TB in Brazil - Burden, control & the impact of COVID

Burden of TB in Brazil

Brazil is one of the 30 high TB burden countries. In 2019 the estimated TB incidence was 96,000. But Brazil is also one of the 30 countries with a markedly lower incidence rate per head of population of 46.

In 2019 an estimated 1,800 HIV positive people died due to TB disease , and an estimated 4,900 HIV negative people also died. 1“Global TB Report 2020”, WHO, 2020, https://www.who.int/tb/publications/global_report/en/.

History of Brazil's Response to TB

TB is believed to have assumed epidemic proportions in the indigenous population after the permanent contact of Brazilian Indians with the Jesuits and colonists infected by the "white plague".

Two Portuguese Jesuit priests (Manuel da Nobrega and Jose de Anchieta) who arrived in Brazil around 1549 and who established the city of Sao Paulo were the first individuals known to be "carriers" of TB. They both died of the disease. 2St. Jose de Anchieta SJ,  https://www.jesuit.org.uk/

The Brazilian fightback against TB began in 1889 with the "Brazilian League Against Tuberculosis" and the Sao Paulo's League Against Tuberculosis, both founded in 1899. The Brazilian League spread throughout Brazil  and the aim was to introduce in the country scientific methods of treatment and prevention that were in vogue in Europe.3Miguel Aiub Hijjar, "Retrospect of tuberculosis control in Brazil", 2007, https://pubmed.ncbi.nlm.nih.gov/18038091/

In the first half of the twentieth century between 1900 and 1945 the mortality from TB was stationary. Then between 1945 and 1985 there was a marked decline of 7% per year.4Jose Leopoldo Ferreira Antunes, "Tuberculosis in the twentieth century: time-series mortality in Sao Paulo, Brazil, 1900-97", 1999, http://www.scielo.br

Control of the disease

It was only by the 1960s that there had been significant achievements in the control of the disease..5Miguel Aiub Hijjar, "Retrospect of tuberculosis control in Brazil", 2007, https://pubmed.ncbi.nlm.nih.gov/18038091/

This was as a result of:

  • mandatory BCG vaccination,
  • inclusion of TB among diseases of compulsory notification,
  • free means of prevention, diagnosis and treatment,
  • expansion of treatment to the less populated regions of the country,
  • rehabilitation of infected patients,
  • and the stimulation of scientific research.

The Following Decades with TB in Brazil

In the following decades there was successful control of the disease, with reductions of 2% to 4% a year.

TB and drug resistant TB in cities in Brazil 2014 ©SciEL

TB and drug resistant TB in cities in Brazil 2014 ©SciEL

At this time old sanatoriums were tranformed into hospitals where hospitalizations occurred only in selected cases.

The decentralization of public health policies was only achieved after the creation of the Brazilian Unified National Health System (SUS) in 1988.

However, since the early 1990s, a number of factors including:

  • the HIV/AIDS epidemic:
  • the deterioration of socioeconomic conditions:
  • insufficient funding:
  • and the disruption of health systems,

have resulted in an alarming increase in the number of TB cases in Brazil and worldwide. Amongst other things this resulted in the World Health Organisation declaring TB to be a global health emergency in 1993.

COVID-19 Another Health Emergency

In 2020 there was to be another health emergency with the arrival of COVID. In April 2020 a flood of COVID deaths forced gravediggers to dig mass burials. By April 2021 similar scenes are being repeated throughout Brazil.

Since the start of 2021 a second wave has pushed Brazil over the total of 300,000 deaths. In April there was a record 4,247 deaths on one day alone. It is expected that before the end of April 2021 there could be more than 5,000 deaths in a single day.6Charlotte Peet, 'out of control': Brazil's COVID surge sparks regional fears, Aljazeera, 2021, https://www.aljazeera.com/news/2021/4/10/out-of-control-brazils-covid-surge-sparks-regional-fears

It is currently unclear what the impact of this will be on TB control in Brazil.

COVID & Children

Between February 2020 and 15th March 2021 Covid-19 officially killed at least 852 of Brazil's children up to the age of 9. But it is also estimated by some doctors that more than twice this number have died.7Nathalia, P, "Why are so many babies dying of Covid-19 in Brazil", BBC Brazil, 2021, https://www.bbc.co.uk/news/world-latin-america-56696907 

Page Updating

This page was last updated in May 2021.
Author Annabel Kanabus

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