-Automatic translation

The highlight of the TB epidemic in Iceland was before medical treatment started. However, the results showed that more people traveled to Europe later than in the fourth decade of the 20th century. In the fifth and sixth decades, drugs emerged which to this day are at the core of the treatment of tuberculosis, i.e. tuberculosis that is sensitive to normal treatment. As a result, fewer TB cases and fewer new infections were started. Over the past 3 decades, the incidence of TB in Iceland has been around 2–5 cases per 100,000 inhabitants each year, with the lowest in Europe. Much of the cases have occurred in Iceland in the past decades, mostly in adulthood, but the resurgence of infection among elderly people who were likely to become infected in Iceland at a young age has played a role in cases in Iceland up to the present. Very few cases in the past 20 years have been attributed to recent domestic infections, but for decades infection has been traced when infectious tuberculosis emerges, offering preventive treatment to those who have contracted tuberculosis that significantly reduces the chance of bacteria colonizing and causing later disease.

Tuberculosis is thriving because war, poverty, famine, and other crises, such as a severe HIV epidemic, interfere with health care and overall health. The global COVID-19 pandemic has led to a reduction in the effectiveness of the fight against tuberculosis, which was on the way widely before 2020. Transport restrictions, curfews, changes in prioritization of health services, relocation of staff to other tasks, etc. have all contributed to the worst-case scenarios under-diagnosis for 2020-2021. It is estimated that around 4 million people with TB did not receive diagnosis and treatment in 2021 or about 40% of all people who became ill with TB that year. In some places, where access to other health services may be scarce but TB has been a priority, this is less noticeable. In S-Africa, for example, TB treatment centers were activated to combat COVID-19 and both infections were systematically searched for when patients sought treatment for respiratory symptoms.

In the former Soviet Union and throughout the world, problems with the availability of drugs, access to diagnosis and treatment with drugs, etc., have led to the emergence of strains of tuberculosis with reduced susceptibility to the drugs that have been most important in the fight against tuberculosis in Iceland and elsewhere. Such strains have so far been extremely rare in Iceland, but have occurred among individuals from areas where drug resistance is a well-known problem.

The treatment of resistant tuberculosis has been extremely complex and long-term, and many drugs with very serious side effects have been used, but in the last 5–10 years new drugs and new research have been developed on the use of older drugs, which have revolutionized the quality of life and prognosis of patients with resistant tuberculosis. Because resistance also discourages prophylaxis, early detection and appropriate treatment of people with resistant tuberculosis are highly desirable, reducing the risk of exposure for weeks or months and reducing the spread of resistant strains. With these new treatments and more sensitive, acute diagnostic methods, the hope that TB can be eradicated has been revived.

See also:

• World TB Day 2023 (WHO)

• Ending tuberculosis in Europe - resetting the course in the post-COVID-19

• ECDC

The Chief Epidemiologist