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EPIDEMIOLOGICAL REVIEW OF

TUBERCULOSIS

IN THE WESTERN PACIFIC REGION

1995

The Research Institute of Tuberculosis Japan Anti-Tuberculosis Association

Tokyo, Japan (WHO Collaborating Centre for Reference,

Research and Training in Tuberculosis)

World Health Organization Regional Office for the Western Pacific

Manila 1995

*f1V/WPIW LlBRAlD lIa11.UG I'liiNf ill.

JRJ[lr THE RESEARCH INSTITUTEr OF TUBERCULOSIS. JAPAN

Preface

The Western Pacific Region. with 36 countries and areas and approximately 1.6 billion population accounts for nearly half the size of tuberculosis problem in Asia. A tuberculosis information network system in the region has been being developed jointly by the Research Institute of Tuberculosis (RIT). Tokyo and the Western Pacific Regional Office (WPRO). WHO since 1990. and reviews have been made for the current tuberculosis situation with reference to national tuberculosis control programme of each country in the region. Since then the database. information collection system and method of analysis have been improved and this report is the third version of the review covering the years from 1975 to 1995.

This report consists of two parts; Part I. an overall epidemiological review of tuberculosis in Western Pacific Region and Part II. tuberculosis data for each country and area in the region with reference to the national tuberculosis control programme.

Report has been developed by a joint team consisting of both RIT and WPRO staff members. Main contributors are; Dr. N. Yamada (RIT) , Dr. N. Ishikawa (RIT). Dr. Dong II Ahn (WPRO) and Dr. L. Blanc (WPRO). Thanks are due to Ms. J. Nakamura for computer programming and editing. The authors are responsible for the selection and review of data in this report. This report does not necessarily represent the official view of the WHOfWPRO.

The users' additional information, corrections and comments are most welcome.

- i -

PART I

TABLE OF CONTENTS

EPIDEMIOLOGICAL REVIEW OF TUBERCUWSIS IN THE WESTERN PACIFIC REGION ................................................ 1

INTRODUCTION ..................................................................... 2

Contents of information: .............................................................. 2 Sources of information: ............................................................... 2 Definition of terms: .................................................................... 4

REVIEW OF TUBERCULOSIS EPIDEMIOLOGy ............................ 5

1. Notification of tuberculosis cases .............................................. 5

1. 1 The latest notification of all newly notified cases ................... 5 1.2 The latest notification of new smear positive

(or bacteriologically positive) cases .................................... 6 1. 3 Time trend of notification of tuberculosis cases ..................... 6 1.4 Proportion of smear positive (or bacteriologically

positive) cases in all cases ............................................... 8

2. Latest number and rate of tuberculosis deaths ............................... 9 3. Age distribution of tuberculosis cases by country .......................... 9 4. Pattern of age specific notification rate ...................................... 10 5. Prevalence of Tuberculosis and Estimated Annual

Risk of Infection ................................................................. 11

5.1 Prevalence of Tuberculosis ............................................. 11 5.2 Estimated Annual Risk of Tuberculosis

Infection (ARI) ............................................................ 11

SUMMARY ........................................................................... 12

TABLES AND FIGURES ........................................................... 13

- ii -

PART II TUBERCULOSIS DATA FOR EACH COUNTRY AND AREA IN THE

I. 2. 3. 4. 5. 6. 7. 8. 9.

WESTERN PACIFIC REGION .................................. 35

American Samoa .............................................................. 37 Australia .................................................................... ; ... 40 Brunei Darussalam ................................ , ........................... 43 Cambodia ...................................................................... .46 China, People's Republic of ................................................. 50 Cook Island ..................................................................... 54 Fiji. ............................................................................... 57 French Polynesia .............................................................. 60 Guam ............................................................................ 63

10. Hong Kong ..................................................................... 66 11. Japan ................ '" .......................................................... 69 12. Kiribati .......................................................................... 72 13. Lao People's Democratic Republic ........................................ 75 14. Macao ........................................................................... 79 15. Malaysia ......................................................................... 82 16. Commonwealth of Northern Mariana Islands ............................ 86 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

Republic of Marshal Islands ................................................. 89 Federated States of Micronesia ............................................. 92 Mongolia ........................................................................ 96 Nauru ............................................................................ 99 New Caledonia ............................................................... 102 New Zealand ................................................................. 105 Niue ............................................................................ 108 Republic of Palau ............................................................ 111 Papua New Guinea .......................................................... 114 Philippines .................................................................... 118 Republic of Korea ........................................................... 122 Western Samoa .............................................................. 126 Singapore ............................................................... , ..... 131 Solomon Islands ............................................................. 133 Tokelau ........................................................................ 137 Tonga .......................................................................... 140 Tuvalu ......................................................................... 144 Vanuatu ....................................................................... 147 Viet Nam ...................................................................... 150

36 . Wallis and Futuna ........................................................... 154

ANNEX .............................................................................. 158

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PART I

EPIDEMIOLOGICAL REVIEW OF TUBERCULOSIS


Abbreviation in the tables and fJgU1'e5

all: All newly notified cases new S + : New smear positive cases new B +: New bacteriologically positive cases

The abbreviation of each country name is as follows:

Name

American Samoa Australia Brunei Darrusalam Cambodia China, People's Republic of Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Northern Mariana Islands Marshall Islands, Republic of Micronesia, Federated States of Mongolia Nauru New Caledonia New Zealand Niue Palau, Republic of Papua New Guinea Philippines Korea, Republic of Western Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis & Futuna

- 1 -

Abbreviation used in the tables and

figures

Am. Samoa

Brunei

China Cook Is.

Fr. Polynesia

Lao PDR

.N. Mariana Is. Marshall Is. Micronesia

Palau

Rep. of Korea Samoa

Solomon Is.

INTRODUCTION

The Western Pacific Region covers 36 countries and areas as shown in Figure 1 and Table 1. They are geographically scattered very widely in the northern. western and southern Pacific.

The total land area is 19.9 rrullion square kilometers. The total estimated population is about 1.6 billion. China with 9.6 million square kilometers in land area and 1.2 billion in population covers almost half of all land area and three-fourth of the total population in the region. In contrast. 12 countries and areas of the Pacific islands have a population of less than 100 000. The region is thus a mixture of a macro and micro countries and areas.

Contents of information:

The following information has been collected and analysed:

Epidemiological indicators:

Notification numbers and rates of tuberculosis cases (all forms. pulmonary cases and smear positive or bacteriologically positive cases). number of deaths and the rates. estimated annual risk of infection and the age distribution of the cases. the age specific notification rates.

National tuberculosis control programme information:

Organization structure and programme for case fmding. treatment regimen. laboratory. BCG or others. and achievement in case fmding. treatment and BCG vaccination.

Sources of information:

Data were collected mainly from the official reports from each country. and partially from other published or unpublished reports.

General indicators:

Main sources were; database of population in Western Pacific Region by WHOIWPRO for population(Filename: POPWPR). Country Health Information Profile(CHIP). Data Bank on Socioeconomic and Health Indicators by Western Pacific Regional Office (WPRO). WHO. Demographic Yearbook by United Nations. World Tables by World Bank. World Development Report by World Bank. Key Indicators of Developing Asian and Pacific Countries by Asian Development Bank and the State of the World Children by UNICEF. Some were collected from official reports such as the Annual Report by the Ministry of Health of each country and area.

- 2 -

Tuberculosis epidemiological indicators and programme information:

Main Source for 1992 - 1994 were questionnaire sheets from each country returned to RIT(1992) and WPRO(since 1993).

Data for the years before 1991 and data which were not obtained through main sources were collected from the following sources:

(1) Officially published reports (domestic and international)

Domestically. annual tuberculosis reports are published by some countries such as Hong Kong. Japan. Macao. Malaysia. Papua New Guinea. Philippines. Korea (The Republic of Korea) and Singapore. These reports are highly useful. though they have sometimes certain difficulties for international comparison. They are. however. often not easily available outside or even to the WPRO simply because of the communication difficulty. Official enquiries through the embassies or consulates in Tokyo have been effective for some countries. Internationally. the World Health Statistics Annual by WHO provides some information.

(2) Documents in the WPRO (Western Pacific Regional Office). WHO.

Though not published openly. a document as Data Bank is compiled periodically in the WPRO as mentioned above. The assignment reports to WPRO on tuberculosis in various countries were highly useful. especially for the countries and areas of the Pacific islands.

(3) Reports and articles on medical journals (international and domestic).

These are often of great use and sometimes the only source of data for some information in some countries. But the authors of these papers on tuberculosis epidemiology especially on international journals are as yet limited in a few countries such as China. Hong Kong. Japan. Philippines and Korea.

(4) Unpublished reports and personal communications

These are sometimes the only means of obtaining information. Unpublished data which had been collected at the RIT in Tokyo were used. International human network established through international antituberculosis activities. including the international training courses at the RIT were also very helpful.

(5) Direct communication with countries and areas concerned

When there were questions on available data. a letter was sent to the countries concerned.

- 3 -

(6) Field visits

Visits made selectively for the tuberculosis information furnished a good amount of data in addition to the above sources(e.g. Laos, Kiribati, Tonga, Papua New Guinea, Micronesia, China, Macao, Malaysia, Philippines and Viet Nam). Information from visits to other countries by other programmes were also utilized.

Definition of terms:

All newly notified cases, new case and relapse:

In this report all newly notified cases refer to the sum of "new cases" and "relapses" defmed each by WHO.

New case conventionally means newly notified (or newly detected) case according to the defmition in each country. The data for new case (or newly notified cases) until recently therefore are not necessarily comparative among countries. As WHO has recently defmed new case as a patient without previous treatment and separated it from relapse, the defmition of new cases in some countries might differ from the previous one within the same countries.

Bacteriologically positive case:

Bacteriologically positive case refers to smear and/or culture positive case. In some countries, it is not specified whether the figure of new cases refers to smear positive or bacteriologically positive case. If not specified, it refers to smear positive case in this report.

Rates of case and death:

Rates of case and death were calculated with the absolute number of those reported from each country and the population consolidated by WHOIWPRO. Therefore the rates used in this report may be different from those obtained from other sources. When only the rate of case was available for a country, the number of cases was calculated by using the rate and the popUlation mentioned above. The figure may be different to some extent from the actual number. The calculated figures are shown in the parentheses in Part II.

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REVIEW OF TUBERCULOSIS EPIDEMIOLOGY

1. Notification of tuberculosis cases

1.1 The latest notification of all newly notified cases

Table 1 and Figure 3 shows the latest number and rate of tuberculosis cases by country, case category and disease classification. According to these figures both reported and calculated, the total number and rate of all newly notified tuberculosis in the Western Pacific Region currently amount to about 725 thousands and 45.6 per 100,000 respectively.

(a) The latest number of all newly notified cases

The latest number of all notified new cases varies among the countries and areas in the region as shown in Table 1. It is more than 10 000 in 7 countries (Cambodia, China, Japan, Malaysia, Philippines, Korea and Viet Nam) and between 1000 and 10 000 in 5 countries. In the remaining countries and areas, it is less than 1000, and in 14 of them have even less than 100. Figure 2 shows that the larger five countries in tuberculosis notification, namely China, Japan, Philippines, Korea and Viet Nam occupy 94 % of all newly notified cases in the region. China occupies 51 % of all.

In some countries such as China, Korea and Philippines, the notified number of tuberculosis is ouly of pulmonary tuberculosis, but in this report it is regarded as that of all forms.

The current total number of new cases in the region excluding Australia, Japan and New Zeal is about 679 thousands. This is about 33 % of the total number of new cases estimated for 1995 by the Oxford University and WHO, Geneva.

(b) The latest notification rate of all newly notified cases

Figure 3 shows the latest notification rate per 100 000 for each country from the largest to the smallest. The rate varies largely among the countries and areas in the region. It is higher than 100 (per 100 000) in 10 out of 36 countries and areas, and higher than 150 in 6 of them (Cambodia. Kiribati, Micronesia, Palau, Philippines and Tuvalu). It is lower than 10 in 3 countries (Am. Samoa, Australia, Tokelau).

Although the current rate is highest in Kiribati, the figure has not been stable and fluctuates largely in this country, while the Philippines has been keeping constantly almost highest rate.

- 5 -

The current notification rate of newly notified cases is 45.6 per 100 000 for the whole region. It is 47.0 excluding Australia, Japan and New Zealand, while the estimated figure by the Oxford University and WHO is 140 for 1995.

1.2 The latest notification of new smear positive (or bacteriologically positive) cases

The latest number and rate of new smear positive (or bacteriologically positive) cases by country are shown in Table 1 and Figure 4.

(a) The latest notification number of new smear positive (or bacteriologically positive) cases

Latest number of new smear positIVe cases varies among the countries. The largest is 104,729 in China. It is 2 or below in 7 Countries. The sum of the latest number of new smear positive (or bacteriologically positive) cases from the countries in the region is 277527.

(b) The latest notification rate of new smear positive (or bacteriologically positive cases)

Figure 4 shows the latest notification rate per 100 000 for each country from the largest to the smallest. It also varies among the countries. The highest is 239 in Kiribati, followed by 132 in Philippines. The average rate of new smear positive (or bacteriologically positive) cases in WPR is 17.4 per 100 000.

1.3 Time trend of notification of tuberculosis cases

Table 2 and Table 3 shows the annual number and rate of all newly notified cases and smear positive (or bacteriologically positive) cases for each country from the year of 1975 to 1994.

(a) Time trend of the average number and rate of new cases by country

To overview the trend of notification number and rate of new cases, the average annual notification numbers and rates in the periods of 1980-1984, 1985-1989 and 1990-1994 are shown with the percent change against those in the period of 1980-1984 in Table 4 and 5. Out of 31 countries where numbers are available, more than 30% increase in 1990-1994 from the years of 1980-1984 is observed in 9 countries, namely Cambodia, China, Guam, Marshal Is, Micronesia, Palau, Papua New Guinea and Philippines. More than 30% decrease during the same period is observed in 7 countries.

In rate. data are available from 31 countries. More than 30% increase in 1990-1994 is observed in 5 countries, namely Palau, Philippines. Micronesia. China and Marshal Is.

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In China and the Philippines, the rate as well as the number has increased, most probably due to the improvement of the service coverage. In the Philippines, the programme has been being intensified since 1987. In China, the prevalence surveys shows the overall declining trend (See 5.1).

More than 30% decrease in rate is observed during the same period in 10 countries, namely Australia, Brunei, Cook Is, Kiribati, Macao, N. Mariana Is, New Zealand, Korea, Singapore and Tonga.

A large number of countries have a decreasing trend in rate more than in number. Even in the countries where number of cases has increased, the percent change in rate is smaller that in number.

In the whole WPR, the average number of new cases increased from 480,351 in 1980-1984 to 782840 in 1990-1994. Percent change between the two periods is 63 %. 80 % of this increase attribute to increased number. in China.

Average rate of new cases in the whole WPR has also increased from 35.5 in 1980-1984 to 51.0 in 1990-1994. The percent change between the two periods is 26% as shown in Table 4.

(b) Time trend of number and rate of all newly notified cases by year in selected countries

Figure 5 shows the time trend of annual notification number of new cases in 6 counties which have recently the largest numbers of all newly notified cases.

In Korea, number as well as rate increased till 1984 but has been decreasing since then. In the Philippines a remarkable increase of number and rate is observed from late 1980s and early 1990s. It is thought to be attributed to the intensified case finding programme. In China, both number and rate of newly notified cases increased remarkably during the years of 1980s and have been almost the same in 199Os. The increase can be attributed mainly to the improvement of service, especially notification system. In assessing the current trend, the change of reporting system must be taken into consideration.

In Japan number and rate have been decreasing although the reduction rate has decreased since late 1980s. In Viet Nam both number and rate show no significant change since late 1980s. In Cambodia both number and rate are increasing with some fractuation.

In other countries, such as Australia, Guam and New Zealand, stagnation of decrease or even increase tendency during recent years is observed. Australia and New Zealand with low incidence rate have the same tendency as European countries. In Australia 70% of notifications are foreign born.

- 7 -

(c) Time trend of average number and rate of new smear positive (or bacteriologically positive) cases by country

Average annual notification numbers and rates in the periods of 1980-1984, 1985-1989 and 1990-1994 and percent change against the period of 1980-1984 are shown in table 5.

Of 25 countries where the number is available, 7 countries, namely Cambodia, China, Kiribati, N. Mariana Islands, Marshall Islands, Palau and Philippines showed more than 30% increase in 1990-1994 from the years of 1980-1984. More than 30% decrease between the same periods is observed in 8 countries, namely Am. Samoa, Micronesia, Mongolia, Papua New Guinea, Korea, Western Samoa, Tonga and Tuvalu.

Of 25 countries where the rate is available, 6 countries, namely Cambodia, China, Kiribati, Marshall Is., Palau and Philippines, showed more than 30% increase in 1990-1994 from the years of 1980-1984. Thirteen countries, namely Am. Samoa, Australia (bacteriologically positive cases), Fr. Polynesia, Guam (bacteriologically positive cases), Micronesia, Mongolia, New Caledonia, Papua New Guinea, Korea (bacteriologically positive cases), Western Samoa, Solomon Is., Tonga and Tuvalu, showed more than 30% decrease during the same period.

On the whole, reduction is larger in rate than in number and percentage change in rate is lower than that in number.

In the whole WPR, the average number of new smear (or bacteriologically positive in some countries) cases increased from 151 475 in 1980-1984 to 280 499 in 1990-1994. Percentage change between the two periods is 85 %. Fifty two percent can be attributed to the increase in China.

Average rate of new smear positive (or bacteriologically positive) cases in the whole WPR has increased from 11.3 in 1980-1984 to 18.0 in 1990-1994. Percent change between two periods is 59% as shown in Table 5.

1.4 Proportion of smear positive (or bacteriologically positive) cases in all cases

Figure 6 shows the notification rates of all cases and smear positive (or bacteriologically positive) cases. The proportion of smear positive (or bacteriologically positive) cases in all cases here dose not necessarily represent the true proportion of smear (bacteriologically) positive cases to all forms, because in some countries, cases with no information of bacteriological status may be included among smear (bacteriologically) negative cases.

