Dr.

Komel Zulfiqar
Assistant professor
Community Medicine
22 HIGH DISEASE BURDEN COUNTRIES
India Russia Combodia
China Kenya Myanmar
Indonesia Vietnam
Nigeria Ur Tanzania
Bangladesh Brazil
Ethiopia Uganda
Philippines Zimbabwe
Pakistan Mozambique
South Africa Thailand
Congo Afghanistan
At the end of lecture students are able to
Describe Epidemiology of T.B
Discuss control of T.B
Discuss prevention of T.B
 LETS RECALL:
What do you know about communicable diseases?
What do you mean by Epidemiology?

EPIDEMIOLOGY
MAGNITUDE OF THE PROBLEM
A world-wide public health problem
Estimated number of infectious cases in the world 15
20 million
About 8 million people develop tuberculosis every year
2 million people die of this disease every year
The problem is acute in developing countries which
account for about 95 per cent of tuberculosis cases
South-East Asia, Western Pacific and Africa are the worst
affected regions (38 %)
 PAKISTAN
TB accounts for 5.1% of the total national disease burden

Two-third of TB cases are in productive age group

Incidence of all form of TB per year 177/100,000

Incidence of sputum-positive cases per year 80/100,000
Open cases per year 120,000
 AGENT FACTORS

Mycobacterium Tuberculosis
Human Variety

Bovine Variety

Murine Variety

Avian Variety

Last two types rarely pathogenic to man

RESERVOIR OF INFECTION
Infected persons (Cases)

Infected animals
 SOURCE OF INFECTION
Human Source
Sputum
Excreta
Bovine Source
Milk
Tuberculous Material
Operation Theatre
Laboratories
Slaughtered animals
 HOST FACTORS
Age:
Male 25-45 years
Female 15-35 years
Sex: more in males
Heredity : not a hereditary disease
Immunity : natural infection & BCG vaccination
Intercurrent infection & concomitant
diseases: measles, pneumonia, whooping ,cough,
influenza etc.
ENVIRONMENTAL FACTORS
Social factors:
Housing, nutrition, education, early marriages, family
size & overcrowding etc

Occupation:
Industrial workers having Silicosis & Anthracosis
Bus Conductors, Counter Clerks at rush offices
Health care workers
 THE CONTROL OF TUBERCULOSIS
Tuberculosis control means reduction in the prevalence
and incidence of disease in the community
As per WHO criteria, tuberculosis control is said to be
achieved when the prevalence of natural infection in the
age group 0 14 years is 1% or less
 CONTROL MEASURES
Curative component: Case Finding and
Treatment

The most powerful weapon in the control of

tuberculosis is case finding and treatment
 TARGET GROUP
Patients who attend hospitals and health
centers with the following symptoms
Persistent cough for 3 weeks or more
Continuous fever
Chest pain
Haemoptysis
Household contacts (especially children &
young adults) of all smear-positive patients
 CASE FINDING TOOLS
Sputum Smear Examination
By direct microscopy
Examination of two consecutive specimens is sufficient
Method of choice is Sputum Culture
For patients with chest symptoms and negative sputum
smear
TREATMENT
BACTERICIDAL DRUGS:
Rifampicin (R) Daily Dose 450-600 mg
The only drug active against the dormant bacilli
INH (H) Daily Dose 300 mg
Action is most marked on rapidly multiplying bacilli
Streptomycin (S) Daily Dose 0.75 to 1 g in a single injection
Acts entirely on rapidly multiplying bacilli
Pyrazinamide (Z) Daily Dose 1.5-2 g
Particularly active against slow-multiplying IC bacilli
 TREATMENT
BACTERIOSTATIC DRUGS:

Ethambutol (E) Daily Dose 800 mg

Prevents emergence of resistance to other drugs

Thioacetazone Daily Dose 150 mg

 PREVENTION
BCG VACCINATION) (Live-attenuated bacilli)
Chalmette & Guerin 1906, 230 Subcultures in 13 years

Universal recognition by 1948, In Pakistan 1950

Dosage: Below 4 weeks 0.05 ml, Above that 0.1 ml

Administration: I/D with Tuberculin syringe, just above the insertion

of Deltoid Muscle

Age: At birth, then at 6 weeks with DPT

Protective Value: For 15 20 years (80%)

 FOR FURTHER READING
K Park Text book of social and preventive Medicine
21st edition

M Ilyas Ansari Text book 20th edition

ANY QUESTION
 TAKE HOME MESSAGE
T.B is highly communicable disease but 100% curable.
Most important step in control of T.B is early case
finding & treatment.
BCG vaccination is live attenuated vaccine given to
children to elicit immune response and protects
against T.B up to 80%.