El deterioro de la tuberculosis en Chile

Abstract

Background:Recent data suggest an increase in tuberculosis (TB) incidence in Chile. Aim: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. Material and Methods: Data analysis from official sources and trend analysis. Results: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. Conclusions: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.

Mortality from AIDS and tuberculosis-HIV coinfection in the Chilean AIDS Cohort of 2000-2017

“…Between 2000 to 2017, 157 deaths due to TB-HIV coinfection were registered, which represents 13.3% of the total deaths in PLWHA in the Chilean AIDS Cohort. This represents a failure of treatment in a marginalized population with less access to public health, as reported in other studies in the country 31,32 . Diagnosis of TB in HIV-positive persons can be limited, in part, to poor infrastructure and failure to address issues of culture, as demonstrated in studies conducted in Latin America countries, added to a delay in the start of ART and multidrug resistant TB 22,33 .…”

Evolución de la coinfección por TB/VIH en la Región Metropolitana de Chile, 2005 a 2018

“…En Chile, la TB venía declinando progresivamente desde el siglo pasado, sin embargo, desde 2014 a la fecha se ha descrito una etapa de reemergencia epidemiológica. Entre los grupos de vulnerabilidad con mayor aumento porcentual entre los casos, se encuentran los extranjeros, y en menor grado, los pacientes con VIH/sida 23 .…”

Vacuna BCG, Inmunodeficiencias Primarias e Inmunodeficiencia Combinada Severa

“…La evolución epidemiológica de la tuberculosis (TB) en Chile es preocupante; una revisión extensa publicada recientemente, destaca que los recortes presupuestarios impuestos al Programa de Control y Eliminación de la Tuberculosis (PROCET) en los últimos gobiernos, han producido una profunda y prolongada debilidad en todas las estrategias de la lucha contra la TB, salvo la vacunación con vacuna de Calmette-Guérin (BCG) 3 . La Organización Mundial de la Salud advierte sobre el peligro de una confianza injustificada en la eficacia protectora de BCG: "… se ha demostrado que la vacuna BCG previene de 60% a 90% de casos de TB meníngea y TB diseminada en niños pequeños, no evita una proporción suficientemente alta de casos en niños o adultos para ser considerada como una medida de eficacia adecuada para el control de la TB."…”