- 8 -

On the whole, the distribution of notification rate of smear (bacteriologically) positive cases is not proportional to that of all forms as shown in Figure 5. The ratio of smear positive (or bacteriologically positive) case varies. The proportion is over 70% in Cambodia, Kiribati, Cook Is., Nauru, Tonga and Viet Nam. It is less than 30% in Fiji, Marshall Is, Micronesia, Mongolia, New Zealand, Palau, Papua New Guinea and Wallis & Futuna. The marked discrepancy in the ratio indicates the great difference in diagnostic criteria and procedures for tuberculosis or reporting system in each country and area. This indicates the difficulty in international comparison of reported cases.

2. Latest number and rate of tuberculosis deaths

The mortality data of tuberculosis are available from 33 countries in the region. The latest number and rate (per 100 000) of tuberculosis deaths are shown in Table I. Figure 7 shows the mortality rates from the highest to the lowest. According to these data, at least about 33 000 tuberculosis deaths are reported recently in the Western Pacific Region (not including Cambodia and China). Rate of the reported deaths is 9.0 per 100 000 in WPR (not including Cambodia and China).

Among the countries with the population of over I million, the rate in the Philippines has been fairly high over 35. In China, nationwide figure of tuberculosis deaths is not available although tuberculosis deaths from registered cases and several figures based on surveillance and survey are available. Based on retrospective survey of deaths in 1984-1985 and 1989 conducted with prevalence survey of tuberculosis, tuberculosis death rate was 35 per 100 000 and 20 per 100 000, respectively. According to National Mortality Statistics based on the data collected from several selected areas, pulmonary tuberculosis death rate is 11. 9 in the year of 1990.

International comparison of tuberculosis deaths may not be easy because in most countries and areas the reporting system of death has not yet been established and the quality of figures is limited. In some countries, e.g. Solomon Is., number of deaths is available only from registered cases.

3. Age distribution of tuberculosis cases by country

The recent age distributions of tuberculosis cases (new cases, mainly new smear positive cases) are available for 19 countries during the years between 1989 and 1994.

For the assessment of epidemiological situation, the age specific rate of cases is more valuable than the age distribution of cases. However they are still useful particularly for estimating the socioeconomic burden of the disease in the country.

- 9-

Figure 8 shows the patterns of the age distribution categorized into 5 groups (A to E) according to the type of distribution; Distribution is higher in younger age groups under or around 20s or 30s and much lower in the older age group (Group A: Viet Nam, China); Distribution is highest in the age group 20s or 30s, with a gradual decline in fairly higher figures in the old age group as well (Group B: Lao PDR, Korea); Distribution is higher in the age group of 40s and 50s with decline in the older age groups (Group C: Guam, New Caledonia); Distnbution is highest in the older age group over 60 and clear peak in 20s and 30s (Group D: Australia, New Zealand, Malaysia, Western Samoa and Hong Kong), Distribution is highest in the older group and fairly low figure in young age group (Group E: Japan, Singapore and Tonga)

Interpretation is very difficult for the countries where number of cases in all age groups is small, namely Am. Samoa, Micronesia, Nauru, Tuvalu and Wallis & Futuna. Accumulation of number for several years is required.

According to available data, it should also be emphasized that tuberculosis is still causing a socioeconomic loss and burden in many countries and areas as 40 to 70 % of tuberculosis are in the productive ages.

4. Pattern ofaee specific notjficatjon rate

The recent age specific incidence rate has been analyzed in 16 countries where both case number and population by age group are available. Figure 9 shows the patterns of the age specific notification rate categorized into 3 groups.

Pattern 1 (Viet Nam, Solomon Is, China)

The age specific notification rate becomes higher in proportion to age up to the middle age. After then it becomes plateau or slightly decreased.

Pattern 2 (Brunei, Fiji, Korea, Macao, Malaysia, Singapore)

The rate becomes higher in proportion to age. No peak is not observed clearly in younger age.

Pattern 3 (Australia, Guam, Hong Kong, Japan, New Zealand, New Caledonia, Kiribati)

The Rate becomes higher in proportion to age. Transient peak is observed in young age.

- 10-

5. Preyalence Qf TuberculQsis and Estimated Annual Risk Qf InfectiQn

5. 1 Prevalence of TuberculQsis

The current data Qf the prevalence of tuberculosis based on national prevalence survey are available only for 3 countries, namely China, Philippines and Korea after 1980. Table 6 shows prevalence rate of tuberculosis (per 100 (00) for 3 countries by type of disease and year.

International comparison of the indices of prevalence such as radiologically active pulmonary tuberculosis Qr smear positive tuberculosis is difficult due to the difference in criteria or diagnostic procedures, as discussed previously for the incidence. Compared to the previous surveys, the prevalence rate is decreasing steadily in China and Korea.

The decline in prevalence rate in China gives a clue to the improvement of notification (or tuberculosis service) as the number of new cases has been increasing in the country.

5.2 Estimated Annual Risk of Tuberculosis Infection (ARI)

Though ARI is regarded as the only Qne universal and comparable indicator for the epidemiological situation of tuberculosis, data on tuberculin survey have been collected from 5 countries as in Table 7: i.e., China, Korea and Philippines, Viet Nam (unpublished report), Fiji.

In most countries of the region, ARI is estimated to be between 0.5% and 1.6%. For China and Korea, the time trend of ARI is also available. ARI has been declining in China and Korea by about 7 % annually.

- 11 -

SUMMARY

In the Western Pacific Region, at least 0.72 million tuberculosis cases (all forms) are reported annually. Half of them are in China, and 94% of them are in 5 larger countries, namely China, Philippines, Korea, Viet Nam and Japan. In 14 countries and areas, the number of all newly notified cases is less than 100, and in approximately two thirds of the countries and areas, it is less than 1000.

The latest notification rate of all forms varies much among countries and areas. But it is higher than 150 per 100 000 in 6 countries (Cambodia, Kiribati, Micronesia, Palau, Philippines and Tuvalu), and it is lower than 10 per 100 000 in 3 countries and areas (Am. Samoa, Australia and Tokelau). The current notification rate of newly notified cases is 45.6 per 100 000 for the whole region.

On the whole, tuberculosis problems in WPR vary by country because of its variety of socioeconomic and geographical situation.

The average notifications in 1990-1994 have increased by 63 % from those in 1980-1984. In case of the notification rate, the increase is 44% between the same periods. More than 20% decrease in both number and rate between the same periods is observed in Australia, Brunei, Cook Is, Japan, Macao, New Zealand, Korea, Singapore and Tonga. More 20% increase is observed in China, Marshall Is., Micronesia, Palau and Philippines.

Looking at the recent time trend of notification rate of new cases in details, the stagnation of decrease or even increase tendency during recent years is observed in some countries, such as Australia, Guam and New Zealand. Australia and New Zealand are economically developed with low incidence rate and have the same tendency as European countries. In Australia 70% of notifications are foreign born people.

Evaluating from the age distribution of new cases in many countries and areas, tuberculosis still attacks to a great extent young productive age group. The age specific rate in the region shows general pattern of increase rate in proportion to age.

In conclusion, tuberculosis is still a big health problem in the Western Pacific Region.

- 12 -

People'. Republic of China

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Table 1

Countryl Area Am, Samoa Australia Brunei Cambodia China I"~) Cook Is. Fiji Fr. Polynesia Guam l-I0n.[J(_ong Japan Kiribati LaoPDR Macao Malaysia N, Mariana Is. Marshall Is. Micronesia Mongolia Nauru New Caledonia New Zealand Niue Palau

Latest Notification of Tuberculosis Cases and Deaths by Country in the Western Pacific Region I number 01 newly notlhed cases rate of newly notlhed cases tubercurosls deatlis 1 pulmonary CaSes extra- pulmoriaryeases--- -- - r -extria- '

population I slllear!'O~!tive" 'I total i pulmonary 1 total_slll.:ar£,>sitiv~ - _ T -toiall pulmonary 1 total year (million) new ,relapse 1 new I relapse year number rate

1993 0,0511 OJ 21 2 4 2.0 0.0 3.9 1993 17.6 "I 557 47 1 I 295 991 *1 3,2 0.3 1993 0.284 68 1331 27 160 23,9 46.8

3,9 \,7

9.5

7.8 1994 5,6 1993

56.3 1993 IS\.6 1994

o 57 2

0.0 0.3 0.7

1994 9.97 11058 540 13793 1319 15112 110.9 5.4 \38.3 \3,2

1994 1208.841 1047291

53118 363804 3638041 8.7 4,4 30,1 1994 0,019 1 2 31 4[ 5.3 10:S -is.r- 5.3

30.11 1990 (134681) (1\.9) ---if.n·-199"--- i---f.3

1994 0.771 60 1711 54, 225 1 7.8 22.2

1994 0.2151 38 71' 78i 111 89 1 17.7 3.3 36.3

29.2 7.0 1994 10 3

1.3 \,4

5.6 5.1

1994 0.147 40 5 851 9 94 27.2 3.4 57.8 6.1 4\'4[ 1994 63.9 1993 8

1994 1994 1994 1994 1993

5.8

124.8 0,077

4.74 0.3841'1

14777 184 752 108

6861 -----!:~:.---o!t~;r'I,- 22

1993 0,051 12 1994 0.1 15 1994 2.25 200 1994 0,011

------ ------------1994 0.178 1994 3.5

0,002 0,016

2

17 I

14

o

7

17 I

--0 8 o o

5852 41486 1

247

1077[' 265

10648 39 48 68

,

3 110t--

177

37

467 3084

6 58 20

\060 3

13 29

I 22 63

6319 44570

253

-I 100.9 -- --- --- .--- ----<---

11.8 - 33.2 239.01 22.1 320.8

8.1 108.9 1994 409 7.1 -.- 2.5 35.7 1994 3094 2.5

7.8 328.6 1994 10 \3.0

11351' 15.9 285 'I 28.1

117Q~ *~ ___ ~_ 46 46.8 61 23.5

22.7 1.2 23.9 1994 23 0.5 69.0 5.2 74.2 1994 21 5.3 54.1 5.4 59.4 1994 400 2.0 ---- --- -- ---83.0 6.4 97.9 1994 0 0.0 94.1 25.5 119.6 1993 0 0.0

3.6

0.0

171 1730

4

15.0 7.0 68.0 29.0 171.0 1994 4 4.0 8.8 0.8 9.6 - 76.9 1994 \30 5.8

18.2 9.1 27.3 9.1 36.4 1994 0 0.0 23.6 0.0 6\.8 12.4 74.2 1994 0 0.0

\,7 0.2 5.1 \.8 10.1 1994 5 0.1 0.0 0.0 50.0 - 100.0 1994 0 0.0

68.8 0.0 231.3 25.0 256.3 1994 0 0.0

Papua New Guinea Philippines----

1994 1994 1994 4.1

42 61 o

11 573

- ------- --._;-. 87401 1994 1994 1994 1994 1994 1994 1994 1994

66.2 300 3918

-I 180044

4 1417

\32 352

2 41

5335 180044 38155

45

14.0 7.3 95.6 34.6 \30.1 1994 163 4.0 132:'0 --.. - 272.0 6.0 ~272.0 1991 22814 36.3

Rep, of Korea 13266 2343 38155

Samoa Singapore Solomon Islands

44.56

0,169

2,821 1'1 0.366

181 861 170 44~ II 156,4 113

--------- ---~----

Tokelau Tonga Tuvalu

0.002 0,098 0,009

Vanuatu 1994 0.165

114 oj-

17

62

236 96 - ----~ --"

o 0

18 8

5 7

1191 33

VietNam 1994 72.91 ___ ~~6231 ,_~?.6~1--~63~31 _, 5440 Wallis & Futuna 1994 0.014 2t - 91 2

WPR(SumoftheabovefJ) 15911 2775271 6036217085651 13662

----r-BacteriolOgicaJly positive cases instead of smear positive cases

16771*1 332

o 23 19

152 51763

11

724848

29.8 5.3 85.6 - 85.6 1992 4082 9.3 10.7 0.6 26.0 0.6 26.6 1994 \0 5.9 30.5 6.0 55.4 4.0 59.4 1994 99 3.5 31.1 - 64.S 26.2 90.7 1994 23 6.3 0.0 - 0.0 0.0 0.0 1994 0 0.0

17.3 I \,1 37.6

18.4 5.1 23.5 1994 2 2.0 88.9 77.8 211.1 1994 2 22.2 72.1 20.0 92.1 1994 5 3.0

48.91 ___ 5.21_ 63.5 __ 7.5 71.0 1993 1536 2.2 14.3 r -r 64.3 i 14.3 78.6 1994 0 0.0

17.4 3.8 44.5 0.91 45.61 (32913) (9.0)

Fi.gure 2 Latest Distribution of Newly Notified Cases in the Western Pacific Region

Rep. of Kont. ('13) 7%

Phllippln •• ('94) 25%

Viet N.m ('13) 7%

J.p.n ('94) 6%

- 15 -

Figure 3 Latest Rate of All Newly Notified Cases by Country

Kiribati('94 )

Philippines('94 )

Palau('94)

Tuvalu('94)

Micronesia(,94 )

Cambodia('94 )

Papua New Guinea('94)

Marshall 15.('93)

Hong Kong(,94)

Niue('94)

N. Mariana 15.('94)

Vanuatu('94)

Solomon 15.(,94)

Rep. of Korea(,94)

Wallis & Futuna('94)

Mongolia('94 )

Macao('93)

New Caledonia(,94)

Viet Nam(,94)

Guam('94)

Malaysia(,94 )

Singapore('94)

Brunei('93 )

Fr. Polynesia(,94)

Nauru('94)

Japan('94)

China('94)

Fiji('94)

Samoa('94)

Lao PDR('94)

Tonga('94)

Cook Is.('94)

New Zealand(,94)

Am. Samoa('93)

Australia('93 )

T okela u('94)

272.0

256.3

211.1

171.0

151.6

130.1

119.6

108.9

100.0

97.9

92.1

90.7

85.6

78.6

76.9

74.2

74.2

71.0

63.9

59.4

59.4

56.3

41.4

36.4

35.7

.30.1

.29.2

,,26.6

~23.9

~23.5

.21.1

.10.1

.7.8

• 5.6

0.0

o 50 100 150 200 250 300

Rate (per 100 (00)

- 16-

328.6

350 400

Figure 4 Latest Rate of New Smear Positive Cases by Country

Philippines('94)

Kiribati('93)

Cambodia('94)

Palau('94)

Viet Nam('94)

N. Mariana Is.('94)

Macao('94)(*)

Hong Kong('93)(*)

Vanuatu('94)

Malaysia('94)(*)

Solomon Is.('94)

Singapore('94)(*)

Rep. of Korea(,94)

Guam('94)

Brunei('93)

New Caledonia(,94)

Marshall Is.('93)

Tuvalu(93)

Nauru('94)

Fr. Polynesia('94)

Tonga('94)

Lao PDR(,94)

Micronesia('94)

Wallis & Futuna('94)

Papua New Guinea('94)

Japan(,94)

Samoa(,94)

Mongolia('94)

China('94)

Fiji('94)

Cook 15.('94)

Australia('93)(*)

New Zealand(,93)

Am. Samoa('93)

Niue('94)

Tokelau('94)

110;9

68.8

48.9

46.8

43.0

41.9

37.6

34.8

31.1

30.5

29.8

27.2

23.9

23.6

23.5

22.2

18.2

17.7

17.3

15.9

15.0

14.3

14.0

11.8

.10.7

_8.9

_8.7

"7.8

.5.3

.3.2

II 2.6

.2.0 *: New bacteriologically positive cases

0.0

0.0

o 50 100

Rate (per 100 000)

- 17 -

132.0

128.6

150

Table 2 Trend of Newly Notified Cases (Number of All and New SmearlBacteriologically Positive Cases)

Countryl Area 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

Am. Samoa all 12 12 7 8 2 2 6 6 8 12 5 8 9 13 5 15 2 4 '~~;;;'s:;""""""""""""""""""""""""········ .. ········· .... ··················· .. ······0· .. ···········(,······· .. ······j·· .... ·········;;············ .. 9········· .. ·· .. 2"· .. ········ .. ·5············ .. 3········· .. ·· .. ···· .............................................................................. j .................. .

Australia all \347 \387 1251 1292 1542 1457 \386 1270 1219 1299 1088 906 907 954 952 1016 950 1011 991 ·~~;;;·B+······· .. ··io26·········j·oo2"··········iiiil··········74·i···········so7··········1(;5··········723··········690··········S96··········634······· .. ·sij······ .. ····· ....................................................... ········· .. ··························· .. ·s·j"6··········s57 .. ·················

Brunei all 336 230 216 196 285 245 276 256 238 212 189 126 128 143 ,160 ............................................................................................................................................................................................................................................................................................................................................................ newS+ 68

Cambodia all 8158 7572 10241 10145 10325 9106 10691 7906 6501 10903 16148 13270 15112 ..................................................................................................................................................................................................................................................................................................................................... _ .............. _ .. newS+ 5801 5316 5507 5235 8715 7173 8246 5842 5132 8507 12910 9560 11058

China all 98654 117557 151564 226899 265095 313604 362114 36n99 375481 376246 344218 363804 ......................................................................................................................................................................................................................................................................................................................................................... new S+ 19236 25628 38367 53078 60949 90184 84898 104729

Cook Is. all 30 37 10 19 29 20 36 17 16 15 12 6 4

newS+ 4 4

Fiji all 268 259 257 183 205 210 180 163 185 165 230 199 173 162 218 252 210 240 225 ................................................................................................................................................................................................................................................................................................................................ _. __ ................. . new S+ 128 122 145 101 114 III 97 98 79 82 99 86 75 65 76 83 63 7S 60

Fr. Polynesia all \34 110 95 78 81 73 58 48 66 73 75 79 63 64 58 59 49 83 82 89 ............................................................................................................................................................................................................................................................................................. _ ...... _ .......... _ ............................. - ... .. new S+ 72 42 41 32 41 52 39 32 48 52 48 49 45 44 43 34 40 39 38

0;; Guam all 49 46 67 64 71 5S 41 49 48 54 37 49 34 41 75 40 70 94 ......................................................................................................................................................................................................................................................................................................................................................... newS+ 53 40

. Hong Kong all 8192 7928 7191 6623 7903 8065 7729 7527 7301 7843 7545 7432 7269 7021 6704 6510 6283 6534 6537 6319 ·;;;;;·8:;: .......... · ........................ · .. · ........ · .... · .................................... · .... · ........................................ · ........ · ............................ 4·i42 .. · .... ·4·j·j·O ........ 4042 ........ 39ii·· ...... ·j·768· ...... ·3670 ........ 3S64 .......... · .............. 2"429 ........ · ........ ..

