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