: cura- 44,3 por cento; abandono- 12,8 por cento; óbito TB- 20 por cento; óbito não TB- 1,4 por cento; falência- 17,2 por cento e transferência para outro Estado- 4,3 por cento. Conclusão: A TBMDR predominou na faixa etária adulto jovem do sexo masculino, em relação ao resultado do tratamento a cura foi baixa nos dois tipos de tratamento.