Epidemiology of Tuberculosis in

The Republic of Mauritius

“ Recent Trends ”

(La Tuberculose à L`ile Maurice)

Epidemiology of Tuberculosis in

The Republic of Mauritius

“ Recent Trends ”

(La Tuberculose à L`ile Maurice)

Dr R.Reesaul Chest Physician

Chest Clinic

P. D`or Hospital

Dr R.Reesaul Chest Physician

Chest Clinic

P. D`or Hospital

INCIDENCE AND MORTALITY OF TB WORLDWIDE PER 100,000 INHABITANTS 2006

350

30

43

125 190

122

50

90

97

72

100

45

12

25

86

22

10

2M

2M

1M 3M

1/3 of world population infected

10 M new cases yearly

3 M cases of death yearly

350

9 75

97

25

11575

17

INCIDENCE AND RATE OF TB IN THE INDIAN OCEAN PER 100,000 INHABITANTS in 2006

44

10115

2M

2M

2M

1M125

20

120

40,000

8000

1M

Low incidence in

a

High risk region

Tuberculosis in MauritiusTuberculosis in Mauritius

Population of 1.2 million( 2006)

Tuberculosis is a notified disease to the MOH

Free treatment of all persons with active TB

Anti- TB drugs(1st line and 2nd line drugs ) are available only at MOH central pharmacy

Only few cases treated in private

Population of 1.2 million( 2006)

Tuberculosis is a notified disease to the MOH

Free treatment of all persons with active TB

Anti- TB drugs(1st line and 2nd line drugs ) are available only at MOH central pharmacy

Only few cases treated in private

CHEST ClinicIn -patients 30 Beds TB AIDS Unit

Home Visits Specialized Nurses

DOTS, DrugsCounselling

W.H.O Africa

AdministrationProcurement, Tenders

Statistics, notifications…

ScreeningContacts

Migrant workersPrisoners

HomesHigh risks

5 Out- patients inRegional Hospitals

Specialized National Laboratory

For TB detection

Specialized Pharmacy Anti-TB Drugs

BCG

M.O.H

ORGANIZATION AND SET UP OF TB IN MAURITIUS

Notification and Incidence rate of Tuberculosis from 1974 to 2006

Years 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988

Incidence per

100,000 inhabitant 35 28 25 24 24 20 14 17 13 16 13 12 12 11 11

Notified Cases 269 223 199 198 195 183 131 163 122 159 120 116 121 111 113

                               

Years 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Incidence per

100,000 inhabitant 13 16 15 13 11 11 12 15 14 10 12 11 12 10 10Notified Cases 141 165 153 146 123 131 140 174 160 119 139 137 139 127 115

                               

INCIDENCE RATE OF TB PER 100,000 INHABITANTS YEAR 1974 TO 2006

INCIDENCE RATE OF TB PER 100,000 INHABITANTS YEAR 1974 TO 2006

0

5

10

15

20

25

30

35

40

Trend Incidence Pulmonary TB 2001-2005

Trend Incidence Pulmonary TB 2001-2005

Incidence de la TB 2001-2005

0

2

4

6

8

10

12

2001 2002 2003 2004 2005

Années

Inc

ide

nc

e p

ou

r 1

00

.00

0

ha

bit

an

ts TB Totale

TB Pulmonaire

ZN+

WHO Notification of TB 2002-2006WHO Notification of TB 2002-2006Year 2002 2003 2004 2005 2006 2007

New ss + P 86 99 117 110 85New ss - P 28 16 3 4 11New E.P 23 17 13 8 15Relapse 2 4 4 3 3Failure 0 1 0 0 0Defaulter 0 1 2 2 1Total 139 137 139 127 115 (99)MDR 0 0 1 0 2 (1)TB +HIV 0 1 2 2 5 (6)Total HIV/AIDS

458 698 1124 1822 2631 (3173)

YEARS

TOTALTB

NOTIFIED

New TOTALPULMONARY

TB

New TOTALEXTRA

PULMONARYTB

ZN (+)

ZN (-)

INCIDENCE

TBMigrant workers

INCIDENCE ZN (+)

TOTALTB

PULMONARYTB

20072006200520042003

(97)115127139137

96114120115

15081317

8511011799 

11040316 

9.51011

11.2 10.8 

(15)5161212 7.5 

2002 139 124 23  86 28  11.8  10.6  11 7.9 

2001 119 113 6  83 5  9.7  9.4  6 8.7 

2000 160 142 18 92 31 13.9 12.3 13 8.0

1999 174 161 13 112 32 15.2 14.1 11 9.8

1998 140 126 14 105 21 12.4 11.0 7 9.3

1997 131 122 9 102 20 11.6 10.9 1 9.1

1996 123 116 7 98 18 11.2 10.5 2 8.9

1995 146 134 12 108 23 13.4 12.0 4 9.9

1994 153 142 11 116 26 14.9 13.0 3 10.7

1993 165 148 18 130 18 15.6 13.9 0 12.2

1992 141 126 15 114 12 13.4 12.0 2 10.8

1991 141 138 3 112 26 13.6 13.3 0 10.4

1990 119 113 6 102 11 11.6 11.0 0 10.0

INCIDENCE / among Migrant workers

Age group and TB 2001-2005Age group and TB 2001-2005

Répartition de la TB par tranche d'age

0

5

10

15

20

25

30

35

40

45

2001 2002 2003 2004 2005

années

no

mb

re

0-14

15-24

25-34

35-44

45-54

55-64

>=65

Few cases <14 , protection BCG vaccin ?

