Further explorations of surveillance data: case detection (all cases vs. bacteriologically confirmed, All strategies) Good afternoon. I will give a brief overview (Next slide) Chris Dye and Jerod Scholten Tuberculosis Control World Health Organization

Why is acid fast bacilli smear an important tool for a TB programme? Allows quick identification of TB cases Inexpensive and low tech Identifies potentially infectious cases Permits a programme to identify and treat patients who can infect others Disadvantage: the AFB smear cannot distinguish non-TB from TB mycobacterium

New, pulmonary, smear-positive TB case detection rates*, 2001** SS+ detection rates (%) < 50 51-69 ≥ 70 * Notified/estimated ** 2000 data for KRG and UKR

Should we use culture in Europe as an indicator of case detection? Culture is the gold standard of TB confirmation Permits identification of mycobacterium species and drug susceptibility (as well as DNA fingerprinting) Not all pulmonary patients who are culture positive will be smear positive Do we miss more infectious patients by focusing on culture? Disadvantages: higher costs, higher tech, slow growing Should this be used selectively in developing countries? Universally in wealthy countries?

Reported laboratory confirmation of new pulmonary TB cases, 2001 Proportion of smear and/or culture confirmed new pulmonary cases < 50% 50-64% ≥ 65% Unknown