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Success and failure in TB surveillance in Hungary

Success and failure in TB surveillance in Hungary. Dr. J. Mester, Dr. I . Vadász , Dr. D. Kozma Korányi Natl. Inst. TB and Pulmonology, Budapest, Hungary Tuberculosis Surveillance Centre. New TB cases in Hungary (1950-2001). Trend of TB incidence in Hungary. Czech Republic 15.9.

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Success and failure in TB surveillance in Hungary

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  1. Success and failure in TB surveillance in Hungary Dr. J. Mester, Dr. I. Vadász, Dr. D. Kozma Korányi Natl. Inst. TB and Pulmonology, Budapest, Hungary Tuberculosis Surveillance Centre

  2. New TB cases in Hungary (1950-2001)

  3. Trend of TB incidence in Hungary

  4. Czech Republic 15.9 Tuberculosis notification rates in Hungary 2002 Slovakia 22.6 Ukraine 64.9 30.4 43.4 24.9 Austria 14.7 27.9 Budapest 33.7 24.8 38.7 39.1 Romania 119.9 28.4 14.5 33.3 14.7 24.5 16.3 21.4 Slovenia 22.0 29.3 Rate per 100,000 inhabitants 15.2 24.6 22.4 < 20 19.9 20-25 Yugoslavia 28.4 Croatia 39.5 25-35 35-45 > 45

  5. TB incidence by age groups and sex in Hungary, 2002

  6. Risk factors of new TB cases, 2002

  7. Proportion of DST (1999-2001) 67% 65% 35% Not representative!

  8. Initial drug-resistance in 2002

  9. Case detection rate in Hungary, 2002 • Case detection rate of bact. conf. cases: 80% • Bact. not confirmed cases: 63% (1762) • 36% of them is overdiagnosed (643) • Real incidence of bact. not confirmed cases: 41% (1128)

  10. Drug sensitivity tests done in 1197 cases • Of them 413 (34%) were not notified by the National TB Surveillance Center (NTSC) • Notified afterwards 201 (49%) cases • No information about 212 (17%) cases

  11. Treatment Outcome Monitoringfor Pulmonary Smear-Positive cases, 2001 New Retreated n=584 n=136 Cured 188 (32%) 29(21%) Completed 83 (14%) 14(10%) Died 96 22 Failed 66 33 Defaulted 38 8 Still on treatment 106 (18%) 25(18%) Transferred out 0 0 Unknown6 5

  12. Treatment Outcome Monitoringfor Pulmonary Culture Positive cases, 2001 New Retreated n=810 n=185 Cured 299 (37%) 54 (30%) Completed 135 (16%) 24 (13%) Died 113 24 Failed 77 43 Defaulted 56 11 Still on treatment 125 (15%) 25 (13%) Transferred out 0 0 Unknown 5 4

  13. Initial treatment of pulmonary TB cases in 2002

  14. Outstanding analytical problems High proportion of bacteriologically not confirmed cases (~60%) Possible reasons: • Overdiagnosis/misdiagnosis of TB • Deficiency in bacteriologic diagnosis

  15. Outstanding analytical problems 1. Békés county: • Proportion of bacteriologically not confirmed cases was 80% • After individual supervision of cases, 36% of them proved overdiagnosed („inactive” TB) or misdiagnosed (i.e. cancer)

  16. Outstanding analytical problems 2. Number of notified cases in 2002: 3007 Bact. not confirmed: 1882 (63%) • Culture negative: 1329 (70%) • Culture not done: 553 (30%) • Unsatisfactory communication among TB labs-hospitals-chest clinincs  bact. results sometimes disappear • Modification of flow of informationTB labs will inform the NTSC • NTSC conveys the results to the proper institution

  17. Conclusion • To improve the quality of TB control it is necessary • To increase the proportion of bacteriologically confirmed cases • To diminish the proportion of previously treated cases • To increase the proportion of initial drug sensitivity tests • To adjust the treatment to national and international guidelines • To modify information flow

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