TB notification in Hong Kong Year Notification rate per 100,000 Rate of decline 1951 689 1961 397 5.4% 1971 223 5.6% 1981 149 4.0% 1991 109 3.1% 2002 97

Estimates on TB incidence and prevalence No prevalence surveys Indirect estimates only Incidence rate about 140/100,000 and 120/100,000 for year 1999 and 2002 assuming 80% cases detected Prevalence rate: ?240/100,000 if each case of bacillary TB last for two years (??over-estimate)

Case detection rate DOTS case detection rate: 56% (1999) and 51% (2002) (WHO figures) Proportion of TB patients seeking medical care from private sector unknown Average age SS +ve over 50 More and more reactivation case Difficult to separate out effect of aging

The way forward ? Examine the relative importance of endogenous reactivation and recent transmission as a cause of disease ? Enhanced communication with private doctors for better case detection and tracking of treatment outcome ? Cohort studies/ ? Prevalence surveys of disease and infection