country update: tuberculosis in thailand dr. chawetsan namwat ntp manager and director of btb, ddc,...

Country Update:Tuberculosis in Thailand

Dr. Chawetsan NamwatNTP manager and

Director of BTB, DDC, MOPH, Thailand

1

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


Missing< 80% 80%-84% 85%-89% ≥ 90%

< 5% 5%-10% > 10%

< 1% 1%-2% ≥ 3%

Treatment outcome, 2011


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

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Kaza

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%MDR TB among New TB cases

Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand


0

5

10

15

20

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Arm

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%MDR TB among New TB cases


Percentage of new TB cases with MDR-TB


01020304050607080

Bela

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%MDR TB among previously-treated TB cases


Percentage of previously treated TB cases with MDR-TB

Drug resistance surveillance 2012 (prelim)

16

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

18

Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)

Participation by age group

19

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


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

20


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

22

23

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

24

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

25

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

26

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

27

28

Plan for DR-TB

29

Plan for DR-TB

ขอบค้�ณค้ร้�บ

30

country update: tuberculosis in thailand dr. chawetsan namwat ntp manager and director of btb, ddc,...

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