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1 J KMA Special Issue Current Situation of Tuberculosis and Its Control in Korea Hee Jin Kim, MD Department of Technical Cooperation, Korean Institute of Tuberculosis, Korean National Tuberculosis Assciation E mail : hatchingbird@yahoo.co.kr J Korean Med Assoc 2006; 49(9): Abstract The prevalence of tuberculosis (TB) has declined owing to the establishment of national tuberculosis (TB) program in 1962, introduction of short course chemotherapy in mid 1980's, economic development, and nationwide medical insurance system. However, it is assumed that 18,000 (0.039%) smear positive and 224,000 (0.32%) radiologically active TB patients are present in 2006 by the extrapolating the figures from the prevalence surveys during the period 1980~1995. The prevalence survey was shifted to an Internet based notification system in June 2000, and a total of 46,969 (97.3/10 5 ) patients were notified in Among them, 72.3% were registered from private sector. The proportion of patients treated at private sector is increasing year by year. Among the 35,269 (73.0/10 5 ) newly diagnosed patients, 11,638 (24.1/10 5 ) were smear positive pulmonary TB. The number of newly diagnosed extra pulmonary TB patients was 5,171 (10.7/10 5 ). The age distribution curve showed a peak in the young generation, which implies that TB is still prevalent in Korea. A total of 2,948 (6.1/10 5 ) patients died of TB in The median age increased from 49 in 1983 to 70 in The initial drug resistance rate had been 10.4% in 1994 and rose to 12.8% in In addition, the rate of initial multi drug resistance was significantly increased from 1.6% to 2.7% during the same period. The treatment success rate in public sector is around 80%, but it is lower in private sector due to the difficulties in the management of active diseases. To accelerate the elimination of TB, it is important to intervene in the management of patients under treatment at private sector through public private collaborations and active investigations on the preventive therapy to manage latent infection. Keywords : Tuberculosis; Notification; Prevalence; Drug resistance 762

2 Tuberculosis and Its Control in Korea Trend of tuberculosis situation according to the national prevalence surveys Annual Risk of Infection Infection rate(0~29,%) Prevalence Radiologically active (%) No. of patients(1,000) 1,240 1, Bacillary positives (%) No. of patients(1,000) Smear positives (%) No. of patients(1,000) Drug resistance (%) Initial resistance Acquired resistance Combined resistance Italics are estimated figure Estimation of annual risk of infection; calculated by the regression equation using infection rate of 5~9 years old; LnY= X (R square: 0.96) Estimation of prevalence; calculated by the age specific reduction rate using the 1980~1995 year survey. 763

3 Kim HJ 764

4 Tuberculosis and Its Control in Korea Trend of new case notification rate per 100,000 by age group, 2001~

5 Kim HJ Tuberculosis death rate and median age of the patients died of tuberculosis Annual trend of tuberculosis patients registered at the health centers and private sector 766

6 Tuberculosis and Its Control in Korea Distribution of notified tuberculosis cases, 2005 Category Total New Relapse T.A.F.* T.A.D. T.I. Chronic Other All forms of TB 46,969 [97.3] 35,269 5, , ,688 <100.0> <75.1> <12.5> <0.8> <1.5> <4.1> <0.3> <5.7> PTB, Active 40,614 [84.1] 30,098 5, , ,280 <100.0> <74.1> <13.4> <0.8> <1.7> <4.1> <0.3> <5.6> Smear 16,458 [34.1] 11,638 2, <100.0> <70.7> <15.9> <1.4> <2.0> <4.0> <0.7> <5.3> EPTB** 6,355 [13.2] 5, <100.0> <81.4> <7.4> <0.4> <0.7> <3.8> <0.1> <6.4> Treatment after Failure, Treatment after Default, Transferred In, Pulmonary tuberculosis, Extra pulmonary tuberculosis 767

7 Kim HJ Drug resistance rates (%) of the patients registered at the health centers Type Pattern ~ * p value Primary Strains tested 2,486 2,370 1,348 2,636 Any resistance INH resistance MDR Acquired Strains tested Any resistance INH resistance MDR Combined Strains tested 2,675 2,653 1,970 2,914 Any resistance INH resistance MDR ; Unpublished data 768

8 Tuberculosis and Its Control in Korea Treatment Regimen based on the surveillance System, 2005 Pattern New % Relapsed % HRZE 28, , HRZE HRZS HRE 1, HRE HRZ HRZ HR HR Others 7, , None 3, H; Isoniazid, R; Rifampin, Z; Pyrazinamide, E; Ethambutol, S; Streptomycin 769

