Global Control of Tuberculosis: Current Status and Future Prospects

Abstract

Tuberculosis is a zoonotic disease that is caused by mycobacterium tuberculosis complex and can infect humans, livestock, and wildlife. It spreads primarily through the respiratory tract and was the leading cause of death due to a single infectious disease before the COVID-19 pandemic. TB is a global public health emergency that has reemerged over the past few decades. Substantial efforts are needed to achieve the goals of the End TB Strategy. The World Health Organization has estimated that approximately 9.9 million people worldwide contracted TB in 2020 and that approximately 140,000 of the 10 million new cases of active TB in 2019 were zoonotic TB. During the COVID-19 pandemic, the number of new TB diagnoses and reports decreased sharply, from 7.1 million in 2019 to 5.8 million in 2020, returning to 2012 levels far below the approximately 10 million TB cases in 2020. Simultaneously, the global decrease in the absolute number of TB deaths until 2019 was followed by an increase in 2020 in four of the six WHO regions and most of the 30 high-TB-burden countries. Therefore, extensive immediate actions worldwide are required to restore the health system, and innovations are needed to accelerate progress toward a tuberculosis-free world.

Main article text

INTRODUCTION

Tuberculosis (TB) is an airborne infectious disease that threatens public health worldwide. Until the advent of COVID-19, which is caused by the SARS-Cov-2 virus, TB was the leading cause of death due to a single infectious agent worldwide, exceeding that due to HIV/AIDS [1]. It is caused by Mycobacterium, a bacterial genus with a wide spectrum of hosts, and differing host susceptibility and infection pathophysiology [2–4]. To differentiate TB in humans and animals, “human tuberculosis” usually refers to Mycobacterium tuberculosis (MTB) infection, whereas “zoonotic tuberculosis” refers to infections in human and animals mainly caused by a closely related species, Mycobacterium bovis [5,6]. Together these and other TB species comprise Mycobacterium tuberculosis complex (MTBC). Most patients with TB (approximately 90%) are adults, and fewer cases occur in women than men [1]. The World Health Organization (WHO) has estimated that 10 million people (range: 8.9–11.0 million) developed TB in 2019, of which 140,000 had new cases of zoonotic TB (range: 69,800–235,000) [7]. Although the disease has slightly declined in recent years, in 2019 alone, approximately 1.2 million people died from TB, and approximately 500,000 people developed rifampicin-resistant TB [7]. This article discusses the current status of global human and zoonotic TB control and future prospects in the context of COVID-19.

TRENDS IN GLOBAL TB

Human TB control and prevention

The history of human infection with TB dates to 3 million years ago [8]. MTB can cause disease in almost any part of the body, but it primarily invades the respiratory tract. Most patients with TB are diagnosed with active pulmonary TB [9,10]. MTB has infected approximately one-third of the population worldwide [11]. Human TB continues to be among the top ten causes of mortality globally, and it is the leading cause of death due to a single infectious agent [7].

After decades-long neglect in mitigating this disease, renewed global efforts to control TB began in 1991, when the WHO declared TB a major global public health problem [12], which was subsequently declared a global emergency in 1993 [13]. Recommendations were released in 1994 for TB control based on directly observed therapy strategy (DOTS) with a short-course regimen [14]. In response to the 2000 United Nations (UN) Millennium Development Goals, with targets to be reached by 2015, the WHO and the global advocacy organization Stop TB Partnership launched historic firsts with the Global Plan to Stop TB 2001–2005 in 2001 and the Stop TB Strategy 2006–2015 in 2006. Importantly, the latter focused on patient-centered care for all TB-infected individuals, rather than on directly observed therapy with a short-course strategy [15].

