Estimation of the future epidemiological situation of tuberculosis in Japan

OBJECTIVE: To estimate the future trends of all forms of tuberculosis (TB) and sputum smear positive pulmonary TB in order to consider the emerging issues of TB control and eliminating TB in Japan. MATERIALS AND METHODS] Annual reports of TB registrations were used for observing past trends of TB, and predictions were then made assuming that past trends would continue. At first, to obtain the number of TB patients by sex and age-group, sex-age-specific incidence rates were estimated for the years 2010, 2015, 2020, 2025 and 2030, and then applied to a sex-age-specific population which was projected by the National Institution of Population and Social Security Research. According to the different methods used to calculate the reduction rates of incidence, we adopted model A and model B. In model A, the reduction rate was calculated by using two groups of the same age group but different members by calendar year. In model B, the reduction rate was calculated by using the same birth cohort but different age by calendar year. We also adopted two sub-models by the observation period of past trends. The incidence rates for the period from 1987 to 2005 were used in model 1 and the incidence rates for the period from 1998 to 2005 were used in model 2. The incidence rate in 1999 was excluded from both model 1 and 2, because the TB incidence rate increased abnormally due to the declaration of a state of emergency concerning tuberculosis in 1999. The speed of decline among particular several sex-age-groups was weighted taking into account the influence of foreign, homeless and elderly cases. The future number of sex-age-specific sputum smear positive pulmonary patients was estimated by applying various parameters, i.e. pulmonary TB rate, sputum smear positive rate and its trend, to the estimated future number of TB incidence. RESULTS: The TB incidence rate, which was 22.2 per 100,000 population as of 2005, would reach 9.8 in model A-1, 5.4 in model A-2, 7.5 in model B-1 and 3.2 in model B-2 by 2030. On the other hand, the sputum smear positive pulmonary incidence rate, which was 8.9 per 100,000 population as of 2005, would decline to 5.5 in model A-1, 3.0 in model A-2, 4.2 in model B-1 and 1.7 in model B-2 by 2030. The future number of TB patients and incidence rates by sex and age were discussed based on a mixed model which used the middle series of estimates, and was obtained by combining model A-2 and model B-1. The number of TB patients by the mixed model will become about 12 thousand with 10.1 per 100,000 population in 2020, and about 7.4 thousand with 6.5 per 100,000 population in 2030. From 2005 to 2020, the age composition of TB patients will change from 0.4% to 0.2% at 0-14 years old, 4% to 4% at 15-24 years old, from 10% to 11% at 25-34 years old, 8% to 11% at 35-44 years old, from 9% to 12% at 45-54 years old, from 15% to 10% at 55-64 years old, 18% to 15% at 64-74 years old, from 24% to 17% at 75-84 years old, and from 11% to 20% at 85 years of age or older. Although the proportion of the elderly aged 65 years or higher will not be so different, the proportion of TB patients aged 85 years or older will almost double. CONCLUSION: The year when the TB incidence rate will reach the level of low-incidence countries, which is defined as a country with a TB incidence rate of less than 10 per 100,000 population, might be around 2020 in Japan. At that time, the age composition of TB patients will tend to be very old patients, and the young adult and middle-aged patients. Problems such as delay in diagnosis and difficulty of treatment are expected among very old patients.     

Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control

BACKGROUND: Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. METHODS: Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. RESULTS: Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. CONCLUSIONS: PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.     

南海市实施结核病控制项目效果分析

目的　评价南海市实施世界银行贷款结核病控制项目的成效。方法 因症就诊胸透筛选、痰检确诊病人,按统一化疗方案治疗,实行全程督导管理。结果 10年间共接诊可疑肺结核症状者19569人,可疑者检查率平均为0.2%,发现活动性肺结核4286例,其中涂阳2558例,涂阳病人占活动性病人59.7%,涂阳登记率从14.07/10万提高到35.66/10万;初复治涂阳比例1:0.14,初治涂阳治愈率94.3%;复治涂阳治愈率82.2%。结论 10年来结核病控制水平整体提高,是实施DOTS现代结核病控制策略的结果。     

Latent tuberculosis infection among undergraduate medical students in Rio de Janeiro State, Brazil.

