Measuring epidemiological impact Christopher Dye TB Monitoring

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Measuring epidemiological impactChristopher
DyeTB Monitoring Evaluation WHO Geneva
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TWO QUESTIONSAre incidence, prevalence and
deaths falling?Are they falling because of DOTS?
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TB patients in Morocco
Men 0.14 0.01
Mean age of adult patients (yr)
Women 0.15 0.02
Year
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Trends in case notification rates in Viet Nam,
1997-2004
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Annual percentage change
0
-4
-8
15-24
25-34
35-44
45-54
55-64
65
total
Women
Total
Men
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Can tuberculin surveys measure risk of infection?
Data from Somalia 2006
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Impact of DOTS in Peru
Declining notification rate
Slides examined (k/yr)
Pulmonary TB cases/100k/year
DOTS
Increasing diagnostic effort
Suarez, P. G. et al. The dynamics of tuberculosis
in response to 10 years of intensive control
effort in Peru. J Inf. Dis 184, 473-8 (2001)
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Measuring TB burden and the impact of control

• Routine surveillance is the ultimate tool for
  evaluating TB epidemiology and control
  completeness of reporting should be formally
  examined in all countries
• Disease prevalence surveys best used for
  measuring prevalence (and change), not incidence
• Tuberculin surveys feasible where ARI high and
  BCG coverage low better for trends application
  of Styblo's rule questionable
• TB death registrations need to be improved in all
  countries with high TB burden, and compared with
  data from NTPs verbal autopsy to be further
  evaluated