Impact of the COVID-19 pandemic on contact tracing of patients with pulmonary tuberculosis

Abstract

Background The COVID-19 pandemic could have negative effects on tuberculosis (TB) control. The objective was to assess the impact of the pandemic in contact tracing and latent tuberculosis infection (LTBI) in contacts of patients with pulmonary TB in Catalonia (Spain). Methods Contact tracing was carried out in cases of pulmonary TB detected during 14 months in the prepandemic period (1/1/2019 to 28/2/2020) and 14 months in the pandemic period (1/3/2020 to 30/4/2021). Contacts received the tuberculin skin test and/or interferon gamma release assay and it was determined whether they had TB or LTBI. Variables associated with TB or LTBI in contacts (study period and sociodemographic variables) were analyzed using adjusted odds ratio OR (aOR) and the 95% confidence intervals (CI). Results The pre-pandemic and pandemic periods showed, respectively: 503 and 255 pulmonary TB reported cases (reduction of 50.7%); and 4676 and 1687 contacts studied (reduction of 36.1%). In these periods the proportion of TB cases among the contacts was 1.9% (84/4307) and 2.2% (30/1381) (p = 0.608); and the proportion of LTBI was 25.3% (1090/4307) and 29.2% (403/1381) (p < 0.001). The pandemic period was associated to higher LTBI proportion (aOR=1.3; 95%CI 1.1-1.5), taking into account the effect on LTBI of the other variables studied as sex, age, household contact and migrant status. Conclusions COVID-19 is affecting TB control due to less exhaustive TB and LTBI case detection. An increase in LTBI was observed during the pandemic period. Efforts should be made to improve detection of TB and LTBI among contacts of TB cases.

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

“… 26 On the other hand, articles revealed that there was an increase in the proportion of LTBI among TB contacts during the pandemic, which ranged from 5.9% to 14.3% difference. 27 28 This trend was more prominent in children as observed through a much higher percentage of LTBI and active TB among children who were household contacts in 2020 compared to 2019 (57.7% vs. 5.3%) 29 and less than 30% of TB preventive treatment rate among children under the age of 5 years. 2 30 …”

“…Like TB testing and screening programs, TB case finding and contact tracing has been impacted by the pandemic, from full suspension of activities in Indonesia to a limited and/or less exhaustive operation in India, China, and Spain. 27 42 43 44 A single country study in Spain suggested that the limited operation of active case finding and contact tracing amidst COVID-19 might have led to increased transmission within households. 27 TB contact tracing is recognized as a labor-intensive process and numerous studies suggested incorporating digital health technologies in its process to promote efficiency.…”

“… 27 42 43 44 A single country study in Spain suggested that the limited operation of active case finding and contact tracing amidst COVID-19 might have led to increased transmission within households. 27 TB contact tracing is recognized as a labor-intensive process and numerous studies suggested incorporating digital health technologies in its process to promote efficiency. 31 42 43 Because infection prevention and control (IPC) of contact tracing and screening sessions was considered as a factor in suboptimal operation of TB detection activities, IPC training, supply of personal protect equipment, and awareness campaigns were also suggested.…”

“…Because TB preventive therapy is one of the critical components in the TB management strategy, the current impact of COVID-19 on LTBI management is especially alarming, as we observe an increase in the proportion of LTBI among TB contacts and higher percentage of LTBI and active TB among household child contacts. 27 28 29 The combined effect of the lower BCG coverage rate and increased LTBI among children may lead to amplification in pediatric TB burden in the near future. It is suggested that TB health services remain functional and early detection activities be maintained even at a minimum level during emergencies.…”

“…It is suggested that TB health services remain functional and early detection activities be maintained even at a minimum level during emergencies. 21 22 25 27 During the pandemic, established TB contact tracing mechanisms could be leveraged for COVID-19 contact tracing, vice versa. In post-pandemic situations, catch-up activities to identify missed cases, strengthening of household contact tracing in response to the increased LTBI, and enforcing LTBI in targeted population groups are necessary.…”