tuberculosis in cuba: control and opportunity for elimination
TRANSCRIPT
Tuberculosis in CubaControl & Opportunity for Elimination
Kathryn Cicerchi, Colorado School of Public HealthMay/June 2015
Tuberculosis Infectious disease caused by mycobacterium
tuberculosis
Can be acute, sub-acute or chronic in nature
Most commonly attacks lungs Can attack any part of the body, such as kidneys,
spine, brain
Can be fatal if not treated properly
Two types of infection: Latent Active
Sources: CDC, WHO 2015
Latent Tuberculosis 1/3 of the world’s population is infected, though most
are not ill and cannot transmit TB
Walled off by healthy immune system
Many with latent TB never progress to active disease
Those who do: Become sick within days of infection before immune
system can fight off Can develop active TB years later when immune system
compromised (malnutrition, diabetes, HIV co-infection)
Lifetime risk of progressing from latent TB to active disease is 10% (WHO)
Sources: CDC, WHO 2015
Active Tuberculosis Symptoms:
Coughing (sputum, blood) Chest pains Weakness Weight loss Fever Night sweats
Spread person to person through droplets
Treatable with antibiotics
Associated with extreme poverty, lack of health care, poor environmental and hygienic conditions (overcrowding)
Sources: CDC, WHO 2015
TB in CubaTB mortality was high throughout Spanish
colonial period
1902: Tuberculosis was main cause of death 4,001 fatalities; 15.7% of total deaths
1907: Special TB wards set up in hospitals to treat extreme cases. Sanitarium set up outside of Havana for the poor.
TB mortality declined throughout 20th century
1943: Mortality rate was estimated to be 65 per 100,000
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TB in CubaBefore the Cuban Revolution in 1959, TB still
caused 1,000 deaths annually
Following the Revolution, an accessible, free, universal health care system established
1962-1963: National Tuberculosis Control Program founded as part of the system
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National Tuberculosis Control Program (NTCP)1963-1971: Sanatorial care with continued
assessment and risk evaluation
By 1970: Cuba established decentralized labs capable of sputum smear microscopy
By 1971: Outpatient basis with directly observed treatment (DOT)
1982: Directly observed treatment, short course
National Tuberculosis Control Program (NTCP)Laboratories
Newborn vaccination
Active contact tracing All TB cases systematically investigated Contacts checked for respiratory symptoms Contacts meeting certain criteria are treated
prophylactically with isoniazid
Local doctors perform all case finding, treatments (DOTS), prophylaxis, community education
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NTCP SuccessBy 1991, TB incidence was 4.7 per 100,000
Down from 65 per 100,000 in 1965
Reduction in incidence and all serious forms of TB
In children under 15, 85% decrease
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Re-Emergence of TBDespite progress, TB began to re-emerge
worldwide in 1990s Worsening social problems Increased drug resistance HIV co-infection Abandonment of control programs
After the breakdown of the Soviet Union, TB incidence in Cuba began to creep up beginning in 1992 14.7 per 100,000
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Re-Emergence of TBCuban Ministry of Public Health gave TB top
priority
In addition to prior tactics: Improved surveillance Mandatory notification system Contact investigations beyond household level Supervised control with annual courses for health
personnel
Emphasis on fighting childhood TB
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Re-Emergence of TBFollowing re-intervention, decrease from
14.7/100,000 in 1994 to 7.2 per 100,000 in 2003
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Declining Mortality 0.4 per 100,000 in 1998 to 0.2 per
100,000 in 2007
Met the WHO’s Global Plan to Stop TB’s 2006-2015 target well in advance (2007)
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EliminationCuba is on track to eventually eliminate
tuberculosis Low rates of MDR-TB Relatively low HIV co-infection
Efforts need to focus on adjusting indicators to be more sensitive
Improve case detection by focusing on vulnerable groups within Cuba
Increase quality of preventive services
Keep an eye on MDR-TB and HIV co-infection
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References Abreu, G., Gonzalez, J. A., Gonzalez, E., Bouza, I., Velazquez, A.,
Perez, T., . . . Sanchez, L. (2011). Cuba's strategy for childhood tuberculosis control, 1995-2005. MEDICC Review, 13(3), 29-34.
Association of Schools of Public Health. (1907). Cuba: Tuberculosis in Cuba. Free sanitarium for tuberculous patients to be established. Public Health Reports (1896-1970), 22(24). Retrieved from http://www.jstor.org/stable/4559252
Centers for Disease Control and Prevention (CDC). (2012, March 13). Basic TB facts. Retrieved from http://www.cdc.gov/tb/topic/basics/default.htm
Gonzalez Ochoa, E., Rosco Oliva, G. E., Borroto Gutierrez, S., Perna Gonzalez, A., & Armas Perez, L. (2009). Tuberculosis mortality trends in Cuba, 1998 to 2007.MEDICC Review, 11(1), 42-47.
Gonzalez, E., Armas, L., & Llanes, M. J. (n.d.). Progress towards tuberculosis elimination in Cuba. The International Journal of Tuberculosis and Lung Disease,11(4), 405-411.
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References Gonzalez, E. R., & Armas, L. (2012). New indicators proposed to
assess tuberculosis control and elimination in Cuba. MEDICC Review, 14(4), 40-43.
Marrero, A., Caminero, J. A., Rodriguez, R., & Billo, N. E. (2000). Towards elimination of tuberculosis in a low income country: the experience of Cuba, 1962–97.Thorax, 55, 39-45.
Navarrete, A. (1943). Present tuberculosis status in Cuba. CHEST, 9(2). doi:10.1378/chest.9.2.175
Pan American Health Organization (PAHO). (n.d.). Tuberculosis. Retrieved May 20, 2015, from http://www.paho.org/hq/index.php?option=com_topics&view=article&id=59&Itemid=40776&lang=en
World Health Organization (WHO). (2015, March). Tuberculosis. Retrieved from http://www.who.int/mediacentre/factsheets/fs104/en/
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