Tuberculosis patients in Ukraine at risk, some refugee groups to be tested

Barrier tape of the German Red Cross on a corridor in an emergency accommodation opened for refugees from Ukraine in a former general hospital in Wedel, northern Germany, 05 April 2022. [EPA-EFE/FOCKE STRANGMANN]

Russia’s invasion of Ukraine has put tuberculosis (TB) patients inside the country at high risk due to the lack of access to treatment, while countries receiving refugees have been advised to screen and test certain groups. 

Every year, 10 million people fall ill with tuberculosis, according to the World Health Organisation (WHO). Despite being a preventable and curable disease, 1.5 million people die from TB each year – making it the world’s second most fatal infectious disease after COVID-19, based on information from the European Centre for Disease Prevention and Control (ECDC).

Ukraine is one of the most affected countries. Not only does it have the fourth-highest TB incidence in the WHO European Region, but it also has the fifth-highest number of confirmed cases of extensively drug-resistant TB in the world, as stated in the Lancet.

The estimated TB incidence in Ukraine is over seven times higher than that of EU/EEA countries: 73 per 100,000 people, as compared to approximately 10 in 100,000. In 2020, the country registered over 19,500 cases of TB; the recorded total in the same year for the whole of the EU/EEA was just over 33,000.

“War in Ukraine could worsen what is already one of the world’s most serious TB epidemics”, the Lancet warned, citing concerns from those involved in tackling the disease in the country.

Hans Henri P. Kluge, WHO’s regional director for Europe, said that despite the high number of cases, Ukraine “had been making excellent progress on specific challenges, turning the corner in his fight against tuberculosis,” following a visit to the humanitarian hub of Lviv in western Ukraine on 4 April.

He added that Ukraine was showing the “best practice in Eastern Europe, with TB incidence falling by almost half in the past 15 years, thanks to the investment in modern diagnostic technologies to rapidly identify TB infection and effective treatment regimens for multidrug-resistant tuberculosis”.

“Despite the war, we are determined to support Ukraine and not to lose this momentum,” he said. But this is easier said than done, as hostilities continue.

COVID-19 and Ukraine war reversed gains in fighting tuberculosis

The global number of tuberculosis (TB) deaths increased last year for the first time in over a decade due to disruptions in vaccination and diagnosis created by the COVID-19 pandemic.

TB patients without access to treatment in Ukraine

Russia’s invasion risks the total erasure of all the improvements made in TB prevention, diagnosis, treatment and care, engagement of communities and civil society at the level of tuberculosis response.

“Destroyed health infrastructure, including limited access to tuberculosis and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of preventive treatment, and treatment of active tuberculosis,” WHO Europe’s regional advisor for TB, Askar Yedilbayev, during an event on 21 March.

The key issue of ensuring the continuation of treatment is hard to resolve as the conflict continues. Healthcare centres have been attacked over 100 times and even common diseases are becoming life-threatening due to lack of access to treatment.

The TB medications distributed to regional warehouses before the war are enough for one or two months, Yedilbayev said, but added that access to medicines might be disrupted due to military actions. 

“Thus, there will be a need to ensure emergency redistribution of procurement of medicines to ensure continuity of treatment,” he said. 

He added that undiagnosed and untreated tuberculosis could lead to “very serious public health consequences, such as much lower chances to be cured of tuberculosis and increased death”. 

But providing drugs or any other humanitarian aid remains challenging. Maksym Dotsenko, the director-general of the Ukrainian Red Cross Society, said at a press briefing on 29 March that “we lack the agreements about the ceasefire to be able to help people”. 

WHO: We are seeing the worst case scenario in Ukraine

The WHO warned that people in Ukraine “are going to start dying from common causes”, due to the lack of access to medical care and humanitarian aid, adding that they are now preparing healthcare workers for treating chemical attacks.

Not all refugees need to be tested or screened

Since the Russian invasion, over 4,6 million people have fled Ukraine, according to the UNHCR.

Yedilbayev urged that treatment must be ensured for refugees who fled the war. However, he added that this might be difficult, as “most of the countries in Europe have a low burden of TB, and they have not been prepared to treat a larger number of patients”.

The ECDC, together with WHO Europe, recommended screening and testing for TB disease for certain refugee groups.

TB infection testing is recommended for household contacts of bacteriologically confirmed pulmonary cases, or those who are immunocompromised, while screening for TB disease can be considered for certain groups at higher risk, such as people living with HIV or contacts of TB patients.

Systematic testing of all refugees was not recommended. It was stressed that testing or screening programme needs to balance the benefits “against potential harm, such as stigmatisation, discrimination, resource use, opportunity costs for other interventions and prompt management of other conditions, such as malnutrition, or mental health issues,” the guidelines stated.

Red Cross humanitarian aid cannot reach Ukrainian cities where hostilities continue

Reaching those in need remains the biggest challenge for the Ukrainian Red Cross, especially in frontline places like Mariupol, where dozens of attempts have failed to bring in humanitarian aid.

[Edited by Nathalie Weatherald]

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