Changing patterns of household transmission of tuberculosis in an eastern state of India: The impact of COVID19 pandemic

BACKGROUND: The COVID-19 Pandemic has affected many components of the Tuberculosis (TB) control program. Due to lockdown and restrictions, people, including TB patients, might have spent more time in the household. There might be an increased TB transmission among the household contacts (HHC). The current study was conducted to measure the household transmission of TB and also find out the relationship with several clinico-social factors. METHODS: Contact tracing data of West Bengal, India, was extracted from Nikshay portal of Central TB Division, Government of India. The anonymized data was divided into two parts, firstly before the lockdown initiation in India and secondly during the lockdown. A modified Poisson regression model was developed to determine the statistical association between clinico-social variables and the pandemic with household-level secondary TB cases. RESULTS: There was a 30% reduction in daily TB case notification, but the proportion of HHC screened was 4% higher during the pandemic than the pre-pandemic period. The secondary attack rate of household TB disease transmission was 34% lower during the pandemic period. Index TB patients aged under ten years, microbiologically positive, Drug-Resistant TB, having three or more HHCs, treatment delay more than seven days, notified from the private sector, and diagnosis during the pre-pandemic period was found to be independently associated with a higher risk of having a secondary TB case at household. CONCLUSION: The risk of household TB transmission was significantly lower during the pandemic period compared to the pre-pandemic period, which may be due to better infection prevention and control practices.