2023-06-07 16:38:57
Par Timothée L’Angevin
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In a Isère college, at the University of Rennes 1… at the beginning of June 2023, several cases of tuberculosis were detected in France. Should we see a resurgence in our country of this infectious and bacterial disease which still causes more than a million deaths a year throughout the world?
Christian Lienhardt, medical epidemiologist and research director emeritus at the Research Institute for Development (IRD), specialist in this disease, wants to be reassuring: “There is no return of this disease, which remains present in us at very low levels,” he explains to actu.fr. “And above all, it hardly kills anymore in France. »
How old is this disease?
Which is far from always having been the case. From the moment it was discovered by Robert Koch in 1882, until the middle of the XXe century, it has been responsible for millions of deaths in industrialized countries. And certainly more, since its existence dates back millennia, infectious agents having been found on Egyptian mummies.
Considered a scourge in Europe, it allowed the discovery of the first vaccine in history 102 years ago by Albert Calmette and Camille Guérin, hence its name BCG (bile vaccine of Calmette and Guérin), as well as d antibiotics in the 1940s.
“Since this period, the number of new cases has continued to decline in France, specifies Christian Lienhardt. While there was an incidence rate of 100 patients per 100,000 inhabitants in 1950, there are 8 per 100,000 today. »
Despite these very low rates, tuberculosis has not disappeared.
It was thought to have disappeared in the 1980s, but the HIV pandemic has caused tuberculosis to reappear, particularly in Africa, with incidence rates of 300 to 400 per 100,000 inhabitants.
Where do we find it?
Today, it remains particularly present in Africa and Asia, notably in China, India, Pakistan, Bangladesh, South Africa and Nigeria. It is therefore found in poor areas, such as remote rural areas, and in highly crowded urban areas such as slums.
“In France, people with tuberculosis are mostly migrants who were infected in their country of origin (those with high prevalence of tuberculosisEditor’s note), homeless people who live in very poor hygienic conditions and people who have returned from a trip, ”explains Christian Lienhardt.
According l’OMS10.6 million people developed the disease in 2021 and 1.6 million people died from it (including 187,000 among HIV-positive people), making it one of the top ten causes of death in the world. the world.
How is tuberculosis transmitted?
It is an infectious disease caused by Koch’s bacillus, a mycobacterium that most often affects the lungs, but sometimes also other organs or parts of the body, such as the kidneys, lymph nodes and bones.
“This agent is transmitted by air when patients cough via droplets”, explains the epidemiologist doctor. Inhalation of a small number of contaminated droplets is sufficient to infect an individual. This explains why areas with a high concentration of populations are particularly affected.
According to the Institut Pasteur, an untreated person with tuberculosis can infect 5 to 15 people on average each year.
Once lodged in the lungs, the bacilli “can remain dormant for months or even years”. That is to say that the person is infected without being sick, which greatly complicates his diagnosis. Once they develop, the first symptoms appear.
What are the symptoms ?
The disease being generally pulmonary, the sick person is the victim of a chronic cough with thick sputum, sometimes including a few threads of blood. “It is also manifested by fever, night sweats, weight loss,” insists Christian Lienhardt.
Without treatment, these symptoms can last several weeks to several months. In the case of a person carrying HIV, tuberculosis is fatal in almost all cases, underlines the Pasteur Institute.
What are the treatments ?
First of all, it is about detecting the disease. For symptomatic people, a sputum test, to determine the presence or absence of tuberculosis germs, is very effective and gives the result in less than two hours.
Once the diagnosis is established, there is a treatment that we have been using since the 1960s: four antibiotics (isoniazid, rifampicin, pyrazinamide and ethambutol) to be taken for six months. It costs 50 euros.
And the vaccine?
In France, the vaccine was given to children until 2007. Today, it is simply recommended by the health authorities. For what ? “Because children are not contagious and the end of vaccination has not caused a resurgence of the disease. »
However, in the most affected countries, vaccination is a means put forward by l’Unicef to fight this disease.
Can we die from it?
Tuberculosis still kills today, as the sad figures of the WHO remind us. “But what kills is the lack of screening and access to care, since we have effective and relatively inexpensive treatments,” concludes Christian Lienhardt.
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