To better address the global TB epidemic in the post–Millennium Development Goal era, the UN began developing Sustainable Development Goals (SDGs) in 2012. These goals include a target of a TB-free world by 2030 [16]. The World Health Assembly, in 2014, formulated the End TB Strategy [17], which was launched by the WHO in 2015. The WHO and the Stop TB Partnership also published the Global Plan to End TB 2016–2020: The Paradigm Shift [18], and the UN subsequently released the SDGs in 2015, which became official on January 1, 2016. In 2018 the UN held a high-level meeting to address TB and garner strong political support for strengthening TB control measures in the coming years, as well as to define targets and responsibilities to facilitate the End TB Strategy [19]. Accordingly, in 2019, the WHO and the Stop TB Partnership published an updated version of their global plan, the Global Plan to End TB 2018–2022: The Paradigm Shift: Reaching the United Nations TB Targets [20].

Human TB is a global public health emergency [21]. Globally in 2020, approximately 9.9 million people were estimated to have contracted TB, which is equivalent to 127 cases per 100,000 people (detailed information in Fig 1). The epidemic slightly decreased after 2019, and a slow downward trend has continued since 2000 [1]. Worldwide, an estimated additional 100,000 deaths occurred among HIV-negative people in 2020, compared with 1.2 million deaths in 2019, and an additional 214,000 deaths occurred among HIV-positive people, representing a small increase from 209,000 in 2019 [1]. The global decrease in the absolute number of TB deaths until 2019 was followed by an increase in 2020 in four of the six WHO regions and most of the 30 high-TB-burden countries, because of the COVID-19 pandemic [1]. Risk factors are critical at the population level, including poor working and living conditions, which increase the risk of TB transmission, as well as factors that impair immunity to TB infection and disease (e.g., malnutrition, HIV infection, diabetes, alcohol abuse, smoking, and indoor air pollution) [22]. However, TB continues to be overshadowed by diseases such as HIV, malaria, and now COVID-19 [23].

FIGURE 1 |

Estimated TB incidence rates, 2020 (excerpted from Global Tuberculosis Report, 2021, WHO, Geneva).

Advances in human TB treatment

Innovation is crucial for TB control and prevention. The vaccine currently in use was developed in the 1930s, the basic treatment for TB was developed in the 1960s, and the last new anti-TB drug was introduced in many countries approximately three decades ago [24]. The global TB situation is critical, but now is also a time of great promise and discovery for TO BE treatment and prevention [25]. Many substantial changes are on the horizon. For example, the efficacy of M72/AS01E, an adjuvanted protein subunit vaccine, has been demonstrated by clinical trials to prevent the development of active TB in latent TB infection, thus bringing some hope for ameliorating this disease [26].

Furthermore, dramatic changes in the treatment landscape for TB occurred with the introduction of three new drugs and drug regimens over the past decade [27]. For instance, the Nix-TB clinical trial has indicated that an all-oral regimen of bedaquiline, pretomanid, and linezolid (BPaL) has favorable outcomes at 6 months post-treatment, thus suggesting that, if safety management is adequate, the BPaL regimen is a feasible option for patients with highly drug-resistant forms of TB [28]. The BPaL regimen has also been recommend by the WHO for the treatment of multidrug-resistant TB with additional fluoroquinolone resistance [29], thus providing hope for patients with drug-resistant TB.

Finally, system innovations such as digital health technologies are influencing the entire TB patient journey [30]. Digital health and other innovations, if deployed at scale, could help end human TB in the SDG era.

Zoonotic TB control and prevention

Several MTBC organisms, which are present in both animals and the natural environment, can cause zoonotic TB, including M. bovis, M. caprae, M. microti, M. pinnipedii, and M. orygis [31–34]. However, M. bovis is the main causal agent of zoonotic TB in humans [35]. In general, cattle are considered the natural hosts of M. bovis; however, zoonotic TB due to M. bovis and other MTBC pathogens has been reported in other species of domesticated animals and wildlife, and remains a major zoonosis [36]. The most common pathways of transmission to humans are inhalation, consumption of unpasteurized milk, and close contact with infected animals or untreated animal products [37]. For example, in recent years, M. bovis has been confirmed in pastoralists in Nigeria [38]. Reverse zoonoses due to M. tuberculosis, which is transmitted from humans to goats, pigs, and cattle, have also been reported in Nigeria [39], owing to close human and animal contact in most pastures, factories and communities in the country.

