Dr R.Reesaul Chest Physician Chest Clinic P. D`or Hospital 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

INCIDENCE AND MORTALITY OF TB WORLDWIDE PER 100,000 INHABITANTS 2006 50 12 43 8 30 6 190 125 1M 25 3M 72 350 2M 122 100 2M 22 90 45 97 10 1/3 of world population infected 10 M new cases yearly 3 M cases of death yearly

Low incidence in a High risk region INCIDENCE AND RATE OF TB IN THE INDIAN OCEAN PER 100,000 INHABITANTS in 2006 75 125 1M 115 1M 2M 44 8000 350 2M 25 20 2M 17 120 97 40,000 Low incidence in a High risk region 10 115 9 75

Tuberculosis 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

ORGANIZATION AND SET UP OF TB IN MAURITIUS Statistics, notifications… M.O.H In -patients 30 Beds TB AIDS Unit CHEST Clinic 5 Out- patients in Regional Hospitals W.H.O Africa Administration Procurement, Tenders Statistics, notifications… Specialized National Laboratory For TB detection Home Visits Specialized Nurses DOTS, Drugs Counselling Specialized Pharmacy Anti-TB Drugs BCG Screening Contacts Migrant workers Prisoners Homes High risks

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 20 14 17 13 16 12 11 Notified Cases 269 223 199 198 195 183 131 163 122 159 120 116 121 111 113   1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 15 10 141 165 153 146 123 140 174 160 119 139 137 127 115

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

Trend Incidence Pulmonary TB 2001-2005

WHO Notification of TB 2002-2006 Year 2002 2003 2004 2005 2006 2007 New ss + P 86 99 117 110 85 New ss - P 28 16 3 4 11 New E.P 23 17 13 8 15 Relapse 2 Failure 1 Defaulter Total 139 137 127 115 (99) MDR (1) TB +HIV 5 (6) Total HIV/AIDS 458 698 1124 1822 2631 (3173)

INCIDENCE / among Migrant workers YEARS TOTAL TB NOTIFIED New TOTAL PULMONARY EXTRA PULMONARY ZN (+) ZN (-) INCIDENCE Migrant workers INCIDENCE ZN (+) TOTALTB 2007 2006 2005 2004 2003 (97) 115 127 139 137 96 114 120 15 08 13 17 85 11011799  11 04 03 16  9.5 10 11.2 10.8  (15) 5 16 12 7.5  2002 124 23  86 28  11.8  10.6  7.9  2001 119 113 6  83 5  9.7  9.4  8.7  2000 160 142 18 92 31 13.9 12.3 8.0 1999 174 161 112 32 15.2 14.1 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 98 10.5 2 8.9 1995 146 134 108 13.4 12.0 4 9.9 1994 153 26 14.9 13.0 3 10.7 1993 165 148 130 15.6 12.2 1992 141 10.8 1991 138 13.6 13.3 10.4 1990 10.0

Few cases <14 , protection BCG vaccin ? Age group and TB 2001-2005 Few cases <14 , protection BCG vaccin ? Max cases age 25-44

Case 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

Extra pulmonary TB 2001-2005

Trend of Incidence TB in districts 2001-2005

EVOLUTION INCIDENCE PER 100,000 INHABITANTS DISTRICT from 1993 AND 2005 17 14 13 12 23 40 20 13 4 9 4 13 5 08 6 13 14 10 Incidence 1993 - 15.6 per 100,000 inhabitants Incidence 2005 - 11 per 100,000 inhabitants

DEATH RATE TB PER 100,000 INHABITANTS 1991 TO 2006

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

CO-INFECTION TB / HIV-AIDS Total Cases of HIV/AIDS YEARS Total Cases of HIV/AIDS Cases TB / HIV 1999 230 1 2000 287 2001 356 2002 458 2003 698 2004 2005 2006 2007 1124 1822 2631 (3173) 2 5 (6)

DOTS 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 major second line drugs )

DOTS monitoring & outcomes 1995-2005

MDR TB 2001-2006 Years Resistance INAH & RIF 2001 2002 2003 2004 1 2005 o 2006 2007 2 (1)

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%

Low death rate < 1/100,000 since 1998 Conclusion 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 You Merci

9 Districts in Mauritius population 1.2 M

Tuberculosis 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

Notified cases and incidence of Tb 2001-2006

TREND OF NOTIFIED CASES YEAR 1974 -2006 YEARS

WHO Case notifications 1998-2005