Indoor Air Pollution and Susceptibility to Tuberculosis Infection in Urban Vietnamese Children

Am J Respir Crit Care Med. 2021 Nov 15;204(10):1211-1221. doi: 10.1164/rccm.202101-0136OC.


Rationale: The Southeast Asian tuberculosis burden is high, and it remains unclear if urban indoor air pollution in this setting is exacerbating the epidemic. Objectives: To determine the associations of latent tuberculosis with common urban indoor air pollution sources (secondhand smoke, indoor motorcycle emissions, and cooking) in Southeast Asia. Methods: We enrolled child household contacts of patients with microbiologically confirmed active tuberculosis in Vietnam, from July 2017 to December 2019. We tested children for latent tuberculosis and evaluated air pollution exposures with questionnaires and personal aerosol sampling. We tested hypotheses using generalized estimating equations. Measurements and Main Results: We enrolled 72 patients with tuberculosis (27% with cavitary disease) and 109 of their child household contacts. Latent tuberculosis was diagnosed in 58 (53%) household contacts at baseline visit. Children experienced a 2.56-fold increased odds of latent tuberculosis for each additional household member who smoked (95% confidence interval, 1.27-5.16). Odds were highest among children exposed to indoor smokers and children <5 years old exposed to household smokers. Each residential floor above street-level pollution decreased the odds of latent tuberculosis by 36% (adjusted odds ratio, 0.64; 95% confidence interval, 0.42-0.96). Motorcycles parked inside children's homes and cooking with liquid petroleum gas compared with electricity increased the odds of latent tuberculosis, whereas kitchen ventilation decreased the effect, but these findings were not statistically significant. Conclusions: Common urban indoor air pollution sources were associated with increased odds of latent tuberculosis infection in child household contacts of patients with active tuberculosis.

Keywords: built environment; cooking; motorcycles; smoking water pipes; tobacco smoke pollution.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Air Pollution, Indoor / adverse effects*
  • Asian People / statistics & numerical data
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cooking*
  • Disease Susceptibility*
  • Female
  • Humans
  • Latent Tuberculosis / chemically induced*
  • Male
  • Odds Ratio
  • Risk Assessment / statistics & numerical data*
  • Tobacco Smoke Pollution / adverse effects*
  • Urban Population / statistics & numerical data
  • Vehicle Emissions*
  • Vietnam


  • Tobacco Smoke Pollution
  • Vehicle Emissions