After the WHO recognized the implications of zoonotic TB to public health in 1950, TB in animals has been controlled and nearly eliminated in several developed countries but in only very few low- and middle-income countries [40], where zoonotic TB has substantial economic effects and can simultaneously affect the health of humans, livestock, and ecosystems [41]. This threat of zoonotic TB spurred development of a resolution in 1983 by the World Organization for Animal Health, or OIE (formerly the Office International des Epizooties), calling for eradication of M. bovis for both public health and economic reasons [42]. In view of the concerns regarding zoonotic TB in humans and animals due to M. bovis infection, in November 1993, the WHO convened a meeting on zoonotic TB in Geneva and proposed a project protocol to further examine the zoonotic features of bovine TB [43]. In the past decade, zoonotic TB has attracted new attention from international health authorities, such as the WHO, the Food and Agriculture Organization (FAO), and OIE [44]. The WHO and Stop TB Partnership’s Global Plan to End TB 2016–2020: The Paradigm Shift first included communities and people at risk of contracting zoonotic TB as a key population [18]. In October 2017, the WHO, FAO, and OIE developed the first roadmap for efforts against zoonotic TB under the One Health (i.e., animal, human, and environmental health) umbrella, which was launched at the 48th Union World Conference on Lung Health that year [45].

A recent study has noted that zoonotic TB is reemerging as an infectious disease in high-income countries and as a neglected disease in low- and middle-income countries [46]. Furthermore, because the burden of M. bovis–associated zoonotic TB is unknown, it is likely to be underestimated [47]. The prevalence estimates of zoonotic TB are also inaccurate, because current laboratory tests cannot distinguish the species of MTBC infecting humans or animals [48]. The WHO has estimated the zoonotic TB burden according to scientific studies since 2016 [49] and has proposed strengthening the surveillance of zoonotic TB to more accurately determine the disease burden. Of the 10 million people in 2019 with new cases of active TB, 140,000 (range: 69,800–235,000) have been estimated to have zoonotic TB (1.4%), and approximately 11,400 (range: 4,470–21,600) ultimately died (8.1%) [7]. For zoonotic TB in cattle, studies have reported a prevalence of confirmed M. bovis zoonotic TB ranging from 0% to 28%; however, some of the culture methods and the array of molecular methods currently used in laboratories are inappropriate for the diagnosis of zoonotic TB [50].

Concerns regarding zoonotic TB, as reported for decades, still remain valid [51,52]. Post-mortem examination and the single intradermal comparative cervical tuberculin test are the major diagnostic tools for bovine TB [53]. However, these tests have biosafety issues, are time-intensive, and lack both political commitment and high-quality surveillance data. Together, these hurdles have contributed to an increase in TB incidence worldwide [46]. To address this challenge, efforts are underway to adapt human TB diagnostics to detect potentially zoonotic TB organisms in cattle [54]. However, because M. bovis cannot be eradicated from livestock while continued transmission occurs between domestic animals and wildlife [55], controlling M. bovis infection with detect and cull policies remains the backbone of zoonotic TB risk reduction. Animal vaccination is also proving beneficial in certain circumstances. Accordingly, oral bacillus Calmette-Guérin vaccine should be administered to animals at large scale as a complement to traditional control measures to induce protection against TB and decrease host reservoirs [56,57]. An even more troubling prospect involves animal carriers of drug-resistant MTB contributing to reverse zoonosis at the human-animal interface [58]. Despite these concerns, the zoonotic TB in humans, compared with other diseases, might have received a disproportionately low allocation of scientific attention and resources in recent years [52].

Effects of the COVID-19 pandemic

The pandemic has created unprecedented global socioeconomic disruption [59]. Its influence on TB control is likely to extend worldwide, particularly in terms of case detection and short-term TB mortality [60]: the number of TB cases is projected to increase by 6.3 million in the next 5 years, together with a 20% increase in deaths from TB in the same period [61,62], thus delaying achievement of the WHO End TB target.

