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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 l.jpg

Tuberculosis in England & Wales

Delane Shingadia

Senior Lecturer in Paediatric Infectious Diseases

Barts and The London


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WHO High Prevalence CountriesNotifications >40/100 000 population


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South Africa

Russia

Brazil

China



Rate of tuberculosis per 100 000 population in england excl london london all england 1988 1998 l.jpg
Rate of tuberculosis per 100,000 population in England (excl. London), London & All England, 1988-1998


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Tuberculosis notification rates, (excl. London), London & All England, 1988-1998

England and Wales, 1982-2001

Sources: Tuberculosis notifications (PHLS/CDSC-NOIDS), population figures (ONS estimates)


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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


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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


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Tuberculosis rates by age group, England and Wales, 1999 - 2002

Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year population estimates


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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


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Tuberculosis rates in persons born abroad by age group, England and Wales, 1999 - 2002

Sources: Enhanced Tuberculosis Surveillance, Labour Force Survey population estimates


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Tuberculosis case reports by ethnic group (%), England and Wales, 1999 - 2002

Source: Enhanced Tuberculosis Surveillance


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Tuberculosis case report rates Wales, 1999 - 2002

(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)


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Rate of all TB notifications Wales, 1999 - 2002In 2000 by London borough


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Annual notifications of paediatric TB Wales, 1999 - 2002 1982-00 by age group and proportion of all cases in London


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Paediatric TB Wales, 1999 - 2002by ethnic groupEnhanced surveillance data 2000


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Rate of paediatric TB notifications Wales, 1999 - 20020-14yr olds in 2000 by London borough


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Reasons for Increase in TB Wales, 1999 - 2002

  • Immigration/Travel

  • Breakdown in TB control

  • HIV infection

  • Multi-drug resistant TB

  • Poverty

  • Overcrowding

  • Incomplete treatment


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Why are rates of TB in children increasing? Wales, 1999 - 2002

  • Parallel increase with overall rates

  • Continued transmission of TB within population

  • Poverty and overcrowding

  • Multidrug resistant TB

  • ? HIV infection


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Natural History of TB in Children Wales, 1999 - 2002

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


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Gohn or Primary Complex Wales, 1999 - 2002


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Outcome of Primary Complex Wales, 1999 - 2002

  • 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)


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Hilar Lymphadenopathy Wales, 1999 - 2002


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Lobar Consolidation Wales, 1999 - 2002


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Haematogenous Spread Wales, 1999 - 2002


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Post-primary Tuberculosis Wales, 1999 - 2002

  • Adult-type reactivation disease

  • Usually follows infection >7 years age

  • Cavitation and smear positive sputum


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Why are childhood TB cases important? Wales, 1999 - 2002

  • 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


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Then….. Wales, 1999 - 2002


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And now Wales, 1999 - 2002

Has it changed?