{:en}Tuberculosis (TB) and Corona Virus Disease (COVID-19) are infectious diseases that infect the respiratory tract. Tuberculosis is caused by Mycobacterium tuberculosis while COVID-19 is caused by SARS CoV-2. Transmission of the disease is through coughing, sneezing and close contact with infected individuals. Tuberculosis disease has spread throughout the world and it is reported that Indonesia is ranked second in the world (543,874 cases), so, serious attention is needed by various sectors to suppress the transmission and elimination of this disease. During the COVID-19 pandemic during the last two years there were indications of COVID-19 coinfection in pulmonary tuberculosis patients, this was due to the risk and severity caused by COVID-19 disease and the high risk of death due to the development of new diseases in TB patients.

Data released by the Ministry of Health of the Republic of Indonesia related to the development of TB cases shows a fluctuating trend over the past decade. In 2020, the incidence of TB cases in Indonesia increased to 845,000 with a mortality of more than 98,000 people. Furthermore, in 2021 there was a decline in cases reaching 2.04% from the previous year as many as 393,323 cases as a result of the government’s attention being focused on reducing the incidence of COVID-19. However, WHO determined that Indonesia urgently needed to carry out epidemiological surveillance of TB disease during the COVID-19 pandemic, this was due to a decrease in monthly and quarterly TB notifications and the first half of 2021 substantially decreased from 2019 in most countries with the highest TB burden. . Reportedly, a relative reduction in annual notifications between 2019 and 2020 was seen in Gabon (80%), the Philippines (37%), Lesotho (35%), Indonesia (31%) and India (25%) so that the real number of TB cases is estimated much higher than those found and treated and a decline in 2021 presumably many cases go unreported.

Taking into account the updated information released by the World Health Organization, secondary data-based epidemiological surveillance was carried out by utilizing regional data reports released annually. The data used is the number of confirmed cases of positive TB and COVID-19 in the East Java Province and compared with each other with other factors or determinants. Geographical mapping of the distribution of cases of tuberculosis and COVID-19 was also carried out using the Quantum Geographic Information System (QGIS) to identify areas that have the potential to have the highest level of risk and severity of these two diseases. There are several indicators that are reviewed for the correlation between these two diseases, including: the correlation between the incidence and mortality rates of tuberculosis and COVID-19 cases, the relationship between case cure rates and death rates for tuberculosis cases, the incidence and success rates of tuberculosis treatment, the correlation between treatment success rates. and the death rate of tuberculosis cases, the rate of case recovery, and the death rate of COVID-19 cases as well as the calculation of geographical factors including the ratio of puskesmas, the number of doctors, nurses, midwives, public health workers, environmental health workers, nutritionists, and pharmacists and all ratios are calculated per 100,000 inhabitants.

The results of the study obtained that the incidence of tuberculosis in East Java Province in 2020 was 95.49/100,000 population with varying case cure rates. TB cases are dominated by the male sex community. The number of women in East Java in 2020 reached 20,374,104, while men reached 20,291,592. The population with tuberculosis which is dominated by women is only found in Probolinggo district with a higher number of women (604) than men (561). Furthermore, the highest infection rate was found in Madiun (296.51/100,000 population), while the lowest was in Malang (0.07/100,000 population). The incidence ratio of tuberculosis cases based on gender was found for men (117.66/100,000 people) higher than women (93.49/100,000 people). The district with the highest incidence of tuberculosis in males is Madiun (342.62/100,000 population) and the lowest is Pacitan (57.88/100,000 population). Furthermore, in the female gender, the highest incidence of tuberculosis was in Pasuruan (223.16/100,000 people) and the lowest was in Pacitan (93.49/100,000 people). Based on the findings, the highest incidence of COVID-19 infection was found in Mojokerto (789.9/100,000 population), while the lowest was found in Sampang (52.5/100,000 population). Analysis by gender found that the incidence of COVID-19 in women (210.74/100,000 population) was higher than that of men (198.04/100,000 population). Meanwhile, the regency with the highest male population is in Mojokerto (744.46/100,000 people), while the lowest is in Sampang (48.58/100,000 people). The district with the highest incidence of COVID-19 in women is Mojokerto (804.51/100,000 people), while the lowest is in Madiun (51.14/100,000 people). The overall death rate for tuberculosis cases in East Java Province in Indonesia is 3.6%. The highest TB infection CFR was found in Probolinggo (7%), while the lowest was found in Surabaya (0.4%). Meanwhile, the highest CFR of COVID-19 infection was found in Pasuruan (11%), while the lowest was found in Tulungagung 2.1%. Furthermore, the highest cure rate for tuberculosis cases was in Magetan (96.6%), while the lowest was in Batu City (11.3%). Meanwhile, the COVID-19 Case Recovery Rate is defined as a COVID-19 patient with a positive result at the beginning of the RT-PCR, and a negative result at the end of the examination. The highest cure rate for COVID-19 cases was in Sidoarjo (92.6%), while the lowest was found in Tuban (64.5%). The highest success rate of tuberculosis treatment was in Magetan (95.97%), while the lowest was found in Bondowoso (65.89%). Calculation of the number of COVID-19 cases based on age group obtained the highest age in the range of 46-59 years (23,947 individuals), while the lowest was found in the age of 3-6 years (771 individuals).

