PROGRAM KAWALAN DAN PENCEGAHAN TB

MALAYSIA

Dr Jiloris F Dony Ketua Sektor TBKUSTA

IPR 15 Jul 2010

Pengenalan• Diketahui sejak 2400 sebelum masihi• 1882 – Robert Koch menemui Mycobacterium TB• 1895 - X ray ditemui• 1921- BCG digunakan kepada manusia• 1949- PAS• 1952 –isoniazid• 1954-pyrazinamide• 1962-Ethambutol• 1963-Rifampicin

TB Burden 1993- “Global Emergency”

TB ranks Seventh as a global cause of death and will remain the major killer through 2020 (Murray and Lopez 1996) From 2005 highlight the TB Epidemic:-

-2 billion people i.e .one-third of the total population, estimated to be infected with M. tuberculosis- 8.9 million new cases of TB (140/100,000 population) - 1.7 million people (27/100,000) died from TB including those co-infected with HIV (248,000)

Milestone of Malaysia’s TBCP

1961

1972

1973

1. VERTICAL PROGRAMME : IPR AS MAIN NATIONAL TB REFERRAL CENTRE

2. AIM TO REACH 95% OF BCG COVERAGE

STATE TB OFFICERS CREATED.

BCG REVACCINATION – ‘BOOSTER DOSE’ FOR 12 Y.O 1975

CENTRAL TB REGISTRY AT IPR AND HOSPITAL (TB CLINICS)

1993

1995

1999

2003

HMIS-TB LAUNCHED

INTEGRATED SYSTEM BEGAN, REGISTRY REMAINED AT CHEST CLINICS

TBIS COMMITTEE CREATED

TBIS LAUNCHED FULLY AND IMPLEMENTED

2002 BCG REVACCINATION – ‘BOOSTER DOSE’ , STOPPED

Policies1. To notify TB patients according to place of residence2. To give standard regime of anti-TB to patients as

according to WHO guidelines3. To screen all HIV patients for TB4. To screen all TB patients for HIV5. Contact screening6. Infectious Disease Control Act 342 7. INH prophylaxis for HIV patients8. HAART for TB/HIV patients

BREAKING TRANSMISSION

National TB Control Programme (NTP)

Organization:• Director of Disease Control

- Head of the program• Head of Institute

Respiratory Medicine - Technical advisor

• State Health Director - State coordinator

• District Health Office – Basic management unit

TB SUPERVISION SYSTEM

OthersChest Clinic & Hospital

Health Centre

DTOT

PrivateUniv Hosp

DTOTDistrict TB Organizer

TeamDTOT

State TB Organizer

Team

DTOT

State(States TB Organizer Team)

RE-ORGANISATION OF TREATMENT CENTRES

District(District TB Organizer Team)

PR1 PR1

PR2

PR2

PR2

PR2 PR2

PR2

District(District TB Organizer Team)

PR1 PR1

PR2PR2

PR2 PR2

PR2

PR1

TB IS A NOTIFIABLE TB IS A NOTIFIABLE DISEASEDISEASE

• All All confirmed TB casesconfirmed TB cases (bacteriology & /or radiology & /or (bacteriology & /or radiology & /or clinical ) must be clinical ) must be notified notified to the to the nearest nearest District Health OfficeDistrict Health Office using CDCISusing CDCIS within 1 week of within 1 week of diagnosis.diagnosis.

• This is required under the This is required under the Infectious Diseases Act Infectious Diseases Act (1988)(1988)

Programs indicators

Programs indicators

do+s 1. Government commitment to

sustained TB control activities 2. Case detection by sputum

smear microscopy among symptomatic patients self-reporting to health services

3. Standardized treatment regimen of six to eight months for at least all sputum smear positive cases, with directly observed therapy (DOT) for at least the initial two months

4. A regular, uninterrupted supply of all essential anti TB drugs

5. A standardized recording and reporting system that allows assessment of treatment results for each patient and of the TB control programs

performance overall

IKRAB

HIGH RISK HIGH RISK GROUPSGROUPS....

• Contacts of PTB Sputum Smear +Contacts of PTB Sputum Smear +• Persons with HIV infectionPersons with HIV infection• Immigrants from high TB burden countriesImmigrants from high TB burden countries• Persons in Institutions (prisons & drug Persons in Institutions (prisons & drug

rehabilitation centers)rehabilitation centers)• Persons with other medical risk factors (diabetes Persons with other medical risk factors (diabetes

mellitus, renal failure, silicosis, prolonged steroid mellitus, renal failure, silicosis, prolonged steroid or other immunosuppressive therapy & or other immunosuppressive therapy & haematological malignancies)haematological malignancies)

Global TB Concerns Global TB Concerns

• *The rising incidence of *The rising incidence of HIV/AIDSHIV/AIDS worldwide and the worldwide and the close interaction close interaction between TB & HIV/AIDS.between TB & HIV/AIDS.

• *Increasing *Increasing international migrationinternational migration• *The emergence of multi-drug resistant *The emergence of multi-drug resistant

tuberculosis tuberculosis (MDRTB)(MDRTB)• Economic strife, war, famine & natural Economic strife, war, famine & natural

disaster which disrupted existing TB control disaster which disrupted existing TB control program.program.

• Decreased awarenessDecreased awareness about TB about TB amongst medical personnel including amongst medical personnel including doctors.doctors.

• The The low priority given to TB low priority given to TB controlcontrol in terms of resource allocation in terms of resource allocation & training.& training.

