COVID-19 Pandemic Affected on Global Tuberculosis Epidemic

COVID-19  Pandemic  Affected  on  Global  Tuberculosis  Epidemic 

Attapon  Cheepsattayakorn1,3*, Ruangrong  Cheepsattayakorn2, Porntep  Siriwanarangsun3


1. 10th  Zonal  Tuberculosis  and  Chest  Disease  Center, Chiang  Mai, Thailand.

2. Department  of  Pathology, Faculty  of  Medicine, Chiang  Mai  University, Chiang  Mai, Thailand.

3. Faculty  of  Medicine, Western  University, Pathumtani  Province, Thailand.

Correspondence to: Attapon  Cheepsattayakorn, 10th  Zonal  Tuberculosis  and  Chest  Disease  Center, 143  Sridornchai  Road  Changklan  Muang  Chiang  Mai  50100  Thailand Tel : 66  53  140767 ; 66  53  276364 ; Fax : 66  53  140773 ; 66  53  273590 ; Email : 


© 2023 Attapon  Cheepsattayakorn. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 01 November 2023

Published: 16 November 2023

COVID-19 Pandemic Affected on Global Tuberculosis Epidemic

Between  2005  and  2019, globally, annual  tuberculosis (TB, caused  by  Mycobacterium  tuberculosis (M  tuberculosis  or  M  tb))  death (around  50 %  of  cases)  decreased  regularly  and  appeared  1.4  million  of  death  in  2019 [1], whereas  TB  deaths  were  back  to  1.5  million  and  1.6  million  in  2020  and  2021, respectively [1].  In  2020, global  TB  notification  rate  substantially  dropped  approximately  18 %, compared  with  2019’s  rate [1], whereas  a  partial  recovery  was  noted  in  2021 [1].  Characteristically, the  disease  affects  the  lungs  with  predominantly  among  adult  men [1].   Geographically, the  TB  incidence  and  mortality  is  high  in  African  and  Asian  countries (Figure  1A, 1B) [1].  In  addition  to  the  impact  of  global  COVID-19  pandemic  on  global  TB  incidences  and  deaths, immunological  responses  in  humans  is  also  affected  by  COVID-19  and  TB  coinfection (Figure 2) [2].  Affection  of  immune  responses  in  COVID-19  and  TB (latent  tuberculosis  infection (LTBI))  coinfection  was  indicated  in  a  previous  systematic  review  of  4-cross-sectional  studies  that  COVID-19-  or  SARS-CoV-2-antigen  responsiveness, CD4-T-cells-specific-against  SARS-CoV-2  or  COVID-19, and  lymphocyte  counts  reduced  among  patients  with  COVID-19  and  active  TB (Figure 2) [2].  Several  recommendations  focus  on  the  following : 1) maintaining  minimal  TB  surveillance, TB  infection  prevention  and  control, and  TB  health  services, 2) leveraging  laboratory  capacity  mechanisms  of  TB  contact  tracing, 3) incorporating  digital  health  technologies, 4) considering  routine-immunization-  and  latent-TB-infection-screening-catching-up-activities, 5) considering  simultaneous  testing  for  COVID-19  and  TB, and  6) securing  BCG-vaccine  stocks  and  its  supply  chain [3]. 


In  conclusion, Immune  responses  in  TB  and  COVID-19  coinfection  is  depended  on  both  innate  and  adaptive  immunity  and  is  complex.  The  current  evidence  demonstrates  that  LTBI  patients  demonstrate  positive  immunomodulation  against  COVID-19.  Active-TB  patients  might  have  lower  lymphocyte  function  and  a  lower  SARS-CoV-2-specific  or  COVID-19-specific  responses.  Further  urgent  longitudinal  studies  are  needed  to  fill  several  knowledge  gaps.  Lessons  learnt  from  the  COVID-19  pandemic  can  assist  in  the  creation  of  the  future  national  TB  control  program.                     


Figure 1 : Demonstrating  A : Estimated TB incidence rates (2021). B : Estimated TB mortality rates in HIV-negative people (2021). C : Global trends in the estimated number of incident TB cases (left) and the incidence rate (right) (2000–2021) (shaded areas represent uncertainty intervals. The horizontal dashed line shows the 2020 milestone of the End TB Strategy). D : Global trends in the estimated number of deaths caused by TB (left) and the mortality rate (right) (2000–2021) (shaded areas represent uncertainty intervals. The horizontal dashed line shows the 2020 milestone of the End TB Strategy) [1].


Figure  2 :  Demonstrating  the immune response in COVID-19 and active tuberculosis. The Th1 response potentiates macrophage activity and the Th17 response favors the recruitment and activation of neutrophils with release of harmful products to the host tissue, further exacerbating the inflammatory process. To appease these responses, an elevated production of IL-10 and differentiation of Treg occurs, however, this generates a low immunologic potential. This response caused by M. tuberculosis generates an unfavorable immune microenvironment for the response against SARS-CoV-2 [2].



1.Falzon  D, Zignol  M, Bastard  M, Floyd  K, Kasaeva  T.  The  impact  of  the  COVID-19  pandemic  on  the  global  tuberculosis  epidemic.  Frontiers  in  Immunology  2023. 

DOI : 10.3389/fimmu.2023.1234785 

2.Flores-Lovon  K, Ortiz-Saavedra  B, Cueva-Chican?a  LA, Aperrrigue-Lira  S, Montes-Madariaga  ES, Soriano-Moreno  DR, et  al.  Immune  responses  in  COVID-19  and  tuberculosis  coinfection : a  scoping  review.  Frontiers  in  Immunology  2022. 

DOI : 10.3389/fimmu.2022.992743 

3.Jeong  Y, Min  J.  Impact  of  COVID-19  pandemic  on  tuberculosis  preventive  services  and  their  post-pandemic  recovery  strategies : a  rapid  review  of  literature.  J  Korean  Med  Sci  2023  Feb 6; 38 (5) : e43. DOI :   

Figure 1

Figure 2