Ibrahim Abubakar, MBBS, MSc, PhD, FFPH

Transcription

1 Ibrahim Abubakar, MBBS, MSc, PhD, FFPH Head of Section / Consultant Epidemiologist Tuberculosis Section HPA Centre for Infections Colindale London UK

2 Outline TB epidemiological situation UK data collection system Challenges in TB data reporting (EuroTB to ECDC) ETS Treatment outcome monitoring

3 TB in the UK Notification rate per 100,000 population Housing and hygiene Chemotherapy BCG Pasteurisation Short course therapy Death rate per 100,000 population Year

4 Epidemiology Tuberculosis rates, England & Wales, Rate (per 100,000)) London England and Wales excluding London Year 9 Place of birth and time since entry, UK, Percentage of cases UK Born Non-UK Born <2 years 2 years Proportion of cases (%) XDR 8 cases from 1995 to 2008* Place of birth Time since entry into the UK to TB diagnosis Year Isoniazid resistant M ulti-drug resistant Resistant to any first line drug Sources: Statutory notifications of infectious diseases (NOIDs) , Enhanced Tuberculosis Surveillance , Office for National Statistics mid-year population estimates, Enhanced Surveillance of Mycobacterial Infections * Abubakar et al Thorax 2009, Kruijshaar et al BMJ 2008, Abubakar et al Epidemiology and Infection 2008

5 Epidemiology * Risk Groups Treatment outcome, Lost to follow up 4.5% Still on treatment 5.7% Died 6.3% Treatment stopped 1.2% Transferred out 2.4% Reason for noncompletion not reported 0.2% Outcome unknown 0.7% Prevalence per 100, HIV Living in Hostel/on street Problem Drug users Prison Black African Recent migrant (arrived <1yr) Chinese or other South Asian Foreign Born Male Black Caribbean Overall Female Born UK White Risk group Completed 79.0% # CMO's target 85% Proportion (%) England Northern Ireland Scotland Wales East Midlands East of England London North East North West South East South West West Midlands Yorkshire and the Humber * Story et al Thorax 2007 # Ditah et al Thorax 2008 Country/region

6 Notification of tuberculosis in England and Wales Diagnosing clinician Notification form Consultant in Communicable Disease Control (Proper Officer) Weekly and quarterly returns HPA Centre for Infections

7 History of TB surveillance in England & Wales Routine system Notifications (NOIDS) (1913) HPA Enhanced surveillance (ETS) (1999) HPA Treatment outcome monitoring (2002) HPA Laboratory reports (Mycobnet) (1994) HPA Tuberculosis Incidents and Outbreaks (TBIOS) HPA Mortality ONS Linkage ETS and mycobnet TB and HIV ETS and HES ETS and Mortality HPA HPA HPA HPA Specific surveys (some examples) London case load profiling BPSU paediatric survey

8 Aims and objectives of TB surveillance To reduce the burden of morbidity and mortality from tuberculosis Local Identification and treatment of cases Identification and management of contacts Local, regional and national Incidence & trends Epidemiology Risk groups/factors Drug resistance Outcome Detection of outbreaks Evaluation of treatment programme Evaluation of control and prevention Policy and guidance

9 Epidemiology Incidence & trends Outcome Risk groups/factors Drug resistance

10 TB Surveillance systems INCIDENT CASES ETS NOIDS TREATMENT OUTCOMES Incidence & trends ISOLATES MycobNet Drug resistance Outcome

11 TB Surveillance systems INCIDENT CASES ETS NOIDS TREATMENT OUTCOMES Death Registrations FINGERPRINTS National strain typing database ISOLATES MycobNet INCIDENTS & OUTBREAKS

12 TB surveillance data flow Clinician & nurse: case of TB Specimen Feedback CCDC in HPU Regional Coordinator Web-based HPA national database Local laboratories Species, sensitivities Culture Reference Labs Matching MycobNet

13 MycobNet Reference Laboratories, UK Scottish Mycobacteria Reference Laboratory, Edinburgh HPA Regional Centre for Mycobacteriology, Newcastle Northern Ireland Public Health Laboratory, Belfast HPA Regional Centre for Mycobacteriology, Birmingham HPA National Mycobacterium Reference Unit, London Wales Centre for Mycobacteriology Royal Brompton Hospital, London

14 Web based TB Surveillance Case reporting Drug susceptibility data Strain typing Contact Information

15 Web based system

16 Web Interface: Reports

17 Web Interface: Reports

18 Cluster Report UPLOADED RECORD NUMBER 2: 3: ETR-MIRU Profile: : : Lab ID: BIR_ BIR_ Key: 13701: 13703: Date typed in laboratory: ************************************************** There are 2 records in the database that match the VNTR profile: ACTIVE CLUSTER - (NAME ASSIGNED: Ghaenia) *************************************************** Key Lab ID ISO RIF ETH PYR Date typed 8605 There are BIR_ records in the database that Smatch the S VNTR profile: S S Key BIR_ Lab ID ISO SRIF SETH SPYR SDate typed BIR_ S S S S BIR_ BIR_ SCO_MR121719G S S S R

19 Challenges in TB data reporting: Routine Surveillance Timeline Content Treatment Outcome

20 Timeline for the optimal for reporting to European level Annual for the moment Annual process fairly seamless now Future. Automated web based monthly upload through Tessy Automated reported will be the next test

21 Content of variables No major concerns with existing variables Some standard Tessy fields may not be collected nationally e.g. travel Definition of variables 'MajorSiteofTBDisease' or MinorSiteofTBDisease' coded value option for Laryngeal TB? ResultMicroscopy' sputum or other smears? Matching of data drug resistance / strain typing Changes

22 Challenges in TB data reporting : Treatment outcome monitoring Categories clear and consistent with national criteria Cured often a difficult category Outcome at 24 months only collected for a subset Outcome at 36 months not collected

23 Thank you!