Recovery in cases in France after several years of decline, war in Ukraine among causes

No need to panic yet but “vigilance is required”. According to a study published on Tuesday by Public Health France, in 2023 France experienced a recovery after three consecutive years of decline.

After 5,114 cases were reported in 2019, the pre-Covid year, there was a “sharp decline in cases and reporting rates the year the epidemic occurred”, followed by “the following two years”, it said. A weekly epidemiologic summary bulletin, preceding World Tuberculosis Day on March 24. But 2023 saw a “change in activity, an increase in incidence” (4,728 cases disclosed, according to provisional data), likely associated with “catch-up in diagnosed cases,” the study authors note.

Vaccination is recommended

Airborne, tuberculosis is a highly contagious bacterial infection that most commonly affects the lungs, but can spread to the brain. Despite vaccines and antibiotics, recently supplanted by Covid-19 as the world’s leading cause of death from infection, tuberculosis continues to be a problem. Its persistence in France, even with fewer than 10 cases/100,000 inhabitants, means that the vaccine there is recommended even though it is mandatory.

Regular declines in declared cases (a decline of about 5% per year for half a century) and deaths in the country are sometimes interrupted by “limited and transient increases” linked to external events, the study shows. The war in Ukraine, which led to a significant movement of refugees to Western Europe, thus affected the epidemic. France has implemented active tuberculosis screening for certain refugees arriving from Ukraine, one of the countries with the highest number of cases in Europe.

“Less than 10% of the 118,000 displaced people in France will be screened by anti-tuberculosis centers in 2022,” according to another SPF study, which estimates a prevalence of 197/100,000 cases among them. To explain this limited screening, the authors mention, among other things, the difficulties in reaching certain refugees, who live in “improvised short-term centers” or with locals. And “few people suffer from symptoms”, encouraging people to take care.

Increase in multidrug-resistant tuberculosis

At the same time, a rise in tuberculosis cases with bacilli multi-resistant to key antibiotics was recorded again in France in 2022 after cases from Ukraine and Georgia, another BEH publication showed.

Over the past ten years, however, the treatment of multidrug-resistant tuberculosis has experienced several revolutions, with “the discovery of new anti-tuberculosis drugs, the repurposing of known antibiotics, and the results of several therapeutic trials combining these molecules”.