رئيس جمعية مكافحة التدرن والامراض الصدريه العراقيعةا

1. Trend in tuberculosis risk of infection in Iraq over 1952 - 2000 الدكتور (( ظافر سلمان هاشم )) رئيس جمعية مكافحة التدرن والامراض الصدريه العراقيعةا مؤتمر التدرن الوطنى السادس دى قار 24/3/2014

3. Trend Tuberculosis Risk of Infection in Iraq over 1952 - 2000 Tuberculosis is re emerge disease world wide now aday . TB is the leading Infectious killer of youth and adults . Athird of the world`s population is infected with the TB bacillus. Some one is infected with tuberculosis every second . About 9.2 million people became sick with TB . Last year.( 1 ) By using tuberculin test (T.T.) survey which is considered as the most appropriate method in determining the size of T.B problem in any community.

4. Also we can get an idea about the trend of the risk of infection and the risk of getting the disease in any country , by repeating this procedure with regular time interval. The annual risk tuberculosis infection (ARI) was used as the index of the size of the T.B. problem and it`s trend . because the infection is more prevalent than disease ,that it can be measured in children , areadily accessible population , and the survey costs are lower. ( M.A.BLEIKER & K.STUBLO. ( Bulet of IUATA Vol.. 53 No. 4 Dec. 1987) .

5. The specificity of the tuberculin skin test varies considerably but to poorly defined degree, depending on age , genetic factors & certain medical conditions , e.g. ( HIV infection ) . Further more climate geography & other factors play role such as environmental mycobacterium which vary from Location to Location .Also B.C.G Vaccination further complicates the inter pretation of test result . Four national wide ( T.T.) survey had been carried out since 1952 on ward using the first grade primary school pupils as a target group . The prevalence of TB infection was detected and also the estimation of annual risk of infection . ( ARI).

6. So the aim of our study is : 1. To estimate the ARI in our country . 2. Identified the trend of ARI since 1952 till 2000. . 3. To estimate the expected number of active pulmonary tuberculosis cases . ( P.T.B)

7. Material and Methods During November 2000 . A random sample of (33473) pupil of first grade primary school , was chosen , from 695 out of the total 8677 primary school distributed all over the country . Examination for the presence of BCG scar was carried out . Only those pupil whose BCG scar size of 0.5 cm & more were considered as positive BCG . <0.5cm >0.5 cm (33473) +ve BCG scar -ve BCG scar T.T. + ve - ve > 10 mm <10 mm

8. On the other hand . (T.T.) was carried out for those pupils with BCG scar negative using Standardized solution. ( 2T.U.RT23,Tween80 ). Measuring the indurations size were done three days later . This is done by skill & well trained personnel in order to avoid interobserver biases. Considering indurations size of (10 mm) & more as appositive reaction only . (Cut off point 10 mm& over )

9. Statistical analysis. Using number & % for negative and positive (T.T.) . The ARI was detected for the current screening as well as for the previous T.T. Screening by using certain equation that proposed by Styblo in addition the expected number of positive P.T.B cases per 100,000 population

10. Result & Discussion The last Two national T.T survey a mong primary school pupil in Iraq . 1995-2000

11. Tuberculin induration in mm of the T.T. reaction among first grade primary school pupils in Iraq (N.T.S. 2000-2001)

12. Cut-off point of T.T. induration among first grade primary school pupils according to governorrate in Iraq 2000-2001

13. Result & Discussion The last Two national T.T survey a mong primary school pupil in Iraq . 1995-2000

14. Fig. 2 : TB infection rate among first year primary school students according to geographical distribution in Iraq . . (1995) %

15. Cut-off point of T.T. induration among first grade primary school pupils according to governorrate in Iraq 1995

16. Fig. 2 :. Frequency of T.T. induration in mm among first grade primary school pupils. (1995)

18. Fig -1( Trend of ART I in Iraq Free 1952- 2000 )( N.T.S 2000 )

19. From the previous table & graph , we can notice that there was a sharp decline in TB infection rate from 18.5 , 10.5 to 1.34 during years 1952 , 1965, 1989, also ARI was declined during these years 3.31, 1.81 , 0.22 , Un fortunately after the years 1990 we can notice that there was an increase in TB infection rate as well as ARI in which 1995 the TB infection rate 1.7 increase to 2.3 in 2000 also, ARI was increase from 0.22 to 0.28 , 0.34 during the years 1989 , 1995 , 2000 so there is steadily in crease in ARI ,most probably attributed to the current situation of Iraq .

20. The five national T.T. survey With inf.rate ,A.R.I Estimated No. of P.T.B Positive cases

21. It is apparent that the rate of transmission of tubercle bacilli is dependent on the number of sources of infection in a society . The number of successful transmissions from infectious cases to susceptible individuals over a defined period of time ( usually one year ) at a certain calendar time determines the risk of infection in the community during that period it was estimated that ( 1 % ) risk of infection corresponds to approximately 50 incident infectious cases . ( Styblo Epidemiology of tuberculosis . Edition 2 . The Hague: Royal Netherlands Tuberculosis Association, 1991 .)

22. Interestingly we detected that there is0.06% increase annually in the risk of infection . When we compare our result with that of Egypt, in which they found a steadily decrease in ARTI in period ( 1950 - 1995) .

23. Trend of ARI in Egypt

24. Active PTB cases notified by NTP / 100,000 Pop.

25. Regarding expected rate of positive P.T.B case estimated according to ARI & to the number of case notified by N.T.P. during 1989, 1995, 2000 and 2001 . This could be attributed to the following points . Firstly the estimation of fifty positive P.T.B. cases to each ( ARTI) is just agreement which may have some limitation of methodology . Secondly there is a limitation of T .T . Survey due to high B.C.G coverage .

26. Thirdly as a result of the current economical situation due to the long standing embargo ,and recurrent wars that lead to an increase in the break down of the actives TB cases from an infected cases . Fourthly in addition the over reporting and recording cases in non DOTS areas.

27. Conclusion It is clear our current study, the risk of tuberculosis infection in Iraq is increase steadily during the last ten years in spite of it’s sharply declined before 1990, (1952-1989). This will confirm the impact of the recurrent war embargo population displacement on the epidemiology of T.B. in Iraq.

28. Recommendation 1. Improvement of health sector & socio economic of all Iraqi population . 2. Continuity & promotion of B.C.G vaccine to new born babies. 3. Political commitment & Support DOTS strategy to ensure high case detection & cure rate and strong surveillance system. 4. National Tuberculin survey should be repeated every 5 years in order to confirm the trend & evaluate TB. Control efforts in Iraq.

29. 5. Mass screening program by using radiological examination as well as sputum laboratory tests is recommended in order to confirm the above results . Un fortunately this program can not be carried out now day because it is coasty and need long time and HR, OR we can repeat the national capture recapture survey.

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