Regional implication Household contact management

1
Regional implicationHousehold contact
management

• 11th NTP managers meetingCairo - Egypt
• Dr. Samiha Baghdadi
• MO-STB
• WHO/EMRO

2
Situation analysis-1Delay study

• Past history of exposure to TB patient
• 12 (Yemen), 93.4 (Pakistan).
• Prevalence of active TB per 100,000 contacts
• 6620 in Pakistan 390 in Egypt 200 in Syria
• Frequency of preventive chemotherapy
• 4.2 in Pakistan 0.6 in Egypt 0.9 in Syria

3
Situation analysis-2Country experience Syria

• During 2005
• The number of contacts for 1339 smear positive
  cases was 5071 contact and only 45 of them
  (2302) were examined.
• The number of smear positive TB cases identified
  among examined contacts was 44 cases.
• This means that the notified incidence of new
  smear positive cases among examined was 1911/100
  000, which represent 100 folds more than the
  national average of notified incidence in the
  year 2005.
• .

4
Situation analysis-3Group work

• Identify categories of TB patients that are
  subject to contacts tracing
• Pulmonary Positive
• Pulmonary Negative
• EP
• Tools and process to examine contacts.
• Symptoms, X Ray, Sputum, TUB test.
• Periodicity after 6m/1y/2y
• Preventive treatment (type, candidates)
• Recording and reporting (forms, register,
  report).
• Role of community/partners

5
Objectives

• All countries by 2007 should have policy for
  household contacts management, and start
  implementation.
• All countries by 2008 should examine 100 of
  contacts identified.
• All countries by 2008 will report quarterly on
  contact management.
• All eligible candidates by 2008 should receive
  preventive treatment.

6
Strategic directions - Policy

• Type of index case House hold contacts for all
  TB patients should be screened for TB.
• Periodicity Screening of house hold contacts
  should be done periodically at least for the
  first 2 years. This needs OR for more
  investigations. For the time being we suggest
  considering tests upon diagnosis, by the first
  year and by the second year of the diagnosis of
  the index case.
• Methodology policy should define methodology of
  screening (symptoms/ x. ray/ sputum). Tuberculin
  test could be informative only in children
  without vaccination!!
• Recording reporting Forms and registers should
  take into consideration providing enough
  information on the contacts of index TB case from
  identification till results of 3 consecutive
  examinations. Family files are preferable with
  family register.
• Preventive treatment INH for 6 months, for
  contacts with no symptoms under 20 years.

7
Work Plan
8
Indicators

• Process
• Policy and guidelines are available.
• Number of trained/planned
• Number of centers implementing (reporting) /
  planned
• No of contacts screened/expected.
• No of TB positive cases among screened contacts
  (rate)
• Outcome
• Increase in case detection attributed to contacts
  tracing.