Basic characteristics for a good tuberculosis prevention and control programmes currently in Spain.

Abstract

6 Rev Esp Sanid Penit. 2021;23(1):6-8 doi: 10.18176/resp.00025 It is hard to find another infectious disease that has had more impact on morbidity and mortality throughout human history than tuberculosis (TB). The conditions of the bacillus (slow growth, resistance of the bacterial wall, airborne transmission, very long latency period, non-specific clinical manifestations and insidious onset) make Mycobacterium tuberculosis a germ with almost ideal potential for silent but inexorable growth. A total of ten million cases and one and a half million deaths every year, along with one quarter of the world’s population infected, and therefore at risk of developing the disease, is ample witness to this fact1,2. Neither should we forget the tremendous economic and emotional impact on the people and families who suffer from it, even more so when people with the disease live in countries with precarious healthcare systems. The resources and measures to cope with such a widely neglected bacillus should be applied at local level in each every, province, epidemiologycal surveillance unit and community. At the same time, a global overview of its impact and transmission is also necessary if we wish to overcome it. The first and most essential element in any TB prevention and control programme (TBPCP) should be to frame it within a free and universal healthcare system. It should be able to diagnose cases early, ensure the correct treatment and monitor the disease until the patient is cured. Furthermore, especially in specially in settings of low and medium TB incidence, it is essential to establish censuses and contact tracing of TB cases in different areas and run screening programmes for latent tuberculosis infection (LTBI) in vulnerable populations to prevent to prevent progression to a disease3-6. But the remedy is not an easy one... To ensure that all these activities are carried out by the professionals concerned (epidemiologists, clinical practitioners, microbiologists, nursing staff, healthcare providers...), there needs to be fluid and adequate communication between stakeholders, with constant backup and coordination form the local public health services3,4. For this kind of programme to work effectively, one very necessary figure is that of the skilled public health public health nurse (PHN), working at territorial epidemiologycal surveillance units (ESU). Their main duties consist of conducting epidemiological surveys and coordinating with primary healthcare, hospitals and directly observed therapy (DOTS) teams, to ensure compliance with treatment and the census and the indication of contact tracing. The inclusion of community health workers who act as mediators has given very positive results over the last 20 years in our TBPCP in Barcelona. There, the TB clinical units and the DOTS teams have constantly worked hand in hand with PHN7-10. One major challenge is to reduce the tremendous TB diagnostic delay that favour transmission of the disease in the community. Early detection of persons with pulmonary TB is essential for starting contact tracing, detecting LTBI and prescribing treatment. One basic measure that can help to make this a reality is to increase the levels of suspicion by clinicians working in emergency services and primary healthcare. Another key aspect is to provide specialists in clinical management of the disease who can apply a multidisciplinary approach to their work in hospital TB care units. Such figures should be another basic part of any TBPCP. Fluid communication between ESU and mycobacteriology laboratories, along with regular notification of clinicians, are other essential features that can ensure that the disease is correctly monitored Editorial