Before COVID-19, a large decline had been observed globally in the number of new human TB diagnoses and reports, from 7.1 million in 2019 to 5.8 million in 2020. The numbers returned to 2012 levels after an 18% decline, far below the approximately 10 million TB cases in 2020 [1]. In China, for example, a marked decrease in case notifications was associated with COVID-19 interventions: in the 11 weeks during and immediately after the COVID-19 lockdown, the case notification rate was 20% lower than that in the corresponding period in 2019 [63]. Similar findings have been reported in other countries [64–66]. Empirical evidence regarding the long-term effects of the pandemic on TB outcomes has been limited to date, and further study is required [67].

FUTURE PROSPECTS

Achieving a TB-free world is a desirable goal with respect to human, animal, and environmental health—according to the tenets of One Health. Given the interspecies transmission of MTBC through close human-animal interaction, human TB cannot be eradicated without addressing the issue of zoonotic TB. The 2020 progress report from the UN Secretary-General recommended ten priority actions to accelerate advancement toward the global TB targets; in addition, the roadmap developed by the WHO, FAO, and OIE proposes ten priorities to address zoonotic TB. Both call for high-level leadership, multisectoral and collaborative action, greater investment in high-quality scientific research and innovation, and universal health coverage for every patient with TB. The WHO, civil society, including Stop TB Partnership, the UNION, the Global Fund, etc., have proposed a strong call to action for greater access to TB preventive treatment, urging governments to support research and innovation, particularly in vaccine development, to better fight against TB and to ensure that at least 30 million people receive TB preventive treatment by 2022 [68].

Although the COVID-19 pandemic has posed severe challenges to global TB control, it also has brought unique opportunities for developing innovative approaches to ensure patient-centered diagnosis, treatment, and management. TB health systems must avoid disruption and provide services under all circumstances, and must have mechanisms to restore routine services in global emergencies, such the COVID-19 pandemic. Governments and health systems worldwide must immediately take ambitious and radical action to integrate the innovations in service delivery developed in response to the COVID-19 pandemic into the current health system, and to use these new methods to accelerate progress toward the End TB Strategy targets.

ACKNOWLEDGEMENTS

This work was supported by the China CDC-Mérieux Foundation TB control project (2021, 3rd round).

CONFLICTS of INTEREST

The authors have no competing interests.

REFERENCES

1. World Health Organization. Global Tuberculosis Report. 2021

2. Quinn PJ, Markey BK, Leonard FC, Hartigan P, Fanning S, Fitzpatrick ES. Veterinary Microbiology and Microbial Disease. 2nd edition. Oxford: Blackwell Science Ltd. 2011

3. Biet F, Boschiroli ML, Thorel MF, Guilloteau LA. Zoonotic aspects of Mycobacterium bovis and Mycobacterium avium-intracellulare complex (MAC). Vet Res. 2005. Vol. 36(3):411–436

4. Garcia-Jimenez WL, Benitez-Medina JM, Fernandez-Llario P, Abecia JA, García-Sánchez A, Martínez R, et al.. Comparative pathology of the natural infections by Mycobacterium bovis and by Mycobacterium caprae in wild boar (Sus scrofa). Transbound Emerg Dis. 2013. Vol. 60(2):102–109

5. Muller B, Durr S, Alonso S, Hattendorf J, Laisse CJM, Parsons SDC, et al.. Zoonotic Mycobacterium bovis-induced tuberculosis in humans. Emerg Infect Dis. 2013. Vol. 19(6):899–908

6. Morse SS, Mazet JA, Woolhouse M, Parrish R, Carroll D, Karesh WB, et al.. Prediction and prevention of the next pandemic zoonosis. Lancet. 2012. Vol. 380(9857):1956–1965

7. World Health Organization. Global Tuberculosis Report. 2020

8. Gutierrez MC, Brisse S, Brosch R, Fabre M, Omaïs B, Marmiesse M, et al.. Ancient origin and gene mosaicism of the progenitor of Mycobacterium tuberculosis. PLoS Pathog. 2005. Vol. 1(1):e5

9. Al-Ghafli H, Varghese B, Enani M, Alrajhi A, Johani SA, Albarrak A, et al.. Demographic risk factors for extra-pulmonary tuberculosis among adolescents and adults in Saudi Arabia. PLoS One. 2019. Vol. 14(3):e0213846

10. Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al.. Tuberculosis. Nat Rev Dis Primers. 2016. Vol. 2:16076

11. Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med. 2015. Vol. 372(22):2127–2135

12. World Health Organization. Forty Fourth World Health Assembly: Tuberculososi Control Programme (WHA44.8). 1991

13. Tuberculosis: a global emergency. World Health Forum. 1993. Vol. 14(4):438

14. World Health Organization. WHO Tuberculosis Programme: Framework for Effective Tuberculosis Control. 1994

15. Raviglione MC, Uplekar MW. WHO’s new Stop TB Strategy. Lancet. 2006. Vol. 367(9514):952–955

16. United Nations. Sustainable Development Goals. 2015 accessed 2021 Aug 4 https://sustainabledevelopment.un.org/topics/sustainabledevelopmentgoals

17. Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM, et al.. WHO’s new end TB strategy. Lancet. 2015. Vol. 385(9979):1799–1801

18. Stop TB Partnership. Global Plan to End TB: the paradigm shift 2016-2010. accessed 2021 Aug 10 http://www.stoptb.org/global/plan/plan2/

19. The Lancet Infectious Diseases. Tuberculosis at the United Nations: a missed chance. Lancet Infect Dis. 2018. Vol. 18(11):1161

20. Stop TB Partnership. The Global Plan to Stop TB. accessed 2021 Aug 15 https://www.stoptb.org/about/global-plan-to-end-tb-2018-2022

21. Nathavitharana RR, Friedland JS. A tale of two global emergencies: tuberculosis control efforts can learn from the Ebola outbreak. Eur Respir J. 2015. Vol. 46(2):293–296

22. Lonnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med. 2009. Vol. 68(12):2240–2246

23. Alagna R, Besozzi G, Codecasa LR, Gori A, Migliori GB, Raviglione M, et al.. Celebrating World Tuberculosis Day at the time of COVID-19. Eur Respir J. 2020. Vol. 55(4):2000650

24. Guinn KM, Rubin EJ. Implementing new approaches to tuberculosis control. China CDC Wkly. 2021. Vol. 3(12):256–259

25. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019. Vol. 393(10181):1642–1656

26. Schrager LK, Vekemens J, Drager N, Lewinsohn DM, Olesen OF. The status of tuberculosis vaccine development. Lancet Infect Dis. 2020. Vol. 20(3):e28–e37

27. Bahuguna A, Rawat DS. An overview of new antitubercular drugs, drug candidates, and their targets. Med Res Rev. 2020. Vol. 40(1):263–292

28. Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, et al.. Treatment of highly drug-resistant pulmonary tuberculosis. N Engl J Med. 2020. Vol. 382(10):893–902

29. World Health Organization. WHO consolidated guidelines on tuberculosis, module 4: treatment – drug-resistant tuberculosis treatment. 2020

30. Falzon D, Migliori GB, Jaramillo E, Weyer K, Joos G, Raviglione M. Digital health to end tuberculosis in the Sustainable Development Goals era: achievements, evidence and future perspectives. Eur Respir J. 2017. Vol. 50(5):1701632

31. Papaventsis D, Dougas G, Kalkouni O, Karabela S, Manika K. Occupational exposure to zoonotic tuberculosis caused by Mycobacterium caprae, Northern Greece, 2019. Emerg Infect Dis. 2021. Vol. 27(7):1997–1999

32. Duffy SC, Srinivasan S, Schilling MA, Stuber T, Danchuk SN, Michael JS, et al.. Reconsidering Mycobacterium bovis as a proxy for zoonotic tuberculosis: a molecular epidemiological surveillance study. Lancet Microbe. 2020. Vol. 1(2):e66–e73

33. Peterhans S, Landolt P, Friedel U, Oberhänsli F, Dennler M, Willi B, et al.. Mycobacterium microti: not just a coincidental pathogen for cats. Front Vet Sci. 2020. Vol. 7:590037

