epidemiology of tuberculosis in the republic of mauritius “ recent trends ” (la tuberculose à...
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Epidemiology of Tuberculosis in
The Republic of Mauritius
“ Recent Trends ”
(La Tuberculose à L`ile Maurice)
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
Dr R.Reesaul Chest Physician
Chest Clinic
P. D`or Hospital
INCIDENCE AND MORTALITY OF TB WORLDWIDE PER 100,000 INHABITANTS 2006
350
30
43
125 190
122
50
90
97
72
100
45
12
25
86
22
10
2M
2M
1M 3M
1/3 of world population infected
10 M new cases yearly
3 M cases of death yearly
350
9 75
97
25
11575
17
INCIDENCE AND RATE OF TB IN THE INDIAN OCEAN PER 100,000 INHABITANTS in 2006
44
10115
2M
2M
2M
1M125
20
120
40,000
8000
1M
Low incidence in
a
High risk region
Tuberculosis in MauritiusTuberculosis 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
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
CHEST ClinicIn -patients 30 Beds TB AIDS Unit
Home Visits Specialized Nurses
DOTS, DrugsCounselling
W.H.O Africa
AdministrationProcurement, Tenders
Statistics, notifications…
ScreeningContacts
Migrant workersPrisoners
HomesHigh risks
5 Out- patients inRegional Hospitals
Specialized National Laboratory
For TB detection
Specialized Pharmacy Anti-TB Drugs
BCG
M.O.H
ORGANIZATION AND SET UP OF TB IN MAURITIUS
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 10Notified 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
INCIDENCE RATE OF TB PER 100,000 INHABITANTS YEAR 1974 TO 2006
0
5
10
15
20
25
30
35
40
Trend Incidence Pulmonary TB 2001-2005
Trend Incidence Pulmonary TB 2001-2005
Incidence de la TB 2001-2005
0
2
4
6
8
10
12
2001 2002 2003 2004 2005
Années
Inc
ide
nc
e p
ou
r 1
00
.00
0
ha
bit
an
ts TB Totale
TB Pulmonaire
ZN+
WHO Notification of TB 2002-2006WHO Notification of TB 2002-2006Year 2002 2003 2004 2005 2006 2007
New ss + P 86 99 117 110 85New ss - P 28 16 3 4 11New E.P 23 17 13 8 15Relapse 2 4 4 3 3Failure 0 1 0 0 0Defaulter 0 1 2 2 1Total 139 137 139 127 115 (99)MDR 0 0 1 0 2 (1)TB +HIV 0 1 2 2 5 (6)Total HIV/AIDS
458 698 1124 1822 2631 (3173)
YEARS
TOTALTB
NOTIFIED
New TOTALPULMONARY
TB
New TOTALEXTRA
PULMONARYTB
ZN (+)
ZN (-)
INCIDENCE
TBMigrant workers
INCIDENCE ZN (+)
TOTALTB
PULMONARYTB
20072006200520042003
(97)115127139137
96114120115
15081317
8511011799
11040316
9.51011
11.2 10.8
(15)5161212 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
INCIDENCE / among Migrant workers
Age group and TB 2001-2005Age group and TB 2001-2005
Répartition de la TB par tranche d'age
0
5
10
15
20
25
30
35
40
45
2001 2002 2003 2004 2005
années
no
mb
re
0-14
15-24
25-34
35-44
45-54
55-64
>=65
Few cases <14 , protection BCG vaccin ?
Max cases age 25-44
Case notifications and sex ratioCase 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
Pulmonary and Extra-pulmonary TB 2001-2005
TB Pulmonaire et Extra Pulmonaire: comparaison
0
20
40
60
80
100
120
140
2001 2002 2003 2004 2005
Années
No
mb
re Pulmonaire
Extra Pulmonaire
Extra pulmonary TB 2001-2005Extra pulmonary TB 2001-2005
TB Extra Pulmonaire 2001-2005
0
5
10
15
20
25
30
35
Les différents types
No
mb
re
Series1
Trend of Incidence TB in districts 2001-2005
Trend of Incidence TB in districts 2001-2005
Incidence de la TB par district: 2001-2005
0
5
10
15
20
25
30
2001 2002 2003 2004 2005
Année
Inci
den
ce
Port Louis
Pamplemousses
Riv du Rempart
Flacq
G.Port
Savane
Riv Noire
Moka
Pl Wilhems
40
13 17
20
1314
9
13
4
23
08
4
1214
13
6
10
5
EVOLUTION INCIDENCE PER 100,000 INHABITANTS DISTRICT from 1993 AND 2005
Incidence 1993 - 15.6 per 100,000 inhabitantsIncidence 2005 - 11 per 100,000 inhabitants
0
0.5
1
1.5
2
2.5
3
DEATH RATE TB PER 100,000 INHABITANTS 1991 TO 2006
Cumulative cases HIV/AIDS( 1st case at P D`or Hospital ) Cumulative cases HIV/AIDS
( 1st case at P D`or Hospital )
Cumulative nº of HIV/AIDS cases (87-04)
1 9 12 17 27 55 67 90 117140168197230287
356458
698
1124
0
200
400
600
800
1000
1200
87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
Year
No
of
ca
ses
`
CO-INFECTION TB / HIV-AIDSYEARS Total Cases of
HIV/AIDSCases
TB / HIV
1999 230 1
2000 287 1
2001 356 1
2002 458 0
2003 698 1
2004
2005
2006
2007
1124
1822
2631
(3173)
2
2
5
(6)
DOTS and case detection rateDOTS 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 majorsecond line drugs )
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 majorsecond line drugs )
DOTS monitoring & outcomes 1995-2005DOTS monitoring & outcomes 1995-2005
MDR TB 2001-2006MDR TB 2001-2006
Years Resistance INAH & RIF
2001 0
2002 0
2003 0
2004 1
2005 o
2006
2007
2
(1)
Risk factors predisposing to TB in % admitted at Poudre D`or Hospital
Risk factors predisposing to TB in % admitted at Poudre D`or Hospital
Causes %Alcoholic Homeless
50-70%
DM 10 -15%
Contacts 5-10%
HIV <5%
Migrant workers 5- 10%
ConclusionConclusion
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 YouThank You
MerciMerci
Thank YouThank You
MerciMerci
9 Districts in Mauritius population 1.2 M 9 Districts in Mauritius population 1.2 M
Tuberculosis in MauritiusTuberculosis 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
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
Notified cases and incidence of Tb 2001-2006
Tendance du nombre de cas de TB: 2001-2005
100
105
110
115
120
125
130
135
140
145
2001 2002 2003 2004 2005
Années
Nom
bre
Nombre de cas
Incidence de la TB: 2001-2005
0
2
4
6
8
10
12
14
2001 2002 2003 2004 2005
Années
Inci
denc
e po
ur 1
00.0
00 h
abita
nts
Incidence résidents
Incidence globale
0
50
100
150
200
250
300
74 77 80 83 86 89 93 96 9920
0220
05
TREND OF NOTIFIED CASES YEAR 1974 -2006
YEARS
WHO Case notifications 1998-2005WHO Case notifications 1998-2005