Joan Caylà: "Catalonia is the region with the most cases of tuberculosis in the state."

BarcelonaJoan Caylà (Badalona, ​​​​1952) is president of the Barcelona Tuberculosis Research Unit (UiTB) and for 23 years was the head of the epidemiology service at the Barcelona Public Health Agency. He has published more than 200 scientific articles on infectious diseases such as COVID-19, HIV, and tuberculosis, of which there was a major outbreak in Catalonia last year, with more than 25 people affected, which is still under investigation.

Are tuberculosis cases increasing?

— Yes, 10.8 million cases are detected worldwide each year, of which 1.25 million result in death, especially in the poorest countries. We're also seeing an increase in diagnoses in Western European countries, and in our country, we're seeing an increase in cases among socially and economically vulnerable people. These people tend to live in poor neighborhoods in large cities like Madrid and Barcelona and are more difficult to treat because they have several additional risk factors. Many of them are not connected to the healthcare system, are malnourished, or use drugs, for example.

What's going wrong that's causing cases to increase?

— The current situation is Kafkaesque. On the one hand, we have the best rapid diagnostic tools and the shortest and most effective tuberculosis treatments in history. On the other hand, cases are increasing. What is clearly failing are prevention and control programs. More public health resources are needed to properly track contacts and break the chains of infection. It's absurd that with the tuberculosis control techniques we have today, there are more cases.

Should the general population be concerned about this situation?

— It's good for people to know that it's currently the most deadly infection worldwide, and that Spain has the second-highest incidence rate among Western European countries. Furthermore, Catalonia is the autonomous community with the most cases in Spain; there may be between 700 and 900 cases each year. One factor may be the large immigration from countries where the prevalence of the disease is high, but there are certainly other factors at play. Next up are Galicia, which historically has always been the most common, and the Basque Country.

Therefore, more public health policies are needed everywhere.

— Yes, we had high hopes that after the pandemic, epidemiological surveillance and the control of notifiable diseases, such as tuberculosis, would improve. More epidemiologists and public health nurses are needed. The plan for the prevention and control of tuberculosis was approved in 2019, but the outbreak of COVID-19 halted its rollout. Resources were allocated to the health crisis at that time, and the current reality is that there is a shortage of personnel in every community.

What should someone do when they become infected with tuberculosis?

— It's an infectious disease transmitted through tiny droplets expelled when a person speaks, coughs, or sneezes, and primarily affects the lungs. It's very important that these people receive treatment and recover, because if they don't, they will spread the infection to others. If someone is found to be infected and doesn't comply, they must be admitted to a specialized center to monitor their treatment and ensure the person is no longer contagious. In very extreme cases, a court order must be requested for mandatory admission to police custody, but these situations are very rare.

What happened last year with the outbreak that is still under investigation?

— It was a much larger outbreak, with more than 25 people affected. This patient wasn't receiving treatment and was addicted, so when he went to drug treatment rooms, he infected more people in a setting that makes contact tracing very difficult. For other reasons, he ended up in prison and received treatment there, but in the meantime, he infected many people, and monitoring is still ongoing in case there are more patients linked to this outbreak, especially people with latent tuberculosis infection.

What does this type of infection consist of?

— These are people who become infected, show no symptoms, and have a small chance of developing active tuberculosis later in life, some even later in life. Of these, 90% will not develop the disease, but 10% will, which is why it's so important to conduct contact tracing, detect them early, and ensure they receive treatment before they begin to infect others.

And focus on those environments where there is more vulnerability.

— Obviously. Eradicating tuberculosis today is a utopia because a high percentage of people worldwide have the latent disease, and cases are more common among individuals for whom contact tracing is more difficult. In Barcelona, there are increasingly more homeless people, but it's also more common in other large cities in Catalonia, and among these groups, the incidence of diseases like this is always higher. It would be necessary to systematically and organizedly review these groups, as they have a much higher incidence than the general population.