Tuberculosis in Thailand

Dr. Chawetsan Namwat

NTP manager and

Director of BTB, DDC, MOPH, Thailand

1

Estimated number of

cases

Estimated number of

deaths

1.4 million 8.7 million

~150,000 630,000

All forms of TB Greatest number of cases in Asia; greatest rates per capita in Africa

Multidrug-resistant TB (MDR-TB)

Extensively drug-resistant TB (XDR-TB) ~50,000 ~30,000

HIV-associated TB 0.97 million 0.43 million

TB: 2011 Global Estimates

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TB prevalence in high burden countries

3 Source: WHO, Global TB report, 2012

Global TB estimates, 2011

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Incidence reduction: 2.2%

TB death reduction: 41% from 1990

Challenges

Incidence 8.7 Million

Deaths: among HIV-ve 0.99M, among HIV+ve 0.43M

MDR-TB: 3.7% in new cases, 20% in previously treated

Tuberculosis situation

5 source: WHO, Global Tuberculosis Report 2012

TB incidence (per 100,000) by WHO region, and in Thailand, 2011

125

262

28 42

189

92

124

0

100

200

300

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

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%MDR TB among New TB cases

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%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

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%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 subjects sputum smear & culture for all suspects

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National TB Prevalence Survey, 2012

Study area ODPC1 นนทบรุ ี ปทมุธาน ี ODPC2 ชยันาท ลพบรุ ี ODPC3 ฉะเชงิเทรา ชลบรุ ี ODPC4 กาญจนบรุ ีสมทุรสงคราม ODPC5 นครราชสมีา สรุนิทร ์ ODPC6 เลย อดุรธาน ี ODPC7 นครพนม อบุลราชธาน ี ODPC8 นครสวรรค ์พจิติร ODPC9 เพชรบรูณ์ สโุขทัย ODPC10 เชยีงใหม ่ พะเยา DOPC11 กระบี ่ นครศรธีรรมราช ODPC12 ตรัง สงขลา

TB prevalence survey Sampling & Eligible

Abnormal CXR Symptom+ (score3+) or

Sputum collection

Sputum culture (**Bact. Confirm**)

Sputum Smear and

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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Num

ber

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

5th National Survey -China 2010 253,000 participants in 176 sites

Region

Smear positive TB

Bacteriological positive

Prevalence (1/100000) Change

(%) Prevalence

(1/100000) Change

(%)

2000 2010 2000 2010

Urban 131

（91，172） 49

（25，74） -62.6

164 （120，208）

73 （46，99）

-55.5

Rural 181

（160，202） 78

（64，93） -56.9

232 （211，254）

153 （133，172）

-34.1

Eastern 124

（102，147） 44

（30，58） -64.5

163 （138，187）

65 （50，81）

-60.1

Middle 217

（176，259） 60

（30，91） -72.4

251 （207，294）

118 （81，154）

-53.0

Western 198

（160，236） 105

（80，130） -47.0

278 （240，316）

198 （167，229）

-28. 8

(China CDC 2011) 25

Courtesy slide: Dr Onozaki, WHO

Challenge when the AEC starts Incidence rate (per 100,000)

AEC

2015

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TB control in Thailand

Align with global stop TB strategy

“Zero and Five to minimize MDR-TB”

คน้ใหพ้บ จบดว้ยหาย ตายนอ้ยกวา่รอ้ยละ 5 ขาดยาเป็น 0

Political commitment & Universal coverage scheme

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TB in Non-Thais

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2011 1182 44 789 253 2268

2010 1028 27 652 220 1927

2009 933 38 804 168 1943

Fiscal Year

New

M+

Relap

se

New

M- EPTB Total

Age distribution of New M+ TB cases in migrants, Thailand 2009-2011

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From strategies to actions:

Disease control competent

districts

Indicators on TB control in district levels

1. การตอบสนองเชงินโยบาย ม ีMr.TB /มผีูรั้บผดิชอบงานผา่นอบรม

2. การคน้หาและวนิจิฉัยผูป่้วยวัณโรค

3. การรักษาดว้ยระบบยาระยะสัน้แบบมพีีเ่ลีย้ง

4. ยารักษาวัณโรคไมข่าดแคลนและมคีณุภาพ

5. ทะเบยีนและรายงานวัณโรค

6. การป้องกนัการแพรก่ระจายเชือ้วัณโรคในโรงพยาบาล

7. การผสมผสานงานวัณโรคและโรคเอดส ์

8. ผลการรักษา

ขอบคณุครับ

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