New diagnostics and hidden epidemics
“In our protocols we have both blood and skin tests for TB infection,” she says. “Patients from the occupied territory have to do the tests locally – they can’t travel to us, so we’re sending cars to the regions to collect samples and bring them to the hospital to check. It’s dangerous.”
“A local nurse can take the blood, and the driver will bring it with all the other samples in a car, so we can check around 100 patients per day. There’s no need for a patient to come to the hospital. But if we’re doing TST skin tests patients need to come to us personally and then return after two days to check the result. In the occupied territory we don’t have too many healthcare workers who can do that.”
In a war situation, blood-based tests have a major advantage over skin tests as they only require one visit to the doctor to be administered, whereas TST skin tests require visits to get tested and then to get the results. Blood-based tests are also more advanced in terms of sensitivity and are not affected by BCG vaccinations, which almost everyone in Ukraine has had.
New diagnostics and new drugs meant that TB infection rates worldwide had been falling for a long time, but the most recent WHO TB report shows that they’re now increasing again – in part, of course, because of the war in Ukraine. But it’s still a condition that’s preventable and curable.
Does she think we’ll hopefully see it eradicated at some point in the not-too-distant future?
“I’m not optimistic – I believe there are hidden epidemics in some regions,” she says. “Before the war we had COVID and the local restrictions, so we had difficulties with transportation and logistics for about two years. People were sitting in their houses and nobody cared about the reason for their cough – they were just prescribed antibiotics by local doctors. Nobody cared about TB at all during that period, and now we have war. So right now nobody cares about COVID, but they continue to ignore the tuberculosis problem.
“So I think this hidden epidemic means that after the war we’ll have increases in the incidence rate for several years – especially among children. If you have children with TB it means they’ve caught the infection from an adult, so we have to try to trace the contacts. It’s very difficult to do.”
“I see that mortality is increasing and I see more and more active cases among children, which is a bad prognostic sign. But my aim is for our patients to become healthy, and to reduce mortality – especially among children.”