Japan ~I 108088 97924 89245 80629 76455 70916 65867 63940 62021 61521 58567 56690 56496 54357 53112 51821 50612 48956 47437 44590 ·~~·S:; ...... · .. i3:;o'3 ...... ·j·j'j'6ii ...... i·3373 ...... ·i3·i98 ...... i28ii6 ...... i·ii9j ........ i:i2'i4 ...... ·j2649 ...... j·j·oj·O ...... j·3277 ...... ·i'3·so'S' ...... j·j·74S ...... j·44Qs ...... ·i4S92 ...... ·j4'1i·o ...... j·S49S ...... ·is28S .. · .... i'S;W ...... j·sii·o ...... 14777· ..

Kiribati all 279 278 97 40 94 146 \87 193 127 III 103 129 1\0 208 121 68 100 253 ·~~·S:; .............. '3·i ...... · ...... 2"3 ............ :i:i .............. 4 .......... · .. i'j" .......... ·j·O ............ 34 ............ ·j·-i ............ ·j·;j .................................... · ....................................................................................................... · .... ·· ............ ;j9 .......... ·ii4· ..

LaoPDR all 1951 994 1905 1135 ......................................................................................................................................................................................................................................................................................................................................................... new S+ 526 459 765 752

Macao all \383 442 1101 585 455 671 571 420 389 320 274 343 329 294 318 349 ......................................................................................................................................................................................................................................................................................... ~ .............. -.............................................. . new B+ 133 124 140 158 108 171

Malaysia all 11692 11098 10264 10441 11094 11168 10970 11894 11634 10577 10569 10735 11068 10944 10686 11802 11586 12285 11708 ......................................................................................................................................................................................................................................................................................................................................................... newB+ 6717 6609 6050 6313 6622 6819 6766 7320 7251 6660 6682 6653 6924 6718 6711 6774 6752 6754 6954 6861

N. Mariana Is. ~I 26 75 74 58 64 16 49 27 28 67 46 .. ..................................................................................................................................................................................................................................................................................................................................................... .. new S+ 0 II 3 28 4 5 22 21 22

Marshall Is. all 17 8 6 4 6 7 12 15 12 15 37 32 \I 7 52 61 ......................................................................................................................................................................................................................................................................................................................................................... new S+ 5 4 6 6 7 8 4 14 12

Micronesia all 67 73 75 66 60 97 77 68 I II 151 171 ......................................................................................................................................................................................................................................................................................................................................................... newS+ \I 32 18 14 10 18 19 8 15

Table 2 Trend of Newly Notified Cases (Number of All and New SmearlBacteriologically Positive Cases) (cont'd)

Countryl Area 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 Mongolia all 1117 1121 1075 1107 1123 1160 1094 1325 1514 1652 2994 2819 2433 2538 2233 1659 1611 1516 1418 1730

'~~;;;'s+""""""""""""""""""""""""'" ..................................................................................................................... ········j·63· .. ·······3Z0······ .. ··27·j··········276········· .. 234········ .. i'8S .. ·········j2S····· .. ······92 ...... · .... ·8:; .. · .. ··· .. 200··· Nauru all 4

·~~;;;·s~ .. · .............. · .... · ...................................................... · .... · ........................................................................................................................................................................................................................ · .......... · ................ 2 .. ·

New Caledonia all 108 128 107 161 144 104 98 74 III 110 130 140 140 149 132 ·~~;;;·s~ .................................................................................................................................. j . .j' ............ ;;o ........................................................... · ........ · .. · .......... · .......... ·40 ............ :i:; ............ :i:i .. · .......... j·2 ........ · .. ·35· .......... ·42 .. ·

New Zealand all 663611 608595542474448437415402359320296295303348335317274352 ......................................................................................................................................................................................................................................................................................................................................................... new S+ 69 66 55 62 91 61

Niue all 2 1 2 ·~~;;;·S~ .. · .... · ...... · .................. · ........ · ................ · .. · ........................................................................................................................................................................................................................................ · ............ · .. 0 ........ · .... ·0 .. ·

Palau all 20 5 7 14 9 17 10 17 14 20 26 13 38 17 3 6 25 41 ·~~;;;·S~ ...................... · ........ · .......... · .................... · .... · .............. · .. · .......... j·o .. · .......... ·s .............. ·z .............. 6 .................. · .......... · ............... ·0 .............. 4 ...................... · .. · .................. · ................ · .................................. ii ............ ·j·j .. ·

Papua New Guinea all 1782 2212 2446 2232 2525 2418 2742 2954 3505 3678 2877 3235 4261 3396 2497 3401 2540 5516 5335 ·~~;;;·S+ .............................. · .............. 8S2 .......... 90·j .......... ·S·S3· ........ ·96:; .. · .... · .. S67 .......... 94·2· ...... · .. S:;O ........ ·j06·j .......... ·S·jO .......... ii06 .......... S39 ...... · .. j2·j·j ...... · .... ;;sj .......... ·;;·j·j .......... 4·S9· .. · .......... · .......... ·S·j2 .... · .... ·s'1'j .. ·

Philippines all 133537 148057 107108 118587 108813 112307 116821 104715 106300 151863 151028 153129 163740 183113 217272 317008 207371 236172 174189 180044 ·~~;;;·S~ .. · ...... · ...... · .... · .... · ................ · .......................................... · .... j·jz7S· .... ·j·9006 ...... 206·j6 ...... j·S6S:; ...... 2·i29·j ...... 3957·j ...... ·S·0624· .... ·:;:ij·SO ...... 636SS .. · .. ·970jO .... · .... · .... · ........................ · .............. ·92:i79 ...... ii:;4ii·j· ..

:a Rep. of Konea all 81910 89803 98532 91572 85669 87169 88789 87419 74460 70012 63904 57864 48070 46999 38155 ......................................................................................................................................................................................................................................................................................................................................................... newB+ 34633 38211 43868 46735 45688 42561 48515 49083 45066 39040 33968 30700 2R79O 17136 16630 18375

Samoa all 51 79 36 59 58 59 49 43 41 37 29 29 31 44 26 49 45 ·~~;;;·S+ ............................................ · ........ · ...... · .................................... · .............. 32 ............ ·j·O ............ 2S ............ 20 .... · ............................................................................................................................ 2 ...... · .... ·2·j ............ ·jS .. ·

Singapone all 3097 2813 2760 2964 2800 2710 2425 2179 2065 2143 1952 1760 1616 1666 1617 1591 1512 1722 1677 ......................................................................................................................................................................................................................................................................................................................................................... newB+ 1424 1361 1285 1375 1197 1266 1062 998 860 992 949 839 740 794 823 840 841 861

Solomon Is all 261 307 355 411 452 266 313 324 302 337 377 292 334 372 488 382 309 364 361 332 ......................................................................................................................................................................................................................................................................................................................................................... newS+ 133 187182 174 184 153 174176130155 155 101 115 137 149 117 88 130 ISS 114

Tokelau all 0 0 2 9 I 0 ......................................................................................................................................................................................................................................................................................................................................................... newS+ 0 0

Tonga all 90 67 62 89 71 64 49 45 50 54 49 35 24 14 35 23 19 23 32 23 ·~~;;;·S~ ........ · ...... 26 .... · .. · .... ·22 ...... · .... ·29 ............ 4·j ............ ·i'8 .. · ........ ·32' .. · ........ ·jS ........ · .. ·2S ............ ·23 .... · ...... ·2S ............ 2·j ............ ·j·S· ............ j:i· ...... · ...... ·j' ............................ j·;;· ............ j7 ............ ·j·j ............ j·;; .......... · .. j7 .. ·

Tuvalu all 7 33 18 12 23 9 32 27 22 24 25 23 16 30 28 19 ......................................................................................................................................................................................................................................................................................................................................................... new S+ 23 10 3 7 3 3 5 7 7 2 7 5 5 2 I

Vanuatu all 214 214 ISO 131 184 178 92 173 171 188 124 131 90 118 144 140 234 141 114 152 ......................................................................................................................................................................................................................................................................................................................................................... new S+ 82 67 57 52 52 59 34 49 55 55 5 I 36 26 46 39 84 41 62

VietNam all 19514 56272 68650 11821 43062 43506 51206 43185 43875 46941 47557 55505 52463 52270 47536 54509 56594 52994 51763 ......................................................................................................................................................................................................................................................................................................................................................... newS+ 33243 33014 32612 30426 34217 30381 34530 39486 35095 30728 35865 38659 36534 35613

Wallis & Futuna an 4 II ......................................................................................................................................................................................................................................................................................................................................................... newS+ 2

Table 3 Trend of Newly Notified Cases (Rate of All and New SmearlBacteriologically Positive Cases; per 100000)

Country/Area 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

Am. Samoa all 40.0 40.0 22.6 25.8 6.3 6.3 18.2 17.1 23.5 34.3 13.9 22.2 24.3 35.1 13.5 31.9 4.2 7.8 '~'~~'s~""""""""""""""""""""""" .. ··············································0·0··········iii:2···········ii:;;·········j·:;::;·········2S··j···········s·6··········i):9···········ii:j·············· ........................................................... ··················2·0···,·············

Australia all 9.7 9.9 8.8 9.0 10.6 99 9.3 8.4 7.9 8.4 6.8 5.7 5.6 5.8 5.7 6.0 5.6 5.8 5.6 ~~;;;·ii:;:··············:;:4··········-:;:2···········(;:2"······ ····s·"i···········S·6···········5·2···········4:9···········;j:s··········i·9"··········4··i···········3::;····· ........................................................ ············································ij···········"3"2····· .. ··········

Brunei all 207.4 133.0 120.7 106.0 147.7 122.5 110.4 95.2 106.3 938 80.4 52.3 55.9 56.3 .............................................................................................................................................................................................................................................................................................................................................. newS+ 23.9

Cambodia all 118.2 106.7 142.2 137.1 135.9 116.7 135.3 98.8 79.3 129.8 187.8 142.7 151.6 ·~~~·s:;:··············································· ...................................................... ······················8;j:j··········:;;j:Cj·········7·6"·S···· .. ···70·7········i·i4·:;·········92:0·······j·ii4:;j·········:;3·0········6i6"·······io·i:)········i50:j········j·02i······j·j·0:Cj·

China all 9.611.514.421.425.229.633.033.133.132.7 30.1 ~~·s~················································· ...................................................... ·······················j·:9··········"2:s···········i·7···········5".0···········5·8············ .. ··············· ........................................................ ·····:;::;···························S:7··

Cook Is. all 166.7 205.6 58.8 105.6 161.1 1053 180.0 85.0 94.1 882 5.0 5.9 70.6 31.6 21.1 . ........................................................................................................................................................................................................................................................................................................................................... .. new S+ 23.5 21.1 5.3

Fiji all 47.1 44.3 43.1 30.1 33.0 33.1 27.8 24,8 27.6 23.6 32.4 27.5 23.1 22.3 29.5 34.1 28.1 31.8 28.7 ·~~~·S~·············22:S·········Z0:9·········24:j·········j·(;·(;·········ji·4··········i7:5··········i5:0·········j·;j:Cj·········j·j··S·········j·j··:;·········j3:"9··········i·i:9··· ... ···j·0:O···········S:Cj· .... ····j·O:3 .. ····· .. ·ji"i···········S:4···········!i:!i···························:;:ii·

Fr. Polynesia all 101.5 80.9 68.4 55.3 55.5 49.0 38.7 31.2 39.5 45.6 46.9 44.1 37.1 33.9 32.2 33.3 27.1 44.9 39.4 41.4 ;:;~;·S~·············:s4:6·········30:9·········2Cj:5·········22·:;········"ii·j·········34·9·········Z6:0·· .. ·····20:8·········2ii·:;·········3"2·S·········"30:0·········2:;:4·········26:5·········23·3·········2j·"9··················· .. ·· .. is:8"········2.:6·········j·s:s·········j7~7··

~ Guam all 64.5 58.2 81.7 76.2 68.3 51.4 37.3 48.5 42.5 45.4 30.8 40.2 27.2 33.1 59.5 31.R 48.6 64.0 .............................................................................................................................................................................................................................................................................................................................................. new S+ 36.8 27.2

Hong Kong all 182.0 176.2 156.3 140.9 161.3 158.1 148.6 144.8 137.8 145.2 137.2 135.1 129.8 123.2 115.6 112.2 106.5 110.8 112.7 109.0 ~~·ii:;:················································· ............................................................................................................ ·············:;:s:j·········:;4::;·········:;2:2·········6"s::;········65·.0·········6):) .. ·······6O:;j·············· ........... ;jj.:9 ................ .

Japan all 96.9 86.8 78.4 70.2 66.0 60.6 56.0 54.0 52.0 51.5 48.5 46.6 46.5 44.6 43.2 41.9 40.8 39.3 38.1 35.7 ·~~·S:;:·············ii)·········11·9·········j·j··:;·········j·j··S·········ji·j··········io:·s··········io:4·········j·O::;·········j·O·Cj·········j·j··j··········ii4 .. ········i·i:j·········j·j·:!i .. ·······iio·········ji"O·········j"i·S······ .. ··i:z:j .. ·······j·i:s·········j·2:2··"""'jis'

Kiribati all 516.7 505.5 173.2 71.4 162.1 243.3 306.6 321.7 208.2 179.0 163.5 201.6 169.2 315.2 177.9 100.0 140.9 328.6 ~~·S:;:············5:;X·······;jl:ii·········jCj:3···········j··j·········36·i·········i6·"-i·········SS::;·········2ii:3 .. ·······23:0········································ ....................................................... ········· .. ········ .. ········· .. ··· .. ·················j·2S:;;·······23CjO·

LaoPDR all 45.4 22.6 41.4 24.0 ·~~;·S~··············································· .......................................................................................................................................................................................................................... ··i2:2·········j·O:;j·· .. ··· .. j·;;:;;· .. ······j-s.·Cj·

Macao all 410.8 196.3 149.7 217.2 145.7 100.7 94.0 72.1 59.6 75.9 69.6 77.2 82.8 87.7 ·~~;·B~··············································· ................................................................................................................................................................... ························2S."9······-27:4·········29:6"· .. ·····;jj·:S·········28:i··········4"3":O·

Malaysia all 98.3 88.8 80.2 79.7 82.8 81.2 77.8 82.0 78.3 69.6 66.6 66.6 66.1 64.5 61.6 66.0 61.9 64.7 59.4 ·~~~·B~············S6::s·········52:9·········;j:;·3·········4ii·2········49"·4········4"9·6·········48:0·········5O:S·········;jS·S········4·j·"ji········42·i·········4"i:j·········;j·i:3·········3Cj·6"·········3S .. 7·········37:9····· .. ··j6:9·········36:.·········36:;;·········34"08"·

N. Mariana Is. all 152.9 441.2 435.3 305.3 320.0 80.0 136.1 71.1 73.7 145.7 97.9 ~~~·S~················································ ...................................................... ········O:O .. ·······6;j::;·········j·:;:7········i47·.4·········20:0·········25:0·········;;j·:j··················· ...................................................... 45::;························:;6:·8··

Marshall Is. all 65.4 29.6 21.4 14.3 19.4 21.9 37.5 45.5 34.3 53.6 127.6 106.7 25.6 17.5 106.1 119.6 ~~·S~·····························································································i6:·i·········j"2:s·········j·si······ .. ii2········"i0·0 .. ·······28:6·········.3:8·· .. ··· .. ············································································ .. ·28:;;·········23:5····· .. ···· .. ····

Micronesia all 93.1 100.0 85.2 12.5 63.8 103.2 79.4 71.6 102.8 151.0 17I.0 ·,;;;~·S:;:················································ ...................................................... ·····················j·s:j··· .. · .. ·43:S·········io .. s··········is·.4··········io:;;·········j·9:2···· .. ·········· ......................................................... i:;:;;···········s:o·········j·s·:O·

Table 3 Trend of Newly Notified Cases (Rate of All and New SmearlBacteriologically Positive Cases; per 100000) (cont'd)

Country! Area 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 Mongolia al\ 78.7 76.3 71.2 71.4 70.2 70.7 65.1 77.0 85.5 91.3 161.8 1484 1248 126.9 109.5 79.0 74.9 69.2 63.9 76.9 ..............................................................................................................................................................................................................................................................................................................................................

new S+ 19.6 16.8 \3.9 \3.8 11.5 8.8 6.2 4.2 3.9 8.9

Nauru all 36.4 .............................................................................................................................................................................................................................................................................................................................................. new S+ 18.2

New Caledonia all 77.7 89.5 723111094.7 69.3 66.2 48.1 69.4 688 79.3 83.8 819 85.1 74.2 .............................................................................................................................................................................................................................................................................................................................................. newS+ 23.0 41.4 25.0 22.6 19.8 18.7 20.0 23.6

New Zealand all 21.4 19.7 19.6 19.2 17.5 15.3 14.5 13.7 13.0 12.2 11.2 9.7 9.0 8.9 8.9 10.2 9.9 9.1 7.8 10.1 ..................................................................... " ..................................................................................................................................................................................................................................................................... .. new S+ 2.2 2.0 1.7 1.9 2.6 1.7

Niue all ·~~;;;·S:;.············· .. ································· .......................................................................................................................................................................................................................................... ~:!. ......... ~?? ..... ~.?.?.:?.. 0.0 00

Palau all 153.9 38.5 50.0 100.0 64.3 113.3 66.7 141.7 100.0 153.9 216.7 92.9 271.4 121.4 25.0 50.0 1563 256.3 .............................................................................................................................................................................................................................................................................................................................................. new S+ 66.7 33.3 16.7 42.9 333 0.0 28.6 50.0 61.8

Papua New Guinea ~!! ..................................... ~:~ ......... ??:? ......... !~ .. ~ .......... ??:.? ......... ~~:~ ......... !.~:? ......... ~~:! .......... ~.~.~ ........ ~.~ .. ~ ........ ~?..~;: ......... ~:~ ......... ~?:? ....... ~.~.~:~ ......... !.?:.~ .......... ~.?:.~ ......... ~?;~ ......... ~~:.I ........ !.~~:~ ....... ~~.?:~ .. newS+ 30.4 31.1 30.5 32.2 28.0 28.6 24.9 32.2 25.6 17.8 23.3 35.4 24.4 16.5 12.9 19.8 14.0

