Cheng shiming National TB Center in China May,3, 2004 Surveillance information and prevalence survey of tuberculosis in China Cheng shiming National TB Center in China May,3, 2004

Latest TB indicators (year:2002) Case type No. Registration rate(1/100,000) % New SS+ 194972 15.06 46.5 New SS- 185840 14.35 44.4 New cases without sputum 38041 2.94 9.1 Total 418853 32.35 100 Population of 2002: 1,294,867,000

Latest TB indicators (year:2002) % re-treatment cases out of total new plus re-treatment 16.7% % population with access to DOTS 77.6% DOTS cure rate New SS+ 94.0% Re-treatment SS+ 88.2% DOTS success rate 96.1% 93.1% DOTS case detection rates 27%

Trends in notification

Provincial data (year:2002) (1) Rate(1/100,000)

Provincial data (year:2002) (2) Rate(1/100,000)

Treatment outcomes of new SS+ case (%) 1998 1999 2000 2001 2002 Cured 94.9 95.7 95.2 95.0 92.8 Completed 0.6 0.5 2.7 Defaulted 1.1 0.9 Failed 0.4 Died 0.8 Transferred out 0.7 Non evaluated 1.7 1.2

Mortality Year Sample size No. of total death No. died of PTB PTB mortality rate(1/100,000) 1984/85 1175427 6591 342 31.0 1990 1538963 7913 294 19.1 2000 420036 2309 37 8.8 TB ranked the ninth of various causes of death in 2000. Data source: nationwide TB epidemic survey

Overall assessment of national information system Country coverage: 100% counties/districts Quality of data, timeliness of reporting: Key information of the reports from 90% county level implementation units were acceptable after confirming Delay of some counties’ reports Variability of indicators between provinces: Significant differences on key indicators in provinces Problems identified: need to be improved on Report: more complete, timely and accurate data Utilization: more analysis and feedback

Prevalence surveys in 2000 (1) Sample size: 365,097 Screening procedures: Suspects examination: Children had an induration ≥10mm of PPD test; Adult with ≥ 3 weeks cough and/or abnormal fluorograph Diagnosis of PTB among suspects: chest X-ray, sputum smear and culture Detected smear positive cases per 100,000: 122 Detected all cases per 100,000: 367 % smear positive: 33.3% % known cases among smear positive: 41.4%

Prevalence surveys in 2000 (2) Difficulties encountered: Insufficient funds: only 8 provinces got provinical prevalence Increased floating population:the investigation rate based on the sampling population was 84.7% Lessons learned: Implementation: 1) Joint work at central and local level; 2) Support from WHO Results: More evidences found in the survey for evaluation the past NTP Correction to the estimated case detection rate: Supplemental support evidence for the estimation

Tuberculosis infection rate (%) Year 0-14 group 7 group 14 group 1979 8.8 7.2 17.9 1984/85 9.6 7.8 20.7 1990 7.5 6.6 13.4 2000 9.0 12.4

Annual Risk of Infection (ARI) Year ARI (%) 1990 0.80 2000 0.72 Data source: Nationwide TB epidemiological sample survey in 1990 and 2000, respectively

Estimation of incidence rate Estimated rate of smear positive new cases from ARI (in 2000): 0.72×50=36/100,000 (Styblo model) Estimated case detection rate (in 2002): 15.06/36×100%=42% Problems encountered: Only 24% of Children have no BCG inoculation history and scar, so the result from infection isn’t fully representative of China.