Tuberculosis in Salvador, Bahia, Brazil, in the 1990s

The characteristics of tuberculosis (TB) cases and deaths were analyzed in order to characterize the epidemiological profile of TB (incidence and mortality) in Salvador, Bahia, Brazil, in the 1990s. Annual incidence and mortality rates were calculated by gender, age bracket, and clinical forms of the disease using databases from the Tuberculosis Information System of the Bahia State Health Secretariat and the Mortality Information System of the Brazilian Ministry of Health. TB spatial distribution was analyzed according to health district. Cases and deaths were predominantly in males in the 15 to 39 year group. The pulmonary form showed the highest incidence and mortality. The existing data did not corroborate the hypothesis that AIDS/TB co-infection might contribute to maintaining the high mortality rates. The greater occurrence of tuberculosis in certain health districts may be associated with population density and unfavorable living conditions.     

Improved Outcomes Found After Implementing a Systematic Evaluation and Program Improvement Process for Tuberculosis

California''s state and local tuberculosis (TB) programs collaborated to develop the Tuberculosis Indicators Project (TIP), a program evaluation and improvement process. In TIP, local and state staff review data, identify program gaps, implement plans to improve local TB program performance, and evaluate outcomes. After 10 years of project implementation, indicator performance changes and patient outcomes were measured. Eighty-seven percent of participating programs showed a performance increase in targeted indicators after three years compared with 57% of comparison groups. Statistically significant performance change was more common in the intervention local health departments (LHDs) than in comparison groups. The most notable performance changes were in the contact investigation and case management indicators. These results indicate that this systematic evaluation and program improvement project was associated with improved LHD TB control performance and may be useful to inform improvement projects in other public health programs.In 1998, the California Department of Public Health, Tuberculosis Control Branch (TBCB) sought to enhance its program evaluation and improvement efforts. The evaluation process had two aims: (1) to measure the effectiveness of California tuberculosis (TB) control programs in implementing well-established TB control guidelines and ensuring positive patient and public health outcomes and (2) to focus interventions where gaps were identified. From 1998 to 2000, the TBCB worked closely with local health departments (LHDs) to design TB program performance indicators and a collaborative process for the state and local TB programs to use the indicators. The resulting evaluation and program improvement initiative, called the Tuberculosis Indicators Project (TIP), was launched in 2000.In this article, we describe the implementation of an evaluation framework in multiple high-morbidity local TB control programs in California. We also quantify the program performance changes associated with TIP and examine why these changes might have occurred.     

Modeling trends of health and health related indicators in Ethiopia (1995-2008): a time-series study

Background  

The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since 1987 E.C. These indicators have been of high importance in indicating the status of health in the country in those years. However, the trends/patterns of these indicators and the factors related to the trends have not yet been investigated in a systematic manner. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend.     

Tuberculosis in Havana City, 1995-1999

OBJECTIVE: Tuberculosis is a worldwide health problem getting a prioritized attention by the Cuban National Health System. To describe the main indicators of the Cuban Tuberculosis Control Program. METHODS: Based on surveillance data from the Provincial Center of Hygiene and Epidemiology, the health care network and strategies of the tuberculosis control program were reviewed; incidence rates, case finding indicators, diagnosis and case management were described. RESULTS: Eight subjects with respiratory symptoms were found per 1,000 attending general medical care services. The incidence rates of all tuberculosis types declined from 16.4 in 1995 to 12.0 x 10(5) people in 1999. Pulmonary tuberculosis incidence rate was reduced from 15.1 in1995 to 10.4 x 10(5) in 1999, whereas extrapulmonary tuberculosis had an increment from 1.3 to 1.6 x 10(5) in the same period. Of all new cases, 40-50 % were diagnosed at multispecialty clinics, 67.6% were diagnosed by positive smears, 15.2 % by positive cultures, 13.8 % by clinical and X-rays evidences only; and 0.9 % and 1.5 % were respectively diagnosed by biopsy and necropsy. There was an increase in the incidence rate in the age group 15-64 years in 1996 and 1997 but it declined again in 1998 and 1999. The age group 64 years and over showed a rate reduction from 1995 to 1999. In general, incidence rates diminished in the overall period. The average delay between onset of symptoms and diagnosis improved from 42 days in 1995 to 28.6 days in 1999. CONCLUSIONS: There seems to be a halt in reporting trends of new cases in 1996. Tuberculosis indicators reveal satisfactory changes in the study period.     