SETTING: Five medical schools in three cities with different tuberculosis (TB) incidence rates in Rio de Janeiro State, Brazil. OBJECTIVE: To estimate prevalence of and associated factors for latent tuberculosis infection (LTBI) among medical students. DESIGN: A cross-sectional survey was conducted among undergraduate students in pre-clinical, early and late clinical years from schools in cities with low (28/100,000), intermediate (63/100,000) and high (114/100,000) TB incidence rates. Information on socio-demographic profile, previous BCG vaccination, potential TB exposure, co-morbidity and use of respiratory protective masks was obtained. A tuberculin skin test (TST) was performed using the Mantoux technique by an experienced professional. A positive TST, defined as induration > or = 10 mm, was considered LTBI. RESULTS: LTBI prevalence was 6.9% (95%CI 5.4-8.6). In multivariate analysis, male sex (adjusted odds ratio [aOR] 1.8; 95% CI 1.1-3.0), late clinical years (aOR 1.9; 95% CI 1.01-3.5), intermediate TB incidence (aOR 4.3; 95% CI 1.3-14.6) and high TB incidence in the city of medical school (aOR 5.1; 95% CI 1.6-16.8) were significantly associated with LTBI. CONCLUSIONS: The higher prevalence of LTBI in late clinical years suggests that medical students are at increased risk for nosocomial Mycobacterium tuberculosis infection. The implementation of a TB control program may be necessary in medical schools, particularly in cities with higher TB incidence.     

Childhood tuberculosis in a low-income Paris suburb: lessons from a resurgence brought under control.

SETTING: Few series of paediatric tuberculosis (TB) have been reported in the last 20 years. OBJECTIVE: To describe diagnostic and treatment practices in children with TB living in Seine-Saint-Denis, a low-income Paris suburb. METHODS: Local TB incidence in 1998 was 34.2/100,000 overall and 10.2/100,000 in children. Between September 1996 and December 1997, the hospitals and prevention units serving the area's paediatric population were sent questionnaires to identify TB cases in children aged under 15 living in Seine-Saint-Denis and treated with at least one anti-tuberculosis drug. RESULTS: Of 92 cases identified, 60 (65%) had been diagnosed during contact tracing; for 52 patients (60%), the index case had been found. The reason for anti-tuberculosis treatment was active TB in 26 (28.3%), latent TB in 46 (50%), and prophylaxis in 20 (21.8%). Forty per cent (37/92) of the patients were aged under 5. Only 15 of the 35 notified cases met the criteria for mandatory notification (at least three anti-tuberculosis drugs). CONCLUSION: TB remains a public health problem in Seine-Saint-Denis. The high proportion of cases identified by contact tracing attests to the efficacy of the local contact-tracing programme. The criteria for mandatory notification in France were too restrictive to ensure effective surveillance of childhood TB. Since 2002, notification has included cases of tuberculous infection in children.     

Tuberculosis incidence in Turin, Italy, 1973-1999.

SETTING: Turin, Italy, 1973-1999. OBJECTIVE: To estimate tuberculosis (TB) incidence rates in Turin between 1973 and 1999. DESIGN: Incidence study. An active search of new TB cases was carried out by examining the clinical records of the three major TB care services in the city. New cases were defined as patients treated for the first time. To evaluate the completeness of this series, data were linked with the TB Notification Register and the Regional Hospital Discharges Register for the years 1997-1999. RESULTS: TB incidence rates declined from 25.6 cases per 100,000 population in 1973 to 6.4 in 1999. TB/human immunodeficiency virus (HIV) co-infection increased after 1985, reaching a peak (16.5%) in 1994-1996, and significantly decreasing in 1997-1999. Foreign-born cases started to increase after 1988, reaching 25.8% of total cases in 1997-1999. TB infections in Italian-born, non-HIV-infected cases occurred mostly among the elderly, while HIV/TB co-infections and TB in immigrants occurred mostly in younger age groups. The study captured 59% of cases diagnosed in Turin in 1997-1999. CONCLUSIONS: In recent years, new cases of TB have been diagnosed mostly among HIV-positive people and immigrants. Preventive and control strategies should focus on these population groups, improving quick identification and effective treatment of cases, and implementing accessible services.     

