Epidemiology of Tuberculosis
in
The Republic of Mauritius
“ Recent Trends ”
(La Tuberculose à L`ile Maurice)
Dr R.Reesaul
Chest Physician
Chest Clinic
P. D`or Hospital
INCIDENCE AND MORTALITY OF TB WORLDWIDE PER 100,000
INHABITANTS 2006
50
12
43
30
8
6
1251M 25
190
3M
72
350
2M
122
100
2M
90
45
97
10
1/3 of world population infected
10 M new cases yearly
3 M cases of death yearly
22
INCIDENCE AND RATE OF TB IN THE INDIAN
OCEAN PER 100,000 INHABITANTS in 2006
75
115
2M
125 1M
1M
44
8000
350
2M
25 20
2M
17
120
97
40,000
9
75
10
115
Low incidence in
a
High risk region
Tuberculosis in Mauritius
 Population of 1.2 million( 2006)
 Tuberculosis is a notified disease to the MOH
 Free treatment of all persons with active TB
 Anti- TB drugs(1st line and 2nd line drugs ) are available
only at MOH central pharmacy
 Only few cases treated in private
ORGANIZATION AND SET UP OF TB IN MAURITIUS
M.O.H
In -patients
30 Beds TB
CHEST Clinic
5 Out- patients in
Regional Hospitals
W.H.O
Africa
Administration
Specialized National
Laboratory
Procurement, Tenders
Statistics, notifications…
For TB detection
Specialized Pharmacy
Anti-TB Drugs
BCG
AIDS Unit
Home Visits
Specialized Nurses
DOTS, Drugs
Counselling
Screening
Contacts
Migrant workers
Prisoners
Homes
High risks
Notification and Incidence rate of Tuberculosis
from 1974 to 2006
Years
1987
1988
35 28 25 24 24 20 14 17 13 16 13 12 12 11
11
269 223 199 198 195 183 131 163 122 159 120 116 121
111
113
1992
2005
2006
Incidence
per
100,000
inhabitant
13 16 15 13 11 11 12 15 14 10 12 11 12 10
10
Notified
Cases
141 165 153 146 123 131 140 174 160 119 139 137 139 127
115
Incidence
per
100,000
inhabitant
Notified
Cases
Years
1974
1975
1993
1976
1994
1977
1995
1978
1996
1979
1997
1980
1998
1981
1999
1982
2000
1983
2001
1984
2002
1985
2003
1986
2004
INCIDENCE RATE OF TB PER 100,000 INHABITANTS
YEAR 1974 TO 2006
40
35
30
25
20
15
10
5
20
00
20
02
20
04
20
06
98
96
94
92
90
88
86
84
82
80
78
76
74
0
Trend Incidence Pulmonary TB
2001-2005
Incidence de la TB 2001-2005
Incidence pour 100.000
habitants
12
10
8
TB Totale
6
TB Pulmonaire
ZN+
4
2
0
2001
2002
2003
Années
2004
2005
WHO Notification of TB 2002-2006
Year
2002
2003
2004
2005
2006
New ss + P
86
99
117
110
85
New ss - P
28
23
2
0
0
139
0
0
16
17
4
1
1
137
0
1
3
13
4
0
2
139
1
2
4
8
3
0
2
127
0
2
11
15
3
0
1
115
2
5
(99)
(1)
(6)
458
698
1124
1822
2631
(3173)
New E.P
Relapse
Failure
Defaulter
Total
MDR
TB +HIV
Total
HIV/AIDS
2007
INCIDENCE / among Migrant workers
INCIDENCE
PULMONARY
TB
TB
Migrant
workers
9.5
10
11
11.2
10.8
(15)
5
16
12
12
7.5
28
11.8
10.6
11
7.9
83
5
9.7
9.4
6
8.7
18
92
31
13.9
12.3
13
8.0
161
13
112
32
15.2
14.1
11
9.8
140
126
14
105
21
12.4
11.0
7
9.3
1997
131
122
9
102
20
11.6
10.9
1
9.1
1996
123
116
7
98
18
11.2
10.5
2
8.9
1995
146
134
12
108
23
13.4
12.0
4
9.9
1994
153
142
11
116
26
14.9
13.0
3
10.7
1993
165
148
18
130
18
15.6
13.9
0
12.2
1992
141
126
15
114
12
13.4
12.0
2
10.8
1991
141
138
3
112
26
13.6
13.3
0
10.4
1990
119
113
6
102
11
11.6
11.0
0
10.0
New TOTAL
PULMONARY
TB
New TOTAL
EXTRA
PULMONARY
TB
YEARS
TOTAL
TB
NOTIFIED
2007
2006
2005
2004
2003
(97)
115
127
139
137
96
114
120
115
15
08
13
17
85
110
117
99
11
04
03
16
2002
139
124
23
86
2001
119
113
6
2000
160
142
1999
174
1998
ZN
(+)
ZN
(-)
TOTAL
TB
INCIDENCE ZN
(+)
Age group and TB 2001-2005
Few cases <14 , protection BCG vaccin ?
