tb epidemiology in thailand

TB epidemiology in Thailand

Philippe Glaziou, on behalf of the epi teamBangkok, August 2013

TB in Thailand: key figures (2012)

80,000 new cases11,000 TB deaths

Thailand among 22 countries with highest TB incidence

TB epidemiology: case notification rate

All forms

Smear pos

Inconsistent trends by province

Under-reporting of childhood TB (2010)

Under-reporting of childhood TB estimated at 45% of diagnosed cases

min(Uc) = 1 – (1 – Ut).(1 – Ub)

Uc = under-reporting childhoodUt = overall under-reporting (prevalence survey)Ub = BTB under-reporting of BoE cases

Treatment success

85% global Treatment success target

At risk populations: health workers• Saraburi hospital: n=1800 health workers• average incidence = 206/100,000 person-year• Relative Risk ≈ 1.4

At risk populations

Population TB risk ratioHIV-infected 17 (vs HIV-negative)Elderly 3.6 (vs 15-24 yr old)Immigrants >2 (vs Thai)Other: - diabetics- smokers - health workers?

TB mortality (excluding HIV)

Raw data from VR

Adjusted for incomplete coverageand ill-defined causes

Determinants of TB: economic growth

1997 financial crisis

Determinants of TB: health system performance (U5MR)

13/1000

Good performance of Thailand relative to country income group

Determinants of TB: HIV in 15-49 yr old population

Source: UNAIDS 2013

HIV prevalence in TB

Source: BTB surveillance

Determinants of TB: rapid aging of the population

Population estimates from UN Pop Division, 2013

Population aging slows down the decline in TB

TB incidence estimated in slow decline -3.4%/year

Impact of TB control?

• Cured 525,000 cases since 2000 (79% of 665,000)

• Prevented the emergence of MDR-TB– 2006: 1.65% (new), 34.5% (retx), 6.4% (combined)– 2013: 1.89% (new), 16.6% (retx), 3.4% (combined)

• Decline in TB incidence and mortality multifactorial– Economic growth, UCS, decline in HIV, TB control,

…

Global targets

• MDG target 6c met (incidence reverted)• Thailand on track to meeting 50% reduction

targets for prevalence and mortality (2015)

But …• The burden of TB in Thailand is still high and

requires a prioritized public health response

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