TB Control in Finland - the role of THL Hanna Soini THL, Department of Health Security 1
TB in Finland 1950-2014 12000 10000 8000 6000 TB ulkomaalaiset TB yhteensä 4000 2000 0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2014 23.11.2017 TB Control - Hanna Soini
TB in Finland 2016 231 new cases were detected Incidence 4.2/100 000 170 pulmonary TB cases, 54 AFB smear positive 6 MDR-TB cases, 1 XDR-TB Average age of patients 50 y Finns 68 y Foreign-born 33 y Origin of patients: Finnish-born 115 (50 %) Foreign-born 106 (46 %) No data 10 (4 %) 38 (16 %) cases had no Finnish identifier (asylum seekers) 23.11.2017 TB Control - Hanna Soini
TB age groups 2016
Ministry of Social Affairs and Health Legislation Overview and follow-up of the national TB control plan Finance Information International collaboration National Institute for Health and Welfare National infectious diseases register TB surveillance Mycobacterial reference laboratory National advisory group for TB control Co-ordination of contact investigation National TB and vaccination guidelines Research and information International collaboration Private Foundations Funding for TB research 3rd sector organizations Information and educational material Reduction of stigma Collaboration in TB control TB Control In Finland Finnish Institute of Occupational Health TB guidelines for occupational health Register of occupational diseases Education, training, information NGOs (Filha ry) National advisory group for TB care Training and education National guidelines Hospitals and Specialized Medical Care TB diagnostics (clinical and laboratory) Initiation and follow-up of TB treatment BCG-vaccination Regional TB surveillance Consultation, information, education Regional support of TB control Primary Health Care General health-care and vaccinations Rapid initial diagnosis and referral to hospitals Implementation of TB treatment Contact investigation Local TB surveillance Local training
The role of THL in TB control Notification of TB cases to National Infectious Diseases Register TB surveillance and reporting to ECDC and WHO International collaboration Mycobacterial reference laboratory M. tuberculosis DST and genotyping NTM identification and DST National advisory group for TB control Implementation of TB program Evaluation of TB situation Updating of national guidelines
Notification of TB Mandatory notification of all TB cases to the National Infectious Diseases Register Laboratory notification (culture, PCR, histology) Physicians notification (also clinically confirmed cases) Electronic notification directly from laboratories or clinicians Treatment outcome monitoring of pulmonary TB cases Data can be combined to other registers with the national identifier Yearly reporting of data to the ECDC database and to the WHO
Mycobacterial Reference Laboratory All Mycobacterium tuberculosis isolates sent to the THL Drug susceptibility testing Phenotypic testing by the MGIT system Rapid genotypic testing by commercial assays Whole genome sequencing (WGS) Genotyping MIRU-VNTR Spoligotyping WGS Laboratory data included in the National Infectious Diseases Register
TB research at THL Enhanced surveillance of foreign-born TB cases Recurrent TB in Finland Comparison of TB cases in the national infectious diseases register and health-care register (HILMO) TB and NTM among children Change of vaccination program in 2006 Whole genome sequencing of M. tuberculosis Prediction of drug resistance Genotyping
TB screening of immigrants Asylum seekers and refugees Arriving from countries with TB ins. 50/100 000 or more Arriving from refugee camps or conflict areas such as Syria and Iraq Within two weeks of arrival Symptomatic individuals immediately Interview and CXR Under 7-yo also IGRA, if no BCG scar found Other immigrants Arriving from countries with TB ins. 150/100 000 or more Within 2 months of arrival Interview and CXR
TB screening of health-care workers All health-care workers and all individuals working with children under 7-yo Arriving from countries with TB ins. 150/100 000 or more Lived for 12 months or worked in health care for 3 months in such countries Worked with TB patients Had close contact with a TB patient Interview and CXR (if needed) before the work starts Applies also to students and unpaid trainees etc.
Contact tracing Mandatory to investigate infectious TB cases THL coordinates investigation of large outbreaks and international contacts National guidelines under revision Aim to reduce work load and concentrate on finding and investigating contacts with highest risk of infection Expansion of the use of IGRA and LTBI treatment to young adults (under 35-yo) New guidelines for congregational exposures New electronic forms
Contact tracing in Finland TUBERCULOSIS PATIENT High risk¹ AFB smear-positive AFB smear-negative but cavitary² KPulmonary TB Low risk³ AFB smear-negative Look for source case if patient is < 16-yo consider if patient is < 35-yo and Finnish-born Under 7-yo total exposure > 8h 4 Other individuals exposure > 40h 4 Family members Participation in risk procedure 5 Under 7-yo total exposure > 40h 4 Family members Other close contacts if needed Investigate exposed individuals Treat TB cases Evaluate the need for LTBI treatment 6 Treat the source case ¹ The period of infectiousness depends on duration of symptoms, if not known previous 3 months. ² Treating physician will estimate the period of infectiousness. ³ The period of infectiousness depends on duration of symptoms, if not known previous 1 month. 4 Exposure happened in a room size 60m² or smaller 5 E.g. resuscitation, intubation, bronchoscopy, respiratory physiotherapy, induction of sputum and autopsy without proper protection 6 Immunocompromised and under 35-yo