• Changes in Changes in global populationglobal population demography.demography.

Global TB ConcernsGlobal TB Concerns

OUR ROLE• General

– *TB treatment and control team– Plan TB activities

• General public• Schools children• Health/medical staffs

– Collaborate with NGOs– *Supervise and monitor the progress of

implementation of TBIS

Role …

• Specific– Make correct and full diagnosis– Notify TB and other communicable

diseases– *Determine correctly the drugs and

dosage– Filling-up TBIS 10A-1, 10E, 10H, 10I– Ensure that TBIS 101A, 101B is

updated

FORMS AND REPORTS

Accessories(< 100 series )

Registers(100 series )

Reports( 200 series )

Treatment10A, 10B …

Lab20A, 20B

Treatment101A, 101B …

Lab102A, 102B

Treatment201A, 201B …

Lab202A

BCG203A

BCG103A, 103B

BCG30A, 30B

PR2PR2

PR1PR1

DHODHO

SHDSHD

MOHMOH

BCGBCGLabLabPt & ContactPt & ContactPlacePlace

Annual Report / WHO

REPORT: LOCATION AND FREQUENCY

201C

201C

201A (S)

201A (D)

201B

202A

202A

203A

203A 203B

203B

203B203A202A

103A101D

103A 103B

203A

203A

Situasi TB di Malaysia

25

Disease

Number of casesIncidence rate (IR)

2003 2004 2005 2006 2007 2007

Dengue Infection

14,76161.65

12.75551.50

15,86264.53

17,14768.47

23,31090.65

46,517177.92

TB 15,58263.29

15,42960.30

15,99161.20

16,66562.56

16,91862.26

17,50663.10

FP 6,62426.45

5,95723.40

4,64117.76

6,93826.04

14,45553.19

17,32262.47

HFMD 1,265 378 6,325 5,141 12,55846.21

15,56456.13

HIV 6,75631.27

6,42729.61

6,12028.09

5,83028.79

4,57721.01

4,57716.71

0

2

4

6

8

10

12

14

2003 2004 2005 2006 2007 2008

%

Peratus kes TB di kalangan wagra asing, 2003 - 2008

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

No

of

Cas

es

Year

TBHIV 1990-2008

No.TB cases No. TBHIV

TB SituationTB Burden Ranking TB among HCW

TB among Immigrant TB-HIV Co-infection

Disease

Number of casesIncidence rate (IR)

2003 2004 2005 2006 2007 2007

Dengue Infection

14,76161.65

12.75551.50

15,86264.53

17,14768.47

23,31090.65

46,517177.92

TB 15,58263.29

15,42960.30

15,99161.20

16,66562.56

16,91862.26

17,50663.10

FP 6,62426.45

5,95723.40

4,64117.76

6,93826.04

14,45553.19

17,32262.47

HFMD 1,265 378 6,325 5,141 12,55846.21

15,56456.13

HIV 6,75631.27

6,42729.61

6,12028.09

5,83028.79

4,57721.01

4,57716.71

TB SituationTB in Malaysia vs ASEAN Country TB Cases and IR 1985-2008

TB among Children Death Associated with TB

Country No. of cases

IR EstimatedNo. of cases

EstimatedIR

%case

detectionBrunei 207 53 230 59 90

Singapore 1359 31 1176 27 115.5

Malaysia 16129 61 27439 103 58.8

Thailand 54793 86 90878 142 60.3

Indonesia 275193 119 528063 228 52.1

TB Cases and Incidence Rate 1985-2008

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Year

No

.of

case

s

52

54

56

58

60

62

64

66

68

70

IR/1

00,0

00

0123

456

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Rate

per

100,0

00

popu

latio

n

Death Rate (per 100,000 population) Target: <3 per 100,000 population

NSP For TB Control 2011-2015

• 6 Strategies• 6 Elemen ( I – AMORE)

–Infrastructure , Advocacy; Manpower; Operational;

Research & Equipment

• 5 KPI • 7 “Vehicles”

– TBKUSTA sector, Family Development & Primary Care, Public Health Lab. Health Promotion and Health Promotion Board, TB Managerial Teams-State & District ,c NGO, CKAPS /MMA

6 Strategies

• Strengthening Components of health system• Enhance Case Detection• Delivering an enhanced and quality TB

treatment• empower people with TB and Community• Limiting people from contracting TB• Promote TB Centered Reseach

Year Death per 100,000

2000 5.6

2001 5.5

2002 5.3

2003 3.9

2004 5.2

2005 5.5

2006 5.4

2007 5.5

2008 5.5

2009  2010  2011  2012  2013  2014  

2015 3.02016

CDR(2008): 68 % 70 % CURE R (2008): 81.7 % 85 %

Succes R (2008): 82.4 85 %Target & Road map to attain MDG Goal 6.c

32.3

NSP

do+s (TBIS)

Integrated health services

Isu dan cabaran

• Integrasi tetapi belum

terlaksana sepenuhnya

• Struktur organisasi kurang

jelas di beberapa negeri

• Pelaksanaan aktiviti

kurang diselaraskan

disebabkan kekurangan

sumber ; tenaga kerja,

kewangan & infrastruktur

Menjejaskan pengesanan kes , kapasiti diagnostik dan efisiensi rawatan

Sasaran MDG – 61 ke 31 setiap 100,000 penduduk

Scatter Diagram CDR & Cure Rate (Registered Cases 2008, Malaysia)