Pulmonary tuberculosis crosses the borders of prisons and slums in Brazil – 11/12/2022

The disease is more common in socially weak societies, but it can infect anyone.

The tuberculosis It is a disease that has followed Brazilians for decades and continues to affect the population, especially the socially weak, although it can infect anyone who comes into contact with a sick person.

Before Covid-19, tuberculosis was the world’s deadliest infectious disease. In Brazil, the average number of diagnoses was about 70,000 each year, and in 2019, the year of the most recent data recorded in Datassus [sistema de informações do Ministério da Saúde]There were 4,500 deaths from the disease, which equates to 12 every day.

But after the new Corona Virus It spread across the country, and the numbers plummeted. “Instead of being a good indicator, it was a false sense of fall,” says Paulo Victor Viana, a public health researcher in tuberculosis epidemiology at the Professor Helio Fraga Reference Centre, associated with the Oswaldo Cruz (Fucruz) Foundation.

“What happened in the years of the epidemic was the lack of diagnosis due to the behavior of a large part of the population to avoid exposure and seek medical attention for fear of contracting the Corona virus,”

Many people with TB had symptoms Cough For more than three weeks they assumed it was covid-19 or were afraid to seek health services for fear of contracting covid-19.

“Or, when they looked for help, they found health professionals who were looking closely at Covid disease. There was a forgetfulness of the disease, reflecting a decrease in the number of cases.”

Globally, according to the Pan American Health Organization (PAHO), in 2020, more people died of tuberculosis, with far fewer people diagnosed and treated or receiving preventive treatment than in 2019, when overall spending on essential services fell for the disease.

The World Health Organization (WHO) predicts that due to the consequences of the covid-19 pandemic, up to 1.5 million people could die from tuberculosis in the world by 2025.

Who are tuberculosis patients?

There is a stigma that tuberculosis is a disease that is “in prisons” or confined to slums. In fact, bacilli can spread more easily in socially unstable environments, where people are naturally more susceptible to infections and comorbidities, which in turn can weaken the immune system.

In addition, among the reasons that contribute to the poorer people being hit the hardest are crowding of people in the same room, lack of quick access to health services (which contributes to the fact that a person with the disease is not diagnosed and does not self-isolate, pollutes others) and even difficulty maintaining treatment.

“Many health centers require the patient to undergo adjuvant therapy, that is, to go to the unit daily to take medicine in front of the health agent, but not everyone can go daily,” Viana explains, describing the reality of thousands of patients. Brazilians who cross their cities for work sometimes have more than one job.

But anyone can be infected with the disease-causing bacteria, which are transmitted through the air after a sick person sneezes or coughs. “It is enough to come into contact with someone with TB on the bus, on the subway, at a party or anywhere else for it to settle in their body,” Viana says.

But for most people, the immune system’s natural defenses are sufficient to fight off the initial infection. “But if there is a decrease in immunity for any reason, the bacteria can leave the dormant phase and begin to multiply,” the researcher notes.

“People with greater purchasing power, access to health care and good food go years or their whole lives without TB. But that doesn’t mean they can’t have the disease.”

Viana explains that people with symptoms typically experience weight loss with potentially poor nutrition and a sick appearance, which contributes to the negative stigma of tuberculosis.

“Another stigma, already historical, is coughing. Chronic cough, for more than three weeks, which sometimes makes the patient bleed due to lung injury. It is called ‘tuberculosis cough.'”

Before there was effective treatment, which today is provided free of charge by the Unified Health System (SUS) in all states and the Federal District, some people with the disease were taken to hospitals in tuberculosis sanatoriums.

“Although today this isolation is done at home and the patient no longer transmits the bacilli after 15 days, the treatment is long. The normal duration is six months, but for resistant cases, it can last up to two years.”

Tuberculosis in different places

Lawyer Thalita Giraldi, 24, who lives in eastern Sao Paulo, believes she came into contact with the bacillus that causes the disease in 2017. “That was when I started to have symptoms Pneumonia It didn’t stop with time, which led to a more thorough investigation.”

Although the PDD (tuberculin skin test) examination gave a reagent for tuberculosis, due to a parallel skin reaction and lack of sputum production, which is usually analyzed in a second bronchoscopy test, to confirm the diagnosis, Thalita underwent two different specialists without an appropriate treatment plan.