In this study, it was reported that there was no significant relationship between the incidence and mortality of tuberculosis cases (p = 0.912, p>0.05). It was also found that there was no significant relationship between the incidence and case fatality rates for COVID-19 (p = 0.219, p > 0.05), case cure rates and case fatality rates for tuberculosis (p = 0.698, p > 0.05). , incidence and success rate of tuberculosis treatment (p = 0.795, p > 0.05), treatment success rate and death rate of tuberculosis cases (p = 0.659, p > 0.05), and case recovery rate and case fatality rate for COVID -19 (p = 0.164, p > 0.05). The difference in the number of male and female tuberculosis patients (p = 0.202, p > 0.05) and COVID-19 (p = 0.942, p > 0.05) was not significant. Calculation of geographic data consisting of the ratio of the number of puskesmas, doctors, nurses, midwives, public health workers, environmental health workers, nutritionists and pharmacists, as well as the incidence of HIV in the area. As a result, the number of health workers per 100,000 population was significantly correlated with the incidence of tuberculosis (p < 0.05). These variables were positively correlated with the incidence of tuberculosis and subsequent findings that the incidence of HIV was correlated with the incidence of tuberculosis (p < 0.05). Furthermore, the case cure rates between TB and COVID-19 differ significantly. While in the aspect of COVID-19, the incidence of COVID-19 is significantly correlated with the incidence of HIV and the number of health workers (doctors, nurses, public health workers, environmental health workers, nutritionists, and pharmacists). These findings suggest that the government and related sectors should increase the success rate of tuberculosis treatment in order to achieve a reduction in incidence, mortality and transmission in the community. In addition, integrated efforts are needed in increasing the detection of tuberculosis cases from an early age to suppress transmission and realize TB elimination by 2030.

Author: Dr. Budi Utomo, dr., M.Kes; Chow Khuen Chan, Ph.D., Prof. Dr. Ni Made Mertaniasih, dr., MS., Sp.MK(K); Dr. Soedarsono, dr., Sp.P(K)., Shifa Fauziyah, S.Si., M.Ked.Trop; Teguh Hari Sucipto, S.Si., M.Si; Febriana Aquaresta; M.Ked. Klin., Sp. MK; Dwinka Syafira Eljatin, dr; I Made Dwi Mertha Adnyana, S.Si., CMIE

Articles can be accessed at the following link: https://www.mdpi.com/2414-6366/7/6/83/htm

Source: unair.ac.id

Picture Source : Republika{:}{:id}Penyakit Tuberkulosis (TB) dan Corona Virus Disease (COVID-19) merupakan penyakit menular yang menginfeksi saluran pernafasan. Tuberkulosis disebabkan oleh Mycobacterium tuberculosis sedangkan COVID-19 disebabkan oleh SARS CoV-2. Penularan penyakit ini melalui batuk, bersin dan kontak erat dengan individu yang terinfeksi.  Penyakit Tuberkulosis telah menjangkit di seluruh dunia dan dilaporkan Indonesia berada peringkat kedua di Dunia (543.874 kasus), sehingga, diperlukan perhatian serius oleh berbagai sektor untuk menekan penularan dan eliminasi penyakit ini. Saat Pandemi COVID-19 selama dua tahun terakhir terdapat indikasi adanya koinfeksi COVID-19 pada pasien tuberkulosis paru, hal ini disebabkan oleh risiko dan tingkat keparahan yang disebabkan oleh penyakit COVID-19 serta tingginya  risiko kematian akibat perkembangan penyakit baru pada penderita TB.

