Symposium 9 - APRC 2024

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Symposium 9：Environment & TB: Air Pollution (Indoor/Outdoor) & Climate

Tuberculosis is the only infectious disease among the top ten leading causes of death in the world. It is still a major public health risk in many countries. Some studies believe that tropical hurricanes and heavy rainfall caused by the recent global temperature rise have changed the transmission pattern of tuberculosis. Extreme weather leads to poor harvests and malnutrition, which in turn increases the number of people who are vulnerable to infection and drives migration leading to the spread of tuberculosis. Changes in climatic variables are also thought to be related to tuberculosis host factors such as vitamin D metabolism and ultraviolet radiation. Studies have shown that some ambient air pollution components are related to the incidence of tuberculosis. In addition, climate change is closely related to air pollutants. To clarify these complex relationships can help the formulation of epidemic prevention policies in the future.

Date: Saturday, April 27, 2024 | Time: 14:50-16:20 (GMT+8)

Moderator: Prof. Inn-Wen Chong (Taiwan) | Dr. Simone Barry (Australia)

Time (GMT+8)	Topic	Speaker	Country / Region
14:50-15:20	The impact of indoor population and ventilation on TB transmission	Dr. Anita Pei-Chun Chan	Taiwan
15:20-15:50	Exploring the Nonlinear Relationship between Air Pollutants and the Incidence of Respiratory Infectious Diseases in China (2013-2018)	Dr. Ta-Chien Chan	Taiwan
15:50-16:20	The impact of climate change on the risk factors for tuberculosis	Dr. Simone Barry	Australia

The impact of indoor population and ventilation on TB transmission

Abstract:
For infection control, wearing proper personal protective equipment and removing all infectious particles are crucial strategies. In TB control, the most effective HVAC (heating, ventilation, and air conditioning) system is one that does not recirculate air, opting for a 100% outside air arrangement. However, continuously heating or cooling outside air to maintain a comfortable room temperature and relative humidity, especially in tropical or subtropical regions, can be cost-prohibitive. Preventing TB transmission in such regions poses challenges, particularly in densely populated facilities striving for environmental sustainability, energy conservation, and carbon reduction.

Post-COVID-19, alongside administrative controls such as early diagnosis, prompt and effective treatment, or proper isolation, facilities still face airborne disease challenges. These facilities should make improvements to ensure that their systems have adequate components in place. These enhancements include introducing fresh outside air to dilute and replace room air, using filters to remove infectious particles from recirculated air, employing UVC lamps to disinfect recirculated air, and designing systems to support pressure differentials for isolation rooms and protective environments. These features can either be incorporated into the design of a new system or added to an existing system to concurrently address TB transmission.

In this talk, we’ll review TB transmission in poorly ventilated, densely populated spaces and address practical ventilation changes and common pitfalls encountered with stakeholders. We’ll share experiences using CO2 levels as a surrogate for standardizing minimal ventilation requirements after outbreak investigations. We also would like to emphasize the importance of legislation for indoor air quality, so that all stakeholders can create a safer environment not only to the people living inside but also to the care providers. This environment control measures can finally help achieving END TB goal by 2035.

Dr. Anita Pei-Chun Chan

Deputy Director Of The Division Of Chronic Infectious Diseases | Taiwan CDC
Taiwan

Professional Experience:

Dr. Anita Chan is presently the Deputy Director at the Division of Chronic Infectious Diseases, the Centers for Disease Control, Ministry of Health and Welfare, Taiwan (Taiwan CDC). She also serves as Associate Director at the Tuberculosis Research Center, Taiwan CDC. Her other positions include Standing Committee of Taiwan Guidelines for TB Diagnosis and Treatment, Adjunct Assistant Professor at the Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan. She has more than 15 years of experience on policy implementation for TB control. Important operational research papers had been published to prove the effectiveness of policy implementation of TB/HIV/STD. Her main research interests are tuberculosis, infection control, vaccination, ethics and law of notifiable diseases, and infectious diseases.

Exploring the Nonlinear Relationship between Air Pollutants and the Incidence of Respiratory Infectious Diseases in China (2013-2018)

Abstract:
Limited research has been conducted on the relationship between air pollutants and the incidence of respiratory diseases, beyond influenza and tuberculosis. Meteorological factors significantly influence the diffusion and concentration of air pollutants. This study aims to explore associations between air pollution (PM2.5, PM10, SO2, NO2, O3, and CO exposure), considering meteorological conditions, and seven respiratory infectious diseases (influenza, pertussis, rubella, mumps, pulmonary tuberculosis, meningitis, and measles).