9 Kim HJ Organization. WHO/HTM/TB/ Ministry of Health and Welfare, Korean National Tuberculosis Association. Report on the 7th tuberculosis prevalence survey in Korea Ministry of Health and Welfare, Korean National Tuberculosis Association Seoul. (Korean) 3. Hong YP, Kim SJ, Lew WJ, Lee EK, Han YC. The seventh nationwide tuberculosis prevalence survey in Korea, Int J Tuberc Lung Dis 1998; 2: Bleiker MA, Sutherland I, Styblo K, ten Dam HG, Misljenovic O. Guidelines for estimating the risk of tuberculosis infection from tuberculin test results in a representative sample of children. Bull Union Tuberc Lung Dis 1989; 64(No.2): Styblo K. Selected paters, Vol 24 Epidemiology of tuberculosis, Royal Netherlands Tuberculosis Association. Hague, The Netherlands Kim SJ, Hong YP, Lew WJ, Yang SC, Lee EG. Incidence of pulmonary tuberculosis in Korean civil servants. Tubercle and Lung Disease. 1995; 76: Bai GH, Kim SJ, Lee EK, Lew WJ. Incidence of pulmonary tuberculosis in Korean civil servants: second study, Int J Tuberc Lung Dis 2001; 5: Korea Centers for Disease Control and Prevention, Korean Institute of Tuberculosis. Annual report on the notified tuberculosis patients in Korea (Based on Korean Tuberculosis Surveillance System) Korea Centers for Disease Control and Prevention, Korean Institute of Tuberculosis, World Health Organization. WHO Report Global Tuberculosis Control. Surveillance, Planning, Financing. World Health 9. Kim CH, Koh WJ, Kwon OJ, Ahn YM, Lim SY, et al. The accuracy of tuberculosis notification reports at a private genereal hospital after enforcement of new Korean tuberculosis surveil- 770

10 Tuberculosis and Its Control in Korea lance system. Tuberc Respir Dis 2003; 54: Korea National Statistical Office Annual report on the cause of death statistics (Based on vital registration) Korea National Statistical Office. Seoul World Health Organization. Anti tuberculosis drugs resistance in the world. The WHO/IUATLD global project on antituberculosis drug resistance surveillance. WHO Global Tuberculosis Programme. Geneva. WHO/TB/ World Health Organization. Anti tuberculosis drugs resistance in the world Report No.2 Prevalence and trends. The WHO/IUATLD global project on anti tuberculosis drug resistance surveillance. Communicable diseases World Health Organization Geneva WHO/TB/ Bai GH. Anti tuberculosis drug resistance in Korea. CDMR. 2005; 16: Chang CL, Lee EY, Park SK, Jeong SH, Park YK, et al. A Trend in Acquired Drug Resistances of Tuberculosis Patients Registered in Health Centers from 1981 to Tuberc Respir Dis 2005; 59: Kim DK, Kim MO, Kim TH, Sohn JW, Yoon HJ, et al. The Prevalence and Risk Factors of Drug Resistant Pulmonary Tuberculosis Investigated at One University Hospital in Seoul. Tuberc Respir Dis 2005; 58: Jung YJ, Park IN, Hong SB, Oh YM, Lim CM, et al. The clinical characteristics, diagnosis, treatment, and outcomes of patients with tuberculosis at a private university hospital in Korea. Tuberc Respir Dis 2006; 60: Son CH, Yang DG, No MS, Jeong JS, Lee H, Lee GN, et al. Prevalence of drug resistances in patients with pulmonary tuberculosis and its association with clinical characteristics at one tertiary referral hospital in Pusan, Korea. Tuberc Respir Dis 2001; 51: Kim JH, Kim JH, Jang TW, Jung MH. Drug resistant pulmonary tuberculosis in Kosin Medical Center. Tuberc Respir Dis 1995; 42: Hong YP, Kim SJ, Lew WJ, Lee SH, Lee EK. Cohort analyses of the treatment of smear positive pulmonary tuberculosis patients under programme conditions in Korea, Int J Tuberc Lung Dis May; 2: Korean Institute of Tuberculosis. A follow up study for the transferred out and defaulters among the bacteriologically positive patients under the national tuberculosis programme. Korean Institute of Tuberculosis Seoul 21. Jang DJ, Jin BW. An Analysis of Tuberculosis Patient Management in Private Sector. Tuberc Respir Dis 1990; 37: Hong YP, Kim SJ, Lee EG, Lew WJ, Bai JY. Treatment of bacillary pulmonary tuberculosis at the chest clinics in the private sector in Korea, Int J Tuberc Lung Dis 1999; 3: Kim YO, Yang WH, Bae JM. A survey of the controlling system for the pulmonary tuberculosis in Jejudo, Tuberc Respir Dis 2004; 56: Koh WJ, Kwon OJ, Kim CH, Ahn YM, Lim SY, et al. Clinical characteristics and treatment outcomes of patients with pulmonary tuberclosis at a private general hospital. Tuberc Respir Dis 2003; 55: Kim HJ, Bai GH, Kang MK, Kim SJ, Lee JK, et al. An intervention trial of a public private collaboration model for improving treatment outcomes of tuberculosis patients in the private 771

Kim HJ sector in Korea. Int J Tuberc Lung Dis 2005; 9(Suppl 1): S55 26. World Health Organization. Public Private Mix for DOTS. Global progress.

11 Kim HJ sector in Korea. Int J Tuberc Lung Dis 2005; 9(Suppl 1): S World Health Organization. Public Private Mix for DOTS. Global progress. Report of the Second Meeting of the PPM Subgroup for DOTS Expansion. World Health Organization. WHO/HTM/TB/ Korea Center for Disease Control and Prevention. Tuberculosis Guidelines Korea Center for Disease Control and Prevention. KCDC 06 15, Seoul, 2006; 5 (Korean) Peer Reviewer Commentary 772

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon