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Effects of COVID-19 pandemic on pediatric tuberculosis: decrease in notification rates and increase in clinical
Andrea Lo Vecchio1, Sara Maria Scarano2, Chiara Amato2
1Department of Translational Medical Sciences - Section of Pediatrics, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy. andrea.lovecchio@unina.it.
Insights
The COVID-19 pandemic led to fewer tuberculosis diagnoses in children, but those diagnosed had more severe disease. This suggests delayed diagnosis and underreporting, not reduced transmission, as children sought care only when critically ill.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted global healthcare systems.
- Access to medical care, including for non-COVID-19 conditions like tuberculosis, was reduced.
- Tuberculosis notification rates have globally decreased during the pandemic.
Purpose of the Study:
- To compare tuberculosis incidence and disease severity in children before and during the COVID-19 pandemic.
- To investigate the impact of the pandemic on pediatric tuberculosis diagnosis and clinical presentation.
Main Methods:
- A cohort study was conducted involving children diagnosed with tuberculosis between January 1, 2010, and December 31, 2021.
- Disease severity was assessed using established criteria, including smear positivity, symptoms, lung cavitation, extrapulmonary involvement, respiratory failure, and intensive care needs.
- Tuberculosis notification rates were analyzed pre-pandemic (2010-2019) and during the pandemic (2020-2021).
Main Results:
- A total of 168 children were diagnosed with tuberculosis; 156 before the pandemic and 12 during.
- The annual tuberculosis notification rate dropped by 73% in 2021 compared to 2019.
- Children diagnosed during the pandemic exhibited significantly higher disease severity, with increased rates of respiratory failure and need for intensive care.
Conclusions:
- The COVID-19 pandemic was associated with a reduced tuberculosis notification rate in the pediatric population.
- A significant increase in pediatric tuberculosis disease severity was observed during the pandemic.
- These findings suggest diagnostic delays and underreporting, rather than reduced transmission, contributed to the observed trends.
Abstract:
The outbreak of COVID-19 resulted in a decrease in tuberculosis notification rates globally. We compared tuberculosis incidence rates and disease severity in children seen in our centre prior and during COVID-19 pandemic.We performed a cohort study enrolling children aged under 18 years who received a diagnosis of tuberculosis (January 1st, 2010-December 31st, 2021) at our Pediatric Infectious Diseases Unit. Disease severity was evaluated based on: the classification proposed by Wiseman et al., smear positivity, presence of symptoms at presentation, lung cavitation, extrapulmonary disease, respiratory failure and need for intensive care support. Overall, 168 children (50.6% female, median age 69 months, IQR 95.4) received a diagnosis of tuberculosis, 156 (92.8%) between 2010-2019, before COVID-19 outbreak, and 12 (7.2%) between 2020-2021, during the pandemic. The annual tuberculosis notification rate dropped by 73% in 2021 (0.38/100000, 95%CI 0.1-0.96) compared with 2019 (1.46/100000, 95%CI 0.84-2.37). Compared to the pre-pandemic period, the proportion of children classified as severe was higher in 2020-2021 (5, 41.6% vs 23, 15.7%, p = 0.006) with a higher rate of respiratory failure (2, 16.7%, vs 4, 2.6%, p = 0.01) and an increased need for intensive care support (1, 8.3% vs 1, 0.6%, p = 0.01). Conclusion: During COVID-19 pandemic we observed a reduction in tuberculosis notification rate in pediatric population and a significant increase in disease severity. This scenario may be the consequence of a delay in diagnosis and an underreporting of cases, rather than the effect of a reduced transmission of tuberculosis. Children reached health-care services only in the need of urgent medical attention. What is Known: • COVID-19 pandemic had a huge impact on national health care systems, resulting in a reduction of access to medical care. What is New: • In Campania Region, Italy, a low tuberculosis incidence country, we witnessed a 75% reduction in tuberculosis notification rate during pandemic. In parallel we demonstrated a significant increase in disease severity, suggesting that the reduction in notification rate may be attributed to an underreporting of cases and consequential diagnostic delay, rather than a reduced transmission of infection.
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