No 3 - 2011

Tuberculosis treatment 2005-2007 

Since 2000 Danish tuberculosis treatment has been monitored via a standard form which is forwarded to the Department of Epidemiology after treatment is concluded, EPI-NEWS 45/03, EPI-NEWS 49/04, EPI-NEWS 50/05 and EPI-NEWS 03/07 (alle pdf).

The standard form used for TB treatment monitoring can be sent by e-mail to ldr@ssi.dk or by phone 32 68 37 44.

For the 2005-2007 period, treatment outcomes are available for in a total of 95 % of the notified TB cases. For 2008, treatment outcome information is currently outstanding in 15 % of cases. Consequently, the 2008 report will be published at a later date.

Treatment outcome

The definitions of possible TB treatment outcomes are shown in Table 1 of EPI-NEWS 50/10.

The outcome "Cured" is only used to denominate patients with culture-positive pulmonary TB and presupposes that culture for M. tuberculosis is negative during the final treatment month and in a minimum of one previous culture.
Treatment success is the sum of the categories "Cured" and "Completed".

The 2005-2007 treatment results for all types of TB patients and for patients with culture-positive pulmonary TB are shown by origin in Table 1 and Table 2.

For the three years as a whole, a total of 83 % (1014/1219) of all TB patients were successfully treated. Among patients with culture-positive TB, the corresponding proportion was 84 % (587/702).

A total of 6 % died during treatment. An increased mortality among Danish patients (10 %) may, as previously, be explained by their more advanced age profile.

Treatment failure was only reported in five cases. A total of 36 patients defaulted treatment: six Danes and 30 immigrants. A total of 28 patients left Denmark during treatment: two Danes and 26 immigrants.

Commentary

The WHO global objective is treatment success in 85 % of all new cases of culture-positive pulmonary TB. For the entire group including all patients notified with culture-positive pulmonary TB in 2005-2007, this objective was almost achieved for immigrants as well as for Danes.

If treatment success is limited to those with known outcomes, the overall success rate was 87 %: 86 % for Danes and 87 % for immigrants.
TB treatment monitoring, particularly of infectious patients, is an essential element of TB control and a response rate approaching 100 % is therefore desirable.

In Denmark, reporting of TB treatment outcomes have hitherto been voluntary. It has only been possible to achieve nearly complete data thanks to extraordinary efforts to collect any missing treatment forms.

Treatment surveillance should be perceived as an integrated part of TB surveillance, and in the long run it may be expedient to include such surveillance in the duty to notify TB disease.
(P.H. Andersen, Department of Epidemiology)

Cholera outbreak in Haiti

Towards the end of October 2010, Haiti witnessed its first cholera outbreak in more than 100 years. During November the outbreak spread across the country.

The outbreak has currently not been controlled, and by 9 January 2011 a total of 185,000 cases and 3,790 fatalities had been recorded. The first cases in the neighbouring Dominican Republic were recorded in November and by the end of December a total of 131 cases had been reported, the majority locally infected cases.
By mid December a total of five cases had been detected in Florida, all associated with Haitian travel activity.

The cause of the outbreak roots in the poor hygienic conditions following the severe earthquake which occurred near the capital of Port au Prince a year ago.

There are indications that the cholera may have been imported from the Indian subcontinent. Vibrio cholera El Tor O1, which is causing the Haitian outbreak, is more closely related to the variant of El Tor O1 which dominates the Indian subcontinent than the type currently circulating in South America.

No restrictions have been imposed on travel to the affected areas, but travellers are recommended to maintain high standards of personal hygiene and to follow any local recommendations.

Vaccination with the oral cholera vaccine Dukoral^® should be considered when travelling to areas affected by cholera outbreaks.
(J.N. Rasmussen, Dept. of Epidemiology)

Individually notifiable diseases and selected laboratory diagnosed infections (pdf) 

19 January 2011