Changes in the incidence, clinical features and outcomes of tuberculosis during COVID-19 pandemic

• Published in: Journal of infection and public health Vol. 17; no. 9; p. 102511
• Main Authors: Chan, King-Pui Florence, Ma, Ting-Fung, Sridhar, Siddharth, Lui, Macy Mei-Sze, Ho, James Chung-Man, Lam, David Chi-Leung, Ip, Mary Sau-Man, Ho, Pak-Leung
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2024; Elsevier
• Subjects: COVID-19; Epidemiology; Influenza; Tuberculosis; COVID-19; Tuberculosis; Epidemiology; Influenza
• ISSN: 1876-0341; 1876-035X; 1876-035X
• DOI: 10.1016/j.jiph.2024.102511

COVID-19 pandemic has disrupted tuberculosis (TB) services in many countries, but the impacts on sites of involvement, drug susceptibility, smear positivity and clinical outcomes, and clinical outcomes of co-infection with influenza and COVID-19 remain unclear. Descriptive epidemiological study using episode-based and patient unique data of tuberculosis from Hospital Authority’s territory-wide electronic medical record database, comparing baseline (January 2015-December 2019) and COVID-19 period (January 2020-December 2022), followed by univariate and multivariate analyses. Effects of co-infection with influenza and COVID-19 were investigated. The study included 10,473 episodes of laboratory-confirmed TB, with 6818 in baseline period and 3655 during COVID-19 period. During COVID-19 period, TB patients had a lower proportion of smear positivity (49.2 % vs 54.7 %, P < 0.001), and fewer cases of extrapulmonary TB (7.0 % vs 8.0 %, P = 0.078) and multidrug resistant TB (1.0 % vs 1.6 %, P = 0.020). Mortality was higher in TB patients with COVID-19 coinfection (OR 1.7, P = 0.003) and influenza coinfection (OR 2.6, P = 0.004). During COVID-19 period, there were higher rates of treatment delay (20.5 % vs 15.5 %, P < 0.001) and episodic death (15.1 % vs 13.3 %, P = 0.006). Factors associated with higher mortality included age ≥ 70 years (OR 7.24), treatment delay (OR 2.16), extrapulmonary TB (OR 2.13). smear positivity (OR 1.71) and Charlson comorbidity index score ≥ 3 (OR 1.37). Higher mortality was observed with co-infection by influenza (OR 1.18) and COVID-19 (OR 1.7). The epidemiology and outcomes of TB were changed during COVID-19 period. Mortality was higher during COVID-19 period and with co-infection by influenza and COVID-19.