Max cases age 25-44

Case notifications and sex ratioCase notifications and sex ratio

Sex ratio: M/F

Age 15-24 : 2/1

Age 25-34 : 3/1

Age 35-44 :4/1

Age 45-54 : 2/1

Age >55 : 4/1

Pulmonary and Extra-pulmonary TB 2001-2005

Pulmonary and Extra-pulmonary TB 2001-2005

TB Pulmonaire et Extra Pulmonaire: comparaison

0

20

40

60

80

100

120

140

2001 2002 2003 2004 2005

Années

No

mb

re Pulmonaire

Extra Pulmonaire

Extra pulmonary TB 2001-2005Extra pulmonary TB 2001-2005

TB Extra Pulmonaire 2001-2005

0

5

10

15

20

25

30

35

Les différents types

No

mb

re

Series1

Trend of Incidence TB in districts 2001-2005

Trend of Incidence TB in districts 2001-2005

Incidence de la TB par district: 2001-2005

0

5

10

15

20

25

30

2001 2002 2003 2004 2005

Année

Inci

den

ce

Port Louis

Pamplemousses

Riv du Rempart

Flacq

G.Port

Savane

Riv Noire

Moka

Pl Wilhems

40

13 17

20

1314

9

13

4

23

08

4

1214

13

6

10

5

EVOLUTION INCIDENCE PER 100,000 INHABITANTS DISTRICT from 1993 AND 2005

Incidence 1993 - 15.6 per 100,000 inhabitantsIncidence 2005 - 11 per 100,000 inhabitants

0

0.5

1

1.5

2

2.5

3

DEATH RATE TB PER 100,000 INHABITANTS 1991 TO 2006

Cumulative cases HIV/AIDS( 1st case at P D`or Hospital ) Cumulative cases HIV/AIDS

( 1st case at P D`or Hospital )

Cumulative nº of HIV/AIDS cases (87-04)

1 9 12 17 27 55 67 90 117140168197230287

356458

698

1124

0

200

400

600

800

1000

1200

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

Year

No

of

ca

ses

`

CO-INFECTION TB / HIV-AIDSYEARS Total Cases of

HIV/AIDSCases

TB / HIV

1999 230 1

2000 287 1

2001 356 1

2002 458 0

2003 698 1

2004

2005

2006

2007

1124

1822

2631

(3173)

2

2

5

(6)

DOTS and case detection rateDOTS and case detection rate

Objectives of WHO Implementation of DOTS coverage ( Directly observed short

course treatment) 100%

Case detection rate of at least 70% of smear positive pulmonary TB cases

Improve Cure rate > 80%

Non-compliance spread of infection lead to :

MDR ( Resistance to INAH & Rifampicin )

XDR TB( MDR and resistance to at least 3 majorsecond line drugs )

Objectives of WHO Implementation of DOTS coverage ( Directly observed short

course treatment) 100%

Case detection rate of at least 70% of smear positive pulmonary TB cases

Improve Cure rate > 80%

Non-compliance spread of infection lead to :

MDR ( Resistance to INAH & Rifampicin )

XDR TB( MDR and resistance to at least 3 majorsecond line drugs )

DOTS monitoring & outcomes 1995-2005DOTS monitoring & outcomes 1995-2005

MDR TB 2001-2006MDR TB 2001-2006

Years Resistance INAH & RIF

2001 0

2002 0

2003 0

2004 1

2005 o

2006

2007

2

(1)

Risk factors predisposing to TB in % admitted at Poudre D`or Hospital

Risk factors predisposing to TB in % admitted at Poudre D`or Hospital

Causes %Alcoholic Homeless

50-70%

DM 10 -15%

Contacts 5-10%

HIV <5%

Migrant workers 5- 10%

ConclusionConclusion

Incidence TB stable 10-14 /100,000 since 1995

Incidence highest among age group 35-45

Increase of extra-pulmonary TB since1992

Low death rate < 1/100,000 since 1998

Increase of TB among migrant workers noted since 1998

Few cases of Co-infection TB / HIV-AIDS and MDR TB

Cases MDR TB not among HIV/AIDS patients

Thank YouThank You

MerciMerci

Thank YouThank You

MerciMerci

9 Districts in Mauritius population 1.2 M 9 Districts in Mauritius population 1.2 M

Tuberculosis in MauritiusTuberculosis in Mauritius

Capital –District of Port Louis

Area 1865 km² , 9 districts + Rodrigues

Population of 1.2 million( 2006)

Tuberculosis notified disease to MOH

Gross national income per capita USD :12.45

Total expenditure on health as % GDP :4.3

Life expectancy at birth M/F :69/76

Free treatment of all persons with active TB

Anti- TB drugs available only at MOH central pharmacy and few cases treated in private

Capital –District of Port Louis

Area 1865 km² , 9 districts + Rodrigues

Population of 1.2 million( 2006)

Tuberculosis notified disease to MOH

Gross national income per capita USD :12.45

Total expenditure on health as % GDP :4.3

Life expectancy at birth M/F :69/76

Free treatment of all persons with active TB

Anti- TB drugs available only at MOH central pharmacy and few cases treated in private

Notified cases and incidence of Tb 2001-2006

Notified cases and incidence of Tb 2001-2006

Tendance du nombre de cas de TB: 2001-2005

100

105

110

115

120

125

130

135

140

145

2001 2002 2003 2004 2005

Années

Nom

bre

Nombre de cas

Incidence de la TB: 2001-2005

0

2

4

6

8

10

12

14

2001 2002 2003 2004 2005

Années

Inci

denc

e po

ur 1

00.0

00 h

abita

nts

Incidence résidents

Incidence globale

0

50

100

150

200

250

300

74 77 80 83 86 89 93 96 9920

0220

05

TREND OF NOTIFIED CASES YEAR 1974 -2006

YEARS

WHO Case notifications 1998-2005WHO Case notifications 1998-2005