Tuberculosis cases in the Negev 1978-1987: ethnicity, sex, and age.

BACKGROUND: The incidence of tuberculosis (TB) in Sub-Sahara Africa is considered to be one of the highest in the world. During the past decade thousands of Jewish refugees from Ethiopia were settled in the Negev and might constitute a potential reservoir of infection for the indigenous populations. This study provides some baseline information about TB in the Negev just prior to and after an Ethiopian immigration peak. METHODS: The files of every case of TB diagnosed during the decade 1978-1987 at Soroka Medical Center were reviewed and each diagnosis was validated by rigorous clinical and microbiological criteria. The age, gender, and ethnic background of each case were recorded, and approximate population denominators were estimated from Ministry of Health and Census data. Annual and decade incidence rates were then calculated for the different demographic categories. RESULTS: 279 cases of TB were verified. The main 10-year incidence rate per 10,000 Israeli Jews was 0.28; for the Negev Beduins it was 1.52; for the Ethiopian Jews, 91.9. In the Jewish population, cases among males (59) far exceeded those among females (7), but the reverse was observed, both among the Beduins (47 female and 31 male cases) and the Ethiopian immigrants (79 female and 56 male cases). In all three groups TB incidence increased with age, ranging from 0.03 per 10,000 for young non-Ethiopian Jews to a remarkable 623.8 per 10,000 for elderly Ethiopian Jews. CONCLUSIONS: The results of this study indicate the existence of a potentially large TB reservoir in the Negev. Health workers must be alerted to the importance of continued case finding, effective case management, and the control of infection transmission. The unique integration of the Negev Health Delivery System should help monitor intervention strategies.     

Trends in tuberculosis incidence--United States, 2006

In 2006, a total of 13,767 tuberculosis (TB) cases (4.6 per 100,000 population) were reported in the United States, representing a 3.2% decline from the 2005 rate. This report summarizes provisional 2006 TB incidence data from the National TB Surveillance System and describes trends since 1993. The TB rate in 2006 was the lowest recorded since national reporting began in 1953, but the rate of decline has slowed since 2000. The average annual percentage decline in the TB incidence rate decreased from 7.3% per year during 1993-2000 (95% confidence interval [CI] = 6.9%-7.8%) to 3.8% during 2000-2006 (CI = 3.1%-4.5%). Foreign-born persons and racial/ethnic minority populations continue to be affected disproportionately by TB in the United States. In 2006, the TB rate among foreign-born persons in the United States was 9.5 times that of U.S.-born persons. The TB rates among blacks, Asians, and Hispanics were 8.4, 21.2, and 7.6 times higher than rates among whites, respectively. The slowing of the decline in the overall national TB rate and the inability to effectively address persistent disparities in TB rates between U.S.-born and foreign-born persons and between whites and racial/ethnic minority populations threaten progress toward the goal of eliminating TB in the United States. In 1989, CDC and the Advisory Committee for the Elimination of Tuberculosis issued a strategic plan for the elimination of TB, setting an interim target case rate of 3.5 per 100,000 population by 2000 and ultimately the elimination of TB (i.e., <1 case per 1 million population) in the United States by 2010.     

Treatment Outcomes of Tuberculosis Patients at Debre Berhan Hospital,Amhara Region,Northern Ethiopia

Background

Directly observed treatment remains one of the most widely-accepted global health interventions for tuberculosis. Tuberculosis treatment outcome is one of the performance indicators of the programme set by World Health Organization. Therefore, evaluating the treatment success rate of Debre Berhan Hospital was mandatory to show the achievement and to indicate where the hospital is against the World Health Organization target.

Methods

A register based cross sectional study covering the period of January 2009 to December 2013 was employed. All clients with complete records of the treatment outcome were included in the study. A checklist was prepared to extract data from patient charts. Data were entered into Epi-info version 3.2.2andanalyzed using SPSS version 16 for windows.

Results

Between January 2009 and December 2013, a total of 1280 tuberculosis cases that had complete records on treatment outcome were included in the analysis. Four in five (79.4%) of the patients had favorable treatment outcome; 15.8% were cured and 63.5%completed their treatment. There was a continuous increment of treatment success rate from 2010 to 2013 in the area and the treatment success rate in the year 2013 was 84.4%.

Conclusion

Despite the recent improvements in treatment success rate, treatment completed and defaulting rate, further efforts should be made by responsible bodies to identify and improve possible promoting factors for successful tuberculosis treatment outcome.     

