Tuberculosis Control in Australia in the 21st Century

1
Tuberculosis Control in Australia in the 21st
Century

• Dr F T S Chiu OAM, MBBS, FRACP, FCCP, JP

Department of Thoracic MedicineRoyal Adelaide
Hospital, South Australia, SA 5000 Australia
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19
M.Tuberculosis- Active Disease Rate in SA,
1905-1998
160
Rate of Decline
140
Pre 1980 includes atypicals
120
100
Introduction of Anti-TB Drugs
2.8
80
Rate/100,000
60
10
40
7
20
0
1905
1919
1932
1945
1958
1971
1984
1998
20
Current International Situation
Europe 33.3
America 34.9
Western Pacific 55.5
EastMediterranean 55.2
South East Asia 94.4
Africa 96.8
Global Emergency WHO 1/3 infected (1900
million) 8 million new cases/year 3 million
death/year TB leading cause of death Global 60
(1994)
Rates (per 100,000) Taux (pour 100,000)
Australia 5.47
gt 100
25 to 100 25 å 100
lt 25
No report Pas de notification
21
Global TB Situation

• Most significant public health threat
• TB infects 2 billion people
• A global Health Emergency- WHO 1993
• Complicated by
• HIV/AIDS
• MDRTB
• 2001 WHO Global Surveillance Program
• 183 countries notified 3.8 million TB cases, 42
  sputum smear ve
• Underestimated
• Global TB incidence increased 0.4 p.a
• esp. .Sub-Saharan Africa .Countries of former
  Soviet Union
• Western Pacific Region (WPR)
• 24 of notified cases
• 4/22 countries high TB burden

22
Global TB Situation (continue)

• Australia
• One of the lowest incidence rates of TB
• Two sub-populations have high incidence rates of
  TB
• - Indigenous Australians
• - People born overseas
• National TB Advisory Committee (NTAC)
• - Implemented a National Strategic Plan for TB
  control in Australia beyond 2000 (Endorsed by
  Communicable Diseases Net Work Australia. CDNA
  2002).
• TB Notification
• - National Mycobacteria Surveillance System
  (past)
• - Enhanced surveillance for TB Notification
  Commenced 2001 as part of National Notifiable
  Diseases Surveillance System

23
Incidence Rates per 100,000 population for
tuberculosis notifications, Australia 1948 to 2002
60
50
Rate per 100,000 population
40
30
Rate per 100,000 population
1996
1997
1998
1999
2000
2001
2002
Year
20
10
0
1952
1957
1962
1967
1972
1977
1982
1987
1992
1997
2002
Year
24
Notifications of new and relapsed cases of
tuberculosis and rates per 100,000 population,
Australia, 2002, by State and Territory

• State New New cases Relapse Relapse case
  Total Total cases rate cases rate rate
• Australian 14 4.3 0 0 14 4.3Capital Territory
• New South Wales 441 6.6 6 0.1 447 6.7
• Northern Territory 37 18.7 1 0.5 38 19.2
• Queensland 124 3.3 9 0.2 133 3.6
• South Australia 43 2.8 3 0.2 46 3
• Tasmania 9 1.9 0 0 9 1.9
• Victoria 272 5.6 7 0.1 279 5.7
• Western Australia 57 3 4 0.2 61 3.2
• Australia 997 5.1 30 0.2 1027 5.2

There was one case where relapse status was
unknown
25
Notification Rates for tuberculosis, Australia,
2000 to 2002, by State and Territory
2000
2001
2002
Rate per 100,000 population
State/Territory
26
TB Notification Rates, 2002
Timor Sea
Coral Sea
Indian Ocean
19.2
3.6
3.2
3
6.7
4.3
Australia - 5.2Red indicates aboveNational
average
5.7
Tasman Sea
1.9
27
Notifications of tuberculosis and incidence Rates
in Indigenous and non- Indigenous people born in
Australia, 2002, by State and Territory

• Site/Territory Indigenous Rate Non-Indigenous
  Rate Total Rate Australia born Australia
  born Australia born
• Australian 0 0.0 1 0.4 1 0.4Capital Territory
• New South Wales 2 1.6 60 1.2 62 1.2
• Northern Territory 24 41.9 2 1.8 26 14.0
• Queensland 9 7.4 34 1.1 43 1.4
• South Australia 1 4.0 10 0.8 11 0.9
• Tasmania 0 0.0 5 1.2 5 1.2
• Victoria 1 4.0 47 1.2 48 1.3
• Western Australia 0 0.0 8 0.6 8 0.6
• Australia 37 8.5 167 1.1 204 1.3

