Epidemiology of Tuberculosis in The Republic of Mauritius by sMu51L72

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									 Epidemiology of Tuberculosis
             in
  The Republic of Mauritius

       “ Recent Trends ”

(La Tuberculose à L`ile Maurice)

                     Dr R.Reesaul
                        Chest Physician
                               Chest Clinic
                           P. D`or Hospital
INCIDENCE AND MORTALITY OF TB WORLDWIDE PER 100,000
                 INHABITANTS 2006


                                              50
                                               12
                          43
30                         8
6
                               1251M 25      190
                                              3M
                                                    72
                       350
                          2M
                           100                           122
                                                          2M
                                                               22


      90
      45                         97
                                        10

                1/3 of world population infected
                      10 M new cases yearly
                    3 M cases of death yearly
           INCIDENCE AND RATE OF TB IN THE INDIAN
            OCEAN PER 100,000 INHABITANTS in 2006

                                                       75
      125 1M                        115                     1M
                                      2M




                                           44
                                            8000
350
2M                25 20                                          2M



      17
       120


           97
        40,000
                      10                            Low incidence in
                 9    115                                    a
                 75                                  High risk region
       Tuberculosis in Mauritius
 Population of 1.2 million( 2006)


 Tuberculosis is a notified disease to the MOH


 Free treatment of all persons with active TB


 Anti- TB drugs(1st line and 2nd line drugs ) are
  available only at MOH central pharmacy


 Only few cases treated in private
ORGANIZATION AND SET UP OF TB IN MAURITIUS

                           M.O.H



      In -patients
      30 Beds TB       CHEST Clinic                 AIDS Unit


  5 Out- patients in                                 W.H.O
 Regional Hospitals                                  Africa

Specialized National                           Administration
    Laboratory                               Procurement, Tenders
For TB detection                            Statistics, notifications…

                          Home Visits           Screening
Specialized Pharmacy   Specialized Nurses       Contacts
   Anti-TB Drugs                             Migrant workers
                         DOTS, Drugs            Prisoners
         BCG              Counselling            Homes
                                                High risks
              Notification and Incidence rate of Tuberculosis
                             from 1974 to 2006

  Years      1974   1975   1976   1977   1978   1979   1980   1981   1982   1983   1984   1985   1986   1987   1988

Incidence
   per
 100,000
inhabitant   35 28 25 24 24 20 14 17 13 16 13 12 12 11                                                         11
 Notified
 Cases       269 223 199 198 195 183 131 163 122 159 120 116 121                                        111    113




  Years      1992   1993   1994   1995   1996   1997   1998   1999   2000   2001   2002   2003   2004   2005   2006


Incidence
   per
 100,000
inhabitant   13 16 15 13 11 11 12 15 14 10 12 11 12 10                                                         10
 Notified
 Cases       141 165 153 146 123 131 140 174 160 119 139 137 139 127                                           115
     INCIDENCE RATE OF TB PER 100,000 INHABITANTS
               YEAR 1974 TO 2006
40
35
30
25
20
15
10
5
0
 74
      76
           78
                80
                     82
                          84
                               86
                                    88
                                         90
                                              92
                                                   94
                                                        96
                                                             98
                                                                00
                                                                02
                                                                04
                                                                06
                                                              20
                                                              20
                                                              20
                                                              20
                          Trend Incidence Pulmonary TB
                                     2001-2005

                                     Incidence de la TB 2001-2005

                         12
Incidence pour 100.000




                         10

                          8
       habitants




                                                                    TB Totale
                          6                                         TB Pulmonaire
                                                                    ZN+
                          4

