Resposta brasileira à tuberculose: contexto, desafios e perspectivas

Abstract

Tuberculosis (TB) has affected mankind for more than 8,000 years. Before the mid-19th century TB was not recognized as a contagious disease and was attributable to several causes such as hereditary, miasmas, and other environmental and social determinants. But, in 1882, Robert Koch identifi ed Mycobacterium tuberculosis, which allowed to defi ning TB as an infectious disease. Then blossoming biomedical research started its quest for vaccines and drug therapies. BCG vaccine was applied for the fi rst time in humans in 1921. Years later, in 1944, streptomycin was successfully used in TB treatment and it was the starting point for a number of anti-TB drug therapies. These breakthroughs created new opportunities for TB prevention and treatment. However, in the 19th century, TB mortality in Europe was remarkably higher than that seen in Africa today. Yet a sharp decline in TB mortality was seen by the end of that century, long before the advent of modern preventive and therapeutic alternatives, most likely due to improved life conditions. Today, in developed countries, TB is a condition confi ned to population groups comprising immigrants from poor countries and other marginalized people (homeless, alcoholics, inmates, among others).Although TB is a potentially curable and preventable disease, it has remained a public health concern in developing countries, including Brazil. Worldwide, it is estimated two billion people have latent TB infection and around 8.8 million new cases are diagnosed every year. In Brazil, about 80,000 cases and 6,000 deaths are reported every year. Owing to its immunosuppressive effect which makes people more susceptible to develop TB, HIV-AIDS epidemic, among other consequences, has contributed to increasing TB cases in many countries.In children, BCG knowingly provides clear protection when given neonatally while, in adults, protection against TB clinical forms is highly variable worldwide, a phenomenon not yet understood. As vaccine is not consistently effective and the major source of TB infection is sick people, the best prevention available in health care is still early detection and treatment of cases. Untreated or inadequately treated cases can infect other people and thus perpetuate TB dissemination chain.TB requires long-term complex treatment with the administration of several drugs for a period of time even after patients have clinically recovered. Treatment default is high and can produce drug-resistant forms of M. tuberculosis, which hinders disease control. The World Health Organization recommends implementation of the directly observed short-course treatment (DOTS) strategy for a fully effective treatment. In Brazil, the successful Family Health Program provides favorable opportunities for expanding access to health care and more effective detection and treatment of diseases such as TB.Starting from 1999, the Brazilian Ministry of Health has set TB as a priority in the health agenda. TB control actions aims at diagnosing at least 90% of expected cases and curing at least 85% o...

Investigação Da Tuberculose Latente Em Trabalhadores De Um Hospital Penitenciário: Implicações Para Saúde Do Trabalhador

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Efetividade do tratamento da tuberculose

“…(5,7,8) Several factors determine or influence adherence to tuberculosis treatment. Therefore, in addition to investigating the dynamics of care and the strategies used at the PCCs studied, we evaluated some of the characteristics of the population profile.…”

Path of infectious diseases in Brazil in the last 50 years: an ongoing challenge

“…In the last decade, RSP published current texts on the topic, and those on the challenges and perspectives of TB control strategies in Brazil 19 , 142 stand out. These studies analyzed the burden of disease, its tendency, and current profile 29 , 30 as well as the drug resistance situation 52 .…”