Page 81 - Proceeding of Plenary Abstract of Parallel Symposim

RESPIROLOGI

Double Burden of TB and Covid-19 in Children: Clinical Management Perspective

Wahyuni Indawati
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Tuberculosis (TB) remains as significant global public health problem today, including Indonesia
as the second top country that has the most tuberculosis cases in the world. Since early 2020, the novel
coronavirus outbreak was declared a public health emergency of international corcern. Up to now Covid-19
pandemic already strikes more than 223 countries around the world, including Indonesia. Discussion Based
on the immunological mechanism involved, a shared dysregulation of immune response in Covid-19 and TB
has been found, suggesting a dual risk posed by coinfection worsening Covid-19 severity and favouring TB
disease progression. Some impacts of Covid-19 on TB consist of increased household transmission of TB,
delayed TB diagnosis and treatment services, affecting TB prevention and control strategies and reactivation
of TB. Provisional data compiled by WHO from 84 countries indicates that an estimated 1.4 million fewer
people received TB care in 2020 than in 2019, a reduction of 21% from 2019. Monthly notifications for TB
cases in Indonesia in 2020 showed 42% shortfall compared with 2019. WHO recommends some key action
to help countries to get back on track to reach End TB targets in the context of the Covid-19 pandemic.
Those key actions include ensure effective infection prevention and control measures to protect the health
and safety of health workers, staff and patients, scale up simultaneous testing for TB and Covid-19, taking
into consideration similarity of symptoms and based on exposure or presence of risk factors, promote access
to people-centered prevention and care services including all-oral TB treatment for multidrug-resistant TB
and extensively drug-resistant TB, stand against stigma and discrimination and promote the human rights of
the most vulnerable also build and strengthen community, youth and civil society engagement to close gaps
in care. This presentation will focus on double burden of TB and Covid-19 in children especially from the
perspective of clinical management.

Challenges in Pediatric Asthma Management during Pandemic

Rini Savitri Daulay
Department of Child Health, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia

Abstract
Background Asthma is the most frequent chronic condition in childhood, and a current concern exists about
asthma in the pediatric population and its risk for severe SARS-CoV-2 infection. Although all ages can be affected,
SARS-CoV-2 infection has a lower clinical impact on children than adults. In adults, data suggest that asthma is one
of the risk factors for Covid-19 morbidity and mortality, yet such a risk in children is still unclear. The situation with
the management of pediatric asthma had differences before and during pandemic Covid-19. Discussion In the
early pandemic Covid-19, many patients feared going to the hospital to seek treatment that caused pediatric asthma
failed to attend their schedule to control because of the higher risk of exposure to the virus in the hospital. Children
with asthma should remain on their current asthma medications, practice physical distancing, regular handwashing,
and aeroallergen avoidance. Global Initiative for Asthma (GINA) recommends that control medication for
asthma, including inhaled steroids, be maintained during the pandemic. The decision to reduce or to step down
daily controller medication should be carefully considered. There is debate about asthma management during
the Covid-19 pandemic era about the use of nebulizers, with some arguing that their use should be discouraged
unless essential as nebulizer is an aerosol-generating procedure, and instead, the metered-dose inhaler should be
recommended in the health care setting and the home. In contrast, some arguing that nebulizers can continue to
be used because the aerosol that is produced will come from the fluid in the nebulizer chamber and not will carry
virus particles from the patient. Conclusion Pandemic Covid-19 has a significant impact on pediatric asthma on
their control or maintenance therapy.

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