陕西省宝鸡市结核病控制项目病人发现工作分析

目的评价宝鸡市实施结核病控制项目3年病人发现工作。方法根据2002—2004年全市项目季报、月报对病人发现工作指标进行分析与评价。结果2002—2004年全市共发现活动性肺结核病人6120例,其中涂阳病人2 340例,分别是项目实施前3年总和的2.6倍(6 120/2 394)、6.1倍(2340/381)。涂阳新登记率逐年提高(5.92/10万、21.26/10万、35.95/10万)。结论实施项目3年病人发现水平逐年提高,发现工作取得了一定的成效。     

Fourteen-year trend of tuberculosis dynamics in the northwest of Turkey

BACKGROUND: The incidence of tuberculosis (TB) in different countries as estimated by the World Health Organization (WHO) vary from 23/100,000 and less in industrialized countries, 191/100,000 in Africa and 237/100,000 in South East Asia. OBJECTIVES: The aim of this study was to analyze the dynamics of TB in the northwest of Turkey, between 1988 and 2001. METHODS: All pulmonary TB cases reported to the National Tuberculosis Center by local TB dispensaries during 1988-2001 were analyzed. The number of new and relapsed TB cases were documented and classified according to age and type of TB (standard classification of TB patients according to disease type: pulmonary, new, smear positive; pulmonary, smear negative; relapse, and extrapulmonary). We recorded information about the prevalence of TB in different patient groups (patients with a contact history, patients who were detected in active community screening or passive case finding), TB trends in different age groups, type of TB, patients who had relapses, percentage of patients who were lost to follow-up. RESULTS: A total number of 288,996 patients were examined at Zonguldak Tuberculosis Dispensary between 1988 and 2001. Case notification rates of TB decreased over the study period. Respiratory TB was the most commonly encountered form of disease (>90%). The percentage of TB decreased in the 0- to 14-, 15- to 24-year-olds and increased in the 25- to 44- and 45- to 64-year-olds. CONCLUSION: Properly designed disease surveillance systems are critical for monitoring the TB trends so that each country can identify its own high-risk groups and target interventions to prevent, diagnose, and treat the disease.     

高州市实施结核病控制项目十年效果评价

目的　高州市实施结核病控制项目的评价。方法　因症就诊胸透筛选痰检确诊病人 ,按统一化疗方案治疗 ,实行全程督导管理。结果　 10年间共接诊可疑肺结核症状者 2 0 12 4人 ,可疑者检痰率为 37.77% ,发现活动性肺结核 5 10 8例 ,其中涂阳肺结核、新发涂阳肺结核分别为 3971和 3317例。涂阳登记率由 13/ 10万提高到 33/10万 ;初治涂阳治愈率达 97.71%、复治涂阳治愈率达 84 .10 %。结论　 10年来结核病控制水平全面提高 ,是实施DOTS现代结核病控制策略的结果。     

肺结核病人归口管理的实施性研究

目的探讨医疗单位向结防机构转诊的结核病人归口管理方法,提高病人发现率,规范病人治疗管理。方法结合湖南省实际,制订切实可行的结核病人归口管理实施办法与措施;对邵阳、常德和怀化3市实施《湖南省结核病人归口管理工作规范》(简称《规范》)前后,结核病人归口管理实施结果进行对照分析。结果实施《规范》前3市共接诊初诊病人29953例,实施《规范》后为51 468例,后者较前者增长了71.8%。在初诊病人中,直接到结核病防治机构就诊者增加13056例,增长了51.0%,医疗单位转诊者增加21 515例,增长194.0%。实施《规范》前,3市共发现新涂阳病人5 201例,实施《规范》后为10596例,前后比较增长了103.7%。在新涂阳病人中,直接到结防机构就诊者较实施《规范》前增加1 944例,增长了47.3%,医疗单位转诊者增加3451例,增长315.2%。在转诊病人中,县级医疗单位和乡级医疗单位比实施《规范》前分别增加1 932和1385例,分别增长了337.8%和324.4%。同期全省实施《规范》地区和未实施《规范》地区新涂阳病人登记率分别58.47/10万和30.13/10万,前者比后者高94.4%。结论《湖南省结核病人归口管理工作规范》的实施方法与措施是可行的结核病人归口管理办法;做好结核病归口管理是提高病人发现率的有效方法。     

