An apple a day to keep TB away - IDSA

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IDSA's Journal Club, which informs readers about important new infectious diseases research, is now available on Science Speaks.

According to the World Health Organization, tuberculosis was the 16th leading cause of death worldwide in 2021 and the second leading cause of deaths by infectious etiology after COVID-19. In India, there were approximately 3 million new cases of TB and 494,000 deaths in 2021, accounting for 27% of global TB cases and 35% of global TB deaths. In addition, undernutrition has been found to have an association with TB incidence and mortality. 

A recent study in The Lancet looked at whether it was possible to reverse this association. Between 2019 and 2021, 2,800 adult patients with TB in Jharkhand, India, received food rations for 6 months. The patients' households were divided into a control and an intervention group, with the latter also receiving the locally available and culturally acceptable food rations for 6 months. There were 10,345 household contacts, with 5,328 in the intervention group and 4,283 in the control group. A total of 34% of households had undernutrition.  

Of the 218 incident cases of TB diagnosed in household contacts, 122 were in the control group (2.6%) and 96 in the intervention group (1.7%). There was a median time to diagnosis of 1.4 years, which was similar in both groups. This translates into a relative reduction of TB in all forms of 39% and pulmonary TB of 48% in the intervention group. In addition, the prevalence of underweight adults declined 5% in the control group but 11% in the intervention group. Approximately 30 households (and 111 household contacts) would need to get food rations to prevent one incident TB case. The authors cited the food rations as "low cost," but there was no detailed cost analysis to outline food ration costs versus the costs associated with one TB case.

Given the mortality and the infectivity of TB, distributing food rations to prevent this infection seems like a win on multiple levels.

(Bhargava et al. The Lancet. 2023;402:627-640.)

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