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Tuberculosis in Thailand
Dr. Chawetsan Namwat
NTP manager and
Director of BTB, DDC, MOPH, Thailand
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Estimated number of
cases
Estimated number of
deaths
1.4 million 8.7 million
~150,000 630,000
All forms of TB Greatest number of cases in Asia; greatest rates per capita in Africa
Multidrug-resistant TB (MDR-TB)
Extensively drug-resistant TB (XDR-TB) ~50,000 ~30,000
HIV-associated TB 0.97 million 0.43 million
TB: 2011 Global Estimates
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TB prevalence in high burden countries
3 Source: WHO, Global TB report, 2012
Global TB estimates, 2011
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Incidence reduction: 2.2%
TB death reduction: 41% from 1990
Challenges
Incidence 8.7 Million
Deaths: among HIV-ve 0.99M, among HIV+ve 0.43M
MDR-TB: 3.7% in new cases, 20% in previously treated
Tuberculosis situation
5 source: WHO, Global Tuberculosis Report 2012
TB incidence (per 100,000) by WHO region, and in Thailand, 2011
125
262
28 42
189
92
124
0
100
200
300
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
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35
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%MDR TB among New TB cases
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%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
Be
laru
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Mo
ldo
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Uzb
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stan
Esto
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Kyr
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Kaz
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Lith
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lan
d
%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)
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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 subjects sputum smear & culture for all suspects
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National TB Prevalence Survey, 2012
Study area ODPC1 นนทบรุ ี ปทมุธาน ี ODPC2 ชยันาท ลพบรุ ี ODPC3 ฉะเชงิเทรา ชลบรุ ี ODPC4 กาญจนบรุ ีสมทุรสงคราม ODPC5 นครราชสมีา สรุนิทร ์ ODPC6 เลย อดุรธาน ี ODPC7 นครพนม อบุลราชธาน ี ODPC8 นครสวรรค ์พจิติร ODPC9 เพชรบรูณ์ สโุขทัย ODPC10 เชยีงใหม ่ พะเยา DOPC11 กระบี ่ นครศรธีรรมราช ODPC12 ตรัง สงขลา
TB prevalence survey Sampling & Eligible
Abnormal CXR Symptom+ (score3+) or
Sputum collection
Sputum culture (**Bact. Confirm**)
Sputum Smear and
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
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Prelim. Result: National TB Prevalence Survey, 2012 (Non-BKK)
Participation by age group
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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
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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
5th National Survey -China 2010 253,000 participants in 176 sites
Region
Smear positive TB
Bacteriological positive
Prevalence (1/100000) Change
(%) Prevalence
(1/100000) Change
(%)
2000 2010 2000 2010
Urban 131
(91,172) 49
(25,74) -62.6
164 (120,208)
73 (46,99)
-55.5
Rural 181
(160,202) 78
(64,93) -56.9
232 (211,254)
153 (133,172)
-34.1
Eastern 124
(102,147) 44
(30,58) -64.5
163 (138,187)
65 (50,81)
-60.1
Middle 217
(176,259) 60
(30,91) -72.4
251 (207,294)
118 (81,154)
-53.0
Western 198
(160,236) 105
(80,130) -47.0
278 (240,316)
198 (167,229)
-28. 8
(China CDC 2011) 25
Courtesy slide: Dr Onozaki, WHO
Challenge when the AEC starts Incidence rate (per 100,000)
AEC
2015
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TB control in Thailand
Align with global stop TB strategy
“Zero and Five to minimize MDR-TB”
คน้ใหพ้บ จบดว้ยหาย ตายนอ้ยกวา่รอ้ยละ 5 ขาดยาเป็น 0
Political commitment & Universal coverage scheme
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TB in Non-Thais
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2011 1182 44 789 253 2268
2010 1028 27 652 220 1927
2009 933 38 804 168 1943
Fiscal Year
New
M+
Relap
se
New
M- EPTB Total
Age distribution of New M+ TB cases in migrants, Thailand 2009-2011
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From strategies to actions:
Disease control competent
districts
Indicators on TB control in district levels
1. การตอบสนองเชงินโยบาย ม ีMr.TB /มผีูรั้บผดิชอบงานผา่นอบรม
2. การคน้หาและวนิจิฉัยผูป่้วยวัณโรค
3. การรักษาดว้ยระบบยาระยะสัน้แบบมพีีเ่ลีย้ง
4. ยารักษาวัณโรคไมข่าดแคลนและมคีณุภาพ
5. ทะเบยีนและรายงานวัณโรค
6. การป้องกนัการแพรก่ระจายเชือ้วัณโรคในโรงพยาบาล
7. การผสมผสานงานวัณโรคและโรคเอดส ์
8. ผลการรักษา
ขอบคณุครับ
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