Data spanning from 2013 to 2018 were collected from China’s notifiable infectious disease report database. Pearson’s correlation coefficient was utilized to examine associations between air pollution exposure and meteorological conditions. Monthly air pollution data were sourced from 1,498 air quality stations or satellite images, while meteorological data came from 756 monitoring stations. A Distributed Lag Non-Linear Model (DLNM) with relative risk was applied to analyze the impact of air pollutants on respiratory infectious diseases.

Tuberculosis and mumps exhibited similar lagged effects. Higher levels of NO2 and CO were correlated with short-term effects on the incidence of pulmonary tuberculosis and mumps. Notably, the overall model performance was superior when using air monitoring stations compared to satellite images. Results from the DLNM revealed that meteorological factors exerted a stronger impact on respiratory infectious diseases with an acute and short-term lag effect compared to air pollutants.

Dr. Ta-Chien Chan

Research Fellow/Professor | Academia Sinica
Taiwan

Professional Experience:

Dr. Ta-Chien Chan is an executive officer and research fellow at the Center for Geographic Information Science of Research Center for Humanities and Social Sciences (RCHSS) and currently serve as a deputy director of RCHSS in Academia Sinica since 2023. He graduated with a doctoral degree (Ph.D.) from the Institute of Epidemiology, National Taiwan University in 2010. Dr. Chan is an interdisciplinary scholar in both health and spatial science. He took advantage of these two specialties and devoted himself to interdisciplinary research. In recent years, Dr. Chan focused on infectious disease surveillance, health impacts from air pollution, noise and green space, and behavioral contagion through social networks. Starting from 2016, he has been building up a smart dengue surveillance system with epidemiological intelligences in seven cities of Taiwan to reduce the risk of dengue epidemics locally, and has won many prestigious information technology and smart city awards. He has also established community syndromic surveillance systems in Taipei City and Kaohsiung City since June 2018, playing a sentinel role in achieving the goal of precision public health. He has devoted his career not only to academic research but also to improving first-line public health systems.

The impact of climate change on the risk factors for tuberculosis

Abstract:

Tuberculosis (TB) remains a persistent global public health threat, surpassing recommended guidelines set by the World Health Organisation and the United Nations. Despite the recent acknowledgement of the link between TB and climate change, this association is often marginalized in global agendas.

Recent research has revealed a positive association between climate change proxies and key TB risk factors such as HIV, diabetes, undernutrition, overcrowding, and poverty, with varying results for indoor air pollution. This evidence suggests that climate change may heighten susceptibility to TB, particularly in developing countries, by amplifying the prevalence of these risk factors.

There is an urgent need to address the relationship between climate change and TB, especially in light of the Intergovernmental Panel on Climate Change’s confirmation of unprecedented climate changes. The failure to integrate climate change considerations into global agendas poses a threat to TB eradication efforts, as evidenced by insufficient reductions in TB incidence and deaths by 2020.

Geographically vulnerable regions, including Africa, Asian mega-deltas, and small island developing states, face heightened TB risks due to the intersection of climate change and existing epidemics.

Relevant to developing economies, this presentation aims to highlight broader implications for climate change and human health. This presentation advocates for increased attention to this evolving research field and concludes by emphasizing the significance of our results for understanding and addressing TB transmission.

Dr. Simone Barry

Thoracic Physician. Head South Australian Tuberculosis Service | Royal Adelaide Hospital
Australia

Professional Experience:

Dr Simone Barry is a respiratory physician working at Royal Adelaide Hospital. She is the Head South Australian Tuberculosis Service. Commensurate with that position, she serves as the state representative for the National TB Advisory Committee to provide expert advice to the Australian Government on the prevention and control of TB. Simone is chair of TSANZ respiratory infectious diseases interest group. She holds a Master of Public Health and Tropical Medicine. Her PhD doctoral thesis examined microRNA as a biomarker for TB. She is currently studying a Master of Public Health Epidemiology through Harvard School of Public Health.

Prof. Inn-Wen Chong

Professor | Kaohsiung Medical University Hospital
Taiwan

Professional Experience:

Director of hospital, Dean, Office of Academic Affairs
Chief, Center for General Education Kaohsiung Medical University
Director, Faculty of Respiratory Care Kaohsiung Medical University
Superintendent, Kaohsiung Municipal Hsaio- Kang Hospital
Superintendent, Kaohsiung Municipal United Hospital
Superintendent, Kaohsiung Municipal Women and Children’s Hospital
Visiting Scientist, Environmental Health Harvard School of Public Health

Symposium 9：Environment & TB: Air Pollution (Indoor/Outdoor) & Climate

APRC 2024 Secretariat

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