Says the lawyer who still suffered from a persistent cough.

In January 2022, she contracted covid-19, and until she was vaccinated, she developed severe symptoms, such as body aches, coughing and fatigue.

Four months later, she was still experiencing sequelae, and given her clinical history, the doctor ordered a lab test called QuantiFERON, which analyzes the immune system’s response to tuberculosis bacilli. The result, as well as the result of the PDD test, was positive.

“My treatment recently ended, but it has been a difficult journey that has made me give up a few things for the past six months,” Thalita says.

“I thought it was a very old disease. At the beginning of the investigation, I didn’t care much because of the other possibilities for the diagnosis, and also because tuberculosis seemed like a very serious thing, I was afraid of dying if it was tuberculosis,” Thaletta says.

For Mariana Romano, symptoms began in 2018, and the diagnosis came a little faster, but not before the disease lost her 10 kilograms.

“I worked a lot and studied and was a housewife. I was doing a lot of things at the same time and wasn’t eating right. One day my immunity went down, I couldn’t stop coughing and I had a high fever. Went to UPA [Unidade de Pronto Atendimento] And they gave me treatment for pneumonia, but I wasn’t getting better and was losing weight every day,” she says, who was 17 at the time and lives in Rocinha favela in Rio de Janeiro, a place known for its disease rate euphoria.

Already weak, Mariana sought help at the Miguel Coto Municipal Hospital and was diagnosed with tuberculosis through bronchoscopy.

Mariana, a 21-year-old juvenile promoter, was in high school and was on vacation at the time of her diagnosis, but had to drop out of her administrative assistant course and work at a pharmacy.

“I had to take four huge pills that made me so sick. Nothing stopped in my stomach, and to be honest, despite taking the medication for the right time, there were days when I felt so bad that I couldn’t take the medication.”

When the epidemic arrived, Mariana’s doctor recommended moving to her mother’s house.

“I lived in a very narrow alley, where only one person passes at a time and you can’t even see the sky properly. It was damp, and my lungs were still at risk, so I suggested I live with my mother in the neighbourhood. From Belford Roxo to avoid contracting coronavirus” .

Current Vaccine and Immunology Under Study

The vaccine that exists today against tuberculosis does not protect against the pneumonic type, which is most common in adults.

BCG, as it is called, is given to children up to 4 years old and works against the most common types that affect this age group: Meningitis Tuberculosis and miliary tuberculosis (a severe form that occurs when bacteria enter the bloodstream and spread).

“Protection is very good until adolescence, but then it decreases. Then we don’t know if BCG does not provide immunity against pulmonary tuberculosis or if it becomes the most common type in adults because the effectiveness of the vaccine decreases with time,” explains Luciana Cezar de Cerqueira Leite, a researcher In the Vaccine Development Laboratory at the Putantan Institute.

Although the BCG vaccine is mandatory for newborns, the BCG vaccine – which protects against severe forms of tuberculosis – has low coverage rates.

Datasus data shows that vaccination coverage decreased from 105% in 2015 to 68.6% in 2021. “Many factors have contributed to this decline, including periodic shortages of BCG,” says Leite.

Since 2016, the only national plant producing BCG and Onco BCG, affiliated with the Atalpho de Paiva Foundation (FAP), in Rio de Janeiro, has been subject to successive bans by the National Health Surveillance Agency (Anvisa) – and since then in a day, the provision of Vaccination in the country is intermittent.

In the early months of 2022, the Department of Health required states to legalize doses, as BBC News Brasil showed in a report published in May.

“There are also daily problems. It is easier to find the vaccine in the capital, where you cross the street and you have a health clinic. And when you arrive, there are no doses, you may end up having to go back another day,” says the researcher, emphasizing the importance of having immunization devices on wide range.

“Ultimately, it is an enduring struggle for science to show that vaccination matters.”

There are currently several studies around the world looking for alternatives to protect the economically active population, aged 20 to 49, from pulmonary tuberculosis. Milk is part of one of the studies on this immunity, which is in development on Butantan.

So far, animal tests have shown that the vaccine is more protective than conventional immunity. But there is still a long way to go before any human benefit is demonstrated.

– The text was originally published in https://www.bbc.com/portuguese/brasil-63408032