Philippines .~!! ................... ~.~~;.~ ....... ~~~:~ ...... ?~!:? ...... ?~:~ ........ ~.~?.~ ....... ~~~:.~ ....... ~~~:? ....... ~~.~ ....... ~.~:~ ........ ~.~ .. ~ ....... :!~;~ ....... ~:.~:;, ....... :!.!:? ....... ~.?.!:?. ....... ~~.!:.~ ....... ~.!~;~ ....... ~~?:!. ....... ~!.?:~ ....... :~!:! ...... :.?~.~. new S+ 35.9 38.4 40.3 35.8 39.9 72.4 90.4 122.9 107.1 161.5 142.4 132.0

IV Rep. of Korea ~~! ................................................................................... ~.!! .. ~ ....... :.~.~:~ ....... ~~~:~ ....................... ~.~.?~~ ........ ~.!L.~ ....... :.!.!:.~ ....... ~.I.::L ...... :?!.:!. ....... ~.??:~ ....... ~.~.~ .. ~ ........ ! 4~;.~ ........ ~~~;? ........ I.!.?.:~ ....... !.~:?. ......... !~.:~ .. newB+ 921100.2113.3 118.8 114.4104.9117.7 117.2 107.1 93.0 80.2 71.866.740.7 37.7 41.2

Samoa all 34.0 52.0 23.4 37.8 36.7 36.7 31.4 27.4 25.5 22.7 11.0 18.0 21.8 27.2 16.2 29.3 26.6 .............................................................................................................................................................................................................................................................................................................................................. newS+ 20.5 19.1 15.5 12.3 1.2 12.6 10.7

Singapore ~!! .................... I.~~;? ........ I.::..:. ....... !.~.!:?. ....... ~.~.~ .. ? ........ !.!?:.~ ........ !.!::~ ......... ??:~ ......... ~!:: ......... ~.7.:~ .......... ~~ .. ~ ......... :.~:.~ ......... ~~:? ......... ~!.:! ......... ~::?. ......... ~.~~ .......... ~~;? ....................... ~~:!. ......... ~!.:?. ......... ~.?.:~ .. newB+ 62.9 59.4 55.3 58.4 50.2 52.4 43.5 40.4 34.4 39.1 37.1 32.4 28.3 30.0 30.7 31.1 29.8 30.5

Solomon Is all 137.4 153.5 171.5 192.1 204.5 117.7 134.3 129.6 116.6 125.3 139.6 102.1 115.6 121.6 152.5 120.1 93.9 109.0 103.7 90.7 .............................................................................................................................................................................................................................................................................................................................................. new S+ 70.0 93.5 87.9 81.3 833 67.7 74.7 70.4 50.2 57.6 57.4 35.3 39.8 44.8 46.6 36.8 26.8 38.9 43.1 31.2

Tokelau all 0.0 0.0 100.0 450.0 50.0 50.0 50.0 0.0 .............................................................................................................................................................................................................................................................................................................................................. new S+ 0.0 0.0

Tonga all 102.3 74.4 68.1 94.7 74.7 68.8 52.1 45.5 48.1 56.3 49.5 36.1 25.3 14.6 29.2 23.2 19.0 23.0 32.7 23.5 .............................................................................................................................................................................................................................................................................................................................................. newS+ 29.6 24.4 31.9 43.6 29.5 34.4 19.2 25.3 22.1 26.0 23.2 18.6 12.6 7.3 . 16.2 17.0 17.0 16.3 17.4

Tuvalu all 100.0 471.4 225.0 150.0 287.5 112.5 400.0 337.5 275.0 300.0 312.5 287.5 200.0 375.0 31 U 211.1 ................. _ .......................................................................................................................................................................................................................................................................................................................... . new S+ 328.6 125.0 37.5 87.5 37.5 37.5 62.5 87.5 87.5 25.0 87.5 62.5 62.5 22.2 11.1

Vanuatu all 225.3 220.6 151.5 128.4 162.8 154.8 76.7 139.5 133.6 144.6 94.7 97.0 62.1 71.7 90.0 95.9 156.0 96.1 73.1 92.1 .............................................................................................................................................................................................................................................................................................................................................. new S+ 86.3 69.1 57.6 51.0 460 51.3 28.3 39.5 43.0 42.3 389 26.7 17.9 30.7 24.4 54.9 26.3 37.6

VietNam all 41.0 1153 \33.8 22.5 80.2 79.3 91.4 75.6 75.3 77.9 77.0 85.5 81.7 80.9 72.0 10.5 81.9 74.3 71.0 .............................................................................................................................................................................................................................................................................................................................................. new S+ 60.6 59.0 57.1 52.2 56.7 49.2 53.2 61.5 54.3 46.6 53.0 56.0 51.2 41.9

Wallis & Futuna all 28.6 78.6

newS+ 14.3

N N

Table 4

Country/Area

Am. Samoa Australia Brunei Cambodia China Cook Is. Fiji Fr. Polynesia Guam Hong Kong Japan Kiribati Lao PDR Macao Malaysia N. Mariana Is. Marshall Is. Micronesia Mongolia Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Rep. of Korea Samoa Singapore Solomon Is. Tokelau Tonga Tuvalu Vanuatu VietNam Wallis & Futuna me wnole 01 WYK

Average Number and Rate of All Newly Notified Cases in 1980-1984, 1985-1989 and 1990-1994 average notification number and rate (all newly notified cases) percentage of change from the period of 1980-1984

1980-1984 1985-1989 1990-1994 1985-1989 1990-1994 number rate number rate number rate number rate number rate

7 20.1 8 21.9 7 14.4 18% 9"10 3% -29"10 1326 8.8 961 5.9 992 5.8 -28% -32% -25% -34% 252 114.7 179 82.6 152 56.1 -29% -28% -40% -51%

8657 122.5 9635 124.5 12387 139.3 1\% 2% 43% 14% 122592 11.9 307102 28.5 364937 31.9 151% 141% 198% 170%

23 127.8 17 90.4 6 31.9 -26% -29"10 -75% -75% 181 27.3 196 26.9 232 30.8 9"10 -1% 28% 13% 64 40.8 68 38.6 72 37.5 7% -5% 14% -80/. 49 44.9 47 38.3 68 48.9 -4% -15% 38% 9%

7693 146.8 7194 128.0 6437 110.2 -6% -13% -16% -25% 64853 54.8 55844 45.9 48683 39.2 -14% -16% -25% -29" ...

153 251.3 134 205.8 140 194.9 -12% -18% -8% -22% - - - - 1496 33.2 - - - -

703 238.5 395 92.8 327 78.2 -44% -61% -54% -67% 11249 77.7 10800 65.0 11845 62.9 -4% -16% 5% -19%

58 )32.9 37 121.1 57 121.5 -37% -64% -3% -63% 10 31.9 20 60.0 57 113.0 96% 88% 443% 254% 72 92.3 74 78.1 144 140.6 3% -15% 101% 52%

1349 78.3 2603 133.6 1587 72.7 93% 71% 18% -7%

- - - - 4 36.4 - - - -130 89.1 99 64.4 138 80.8 -23% -28% 7% -9% 435 13.7 315 9.5 325 9.4 -28% -30% -25% -31%

- - - - 2 71.4 - - - -16 1\3.0 19 147.0 24 163.6 24% 30% 54% 45%

2829 87.3 3489 97.5 3858 98.4 23% 12% 36% \3% 118401 232.7 173656 300.5 222957 350.6 47% 29" ... 88% 51% 91394 232.3 81570 194.7 50998 116.9 -11% -16% -44% -50"10

46 28.7 32 19.3 41 24.9 -31% -33% -10"10 -13% 2304 93.1 1722 65.8 1626 58.4 -25% -29"10 -29% -37%

308 .124.7 373 126.7 351 103.1 21% 2% 14% -1,-... 0 0.0 4 200.0 I 33.3 - - - -

52 53.9 31 31.0 24 24.2 -40"10 -43% -54% -55% 19 243.6 26 325.0 23 276.2 37% 33% 22% 13%

160 130.0 121 84.2 157 102.2 -24% -35% -2% -21% 44967 80.3 50947 80.7 52679 75.9 13% 0"10 1'-10 -5%

- - - - 8 53.6 - - - -41103:jJ 35.5 707721 4'1.11 fll.lll4U 51.0 4,../. 41n'. OJ.,,. __ 44~

~

Table 5 Average Notification Rate of New Smear Positive Cases in 1980-1984, 1985-1989 and 1990-1994

Country! Area Am.Sanioa AuS1ralia(*) Brunei Cambodia China

Cook Is. Fiji Fr. Polynesia Guam Hong Kong(*)

average notification number and rale (new smear positive cases) 1980-1984 1985·1989 1990-1994

number 5

682

5541

rate

14.2 4.5

78.4 27744 2.7 ------------_.

93 45

14.1 28.6

number 3

583

7042 57014

80 46

3016

rate 9.2 3.7

number

547 68

91.0 9433 5.4 94814 .---- --.----.. ---- --f'---'

11.0 26.1

70 38 47

53.7 2778

rate

2.0 3.1

23.9 106.1

8.2 16.4 9.3

19.1 32.0 47.4

percent change from the period of 1980..1984 1985-1989 1990-1994

number rate number rate

-J 1% -35% -79% -86% -14% -18% -20".4 -31%

27% 16% 70".4 3S% 106% 10 I % 242% 206%

-14% 3%

-22% -9%

-25% -34% -15% -33%

Japan 12688 '--IO~7- ---i42n-- ----flj-·- ---1-5262 12.3 12% -100".4

9% -100%

20% 428%

15% 31S% K~mm 19

LaoPOR Macao(*)

Malaysia(*) N.Manana I-s. - - -.- ..

MatshaII Is. Micronesia Mongolia Nauru

6963 -if

6 20

243

-~---.---.----- --- .. -.-. - .- -----_._ .. New Caledonia 47 NewZeaIand Niue Palau 6

31.0

133 48.1 6738

. - 60.0 --- - - . ---10--17.2 6 26.2 14 14.1 289

32.1

41.1

40 63

3

28.9 40.6 40.8 2J.J 15.1 14.8

99 626 140

6819 - -i2

13 14

'130 2

2S.0 -- ...... -. 36

1.9 76 o

20.0 10

128.6 13.9 33.6 36.4 -3"1. -16% -2% -24% -46~i------ . -2"- -32% IOS% -23%

26.0 7% 23% 132% S 1 % 13.6 -31% -43% -31% -48% 5.9 19% 5% -47% -S8%

18.21 --20.9 ------ -IS% .:22% -24% -3S%

2.2 0.0

S9.4 -54% -S 1% 6S% 45% Papua New Guinea Philippines- -

941 29.1 908 25.4 621 1S.8 -4% -13% -34% -46o/e

Rep. ofKorea.(*) s-c. Singapore Solomon Is. Tokclnll--- -

TOII8Il Tuv ....

Vma.ru

-1938-1-----38.1----·-64614- . --111:8---- 89840---137.2 233% 193% 364% 260%

43413 27

1036 _______ . ___ 158

25 9

SO

110.4 43134 102.9 22446 51.4 -1% -7% -48% -S3% 16.8 14 8.3 -100% -100% . -49% -SI% 41.9 829 31.7 847 3O.S -20% -24% -11% -27% 63.7 131 44.7 121 3S.S -17% -30% -23% -44%

--.- - --. .---- -.---- ----- -1)"-· .-- 0.0

25.3 11 •. 0 40.8

IS IS.S 17 16.8 -39% -39% -33% -34% S 60.0 4 47.6 -41% -49% -S'7% """"

4() 21.3 62 39.S -21% -33% 24% -3% Viet NEt 32324 57. I 34742 55.0 3S430 5J.J ,..4 -4% 10% -1\% Wallis.t Futuna --------- ------ - 2 14.3

1lIeWiloleofWPR J3J4n IJ.3 23374'J lTi.6""210499 - --......-s:u ~ 41% "'" 59%

.: ~ically potiIive c:uos

Figure 5 Time Trend of Number of Newly Notified Casel in Selected Countries

Number

I~r---------------------------______ ~

100000 ......... / .. x '. .......... .. .. .. .. ..

... ~--x-A-~-

I

10000 0-0' ~,o 9 , ."", I

0.. "0/ .~ :

'J

1000L-~~~~~~~~~~~~~~~~~

1975 1980 1885

Year

1990

- 24-

I ---0-- China

I \ •••••. Japan

I

---- Philippines

-6-- Rep. of Korea

-~-VietNam

- ~ - Cambodia L ____ --"

Figure 6

KiribatiC94)(790/0)

PalauC94)(270/0)

Microne5ia(,94)(130/0)

Papua New Guinea('94)(160/0)

Hong Kong(*)('93)(470/0)

N. Mariana 15.('94)(48%)

Solomon 15.('94)(34%)

Macao(*)('93)(38%)

Mongolia('94)( 12%)

Viet Nam(,94)(78%)

Singapore(*)('94)(61 %)

Brunei('93)(43%)

Nauru('94)(75%)

China('94)(43%)

Samoa(,94)(42%)

Tonga('94)(74%)

New Zealand('94)(20%)

Australia(*)('93)(61 %)

Latest Notification Rate of Smear Positive Cases and Smear Negative Cases by Country

.----~---

~ , 0 smear negative cases or unkown i

" • smear positive case

~ ~ .: bacteriologically positive cases

D Parenthesized percentage refers to proportion of

~ ~

smear (or bacteriologically) positive coses in all cases.

o 50 100 150 200 250

Rate (per 100 000)

- 25 -

.

300 350

Figure 7 Latest Rate of Tuberculosis Death by Country

.

13.0

11.9

9.4

7.1

6.3

5.9

5.8

5.6

PhllippinesC91)

KiribatiC94)

ChinaC90)

Rep. of KoreaC92)

Hong KongC93)

Solomon Is.C94)

SamoaC94)

MongoliaC94)

Guam('93}

Macao('94}

Micronesia('94}

5.3

Papua New Guinea('94}

Singapore(,94}

Vanuatu('94}

Japan('94}

Viet Nam(,93}

Malaysia('94)

Tonga('94}

Fr. Polynesia('94}

Fiji('94)

Brunei('93)

Lao PDR('93}

Australia(,93)

New Zealand('93}

Am. Samoa(,93}

Cook Is.(,92)

N. Mariana 15('94)

Marshallls.(,93}

Nauru('94)

New Caledonia('94}

Niue('94}

Palau('94)

Tokelau(,94}

Tuvalu(,93)

Wallis & Futuna(,94}

4.0

4.0

3.5

_3.0

_2.5

_2.2

~2.0

~2.0

.. 1.4

~\.3 ~ 0.7

0.4

0.3

0.1

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

o 5 10 15 20 25 30

Rate (per 100 000)

- 26-

36.3

35 40

Figure 8 Age Distribution of Tubereulolis Cales Group A: Distribution Is higher in young age groupe under or

around 20S or 30a and much lower In the older ega groupe.

China (1994) Smear Positive C_ (N=I26448) venuetu (11114) SmHr Po.IIIve c... (""2)

~r-----------------------------' 50% ..-----------------,--------, 40%

30%

20%

10% 2%

18%

0% ~-.-+-

23% 40% 30% ~

10% 0% .j.....II--+-

()'14 15-24 25-34 35-44 45-54 5U4 85- ()'14 1~24 IW4 35-44 45-64 ...... It-

Age Group

French Poly,,"ie (1994) Bacteriologicelly Positive Cal8l (N~)

~! 30%

20% ~ 3% 10% 0% -

~ 22% 17% 18% 15%

,1,1,1,1,-7% ,-

()'1. 15-24 25-34 35-44 45-54 55-e4 85-

Age Group

Group B: Distribution is highest In the age group of 20s or 308. while gradual decline with fairty higher figures In the older age groups as _II.

1GeGroup

Korea (1993) Bacteriologically Positive Cal8l Lao POR (11194) Smear Po.wv. Ca_

50%

40%

30%

20%

10% 1% 0%

().14

(N=I6630)

17% 21%

15-24 25-34 J5.44 45-54 55-e4

Age Group

Viet Nllm (1993) Smear Positive CIII8I (N=36534)

18%

85-

50% ,-----------------, 40% 30% 20% 10% 0%

19% 21% 16% 21% 16%

0% .I---+-'--+-()'1. 15-24 25-34 35-44 45-54 5U4 05-

Age Group

~----------------------------~-27-

(N=752)

50%

40% 30% 23% 19% 111% 20% 10% 0% 0%

0-14 15-24 25-34 35-44 45-54 55-e4

Age Group

19%

85-

Figure 8 Age Distribution of Tuberculosis C •• es (Cont'd) Group c: Distribution II higher In the age group of 40. end !iOI with decline

In the older age groupl.

Guam (1993-1994) All c_ .... CeIIIdonIII (1"'11184) (N.I64) PuImonIrY c- (N-e68)

50% ... 40%

~I ,iIi] 30% 19% 23%

20% 8.1% 7.0%

10%

0% 0-14 15-1. 20-31 40-58 eo. ()'14 15-24 2S-34 3S-44 45-54 55-&4 ..

",. Group Age Group

Group 0: Distribu1ion Is highest In the age group of over 80s and clNr pe.k In 205 and 3Os.

50%

40%

30%

20%

10%

0% ()'14

Austrslia (1993) All Cases (N=944)

15-24 2S-34 35-44 45-54 5~ Age Group

Malaysia (1994) Smear Positive Casel (N=6861)

27%

65-

~%r-------------------------------' 40%

30% 20% 10% 2%

0% -I--'---+-()'14

r-----------------

Hong Kong (1993) Bacteriologically Positive Ca_ (N=2415)

5O%r------------------------------, 40% 34%

30%

20% 10% 1%

0% +-o--+-()'14 15-24 25-34 35-44 45-54 55-&4 85-

Age Group

50% 40% 30% 20% 10% 0%

50% 40% 30% 20% 10% 0%

- 28-

New Zealand (1993) Sme.r P~1v8 C_ (N=91)

27%

15% 19% 13% 13% 10%

2%

()'14 15-24 2S-34 3S-44 45-54 5U4

Age Group

w. Samoa (1993-94) Smear Positive C(N=40)

23% 23%

..

28%

0-14 15-24 2S-34 35-44 45-54 5U4 85-Age Group

Figure 8 Age Distribution of Tuberculosis Cases Group E: Distribution Is highest In the older group and faly low figure

In young age groups.

