Country Update:Tuberculosis in Thailand
Dr. Chawetsan NamwatNTP manager and
Director of BTB, DDC, MOPH, Thailand
1
TB prevalence in high burden countries
2Source: WHO, Global TB report, 2012
Tuberculosis situation
3 source: WHO, Global Tuberculosis Report 2012
TB incidence (per 100,000) by WHO region,
and in Thailand, 2011
0
100
200
300
125
262
28 42
189
92124
2011
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
Missing< 80% 80%-84% 85%-89% ≥ 90%
< 5% 5%-10% > 10%
< 1% 1%-2% ≥ 3%
Treatment outcome, 2011
BTB-Updated : May 28, 2013
Estimates of MDR-TB burden (2011),Thailand
Estimates among notified cases% of new TB cases with MDR-TB 1.7 (1.0–2.6)
% of retreatment TB cases with MDR-TB 35 (28–42)
Estimated MDR-TB cases among new pulmonary TB cases notified in 2010
890 (540–1 400)
Estimated MDR-TB cases among retreated pulmonary TB cases notified in 2010
1 300 (1 000–1 600)
Source: WHO Global TB Report 2012
MDR TB in High Burden Countries and Thailand
0
5
10
15
20
25
30
35
Bela
rus
Kaza
khst
anKy
rgyz
stan
Esto
nia
Uzbe
kist
anAz
erba
ijan
Russ
iaM
oldo
vaUk
rain
eLa
tvia
Tajik
istan
Geor
gia
Lith
uani
aAr
men
iaCh
ina
Mya
nmar
Phili
ppin
esPa
kist
anCo
ngo
Nige
riaVi
et N
amIn
dia
Bulg
aria
Indo
nesia
Sout
h Af
rica
Ethi
opia
Bang
lade
shTh
aila
nd
%MDR TB among New TB cases
Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand
MDR TB in High Burden Countries and Thailand
0
5
10
15
20
25
30
35
Arm
enia
Azer
baija
nBa
ngla
desh
Bela
rus
Bulg
aria
Chin
aCo
ngo
Esto
nia
Ethi
opia
Geor
gia
Indi
aIn
done
siaKa
zakh
stan
Kyrg
yzst
anLa
tvia
Lith
uani
aM
yanm
arNi
geria
Paki
stan
Phili
ppin
esM
oldo
vaRu
ssia
Sout
h Af
rica
Tajik
istan
Ukra
ine
Uzbe
kist
anVi
et N
amTh
aila
nd
%MDR TB among New TB cases
Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand
Percentage of new TB cases with MDR-TB
MDR TB in High Burden Countries and Thailand
01020304050607080
Bela
rus
Mol
dova
Uzbe
kist
anEs
toni
aAz
erba
ijan
Tajik
istan
Kyrg
yzst
anKa
zakh
stan
Lith
uani
aRu
ssia
Ukra
ine
Arm
enia
Geor
gia
Latv
iaPa
kist
anBa
ngla
desh
Chin
aBu
lgar
iaPh
ilipp
ines
Viet
Nam
Indi
aIn
done
siaEt
hiop
iaM
yanm
arCo
ngo
Nige
riaSo
uth
Afric
aTh
aila
nd
%MDR TB among previously-treated TB cases
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)
16
Preliminary data of 4th Surveillance of Drug resistance in Tuberculosis: THAILAND 2012
ITEMS Newly Treated
Cases Previously
Treated Cases Combined Drug
resistance
N Pct N Pct N Pct Total tested 1456 100.00% 175 100.00% 1631 100.00%
Fully sensitive 1216 83.52% 110 62.86% 1326 81.30% Any resistance 240 16.48% 65 37.14% 305 18.70%
H+R resistance (MDR-TB) 27 1.85% 29 16.57% 56 3.43%
Mono-resistance 164 11.26% 32 18.29% 196 12.02% Two drugs resistance 47 3.23% 3 1.71% 50 3.07%
Three drugs resistance 2 0.14% 1 0.57% 3 0.18% Four drugs resistance 3 0.21% 4 2.29% 7 0.43%
Any H-resistance 174 11.95% 46 26.29% 229 1.41% Any R-resistance 30 2.06% 39 22.29% 69 4.23%
Mono H-resistance 99 6.80% 16 9.14% 115 7.05% Mono R-resistance 2 0.14% 7 4% 9 0.55%
Note: Total = 1747 cases, 116 cases are waiting for analysis, NTRL NTP-May2013
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 subjectssputum smear & culture for all suspects17
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
Symptom+ 35% (Symptom score 3+) CXR abnormal, no symptom 65%
P R E L I M I N A RY R E S U LT. N O T F O R R E F E R E N C E
18
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
Participation by age group
19
Num
ber
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
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
Age distribution of TB cases(N=142)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
20
Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
0-4Yr, 1.0%
5-9Yr, 0.5% 10-14Yr, 0.6%
15-24Yr, 7.3%
25-34Yr, 15.2%
35-44Yr, 18.6%
45-54Yr, 18.4%
55-64Yr, 15.9%
65+Yr, 22.5%
0-4Yr
5-9Yr
10-14Yr
15-24Yr
25-34Yr
35-44Yr
45-54Yr
55-64Yr
65+Yr
Age distribution of smear+ PTB, Report.506
Source: R506: Pulm TB New M+ /2008-2011, BOE
Age distribution of smear+ PTB, Report.506
22
23
Challenge when the AEC startsIncidence rate (per 100,000)
AEC
2015
TB control in Thailand Align with global stop TB strategy “Zero and Five to minimize MDR-TB”
ค้นใหพ้บ จบด้วยหายตายน้อยกวา่รอ้ยละ 5ขาดยาเป็น 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 non-documented migrant labors
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Plan for DR-TB
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Plan for DR-TB
ขอบคณุครบั
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