country update: tuberculosis in thailand dr. chawetsan namwat ntp manager and director of btb, ddc,...
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Country Update:Tuberculosis in Thailand
Dr. Chawetsan NamwatNTP manager and
Director of BTB, DDC, MOPH, Thailand
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TB prevalence in high burden countries
2Source: WHO, Global TB report, 2012
Tuberculosis situation
3source: WHO, Global Tuberculosis Report 2012
TB incidence (per 100,000) by WHO region,
and in Thailand, 2011
0
100
200
300
125
262
28 42
189
92124
2011
source: WHO, Global Tuberculosis Report 2012
TB incidence in Thailand is 2.5 – 4 times higher than Europe & America regions
Thailand: Estimated TB incidence rates,Trends in estimated TB incidence rates (green) and estimated incidence rates of HIV-positive TB (red).
source: WHO, Global Tuberculosis Report 2012
Trend of New smear-positive (New M+) case notification by all types
of TB in Thailand, 2001 -2012
BTB-Updated : May 28, 2013
Treatment outcome, 2001-2011
BTB-Updated : May 28, 2013
Treatment outcome, 2001-2011
BTB-Updated : May 28, 2013
Missing< 80% 80%-84% 85%-89% ≥ 90%
< 5% 5%-10% > 10%
< 1% 1%-2% ≥ 3%
Treatment outcome, 2011
BTB-Updated : May 28, 2013
Estimates of MDR-TB burden (2011),Thailand
Estimates among notified cases% of new TB cases with MDR-TB 1.7 (1.0–2.6)
% of retreatment TB cases with MDR-TB 35 (28–42)
Estimated MDR-TB cases among new pulmonary TB cases notified in 2010
890 (540–1 400)
Estimated MDR-TB cases among retreated pulmonary TB cases notified in 2010
1 300 (1 000–1 600)
Source: WHO Global TB Report 2012
MDR TB in High Burden Countries and Thailand
0
5
10
15
20
25
30
35
Bela
rus
Kaza
khst
anKy
rgyz
stan
Esto
nia
Uzb
ekis
tan
Aze
rbai
jan
Russ
iaM
oldo
vaU
krai
neLa
tvia
Tajik
ista
nG
eorg
iaLi
thua
nia
Arm
enia
Chin
aM
yanm
arPh
ilipp
ines
Paki
stan
Cong
oN
iger
iaVi
et N
amIn
dia
Bulg
aria
Indo
nesi
aSo
uth
Afr
ica
Ethi
opia
Bang
lade
shTh
aila
nd
%MDR TB among New TB cases
Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand
MDR TB in High Burden Countries and Thailand
0
5
10
15
20
25
30
35
Arm
enia
Aze
rbai
jan
Bang
lade
shBe
laru
sBu
lgar
iaCh
ina
Cong
oEs
toni
aEt
hiop
iaG
eorg
iaIn
dia
Indo
nesi
aKa
zakh
stan
Kyrg
yzst
anLa
tvia
Lith
uani
aM
yanm
arN
iger
iaPa
kist
anPh
ilipp
ines
Mol
dova
Russ
iaSo
uth
Afr
ica
Tajik
ista
nU
krai
neU
zbek
ista
nVi
et N
amTh
aila
nd
%MDR TB among New TB cases
Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand
Percentage of new TB cases with MDR-TB
MDR TB in High Burden Countries and Thailand
01020304050607080
Bela
rus
Mol
dova
Uzb
ekis
tan
Esto
nia
Aze
rbai
jan
Tajik
ista
nKy
rgyz
stan
Kaza
khst
anLi
thua
nia
Russ
iaU
krai
neA
rmen
iaG
eorg
iaLa
tvia
Paki
stan
Bang
lade
shCh
ina
Bulg
aria
Phili
ppin
esVi
et N
amIn
dia
Indo
nesi
aEt
hiop
iaM
yanm
arCo
ngo
Nig
eria
Sout
h A
fric
aTh
aila
nd
%MDR TB among previously-treated TB cases
Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand
Percentage of previously treated TB cases with MDR-TB
Drug resistance surveillance 2012 (prelim)
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Preliminary data of 4th Surveillance of Drug resistance in Tuberculosis: THAILAND 2012
ITEMS Newly Treated
Cases Previously
Treated Cases Combined Drug
resistance
N Pct N Pct N Pct