Assessment of declines in reported tuberculosis cases--Georgia and Pennsylvania, 2009

In 2009, the largest single-year percentage decrease in tuberculosis (TB) cases was reported since national TB surveillance began in the United States in 1953. Overall, TB rates decreased 11.4% to 3.8 cases per 100,000 population, compared with an average annual decline of 3.8% each year since 2000. Georgia and Pennsylvania were among 36 states reporting decreases from 2008; TB case rates fell 14.3% (from 4.9 to 4.2) in Georgia and 38.7% (from 3.1 to 1.9) in Pennsylvania. Concerned about the possibility of unidentified TB cases, the Georgia Division of Public Health and the Pennsylvania Department of Health, in collaboration with CDC, conducted investigations centering on four hypotheses for the declines: 1) surveillance artifact, 2) underreporting, 3) underdiagnosis, and 4) actual decline. This report summarizes the results of those investigations, which found no evidence of surveillance artifact, underreporting, or underdiagnosis substantial enough to account for the magnitude of the declines. Instead, a decrease in the number of laboratory-confirmed Mycobacterium tuberculosis complex diagnoses and a decrease in the percentage of suspected TB cases ultimately counted as meeting the TB case definition; both suggested a true decline in TB in 2009. The population groups with the largest declines were foreign-born persons and children. Continued TB surveillance, including vigilance in suspecting, diagnosing, and reporting TB cases to public health departments, will help clarify the cause of this decline and determine long-term TB trends in the United States.     

Evolution of the health sector and tuberculosis control in Brazil.

OBJECTIVE: To summarize the epidemiological situation of tuberculosis (TB) in Brazil, especially as it relates to the evolution of the health sector in recent decades, the process of health sector reform, and current proposals of the Brazilian Ministry of Health. METHODS: A review was conducted of data from the Ministry of Health of Brazil on tuberculosis in the country over the last 20 years, as well as of the history of changes in the health sector. RESULTS: There have been major changes in the epidemiological situation of TB and also in the structure of the health system in Brazil. CONCLUSIONS: The overall prospects are promising for Brazil's National Plan for Tuberculosis Control.     

Tuberculosis outbreak in a low-incidence state--Indiana, 2001-2004

States with fewer than 3.5 cases of tuberculosis (TB) per 100,000 population are designated as states with low incidence for TB, corresponding to CDC's interim target rate for 2000, with a goal to eliminate TB in the United States by 2010. Indiana is a low-incidence state, with a TB case rate of 2.3 per 100,000 population in 2003. However, during 2000-2002, Allen County, Indiana, exceeded the state TB case rate with a mean case rate of 2.9 (range: 2.7-3.0) per 100,000 population. The TB case rate in Allen County increased to 4.7 per 100,000 population (with 16 patients reported with TB disease) in 2003 and to 7.0 per 100,000 population (with 12 patients reported with TB disease) during the first half of 2004. The Allen County Department of Health (ACDH), the Indiana State Department of Health, and CDC are investigating this ongoing TB outbreak. This report describes the preliminary results of the investigation, the efforts of ACDH to restructure its TB program, and the importance of maintaining TB-control efforts in low-incidence states.     

Trends in tuberculosis--United States, 2007

In 2007, a total of 13,293 tuberculosis (TB) cases were reported in the United States; the TB rate declined 4.2% from 2006 to 4.4 cases per 100,000 population. This report summarizes provisional 2007 data from the National TB Surveillance System and describes trends since 1993. The TB incidence rate in 2007 was the lowest recorded since national reporting began in 1953. Despite this overall improvement, progress has slowed in recent years; the average annual percentage decline in the TB rate slowed from 7.3% per year during 1993-2000 to 3.8% during 2000-2007. Foreign-born persons and racial/ethnic minorities continued to bear a disproportionate burden of TB disease in the United States. In 2007, the TB rate in foreign-born persons in the United States was 9.7 times higher than in U.S.-born persons. TB rates among Hispanics, blacks, and Asians were 7.4, 8.3, and 22.9 times higher than among non-Hispanic whites, respectively. In 2007, foreign-born persons accounted for a majority of TB cases among Hispanics (77.2% [2,942 of 3,812]) and among Asians (96.1% [3,261 of 3,393]), whereas U.S.-born persons accounted for a majority of TB cases among blacks (71.2% [2,439 of 3,427]). Among U.S.-born racial and ethnic groups, the greatest disparity in TB rates was for U.S.-born blacks, whose rate remained nearly eight times that of U.S.-born whites. The slowing decline in TB incidence and persistent disparities between U.S.-born and foreign-born persons and between whites and minorities threaten progress toward TB elimination in the United States. The strategic plan for the elimination of TB issued in 1989 by CDC and the Advisory Committee for the Elimination of Tuberculosis set a goal of TB elimination (i.e., less than one case per 1 million population) by 2010 and an interim target case rate of 3.5 per 100,000 population by 2000.     

