# Evolving Nature of Tuberculosis in the Post-pandemic World

## TL;DR

This study investigates whether a history of COVID-19 or vaccination affects the likelihood of developing tuberculosis, finding no significant link.

## Contribution

The study explores the evolving relationship between TB and post-pandemic factors like prior COVID-19 infection and vaccination.

## Key findings

- Active TB was identified in 14% of those with prior COVID-19 and 19% of those without.
- Vaccinated individuals had lower odds of TB infection, but the difference was not statistically significant.

## Abstract

Introduction

Tuberculosis (TB) and COVID-19 are highly transmissible respiratory diseases. The sequel of development of active TB after COVID-19 disease has been hypothesized to increase due to many reasons. We aimed to explore the association between COVID-19 infection, COVID-19 vaccination, and the development of active TB and navigate any existing patterns if present.

Materials and methods

This prospective observational study was conducted over a span of one year in two hospitals. A total of 200 patients with suspected TB were recruited and divided into two groups: Group A (n=100) had previous infection with COVID-19, and Group B (n=100) had no previous COVID-19 disease. Diagnosis of TB was done from both pulmonary and extrapulmonary samples by microscopy using the Ziehl-Neelsen (ZN) technique for acid-fast bacilli, culture using the Mycobacteria Growth Indicator Tube-960 (MGIT-960) (Becton, Dickinson and Company, Sparks, Maryland, United States), and molecular assays such as the GeneXpert® MTB/RIF (Cepheid, Sunnyvale, California, United States). Epidemiological data, clinical picture, and their pattern of sequence of TB after COVID-19 vaccination and COVID-19 disease were investigated.

Results

In Group A, 37 (37%) were females with a mean age of 39.4 years, and 63 (63%) were males with a mean age of 41.9 years. In Group B, 45 (45%) were females, and 55 (55%) were males, with mean ages of 41.02 years and 44.16 years, respectively. Confirmation of TB cases was done using ZN staining, MGIT-960, and GeneXpert® MTB/RIF assay. Active TB infection was identified in 14 (14%) participants in Group A, of whom 11 (78.5%) were COVID-19 vaccinated, and in 19 (19%) participants in Group B, of whom 14 (73.6%) were vaccinated. Covishield was the predominant vaccine received. Most of the patients had received both doses of the vaccine. Logistic regression analysis was performed, which showed that vaccinated individuals had a lower odds of TB infection than unvaccinated individuals in both groups. However, the findings were not statistically significant (p>0.05).

Conclusion

No association between COVID-19 vaccination and the subsequent development of active TB was seen.