Childhood TB: experience of Kazakhstan, national policy and issues of the outpatient treatment

Transcription

1 Childhood TB: experience of Kazakhstan, national policy and issues of the outpatient treatment K.S. Serikbayeva National coordinator of childhood TB management Wolfheze, 2013

2 Republic of Kazakhstan Total area 2,72 mln. sq. km. Population 16.7 mln., including 4.2 mln children. (24.7%) and 0.8 mln. (4.8%) adolescents Average density of the population 6.1 persons per 1 sq. km.

3 Incidence trend (per 100,000 population) ,2 155,7 165,1 160,4 154,3 147,3 132,1 Annual decrease of TB incidence in children by 6.% 126,4 125, ,3 95,5 86,6 81, ,6 50,9 48,4 43,3 47,2 40,1 39,4 31,7 30, ,9 18,3 15,1 14, общая General заболеваемость incidence детская Incidence заболеваемость among children

4 Epidemiology of childhood TB in Kazakhstan The TB incidence rate in children decreased from in 1999 to 14.1 per 100,000 population in 2012, with the average annual decrease of 6.0%. The proportion of childhood TB among all notified TB cases in Kazakhstan in decreased from 9.6% to 4.2%. In 2012, 578 TB cases were notified including 29 cases of MD-TB. Pulmonary TB (45.8%): confirmed by microscopy 8.7% by culture 22.9% Extrapulmonary TB - 313(54.2%): TB meningitis decreased from 45 in 1999 to 2 in 2012.

5 MDR-TB incidence rate in children 3,5 3 2,5 2 1,5 1 Proportion удельный of вес children детей among среди НС МЛУ ТБ new MDR-TB cases MDR-TB incidence among children заболеваемость детей МЛУ ТБ 2,1 0,3 0,2 0,9 2, Proportion of MDR-TB decreased by 1.3 MDR-TB incidence increased by 2.3 1,1 1,1 3,1 2,6 2,1 0,9 1,6 0,7 1,2 1 0,8 0,6 0,4 0,5 0,8 0,

6 Vaccine prevention on TB in children BCG vaccine: in birth days (1-4) of life in 6-7 years

7 Problems related to the adverse reactions to BCG vaccination The number of vaccinated by Torlak BCG vaccine, Serbia, Montenegro The number of reported postvaccinal complications of BCG 0.59%) Lack of BCG vaccine from March 2005 to Microgene BCG vaccine 0.04% BCG vaccine, Japan 0.01% % in By the time BCG vaccine from Japan became available: - 99 (0.05%) children of those non-vaccinated at birth developed TB, of them 13(13.1%) died; (0.1%) children got infected with TB mycobacteria.

8 TB detection among children Tuberculosis was detected through (%) 30,3 5,2 Contact examination Manteaux test 2TU 64,5 Clinical and radiological manifestations

9 Number of TB and M/XDR TB in children, notified in Число МЛУ ТБ Число ТБ

10 MDR-TB diagnostics Standard examination by microscopy method and culture (on solid and liquid BACTEC media) prior to treatment initiation. Drug susceptibility testing to the first- and second-line drugs, as well as performance of the molecular-genetic tests (Hein-test, Xpert MTB/RIF). Identified contacts with a known MDR-TB patient within or outside the family. Availability of clinical and radiological data indicating active TB, the lack of effect from the standard therapy by HRZE is the reason to suspect MDR-TB. The MDR-TB council of physicians and the process of making decisions regarding chemotherapy with the second-line drugs by category IV.

11 Results of G-Xpert MTB/RIF G-Xpert MTB/RIF was introduced in August 2012 in 4 pilot projects. Of 110 examined children, TB was detected in 33(30%): - susceptible 23 (69.7%) - resistant to R 9 (27.3%) - indeterminate result-1 (3.0%)

12 Treatment of tuberculosis in children In Kazakhstan children under 30 kg of weight are treated with the combination TB drugs provided through the GDF grant and in accordance with the WHO recommendations of Since 2010, treatment has been provided by categories I and II due to a high level of resistance to Н. Streptomycin is being used for 2 months in cases of TB meningitis and category II treatment. Treatment with the second-line drugs in the country is standardized. The treatment regime is: 8CmLfxPtoCsPACZ(E) 12LfxPtoCsPAC

13 OUTPATIENT TREATMENT Decisions regarding the outpatient TB management are being made by the Council of physicians at the level of the National Centre for Tuberculosis Problems and the regional TB centers. Main indications: - newly detected localized and not complicated processes; - continuation phase of treatment with a satisfactory condition of a patient.

14 Effectiveness of treatment by the first- and second-line drugs Treatment outcomes in the cohort of 2011, first-line drugs Treatment outcomes in the cohort of 2010, second-line drugs, cat. IV Treatment success 87.4% Treatment failure 1.8% Died 0.9% Transferred out 0.9% Treatment default 0.2% Transferred to cat. IV 8.7% Treatment success 89% Treatment failure 1.1% Died 5.5% Transferred out 4.4% Treatment default 0

15 Conclusions The modern international recommendations on TB detection, diagnostics, treatment and prevention in children are introduced in the country. Drugs in pediatric doses are used for treatment and prevention of tuberculosis. The effectiveness of Diaskintest in detection of TB among children is being studied. The system of TB surveillance among children is in place. The outpatient model of childhood TB treatment is being introduced. The algorithm for monitoring TB detection, diagnostics, treatment and prevention among children is developed.