DR.MAMMEN P CHERIANMBBS, PGDOR

MEDICAL OFFICER IN CHARGE, PHC NIRANAM

MOTC THIRUVALLA TU

RNTCPTraining for

LSGD MEMBERSCHATHENKERY

24/04/2015

TB Infection

• Chances of getting infected depends on:

1. The duration of exposure2. The frequency of exposure3. The immune status of an

individual

Infection• Entry and establishment of organism in human body• Takes about 6-8 weeks.• Indicated by +ve tuberculin skin test.1. Primary infection – infection occurring for the first time in a susceptible • Individual exposed to M.tb.• Primary complex• Secondary bacillary multiplication that occurs at regional LN• 2.Post primary TB – after a latent period of many months or even years after

primary infection.• Risk of spread of infection:• To 10-15 persons/year for 2-3 years• Risk factors for developing disease:• Strongest risk factor- HIV Co-infection, DM, SMOKING, ALCOHOL ABUSE

India is the highest TB burden country accounting for more than one-fifth of the global incidence

Indonesia6%

Nigeria5%

Other countries20%

Other 13 HBCs16% China

14%

South Africa5%

Bangladesh4%

Ethiopia3%

Pakistan3%

Phillipines3%

India21%

Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing

Global annual incidence = 9.4 millionIndia annual incidence = 1.98 million

India is 17th among 22 High Burden

Countries (in terms of TB incidence rate)

WHO estimates for TB in India (2013)

Incidence of TB disease

2.2 million per annum

(176 per 100,000 pop. per year)

Prevalence of TB disease

2.8 million (230 per 100,000 pop. per year)

Mortality due to TB

270,000 per annum (>900/day)

(22 per 100,000 pop. per year)

Problem of TB in India• Incidence: >1.98 million new TB cases annually

– 0.8 million new infectious cases– 75 NSP cases / 100,000 population / year – Incidence more in north and less in south– Incidence more in urban areas – TB is more common among males

• Prevalence: – WHO estimate (2007) – 3.3 million TB cases

• Deaths: about 2,76,000 deaths due to TB each year– One of the leading infectious cause of death– Nearly 1000 deaths due to TB per day; about 2 deaths every 3 minutes

Problem of TB in India..• Infection: 40% (~400m) infected with tuberculosis bacteria

– Only 10% of them will develop TB disease in lifetime– Co-infection with HIV increases risk of TB disease by 6 to 8 times– Several other factors also increase this risk, e.g. diabetes, smoking, poor

nutrition, etc• HIV : 1. 2.27 million people living with HIV; nearly 1 million co-infected with HIV and TB

2. About 5% of TB patients estimated to be HIV positive3. HIV in TB varies greatly between districts and states (<1% to 14%)4. More in south (except Kerala), north-east and some scattered districts• Estimated Multi-drug resistant TB

1-3% in new cases12-17% in re-treatment cases

• DM, SMOKING

Estimated* Incidence of TB in India(No. of NSP Cases per 100,000 population, per year)

National 75 North Zone 95East Zone 65**West Zone 80South Zone 50**

North

West East

South

* Estimated from ARTI survey

** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75

ARTI survey by NTI 2001-2003

Annual Risk of Tuberculosis Infection(ARTI)

Proportion of population that gets newly infected ( or re-infected ) with tubercle bacilli during the course of one year

ARTI for the country is 1.5%. For Kerala it is 1.0%

203 cases per lakh population is infected each year.

135 cases/L/Year-Kerala

Type of case Occurrence / lakh / year

NSP (Definitive) 75 cases

NSN (Probable) 75 cases

Previously treated

38 cases

EP 15 cases

Total 203 cases

Type of case Occurrence / lakh / year

NSP (Definitive) 50 cases

NSN (Probable) 50 cases

Previously treated

25 cases

EP 10 cases

Total 135 cases

OUR BLOCK

PHC Ned

umpuram

PHC Nira

nam

PHC Kutta

ppuzha

PHC Kad

apra

PHC Kutto

or

CHC Chath

enkery

0

1

2

3

4

5

6

7

NSP 1Q2014NSP 2Q2014NSP 3Q2014NSP 4Q2014

NEW SMEAR POSITIVE CASES

0

1

2

3

4

5

6

1

3

4

1 1

3

2

1 1 1 1 1 1 1 1 1

3

1

5

22

3

1 1 1

4

1 1

2 2

3

1

3

1 1

5

4

1 1 1

3

1

2 2

1

2

4

3

1

2 2

1

2

1

2

5

6

1 1

5

2

1 1

3

1

4

2

1 1 1

1Q2014 2Q2014 3Q2014 4Q2014

NEW SMEAR POSITIVE CASES

PHC Ned

umpuram

PHC Nira

nam

PHC Kutta

ppuzha

PHC Kad

apra

PHC Kutto

or

CHC Chath

enkery

0

0.5

1

1.5

2

2.5

3

3.5

NSN 1Q2014NSN 2Q2014NSN 3Q2014NSN 4Q2014

NEW SMEAR NEGATIVE CASES

PHC Nedum

pura

m

PHC Nirana

m

PHC Kutt

appuz

ha

PHC Kada

pra

PHC Kutt

oor

CHC Chathe

nkery

THQH Mall

appall

y

CHC Chathe

nkery

PMCH Thiruva

lla

PHC Kott

angal

PHC Kav

iyoor

PHC Kun

namthan

am

PHC Anicad

u

PHC Kott

anadu

CHC Kallo

oppar

a

PHC Thelliy

oor

CHC Ezhum

attoor

PHC Kum

bana

du

PHC Puramatt

om

PHC Othe

ra

CHC Kanje

ttuka

ra

PHC Koipur

am

PHC Thottapp

uzha

ssery

0

0.5

1

1.5

2

2.5

3

3.5

4

1

3

2

1

2

3

1 1

4

22

1 1 1 1 1 1 11 1 1

2 2

1 1 1 1

2 2

11 1 1 1 1 1

1Q2014 2Q2014 3Q2014 4Q2014

NEW SMEAR NEGATIVE CASES

PHC Ned

umpuram

PHC Nira

nam

PHC Kutta

ppuzha

PHC Kad

apra

PHC Kutto

or

CHC Chath

enkery

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

NEP 1Q2014NEP 2Q2014NEP 3Q2014NEP 4Q2014

NEW EXTRA PULMONARY CASES

0

1

2

3

4

5

6

7

3

1

2

4

1 1 1

2

1

2

1 1 1 1 1

3

1 1

2

5

1 1 1 1 1 1

4

2

1 1

2

7

1

2

1 1 1 1 1 1

2 2

3

2

1 1

3

2

1 1 1 1 1

1Q2014 2Q2014 3Q2014 4Q2014

NEW EXTRA PULMONARY CASES

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

11 1 1 1 11 1 1 11

1Q2014 2Q2014 3Q2014 4Q2014

PAEDIATRICS TB

THANK YOU