Catalonia seeks tuberculosis treatment as cases rise

BarcelonaIf the person with tuberculosis doesn't go to the healthcare system, the healthcare system goes to the person with tuberculosis. This is how professionals from the Public Health Agency of Catalonia have been monitoring the disease for years. They travel to areas of extreme social vulnerability to detect cases among people who don't see a doctor very often and have trouble following treatment. However, this makes contact tracing difficult and increases the risk of new infections. In fact, they estimate that one in three tuberculosis patients in Catalonia comes from these areas, either because they are in an irregular situation, barely speak Catalan or Spanish, or have an addiction problem that prevents them from properly completing treatment.

To reach more people, at a time when cases of the disease are on the rise, Public Health has rolled out a new program specifically aimed at people who use drugs. In fact, as the ARA (National Association of Public Health) announced earlier this week, this year epidemiological surveillance professionals have detected a case of extremely resistant tuberculosis who had not been seen in Catalonia for five years. This is a person with a "history of serious social problems and substance use" who was diagnosed with pulmonary tuberculosis in September 2022, but who never completed treatment and the disease became more resistant over the years.

This case is now under control: the affected person has voluntarily entered a specialized health center where he is receiving anti-tuberculosis treatment. The head of the tuberculosis prevention and control service at Public Health, Laura Gavaldà, maintains that this disease requires a three-pronged approach: epidemiological, clinical, and social. This means tracing contacts, caring for the sick, and, in a third of cases, also their determinants.

Therefore, people with addictions are one of the priorities in controlling the disease. Since this year, community public health workers and the General Subdirectorate of Addictions have been working together to ensure that these people, if they have tuberculosis, receive treatment correctly and complete it. They travel to consumption rooms and other settings to proactively detect cases and thus prevent the spread of infection. They are also testing prevention strategies aimed at other vulnerable groups, such as seasonal workers who come to carry out the fruit campaign, to raise awareness about the disease and encourage them to see a doctor if they have symptoms.

Approximately 200 more cases

Tuberculosis is a contagious disease that isbooming worldwide: 10.8 million cases are detected each year, of which 1.25 million end in death, especially in poorer countries, according to the Barcelona Tuberculosis Research Unit (UITB). Gavaldà confirmed that in Catalonia they are also observing an upward trend and, with provisional data for 2024, they estimate that they detected between 150 and 200 more cases than in 2023, when a thousand were detected. Even so, she clarified that this is not "a worrying increase," as the data is somewhat higher than before the COVID pandemic, but she did emphasize that they must be vigilant and more proactive in those vulnerable environments where cases can escape.

The expert has boasted of two strategies against the disease that have been working for years and are already consolidated in Catalonia. On the one hand, genomic sequencing, a technique that allows for the identification of genetic antecedents in tuberculosis cases and determines whether or not they are related. In fact, this is how they detected a major outbreak last year with more than 25 people affected. It did not cause any deaths, but is still under investigation.

The second consolidated program targets migrants, a particularly vulnerable social group. Community agents act as mediators to link them to the healthcare system and act as quickly as possible if a positive tuberculosis case is detected.