34. Martins Melo A, Silva Filho RPD, von Groll A, Reis AJ, Diniz J, Perdigao J, et al.. Tuberculosis caused by Mycobacterium pinnipedii in a wild South American sea lion Otaria flavescens stranded in southern Brazil. Dis Aquat Organ. 2019. Vol. 133(3):189–194

35. de la Rua-Domenech R. Human Mycobacterium bovis infection in the United Kingdom: incidence, risks, control measures and review of the zoonotic aspects of bovine tuberculosis. Tuberculosis (Edinb). 2006. Vol. 86(2):77–109

36. Good M, Bakker D, Duignan A, Collins DM. The history of in vivo tuberculin testing in bovines: tuberculosis, a “One Health” issue. Front Vet Sci. 2018. Vol. 5:59

37. Teppawar RN, Chaudhari S, Moon SL, Shinde SV, Khan WA, Patil AR. Zoonotic Tuberculosis: A Concern and Strategies to Combat. London: IntechOpen Limited. 2018

38. Adesokan HK, Akinseye VO, Streicher EM, Van Helden P, Warren RM, Cadmus SI. Reverse zoonotic tuberculosis transmission from an emerging Uganda I strain between pastoralists and cattle in South-Eastern Nigeria. BMC Vet Res. 2019. Vol. 15(1):437

39. Cadmus S, Akinseye VO, van Soolingen D. Mycobacterium bovis in humans and M. tuberculosis in animals in Nigeria: an overview from 1975-2014. Int J Tuberc Lung Dis. 2019. Vol. 23(11):1162–1170

40. Cosivi O, Grange JM, Daborn CJ, Raviglione MC, Fujikura T, Cousins D, et al.. Zoonotic tuberculosis due to Mycobacterium bovis in developing countries. Emerg Infect Dis. 1998. Vol. 4(1):59–70

41. Michel AL, Muller B, van Helden PD. Mycobacterium bovis at the animal-human interface: a problem, or not? Vet Microbiol. 2010. Vol. 140(3-4):371–381

42. Kleeberg H. Human tuberculosis of bovine origin in relation to public health. Rev Sci Tech Off Int Epiz. 1984. Vol. 3(1):11–32

43. Zoonotic tuberculosis (Mycobacterium bovis): memorandum from a WHO meeting (with the participation of FAO). Bull World Health Organ. 1994. Vol. 72(6):851–857

44. World Health Organization. The Control of Neglected Zoonotic Diseases: From Advocacy To Action. 2014

45. WHO, OIE, FAO, UNION. Roadmpa for Zoonotic Tuberculosis. accessed 2021 Aug 2 http://apps.who.int/iris/bitstream/10665/259229/1/9789241513043-eng.pdf?ua=1

46. Macedo Couto R, Ranzani OT, Waldman EA. Zoonotic tuberculosis in humans: control, surveillance, and the one health approach. Epidemiol Rev. 2019. Vol. 41(1):130–144

47. Olea-Popelka F, Fujiwara PI. Building a multi-institutional and interdisciplinary team to develop a zoonotic tuberculosis roadmap. Front Public Health. 2018. Vol. 6:167

48. Love DM, Garner MM, Lyashchenko KP, Sikar-Gang A, Bradway DS, Robbe-Austerman S, et al.. Tuberculosis caused by Mycobacterium Orygis in a greater one-horned rhinoceros (Rhinoceros Unicornis): first report in the Western Hemisphere. J Zoo Wildl Med. 2020. Vol. 50(4):1000–1004

49. World Health Organization. Global Tuberculosis Report. 2016

50. Luciano SA, Roess A. Human zoonotic tuberculosis and livestock exposure in low- and middle-income countries: a systematic review identifying challenges in laboratory diagnosis. Zoonoses Public Health. 2020. Vol. 67(2):97–111

51. Zumla A, Yeboah-Manu D, Michel AL, Azhar EI, Torrelles JB, Cadmus SI, et al.. Zoonotic tuberculosis – a call for an open One Health debate. Lancet Infect Dis. 2020. Vol. 20(6):642–644