How Far Does Highly Active Antiretroviral Treatment Reduce TB Incidence among Children? A Marginal Structural Modeling Analysis,Southwest Ethiopia

BackgroundChildren younger than 15 years, carry almost 80% of the global burden of HIV/AIDS. HIV worsens the progression of latent TB to active TB disease. Although antiretroviral treatment has shown marked reduction in Tuberculosis incidence, TB continues to occur in Sub-Saharan countries including Ethiopia. The aim of this study was to investigate the impact of HAART on the incidence of tuberculosis among children infected with HIV in Southwest Ethiopia.MethodsA retrospective cohort study was conducted between 2009 to 2014. We used chi-square test, and Mann-Whitney U test to compare non-HAART and HAART cohort. We estimated the effect of HAART on TB incidence using marginal structural model after adjusting for time-dependent confounders affected by exposure.ResultA total of 844 children were followed. We observed them for a median of 51 months (IQR 31) and a total of 2942.99 child-years. The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933–9.002). TB incidence for specific HAART and non-HAART cohort were 7.67 per 100 child-years (95% CI, 6.318–9.217) and 8.17 per 100 child-years (95% CI, 6.772–9.767) respectively. From marginal structural modeling, children on HAART were 36% (HR=0.642, 95% CI 0.442–0.931, p<0.02) less likely to develop TB compared to those who were not.ConclusionHAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than what is expected.     

2001-2009年常德市结核病控制效果分析

目的分析常德市结核病控制项目实施9年的效果,为结核病防治工作可持续发展提供依据。方法收集2001-2009年湖南省常德市中国疾病预防控制信息系统资料、13个县(市、区)中国结核病防治规划登记资料、相关纸质文书、报表等资料。按照《中国结核病防治规划实施工作指南》和其它相关要求进行统计分析。结果常德市2002年启动现代结核病控制策略,2004年以县为单位DOTS策略覆盖率达到100%。2001-2009年全市共接诊结核病可疑症状者123 538例,可疑者年就诊率从2001年的113.74/10万上升到2009年的324.61/10万;发现涂阳肺结核患者25 758例,其中新涂阳患者21 800例,新涂阳肺结核登记率平均为40.07/10万,新涂阳肺结核发现率平均为65.63%;初治涂阳平均治愈率为88.8%,复治涂阳平均治愈率为82.0%。结论实施DOTS策略,可提高肺结核患者的发现率和治愈率,减少结核病的传播,产生明显的社会防治效益。     

Trends and Characteristics of HIV Infection among Suspected Tuberculosis Cases in Public Health Centers in Korea: 2001–2013

ObjectivesThe Republic of Korea reports approximately 35,000 new tuberculosis (TB) patients each year, and the number of HIV-infected individuals is steadily increasing. Public health centers (PHCs) conduct TB diagnosis and treatment for risk groups in communities. This study aimed to identify possible trends and characteristics of HIV infection among suspected TB cases in PHCs.MethodsStudy subjects were suspected TB cases in PHCs who agreed to be tested for HIV from 2001 to 2013. Trends in HIV seroprevalence were assessed through a series of annual cross-sectional analyses. We analyzed suspected TB cases, and HIV-infected individuals among suspected TB cases, by gender, age, nationality, and region.ResultsThe number of suspected tuberculosis cases who took an HIV test in PHCs was approximately 6,000 each year from 2001 to 2013. Among the suspected TB cases who took an HIV test, the number of those aged 20–39 is gradually decreasing, while the number of those aged 50–69 is increasing. During this period, 32 HIV-infected individuals were identified; the majority were men (94%), aged 30–49 (68%), Korean (94%), and residents in a metropolitan area (53%). HIV seroprevalence decreased from 8.2 per 10,000 persons in 2001 to 1.9 per 10,000 persons in 2013.ConclusionThis study has identified trends and characteristics of HIV infection among suspected tuberculosis cases in PHCs. This national data provides a basis for public health policy for HIV and tuberculosis infections.     

