Impact of Wars and Disasters on Tuberculosis Epidemiology

Tuberculosis (TB) remains one of the major public health problems globally. Key risk factors for TB include poverty, living conditions such as overcrowding, and the presence and prevalence of significant biological and behavioral risk factors that impair the immune system or contribute to additional biological risk factors. Wars and disasters increase the risk of developing TB mainly due to population movement and displacement into overcrowded camps and temporary shelters, destruction of infrastructure, breakdown of health services, or discontinuation of ongoing treatment for human immunodeficiency virus (HIV) co-infection. This leads to a higher risk of TB transmission, reactivation of latent TB infection, worsening of active disease, and increased vulnerabilities. Any factor that increases risk factors for TB is a primary driver of changes in TB epidemiology during wars and disasters. A TB preparedness plan should include a coordination mechanism, pre-assessment of data such as TB prevalence and incidence, drug-resistance status, prevailing major biological and behavioral risk factors for TB, resource requirements, a contingency plan for procurement and supply chain, surveillance, monitoring and evaluation tools, health facility details, effective TB infection control measures, and testing and screening protocols. Strategies to ensure the continuity of the National TB Control Program and to decrease vulnerabilities and risk factors for TB should be developed. Since most wars and disasters cause refugees to cross borders and affect multiple countries, developing an international data-sharing system would be useful.