Report of WS on Prevalence Survey in Beijing. Norio Yamada RIT/JATA

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1 Report of WS on Prevalence Survey in Beijing Norio Yamada RIT/JATA

2 Objectives of WS To review prevalence survey recently conducted and currently planed To review and discuss TB screening methods in prevalence survey

3 Agenda of WS 1) Review of Implemented and planned prevalence surveys and issues to be addressed in methodologies of prevalence surveys (Onozaki) 2) Experience of using digital CXR in prevalence survey in Viet Nam (Nhung) 3) Prevalence survey in Philippines (Vianzon) 4) Comments about TB bacteriologic examination in prevalence survey of Philippines (Kim) 5) Plan of prevalence survey in China (Hui) 6) Review of TB screening methods (Yamada)

4 CXR Digital X-ray system might reduce workload and time required for CXR screening Reading by un-experienced person might lead to workload burden to laboratory as well as missing shadows eligible for sputum examination.

5 Role of symptom screening It is necessary to analyze the existing data of prevalence survey to assess a role of symptom screening Detection of cases without shadow From a practical viewpoint, it might contribute to preventing missing CXR shadow in the field settings.

6 Cross-checking of CXR reading in the field It is experienced that simple mistake (missing shadow) occurred during busy field operations. Double check such as reviewing films in the evening of each day is recommended.

7 Laboratory Simple method of culture may be appropriate for samples from survey. Time between sputum collection and culture examination is critical. Preferably 3 days At latest 7 days Pauci-bacillary positive without shadow: needs of case definition

8 Comparison of Strategies (Assessing tuberculosis prevalence through population-based surveys. WHO)

9 Substantial Difference among strategies Strategy 3 v.s. Strategy-1,2,4 : Selection of individuals for sputum collection. Strategy-1,2,4, quality sputum may not be taken while theoretically there is no missed cases. Strategy-4 v.s. Strategy 2-3 : S(-)C(-) is missed because culture is given only to smear positive cases. The whole of picture of TB problem may not be assessed. Smear positive cases seem to decrease more rapidly than other type of pulmonary TB.

10 Quality sputum easily to obtain? Majority of participants have no cough or mild symptom: setting different from clinic. cough % No 57% Yes (<3wk) 36% Yes (>= 3wk) 7% (Cambodia Survey, 2002) Even in clinical settings, instruction might be necessary:..lower smear positivity in women than in men was mainly a function of poor-quality specimen submission. Smear positivity in women was increased substantially by provision of brief instructions. (MS Khan et al, Lancet 2007).

11 Smear is enough? A proportion of smear positive in prevalent cases Year Bac(+) Smear(+) S(+)/Bac(+) Cambodia % China % % Yangon, Myanmar % Philippines % % % Rep of Korea % % % %

12 Smear is enough? Previous surveys show a proportion of smear positive among bacteriologicallypositive cases is low and smear positive decrease most rapidly than S(-)C(+) and Bac(-) TB cases. If prevalence of only smear-positive TB are measured, the whole of TB situation is not observed.

13 General Recommendation of Screening TB screening by using both CXR and symptom is the most recommended currently taking into account the issues mentioned in the previous slides, difficulty of collecting quality sputum from all and workload of laboratory.

14 Age Group of Survey Population Considering technical difficulty and ethical aspect (majority of child has no tuberculosis which can be detected by survey), the current recommendation of excluding population aged under 15 is regarded appropriate.

15 Usefulness of survey Usefulness of prevalence survey measuring prevalence (primary objectives) obtaining more detailed information for understanding the situation of tuberculosis and tuberculosis control the situation of patients who have not yet been cared under NTP comparison of prevalence data with reported cases.

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