El Salvador is facing a troubling surge in tuberculosis (TB) cases, with health experts warning of an emerging epidemic concentrated in prisons but increasingly spilling into the general population. The warning, issued by medical associations and public health professionals, highlights the urgent need for government intervention, transparency, and robust epidemiological controls.
Dr. Rafael Aguirre, general secretary of the Salvadoran Medical Union for Public Health Professionals (SIMETRISSS), voiced concern in a recent interview with the Association of Radios and Participatory Programs of El Salvador (ARPAS), confirming a notable uptick in TB infections, particularly within the country’s overcrowded and unsanitary prison system.
“Yes, there is an increase in cases of tuberculosis, especially at the prison level,” Dr. Aguirre said. “These are individuals who have been in close contact with infected persons while incarcerated and, once released, may carry the disease back into the broader community. We must be vigilant in monitoring this dynamic.”
Echoing this concern, the Latin American Association of Social Medicine (ALAMES) in El Salvador emphasized that TB is no longer confined to prison walls. The group stated there is now growing evidence that the disease is spreading among the general population, and called for the publication of detailed epidemiological data to increase public awareness and preparedness.
“There is a tuberculosis epidemic, silent and concentrated in prisons,” ALAMES said in a statement to La Prensa Gráfica. “Without proper attention to incarcerated individuals, this concentrated epidemic may extend and affect the public at large.”
Health professionals say the ongoing state of emergency—first declared in March 2022 as part of a government crackdown on gangs—has led to mass detentions and dangerously overcrowded conditions in prisons, creating an ideal environment for the airborne disease to spread. The lack of adequate ventilation, medical screening, and sanitation within detention centers is accelerating transmission.
In addition to tuberculosis, Dr. Aguirre noted that former inmates are also potential carriers of other infectious diseases such as hepatitis B, hepatitis C, syphilis, and HIV. He urged the Ministry of Health (MINSAL) to implement mandatory health screenings for individuals upon their release to prevent further outbreaks in the community.
“People being released from prison should undergo thorough medical examinations to detect any transmissible diseases,” he stressed. “Only then can we ensure that we are not inadvertently allowing these infections to take root in our communities.”
Despite repeated requests from La Prensa Gráfica, Minister of Health Francisco Alabi and Social Security Director Dr. Mónica Ayala have not responded with confirmation of tuberculosis case numbers or outlined any strategies to contain the disease. ALAMES criticized this lack of transparency, stating that public access to epidemiological data is critical for assessing health risks and formulating effective prevention plans.
According to the Pan American Health Organization (PAHO), tuberculosis is caused by the bacterium Mycobacterium tuberculosis and is primarily transmitted through airborne droplets released when infected individuals cough or sneeze. Symptoms include a persistent cough, chest pain, fatigue, weight loss, fever, and night sweats. If left untreated, the disease can be fatal.
Globally, TB remains one of the deadliest infectious diseases, killing an estimated 4,300 people per day. Complicating matters further, drug-resistant strains have emerged, making treatment more difficult and costly.
Infectious disease specialist Dr. Jorge Panameño explained that pulmonary TB—the most common form—poses significant public health challenges due to its rapid contagion and disproportionate impact on vulnerable populations, particularly those in conditions of overcrowding, malnutrition, or with weakened immune systems.
“Pulmonary tuberculosis is highly contagious and can spread quickly in environments like prisons or urban slums,” Dr. Panameño said. “But extrapulmonary tuberculosis, which affects other organs, is also being diagnosed with increasing frequency.”
Extrapulmonary TB, as noted by PAHO, can target various parts of the body including lymph nodes, bones, the digestive system, kidneys, eyes, and even the central nervous system. “I’ve seen TB in the eyes, liver, knees—it can appear almost anywhere,” Dr. Panameño added.
While El Salvador administers the Bacille Calmette-Guérin (BCG) vaccine to newborns as a preventive measure against tuberculosis, doctors warn that this vaccine is not always effective against adult pulmonary TB or drug-resistant strains, especially in high-risk environments.
The rising TB crisis in El Salvador underscores a broader need for stronger health infrastructure, especially in custodial settings. Public health advocates are urging the government to develop a national strategy that includes:
- Mandatory screening and treatment for incarcerated and recently released individuals
- Transparent publication of national TB statistics and outbreaks
- Community education campaigns to inform the public about symptoms, risks, and preventive measures
- Investment in diagnostic infrastructure to quickly detect and isolate TB cases
- Cross-agency collaboration to prevent the spread of TB and other infectious diseases
With the situation deteriorating, health experts stress that time is of the essence. Without immediate action, El Salvador may be on the brink of a public health crisis with far-reaching consequences.