(Cont'd)

Japan (1993) Smear Positive Ca_ (N,.15210)

SingIpore (1994) BedIrioIogIcaIly PoIItive

~%r-----------------------------' 40%

30%

20%

10% 1% 0% ...... ~--t-J--+--'-+-

31%

0-19 2().29 3C).39 40-49 5().4jO .... 9 70-Age Group

Tonga (1994) Smear Positive Casas (N=17)

59% 80% r--------------------------50%

40% 30% 20%

10% 0% ~--I-

0-14 15-24 25-34 35-44 45-54 55-84 as. Age Group

50%

40% 30% 20% 10% 0%

'----------------------------------'

- 29-

c.as ("'1)

0%

0-14 15-24 25-34 35-44 45-54 116-61 AgeGfoup

32%

f6.

Figure 9 Age Specific Notification Rate Pattern 1: Age specific incidence rate becomes higher in proportion to age up

to middle age. After then it becomes plateau or slightly decreased.

100

10

1

China (1993) Smear Positive C ••••

• • • •

0.1 ---j---------+----I-I----I-I ------f--+--+-- - +----1

o 10 20

--------- ---

30 40 50 60 Age

Solomon Is.(1993) Smear Positive Cases

•

70 80 90

• '~ l~--j __ 1--_ 1------1---1--;-----1-----1

o

1000

100

10 -

1

10 20 30 40 50 60 Age

Viet Nam (1993) Smear Positive Cases

70 80 90

0.1 i----+----+----i---f---+---+----+---lI----1 o 10 20 30 40 50 60 70 80 90

Age

- 30-

Figure 9 Age Specific Notification Rate (Cont'd)

Pattern 2: Rate becomes higher In proportion 10 age. No peak Is obMI'ved clearly In younger age.

1000

100

10

(p

1000

100

10

1

Rep. of Korea (1993) Smear Positive C ....

J 0 10

0 10

20 30 40 so 60 Age

Malaysia (1993) Smaar PoslUve C .. e

20 30 4OAqeSO

Brunei (1993) Smear Positive

60

...

70 60 90

70 60 90

1~j 0.: ----+--+---+-+---+-+---+--f---<

o 10 20 30 40 SO 60 ro 80 90 Age

- 31 -

0

(p

1000

100

10

1 . 0

'"' (1992) A.C ....

. 1 1- 1--+-1 to 20 30 401qe50 60 70 80 90

-----

Macao (1H3) Smear Positive Ca ...

.... • • /. -+--+-+

10 20 30 40 SO 60 1qe

Singapore (1110) Pulmonary ca ...

70 80 90

1:1 ---- • :.~ lL-I-1 -+--+--+---+--+1--1

...

o 10 20 30 40A

SO 80 70 80 90 ge

Figure 9 Age Specific Notification Rate (CoDt'd) Pattern 3: Rate becomes higher In proportion to age. Traneient peak Ia oblerved

in young age.

100

10

Austral" (1H2) All Ca ...

o w w ~ ~ ~ ~ ro ~ 00 Age

Japan (1993) Sm •• r POIHlve Ca •••

o 10 20 30 40 50 60 70 80 00 Age

New Caledonia (1993,1994) Pulmonary Casea

1:L?- -.

1~ ~-I----I-.f--'-i o 10 20 ~ 40 50 60 70 ~ 00

Age

-------------------------------~

1:t ~ KIribati (1993)

Sm.ar Positive Cas ..

1~ L-+--4-~.~If____I_--I____+___i o 10 20 ~ ~ ~ 80 70 80 00

Age

- 32 -

100

10

New ZNlend (1113, Smear Poaltlve C_

/ ... _._._ ......... •

0.1 +----t---t---+--+---+---t__-+--+----<

o 10 20 ~ ~ ~ ~ 70 80 00 Age

---.--------------~

Hong Kong (1893) Bacteriologically Positive C ....

o 10 W ~ ~ ~ ~ ro 80 00 Age

Guam (1993) Sme.r POIltlve C ....

f--+----i---+--

20~40~80708O00

Age

Fr. PoIyne.l. (1993) Sm •• r POIltive C ....

': 1 1 --+---+--+--+----1---+----1---+----1

o 10 ~ ~ ~ ~ ~ ro 80 00 Age

Table 6 Prevalence Rate of Tuberculosis by National Survey

Prevalence Rate (per 100 000)

Country/Area Year X-ray Active Bac(+) Smear(+) Reference

China 1979 717 187 1 st National Survey

1984 550 205 156 2nd National Survey

1990 523 177 134 3rd National Survey

Philippines 1983 2900 860 660 National Survey

Rep. of Korea 1965 5100 940 690 I st National Survey

1970 4200 740 560 2nd National Survey

1975 3300 760 480 3rd National Survey

1980 2500 540 310 4th National Survey



Table 7 Annual Risk of Infection (TuberculiD Survey)

Country/Area Year ARt (%) Reference

China 1979 1.1 I st National Survey

1984 0.6 2nd National Survey

1990 I 3rd National Survey

Fiji 1979 0.9 Tuberculin Survey

Philippines 1983 2.5 National Survey

1989 2.08 Tuberulin Survey

Rep. of Korea 1965 5.3 1st National Survey

1970 2.9 2nd National Survey

1975 2.3 3rd National Survey

1980 1.8 4th National Survey

1985 1.2 5th National Survey

1990 1.1 6th National Survey ._---

VietNam 1986 2.8 Hochi Minh City Survey

1987/88 0.26 Hanoi city Survey

- 33 -

PART II

TUBERCULOSIS DATA FOR EACH COUNTRY AND AREA


This part provides information of NTP and the tables and figures of tuberculosis notification of each country.

Case defmition was not standardized until 1992. Therefore case definition may be different from the current WHO defmition.

- 35 -

ABBREVIATIONS

EpidemiologylProgramme

ARI CHIP EPI HC MMR NTP RIT SCC WHO WPRO

Name of Drugs

Annual Risk of Tuberculosis Infection Country Health Information Expanded Programme on Immunization Health Centre Mass Miniature X-Ray National Tuberculosis Control Programme Research Institute of Tuberculosis, Tokyo Short Course Chemotherapy World Health Organization Western Pacific Regional Office of WHO

S Streptomycin (SM) H Isoniazid (INH) R Rifampicine (RFP) E Ethambutol (EB) Z Pyrazinamide (PZA) T Thiacetazone

Tables and Figures

all: all newly notified cases new S + : new smear positive cases new B+: new bacteriologically positive cases

The abbreviation of country name is in Annex 1.

- 36-

1. AMERICAN SAMOA

• Population: 53 ()()() in 1994

• Epidemiology:

The number of newly reported cases has been about 10 and almost stable from 1975 to 1990 and from 1991 the number discovered is less than 5. The number of bacteriologically confirmed cases has been between 5 and 10 until 1990.

• Programme:

Case finding: Passive case fmding

Treatment: All the tuberculosis suspects are referred to the Lyndon Baines Johnson Hospital. Sputum positive patients are admitted to the hospital for the initial intensive phase treatment. The patients are allowed to discharge only after bacillary conversion. After discharge. the patients are given with the drugs every 1-3 month from the hospital (Unsupervised domiciliary chemotherapy).

Laboratory: Almost all the symptomatics are examined with the sputum smear and culture examinations in Hawaii. No laboratory was working here in 1994.

Regimen: 2SHRZ/4HR since 1986. But sometimes the treatment continues longer.

BCG: Not done

Preventive chemotherapy: As it is in USA. preventive therapy is emphasized. Those who are positive with tuberculin (PPD 5TU. > 10 mm induration) are put on preventive chemotherapy. INH 6 months.

• Achievement:

Treatment Outcome: Completed: 46%, died: 18%, lost: 28% (1980-87)

• Reference:

(1) Pacific Morbidity and Mortality Monthly. USA, Feb. 1990, Vol.3 No.2.

(2) Fu, Q. Y. Report on a field visit to American Samoa. WHO. May 1988.

(3) Fu, Q. Y. Report on a field visit to American Samoa. WHO, Aug. 1987.

(4) CHIP. 1986.

(5) Farrugia, R. Leprosy and TB control. Mission report. WHO. April 1994.

- 37 -

Am. Samoa Am. Samoa

Tuberculosis Notification

Number of Newly Notified Cases Rate of Newly Notified Cases Deaths

Year all pulmonary newS+ relapse all pulmonary newS+ number rate

1975 12 40

1976 12 40

1977 7 22.6

1978 8 25.8

1979 2 6.3

1980 2 2 0 6.3 6.3 0 0 0

1981 6 6 6 18.2 18.2 18.2 1 3

1982 6 5 3 17.1 14.3 8.6 3 8.6

1983 8 8 6 23.5 23.5 17.6 1 2.9

1984 12 12 9 34.3 34.3 25.7 1 2.9

1985 5 5 2 13.9 13.9 5.6 1 2.8

1986 8 6 5 22.2 16.7 13.9 1 2.8

1987 9 8 3 24.3 21.6 8.1 1 2.7

1988 13 11 35.1 29.7

1989 5 5 13.5 13.5

1990 15 31.9

1991 2 4.2

1992

1993 4 2 1 0 7.8 3.9 2 0 0

1994 0 0

Rate: number per 100 000 population

- 38-

Am. Samoa

Notification Rate (per 100 000)

100~------------------------~

80 "" - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

60 ----------------------""-------------

40

20

O~_r--~~~_r~~~~~~~

1975 1980 1985 1990

Year

Rate of TB Deaths (per 100 000)

~ ~

10~----------------------------_.

8 - -----

6

4"

2 ------

O~~----~~~_r~+_~_+_r~~~

1975 1980 1985 1990

Year

- 39-

Am. Samoa

2. AUSTRALIA

• Population: 17.9 million in 1994

• Epidemiology:

There were 1,071 new cases in 1993. The number has decreased until 1987 but is increasing since then. Culture positive cases in 1989 were 610. About a quarter of the total cases were extra-pulmonary in 1984. The number of TB death is about 50 and stable in the 1980s. The incidence rate among aboriginal community was 4 times higher than that of the average. Among the 983 new cases registered in 1992, 606 cases were foreign born cases (15.11100 000), 218 cases were Australia born cases (1.62/100 000) and the origins of 159 cases are unknown, and 28 relapse cases were also registered. Among about 600 cases whose drug susceptibility test was done, 7.4% were resistant to INH (47/604) and 1.2% were resistant to RFP (7/605), including cases with previous history of treatment.

• Programme:

Case finding:

Laboratory: The sensitivity test is made at either of the five State Tuberculosis Reference Laboratories.

Regimen: The standard regimen for smear positive cases is 3HRS (or E)+ 6-9HR for patients born in Australia. For Asian immigrants, HRZE for the first 2 months, and after that, according to the result of sensitivity test.

• Reference:

(1) Information from Dr. J. Christensen (Statistical service section, Department of Community Services and Health). March 1991.

(2) Communicable Diseases Intelligence. 1989, 89/21.

(3) Treatment of tuberculosis in Australia. Medical J. of Australia, 1985; Vo1.l43.

(4) Annual report. Public Health Department (Western Australia).

(5) Annual report. Commonwealth Department of Health, 1986.

(6) Annual report. Commonwealth Department of Health, 1983.

(7) CHIP. 1990.

(8) TB surveillance in the South Australian aboriginal community. Medical J. in Australia, 1990; Vol.l53 No.3, pp.149-155.

(9) J. Hargreaves. Tuberculosis notifications in Australia. CD!, 1992, Vol. 18/No. 14, II July 1994.

- 40-

Australia Australia


Number of Newly Notified Cases Rate of Newty Notified cases Deaths

Year all pulmonary newB+ relapse all pulmonary newB+ number rate

1975 1347 1126 1026 9.7 8.1 7.4 128 0.9

1976 1387 1142 1002 9.9 8.2 7.2 125 0.9

1m 1251 1010 881 8.8 7.1 6.2 108 0.8

1978 1292 1042 741 9 7.2 5.1 108 0.8

1979 1542 1275 807 10.6 8.8 5.6 67 0.5

1980 1457 1197 765 9.9 8.1 5.2 65 0.4

1981 1386 1127 723 9.3 7.6 4.9 81 0.5

1982 1270 1009 690 8.4 6.6 4.5 63 0.4

1983 1219 902 596 7.9 5.9 3.9 75 0.5

1984 1299 921 634 8.4 5.9 4.1 58 0.4

1985 1088 831 583 6.8 5.2 3.7 51 0.3

1986 906 43 5.7 61 0.4

1987 907 39 5.6 54 0.3

1988 954 29 5.8 54 0.3

1989 952 50 5.7 56 0.3

1990 1016 37 6 63 0.4

1991 950 47 5.6 57 0.3

1992 1011 536 28 5.8 3.1

1993 991 557 47 5.6 3.2 57 0.3

1994


- 41 -

Australia


50r-----------------------------~

40 -----------------------------------------

30 ----------------------------------------

-20 ------------------------- ---------------

10 -- --... ~~ ~ -.--- - -...... o ~_+~~+_~_+~~~_+_r~+_~~ 1975 1980 1985 1990

Year


5,-------------------------------~

4 -------------------------------------------

3 -----

2 ---- - -------------------------------------

1 -...... - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - ~ --. o+-~-+-+~~+_~_+_+~~+_+__+_+~

1975 1980 1985 1990

Y.r

- 42-

Australia

~ l~~

3. BRUNEI DARUSSALAM

• Population: 280 000 in 1994

• Epidemiology:

The number of the newly registered all cases has been decreasing in 1975-1988 but it has been increasing since 1988 and it was 164 in 1993. The number of TB deaths has decreased and was 8 in 1988.

• Programme:

Case finding: Both passive and active (by MMR)

BCG: Programme since 1970

• Reference

(1) The report. Ministry of Health. 1988.

(2) The experience in Brunei Darrusalam. 1990.

(3) CHIP. 1990.

(4) SEAMIC Health Statistics. SEAMIC.

(5) CHIP. 1984.

- 43 -

Brunei Brunei




1975

1976 336 207.4

1977

1978 230 132.9

1979 216 120.7 13 7.3

1980 196 105.9 28 15.1

1981 285 147.7 11 5.7

1982 245 122.5 20 10

1983 276 110.4 16 6.4

1984 256 95.2 15 5.6

1985 238 106.3 19 8.5

1986 212 93.8 11 4.9

1987 189 80.4 4 1.7

1988 126 52.3 8 3.3

1989 128

1990 143 55.9

1991

1992

1993 160 133 68 56.3 46.8 23.9 2 0.7

1994


- 44-

Brunei


200~~------------------------~

150

100

50 - - --- --- -~-

• O~-+~+-~~~~~~~~~+-~

1975 1980 1985 1990

Vear


50 r-----------------------------~

40

30

20 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -

o··~~--~~~~_r~~~_+~+_~~

1975 1980 1985 1990

Vear

- 45-

Brunei

........ al~ -+-newS+

4. CAMBODIA


• Epidemiology:

The ARI in 1966-68 was estimated to be 2-3 % and the prevalence rate in 1967-68 (in some provinces) was 2.1 % (all) or 0.3% (smear positive). In 1980s, some local data shows that the prevalence rate of smear positive cases was about 0.24% and there has been no improvement since 1960s. TB is 7th cause of death in hospitals. The number of cases treated at various hospitals was 15 489 (among these, 12 001 cases were smear positive) in 1994 and these numbers are increasing in 199Os. HIV is becoming prevalent in Phnom Penh and HIV positive TB is thought to increase.

• Programme:

Since 1981, 5-year tuberculosis control programme has been operated (the 3rd programme is undergoing in 1991-1995), and WHO is assisting the programme.

Organization: National level: National Anti-Tuberculosis Institute. Provincial level: 21 Provincial unit among 22 Provinces are with TB unit. District level: 100 District hospitals out of 150 districts with TB centers and microscopists. Commune level: nurses for referral and supervision. Village level: health workers for education.

Case finding: Passive by sputum microscopy. (In provincial hospitals, X ray examinations are rarely done.)

Laboratory: Microscopy only. Supervision is considered to be done.

Hospitalization: In the central hospital, about half of the cases are hospitalized. Mean duration of stay is about 3 month.

Regimen: WHO 3 CAT regimen is now expanding but its coverage is 20% in 1994. Others are treated with 3SHZ/9SH and 3SHRZ/9SH for failure cases.

BCG: Under EPJ.

Supervision: The central hospital is thought to do supervision visit of provincial hospitals 2-4 times per year.

• Achievement:

Treatment outcome: Cohort analysis (1983-1992, 103 410 cases) shows cure: 44%, die: 2%, defaulter: 28%, T/O:IO%.

- 46-

Laboratory: There are 120 microscopy centers in 1994.

Supervision: Recording and reporting from district to province and from province to central are routinely done.

Drug supply: Most of the drugs are supplied from the foreign aid. And its coordination is the problem.

Private sector: Drugs can be bought in drug stores includingRFP.

• Reference

(1) Personal communication with CENAT(National Anti-tuberculosis Institute) staff (1991, 94, 95).

(2) Anti-Tuberculosis progranune in Cambodia. French Red Cross, 1991.

(3) Mori, T. Report. RIT-llCA, 1992.

- 47 -

Cambodia Cambodia




1975

1976

1977

1978

1979

1980

1981

1982 8158 5801 118.2 84.1

1983 7572 5316 106.6 74.9

1984 10241 5507 142.2 76.5

1985 10145 5235 137.1 70.7

1986 10325 8715 135.9 114.7

1987 9106 7173 116.7 92

1988 10691 8246 135.3 104.4

1989 7906 5842 98.8 73

1990 6501 5132 79.3 62.6

1991 10903 8507 129.8 101.3

1992 16148 15283 12910 187.8 177.7 150.1

1993 13270 12358 9560 381 142.7 132.9 102.8

1994 15112 13793 11058 540 151.6 138.3 110.9


- 48 -

Cambodia


200.-----------------------------. 150

100

50 - - - .. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. - - - - -

O~~_r~~~_r~~~_r~~~~

1975 1980 1985 1990

Year

- 49-

Cambodia

Fl ~

S. CHINA, PEOPLE'S REPUBLIC OF

• Population: 1209 million in 1994

• Epidemiology:

Three nationwide surveys were done in 1979, 1984/85, and 1990. The average prevalence rate was 523/100 000 for all TB cases, and 134/100 000 for smear positive cases in 1990. The ARI is estimated to be 1 % in 1990. Based on the registration reports from whole provinces, incidence of tuberculosis was 344 218 in 1993 (The incidence rate is 27/100 (00) and bacillary positive cases were 79 786 in 1991 (incidence rate: 71100 (00). Although the incidence is increasing, they still seem to be lower than the real figures calculated from the survey data and this reflects the improving but still low coverage of NTP. The incidence of bacillary confirmed pulmonary cases in Beijing and Shanghai with high service coverage was 14/100 000 and 18/100 000 in 1991.