Data yang dirilis oleh Kementerian Kesehatan Republik Indonesia terkait dengan perkembangan kasus TB menunjukkan tren fluktuatif selama satu dekade terakhir. Pada tahun 2020, kejadian kasus TB di Indonesia meningkat menjadi 845.000 dengan mortalitas lebih dari 98.000 orang. Selanjutnya, tahun 2021 terjadi penurunan kasus mencapai 2,04% dari tahun sebelumnya sebanyak 393.323 kasus sebagai akibat perhatian pemerintah terfokus pada penurunan insiden COVID-19. Namun demikian, WHO menetapkan Indonesia sangat perlu untuk melakukan surveilans epidemiologi penyakit TB pada masa pandemi COVID-19, hal ini disebabkan oleh penurunan pemberitahuan TB bulanan dan triwulanan dan paruh pertama tahun 2021 secara substansial menurun dari tahun 2019 di sebagian besar negara dengan beban TB tertinggi. Dilaporkan, pengurangan relatif dalam notifikasi tahunan antara 2019 dan 2020 terlihat di Gabon (80%), Filipina (37%), Lesotho (35%), Indonesia (31%) dan India (25%) sehingga, jumlah riil dari kasus TB diperkirakan jauh lebih tinggi daripada yang ditemukan dan diobati serta penurunan pada tahun 2021 diduga banyak kasus yang tidak terlaporkan.

Memperhatikan update informasi yang dirilis oleh Organisasi Kesehatan Dunia, dilakukan surveilans epidemiologi berbasis data sekunder dengan memanfaatkan laporan data regional yang dirilis setiap tahunnya. Data yang digunakan yakni jumlah kasus terkonfirmasi positif TB dan COVID-19 yang berada di wilayah Provinsi Jawa Timur dan dibandingkan satu sama lain dengan faktor  atau determinan lainnya. Pemetaan geografis persebaran kasus tuberkulosis dan COVID-19 juga dilakukan dengan menggunakan Quantum Geographic Information System (QGIS) untuk mengidentifikasi wilayah yang berpotensi memiliki tingkat risiko dan keparahan tertinggi dari kedua penyakit ini. Terdapat beberapa indikator yang ditinjau korelasi antar kedua penyakit ini meliputi: korelasi antara tingkat kejadian dan tingkat kematian kasus tuberkulosis dan COVID-19, hubungan antara angka kesembuhan kasus dan angka kematian kasus tuberkulosis, angka kejadian dan angka keberhasilan pengobatan tuberkulosis, korelasi antara tingkat keberhasilan pengobatan dan tingkat kematian kasus tuberkulosis, tingkat pemulihan kasus, dan tingkat kematian kasus COVID-19 serta perhitungan faktor geografis termasuk rasio puskesmas, jumlah dokter, perawat, bidan, tenaga kesehatan masyarakat, tenaga kesehatan lingkungan, ahli gizi, dan apoteker serta semua rasio dihitung per 100.000 penduduk.

Hasil penelitian diperoleh angka kejadian tuberkulosis di Provinsi Jawa Timur tahun 2020 sebesar  95,49/100.000 penduduk dengan angka kesembuhan kasus yang bervariasi. Kasus TB didominasi oleh masyarakat berjenis kelamin laki – laki. Jumlah perempuan di Jawa Timur tahun 2020 mencapai 20.374.104, sedangkan laki-laki mencapai 20.291.592. Penduduk dengan tuberkulosis yang didominasi oleh perempuan hanya ditemukan di kabupaten Probolinggo dengan jumlah perempuan (604) lebih tinggi dibandingkan laki-laki (561). Selanjutnya, tingkat infeksi tertinggi ditemukan di Madiun (296,51/100.000 penduduk),  sedangkan yang terendah di Malang (0,07/100.000 penduduk). Rasio insiden kasus tuberkulosis berdasarkan jenis kelamin diperoleh laki-laki (117,66/100.000 jiwa) lebih tinggi daripada perempuan (93.49/100.000 jiwa). Kabupaten dengan angka kejadian tuberkulosis pada laki-laki tertinggi adalah Madiun (342,62/100.000 penduduk) dan yang terendah terdapat di Pacitan (57,88/100.000 penduduk). Selanjutnya, pada jenis kelamin perempuan angka kejadian tuberkulosis tertinggi di Pasuruan (223,16/100.000 jiwa) dan terendah di Pacitan (93,49/100.000 jiwa). Berdasarkan temuan, angka kejadian infeksi COVID-19 tertinggi ditemukan di Mojokerto (789,9/100.000 penduduk), sedangkan terendah ditemukan di Sampang (52,5/100.000 penduduk). Analisis berdasarkan jenis kelamin diperoleh tingkat kejadian COVID-19 pada perempuan (210,74/100.000 penduduk) lebih tinggi daripada laki-laki (198,04/100.000 penduduk). Sedangkan Kabupaten dengan jumlah penduduk laki-laki tertinggi di Mojokerto (744,46/100.000 jiwa), sedangkan terendah di Sampang (48,58/100.000 jiwa). Kabupaten dengan angka kejadian COVID-19 pada perempuan tertinggi adalah Mojokerto (804,51/100.000 jiwa), sedangkan yang terendah terdapat di Madiun (51.14/100.000 jiwa). Angka kematian kasus tuberkulosis secara keseluruhan di Provinsi Jawa Timur di Indonesia adalah 3,6%. CFR infeksi TB tertinggi ditemukan di Probolinggo (7%), sedangkan terendah ditemukan di Surabaya (0,4%). Sementara itu, CFR infeksi COVID-19 tertinggi diperoleh di Pasuruan (11%), sedangkan terendah ditemukan di Tulungagung 2,1%. Selanjutnya, angka kesembuhan kasus tuberkulosis tertinggi terdapat di Magetan (96,6%), sedangkan terendah di Kota Batu (11,3%). Sementara itu, Case Recovery Rate COVID-19 didefinisikan sebagai pasien COVID-19 dengan hasil positif pada awal RT-PCR, dan hasil negatif pada akhir pemeriksaan. Angka kesembuhan kasus COVID-19 tertinggi terdapat di Sidoarjo (92,6%), sedangkan terendah ditemukan di Tuban (64,5%). Tingkat keberhasilan pengobatan tuberkulosis tertinggi terdapat di Magetan (95,97%), sedangkan terendah ditemukan di Bondowoso (65,89%). Perhitungan jumlah kasus COVID-19 berdasarkan kelompok umur diperoleh usia tertinggi di kisaran 46-59 tahun (23.947 individu), sedangkan terendah ditemukan pada usia 3-6 tahun (771 individu).

