Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines

Abstract

In 2013, a severe earthquake and typhoon affected Bohol, Philippines. To assess the postdisaster risk for emergence of Mycobacterium tuberculosis infection in children, we conducted a cross-sectional multistage cluster study to estimate the prevalence of tuberculin skin test (TST) positivity and tuberculosis (TB) in children from 200 villages in heavily affected and less affected disaster areas. Of the 5,476 children we enrolled, 355 were TST-positive (weighted prevalence 6.4%); 16 children had active TB. Fourteen (7%) villages had >20% TST-positive prevalence. Although prevalence did not differ significantly between heavily affected and less affected areas, living in a shelter with >25 persons approached significance. TST positivity was independently associated with older age, prior TB treatment, known contact with a person with TB, and living on a geographically isolated island. We found a high TST-positive prevalence, suggesting that national programs should consider the differential vulnerability of children and the role of geographically isolated communities in TB emergence.

Keywords: Philippines; bacteria; children; cluster survey; epidemiology; natural disasters; pediatric tuberculosis; prevalence; tuberculosis and other mycobacteria.

Figure 1

Procedures and decision tree for enrollment of study participants during community-based cluster survey of TB in children in areas affected by 2013 natural disasters, Bohol, Philippines. Positive result on chest radiograph means evidence of infiltrates, consolidation, or cavitary lesions suggestive of TB disease. DSSM, direct sputum smear microscopy; IPT, isoniazid preventive therapy; neg, negative; pos, positive; TB, tuberculosis; TST, tuberculin skin test.

Figure 2

Prevalence of tuberculin skin test positivity by municipality obtained in study of tuberculosis in children in areas affected by 2013 natural disasters, Bohol, Philippines, 2016–2018. Epicenter of 2013 earthquake is indicated.

Figure 3

Distribution of patients by age in study of tuberculosis in children in areas affected by 2013 natural disasters, Bohol, Philippines. A) Number of children who screened positive by TST; B) prevalence of TST positivity. Black bars, TST positive; gray bars, TST negative. TST, tuberculin skin test.