• Programme: From 1992, World Bank has started the loan with technical assistance of WHO in 12 provinces.

Organization: Responsible units are National Tuberculosis Control Center under the Bureau of Epidemic Prevention in the Ministry of Public Health, Provincial Tuberculosis Dispensaries, County tuberculosis dispensaries. Below this level, TB control is integrated to general health services at the community level.

Case finding: Usually sputum smear fluoroscopy for symptomatic cases is done for the final diagnosis. The WHO assisted programme shows that about half of cases who start treatment have previous history of treatment.

. Laboratory: provincial level. surveillance.

Drug susceptibility test is available at central and Its QC is underway with global drug susceptibility

Regimen: SCC for all cases has been implemented. New case with 2HRZS/4HR and retreatment case is 2HRZSE/6HRE.

Case management: Full supervised treatment is recommended for RFP use. Within WB loan project, full supervision during the treatment is conducted.

BCG: Programme since 1950. Primary vaccination to infants and revaccination to schoolchildren.

- 50-

• Achievement:

Treatment Outcome: The cure rate of bacillary positive case in 1991 was 75.9%. In world bank loan project, the cure rate of new smear positive cases in 1991-94 was 89.5% (55210 cases were analyzed) and for re-treatment in 1991-94 was 80% (57847 cases were analyzed).

BCG: The coverage in 1986 was estimated to be 67% (in Shanghai, 96%).

• Reference:

(1) Personal communication with Dr. Duan-Mu Hong lin. (National Tuberculosis Control and Research Center Beijing, Oct. 1991).

(2) 1986-88 National Tuberculosis Surveillance Program. National· Tuberculosis Control Center in Beijing.

(3) Nationwide Random Survey for the Epidemiology of Tuberculosis in 1984/85. Ministry of Public Health.

(4) Kan G. (Beijing Tuberculosis Center). Tuberculosis Control in Beijing.

(5) Styblo K. Assignment report. WHO, 7-25 Oct. 1987.

(6) Li-Xing Z. Case Finding of Tuberculosis in China.

(7) Pers~nal'communication with Dr. Farrugia (9 July 1992).

(8) L-X. Zhang (Beijing TB center) et aI, TB control program in Beijing Tubercle and Lung Disease. Vo1.73, 162-166, 1992.

(9) TB in China. Tubercle Vo1.70, pp.293-296, 1989.

(10) Manual of National Tuberculosis Control Programme (Chinese).

(11) Manual of World Bank loan tuberculosis control project (Chinese).

(12) Seita A. Assignment report. WHO, 1993.

- 51 -

China China




1975

1976

1977

1978

1979

1980

1981

1982 98654 98654 19236 9.6 9.6 1.9

1983 117557 117557 25628 11.5 11.5 2.5

1984 151564 151564 38367 14.4 14.4 3.6

1985 226899 226899 53078 21.4 21.4 5

1986 265095 265095 60949 25.2 25.2 5.8

1987 313604 5018 29.6 22.9

1988 362114 5947 33 26.8

1989 367799 6315 33.1 26.5

1990 375481 6766 33.1 27.7

1991 376246 7485 32.7 27.6

1992 90184 27.5 7.7

1993 344218 344218 84898 45946

1994 363804 363804 104729 53118 30.1 30.1 8.7


- 52 -

China


100~------------------------~

80 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - ~

60 ~ ~ ~ -- ~ ~ ~ - ~ - - ~ - ~ - ~ - ~ ~ ~ ~ ~ - - ~ ~ ~ - - ~ - ~ - ~ - ~ - ~

40 ~ ~ - -- ~ ~ ~ ~ ~ ~ - ~ ~ ~ - - ~ - ~ ~ ~ ~ ~ - ~ ~ -- - ~ ~ ~ ~ ~ - ~ - - -

20

1980 1985 1990

Year

- 53 -

China

___ all

....-newS+

6. COOK ISLAND

• Population: 19 ()()() in 1994

• Epidemiology: The number of new cases has been fluctuating between 10 to 40. There is a tendency of decrease mainly in Ralotonga Island (main island), but in other islands it is almost stable. The number of smear or culture positive cases is not available.

• Programme:

Laboratory: In Ralotonga Island, almost all cases are examined by the sputum examination since 1985.

Regimen: sec is recommended but the coverage is not known.

BCG: Primary vaccination to infants and re-vaccination at school.

• Achievement:

Treatment outcome: Completed: 70%, Transferred: 23% (Ralotonga Island).

BCG: Primary vaccination coverage: 70%. The coverage of revaccination for school children is nearly 100%. (Both in the Ralotonga Island.)

• Reference:

(1) Fu, Q. Y. Notes on field visit. WHO, March 1988.

(2) Fu, Q. Y. Notes on field visit. WHO, March 1986.

(3) CHIP. 1990.

- 54-

Cook Is. Cook Is.




1975

1976

1977

1978

1979 30 166.7

1980 37 205.6

1981 10 58.8

1982 19 105.6

1983 29 161.1

1984 20 105.3

1985 36 180

1986 17 85

1987 16 94.1

1988 15 88.2 .

1989 1 5

1990 1 5.9

1991

1992 12 12 4 70.6 70.6 23.5 0 0

1993 6 6 4 2 31.6 31.6 21.1

1994 4 3 1 2 21.1 15.8 5.3 1 5.3


- 55 -

Cook Is.

NotIfIcatIon .... (per 100 000)

300 .---------------,

250 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

200

150

100

50

O~-~+_~~+_~_r+_~~+_~~

1975 1980 1985 1990

Vear


5 .---------------~

4 ---.- -- .. --------------._._-----. - .---.--------

3 ----------------------------

2 - - - ._. - - - - . - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - -

1 - - - .- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

O+-~--~~~~_+~+_~_+~~._~

1975 1980 1985 1990

Ve.r

- 56-

Cook Is.

Fl ~

7. FUI


• Epidemiology: The number of new cases fluctuates around 200 since 1978 and the number of smear positive cases was around 80 since 1982. The incidence rate has decreased to 30/100 000 for all and 91100 000 for smear positive in 1992.

• Programme: All the cases and suspects are hospitalized to either the Tamavua tuberculosis hospital or the Lautoka hospital for 2 months for initial phase treatment. Then semi-supervised chemotherapy is given at OPD.

Case finding: Passive. MMR is done only for some groups such as army and police recruits.

Laboratory: Smear and culture examination is routinely done.

Regimen: 2S(or E)HRZ + 7HRE(or 7HR).

• Achievement:

Treatment Outcome: Completed: 90%, lost: 5%, dead: 5% (1988-89)

BCG: Coverage for infants is over 90%.

• Reference:

(1) Umemura N. Assignment report. WHO, Oct.-Nov. 1990.

(2) Ministry of Health: Tuberculosis situation in Fiji 1989.

(3) Annual report. Ministry of Health, 1985-86.

(4) Fu, Q. Y. Notes on field visit. WHO, July 1986.

(5) Farrugia, R. Mission report. WHO, May 1993.

- 57 -

Fiji Fiji


Number of Newly Notified Cases Rate of Newly Notified Case! Deaths


1975 268 128 47.1 22.5

1976 259 122 44.3 20.9 .

1977 257 145 43 24.3

1978 183 101 30 16.6 32 5.3

1979 205 114 33 18.4

1980 210 111 33.1 17.5

1981 180 97 27.8 15

1982 163 98 24.8 14.9

1983 185 79 27.6 11.8

1984 165 133 82 23.6 19 11.7

1985 230 173 99 32.4 24.4 13.9

1986 199 146 86 27.5 20.2 11.9

1987 173 151 75 23.1 20.1 10

1988 162 129 65 22.3 17.7 8.9

1989 218 176 76 29.5 23.8 10.3

1990 252 188 83 34.1 25.4 11.2

1991 210 175 63 28.1 23.4 8.4

1992 240 205 75 31.7 27.1 9.9

1993 1994


- 58 -

Fiji


100~--------------------------~

90 80 70 -60 50 40

20 10

_L_

1975 1980 1985 1990

Year


10 r-----------------------------~

8 --

6 -

4-

2

O~~_r~+_~_+~~~_+ __ ~+_~~

1975 1980 1985 1990

Year

- 59-

Fiji

___ all

I ......... news+1

8. FRENCH POLYNESIA

• Population: 215 ()()() in 1994

• Epidemiology: The nwnber of newly registered cases fluctuates around 50-80 since 1978. The incidence rate has been decreasing remarkably in 1970s and only a little in 1980s (44/100 ()()() for all and 20/100 ()()() for smear positive in 1992). There was only 1 case of tuberculosis meningitis between 1983-87. From the tuberculin survey, ARI was estimated to be 0.4% in 1979.

• Programme: The tuberculosis service is mainly given in the Institute Malarde.

Case finding: Mainly passive, and active for high risk groups.

Laboratory: Sputum smear examination is made for almost all cases. 90% of the pulmonary TB cases are confirmed with the culture or the pathological examinations.

Regimen: 2HRZ4HR is recommended

BCG: Primary to newborn babies and re-vaccination to school age children (10 years old).

Preventive chemotherapy: 2HR is recommended for the contact of bacillary confirmed cases.

• Achievement:

Treatment result: 75 % of all cases are estimated to take drugs regularly. Follow up for the cases in Tahiti is satisfactory but in other islands the follow up is not well done.

Supply: Overall well supplied.

BCG: Coverage was 95%.

• Reference:

(1) Rapport annuel d' activites polynesie direction de la sante. Sante publique, 1988.

(2) Rapport annuel d'activites polynesie direction de la sante. Sante publique, 1986.

(3) Information from sante publique 1986.

(4) Information from Dr. Jacque Drollet (ministere de la sante de l'environnement, Oct. 26, 1990).

(5) Farrugia, R. Mission report. WHO, April 1992.

- 60-

Fr. Polynesia Fr. Polynesia


Number of Newly Notified Cases Rate of Newly Notified Case Deaths

Year all pulmonary newS relapse all pulmonary newS+ number rate

1975 134 72 101.5 54.5

1976 110 42 80.9 30.9

1977 95 41 68.3 29.5 .

1978 78 32 55.3 22.7

1979 81 41 55.5 28.1

1980 73 52 49 34.9

1981 58 39 38.7 26

1982 48 32 31.2 20.8

1983 66 48 39.5 28.7

1984 73 52 45.6 32.5

1985 75 48 46.9 30 8 5

1986 79 49 44.1 27.4 7 3.9

1987 63 45 37.1 26.5 12 7.1

1988 64 56 44 33.9 29.6 23.3 5 2.6

1989 58 43 32.2 23.9 4 2.2

1990 59 33.3 4 2.3

1991 49 34 27.1 25.4 0 0

1992 83 77 40 44.9 41.6 21.6 4 2.2

1993 82 76 39 4 39.4 36.5 18.8 5 2.4

1994 89 78 38 7 41.4 36.3 45.6 3 1.4

Rate. number per 100 000 population .

- 61 -

Fr. Polynesia


200~------------------------~ 180 160 140 ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --

120 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

100 80 60 40 20 O~--~~~+-~~~_+~~~~

1975 1980 1985 1990

Year


10 ~----------------------------.

8

6 -------

4

2

o ~_+~~~_+~+_~_+--+_~r+~ 1975 1980 1985 1990

Year

- 62 -

Fr. Polynesia

r~ i-+-news+1

9. GUAM

• Population: 147 ()()() in 1994

• Epidemiology: The number of new cases fluctuates about 40-70 since 1975 and the incidence rate was 62/100 ()()() in 1989.

• Programme: Basically follows the programme of USA.

Case finding: Passive. Active for Immigrants (13% of patients were migrants in 1981).

Laboratory: Microscopy and culture (class 2 in CDC classification). Sensitivity test and identification test are done in USA (CDC).

Treatment: Treatment is given at private practitioners and Guam Memorial Hospital.

Regimen: SCC (as in USA)

• Reference:

(1) Pacific Morbidity and Mortality Monthly. USA, Vol.3, No.2, Feb. 1990.

(2) Tuberculosis statistics in the US. CDC, USA, 1987.

(3) Annual summary of notifiable diseases. Guam, 1980-88.

(4) Statistical report. Department of public health and social services, 1988.

(5) Eng. Assignment report. WHO, Sept. 1981.

(6) CHIP. 1989.

- 63 -

Guam Guam




1975 49 46 64.5 60.5

1976 46 39 58.2 49.4

1977 67 57 81.7 69.5

1978 64 61 76.2 72.6

1979 71 61 68.3 58.7

1980 55 49 51.4 45.8 4 3.7

1981 41 34 37.3 30.9 6 5.5

1982 49 47 48.5 46.5 5 5

1983 48 38 42.5 33.6 1 0.9

1984 54 50 45.4 42 3 2.5

1985 37 37 30.8 30.8 3 2.5

1986 49 39 40.2 32 2 1.6

1987 34 27 27.2 21.6 5 4

1988 41 35 33.1 28.2 4 3.2

1989 75 66 59;5 52.4

1990 40 31.7

1991

1992

1993 70 66 53 0 48.6 45.8 36.8 8 5.6

1994 94 85 40 5 63.9 57.8 27.2


- 64-

Guam

100

80

60

40

20 - -

0 1975


------_. __ .- -_._-------

1980

. - - .... - - -------

1985 1990

Year


10 .---------------------------~

8

6

4-

2

o ~----~~~~~----~~_+~~ 1975 1980 1985 1990

Year

- 65 -

Guam

I---an i : I

l-+-new 5+1

10. HONG KONG


• Epidemiology: Tuberculosis mortality rate decreased but almost stable since 1988 and was 7/100 000 in 1992. The incidence rate of all cases was almost steadily decreasing to 113/100 000 for all and 49/100 000 for smear positive in 1992, though the number of new cases showed a Iinle decline only after 1984 and it was 6 536 in 1993.

• Programme:

Case finding: Passive and active (including MMR) and contacts survey.

Treatment: Duration: 6 months. Initially admined to hospital for 2 months (There are 1181 TB beds).

Regimen: SCC.

Chemoprophylaxis: Applicants for migrating to Australia, Canada and other countries must have preventive chemotherapy to fulfill the migration criteria when they have stable radiographic shadows.

BCG: Primary directly to new born babies before 6 weeks or tuberculin negative infants over 6 weeks old. Re-vaccination to the tuberculin negative school entrants. Contacts under 5 years old with negative tuberculin is given BCG. For refugees under 14 years old, direct BCG is given.

• Achievement:

Case finding: examination)

Both passive and active (MMR and contact

Contact examination: In 1988, 14 433 contacts of 7 433 cases were traced, among whom 166 pulmonary and 3 extra-pulmonary tuberculosis cases were detected.

Laboratory: The laboratories made 90 000 direct smears, 80 000 cultures and 9 000 sensitivity tests mainly against SM, INH and RFP in 1988, by which about 7 000 cases were newly detected.

BCG: Coverage of the first vaccination: 98.4% in 1988.

• Reference:

(1) Director of medical and health services. Departmental report. 1988-89.

(2) Director of medical and health services. Annual report. 1988.

(3) CHIP. 1990.

(4) Director of medical and health services. Annual report. 1980.

- 66-

Hong Kong Hong Kong



Year all pulmonary new 8+ relapse all pulmonary newB+ number rate

1975 8192 7995 182 177.7 646 14.4

1976 7928 7703 176.2 171.2 568 12.6

1977 7191 6944 156.3 151 532 11.6

1978 6623 6246 140.9 132.9 420 8.9

1979 7903 7481 161.3 152.7 523 10.7

1980 8065 7620 158.1 149.4 551 10.8

1981 7729 7347 148.6 141.3 489 9.4

1982 7527 7101 144.8 136.6 454 8.7

1983 7301 6866 137.8 129.5 446 8.4

1984 7843 7365 145.2 136.4 420 7.8

1985 7545 7146 4142 137.2 129.9 75.3 409 7.4

1986 7432 6963 4110 135.1 126.6 74.7 407 7.4

1987 7269 6826 4042 129.8 121.9 72.2 405 7.2

1988 7021 6581 3918 123.2 115.5 68.7 388 6.8

1989 6704 6249 3768 115.6 107.7 65 403 6.9

1990 6510 6076 3670 112.2 104.8 63.3 382 6.6

1991 6283 5866 3564 106.5 99.4 60.4 409 6.9

1992 6534 6048 110.7 102.5 409 6.9

1993 6537 6032 2429 397 112.7 112.7 41.9 396 6.8

1994 6319 108.9 409 7.1

Rate. number per 100 000 population

- 67 -

Hong Kong


200r---------------------------~

150

100 - - - - . - - - - -- - - - - - - - - - - - - - - - - -- - - - - - -- - - -.. -... - ---. ...

50 ----------------- -------• o ~--~+_~~~----~--~--~~ 1975 1980 1985 1990

Year


20 ,------------------------------,

15

10

5 --

o ~~ __ ~+-~~_r~+-~_+--~+_~ 1975 1980 1985

Year

- 68-

1990

Hong Kong

r~-;I ! _.. I

! -+-new B+I I

11. JAPAN


• Epidemiology: Though the number and incidence rate of all new cases have been decreasing steadily, the reduction rate has slowed down since 1977. The number and incidence rate were 48 956 and 39/100 000 respectively in 1993. The number of bacillary positive cases is about 18 000 and almost the same for these 20 years. The number of smear positive cases increased slightly in the 1980s and was 15210 in 1993. Half of the cases are over 60 years old.

• Programme: Tuberculosis prevention law was legislated since 1919 and revised in 1951. NTP is fully integrated with general health services with full coverage of health insurance system. Patients are diagnosed and treated both at private and public clinics and hospitals. Registration is made at governmental Health Center which covers about 100 000 population and is responsible for the public health programme of the area. The law covers the expenditures necessary for the tuberculosis treatment together with health insurance. The public health nurses of the Health Center visit patients regularly, take actions against defaulters and make the contact tracing. The computerized surveillance system is maintained since 1987.

