1. 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

2. INCIDENCE AND MORTALITY OF TB WORLDWIDE PER 100,000 INHABITANTS 200650 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

3. 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

4. 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

5. 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

6. 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

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

8. Trend Incidence Pulmonary TB 2001-2005

9. 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)

10. 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   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

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

12. Case notifications and sex ratio
Sex ratio: M/F
Age : 2/1
Age : 3/1
Age :4/1
Age : 2/1
Age >55 : 4/1

13. Pulmonary and Extra-pulmonary TB 2001-2005

14. Extra pulmonary TB

15. Trend of Incidence TB in districts 2001-2005

16. EVOLUTION INCIDENCE PER 100,000 INHABITANTS DISTRICT from 1993 AND 200517 14 13 12 23 40 20 13 4 9 4 13 5 08 6 13 14 10
Incidence per 100,000 inhabitants
Incidence per 100,000 inhabitants

17. DEATH RATE TB PER 100,000 INHABITANTS 1991 TO 2006

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

19. 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)

20. 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 )

21. DOTS monitoring & outcomes 1995-2005

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

23. 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%

24. Low death rate < 1/100,000 since 1998
Conclusion
Incidence TB stable /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

25. Thank You Merci

26. 9 Districts in Mauritius population 1.2 M

27. 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

28. Notified cases and incidence of Tb 2001-2006

29. TREND OF NOTIFIED CASES YEAR 1974 -2006
YEARS

30. WHO Case notifications 1998-2005