Tuberculosis tips on how to prevent recurrence

Mark Agana used to work out regularly and was a member of a dragon boat rowing team. But in 2014, he was diagnosed with Pulmonary Tuberculosis or TB. Two months into his treatment, he felt like his old self, going several days without medication. Believing everything was fine, he did not return to his doctor for a follow-up consultation.

Almost two years later in 2016, he started feeling weak again. He noticed some swelling around his neck and was surprised to learn he had TB once more. 

“I was blaming myself heavily for being stubborn,” he said. “I self-medicated even during my first TB treatment. I did not go back for follow-up consultations. Maybe because, in our society, men are expected to act tough even when feeling weak. This is likely why most Filipino men delay their medical check-ups or do not even go for a check-up.”

Mark Agana, TB survivor and advocate

Today he is back on track, speaking in radio stations based in Mindanao as a TB survivor advocate. ”I hope to be the voice of Filipino men who need to get screened, tested, and treated for TB. It is more manly to own up to our weaknesses. It takes a man of strong character to ask for help,” he said. 

Like Mark, there have been people who have undergone TB recurrence. According to Dr. Mary Rose Santiago, TB/DR-TB Technical Advisor of the TB Innovations and Health Systems Strengthening Project (TBIHSS), most susceptible are individuals who had completed treatment for TB. 

Some individuals are also at greater risk due to weakened immune systems, having clinical management and programmatic issues during TB treatment, or having a high level of community transmission as in the case of reinfection.

“Recurrence of TB disease can result from either relapse of an original or old infection or reinfection with a new strain of TB bacilli,” Dr. Santiago said. “It occurs when a patient who has completed treatment for TB is recently exposed to a person with TB having a different strain of TB bacteria, then TB exposure will progress to TB infection and later to TB disease. This progression is dependent on various factors such as intensity, duration, and frequency of exposure, environment, and more importantly the host immune responses.” 

She added, “On the other hand, TB relapse occurs when TB bacteria become active again in a patient who had completed treatment for TB. This reactivation of TB bacteria is due to several reasons such as irregular intake of anti-TB drugs, inadequate treatment regimen or duration, poor treatment adherence, among others.”

Prevention and Treatment

Dr. Santiago explained that treatment depends on the type of TB, whether drug-susceptible or drug-resistant. For drug-susceptible TB: Regimens 1 and 2 while for drug-resistant TB: Regimens 3, 4, and 5 (adults), 6 and 7 (children).

But prevention is still better than cure. She said patients undergoing treatment for active TB disease should adhere to the recommended treatment regimen, dosing, and duration including the timing of drug intake. Anti-TB drugs provided to patients should be of high quality and consistently available or there is a continuous supply.

To prevent reinfection or relapse, the transmission of TB bacteria in communities and households should be stopped. Infection prevention and control measures should be consistently observed and in place. It is also important to have a healthy immune system by practicing healthy habits like eating a well-balanced diet, getting enough rest and exercise, and avoiding risky behaviors like smoking and excessive alcohol drinking. Pre-existing medical conditions such as HIV and diabetes should also be appropriately managed or well-controlled.

“Patients with TB need to inform their health care providers if they are taking any concomitant medications that may interact with any of the anti-TB drugs they are taking,” Dr. Santiago said. “Family members are encouraged to support patients to adhere to their treatment and be the source of the patient's strength and inspiration. Basic infection prevention and control measures should be observed in the house like wearing a mask, especially if with signs and symptoms of TB or proper covering of their cough.” 

For Mark, it is really important to adhere to the doctor's or healthcare provider’s instructions and medications. “I learned that everyone is vulnerable to acquiring TB when exposed to the bacteria. Even athletic and healthy people like I was back then can get infected.”

For more information about TB, visit This includes an online self-assessment:  tool to help with TB identification and treatment. It may also be used to check for suspected TB, and locate the nearest health facility.

The is part of the Department of Health (DOH)'s local communication campaign, Para Healthy Lungs, KonsulTayo, which is supported by USAID's TB Innovations and Health Systems Project (TBIHSS). It aims to raise tuberculosis as a public health priority in the country using social and conventional media methods.