Case finding: Passive (about 80%) and Active (20%: MMR and contact tracing)

Laboratory: About 95 % of cases are examined with sputum smear or culture. Sensitivity test and Niacin test are routinely done.

Regimen: 6HRS(or E)+3HR for the smear positive new cases. 6HR for X-ray active cases.

Preventive chemotherapy: Tuberculin strongly positive children (particularly contacts) are given chemoprophylaxis with 6 month of INH.

BCG: Primary vaccination to tuberculin negative infants .. Revaccination to tuberculin negative primary and secondary school entrants (at the ages of 6 and 13 years).

• Achievement:

Total Delay: 66 % of TB cases start treatment within 2 month of duration of symptoms.

BCG: The coverage is 88%.

• Reference:

(1) Statistical Year Book of Tuberculosis. Ministry of Health and Welfare, 1975-1995.

(2) Health and Welfare Service in Japan. Ministry of Health and Welfare, 1991.

- 69-

Japan Japan




1975 108088 96872 13703 96.9 86.8 12.3 10567 9.5

1976 97924 87670 .13360 86.8 77.7 11.8 9578 8.5

1977 89245 79350 13373 78.4 69.7 11.7 8803 7.7

1978 80629 71995 13198 . 70.2 62.7 11.5 8261 7.2

1979 76455 68367 12806 66 59 11.1 6738 5.8

1980 70916 63195 12291 60.6 54 10.5 6439 5.5

1981 65867 58861 12214 56 50 10.4 5698 4.8

1982 63940 57550 12649 54 48.6 10.7 5343 4.5

1983 62021 55884 13010 52 46.9 10.9 5329 4.5

1984 61521 55629 13277 51.5 46.6 11.1 4950 4.1

1985 58567 53287 13808 48.5 44.1 11.4 4692 3.9

1986 56690 51870 13745 46.6 42.6 11.3 4170 3.4

1987 56496 52077 14405 46.5 42.8 11.9 4022 3.3

1988 54357 50014 14592 44.5 41 12 3872 3.2

1989 53112 48827 14710 43.2 39.7 12 3527 2.9

1990 51821 47774 15498 41.9 38.6 12.5 3659 3

1991 50612 46809 15285 40.8 37.7 12.3 3325 2.7

1992 48956 45474 15540 39.3 36.5 12.5 3347 2.7

1993 47437 44082 15210 38.1 35.4 12.2 3235 2.6

1994 44590 41486 14777 35.7 33.2 11.8 3094 2.5


- 70-

Japan


100 __ --------------------------~

80

60

40·

20

o~--~~~_+~+_~_+~+_~_+~

1975 1980

2

1985 1990

Year


0+-~-+~~4-+_~_+_+--4_+_~~_+~

1975 1980 1985 1990

Year

- 71 -

Japan

Fl l-+-newS+1 L I

12. KIRIBATI

• Population: 77000 in 1994

• Epidemiology: The number of new cases fluctuates between 100-300 and varies very much, possibly due to the diagnostic criteria. The incidence rate fluctuates between 100-400/100 000 and sometimes it was the highest in WPR. The proportion of smear positive cases to all cases was about 10% in early 1980s. (No data is available since 1984.)

• Programme: Under the public health section, with a central registry.

Case finding: Passive. Most of the symptomatic cases are refereed to the hospital in the main island and both sputum examinations and X ray examinations are done. In other islands, the sputum examinations of symptomatic cases are done by either sending the slides to the main island or microscopy examinations are done by medical assistants in the islands. X-ray is available in the main island only.

Laboratory: Sputum smear examination can be done in the main island (by microscopist). No quality control. In other islands, microscopes are equipped in the health centers but examinations are not really done probably by the difficulty of technique and shortage of reagents. In Tarawa Island, culture examination has started in 1991. But its reliability leaves much to be improved.

Regimen: In Tarawa Island (main island), the regimen used in the hospital is 2SHRZ/4HR. In other islands, both SCC and RFP not containing regimen is used.

BCG: Infants only (re-vaccination was done previously but not now).

Registration: Medical assistants must report to the statistics officer every month about how many cases are diagnosed, how many cases are under treatment and how many cases stop treatment. But there is no definite form of registration. So cohort analysis is not done.

• Achievement:

Treatment outcome: Completed: 38.8%, Dead: 8.1 %, Lost: 17.1 %, Transferred: 36% in 1986-88. In 1991-2, according to a small sample study in Tarawa Island, over half of the cases dropped out.

BCG: Coverage is nearly 100% but it may be due to the overreporting.

• Reference:

(1) Fu, Q.Y. Notes on field visit. WHO, July 1987.

(2) CHIP. 1989.

(3) Yoshiyama T. Assignment report. WHO, Nov. 1992.

- 72 -

Kiribati Kiribati



Year all pulmonal) newS+ relapse all pulmonary newS+ number rate

1975 279 210 31 516.7 388.9 57.4 23 42.6 .

1976 278 190 23 505.5 345.5 41.8 15 27.3

1977 97 83 22 173.2 148.2 39.3 15 26.8

1978 40 59 4 71.4 105.4 7.1 3 5.4

1979 94 73 21 162.1 125.9 36.2 8 13.8

1980 146 95 10 243.3 158.3 16.7 14 23.3

1981 187 125 34 306.6 204.9 55.7 8 13.1

1982 193 107 17 321.7· 178.3 28.3 3 5

1983 127 83 14 208.2 136.1 23 8 13.1

1984 111 105 179 169.4 7 11.3

1985 103 87 163.5 138.1 15 23.8

1986 129 89 201.6 139.1 10 15.6

1987 110 169.2

1988 208 315.2 10 15.2

1989 121 177.9 6 8.8

1990 68 100 14 20,,6

1991

1992 100 140.8 6 8.5

1993 99 128.6 9 11.7

1994 253 247 184 17 328.6 320.8 239 10 13


- 73 -

Kiribati


600 .,--------------,

500

400 - ---------------------------------

300

200

• 100

O~~~~~~r_~--r_~~

1975 1980 1985 Vear

1990


50.---------------,

40

30

--~ -- -t ---- ----y-- ---

20

10

Kiribati

FJ I-+-news+ I L - I

O~~~~~~~~+__+~~_+~

1975 1980 1985 1990

Vear

-74 -

13. LAO, PEOPLE'S DEMOCRATIC REPUBLIC


Epidemiology: There is no datwn on the tuberculosis prevalence and the incidence. It is roughly estimated that the prevalence rate is 2% for all cases and 0.5% for smear positive cases, and the number of newly registered cases is 8 000.

• Programme: NTP has started since 1986 after the national seminar. And after that several regional seminars have been held every year. In July 1992, first nationwide seminar (15 of 17 provinces participated) was held. National level-National TB Center Intermediate level- Provincial office. (In some provinces the Provincial TB office is in the Provincial hospital.)

Case finding: Passive only.

Laboratory: Microscopy only. Microscopes are equipped in NTC, 12 provincial hospitals among 17 provinces and some district hospitals. But in 1993, most provincial hospitals and district hospitals could not provide sputwn AFB smear services because of the lack of reagent and education (microscopes were used for Malaria and other purposes). Technicians are educated with 3 year basic course.

Diagnosis: In provincial hospitals where there is no sputum smear examination and all district hospitals, diagnosis is done· almost with symptoms and signs only. No X-ray. Only in Vientiane, smear and X ray is available.

Regimen: RFP not containing regimen is the standar<i. Thiacetazone was used formally but now it is not used because of its side effects. So the most popular regimen is 2 drug treatment (SM and INH: daily for the first 2 month and intermittently after that). In some provincial hospitals, doctors only gave the prescriptions and advise the patients to visit drug stores where . RFP, EB, and other drugs are sold. Only in the national tuberculosis center, RFP containing regimen is given (2SHRZ/4HR, 2EHRZ/4HR, 2SHRZ/6HE, 2HRZE/6HE). Treatment is done free of charge if drugs are available.

BCG: Since 1981, BCG has been given in EPI under the responsibility of the Institute of Hygiene and Epidemiology.

Registration: The doctors are considered to register the TB case and report it to the provincial hospital and from Province to NTC. But the reporting has not been routinely done.

- 75 -

Cohort analysis: Not done routinely.

• Achievement:

Case finding: The number of cases reported in 1991 from 8 provinces were 1951 and 562 were smear positive.

Regimen: Even in the central facilities where RFP. containing regimen is thought to be used, some cases had to change regimen due to the lack of budget and drugs.

Case holding: RFP containing regimen: Treatment completion rate is about 30% (Dr. littinandana).

BCG: BCG coverage is about 30% and improving.

• Reference:

(I) personal communication with Dr. Houmdaophet (National Tuberculosis Center, April 1991).

(2) Nagpaul,D.R. Assignment report. WHO, 1989.

(3) Observational Report on Infectious Diseases in Lao People's Democratic Republic. JICA, 1990

(4) CHIP

(5) littinandana, A. Mission report. WHO, 1992.

(6) Yoshiyama, T. Assignment Report. WHO, 1992

(7) Farrugia, R. Mission report. WHO, March 1993

- 76-

LaoPDR LaoPDR




1975

1976

1977 .

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991 1951 526 45.4 12.2

1992 994 941 459 22.6 21,4 10.4

1993 1905 1863 765 12 41.4 40.5 16.6 20 0.4

1994 1135 1077 752 1 23.9 22.7 15.9 23 0.5


- 77 -

LaoPDR


100r-------------------------~ 90 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

80 70 .- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -60 50 40 30 20 - -- - - - - - - - - -

10 Ol---.--t--.......... --'--+-+--+-+--+-...---+--r--'---<---.---t-!

1975 1980 1985 1990

Year


5~-----------------------------,

4 ------

3 -. - -- - - . - - - - - - - - - - - - - - - - - - .- - .. - -- - - - - - - .- - - -

2

1 ------------------------

O+-~~~_+_~_+_r~+_~~~_+_~~

1975 1980 1985 1990

Year

- 78-

LaoPDR

r -+-all

I-+-news+ ,

14. MACAO


• Epidemiology: The incidence and mortality of pulmonary TB have been steadily declining. In 1983, they were 165/100 000 and 34/100 000 and then in 1992 they were 79/100 000 and 51100 000, respectively. The age-specific incidence of bacillary positive TB cases also shows the high incidence in the elder age-group. .

• Programme:

Organization: Technical Unit for the Fight against Tuberculosis (UTLCT in Portuguese) is in charge of TB control in Macao. TB treatment is fully integrated into nine health centers.

Laboratory: Central Public Health Laboratory conducts sputum smear examination, culture, identification and sensitivity test.

Recording and Reporting: Patient treatment card is standardized. All the tuberculosis cases are diagnosed registered and treated at UTLCT clinic. Treatment outcome is analyzed with this central register by UTLCT.

Case finding: Passive case-finding is the main method. Active casefmding (MMR) is partially conducted.

Regimen: SCC (2HRZS+4HR is most widely used). fully supervised (daily supervision) during the treatment. taking all the drug in front of nurses.

BCG: Primary to infants. Re-vaccinationis also given.

• Achievement:

Treatment is Patients are

Treatment outcome: The cohort analysis of treatment outcome is not routinely conducted. The available data shows cure rate in 1992 was 73 % and abandoned rate was 21 %.

BCG: BCG coverage at birth in 1992 was 98.8%.

• Reference:

(I) Relatorio Annual. Government of Macao, 1992.

(2) Relatorio Annual. Government of Macao, 1991.

(3) CHIP. 1986.

(4) The Health Services of Macau. Department of Health.

(5) Seita, A. Assignment Report. WHO, 1994.

- 79 -

Macao Macao




1975 1383 158

1976 140

1977 124

1978 71

1979 442 438 113

1980 1101 410.8 109 40.7

1981 585 196.3 99 33.2

1982 92 23.8

1983 455 149.7 94 30.9

1984 671 217.2 58 18.8

1985 571 145.7 44 11.2

1986 420 100.7 34 8.2

1987 389 94 27 . 6.5

1988 320 72.1 24 5.4

1989 274 133 59.6 28.9 14 3

1990 343 124 75.9 27.4 30 6.6

1991 329 140 69.6 29.6 18 3.8

1992 294 158 77.2 41.5 27 7.1

1993 318 265 108 14 82.8 69 28.1 21 5.5

1994 349 171 87.7 43 21 5.3


- 80-

Macao


500,---------------------------,

400

300

200

100

o~-+~~_+~~_+~~_+~~~

1975 1980 1985 1990

Vear

Rate of T8 Deaths (per 100 000)

50,-----------------------------.

40

30

20

10

O+-~_+~+_~_+~+_~_+~+_r+~

1975 1980 1985 1990

Vear

- 81 -

Macao

-.-all

-+-newB+

15. MALAYSIA


• Epidemiology: The numbers of new cases and smear positive cases have been almost stable around 10 ()()() and 7 ()()() respectively for these 15 years. The incidence rate of all cases had been decreasing until 1985, but has been almost stable since then (67/100 ()()() in 1990).

Proportion of Drug resistance in clinical materials without treatment history between 1984 and 1987 is 36 out of 856(4.2%) for INH, 8 out of 835(1.0%) for RFP, 65 out of 850(7.6%) for SM. Resistance to both INH and RFP was not isolated.

• Programme: National tuberculosis control programme (NTP) has started since 1961.

Organization:

• National level: National Tuberculosis Center with 276 beds is the headquarters of TB Division under MOH and the head is the director ofNTP.

• State level: State chest clinic is situated at State general hospital. State management team consists of organizer for BCG, Case· finding and treatment, recording and reporting and laboratory.

• District level: District state clinic is situated at District hospital.

• Health center: Case finding and holding are conducted as an integrated health service.

Case finding: Passive and contact tracing. MMR was abolished in 1968.

Laboratory: Central laboratory situated at National Tuberculosis Center implements drug susceptibility tests. Absolute concentration method on L-J media is used. Culture examination is available in the state general hospital laboratory except in one state situated close to Kuala Lumpur. L-J media is used for primary isolation from sputum specimens with Ogawa media for stool specimen.

Microscopic examination is available in State and District General Hospital laboratory and selected health centers. State laboratory organizer conducts supervision and quality control of sputum smear examination at District and Health Center laboratory.

- 82 -

Regimen: 6 Month SCC[2HRZ/4HR(SM or EB may be added)]. In principle treatment is supervised.

BCG: Primary to infants and re-vaccination at school. Both directly. Quality control is made.

Training and Supervision: Centralized training in the National TB Center and regular visits for the spot training.

• Achievement:

Treatment Outcome: Treatment outcome is assessed by cohort analysis at 2 years after treatment initiation according to fmal outcome. Cure rate of bacteriologically positive cases has been over 80 % since 1985.

BCG: The coverage is 90%.

• Reference:

(1) Pusat tibi negara. Laporan Tahunan, Rancangan kawalan tibi kebaugsaan. MOH, 1988, 1989, 1992, 1993.

(2) Pusat tibi negara. Perpustakaan. MOH, 1987.

(3) Yamada, N. Report. WHO, 1994.

- 83 -

Malaysia Malaysia




1975 11692 10953 6717 98.3 92 56.4 782 6.6

1976 11098 10360 6609 88.8 82.9 52.9

1977 10264 9471 6050 80.2 74 47.3

1978 10441 9712 6313 79.7 74.1 48.2

1979 11094 10307 6622 82.8 76.9 49.4

1980 11168 10411 6819 81.2 75.7 49.6 934 6.8

1981 10970 10141 6766 77.8 71.9 48 856 6.1

1982 11894 10824 7320 82 74.6 50.5 839 5.8

1983 11634 10632 7251 78.3 71.5 48.8 753 5.1

1984 10577 9784· 6660 69.6 64.4 43.8 776 5.1

1985 10569 9675 6682 66.6 60.9 42.1 514 3.2

1986 10735 9756 6653 66.6 60.6 41.3 528 3.3

1987 11068 9992 6924 66.1 59.7 41.3 531 3.2

1988 10944 9874 6718 64.5 58.2 39.6 637 3.8

1989 10686 9676 6711 61.6 55.8 38.7 464 2.7

1990 11802 10816 6774 66 60.5 37.9 545 3

1991 6752 36.9 364 2

1992 11586 10498 6754 166 61.9 56.1 36.1 305 1.6

1993 12285 11003 6954 210 64.7 57.9 36.6 324 1.7

1994 11708 10648 6861 59.4 54.1 34.8 400 2


- 84-

Malaysia


100 __ ----------------------------~

80 ~~~.-I--- - - - - - - - - - - - - - - - - - - -- - -

60 -

40 --

20 --

o~~~~~ __ ~~--~~~~~_+~

1975 1980 1985 1990

Year


10 -,-------------------------------,

8-

6

4

2

o~--_+~~~~_+_+ __ ~--~--_+~~

1975 1980 1985 1990

Year

- 85 -

Malaysia

--:::1 __ all

-+-newS+ I

16. COMMONWEAL m OF NORTHERN MARIANA ISLANDS


• Epidemiology: The number of all cases and sputum positive cases fluctuates very much between 25-75 and 3-30 respectively in these 10 years. Most of the cases are of pulmonary tuberculosis. 30% of all cases are migrant workers who are diagnosed at the conventional alliance physical examination at the time of starting job.

• Programme:

Case finding: Both passive (60%) and active. Active case finding includes contact tracing (6 % ) and conventional alliance physical examination of migrant workers(34 % ).

Laboratory: Until 1985, over half of the TB patients are not examined with sputum smear microscopy. But the situation has much improved since 1986. Cross-check was not done in 1986.

Regimen: In 1988, the regimen was not standardized. SCC was recommended by WHO.

• Achievement:

Treatment outcome: Completed: 56%, lost: 30% in 1986-87 (12 month completion rate was 75%).

• Reference:

(I) Department of State, USA: Pacific morbidity and mortality monthly Vol. 3 No.2, Feb. 1991.

(2) TIPI annual report. Department of State, USA, 1986.

(3) Fu, Q.Y. Report on a field visit to CNMI. WHO, July-Aug. 1988.

(4) Fu, Q.Y. Notes on a field visit to CNMI. WHO, Oct. 1986.

(5) Monthly morbidity summary. Department of Health and Environmental Services, 1988.

(6) CHIP. 1989.

