Impact of the Great Kermanshah Earthquake on the trend of tuberculosis incidence: an interrupted time series analysis BMC infectious diseases

This study evaluated the impact of the 7.3 magnitude Kermanshah earthquake on TB trends in the three most affected cities: Sarpol-e Zahab, Qasr Shirin, and Salas Babajani. In Sarpol-e-Dhahab, TB cases initially increased after the earthquake, indicating an immediate effect, but later decreased compared to pre-earthquake levels, reflecting an effect over time. In Qasr Shirin, the trend in TB cases decreased in the period leading up to the earthquake, and while there was an increase in cases afterward, this change was not statistically significant. However, the post-earthquake trend showed a significant upward slope compared to the pre-intervention period, suggesting an effect over time. Conversely, Salas Babajani saw a steady decline in TB cases without any noticeable changes after the earthquake.

The study conducted by Koenig et al. He points out that there was a rise in reported cases of tuberculosis in Haiti after the earthquake. However, data are too limited to determine whether this increase is due to a higher burden of TB or better detection methods. Although active case-finding initiatives have been successful in identifying more TB patients, the current scale of these efforts does not adequately explain the observed rise in cases [8]. Research conducted in China revealed that there are several factors that influence the incidence of pulmonary tuberculosis during and after an earthquake. These factors include the presence of minority populations, the percentage of the labor force, the latitude of the city, and the intensity of the earthquake. Over time, the influence of minority areas, occupational factors and the distribution of health resources has diminished, while economic development and population mobility have become increasingly important. [9]. Yang et al.'s study in the area affected by the Wenchuan earthquake found a stable trend without cracking after the earthquake from 2004 to 2012, indicating a decrease in earthquake occurrence from north to south across Sichuan Province. [10]. A study of the health conditions in the cities of Kermanshah Province affected by the earthquake revealed that the health and treatment system suffered major damage. Problems identified include insufficient case registration, poor management of health concerns, and inadequate patient tracking, despite the establishment of patient guidance centers. [11]. Inconsistencies in the study findings may stem from incomplete reporting following the earthquake, which resulted from disruptions at public health centers (PHCs). Moreover, many patients may have avoided visiting health centers due to shock and depression caused by the earthquake. Another factor may be reliance on limited or diverse data sources across different studies. For example, research conducted in Haiti used a data source on TB that may not accurately reflect changes in prevalence [8]. In contrast, this study used three sources of data, which enhances the reliability of the results.

In research by Kanamori et al, which investigated TB transmission following the 2011 earthquake and tsunami in Japan, several risk factors for TB diagnosis were identified. These factors include advanced age, low blood albumin levels, functional status during hospitalization, and the need for oxygen. In addition, results from variable number of tandem repeats (VNTR) analysis indicate that most cases of pulmonary TB were associated with reactivation of latent TB infection, likely caused by the effects of the earthquake and tsunami. [12].

In Qasr Shirin, the trend of TB cases showed a decline before the earthquake. After the earthquake, there was an increase in cases, although this change was not statistically significant. However, the trend of cases after the earthquake showed a significant upward decline compared to the pre-intervention period. Follow-up studies on TB infection in the northern coastal area of ​​Miyagi after the Great East Japan Earthquake revealed that in the early phase (2011–2012), there was a significant increase in the total number of TB patients, as well as TB cases. Pulmonary tuberculosis and latent tuberculosis infection (LTBI) specifically in coastal areas that were severely affected by the tsunami. However, during the middle phase (2013–2014), although there was a significant decline in total cases of TB, pulmonary TB, and LTBI, their prevalence did not return to the levels seen before the disaster. These results indicate that the effects of the Great East Japan Earthquake are still ongoing [13]. The rapid increase in cases could stem from increased relief services and the presence of health care teams sent from other areas during the period when damage is most severe, resulting in a greater number of TB cases being diagnosed. In other words, earthquakes do not increase TB cases over a period of only a few weeks; Hence, the long-term downward trend compared to the period before the earthquake may be due to poor disease management.

Previous studies show that after the earthquake, there was a significant increase in cases of TB and latent TB, especially among individuals in crowded shelters. The main factors contributing to this rise include power and water outages, road closures affecting access to food and medical care, and the destruction of health care facilities. [14,15,16]. In addition, low intake of essential nutrients during crises increases the risk of TB development and mortality. Overcrowding in shelters underscores the need for effective preparation to prevent overcrowding [17, 18]. A strong healthcare system is vital to combat TB in disaster situations, but interruptions to services can worsen the disease and accelerate transmission. [19]. Earthquakes also lead to conditions such as stress, malnutrition, and poor sanitation, which may increase smoking behaviors, increasing the risk of contracting and developing TB. [20,21,22,23,24] .

The trend of TB in Sarpol Dahab, Qasr Shirin, and Salas Babajani after the earthquake may have been mixed due to differences in damage to health care infrastructure, access to medical services, and health care-seeking behavior influenced by psychological trauma. Socioeconomic conditions have also influenced responses to health crises, while discrepancies in data quality can lead to inconsistencies in reported prevalence rates.

Access to data at appropriate time intervals to conduct ITS analysis was a notable strength of this study. However, during disasters such as earthquakes, routine patient registration programs may be disrupted, leading to a decline in caseloads. In addition, there was relatively insufficient diagnosis of tuberculosis, and there was no complete recording of patient information at the centers participating in the study. This may have resulted in incomplete or inaccurate data being collected.

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