Notes from the Field : Tuberculosis Control in the Aftermath of Hurricane Maria — Puerto Rico, 2017

Abstract

The Puerto Rico Department of Health Tuberculosis Control Program (PRTB) conducts tuberculosis (TB) surveillance and control activities through six regional clinics, directed by a central office in San Juan. PRTB uses directly observed therapy as the standard of care to ensure adherence to treatment. Beginning in mid-2016, PRTB had transitioned some patients from self-administered or directly observed therapy to video-observed therapy (vDOT) using a smartphone. However, the widespread and extended interruption in power and wireless communication made vDOT unavailable after the hurricane. The PRTB laboratory was severely damaged. To maintain TB surveillance capacity, PRTB received assistance from CDC's Division of Tuberculosis Elimination, Laboratory Branch, the Association of Public Health Laboratories (APHL), three state APHL laboratories (Florida, Georgia, and Virginia), and the CDC Foundation to transport and test clinical specimens for Mycobacterium tuberculosis. The first package of M. tuberculosis specimens was sent of 17 October, 4 weeks after the disaster, and the process continued until local laboratory testing resumed in July 2018. This natural disaster led PRTB to strengthen its preparedness plan. Although PRTB patients fared better than did patients with acute and chronic conditions in terms of access to medications, PRTB identified that it is imperative to ensure that a minimum 2-month supply inventory of TB medication be available in each regional clinic to be able to anticipate postdisaster needs and delay of external aid in similar disasters.