TB epidemiology in Thailand Philippe Glaziou, on behalf of the epi team Bangkok, August 2013

TB in Thailand: key figures (2012) 80,000 new cases 11,000 TB deaths Thailand among 22 countries with highest TB incidence

TB epidemiology: case notification rate All forms Smear pos

Inconsistent trends by province

Under-reporting of childhood TB (2010) Under-reporting of childhood TB estimated at 45% of diagnosed cases min(U c ) = 1 – (1 – U t ).(1 – U b ) U c = under-reporting childhood U t = overall under-reporting (prevalence survey) U b = BTB under-reporting of BoE cases

Treatment success 85% global Treatment success target

At risk populations: health workers Saraburi hospital: n=1800 health workers average incidence = 206/100,000 person-year Relative Risk ≈ 1.4

At risk populations PopulationTB risk ratio HIV-infected17 (vs HIV-negative) Elderly3.6 (vs yr old) Immigrants>2 (vs Thai) Other: - diabetics - smokers - health workers?

TB mortality (excluding HIV) Raw data from VR Adjusted for incomplete coverage and ill-defined causes

Determinants of TB: economic growth 1997 financial crisis

Determinants of TB: health system performance (U5MR) 13/1000

Good performance of Thailand relative to country income group

Determinants of TB: HIV in yr old population Source: UNAIDS 2013

HIV prevalence in TB Source: BTB surveillance

Determinants of TB: rapid aging of the population Population estimates from UN Pop Division, 2013

Population aging slows down the decline in TB

TB incidence estimated in slow decline -3.4%/year

Impact of TB control? Cured 525,000 cases since 2000 (79% of 665,000) Prevented the emergence of MDR-TB – 2006: 1.65% (new), 34.5% (retx), 6.4% (combined) – 2013: 1.89% (new), 16.6% (retx), 3.4% (combined) Decline in TB incidence and mortality multifactorial – Economic growth, UCS, decline in HIV, TB control,…

Global targets MDG target 6c met (incidence reverted) Thailand on track to meeting 50% reduction targets for prevalence and mortality (2015) But … The burden of TB in Thailand is still high and requires a prioritized public health response

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