Trends in tuberculosis--United States, 1998-2003

During 2003, a total of 14,871 tuberculosis (TB) cases (5.1 cases per 100,000 population) were reported in the United States, representing a 1.4% decrease in cases and a 1.9% decline in the rate from 2002. This decline is the smallest since 1992, when TB incidence peaked after a 7-year resurgence. In addition, the rate remains higher than the national interim goal of 3.5 cases per 100,000 population that was set for 2000. This report summarizes data from the national TB surveillance system for 2003 and describes trends during a 5-year period, with comparison to 1998 and 2002. Despite a decline in TB nationwide, rates have increased in certain states, and elevated TB rates continue to be reported in certain populations (e.g., foreign-born persons and racial/ethnic minorities). Targeted interventions for these at-risk populations, continued collaborative efforts toward the global fight against TB, and adequate local resources are essential to eliminating TB in the United States.     

Trends in tuberculosis--United States, 2010

In 2010, a total of 11,181 tuberculosis (TB) cases were reported in the United States, for a rate of 3.6 cases per 100,000 population, which was a decline of 3.9% from 2009 and the lowest rate recorded since national reporting began in 1953. This report summarizes provisional 2010 data from the National TB Surveillance System and describes trends since 1993. Despite an average decline in TB rates of 3.8% per year during 2000-2008, a record decline of 11.4% in 2009, and the 2010 decline of 3.9%, the national goal of TB elimination (defined as <0.1 case per 100,000 population) by 2010 was not met. Although TB cases and rates decreased among foreign-born and U.S.-born persons, foreign-born persons and racial/ethnic minorities were affected disproportionately by TB in the United States. In 2010, the TB rate among foreign-born persons in the United States was 11 times greater than among U.S.-born persons. TB rates among Hispanics, non-Hispanic blacks, and Asians were seven, eight, and 25 times greater, respectively, than among non-Hispanic whites. Among U.S.-born racial and ethnic groups, the greatest racial disparity in TB rates was for non-Hispanic blacks, whose rate was seven times greater than the rate for non-Hispanic whites. Progress toward TB elimination in the United States will require ongoing surveillance and improved TB control and prevention activities to address persistent disparities between U.S.-born and foreign-born persons and between whites and minorities.     

2000-2009年潍坊市结核病资料分析

[目的]评价潍坊市2000-2009年结核病控制效果,为制定潍坊市结核病控制规划提供科学依据。[方法]对潍坊市2000-2009年结核病相关资料进行分析。[结果]2000-2009年全市累计接诊肺结核可疑症状病人183221人,年均就诊率为2．15‰。可疑症状者年均查痰率为25．83％,痰检者抗酸杆菌平均阳性率为35．88％。累计登记活动性肺结核病人21668例,年均登记患病率为25．38／10万,其中新涂阳病人14901例,年均新登记率为17．45／10万。治疗的14901例新治涂阳病例中,1年后治愈14256例,治愈率为96．02％,死亡208例,病死率为1．40％。[结论]2000～2009年潍坊市结核病控制效果不理想。     

广州市第四次结核病流行病学抽样调查

目的 调查结核病疫情现状。方法 分层整群随机抽样,按《2000年全国结核病流行病学抽样调查实施细则》在广州市城乡10个点开展流调。结果 活动性肺结核患病率145．7／10万,涂阳患病率48．6／10万,患病率和涂阳患病率的年均递降率分别为4．8％和3．0％。结核病死亡居各类死因的第9位,死亡专率5．5／10万。患病趋势随着年龄增长而增高,城乡之间的差异缩小。结论 广州市结核病疫情持续改善,但下降速度缓慢。     

Tuberculosis notifications in Australia, 2002.

In 2002, there were 1,028 cases of tuberculosis (TB) reported to the National Notifiable Disease Surveillance System, of which 997 were new cases, 30 were relapses and 1 unknown. The incidence rate of TB in Australia in 2002 was 5.2 cases per 100,000 population. The highest incidence of TB was reported in people born overseas (20.2 cases per 100,000 population), followed by Indigenous Australians (8.5 cases per 100,000 population). By contrast, the incidence rate of TB in the nonIndigenous Australian-born population was 1.1 cases per 100,000 population. This pattern of TB incidence rates amongst the sub-populations of Australia has been observed for over 10 years. The rates were evaluated against the performance indicators set by the National Tuberculosis Advisory Committee to ensure that Australia's record of TB control is maintained and improved.