Total tested 1456 100.00% 175 100.00% 1631 100.00%
Fully sensitive 1216 83.52% 110 62.86% 1326 81.30%
Any resistance 240 16.48% 65 37.14% 305 18.70%
H+R resistance (MDR-TB) 27 1.85% 29 16.57% 56 3.43%
Mono-resistance 164 11.26% 32 18.29% 196 12.02%
Two drugs resistance 47 3.23% 3 1.71% 50 3.07%
Three drugs resistance 2 0.14% 1 0.57% 3 0.18%
Four drugs resistance 3 0.21% 4 2.29% 7 0.43%
Any H-resistance 174 11.95% 46 26.29% 229 1.41%
Any R-resistance 30 2.06% 39 22.29% 69 4.23%
Mono H-resistance 99 6.80% 16 9.14% 115 7.05%
Mono R-resistance 2 0.14% 7 4% 9 0.55% Note: Total = 1747 cases, 116 cases are waiting for analysis, NTRL NTP-May2013
National TB Prevalence Survey, 2012
Principal Investigator: Dr Sriprapa Nateniyom
Multi-stage cluster sampling 100 clusters x 900 subjects = 90,000
subjects BKK 17 clusters, Non-BKK 83 clusters
Study Population age 15+ years At least 14 days resided in the survey area
Interview and CXR all subjectssputum smear & culture for all suspects17
83 clusters in non-BKK 61,651 participants (M=27,478; F=34,173)
142 culture-confirmed TB cases (M=98, F=44) Age: 44% age 60+yr. Smear+ 41%, Smear- 59% Symptom & CXR
Symptom+ 35% (Symptom score 3+) CXR abnormal, no symptom 65%
P R E L I M I N A RY R E S U LT. N O T F O R R E F E R E N C E
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Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
Participation by age group
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Nu
mb
er
P R E L I M I N A R Y R E S U LT. N O T F O R R E F E R E N C E
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
Age distribution of TB cases(N=142)
P R E L I M I N A R Y R E S U L T . N O T F O R R E F E R E N C E
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Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
0-4Yr, 1.0%
5-9Yr, 0.5% 10-14Yr, 0.6%
15-24Yr, 7.3%
25-34Yr, 15.2%
35-44Yr, 18.6%
45-54Yr, 18.4%
55-64Yr, 15.9%
65+Yr, 22.5%
0-4Yr
5-9Yr
10-14Yr
15-24Yr
25-34Yr
35-44Yr
45-54Yr
55-64Yr
65+Yr
Age distribution of smear+ PTB, Report.506
Source: R506: Pulm TB New M+ /2008-2011, BOE
Age distribution of smear+ PTB, Report.506
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Challenge when the AEC startsIncidence rate (per 100,000)
AEC
2015
TB control in Thailand
Align with global stop TB strategy “Zero and Five to minimize MDR-TB”
ค้�นให้�พบ จบด้�วยห้ายตายน�อยกว�าร้�อยละ 5ขาด้ยาเป็�น 0
Political commitment & Universal coverage scheme
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Plan for DR-TB
Magnitude of problem DRS 2012 :
MDR: 1.8% among new TB, 17% among retreatment TB
Case detection C/ DST : Re – On – Pre Network of lab
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Plan for DR-TB
Treatment & Patient Support Guideline & Training MDR-TB treatment center (general & regional
hospitals) – NHSO approved Consultation mechanism Lab for f/u R&R – paper & electronic DOT
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Plan for DR-TB Specific issues for migrants:
Multi-country proposal : for GF support Referral system at border area : Health insurance for migrants: documented
and non-documented migrant labors
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Plan for DR-TB
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Plan for DR-TB
ขอบค้�ณค้ร้�บ
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