Tuberculosis cases decrease, but there is an increase among immigrants | Health

Portugal maintained the progressive reduction in tuberculosis cases in 2022, totaling 1518, but still remains one of the European countries with the highest incidence of the disease, reveals a report from the Directorate-General for Health (DGS).

Of the 1518 cases reported, 1403 were new cases and 115 retreatments, corresponding to a notification rate of 14.5 cases per 100 thousand inhabitants and an incidence rate of 13.4 cases per 100 thousand inhabitants, according to the Surveillance and Monitoring Report of Tuberculosis in Portugal 2022, which is presented this Friday at the meeting promoted by the DGS “Tuberculosis: a current disease” to mark World Tuberculosis Day, which is celebrated on March 24th.

Despite the reduction that has been consistent over the last six years, “Portugal remains one of the European countries with an incidence above 10 cases per 100 thousand inhabitants”, highlights the document published by the National Tuberculosis Program (PNT) of the DGS.

Furthermore, according to the report, cases of tuberculosis in the immigrant population in Portugal increased in 2022, totaling 457, which represents 30.1% of the total number of diagnosed situations.

“The immigrant population remained a population in a situation of greater vulnerability, with a notification rate four times higher than the national average (58.5 cases per 100 thousand immigrants in 2022), with an increase in the proportion of cases , compared to 2021 (30.1% in 2022 and 25.9% in 2021)”, highlights the DGS. Of the 457 cases reported, 189 cases (41.4%) belonged to immigrants who entered Portugal less than two years ago.

The majority of patients are men and from Lisbon

Speaking to the Lusa agency, the director of the PNT, Isabel Carvalho, stated that cases among the native population are not “reducing as quickly” as desired to achieve the objectives that the World Health Organization (WHO) proposes by 2035 of reduce tuberculosis deaths by 95% and the incidence rate by 90%, using 2015 as base values.

“Despite everything (…) from 2015 to 2022, we managed to have a reduction of around 31% and 30.7% in the incidence of the disease in Portugal and a 43% reduction in deaths caused by tuberculosis, which gives a annual percentage decrease of around 4% in relation to incidence and around 6% in relation to mortality”, but, he stressed, “the ideal” would be a “more pronounced decrease, close to 5.6%” per year.

Men continue to be more affected than women (65.7% of total cases reported in 2022), especially in adulthood, notes the document, adding that 3.3% of total cases occurred in children and adolescents up to at 15 years old. In 2022, 91 deaths from tuberculosis were recorded, which corresponds to a fatality rate of 8.6% in all cases.

Regarding the distribution of cases reported across the seven regions of the country, the predominance of Lisbon and Vale do Tejo and Norte continued. “Between 2021 and 2022, in the Lisbon and Tagus Valley region there was an increase in the notification rate from 16.8 to 17.8 cases per 100 thousand inhabitants, while in the North region a decrease was identified from 17.5 to 15.8 per 100 thousand inhabitants”, highlights the document.

The authors of the report point to the increase in the number of cases in the Lisbon district (495 in 2022 against 440 in 2021) as an explanation for the increase in the notification rate in Lisbon and Vale do Tejo, values ​​similar to those in 2020 (more than 20 cases per 100 thousand inhabitants). The Porto district showed a slight decrease in reported cases (376 in 2022; 384 in 2021), corresponding to a notification rate of 20.7 cases per 100 thousand inhabitants.

The number of days until diagnosis remained high in 2022 (82 days), although less than in 2021 (86 days), a decline that Isabel Carvalho argued should be more pronounced. The person in charge explained that healthcare professionals take around 12 days to make a diagnosis, but this only happens when the patient enters healthcare.

“Until then, it takes the patient an average of 40 days to seek help”, which can happen because they have barriers or are unaware of how to access healthcare, in the case of immigrants, or because the patient does not value the symptoms. Isabel Carvalho added that in countries with a low incidence of cases the “negative consequence” is that tuberculosis is no longer thought of, “even sometimes wrongly considering that the disease has been eradicated in Portugal”.

“It is not [erradicada em Portugal]is not eradicated in the world and, therefore, we have to be more alert and continue talking about tuberculosis, because the disease actually exists”, he stressed, maintaining: “There are fewer cases, but it is a disease that is very transmissible, especially when we are adults and have pulmonary forms of the disease.”

Incidence increased among children

He warned about the situation of children and people who are immunosuppressed, with reduced defenses, “who with little exposure time could become infected, sometimes even unaware that the chance contact they had had tuberculosis”. According to the report, 32 cases of tuberculosis were detected in children under five years of age, corresponding to a notification rate of 6.2 cases per 100,000 children, according to a report.

It is “an increase in the incidence rate compared to 2021 (6.1 cases per 100 thousand children aged between zero and five) and 2020 (4.8 cases per 100 thousand children). Eight of the children (25%) with tuberculosis reported in this age group they were vaccinated with BCG. The majority of tuberculosis cases occurred in Portuguese children (81.3%), with cases also being recorded in children from Brazil, Germany, Angola, France and Uzbekistan.

The director of the PNT, Isabel Carvalho, highlighted that, despite the increase in incidence, there are “small numbers” and highlighted the fact that there are “no cases of meningeal tuberculosis” which is the purpose of the BCG vaccine. “We have two cases of disseminated tuberculosis, which is also a serious form of the disease, but what I think is relevant is that there continue to be children with tuberculosis, younger children, under the age of six, with tuberculosis and with BCG vaccination. “, said Isabel Carvalho.

The official explained that what happens is that adults with tuberculosis “take a long time to be diagnosed” and end up infecting those who are more susceptible more easily, including children under the age of six, who can develop the infection with less exposure time. .

“They are more likely to progress to active disease (…) and that is why children are a priority if they are exposed to tuberculosis. Priority in their screening and priority in starting preventive treatment, regardless of whether they are infected or not”, he highlighted .

Immigrants most vulnerable to tuberculosis

The majority of tuberculosis cases occur in the native population, but “the proportion of cases in immigrants has had an increasing trend”, explained Isabel Carvalho, representing 30.1% of the total cases reported in 2022. Speaking to the Lusa agency, the director of the PNT stated that “the immigrant population is no longer vulnerable just and exclusively because they are immigrants”.

“They are more vulnerable because they have difficulty accessing healthcare, they are more vulnerable because they may be homeless, they may have other diseases, namely HIV infection or hepatitis, or even have some type of dependency and this still makes them makes them more susceptible to tuberculosis”, he highlighted.

On the other hand, they also do not know how to access healthcare, which, in the case of tuberculosis, is free.

Isabel Carvalho argued that it is necessary for these citizens to be helped so that they know how and where to access healthcare, so that they can make a diagnosis and start treatment if diagnosed. “It is with this aim that we increasingly establish partnerships with community-based organizations and social structures and also with immigrant support services, because in fact it is not just being an immigrant that makes you more susceptible to tuberculosis”, he stressed. she.

The report states that, as in previous years, the largest number of tuberculosis cases in immigrants occurred in citizens from Angola (100), followed by Brazil (71), Guinea-Bissau (66) and Cape Verde (38). For the authors of the report, “the active search for cases through screening for active tuberculosis and latent infection in these populations remains a fundamental strategy for the control and elimination of tuberculosis in Portugal”.

“It’s looking for people who are not yet sick, who are not yet a case of active tuberculosis, but who are unaware that they are infected and who, if they undergo preventive treatment, which is much simpler than treating active tuberculosis, may not develop the disease in the future”, explained Isabel Carvalho.