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Trends of tuberculosis incidence rates,
Australia, 1991 to 2002, by Indigenous status
and country of birth
Overseas-born person
Indigenous Australians
25
Non-indigenous Australians
20
15
Rate per 100,000 population
10
5
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
2001
Year
29
Notification of Tuberculosis and estimated rate
per 100,000 population for selected countries of
birth, Australia, 2002

• Country New Relapsed Total Estimated
  Australia Rate per 100,000 WHO incidenceof
  Birth Cases Cases Cases Resident Population
  population in rate (per 100,000 by country
  of Birth, Australia by Country population
  for 2001 of Birth, 2002 country, 2001
• India 106 0 106 95455 111.0 43
• Vietnam 98 4 102 154833 65.9 115
• Philippines 91 1 92 103942 88.5 139
• China 54 1 55 142778 38.5 38
• Indonesia 48 0 48 47156 101.8 134
• Papua 21 3 24 23618 101.6 323New Guinea
• Somalia 22 1 23 3713 619.4 75
• Thailan 22 0 22 23599 93.2 78
• HongKong 19 1 20 67121 29.8 109

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Notification of Tuberculosis and estimated rate
per 100,000 population for selected countries of
birth, Australia, 2002

• Country New Relapsed Total Estimated
  Australia Rate per 100,000 WHO incidenceof
  Birth Cases Cases Cases Resident Population
  population in rate (per 100,000 by country
  of Birth, Australia by Country population
  for 2001 of Birth, 2002 country, 2001
• Korea 16 1 17 38958 43.6 79
• Malaysia 15 0 15 78858 19.0 66
• United 14 0 14 1083318 1.3 10Kingdom
• Cambodia 13 0 13 22979 56.6 143
• Sri Lanka 12 0 12 53460 22.4 39
• Other 247 9 259 2148140
• Overseas 798 21 819 4087928 19.9
• Australia 197 7 204 15619272 1.3
• Not Stated 2 2 4
• Total 997 30 1027 19707200 5.2

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Notifications and Estimated Incidence Rate of
Tuberculosis per 100,000 Population, Australia,
2002, by Age Group, Indigenous Status and Country
of Birth

• Age Indigenous Indigenous Non-Indigenous
  Non-Indigenous Overseas OverseasGroup Australia
  born Australia born Australia born Australia
  born -born -born
• NUMBER RATE NUMBER RATE NUMBER RATE
• 0 - 4 3 5.7 12 1 4 15.9
• 5 - 14 4 3.7 7 0.3 10 5.6
• Sub total 7 4.3 19 0.5 14 6.9forlt15 years
• 15 - 24 2 2.7 15 0.7 109 27.7
• 25 - 34 6 9.4 15 0.7 191 31.6
• 35 - 44 9 17.8 17 0.8 148 17.1
• 45 - 54 3 9.3 16 0.9 120 13.7
• 55 - 64 7 43.4 18 1.5 69 9.9
• 65 3 26.2 67 4.1 159 18.
• AUTRALIA 37 9 167 1.1 810 18.1

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Incidence rate of Tuberculosis in Australian-born
and Overseas-born people, 2002, by Age Group and
Sex
Male Australia-born
40
Male Overseas-born
35
Female Overseas-born
Female Australian-born
30
25
Rate per 100,000 population
20
15
10
5
0
0 - 4
5 - 14
15 - 24
25 - 34
35 -44
45 - 54
55 - 64
65
Age Group (Years)
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TB and Selected Risk Factors

• 2002
• 220/1028 (21.4) cases reported
• 139 household members or close contacts
• 9 Correctional Services
• 17 Aged Care Facilities
• Individuals Working in High Risk Settings
• 3 Correctional Facilities or Aged Care Facilities
  
• 10 Health Industries
• 140 resided gt3 months in High Risk Countries

34
TB HIV Status

• 2002
• 281/1028 (27.3) TB case notified reported HIV
  Status
• 11 HIV positive
• 2 born in Australia
• 9 born overseas
• 2001
• 4.2 TB case notified reported HIV status

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New and relapsed cases in Australia, 2002, by
site of disease

• Site New cases Relapse cases Total cases of
  cases
• Pulmonary 585 17 602 58.7
• Lymphatic 160 5 165 16.1
• Pleural 93 4 97 9.5
• Bone/Joint 51 1 52 5.1
• Meningeal 21 0 21 2.0
• Genitourinary 19 1 20 2.0
• Miliary 11 0 11 1.1
• Peritoneal 7 0 7 0.7
• Other 23 0 23 2.2

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Antimicrobial Therapy

• 2002
• Antimicrobial drug regime reported for 930
  (90.5) TB cases
• 23 cases 2D
• 101 cases 3D
• 804 cases 4D (99.69, INH, RIF, PYZ, ETM)
• 2 cases gt5D
• Under 8 years
• 13 cases 3D (INH, RIF, PYZ)

