Pediatric TB detection in the era of COVID-19

Abstract

The affect of COVID-19 and measures in response to it on human lives was enormous, including healthcare. The necessary healthcare services including communicable diseases, such as Tuberculosis (TB) were badly affected. Here an attempt has been made to trace the number of notified Pediatric TB cases during and after COVID-19 lockdown and unlock period, and then compared with same period of previous year. The epidemic data on notified pediatric TB cases for 2019 and 2020 were extracted from Health Management Information System (HMIS) database. The absolute numbers of monthly pediatric TB notifications from January to September for the year 2020 were compared to 2019, and the percentage decrease was estimated. The HMIS data shows that there is a significant decrease in pediatric TB notifications during COVID-19 epidemic in India. Especially, when the lockdown and related restrictions in response to COVID-19 was imposed, notifications were significantly decreased compared to same period during the previous year. Even, the reduction numbers of pediatric TB notifications during post-lockdown are still more worrying. Though, little improvements were observed sudden after lockdown was removed, but then-after again consisted decrease was reported; and these numbers again substantially lower than the numbers of previous year. Adequate measures to diagnose, control, and prevent TB focusing young children, should be implemented simultaneously with response to COVID-19 pandemic. Further, effective steps should be taken to remove the fear arise due COVID-19 pandemic among masses, so that the healthcare seeking may be improved.

Impact of COVID-19 Pandemic on Tuberculosis Preventive Services and Their Post-Pandemic Recovery Strategies: A Rapid Review of Literature

“…WHO reported that the global TB vaccination dropped from 88% in 2019 to 85% in 2020 9 while articles from individual countries reported a drop in coverage that ranged from 7% to 60%. 10 11 12 13 14 In Pakistan, the BCG vaccine was the vaccination that showed the highest decline (40.6%) among routine vaccination. 11 In one modeling study, the COVID-19-disrupted BCG vaccination coverage was estimated to be a global decline of 25%, with an additional 33,000 TB deaths in children.…”

Pediatric Tuberculosis Management: A Global Challenge or Breakthrough?

“…The “three-drug regimen” encompasses the use of isoniazid, rifampicin, and pyrazinamide for two months in the intensive phase, and isoniazid and rifampicin for four months in the continuation phase. This is often the treatment option for children with suspected or confirmed pulmonary TB who live in areas where the prevalence of HIV is minimal, are HIV-negative, and whose resistance to isoniazid is low [ 12 ]. The “four-drug regimen” on the other hand is the regimen of choice for children with pulmonary TB who reside in locations with a high HIV prevalence, are highly susceptible to isoniazid resistance, and have extensive pulmonary disease.…”

“…The coronavirus disease is a global emergency and possibly a nightmare to healthcare systems due to the overload it has imposed on global healthcare facilities and personnel, which has been so much such that even well-developed countries were on the brink of a breakdown. With the way that COVID-19 prevalence and hospital admissions have overloaded the healthcare systems, it has negatively affected the control over other threats to global health such as TB, HIV/AIDS, and malaria [ 12 , 300 , 301 , 302 ]]. Laboratories are prioritizing COVID-19 diagnostic tests over many other important investigative tests for these infectious diseases [ 300 ].…”

“…The global burden of pediatric TB remains considerably high, and many cases are seen in children under the age of fifteen. With approximately 1.1 million cases and 230,000 deaths (80% were younger than five years old) reported annually worldwide, plus a much higher risk of severe illness and even death within this fragile group relative to adults; pediatric TB continues to be an ongoing public health challenge, especially in developing countries where there are limited public health infrastructures [ 6 , 8 , 9 , 10 , 11 , 12 ].…”

Review of Pediatric Tuberculosis in the Aftermath of COVID-19

“…Across 2019 and 2020, it was found that patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-rays than patients diagnosed in 2019 ( p = 0.004), as well as a higher percentage of latent and active TB infection in children in households of patients diagnosed in 2020 compared to 2019 ( p = 0.001) [ 6 ]. In another part of the world, Golandaj et al from India reported a 24% decrease in reported pediatric TB cases during the overall lockdown period between March and May 2020 with an even greater 36% reduction post-lockdown from June to September of 2020 compared to the same months in 2019, which is concerning [ 110 ].…”