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): 762-72 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 2005. 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 2004. The median age increased from 49 in 1983 to 70 in 2004. The initial drug resistance rate had been 10.4% in 1994 and rose to 12.8% in 2004. 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
Tuberculosis and Its Control in Korea Trend of tuberculosis situation according to the national prevalence surveys 1965 1975 1980 1985 1990 1995 2006 2010 Annual Risk of Infection 5.3 2.3 1.8 1.2 1.1 0.5 0.21 0.16 Infection rate(0~29,%) 44.5 46.9 41.7 38.7 27.3 15.5 8.4 6.5 Prevalence Radiologically active (%) 5.1 3.3 2.5 2.2 1.8 1.0 0.486 0.380 No. of patients(1,000) 1,240 1,014 852 798 728 429 224 178 Bacillary positives (%) 0.94 0.76 0.54 0.44 0.24 0.22 0.095 0.079 No. of patients(1,000) 226 235 186 164 95 91 44 37 Smear positives (%) 0.69 0.48 0.31 0.24 0.14 0.09 0.039 0.033 No. of patients(1,000) 170 146 104 89 56 39 18 15 Drug resistance (%) Initial resistance 26.2 27.3 23.8 19.0 15.4 5.8 Acquired resistance 55.2 73.3 74.5 58.6 54.3 25.0 Combined resistance 38.0 38.3 47.5 35.3 27.4 9.9 Italics are estimated figure Estimation of annual risk of infection; calculated by the regression equation using infection rate of 5~9 years old; LnY=6.37253 0.07485 X (R square: 0.96) Estimation of prevalence; calculated by the age specific reduction rate using the 1980~1995 year survey. 763
Kim HJ 764
Tuberculosis and Its Control in Korea Trend of new case notification rate per 100,000 by age group, 2001~2005 765
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
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 5,891 363 711 1,914 133 2,688 <100.0> <75.1> <12.5> <0.8> <1.5> <4.1> <0.3> <5.7> PTB, Active 40,614 [84.1] 30,098 5,424 340 669 1,676 127 2,280 <100.0> <74.1> <13.4> <0.8> <1.7> <4.1> <0.3> <5.6> Smear 16,458 [34.1] 11,638 2,616 222 334 653 116 879 <100.0> <70.7> <15.9> <1.4> <2.0> <4.0> <0.7> <5.3> EPTB** 6,355 [13.2] 5,171 467 23 42 238 6 408 <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
Kim HJ Drug resistance rates (%) of the patients registered at the health centers Type Pattern 1994 1998~9 2003 2004* p value Primary Strains tested 2,486 2,370 1,348 2,636 Any resistance 11.3 10.9 12.8 12.8 0.0378 INH resistance 7.7 8.6 9.9 9.9 0.0031 MDR 1.6 2.2 2.4 2.7 0.0068 Acquired Strains tested 189 283 622 278 Any resistance 54.0 22.3 28.9 27.7 0.0000 INH resistance 45.5 17.3 24.8 24.1 0.0003 MDR 27.5 7.4 13.0 14.0 0.0079 Combined Strains tested 2,675 2,653 1,970 2,914 Any resistance 14.4 12.1 17.9 14.2 0.0122 INH resistance 10.4 9.5 14.6 11.3 0.0144 MDR 3.4 2.8 5.7 3.8 0.0325 2004; Unpublished data 768
Tuberculosis and Its Control in Korea Treatment Regimen based on the surveillance System, 2005 Pattern New % Relapsed % HRZE 28,273 80.16 4,508 76.52 HRZE+ 410 1.16 110 1.87 HRZS 40 0.11 9 0.15 HRE 1,539 4.36 273 4.63 HRE+ 235 0.67 53 0.90 HRZ 487 1.38 53 0.90 HRZ+ 57 0.16 14 0.24 HR 217 0.62 20 0.34 HR+ 50 0.14 19 0.32 Others 7,220 20.47 1,285 21.81 None 3,259 9.24 453 7.69 H; Isoniazid, R; Rifampin, Z; Pyrazinamide, E; Ethambutol, S; Streptomycin 769
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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. Report of the Second Meeting of the PPM Subgroup for DOTS Expansion. World Health Organization. WHO/HTM/TB/2004.338 27. Korea Center for Disease Control and Prevention. Tuberculosis Guidelines. 2006. Korea Center for Disease Control and Prevention. KCDC 06 15, Seoul, 2006; 5 (Korean) Peer Reviewer Commentary 772