Max cases age 25-44
Répartition de la TB par tranche d'age
45
nombre
40
35
0-14
30
15-24
25
25-34
35-44
20
45-54
15
55-64
>=65
10
5
0
2001
2002
2003
années
2004
2005
Case notifications and sex ratio
Sex ratio: M/F
Age 15-24 : 2/1
Age 25-34 : 3/1
Age 35-44 :4/1
Age 45-54 : 2/1
Age >55 : 4/1
Pulmonary and Extra-pulmonary TB
2001-2005
TB Pulmonaire et Extra Pulmonaire: comparaison
140
120
Nombre
100
80
Pulmonaire
60
Extra Pulmonaire
40
20
0
2001
2002
2003
Années
2004
2005
Extra pulmonary TB 2001-2005
TB Extra Pulmonaire 2001-2005
35
25
20
15
Series1
10
5
Les différents types
Pl
eu
ra
le
ér
éb
ra
le
C
ut
G
an
an
ée
gl
in
on
na
ire
M
as
t it
O
e
ph
ta
lm
iq
ue
O
ss
eu
se
C
cit
e
0
As
Nombre
30
Trend of Incidence TB in districts
2001-2005
Incidence de la TB par district: 2001-2005
30
Port Louis
Incidence
25
Pamplemousses
20
Riv du Rempart
15
Flacq
G.Port
10
Savane
5
Riv Noire
0
Moka
2001
2002
2003
Année
2004
2005
Pl Wilhems
EVOLUTION INCIDENCE PER 100,000 INHABITANTS
DISTRICT from 1993 AND 2005
13 12
17 14
40 23
9
5
4
13
20
13
4
08
13
6
14 10
Incidence 1993 - 15.6 per 100,000 inhabitants
Incidence 2005 - 11 per 100,000 inhabitants
DEATH RATE TB PER 100,000 INHABITANTS 1991
TO 2006
3
2.5
2
1.5
1
0.5
20
05
20
03
20
01
19
99
19
97
19
95
19
93
19
91
0
Cumulative cases HIV/AIDS
( 1st case at P D`or Hospital )
Cumulative nº of HIV/AIDS cases (87-04)
1124
1200
No of cases
1000
800
698
600
`
458
400
200
0
1
9
117140
90
55 67
12 17 27
168
197 230
287
356
87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
Year
CO-INFECTION TB / HIV-AIDS
YEARS
Total Cases of
HIV/AIDS
Cases
TB / HIV
1999
230
1
2000
287
1
2001
356
1
2002
458
0
2003
698
1
2004
2005
2006
2007
1124
1822
2631
(3173)
2
2
5
(6)
DOTS and case detection rate
Objectives of WHO
 Implementation of DOTS coverage ( Directly observed short
course treatment) 100%

Case detection rate of at least 70% of smear positive
pulmonary TB cases
 Improve Cure rate > 80%
 Non-compliance spread of infection lead to :
MDR ( Resistance to INAH & Rifampicin )
XDR TB( MDR and resistance to at least 3 major
second line drugs )
DOTS monitoring & outcomes 1995-2005
MDR TB 2001-2006
Years
Resistance INAH & RIF
2001
0
2002
0
2003
0
2004
1
2005
o
2006
2007
2
(1)
Risk factors predisposing to TB in %
admitted at Poudre D`or Hospital
Causes
%
Alcoholic
Homeless
50-70%
DM
10 -15%
Contacts
5-10%
HIV
<5%
Migrant workers
5- 10%
Conclusion
Incidence TB stable 10-14 /100,000 since 1995
Incidence highest among age group 35-45
Increase of extra-pulmonary TB since1992
Low death rate < 1/100,000 since 1998
Increase of TB among migrant workers noted since 1998
Few cases of Co-infection TB / HIV-AIDS and MDR TB
Cases MDR TB not among HIV/AIDS patients
Thank You
Merci
9 Districts in Mauritius population 1.2 M
Tuberculosis in Mauritius
 Capital –District of Port Louis
 Area 1865 km² , 9 districts + Rodrigues
 Population of 1.2 million( 2006)
 Tuberculosis notified disease to MOH
 Gross national income per capita USD :12.45
 Total expenditure on health as % GDP :4.3
 Life expectancy at birth M/F :69/76
 Free treatment of all persons with active TB
 Anti- TB drugs available only at MOH central
pharmacy and few cases treated in private
Notified cases and incidence of Tb
2001-2006
Incidence de la TB: 2001-2005
Nombre
145
140
135
130
125
120
Nombre de cas
115
110
105
100
2001
2002
2003
Années
2004
2005
Incidence pour 100.000 habitants
Tendance du nombre de cas de TB: 2001-2005
14
12
10
8
Incidence résidents
6
Incidence globale
4
2
0
2001
2002
2003
Années
2004
2005
TREND OF NOTIFIED CASES
YEAR 1974 -2006
300
250
200
150
100
50
99
20
02
20
05
YEARS
96
93
89
86
83
80
77
74
0
WHO Case notifications 1998-2005