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Tuberculosis in England & Wales

Tuberculosis in England & Wales. Delane Shingadia Senior Lecturer in Paediatric Infectious Diseases Barts and The London. WHO High Prevalence Countries Notifications >40/100 000 population. South Africa. Russia. Brazil. China. TB notification rates per 100,000 population, Europe, 2002.

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Tuberculosis in England & Wales

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  1. Tuberculosis in England & Wales Delane Shingadia Senior Lecturer in Paediatric Infectious Diseases Barts and The London

  2. WHO High Prevalence CountriesNotifications >40/100 000 population

  3. South Africa Russia Brazil China

  4. TB notification rates per 100,000 population, Europe, 2002 EuroTB

  5. Rate of tuberculosis per 100,000 population in England (excl. London), London & All England, 1988-1998

  6. Tuberculosis notification rates, England and Wales, 1982-2001 Sources: Tuberculosis notifications (PHLS/CDSC-NOIDS), population figures (ONS estimates)

  7. Tuberculosis case reports and rates by age group and sex, England, Wales and Northern Ireland, 2002 Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year population estimates

  8. Tuberculosis rates by place of birth (born in the UK vs. born abroad), England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates

  9. Tuberculosis rates by age group, England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year population estimates

  10. Tuberculosis rates in persons born in the UK by age group, England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates

  11. Tuberculosis rates in persons born abroad by age group, England and Wales, 1999 - 2002 Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates

  12. Tuberculosis case reports by ethnic group (%), England and Wales, 1999 - 2002 Source: Enhanced Tuberculosis Surveillance

  13. Tuberculosis case report rates (per 100 000 population), by geographic origin and ethnic group, England and Wales, 1998-2000 England and Wales = 11.2 Sources: Tuberculosis case reports (1998: National TB survey, 1999, 2000: Enhanced TB surveillance), Population figures: (ONS-Labour force survey)

  14. Rate of all TB notifications In 2000 by London borough

  15. Annual notifications of paediatric TB 1982-00 by age group and proportion of all cases in London

  16. Paediatric TB by ethnic groupEnhanced surveillance data 2000

  17. Rate of paediatric TB notifications 0-14yr olds in 2000 by London borough

  18. Reasons for Increase in TB • Immigration/Travel • Breakdown in TB control • HIV infection • Multi-drug resistant TB • Poverty • Overcrowding • Incomplete treatment

  19. Why are rates of TB in children increasing? • Parallel increase with overall rates • Continued transmission of TB within population • Poverty and overcrowding • Multidrug resistant TB • ? HIV infection

  20. Natural History of TB in Children No signs/symptoms, negative tuberculin skin test Exposure Exposure Months to years No signs/symptoms but positive tuberculin skin test Infection Signs/symptoms or radiographic evidence of TB Disease

  21. Gohn or Primary Complex

  22. Outcome of Primary Complex • Resolution in the majority of children • Lymphadenopathy with bronchial compression • Caseation with progressive liquefaction and pleural/pericardial involvement • Haematogenous spread to lungs (miliary) and extrapulmonary sites (CNS, bone/joint, renal)

  23. Hilar Lymphadenopathy

  24. Lobar Consolidation

  25. Haematogenous Spread

  26. Post-primary Tuberculosis • Adult-type reactivation disease • Usually follows infection >7 years age • Cavitation and smear positive sputum

  27. Why are childhood TB cases important? • Children are more likely to develop progressive primary disease rather than reactivation (adult-type) disease • Children may develop disease more rapidly • Children are more likely to have extra-pulmonary disease and are usually not infectious • Childhood TB cases represent a sentinel event in a community suggesting recent transmission, usually from an infectious adult

  28. Then…..

  29. And now Has it changed?

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