1. Control of Tuberculosis in Australia Guy B. Marks Woolcock Institute of Medical Research Department of Respiratory Medicine, Liverpool Hospital

2. Outline Organisation of Care Descriptive Epidemiology –Roche P, Bastian I, Krause V, National Tuberculosis Advisory Committee, for Communicable Diseases Network Australia. Tuberculosis notifications in Australia, 2005. Commun Dis Intell. 2007;31:71-80. Outcomes of Treatment Program Priorities

3. TB control in Australia Under control of eight jurisdictions DOTS in most but not all jurisdictions Mostly public sector but private sector involvement in some activities Other State TB control activities –Contact tracing –Screening high risk groups National role –Data reporting –Screening intending migrants and visa applicants

4. Roche et al. Comm Dis Intell 2007; 31:71-80 Incidence of TB in Australia, 1960 - 2005 1072 cases, 5.3 / 100,000

5. Roche et al. Comm Dis Intell 2007; 31:71-80 Incidence in indigenous, non-indigenous Australian-born and overseas-born, Australia 1991 - 2005 27 cases 5.9 / 100,000 122 cases 0.8 / 100,00 923 cases 19.1 / 100,000

6. Roche et al. Comm Dis Intell 2007; 31:71-80 Incidence by country of birth, Australia, 2005

7. Roche et al. Comm Dis Intell 2007; 31:71-80 Age-Distribution by Birthplace, Australia, 2005

8. HIV co-infection No representative data HIV status report for 37% of notifications Nine (2.3%) of these were HIV +ve

9. Roche et al. Comm Dis Intell 2007; 31:71-80 Site of Disease Extra-pulmonary only Pulmonary only Pulm. + XP

10. Lumb et al. Comm Dis Intell 2007; 31:80-86 Multi-drug Resistance Rates Australia, 1995-2005

11. Roche et al. Comm Dis Intell 2007; 31:71-80 Outcomes of TB Cohort, Australia, 2004 11 deaths attributed to TB

12. Roche et al. Comm Dis Intell 2007; 31:71-80

13. Priorities Early detection –Awareness –Primary health care Effective treatment completion –Free treatment –DOTS Control of disease in high risk groups –Migrants –Contacts of infectious cases

14. Control of TB in Migrants Screening prior to migration or on application for change in visa status Treatment of active and some inactive disease Post-migration follow-up of migrants with evidence of past TB

15. Conclusions Australia is a low burden country Many visitors and migrants from high- burden countries TB control requires continued vigilance and active control measures