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TB epidemiology in Thailand. Philippe Glaziou, on behalf of the epi team Bangkok, August 2013. TB in Thailand: key figures (2012). 80,000 new cases 11,000 TB deaths. Thailand among 22 countries with highest TB incidence. TB epidemiology: case notification rate. All forms. Smear pos. - PowerPoint PPT Presentation
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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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