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. Tuberculosis notification rates in Hungary 2002
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
33.7
Budapest
24.8
38.7
39.1
28.4
Romania
119.9
14.5
33.3
14.7
24.5
16.3
21.4
Slovenia
22.0
29.3
Rate per 100,000 inhabitants
24.6
15.2
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 ( )
67%
65%
35%
Not representative!

8. Initial drug-resistance in 2002
Previously
Drug sensitivity test done
Resistant to any drugs
INH resistant
MDR INH+RMPresistant
Not treated
678
(70%) 87
(13%) 52
(8%) 13
(2%)
Treated
123
(54%) 31
(25%) 20
(16%) 8
(7%)
All cases
801
(68%)
118
(15%) 72
(9%) 21
(3%)

9. Case detection rate in Hungary, 2002%
Estimated real incidence
Total notification
3007
100
2684
Bact. confirmed
1254 37
1556 58
Bact. not confirmed
1762 63
1128 42
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. Notified afterwards 201 (49%) cases
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 Monitoring for Pulmonary Smear-Positive cases, 2001
New Retreated
n= n=136
Cured (32%) (21%)
Completed (14%) (10%)
Died
Failed
Defaulted
Still on treatment (18%) (18%)
Transferred out
Unknown

12. Treatment Outcome Monitoring for Pulmonary Culture Positive cases, 2001
New Retreated
n= n=185
Cured (37%) (30%)
Completed (16%) (13%)
Died
Failed
Defaulted
Still on treatment (15%) (13%)
Transferred out
Unknown

13. Initial treatment of pulmonary TB cases in 2002
Smear and culture positive cases
Only culture positive cases
Bacteriologically not confirmed cases
3 drugs
165
(25%)
175
(36%)
1240
(74%)
4 or more drugs
432
(67%)
200
(41%)
312
(19%)

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: (63%)
Culture negative: (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