全国初治涂阴肺结核病例登记现状分析

目的分析全国各省初治涂阴肺结核病例登记现状,为评价初治涂阴肺结核病例诊断质量提供依据。方法根据2004—2005年全国结核病防治规划报表中初治涂阴和初治涂阳肺结核病例登记资料,分析各省2年初治涂阴肺结核病例登记率变化和增长幅度;统计各省及不同地区初治涂阴与初治涂阳肺结核病例登记率;对各省初治涂阴与初治涂阳肺结核病例登记率进行直线回归分析。结果2005年全国登记初治涂阴肺结核病例316 405例,登记率为24.27/10万,各省登记率在6.01/10万72.17/10万;2005年登记初治涂阴病例数比2004年增加了19.9%,其中2个省登记数呈负增长,其余各省登记数增长了0.5%62.3%;2005年全国初治涂阳病例登记率是涂阴病例登记率的1.5倍,其中23个省初治涂阳病例登记率高于涂阴病例登记率,8个省相反;初治涂阴病例占初治涂阳病人登记率的比例,京津沪地区为149.28%,非项目地区为83.6%,项目地区为50.3%;对涂阳和涂阴病例登记率进行直线回归分析,回归方程y=22.342+0.563 6x。结论对初治涂阴肺结核患者实行免费政策后,全国涂阴肺结核病例登记率提高。但各省初治涂阴病例登记率和增长幅度以及涂阴病例登记率与涂阳病例登记率的比例悬殊。由于涂阴病例诊断困难,对于涂阴病例登记率高或增长幅度大的地区,特别在DOTS执行时间短和人力资源有限的地区,应对涂阴病例诊断质量予以进一步检查和评价。     

Notification of tuberculosis in the south-west health region of Norway: incidence and trends

A survey of tuberculosis notification from the south-west health region of Norway showed a decrease from 17.7 cases of tuberculosis per 100,000 population during 1969-1973 to 12.3 cases per 100,000 during 1979-1983. The notification rate linearly increased with age from the age of 20 years on a logarithmic scale. The downward trend in notification was less marked in the last 5-year period compared with the first 5-year period probably due to changes in notification procedures in 1976, an epidemic of tuberculosis in the health region and on oil platforms in the North Sea in 1980 and an increased immigration of people from areas with high incidence of tuberculosis. Tuberculosis of the extrathoracic lymph nodes was during 1979-1983 the most frequent location of non-respiratory tuberculosis.     

TB epidemiology in an elderly group in Japan

PURPOSE: To analyze the epidemiological situation of TB among the elderly in Japan. METHODS: By using the data of TB surveillance, national survey statistics and national basic survey of life. RESULTS: TB incidence in both sexes increased with age in all survey years. TB incidence among the jobless was higher than among employees in both sexes. TB incidence among female housekeepers was consistently lower than among other groups. TB incidence among both the employed and unemployed has declined rapidly in the last 15 years. The main mode of TB detection was the detection at clinics/hospitals irrespective of presence or absence of TB symptoms. The death rate was higher in cases with immunosuppressive therapy and cases with malignancy. CONCLUSION: Causes of higher TB incidence in the elderly unemployed population should be analyzed. Better detection of TB by improving passive case-finding for TB symptomatic and high-risk groups at clinics/hospitals will be recommended. To reduce the death rate, early diagnosis of TB with immunosuppressive therapy could be strengthened, however its impact might be limited.     

