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Tuberculosis in England & Wales. Delane Shingadia Senior Lecturer in Paediatric Infectious Diseases Barts and The London. WHO High Prevalence Countries Notifications >40/100 000 population. South Africa. Russia. Brazil. China. TB notification rates per 100,000 population, Europe, 2002.
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Tuberculosis in England & Wales Delane Shingadia Senior Lecturer in Paediatric Infectious Diseases Barts and The London
WHO High Prevalence CountriesNotifications >40/100 000 population
South Africa Russia Brazil China
TB notification rates per 100,000 population, Europe, 2002 EuroTB
Rate of tuberculosis per 100,000 population in England (excl. London), London & All England, 1988-1998
Tuberculosis notification rates, England and Wales, 1982-2001 Sources: Tuberculosis notifications (PHLS/CDSC-NOIDS), population figures (ONS estimates)
Tuberculosis case reports and rates by age group and sex, England, Wales and Northern Ireland, 2002 Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year population estimates
Tuberculosis rates by place of birth (born in the UK vs. born abroad), England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates
Tuberculosis rates by age group, England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year population estimates
Tuberculosis rates in persons born in the UK by age group, England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates
Tuberculosis rates in persons born abroad by age group, England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates
Tuberculosis case reports by ethnic group (%), England and Wales, 1999 - 2002 Source: Enhanced Tuberculosis Surveillance
Tuberculosis case report rates (per 100 000 population), by geographic origin and ethnic group, England and Wales, 1998-2000 England and Wales = 11.2 Sources: Tuberculosis case reports (1998: National TB survey, 1999, 2000: Enhanced TB surveillance), Population figures: (ONS-Labour force survey)
Annual notifications of paediatric TB 1982-00 by age group and proportion of all cases in London
Paediatric TB by ethnic groupEnhanced surveillance data 2000
Rate of paediatric TB notifications 0-14yr olds in 2000 by London borough
Reasons for Increase in TB • Immigration/Travel • Breakdown in TB control • HIV infection • Multi-drug resistant TB • Poverty • Overcrowding • Incomplete treatment
Why are rates of TB in children increasing? • Parallel increase with overall rates • Continued transmission of TB within population • Poverty and overcrowding • Multidrug resistant TB • ? HIV infection
Natural History of TB in Children No signs/symptoms, negative tuberculin skin test Exposure Exposure Months to years No signs/symptoms but positive tuberculin skin test Infection Signs/symptoms or radiographic evidence of TB Disease
Outcome of Primary Complex • Resolution in the majority of children • Lymphadenopathy with bronchial compression • Caseation with progressive liquefaction and pleural/pericardial involvement • Haematogenous spread to lungs (miliary) and extrapulmonary sites (CNS, bone/joint, renal)
Post-primary Tuberculosis • Adult-type reactivation disease • Usually follows infection >7 years age • Cavitation and smear positive sputum
Why are childhood TB cases important? • Children are more likely to develop progressive primary disease rather than reactivation (adult-type) disease • Children may develop disease more rapidly • Children are more likely to have extra-pulmonary disease and are usually not infectious • Childhood TB cases represent a sentinel event in a community suggesting recent transmission, usually from an infectious adult
And now Has it changed?