Epidemiology of Tuberculosis
BY
DR. FARYAL SHAIKH
MBBS,MPH
SENIOR LECTURER, FRPMC
Learning Objectives :
By the end of session, students will be able to:
Delineate epidemiological determinants of
Tuberculosis (TB)
Discuss epidemiology of Tuberculosis globally and
locally
Describe key objectives of National program for TB
control and prevention
Discuss the WHO Global TB Strategies
Tuberculosis :
Myocobacterium Tuberculosis
It affects primarily lungs
Also affect
- Intestine
- Meninges
- Bones & Joint
-Lymph gland, skin & other tissues
TB is curable and preventable
Epidemiological Determinants of TB:
Agent :
Source of infection:
- Human case whose sputum is positive for tubercle bacilli
- Bovine source
Host Factors :
- Age: Affects all ages. Sharp rise in infection rates from
childhood to adolescence
- Sex: More prevalent in males than in females
- Immunity :
Mode of Transmission :
TB is transmitted mainly by droplet infection
and droplet nuclei
Incubation Period : 3 to 6 weeks
Tuberculosis- Epidemiology
TB is the 13th leading cause of death and the second leading
infectious killer globally
In 2021, an estimated 10.6 million people fell ill with TB worldwide.
- Six million men, 3.4 million women and 1.2 million children
Multidrug- resistance TB ( MDR-TB) remains a public health crisis
and health security threat
An estimated 66 million lives were saved through TB diagnosis
and treatment between 2000 and 2020
Ending the TB epidemic by 2030 is among the health targets of UN
SDGs
Ref: World Health
Organization
Situation Analysis of TB in Pakistan :
Pakistan ranks 5th amongst the high burden countries
in the world.
The prevalence and mortality per 100,000 population
per year from TB in Pakistan are 348, 276 and 34
respectively.
Control of Tuberculosis (TB):
The control measures consists of :
Curative component
- Case finding
- Intensified TB Case finding :
- Case-finding Tools :
(a) Sputum examination (b) Ziehl-Neelsen acid-fast stain
(c) Fluorescence microscopy (d) Radiography (e) Sputum culture
(f) Genotypic methods : 1) PCR 2) NAAT 3) GeneXpert MTB/RIF
(g) Skin sensitivity test: 1) Tuberculin test 2) Mantoux test
- Treatment
Preventive component
- BCG vaccination
A New Tool to Diagnose Tuberculosis: The Xpert
MTB/RIF Assay
The Xpert MTB/RIF assay is a new test that is revolutionizing
tuberculosis (TB) control by contributing to the rapid diagnosis of TB
disease and drug resistance.
Advantages of The Xpert MTB/RIF Assay:
Results are available quickly
Minimal technical training is required to run the test.
Ref CDC
National Tuberculosis Control Program (NTP)
NTP revived under Ministry of Health subsequent to
declaration of TB as national emergency in Pakistan in
2001 and is currently working along with National Institutes
of Health, Pakistan
Vision:
Universal access to quality TB care and achieving Zero TB
death
Goal :
TB free Pakistan by reducing 50 % prevalence of TB in
general population by 2025
Key Objectives of NTP :
To increase the number of notified TB cases and
maintaining the treatment success rate at 91%
To reduce the prevalence of MDR-TB by atleast 5% per
year by 2020
Strengthen programmatic and operational
management capacity of TB Control program while
enhancing public sector support by 2020
WHO Global TB Strategies :
The DOTS Strategy (1994)
The STOP TB Strategy (2006)
The END TB Strategy (2015)
The DOTS Strategy :
To ensure cure by providing the most effective medicine
and confirming that it is taken
Components of DOTS strategy:
1. Government commitment
2. Case detection through passive case finding
3. Standardized short-course chemotherapy to atleast all
confirmed sputum smear positive cases of TB
4. Establishment of system for regular drug supply of all
essential anti-TB drugs
5. Maintenance of a monitoring system for program
supervision and evaluation
The Stop TB Strategy :
Objectives:
1. Universal access to high quality care for TB
2. Protect vulnerable population
3. Support new tools
Goal :
To reduce global burden of TB by 2015
Components of Stop TB Strategy :
Pursue high quality DOTS expansion and
enhancement
Address TB/HIV,MDR-TB and other challenges
Contribute to health system strengthening
Engage all care providers
Empower people with TB and communities
Enable and promote research
The END TB Strategy (2016-2035):
Vision: A world free of TB-zero deaths ;disease and
suffering
due to TB
Goal : To end the global TB epidemic
The END TB Strategy (2016-2035):
To facilitate the adoption of the End TB Strategy, a
framework of three pillars was established:
1) integrated, patient-centered care and prevention
2) bold policies and supportive systems
3) intensified research and innovation
References :
Park’s Textbook of Preventive and Social Medicine 25th edition
World Health Organization
National Tuberculosis Control Program- National Institutes of
Health
Available at : of https://www.nih.org.pk/national-tb-control-
program
Thank you