Risk factors of tuberculosis among health care workers in Sabah, Malaysia

Tuberculosis (TB) is one of the main public health problems in Sabah; 30% of the total number of TB cases reported in Malaysia every year occur in Sabah. The average incidence of TB among health care workers over the past 5 years is 280.4 per 100,000 population (1, Annual Report of Sabah State TB Control Programme, 1998). At present, there are no specific measures for the prevention of TB transmission in health care facilities. A case-control study was conducted among health care workers in Sabah in 2000-2001. Cases were health care workers with TB diagnosed between January 1990 and June 2000. Controls were health care workers without TB and working in the same facility as cases during the disease episode. The study attempted to identify risk factors for TB among the study population. Data were collected through structured interviews and review of patients' records. The notification rate of TB among health care workers was significantly higher than that to the general population (Z=4.893, p<0.01). The average notification rate of TB among health care workers over the last 5 years was two times higher than in the general population (280.4/100,000 compared to 153.9/100,000). Regression results showed that ethnicity, designation, family contact and TB related knowledge did not significantly contribute to the risk of contracting TB in this study. However, after controlling for the above factors, age, gender, history of TB contact outside the workplace (other than family contact), duration of service and failure to use respiratory protection when performing high-risk procedures, were the main risk factors of TB among health care workers. This study succeeded in identifying some of the risk factors of TB among health care workers. We managed to include the large ratio of controls to case (3:1) and those cases spanned over a period of 10 years. However, the findings from the study have to be applied with caution due to the limitations of this study, which include recall bias, dropouts, and small sample size. Based on the study findings, we recommend that health care workers in the first 10 years of service should take extra precautions, such as using respiratory protection when performing procedures that are considered to be of high risk with respect to TB infection. They should also undergo TB screening at least once every 2 years and, if symptomatic, offered prophylactic treatment. The Respiratory Protection Programme should be fully implemented to help reduce the risk of TB among health care workers in Sabah.     

Excess mortality and tuberculosis among individuals with prolonged cough: a population-based study from Vietnam.

SETTING: A demographic surveillance site in north-west Vietnam. OBJECTIVES: To compare notification rates of sputum smear-positive tuberculosis (TB) and mortality rates between the general population and individuals with prolonged cough. DESIGN: A cohort study of 559 prolonged cough cases in a total population of 35,832, observed over 2.5 years. Outcome measures were sputum smear-positive TB and death. RESULTS: The age-standardised smear-positive TB notification rate among cough cases (553/100,000 person-years [py], 95%CI 268-1143) was significantly higher than in the general population (50/100,000 py, 95%CI 43-57), with a relative risk of 11.06 (95%CI 8.28-14.77). Among those who had a chest X-ray suggestive of TB but negative sputum smears prior to the study start, the rate was 6542/100,000 py (95%CI 2906-12,511). The cough cohort had a 2.61 (95%CI 2.38-2.87) times higher risk of dying than the general population. CONCLUSIONS: Individuals with prolonged cough in this study run a significantly increased risk of developing infectious TB and of dying. We recommend further evaluations of improved follow-up systems aimed at identifying and treating sputum smear-negative TB cases before they convert to an infectious stage.     

Discussing the current situation of tuberculosis case-finding by mass miniature radiography in Japan