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Outcome of Treatment for Tuberculosis amongst
cases evaluated, Australia, 2002, by
Australian-born (Indigenous and Non-indigenous)
and Overseas-born individuals

• Treatment Indigenous Non-Indigenous
  Overseas Unknown Total Percent Outcome
  Australia Australia born of Cases born
  born
• Cured (Bacteriological 19 11 43 1 74 9.2confirme
  d)
• Completed Treatment 9 87 482 0 578 72.1
• Interrupted Treatment 0 1 2 0 3 0.4
• Died of TB 2 5 10 1 18 2.2
• Died of Other Cause 2 20 40 2 64 8.0
• Defaulted 0 2 4 0 6 0.7
• Failed 0 0 1 0 1 0.1
• Transferred out of 1 2 53 2 58 7.2Australia
• Total 33 128 635 6 802

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National Tuberculosis performance indicators,
performance criteria and the current status of
Tuberculosis in Australia, 2002

• National TB Performance Indicator Performance
  2001 2002 CriteriaAnnual Incidence of TB (per
  100,000 population) Crude
  IncidenceIndigenous Australians lt1 9.8 8.5Non-in
  digenous Australian-born lt1 1 1.1Overseas-born
  persons 10.2 11.5 lt2 of total NA? NA?
  Relapse cases initially treated in Australia
  treated cases
• Incidence in children lt15 years, by risk group
  Indigenous Australian Children
  lt0.1 2.4 4.3Non-indigenous Australian-born
  Children lt0.1 0.5 0.5Overseas-born
  Children 1 0.1Collection of HIV status in TB
  case 100 over ( of cases with data
  collected) next 3 years 4.2 27.3Treatment
  outcome measures()
• Cases evaluated for outcome 100 76.9 78
• Cases that have treatment completed and are
  cured gt90 83.6 80
• Cases recorded as treatment failures lt2 0.9 0.1

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Communities at Risk for Tuberculosis
Unemployed
No access to care
Health Care Workers
Malnutrition
Elderly
Poverty
HIV/AIDS
Tuberculosis
Minorities
Drug Abusers
Indigenous Australian(Aboriginal Torres Strait
Island People)
Incarcerated
Immigrants
Homeless
Uneducated
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TB Notifications in South Australia 1990-2000
Pulmonary
Extra-Pulmonary
Linear (Pulmonary)
Linear (Extra-Pulmonary)
80
70
60
50
Number of cases
40
30
20
10
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Year
41
Extra-Pulmonary Tuberculosis 1990-2000
43
Lymph Node
Pleura
18
Genito/urinary
11
Bone/Joint
10
Other
6
Site of Disease
Miliary
5
Meningeal
3
Skin
2
Peritoneal
1
GIT
1
0
10
20
30
40
50
60
70
80
Number of Cases
42
M.tuberculosis Notification Rates Compared with
Abnormal TST Rates
60
Active Disease
50
Abnormal TST
40
Rate per 100,000
30
20
10
0
1945
1960
1975
1990
SA 2.3/100,000 Aust 5.47/100,000
Year
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Current Situation

• Australia has one of the lowest incidences of TB
  in the Western Pacific Region
• 2002
• 5.2/100,000 (5 to 6/100,000 since mid -1980)
• Sub-population
• Indigenous Australians
• 8.5/100,000 (2/3 in Northern Territory, 28 of
  overall population c/w 2 national wide)
• Those born overseas
• 20.2/100,000
• Highest rates of TB in 1534 years old
• 34.5 of all TB notified in people born in India,
  Vietnam, Philippines, Indonesia China.

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Global Partnership

• To foster global partnerships
• RAH Bali TB project in partnership with Bali
  Department of Health
• Australia Red Cross
• 400,000 grant over six years
• training in treatment and laboratory services
  based on WHO DOT strategy
• IMVS
• Indonesian - Australian Specialized Training
  Project for laboratory diagnosis of TB, quality
  assurance and TB community development
• Train the trainer approaches
• SA at forefront of regional TB control

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Footnote on Chinese Community in Australia

• Chinese population in Australia relatively small
  (? Official censors)
• Chinese have overcome racial prejudice and
  blended into the Australian Community
• National Centenary Celebration of Federation of
  Australia
• held in Melbourne 2001
• Chinese also held national conference at the
  same time
• Chinese widely respected and enjoy proportional
  previleges
• Many Chinese Organizations
• Medical eg ACMA, ACCMA
• Other organizations, culture clubs, Chambes of
  Commerce, welfare associations etc
• Federation
• In SA, Forum of Chinese organizations in SA 1996
• Federation of Chinese organizations
  in SA (FOCOSA) 2001
• Chinese Community in Australia
• A cohesive and fairly united group
• Future fairly bright

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