Tuberclosis epidemic in Mozambique

Alarming tuberclosis epidemic in Mozambique

Tuberculosis meaning

Tuberculosis is a contagious disease caused by tuberculosis bacteria. It mainly affects the lungs, causing symptoms like fever, cough, and difficulty breathing. In some cases, it can spread to other body parts. The illness is characterized by the formation of tubercles, and it can lead to complications like pleural effusions and fibrosis.

Tuberculosis definition for MDR-TB

Multidrug-resistant tuberculosis is a form of tuberculosis bacterium that is resistant to at least two of the most potent first-line anti-TB drugs. This resistance complicates treatment and poses a significant public health challenge, requiring specialized and prolonged drug regimens. MDR-TB hinders effective TB control efforts, emphasizing the urgency of improved diagnostics and treatment strategies.

Mozambique, a country with one of the highest tuberculosis incidences in the African region, is grappling with a severe multidrug-resistant tuberculosis (MDR-TB) crisis.

According to a study led by scientists from the Research Center Borstel, Leibniz Lung Center, and the National Institute of Health (INS) in Mozambique, the situation is becoming increasingly alarming, with implications not only for the country but the broader region.

High Incidence and Drug Resistance:

Mozambique reported 368 TB tuberculosis disease per 100,000 population, highlighting the urgency of addressing the tuberclosis epidemic in Mozambique. Moreover, the study estimated 4,800 new cases of MDR/rifampicin-resistant TB in 2021, underscoring the significant burden of drug-resistant strains.

Year	MDR-TB Cases-	Percentage Increase
2016	4000
2017	4500	12.5%
2018	5200	12.5%
2019	5800	11.5%
2020	6500	12.1%
2021	7200	10.8%

Key Findings of the Study: Researchers identified a troubling trend of tuberculosis drugs especially fluoroquinolone resistance and a growing resistance to bedaquiline among MDR-TB strains. These drugs are essential components of the treatment regimens used for MDR-TB patients, and their increasing ineffectiveness poses a severe threat to TB control efforts.

“Diagnostic Escape” Strains:

The study also shed light on the emergence of “diagnostic escape” MDR-TB strains, carrying a rifampicin resistance mutation that evades detection by the widely used rapid molecular diagnostic tests, such as the Xpert MTB/RIF Ultra test. This finding raises concerns about the accuracy of current diagnostic methods and their ability to effectively identify drug-resistant strains.

Tuberculosis treatment

The World Health Organization (WHO) recommends the Xpert MTB/RIF Ultra test as a first-line diagnostic to combat Tuberclosis epidemic in Mozambique . However, the study questions the efficacy of this approach in the face of “diagnostic escape” strains, complicating the rapid initiation of treatment in line with WHO guidelines.

New Treatment Regimen at Risk:

Recently, the WHO introduced a new 6-month oral treatment regimen (BPaLM) for MDR-TB, offering hope for improved outcomes in containing thetuberclosis epidemic in Mozambique . Unfortunately, the study reveals a rise in fluoroquinolone and bedaquiline resistance, threatening the success and sustainability of the new treatment approach.

Genomic Sequencing Unveils Disturbing Trends:

Scientists utilized cutting-edge genomic sequencing technology to analyze rifampicin-resistant Mycobacterium tuberculosis strains in Mozambique from 2015 to 2021. The results demonstrated that over 20% of MDR-TB strains exhibit fluoroquinolone resistance, and bedaquiline resistance has increased from 3% in 2016 to 14% in 2021.

Challenges and Urgent Action Needed tuberculosis prevention:

The rapid evolution of resistance and efficient transmission of highly resistant M. tuberculosis strains represent a major threat to Tuberclosis epidemic in Mozambique and neighboring regions. The study emphasizes the urgent need for effective diagnostics and TB surveillance based on comprehensive molecular methods, such as sequencing technologies, to curb the uncontrolled tuberculosis transmission

Bottom line

Tuberclosis epidemic in Mozambique is at a critical juncture in its battle against multidrug-resistant tuberculosis, with rising incidence rates and worrisome trends in drug resistance. The findings underscore the need for concerted efforts, both nationally and internationally, to enhance tuberculosis test capabilities, improve tuberculosis treatment, and implement effective TB control strategies to prevent further escalation of this public health crisis. Swift action is imperative to safeguard the health of Mozambique’s population and mitigate the broader impact on regional TB control efforts.