Since 2020, the number of deaths from tuberculosis increased for the first time in a decade, caused by the COVID pandemic: fewer people had access to the right care on time. Some catching up is needed. But tuberculosis specialists of Radboud university medical center are also worried about the war in Ukraine. ‘We expect that the number of patients will increase.'
Tuberculosis (TB) is the second most deadly infectious disease after COVID-19. Every year 1.4 million people die from it. In 2020, as many as 2.4 million died, a direct result of the COVID-pandemic. On the one hand, the pandemic caused patients to avoid care; on the other hand, care for COVID-19 patients displaced much other care. Worldwide, 9 to 10 million new TB patients are diagnosed each year, the vast majority in poor countries. As much as 20 percent of the world's population is a carrier of the bacteria. That doesn't mean they are sick or contagious, but it does mean they are at risk of getting sick from it.
On March 24, World TB-Day, tuberculosis experts are calling for more attention to the disease. Reinout van Crevel, Professor of Global Health and Infectious Diseases at Radboudumc: 'In 2020, 900 million dollars were invested worldwide in all hot tuberculosis research together. And for COVID-19 a whopping $53 billion on just vaccine development! That difference is huge. There is an awful lot to do now, because of COVID we have been thrown back in the fight against tuberculosis.'
As far as Van Crevel is concerned, the biggest challenges are in the areas of prevention, diagnostics and access to care. 'Ultimately, of course, we want to eradicate the disease. But that starts with making the diagnosis in time and offering people better access to care. That also reduces the risk of antibiotic resistance, an ever-increasing problem.'
Pulmonologist Martin Boeree is professor of Tuberculosis at Radboudumc and head of the tuberculosis sanatorium at Dekkerswald. He emphasizes the importance of better and shorter treatment. In addition, he agrees with the concerns surrounding antibiotic resistance. In the partnership UNITE4TB, as project leader, he tries to realize new combinations of drugs as a successful treatment.
Tuberculosis patients in Ukraine
Boeree also expresses his concern about the war in Ukraine. Ukraine is one of the countries in Europe where tuberculosis is most common. About 70 per 100,000 inhabitants. Those are different figures than we see in Africa, but it's ten times more than in the Netherlands. It is becoming increasingly difficult to provide care for these patients in their home countries. How this will continue, we do not know. An additional problem is that in Ukraine a relatively large number of patients are antibiotic resistant and do not benefit from regular treatment. 'Good care is indispensable for these patients. Together with European colleagues, we are investigating how we can help these patients.'
Nijmegen as a hotspot in the fight against tuberculosis
Radboudumc hosts an international two-day course on tuberculosis and related bacterial infections, organized by Van Crevel and Jakko van Ingen of the Department of Medical Microbiology on March 24 and 25. One of the speakers is Christoph Lange, international expert and chairman of the most important German tuberculosis center: ‘Radboudumc is a leading university in care and research for TB and nontuberculous mycobacterial infections in the world, certainly among the top academic institutes in Europe. I do not know any academic institution where pathogenesis, epidemiology, prevention, diagnosis and treatment of tuberculosis and diseases caused by nontuberculous mycobacteria is addressed at a higher international level than at Radboudumc. Research at Radboud has impact both for better understanding of disease, patient care, and global health, with a very strong capacity building component.’
Van Crevel: 'It's not without reason that we are holding this conference in Nijmegen. In the Netherlands, we are the center for research into and care of patients with tuberculosis. Patients come to us from all over the country. We currently have over 25 PhD students who are doing research into various aspects of the disease, divided over four departments: Pharmacy, Internal Medicine, Medical Microbiology and Pulmonary Diseases. They contribute to our knowledge of the disease.’
Tuberculosis out of the world by 2050?
Asked about the most important steps that need to be taken, both experts emphasize access to the right care, but also better understanding. Van Crevel: 'I want to understand the disease even better. Who gets sick from tuberculosis and who doesn't? Why is one person more contagious than another? There is still a lot to learn.
Boeree: ‘I think it is possible to eradicate tuberculosis from the world by 2050. But that requires joint efforts and money. Tuberculosis is a disease of poverty. Take away the poverty, and the disease will decrease. That sounds logical, and it is. But something has to be done.'
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