2. Magnitude of the problem Annually 8 million new cases 3 million deaths 95% from developing countries 19-43% of world population is infected Between 2000-2020 G. One billion will get infection 200 million get sick 35 million will die

4. Selected morbidity indicators Cholera 12 2005 Malaria 1059 2005 Poliomyelitis 0 2005 Measles 373 2005 Pulmonary tuberculosis 21922005 Diphtheria 72005 Tetanus 322005 Neonatal tetanus 222005 AIDS 63 2005 Meningococcal meningitis 182005

5. WHO REPORT 2007 GLOBAL TUBERCULOSIS CONTROL TB is still a major cause of death worldwide, but the global epidemic is on the threshold of decline 1. There were an estimated 8.8 million new TB cases in 2005, 7.4 million in Asia and sub-Saharan Africa. A total of 1.6 million people died of TB, including 195 000 patients infected with HIV.

6. TB prevalence and death rates have probably been falling globally for several years. In 2005, the TB incidence rate was stable or in decline in all six WHO regions, and had reached a peak worldwide. However, The total number of new TB cases was still rising slowly, because the case-load continued to grow in the African, Eastern Mediterranean and South-East Asia regions.

7. 3. More than 90 million TB patients were reported to WHO between 1980 and 2005. 26.5 million patients were notified by DOTS programmes between 1995 and 2005. 10.8 million new smear-positive cases were registered for treatment by DOTS programmes between 1994 and 2004.

8. A total of 199 countries/areas reported 5 million episodes of TB in 2005 (new patients and relapses). 2.3 million new pulmonary smear-positive patients were reported by DOTS programmes in 2005. and 2.1 million were registered for treatment in 2004.

9. Almost 60 per cent of TB cases worldwide are now detected, and out of those, the vast majority are cured. Over the past decade, 26 million patients have been placed on effective TB treatment thanks to the efforts of governments and a wide range of partners. But the disease still kills 4400 people every day."

11. Factors contributing to rise of TB occurrence HIV/AIDS 15% of deaths among AIDS patients due to TB. Poorly managed TB programs Wrong treatment regimen and inconsistent or partial treatment lead to multidrug resistant TB (MDR-TB). Movement of people Global trade, traveling and migration

12. Agent Mycobacterium tuberculosis complex M. Tuberculosis M. bovis M. africanum M. microti M. canetti

13. Tuberculosis Bacillus Tuberculosis Bacillus Bacillus is thin, somewhat curved, from 1 to 4 microns in length, with a complex cellular wall (lipid core) responsible for its characteristic coloration (acid-alcohol-resistant). Susceptible to sunlight, heat and dryness. Strictly parasitic and airborne; slow multiplier.

14. Reservoir Human Cattle

15. Modes of transmission 1-Air-borne droplet nuclei 1-5 μ m in diameter. remain airborne for long times. Factors determining the probability of infection No. of organisms expelled Conc. of organisms in air Length of exposure Immune status of exposed person

16. 2-Ingesion of raw milk & diary products. 3-Direct invasion through wounds

17. Immune System Response Bacteria invades lung tissue White cells surround the invaders and try to destroy them. Body builds a wall of cells and fibers around the bacteria to confine them, forming a small hard lump.

18. Bacteria cannot cause more damage as long as the confining walls remain unbroken. Most infected individuals never progress to active TB. Most remain latently-infected for life. Infection progresses and develops into active TB in less than 10% of the cases.

19. Incubation period: 4-12 weeks.

20. Diagnosis: No single test is diagnostic in all situations, but complementary techniques should be used to generate complete & rapid information. 1-tuberculin test to identify infection* 2-Acid fast bacilli smear 3-Culture MMR & X-ray Genotype (DNA fingerprinting)*

21. Tuberculin test 0.1ml intradermal. 48-72 hours false negative poor nutrition poor general health overwhelming acute illness Immunosuppression False positive BCG vaccination Other mycobacteria infection

22. Interpretation: On the basis of sensitivity, specificity and the prevalence of TB in different groups three cut points have been recommended for defining positive tuberculin reaction. 5mm. 10 mm. 15 mm.

23. Classification of tuberculosis Based on exposure history, infection & disease. Class 0: No history of exposure Negative tuberculin test (no infection) Class 1: History of exposure Negative tuberculin

24. Class 2: Positive tuberculin (latent infection) Negative X-ray Negative bacteriology & radiol. Class 3: Patients with clinically active TB Whose diagnostic procedures were completed (positive clinical, bacteriological or/and radiological of current TB).

25. Remain in this stage until treatment is completed Pulmonary Pleural Lymphatic Bone and/or joint Genitourinary Miliary Meningeal Peritonial Others

26. Class 4: -Not clinically active TB -Receiving treatment for latent infection -Completed previously prescribed -course of chemotherapy -Abnormal stable radiol. With negative bacteriology and positive tuberculin

27. Class 5: Tuberculosis suspect -Clinically active disease has not been ruled out. -Persons not adequately treated in the past. -Patient should not remain in this stage more than 3 months

28. Prevention and control Prevention: Case finding Vaccination Chemoprophylasis Environmental

29. Control: Reporting Isolation Concurrent disinfect ion Contact measures Treatment

30. Elements of the DOTS Strategy Political commitment Bacteriological diagnostic capacity Regular supply of medications and supplies Directly Observed Treatment Strategy Information system Registries