1. Epidemiology of Tuberculosis in Hong Kong
Dr Chan Chi-kuen, Alan
Senior Medical Officer
TB & Chest Service, Department of Health
Hong Kong Special Administrative Region

2. Location and population of Hong Kong
Situated in south of China
land area 1,098 square kilometers
population of 6,782,100 at mid-2000
population density of ~6,500 /sq.Km
proportion aged 65 and over: 8% in 1989 and 10.9% in 2000

3. Location and population of Hong Kong
Highly mobile population
people from 170 countries visit Hong Kong visa free
passenger traffic: million in 1998 and 129 million in 1999
increase mainly due to heavy cross-boundary traffic on land after return of Hong Kong’s sovereignty to China in 1997

4. General Background (1) (Year 2000)
Mid-year
Male
Female
GDP per capita : US$24,403*
Annual population growth rate : 0.9%
Life expectancy at birth
- Male : 77.0 years
- Female : 82.2 years
Infant mortality rate : 2.9
(per registered live births)
% population with access to safe water : 99.9%†
Literacy rate : 92.4%
(percentage of population aged 15 and over who have attained primary education or above)
Notes : * Figure is subject to revision later on.
† Figure for year 1999
Population (in thousands)

5. Population pyramids 2001 (mid-year) 1971 (mid-year) Male Female Male
85+
80-84
85+
80-84
Population (in thousands)
Population (in thousands)

6. General health services (1) Health infrastructure (As at end 2000)
Notes : * The figure refers to Hospital Authority hospitals.
† The figure covers the institutions licensed under the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (Cap. 165).
‡ The figure covers the clinics and maternity homes under the Department of Health and the clinics in the correctional institutions.
§ The figure covers the GOP clinics with A&E service and maternity homes of the Department of Health and the hospitals in the correctional institutions.

7. Latest TB indicators (2001)
No of new cases (all types) and rate
6,556 (97.5/100,000)
No new smear positive and rate
1,857 (27.6/100,000)
% smear positive out of total new cases
28.3%
% retreatment cases out of total new
plus retreatment
9.7%
% population with access to DOTS
Near 100%
DOTS cure rate (new bact. positive cases)
67.9%
DOTS success rate (new bact. positive cases)
76.8%
DOTS case detection rates
51%(WHO estimation)

12. No. of TB cases (2002)

13. TB rate per 100,000 (2002)

16. General Background (2) 5 Leading Causes of Hospitalisation (1999)
5 Leading Cause of Mortality (1999)
Male & Female combined
Male
Female
Heart disease and stroke
Malignant neoplasm
Malignant neoplasms
Heart diseases, including hypertensive heart disease
Unintentional injury
Cerebrovascular disease
Direct obstetric causes
Pneumonia, all forms
COPD and asthma
Injury and poisoning
Note: hospitalization figures include data from private and public hospitals
Source: Department of Health, Annual Report 1999/2000

17. Treatment outcomes (percents)
1998
1999
2000
2001
2002
Cured
71.8%
70.4%
64.8%
67.0% -
Completed
7.8%
7.3%
8.0%
8.7%
Defaulted
4.6%
4.7%
6.1%
4.5%
Failed
6.9%
7.9%
9.2%
8.1%
Died
4.2%
5.5%
3.9%
5.4%
Transferred out
2.8%
Non evaluated
3.5%

18. HIV Prevalence (2002) No. of samples/ type of sample
No. of samples tested anti-HIV +
Prevalence (%)
Blood donors
42,292 (blood) 1
0.002
Clients attending Social Hygiene Services
53,363 (blood) 41
0.077
Drug users attending methadone clinic (UAS)
4,037 (urine) 10
0.248
Drug users attending methadone clinic
(voluntary blood testing)
318 (blood)

19. HIV Prevalence (2002) No. of samples/ type of sample
No. of samples tested anti-HIV +
Prevalence (%)
Patients attending chest clinic (UAS)
866 (urine) 8
0.924
Patients attending chest clinics (voluntary blood testing)
3,186 (blood) 7
0.22
Antenatal women
41,932 (blood)
0.02%

20. UAS for HIV in TB & Chest Service (1990 to 2001)
Period
Category
Sample
No. Tested
(No. +ve)
Outpatient
Blood
1548
Inpatient
485 –
1469
(2) –
1173
Sep 95 – Nov 95
Urine
895
Sep 96 – Dec 96
998
(4)
Oct 97 – Jan 98
1003
Oct 98 – Jan 99
833
Sep 99 – Dec 99
1166
(8)
Sep 00 – Dec 00
1018
(5)
Oct 01 – Dec 01
1071

21. Information system National Reference Lab (since 1998)
Data flow
National Reference Lab (since 1998)
PATIENT WITH TUBERCULOSIS
Data for cross-matching
Department
of Health
General out-
patient
clinics
Hospital
Authority
Accident
and
Emergency
Departments
Department of Health Chest Clinic (Case notification) & (Follow up)
PRIMARY
LEVEL
Private
Practitioner
Death certificates (since 1999)
Please use the sample flowchart provided, or modify it in accordance to your information system, to explain the process of TB surveillance as follows:
What data are collected
Where are data collected: at what level and by whom
Where do data go—which levels
Where are data compiled for reporting
Who reports and to where
How is treatment evaluated, e.g. cohort analysis
Hospital Authority
Chest Hospitals
Hospital
Authority
Specialist
Out-patient
Clinics
Private
Hospitals
SECONDARY
LEVEL
Hospital
Authority
General

22. Sample of TB
Notification
Form (used
since 1995)

24. Using information from death certificate
The percentages of notified cases traced back by using TB lab. data and death cert. information
Year
Using TB lab.data
Using information from death certificate
1998
13.06% -
1999
10.34%
12.68%
2000
7.92%
12.96%
2001
5.14%
7.32%
2002
4.84%
6.31%
2003
4.47%
5.67%
Overall
7.55%
8.85%

25. Sample of TB Denotification Form (Since 1999)

26. No. of notifications and de-notifications by year
No. of de-notifications
1998
7,673 38
1999
7,512 77
2000
7,578 87
2001
7,262
228
2002
6,602
274

27. CONTROL OF TUBERCULOSIS IN HONG KONG Strategies
- Case finding: passive vs active
- Effective chemotherapy: DOTS
- Treatment of latent TB infection (preventive treatment or chemoprophylaxis)
- BCG vaccination
- (Health education) 23