                          2

                          0
                              2001    2002    2003    2004   2005
                                             Années
             WHO Notification of TB 2002-2006
Year         2002   2003   2004   2005   2006   2007
New ss + P   86     99     117    110    85
New ss - P   28     16     3      4      11
New E.P      23     17     13     8      15
Relapse      2      4      4      3      3
Failure      0      1      0      0      0
Defaulter    0      1      2      2      1
Total        139    137    139    127    115    (99)
MDR          0      0      1      0      2      (1)
TB +HIV      0      1      2      2      5      (6)
Total        458    698    1124   1822   2631   (3173)
HIV/AIDS
        INCIDENCE / among Migrant workers
                                                                 INCIDENCE

                                 New TOTAL                                        TB
          TOTAL     New TOTAL      EXTRA                                        Migrant
           TB       PULMONARY   PULMONARY    ZN    ZN    TOTAL      PULMONARY             INCIDENCE ZN
YEARS    NOTIFIED       TB           TB      (+)   (-)    TB           TB       workers       (+)
2007      (97)                                                                    (15)
2006      115         96           15        85    11    9.5                        5
2005      127         114          08        110   04     10                       16
2004      139         120          13        117   03     11                       12
2003      137         115          17        99    16    11.2          10.8        12        7.5
2002       139        124          23        86    28    11.8          10.6       11         7.9
2001       119        113           6        83    5     9.7           9.4         6         8.7
2000       160        142          18        92    31    13.9          12.3       13          8.0
1999       174        161          13        112   32    15.2          14.1       11          9.8
1998       140        126          14        105   21    12.4          11.0        7          9.3
1997       131        122           9        102   20    11.6          10.9        1          9.1
1996       123        116           7        98    18    11.2          10.5        2          8.9
1995       146        134          12        108   23    13.4          12.0        4          9.9
1994       153        142          11        116   26    14.9          13.0        3         10.7
1993       165        148          18        130   18    15.6          13.9        0         12.2
1992       141        126          15        114   12    13.4          12.0        2         10.8
1991       141        138           3        112   26    13.6          13.3        0         10.4
1990       119        113           6        102   11    11.6          11.0        0         10.0
              Age group and TB 2001-2005
                 Few cases <14 , protection BCG vaccin ?
                         Max cases age 25-44


                      Répartition de la TB par tranche d'age

         45
         40
         35                                                      0-14
         30                                                      15-24
nombre




                                                                 25-34
         25
                                                                 35-44
         20
                                                                 45-54
         15                                                      55-64
         10                                                      >=65
          5
          0
               2001        2002      2003       2004      2005
                                    années
          Case notifications and sex ratio


Sex ratio: M/F

Age 15-24 : 2/1
Age 25-34 : 3/1
Age 35-44 :4/1
Age 45-54 : 2/1
Age >55 : 4/1
Pulmonary and Extra-pulmonary TB
           2001-2005

           TB Pulmonaire et Extra Pulmonaire: comparaison

         140
         120
         100
Nombre




         80                                         Pulmonaire
         60                                         Extra Pulmonaire

         40
         20
          0
               2001   2002    2003    2004   2005
                             Années
         Extra pulmonary TB 2001-2005

                                    TB Extra Pulmonaire 2001-2005

         35
         30
         25
Nombre




         20
                                                                    Series1
         15
         10
         5
         0
                                               ire




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                                        Les différents types
                 Trend of Incidence TB in districts
                             2001-2005
                   Incidence de la TB par district: 2001-2005

            30

            25                                            Port Louis
                                                          Pamplemousses
            20
Incidence




                                                          Riv du Rempart
            15                                            Flacq
                                                          G.Port
            10
                                                          Savane
            5                                             Riv Noire
            0                                             Moka
                  2001   2002   2003    2004   2005       Pl Wilhems
                                Année
EVOLUTION INCIDENCE PER 100,000 INHABITANTS
        DISTRICT from 1993 AND 2005




                               13 12    17 14


                      40 23                     20
                                                     13
                 9             4   4

             5       13
                          08




                                            6
                                       13
             14 10


      Incidence 1993 - 15.6 per 100,000 inhabitants
      Incidence 2005 - 11 per 100,000 inhabitants
DEATH RATE TB PER 100,000 INHABITANTS 1991
                TO 2006