52. Olea-Popelka F, Muwonge A, Perera A, Dean AS, Mumford E, Erlacher-Vindel E, et al.. Zoonotic tuberculosis in human beings caused by Mycobacterium bovis-a call for action. Lancet Infect Dis. 2017. Vol. 17(1):e21–e25

53. O’Hagan MJH, Ni H, Menzies FD, Pascual-Linaza AV, Georgaki A, Stegeman JA. Test characteristics of the tuberculin skin test and post-mortem examination for bovine tuberculosis diagnosis in cattle in Northern Ireland estimated by Bayesian latent class analysis with adjustments for covariates. Epidemiol Infect. 2019. Vol. 147:e209

54. Kelley HV, Waibel SM, Sidiki S, Tomatis-Souverbielle C, Scordo JM, Hunt WG, et al.. Accuracy of two point-of-care tests for rapid diagnosis of bovine tuberculosis at animal level using non-invasive specimens. Sci Rep. 2020. Vol. 10(1):5441

55. Palmer MV. Tuberculosis: a reemerging disease at the interface of domestic animals and wildlife. Curr Top Microbiol Immunol. 2007. Vol. 315:195–215

56. Buddle BM, Vordermeier HM, Chambers MA, de Klerk-Lorist LM. Efficacy and safety of BCG vaccine for control of tuberculosis in domestic livestock and wildlife. Front Vet Sci. 2018. Vol. 5:259

57. Kock R, Michel AL, Yeboah-Manu D, Azhar EI, Torrelles JB, Cadmus SI, et al.. Zoonotic tuberculosis - The changing landscape. Int J Infect Dis. 2021. Vol. 113 Suppl 1:S68–S72

58. Botelho A, Perdigao J, Canto A, Albuquerque T, Leal N, Macedo R, et al.. Pre-multidrug-resistant Mycobacterium tuberculosis Beijing strain associated with disseminated tuberculosis in a pet dog. J Clin Microbiol. 2014. Vol. 52(1):354–356

59. V’Kovski P, Kratzel A, Steiner S, Stalder H, Thiel V. Coronavirus biology and replication: implications for SARS-CoV-2. Nat Rev Microbiol. 2021. Vol. 19(3):155–170

60. McQuaid CF, McCreesh N, Read JM, Sumner T; CMMID COVID-19 Working Group; Houben RMGJ, et al.. The potential impact of COVID-19-related disruption on tuberculosis burden. Eur Respir J. 2020. Vol. 56(2):2001718

61. Hogan AB, Jewell BL, Sherrard-Smith E, Vesga JF, Watson OJ, Whittaker C, et al.. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020. Vol. 8(9):e1132–e1141

62. Cilloni L, Fu H, Vesga JF, Dowdy D, Pretorius C, Ahmedov S, et al.. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis. EClinicalMedicine. 2020. Vol. 28:100603

63. Fei H, Yinyin X, Hui C, Ni W, Xin D, Wei C, et al.. The impact of the COVID-19 epidemic on tuberculosis control in China. Lancet Reg Health West Pac. 2020. Vol. 3:100032

64. Buonsenso D, Iodice F, Sorba Biala J, Goletti D. COVID-19 effects on tuberculosis care in Sierra Leone. Pulmonology. 2021. Vol. 27(1):67–69

65. Gupta A, Singla R, Caminero JA, Singla N, Mrigpuri P, Mohan A. Impact of COVID-19 on tuberculosis services in India. Int J Tuberc Lung Dis. 2020. Vol. 24(6):637–639

66. de Souza CDF, Coutinho HS, Costa MM, Magalhaes M, Carmo RF. Impact of COVID-19 on TB diagnosis in Northeastern Brazil. Int J Tuberc Lung Dis. 2020. Vol. 24(11):1220–1222

67. McQuaid CF, Vassall A, Cohen T, Fiekert K, White RG. The impact of COVID-19 on TB: a review of the data. Int J Tuberc Lung Dis. 2021. Vol. 25(6):436–446

68. A Global Drive to Scale Up TB Prevention. Genva: World Health Organization. 2021