The system of tuberculosis (TB) case-finding by mass miniature radiography (MMR) was established and expanded for almost all Japanese citizens in the 1950s. And, as stipulated by the TB Prevention Law, periodic mass screenings for schools, inhabitants, employees and institutions have been carried out. Among those aged over 25 years, the proportion of people screened by MMR was estimated to be 60.3%. This means that about 54 million people aged over 25 years are receiving medical service with MMR every year. However, the detection rates of TB cases by MMR have declined markedly compared with those in 1950s. As of 1998, the detection rate was 0.03 per 1,000 for school children and students, 0.06 per 1,000 for employees, and 0.16 per 1,000 for inhabitants. The proportion of cases detected by MMR among newly notified TB cases was 12.8% in 1998, and this ratio has been almost constant for the last 10 years. This ratio was greater among young adult TB cases. Approximately 20% of notified TB cases aged 20-39 years were detected by MMR for employees. Although the purpose of MMR is to find the cases before discharging TB bacilli, 35.1% of the cases were bacteriologically confirmed, and this proportion was greater among elderly TB cases. The Japan Anti-Tuberculosis Association (JATA) has been carrying out MMR for a long time. Eight selected branches of JATA that has been doing high quality case-finding reported 228 TB cases out of 965,440 inhabitants aged over 40 years examined by MMR in 1996. Based on these results, the cost per TB case detected by MMR was calculated. The cost was 4.4 millions yen (yen) per case for all forms of TB, yen 2.3 millions for male, yen 8.4 millions for female, yen 7.3 millions for those aged 40-49 years and yen 1.8 millions for those aged over 80 years. TB detection rate by MMR for inhabitants was correlated with TB incidence rate in various areas, and based on this correlation, the cost was calculated for various incidence rates. For all forms of TB, the cost was yen 4.0 millions per case for an incidence rate of 30 per 100,000, and yen 6.7 millions for an incidence rate of 20 per 100,000. MMR is not economically cost-effective even among elderly people and in areas with incidence rate less than 50 per 100,000, because the medical expense for a TB patient treated under hospitalization for 2 months and outpatient's clinic for 4 months is approximately yen 0.9 millions in 1996. The decision making in continuation or abolition or limitation of MMR should be discussed from a wide range of cost-effectiveness analyses as well as from the view of public health service and willingness of people. For the purpose of decision making, this study provides the detection rates; the costs stratified by sex, age and incidence; and the proportion of cases detected by MMR among newly notified TB cases by age-group and bacteriological status.     

福建省结核病登记报告及治疗管理8年监测评价

目的分析福建省肺结核病登记报告及治疗管理监测结果,为评价结核病控制规划和结核病防治可持续发展提供技术政策依据。方法收集1997—2004年福建省的传染病疫情报表和结核病专业系统报表及有关资料进行分析。结果肺结核病疫情报告病例数逐年提高;肺结核病报告新登记率连续8年仅次于肝炎居第二位;发病年龄以青壮年为主,6070岁组也有一高峰;职业分布以农民和工人为主;流动人口肺结核病人主要分布在泉州、厦门和福州,以省际流动人口病例居多;涂阳肺结核病人新登记率从1997年的7.2/10万上升到41.0/10万,涂阳肺结核病人治愈率从1997年的82.0%提高到89.8%。结论福建省结核病控制效果显著,实现“十五”规划目标关键仍在于落实DOTS策略和提高DOTS质量。     

石家庄市实施世界银行贷款中国结核病控制项目效果分析

目的　分析石家庄市实施世界银行贷款中国结核病控制项目效果,为结核病控制可持续发展提供科学依据。方法 对 1991—2001年项目执行情况进行总结分析。结果 全市共接诊可疑肺结核病症状者 102396例,发现活动性肺结核病人 27149例,活动性肺结核新登记率由 1993年全面实施项目后的 21.0210万增加到 2001年的 39.9610万,涂阳登记率由 16.8510万提高到 29.7510万,新发涂阳治愈率达到 98.7%,复治涂阳治愈率达 94.4%。结论 石家庄市结控项目取得了满意效果。     

Towards the elimination of tuberculosis in a developing country: 25 years of tuberculosis control in Oman.

OBJECTIVE: To analyse trends of tuberculosis (TB) in Oman (1981-2005) in relation to the socio-economic development of the country. METHODS: Data were used from the National Tuberculosis Control Programme (NTP). Information on TB cases' age, sex and type were obtained from the national book (1981-1991) and the computer database (1992-2005). RESULTS: TB notification rates among Omani nationals declined by more than 85% from 1981 to 1995. During the period 1981-1993, the TB notification rate declined by around 15% per year, compared to only 3.6% per year in subsequent years. Males and the age group > or = 50 years have higher rates than females and younger age groups, respectively. Non-nationals contributed 21% of all TB cases notified and 40% of all smear-positive cases. Of cases among nationals notified between 2004 and 2005, 95% had a family income lower than the national average. CONCLUSION: Although TB notification in Oman has declined by more than 85% over the last 25 years, the decline has slowed down over the last 10 years, requiring a detailed analysis of existing TB control measures and implementation of additional measures for TB elimination.