  3

2.5

  2

1.5

  1

0.5

  0
    91


            93


                    95


                            97


                                    99


                                            01


                                                    03


                                                            05
 19


         19


                 19


                         19


                                 19


                                         20


                                                 20


                                                         20
                 Cumulative cases HIV/AIDS
                ( 1st case at P D`or Hospital )
                Cumulative nº of HIV/AIDS cases (87-04)
                                                                                         1124
              1200

              1000
No of cases




               800
                                                                                             698
               600
                                             `                                         458
               400
                                                                                 356
                                                                           287
               200                                         168   197 230
                                                     140
                                        55 67 90 117
                 0     1   9   12 17 27
                     87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

                                                 Year
CO-INFECTION TB / HIV-AIDS
YEARS    Total Cases of    Cases
          HIV/AIDS        TB / HIV
 1999         230            1

 2000         287            1

 2001         356            1

 2002         458            0

 2003         698            1

 2004         1124           2
 2005         1822           2
 2006         2631           5
 2007        (3173)         (6)
        DOTS and case detection rate
Objectives of WHO
 Implementation of DOTS coverage ( Directly observed short
  course treatment) 100%

   Case detection rate of at least 70% of smear positive
    pulmonary TB cases

 Improve Cure rate > 80%

     Non-compliance spread of infection lead to :

        MDR ( Resistance to INAH & Rifampicin )


        XDR TB( MDR and resistance to at least 3 major
                     second line drugs )
DOTS monitoring & outcomes 1995-2005
  MDR TB 2001-2006
Years     Resistance INAH & RIF

2001               0
2002               0
2003               0
2004               1
2005               o
2006                2
2007               (1)
 Risk factors predisposing to TB in %
   admitted at Poudre D`or Hospital


  Causes            %
  Alcoholic       50-70%
  Homeless
     DM           10 -15%
   Contacts       5-10%
     HIV           <5%
Migrant workers   5- 10%
                       Conclusion

Incidence TB stable 10-14 /100,000 since 1995

Incidence highest among age group 35-45

Increase of extra-pulmonary TB since1992

Low death rate < 1/100,000 since 1998
Increase of TB among migrant workers noted since 1998

Few cases of Co-infection TB / HIV-AIDS and MDR TB

Cases MDR TB not among HIV/AIDS patients
Thank You

  Merci
9 Districts in Mauritius population 1.2 M
       Tuberculosis in Mauritius

 Capital –District of Port Louis
 Area 1865 km² , 9 districts + Rodrigues
 Population of 1.2 million( 2006)
 Tuberculosis notified disease to MOH
 Gross national income per capita USD :12.45
 Total expenditure on health as % GDP :4.3
 Life expectancy at birth M/F :69/76
 Free treatment of all persons with active TB
 Anti- TB drugs available only at MOH central
  pharmacy and few cases treated in private
                       Notified cases and incidence of Tb
                                    2001-2006

               Tendance du nombre de cas de TB: 2001-2005                                                           Incidence de la TB: 2001-2005

                                                                                                        14




                                                                     Incidence pour 100.000 habitants
         145
         140                                                                                            12
         135
                                                                                                        10
         130
Nombre




         125                                                                                            8                                           Incidence résidents
                                                     Nombre de cas
         120                                                                                            6                                           Incidence globale
         115
                                                                                                        4
         110
         105                                                                                            2
         100                                                                                            0
                2001   2002    2003    2004   2005                                                           2001   2002    2003    2004   2005
                              Années                                                                                       Années
                TREND OF NOTIFIED CASES
                    YEAR 1974 -2006
300

250

200

150

100

50

 0




                                                    02

                                                    05
 74

      77

           80

                83

                     86

                          89

                                93

                                       96

                                            99
                                                 20

                                                 20
                               YEARS
WHO Case notifications 1998-2005

								
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