Pada studi tersebut, dilaporkan tidak ada hubungan yang bermakna antara angka kejadian dan angka kematian kasus tuberkulosis (p = 0,912, p>0,05). Ditemukan juga bahwa tidak ada hubungan yang signifikan antara angka kejadian dan angka kematian kasus untuk COVID-19 (p = 0,219, p >0,05), angka kesembuhan kasus dan angka kematian kasus tuberkulosis (p = 0,698, p >0,05), angka kejadian dan angka keberhasilan pengobatan tuberkulosis (p = 0,795, p >0,05), angka keberhasilan pengobatan dan angka kematian kasus tuberkulosis (p = 0,659, p >0,05), dan case recovery rate dan case fatality rate untuk COVID-19 ( p = 0,164, p > 0,05). Perbedaan jumlah penderita tuberkulosis laki-laki dan perempuan (p = 0,202, p > 0,05) dan COVID-19 ( p = 0,942, p > 0,05) tidak signifikan. Perhitungan data geografis yang terdiri dari rasio jumlah puskesmas, dokter, perawat, bidan, tenaga kesehatan masyarakat, tenaga kesehatan lingkungan, ahli gizi dan apoteker, serta angka kejadian HIV di wilayah tersebut. Hasilnya,  jumlah tenaga kesehatan per 100.000 penduduk berkorelasi bermakna dengan angka kejadian tuberkulosis ( p < 0,05). Variabel tersebut berkorelasi positif dengan angka kejadian tuberkulosis dan temuan selanjutnya tingkat kejadian HIV berkorelasi dengan tingkat kejadian TB ( p <0,05). Selanjutnya, angka kesembuhan kasus antara TB dan COVID-19 berbeda secara signifikan. Sedangkan pada aspek COVID-19, angka kejadian COVID-19 berkorelasi signifikan dengan angka kejadian HIV dan jumlah tenaga kesehatan (dokter, perawat, petugas kesehatan masyarakat, petugas kesehatan lingkungan, ahli gizi, dan apoteker). Temuan tersebut mengisyaratkan pemerintah dan sektor terkait untuk meningkatkan angka keberhasilan pengobatan tuberkulosis guna mencapai penurunan insiden, mortalitas dan penularan di masyarakat. Selain itu, diperlukan upaya terintegrasi dalam meningkatkan deteksi kasus tuberkulosis sejak dini untuk menekan penularan dan merealisasikan eliminasi TB tahun 2030.

Penulis: Dr. Budi Utomo, dr., M.Kes; Chow Khuen Chan, Ph.D., Prof. Dr. Ni Made Mertaniasih, dr., MS., Sp.MK(K); Dr. Soedarsono, dr., Sp.P(K)., Shifa Fauziyah, S.Si., M.Ked.Trop; Teguh Hari Sucipto, S.Si., M.Si; Febriana Aquaresta; M.Ked. Klin., Sp. MK; Dwinka Syafira Eljatin, dr; I Made Dwi Mertha Adnyana, S.Si., CMIE

Artikel dapat diakses pada link berikut: https://www.mdpi.com/2414-6366/7/6/83/htm

Sumber : unair.ac.id

Sumber Gambar : Republika{:}