Country Update:
Tuberculosis in Thailand
Dr. Chawetsan Namwat
NTP manager and
Director of BTB, DDC, MOPH, Thailand
1
TB prevalence in high burden countries
Source: WHO, Global TB report, 2012
2
Tuberculosis situation
3
source: WHO, Global Tuberculosis Report 2012
TB incidence (per 100,000) by WHO region,
and in Thailand, 2011
2011
300
262
189
200
125
124
92
100
28
42
0
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
Treatment outcome, 2011
Missing
< 80%
80%-84%
85%-89%
≥ 90%
< 5%
5%-10%
> 10%
< 1%
1%-2%
≥ 3%
BTB-Updated : May 28, 2013
Estimates of MDR-TB burden (2011),Thailand
Estimates among notified cases
% of new TB cases with MDR-TB
% of retreatment TB cases with MDR-TB
Estimated MDR-TB cases among new
pulmonary TB cases notified in 2010
Estimated MDR-TB cases among
retreated pulmonary TB cases notified in
2010
Source: WHO Global TB Report 2012
1.7 (1.0–2.6)
35 (28–42)
890 (540–1 400)
1 300 (1 000–1 600)
Belarus
Kazakhstan
Kyrgyzstan
Estonia
Uzbekistan
Azerbaijan
Russia
Moldova
Ukraine
Latvia
Tajikistan
Georgia
Lithuania
Armenia
China
Myanmar
Philippines
Pakistan
Congo
Nigeria
Viet Nam
India
Bulgaria
Indonesia
South Africa
Ethiopia
Bangladesh
Thailand
MDR TB in High Burden Countries and Thailand
%MDR TB among New TB cases
35
30
25
20
15
10
5
0
Sources: WHO, Global TB Report 2012 and
Bureau of Tuberculosis, DDC, MOPH, Thailand
Armenia
Azerbaijan
Bangladesh
Belarus
Bulgaria
China
Congo
Estonia
Ethiopia
Georgia
India
Indonesia
Kazakhstan
Kyrgyzstan
Latvia
Lithuania
Myanmar
Nigeria
Pakistan
Philippines
Moldova
Russia
South Africa
Tajikistan
Ukraine
Uzbekistan
Viet Nam
Thailand
MDR TB in High Burden Countries and Thailand
%MDR TB among New TB cases
35
30
25
20
15
10
5
0
Sources: WHO, Global TB Report 2012 and
Bureau of Tuberculosis, DDC, MOPH, Thailand
Percentage of new TB cases with MDR-TB
Belarus
Moldova
Uzbekistan
Estonia
Azerbaijan
Tajikistan
Kyrgyzstan
Kazakhstan
Lithuania
Russia
Ukraine
Armenia
Georgia
Latvia
Pakistan
Bangladesh
China
Bulgaria
Philippines
Viet Nam
India
Indonesia
Ethiopia
Myanmar
Congo
Nigeria
South Africa
Thailand
MDR TB in High Burden Countries and Thailand
%MDR TB among previously-treated TB
cases
80
70
60
50
40
30
20
10
0
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)
Preliminary data of 4th Surveillance of Drug resistance in Tuberculosis: THAILAND 2012
Newly Treated
Cases
Previously
Treated Cases
Combined Drug
resistance
Total tested
Fully sensitive
Any resistance
N
1456
1216
240
Pct
100.00%
83.52%
16.48%
N
175
110
65
Pct
100.00%
62.86%
37.14%
N
1631
1326
305
Pct
100.00%
81.30%
18.70%
H+R resistance (MDR-TB)
27
1.85%
29
16.57%
56
3.43%
Mono-resistance
Two drugs resistance
Three drugs resistance
Four drugs resistance
164
47
2
3
11.26%
3.23%
0.14%
0.21%
32
3
1
4
18.29%
1.71%
0.57%
2.29%
196
50
3
7
12.02%
3.07%
0.18%
0.43%
Any H-resistance
Any R-resistance
174
30
11.95%
2.06%
46
39
26.29%
22.29%
229
69
1.41%
4.23%
Mono H-resistance
Mono R-resistance
99
2
6.80%
0.14%
16
7
9.14%
4%
115
9
7.05%
0.55%
ITEMS
Note: Total = 1747 cases, 116 cases are waiting for analysis, NTRL NTP-May2013
16
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
17
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
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
 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


18
Symptom+ 35% (Symptom score 3+)
CXR abnormal, no symptom 65%
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
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
Number
Participation by age group
19
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
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
Age distribution of TB cases(N=142)
20
Age distribution of smear+ PTB, Report.506
5-9Yr, 0.5%
10-14Yr, 0.6%
0-4Yr, 1.0%
15-24Yr, 7.3%
65+Yr,
22.5%
0-4Yr
5-9Yr
10-14Yr
15-24Yr
25-34Yr,
15.2%
25-34Yr
35-44Yr
55-64Yr,
15.9%
35-44Yr,
18.6%
45-54Yr,
18.4%
Source: R506: Pulm TB New M+ /2008-2011, BOE
45-54Yr
55-64Yr
65+Yr
Age distribution of smear+ PTB, Report.506
22
Challenge when the AEC starts
Incidence rate (per 100,000)
AEC
2015
23
TB control in Thailand
 Align with global stop TB strategy
 “Zero and Five to minimize MDR-TB”
ค ้นให ้พบ
จบด ้วยหาย
ตายน ้อยกว่าร ้อยละ 5
ขาดยาเป็ น 0
 Political commitment & Universal
coverage scheme
24
Plan for DR-TB
 Magnitude of problem
 DRS 2012 :
MDR: 1.8% among new TB,
17% among retreatment TB
 Case detection
 C/ DST : Re – On – Pre
 Network of lab
25
Plan for DR-TB
 Treatment & Patient Support
 Guideline & Training
 MDR-TB treatment center (general & regional
hospitals) – NHSO approved
 Consultation mechanism
 Lab for f/u
 R&R – paper & electronic
 DOT
26
Plan for DR-TB
 Specific issues for migrants:
 Multi-country proposal : for GF support
 Referral system at border area :
 Health insurance for migrants: documented and nondocumented migrant labors
27
Plan for DR-TB
28
Plan for DR-TB
29
ขอบคุณครับ
30