Download Control of Tuberculosis in Australia

Control of Tuberculosis in
Australia
Guy B. Marks
Woolcock Institute of Medical Research
Department of Respiratory Medicine, Liverpool Hospital
Outline
• Organisation of Care
• Descriptive Epidemiology
– Roche P, Bastian I, Krause V, National Tuberculosis Advisory
Committee, for Communicable Diseases Network Australia.
Tuberculosis notifications in Australia, 2005. Commun Dis
Intell. 2007;31:71-80.
• Outcomes of Treatment
• Program Priorities
TB control in Australia
• Under control of eight jurisdictions
• DOTS in most but not all jurisdictions
• Mostly public sector but private sector
involvement in some activities
• Other State TB control activities
– Contact tracing
– Screening high risk groups
• National role
– Data reporting
– Screening intending migrants and visa applicants
Incidence of TB in Australia, 1960 - 2005
1072 cases,
5.3 / 100,000
Roche et al. Comm Dis Intell 2007; 31:71-80
Incidence in indigenous, non-indigenous
Australian-born and overseas-born,
Australia 1991 - 2005
923 cases
19.1 / 100,000
27 cases
5.9 / 100,000
122 cases
0.8 / 100,00
Roche et al. Comm Dis Intell 2007; 31:71-80
Incidence by country of birth,
Australia, 2005
Cases
600
Rate per 100,000 population in
Australia
WHO incidence rate per 100,000
500
400
300
200
100
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Roche et al. Comm Dis Intell 2007; 31:71-80
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Age-Distribution by Birthplace,
Australia, 2005
40
35
Overseas-born
Australian-born
Rate (per 100,000)
30
25
20
15
10
5
0
< 15
15–24
25–34
35–44
Age Group
Roche et al. Comm Dis Intell 2007; 31:71-80
45–54
55–64
65+
HIV co-infection
• No representative data
• HIV status report for 37% of
notifications
• Nine (2.3%) of these were HIV +ve
Site of Disease
Extra-pulmonary
only
Pulm. +
XP
Roche et al. Comm Dis Intell 2007; 31:71-80
Pulmonary
only
Multi-drug Resistance Rates
Australia, 1995-2005
16
N
%
14
12
10
8
6
4
2
0
1995
1996
1997
1998
1999
Lumb et al. Comm Dis Intell 2007; 31:80-86
2000
2001
2002
2003
2004
2005
Outcomes of TB Cohort,
Australia, 2004
11 deaths
attributed to TB
Cured
Completed
Interrupted Rx
Died of TB
Defaulted
Failure
Outcome unknown
Transferred out
Died other causes
Still under Rx
Roche et al. Comm Dis Intell 2007; 31:71-80
Roche et al. Comm Dis Intell 2007; 31:71-80
Priorities
• Early detection
– Awareness
– Primary health care
• Effective treatment completion
– Free treatment
– DOTS
• Control of disease in high risk groups
– Migrants
– Contacts of infectious cases
Control of TB in Migrants
• Screening prior to migration or on
application for change in visa status
• Treatment of active and some inactive
disease
• Post-migration follow-up of migrants
with evidence of past TB
Conclusions
• Australia is a low burden country
• Many visitors and migrants from highburden countries
• TB control requires continued vigilance
and active control measures