control of tuberculosis in australia guy b. marks woolcock institute of medical research department...
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Control of Tuberculosis in Australia
Guy B. Marks
Woolcock Institute of Medical Research
Department of Respiratory Medicine, Liverpool Hospital
Outline
• Organisation of Care
• Descriptive Epidemiology– Roche P, Bastian I, Krause V, National Tuberculosis
Advisory Committee, for Communicable Diseases Network Australia. Tuberculosis notifications in Australia, 2005.
Commun Dis Intell. 2007;31:71-80.
• Outcomes of Treatment
• Program Priorities
TB control in Australia
• Under control of eight jurisdictions• DOTS in most but not all jurisdictions• Mostly public sector but private sector
involvement in some activities• Other State TB control activities
– Contact tracing– Screening high risk groups
• National role– Data reporting– Screening intending migrants and visa applicants
Roche et al. Comm Dis Intell 2007; 31:71-80
Incidence of TB in Australia, 1960 - 2005
1072 cases,
5.3 / 100,000
Roche et al. Comm Dis Intell 2007; 31:71-80
Incidence in indigenous, non-indigenous Australian-born and overseas-born,
Australia 1991 - 2005
27 cases5.9 / 100,000
122 cases0.8 / 100,00
923 cases19.1 / 100,000
Roche et al. Comm Dis Intell 2007; 31:71-80
Incidence by country of birth,Australia, 2005
0
100
200
300
400
500
600
Indi
a
Vietna
m
Philipp
ines
China
Indo
nesia
Sudan
PNG
Somali
a
Cambo
dia
Bangl
ades
h
Pakist
an
Hong
Kong
SAR
Greec
e
Thaila
nd
Ethiop
ia
Other
OS-b
orn
Cases
Rate per 100,000 population inAustralia
WHO incidence rate per 100,000
Roche et al. Comm Dis Intell 2007; 31:71-80
Age-Distribution by Birthplace,Australia, 2005
0
5
10
15
20
25
30
35
40
< 15 15–24 25–34 35–44 45–54 55–64 65+
Age Group
Ra
te (
pe
r 1
00
,00
0)
Overseas-born
Australian-born
HIV co-infection
• No representative data
• HIV status report for 37% of notifications
• Nine (2.3%) of these were HIV +ve
Roche et al. Comm Dis Intell 2007; 31:71-80
Site of DiseaseExtra-pulmonary
only
Pulmonary only
Pulm. + XP
Lumb et al. Comm Dis Intell 2007; 31:80-86
Multi-drug Resistance RatesAustralia, 1995-2005
0
2
4
6
8
10
12
14
16
20052004200320022001200019991998199719961995
N
%
Roche et al. Comm Dis Intell 2007; 31:71-80
Outcomes of TB Cohort, Australia, 2004
Cured
Completed
Interrupted Rx
Died of TB
Defaulted
Failure
Outcome unknown
Transferred out
Died other causes
Still under Rx
11 deaths attributed to TB
Roche et al. Comm Dis Intell 2007; 31:71-80
Priorities
• Early detection – Awareness– Primary health care
• Effective treatment completion– Free treatment– DOTS
• Control of disease in high risk groups– Migrants– Contacts of infectious cases
Control of TB in Migrants
• Screening prior to migration or on application for change in visa status
• Treatment of active and some inactive disease
• Post-migration follow-up of migrants with evidence of past TB
Conclusions
• Australia is a low burden country
• Many visitors and migrants from high-burden countries
• TB control requires continued vigilance and active control measures