- 86-

N. Mariana Is. N. Mariana Is.


Number of Newly Notified Cases Rate of Newly Notified Cas Deaths


1975

1976

1977

1978

1979

1980 2 12.5

1981 26 24 0 152.9 141.2 0 1 5.9

1982 75 69 11 441.2 405.9 64.7 1 5.9

1983 74 66 3 435.3 388.2 17.6 0 0

1984 58 53 28 305.3 278.9 147.4 1 5.3

1985 64 60 4 320 300 20

1986 16 14 5 80 70 25

1987 49 48 22 136.1 133.3 61.1

1988 27 22 71.1 57.9

1989 28 24 . 73.7 63.2

1990

1991

1992 67 55 21 145.7 1.19.6 45.7 1 2.2

1993 1994 46 39 22 0 97.9 83 46.8 0 0


- 87 -

N. Mariana Is.


500r-------------------------~

400-

300

200

• 100

• O~~~~~~~~--;_--~~~

1975 1980 1985 1990

Vear


50·~----------------------------

40 ------- ..... -- .. ------ ... - ..

30

20

10

O~_+~+_~~~~~~~~~+·~ 1975 1980 1985 1990

Vear

- 88-

N. Mariana Is.

___ all

-+-newS+

17. REPUBLIC OF MARSHALL ISLANDS

• Population: 52 ()()() in 1994

• Epidemiology: The number of new cases fluctuates between 6-32 in these 10 years. The number of sputum positive cases is less than 10 and the number of TB death is around 2 every yellf. Sudden increase of new cases since 1992 needs investigation.

• Programme: No manual or written policy was available in 1992.

Case finding: Both passive (70%) and contacts tracing (30%).

Regimen: Not standardized in 1986. SCC(2HRE/1HR) was recommended by WHO.

BCG: Started in 1986.

Recording and reporting: No system

• Achievement:

Case finding: Among the 212 cases registered in 1987-1991, 91 cases were diagnosed only with PPD and 60 cases were diagnosed only with clinical symptoms. (Only 21 cases were examined with sputum smear.)

Treatment regimen: Not standardized.

Treatment outcome: Completed: 33%, lost: 47% in 1986 and 87. In 1991, only 29% of cases continued treatment more than 6 months and 71 % stopped before 6 months.

Laboratory: Over half of the cases were not examined with sputum examination between 1986-1988.

Supply: No problem of shortage.

BCG: Only 6 babies among 563 vaccinated babies in 1991 had BCG scars.

• Reference:

(1) Fu,Q.Y. Reportofa field visit. WHO, July 1988.

(2) Pacific morbidity and mortality monthly. Department of State, USA: Vol.3 No.2, Feb. 1991.


(4) Fu, Q.Y. Report ofa field visit. WHO, Oct. 1986.

(5) Health & vital statistics quarterly. Ministry of Health Services, 1989, 1990.

(6) CHIP. 1989.

(7) Valeza F. Mission report. WHO, Aug. 1992.

- 89-

Marshall Is. Marshall Is.




1975

1976 17 8 65.4 30.8 2 7.7

1977 8 7 29.6 25.9 2 7.4

1978 6 5 .21.4 17.9 1 3.6

1979 4 3 14.3 10.7 1 3.6

1980 6 5 5 19.4 16.1 16.1 3 9.7

1981 7 6 4 21.9 18.8 12.5 2 6.3

1982 12 9 6 37.5 28.11· 18.8 1 3.1

1983 15 10 6 45.5 30.3 18.2 1 3

1984 12 9 7 34.3 25.7 20 2 5.7

1985 15 13 8 53.6 46.4 28.6 0 0

1986 37 28 4 127.6 96.6 13.8 2 6.9

1987 32 32 106.7 106.7 0 0

1988 11 11 25.6 25.6

1989 7 7 17.5 17.5

1990

1991

1992 52 50 14 106.1 102 28.6 0 0

1993 61 48 12 119.6 94.1 23.5 0 0

1994


- 90-

Marshall Is.


200~----------------------~

150 . - - - - - - - . - - - - - - - - - - -- - - - - - - - - - - - --

Marshall Is.

100 ___ .... _________________________ ~_ -+-all

50

0~~~--~~~_+~~4_r+~

1975 1980 1985 1990

Year


10.-----~------------------__.

8

6

4

O~_+~~_+~~_*~~-+~~~

1975 1980 1985 1990

Year

- 91 -

--...newS+

18. FEDERATED STATES OF MICRONESIA


• Epidemiology: In 1982-1985, notification number of new cases was around 70. In 1990 - 1992, it is around 100. Notification number and rate in 1992 are 107 and 101 per 100 000 respectively. This country consists of 4 states. In 1992, 77 % of all reported cases were from Pohnpei. The notification number and rate are 82 and 231 per 100 000 in this state in 1992. One meningitis case in this state was reported there in 1993. According to tuberculin survey in 1983, out of 439 persons aged of 0-19 years (mean age 11 years old), 65 was regarded as positive reactors.

• Programme:

Guideline: In 1990 the National Plan was approved by all of the four states in the country. High priority is given to the passive case finding with smear examination and supervised treatment.

Organization: The national level has one tuberculosis and leprosy coordinator. Two of 4 states have a full-time tuberculosis and leprosy coordinator.

Case finding: Passive case finding and contact examination. Chest X-ray and smear examination is available only in the state hospitals.

Laboratory: No culture facility is available in the country. The microscopic examination is given high priority. But only a few technicians are trained for smear examination.

Treatment: A principle is ambulatory treatment through hospital OPD, division of Public health and health centres.

Regimen: 2HRZ/4HR. (Both smear positive and negative cases.) SM or EB is added for re-treatment cases.

BCG: Only Chuuk state has mass BCG vaccination programme to cover the newborn infants delivered in the state hospital.

Registration: The state has a state tuberculosis registry. It is not standardized.

Reporting: There are 3 types of reports submitted by the state to nation: monthly reports of treatment started and discharged cases, verified case reports and annual state tuberculosis reports of new cases by age, sex and disease type.

• Achievement:

- 92 -

Laboratory: According to quarterly laboratory reports in January to June 1993, total number of examined specimens is 547. Out of them number of positive smears is 7 (1.3 % ). One of reasons of low positive rate is thought to be inappropriate sputum collection. In Chuuk state in 1992, 63 out of 274 specimens (23 %) are regarded salivary specimen in laboratory record.

Case rmding: Among 367 cases detected in 1988-90, only 39 cases were smear positive, 163 were X rays positive and 16'i were detected with clinical examinations and PPD testing. According to lerified case reports in 1992 and 1993 in Pohnpei state, 30% were diagnosed without smear examination or with the unknown result.

Case holding: Most cases are treated on unsupervised ambulatory base. No cohort analysis is conducted. According to monthly reports in 1990-1991, 90 cases completed and 112 cases defaulted.

Case holding: Most cases are treated on unsupervised ambulatory base. No cohort analysis is conducted. According to monthly reports in 1990-1991, 90 cases completed and 112 cases defaulted.

Chemoprophylaxis: According to monthly reports, 20 persons started chemoprophylaxis in 1992.

BCG: In Chuuk state around 100 infants are given BCG monthly.

• Reference:

(1) Information from Dr. Sally Jo Manea (Dec. 11 1990).

(2) Pacific morbidity and mortality monthly. Department of State, USA: Yol.3 No.2 Feb. 1991.

(3) Fu, Q.Y. Report on a field visit. WHO, 1986.

(4) Department of Human Resources: National tuberculosis plan 1989.

(5) Yaleza, F.S. Mission report. WHO, Oct. 1 - Nov. 7 1991.

(6) Donna Wichimai. Tuberculosis programme review. Department of Health Service.

(7) Yamada, N. Assignment Report. WHO, 1993.

- 93 -

Micronesia Micronesia




1975

1976

1977

1978

1979

1980

1981

1982 67 53 11 93.1 73.6 15.3

1983 73 59 32 100 80.8 43.8

1984 75 59 18 85.2 67 20.5 .

1985 66 58 14 72.5 63.7 15.4

1986 60 50 10 63.8 53.2 10.6 11 11.7

1987 97 93 18 103.2 98.9 19.1 8 8.5

1988 77 72 79.4 74.2 10 10.3

1989 68 64 71.6 67.4 6 6.3

1990 4 4

1991

1992 I

111 87 19 102.8 80.6 17.6

1993 151 101 8 3 151 101 8 0 0

1994 171 68 15 7 171 68 15 4 4


- 94-

Micronesia


200 -y---------------,

150 - - - - - - - - - - - - - - - - - -- - - -- - -- - - - - - - - --

100

50

~- ---

~----------

0~_r~~~~_+4_r_~~_+~~

1975 1980 1985 1990

Year


50 ,---------------,

40

30

20 - --

10 -------- --------~-------

O~~+_~~~_+~~--+__+~*/~ 1975 1980 1985 1990

Year

- 95 -

Micronesia

I---an , I i I • l.......-newS+1 !

19. MONGOLIA


• Epidemiology: The number of TB cases detected has increased to 2819 in 1986 but is decreasing since then (1611 in 1991). There is no data available about the prevalence survey and ARl. No data is available about the number of smear positive and culture positive cases.

• Programme:

Organization: Administrative: National TB center (NTC) is working for NTP. At regional level, TB hospital in Ulaanbaatar and TB ward and TB dispensaries in regional hospitals are working as registration unit.

Case finding: Mainly Mass examination (X ray) was widely done but it has become difficult to maintain with financial reasons. Passive case finding is done.

Laboratory: 20 regional facilities with microscopes. 1 laboratory in NTC is with culture, sensitivity and identification test.

Diagnosis: X-ray first (only 117=7.3% of all were sputum positive in 1991).

Treatment: 3HSE/6-9HE was done and WHO 3 CAT regimen is going to start with Danish aid.

BCG: newborns and revaccination

• Achievement:

MMR: Coverage has decreased from 33.6% in 1990 to 19.2% in 1991.

Completion rate: Defaulter was 32 % for RFP- regimen.

BCG: Coverage about 80% but scar is positive only among 50-60%.

• Reference:

(1) personal communication with Dr. Tsogt (director, National TB Center, 1994).

(2) T. MORl et al (RIT). Report. 1994.

- 96-

Mongolia Mongolia




1975 1117 78.7 99 7

1976 1121 76.3 132 9

1977 1075 71.2 108 7.2

1978 1107 71.4 105 6.8

1979 1123 70.2 139 8.7

1980 1160 70.7 164 10

1981 1094 65.1 132 7.9

1982 1325 77 152 8.8

1983 1514 85.5 159 9

1984 1652 91.3 139 7.7

1985 2994 363 161.8 19.6 144 7.8

1986 2819 320 148.4 16.8 166 8.7

1987 2433 271 124.8 13.9 139 7.1

1988 2538 276 126.9 13.8 140 7

1989 2233 234 109.5 11.5 139 6.8

1990 1659 185 79 8.8 101 4.8

1991 1611 134 74.9 6.2 132 6.1

1992 1516 92 69.2 4.2 119 5.4

1993 1418 87 63.9 3.9 124 5.6

1994 1730 200 17 76.9 8.9 130 5.8


- 97 -

Mongolia


200~--------------------------~

150

100

50 -- -------------------------------------

oL-~~--~~~~~~ 1975 1980 1985 1990

Year


10 r-------~--------------------__.

8

6

4-

2 ------------- -----------------------------

o+-r--+~~+_+_~_+_r~+_~_+~~

1975 1980 1985 1990

Year

- 98-

Mongolia

[ ....... 811

I I I -

L~news+!

20. NAURU


No data is available on the control programme of tuberculosis.

• Reference:

(1) Kiki Thoma (Director of medical service)et al. Nauruan mortality. 1976-1981.

(2) CHIP. 1989.

- 99-

Nauru Nauru




1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993 1994 4 3 2 1 36.4 27.3 18.2 0 0


- 100-

Nauru


50.-----------------------------~

40 - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

30 ---- ------------------------------------

20

10

O+-~_+~+_~~~~~_+~~~~~

1975 1980 1985 1990

Year


5-r-------------------------------.

4

3 -------- -- ----------------------------------

2

1

O+-~-+~~~+_~_+~--+_~~_+~~

1975 1980 1985 1990

Year

- 101 -

Nauru

~ -+-newS+

21. NEW CALEDONIA


• Epidemiology: Though there was a slight peak in 1983 and 1991, the number and rate of new cases has been stable. The numbers of new all cases were 140 and smear positive cases were 29 in 1992. The incidence rates were 81.3/100 000 and 24.4/100 000 respectively in 1989. .

Among the 631 cases (including primary infection without diseases) registered in 1989-1992, 212 cases were examined for HIY and 43 were positive.

• Programme: There is a central registration system.

Laboratory: Smear and culture examinations are routinely done. 35 of 75 specimens were positive in culture examination in 1989. In 1989-1992, 135 smear positive and 157 culture positive cases were found.

Regimen: 2HRZE4HR or 3HRE6HR

Preventive chemotherapy: Preventive chemotherapy is given (6HR).

• Achievement:

Treatment result: The monitoring result is expressed in other categories than WHO system. Among the 135 cases whose treatment started in 1989-1992, 78 cases were cured (57%). 21 cases (among these 9 cases started treatment before 1992) were still on treatment.

• Reference:

(1) Information from Dr. Lee(WHO, Nov. 1990).

(2) Ecole nationale de la sante. La sante en nouvelle caledonie et dependances, 1987.

(3) L'activite du service de sante. Service de sante, 1983.

(4) CHIP. 1990.

(5) Etat de Sante den Nouvelle-Caledonien 9. 1992.

- 102-

New Caledonia New Caledonia




1975

1976

1977

1978

1979

1980 108 78 77.7 56.1

1981 128 89.5

1982 107 76 34 72.3 51.4 23

1983 161 122 60 111 84.1 41.4

1984 144 94.7

1985 104 69.3

1986 98 66.2

1987 74 48.1

1988 111 69.4

1989 110 82 40 68.8 51.3 25

1990 130 92 37 79.3 56.1 22.6

1991 140 93 33 83.8 55.7 19.8

1992 140 90 32 81.9 52.6 18.7

1993 149 112 35 85.1 64 20

1994 132 110 42 0 74.2 61.8 23.6 0 0


-103 -

New Caledonia


200~--------------------------~

150

100

50 -- ----------------

/ OL-~~~~~~~~~~~~~~

1975 1980 1985 1990

Year


5 ~------------------------------

4

3-

2 - - -

1 - -

o·~~~~~~~~~+_~~--~--~

1975 1980 1985 1990

Year

-104 -

ew Caledonia

i-+-all I

1--'-new S+ I L- I

22. NEW ZEALAND


• Epidemiology: Though the number and rate of new cases had been steadily decreased, the decline has stopped since 1987. The incidence rate of all cases and mortality rale were to 9.91100 000 and 0.41100 000 respectively in 1991. The incidence rate of all cases was 40.5/100 000 for the Maori and Polynesians in contrast to 2/100 000 for the European descent population in 19~9. Refugees consisted 14.5% of the notifications in 1989. A small proportion of new cases had HIV infection.

• Programme:

BCG: Given not routinely but only in some areas and to high risk children.

Chemoprophylaxis: Chemoprophylaxis is given.

• Reference:

(1) personal communication with Dr. J. Stehr-Green(Epidemiology unit, CDC, Oct.-Nov. 1990).

(2) Key statistics. Department of Statistics. Nov. 1990.

(3) Public Health Report. Department of Health. 1982.

(4) Morbidity and Demographic Data. Department of Health, 1987.

(5) CHIP. 1990.

- 105 -

New Zealand New Zealand




1975 663 556 21.4 17.9 74 2.4

1976 611 503 19.7 16.2 62 2

1977 608 531 19.6 17.1 71 2.3

1978 595 513 19.2 16.5 59 1.9

1979 542 348 17.5 11.2 34 1.1

1980 474 309 15.3 10 27 0.9

1981 448 268 14.5 8.6 25 0.8

1982 437 280 13.7 8.8 22. 0.7

1983 415 234 13 7.3 13 0.4

1984 402 254 12.2 7.7 25 0.8

1985 359 209 69 11.2 6.5 2.2 22 0.7

1986 320 196 66 . 9.7 5.9 2 16 0.5

1987 296 177 55 9 5.4 1.7 10 0.3

1988 295 195 62 8.9 5.9 1.9 8 0.2

1989 303 212 8.9 6.2 10 0.3

1990 348 249 10.2 7.3 11 0.3

1991 335 250 9.9 7.4 12 0.4

1992 317 9.1

1993 274 219 91 7.8 6.3 2.6 4 0.1

1994 344 168 61 9.8 4.8 1.7 5 0.1


-106 -

New Zealand


50r---------------------------~

40 - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

30 ---------------------------------------

20 'ft-. .......... - a.:..::..- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -10 _ .. _------

0 1975 1980

------....

1985 1990

Ye.r


--.J -.. ,.....

5.-----------------------------, 4 - ---------- -----------------------------

3

D~~~~~~~~~~~~ 1975 1980 1985

Ye.r

-107 -

1990

New Zealand

) ___ all I

I • news+i

23. NIUE


In 1980, there were only 2 doctors.

• Epidemiology: There were only 17 tuberculosis cases between 1976-93 and the average annual incidence rate was 3110 000. Until 1985, only one was sputum positive.

• Programme: The case finding and treatment is centralized to the general hospital in Alofi.

Case finding: Passive.

Laboratory: There is only one technician. Culture specimens are sent to New Zealand. .

Regimen: SM, INH and RFP are used.

BCG: Primary vaccination to newborn babies. Re-vaccination at school.

• Achievement:

Duration of treatment: Most of the cases drop out within a year though the recommended duration is 18 months.

BCG: The coverage of primary vaccination is 100% because almost all babies are delivered in the only hospital. Re-vaccination coverage was 62% in 1984.

• Reference:

(I) Fu, Q.Y. Notes on a field visit to Niue. WHO, June-July 1985.

(2) Statistics Unit in Administrative Department. Niue census of population and dwellings, 1986

(3) CHIP. 1989.

- 108 -

Niue Niue




1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992 2 2 66.7 66.7 0 0

1993 1 1 0 0 50 50 0 0 0

1994 2 1 0 0 100 50 0 0 0


-109 -

Niue


200r---------------------------~ 180 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -160 -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -140 - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -120 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -100

20 0+-~_r--~-+~~r4--~~~~~

1975 1980 1985 1990

Year


5r-------------------------------. 4

3 --------------------------

2

1

o ~_+_r~~+_~_+~~+_~_+~~~_ 1975 1980 1985 1990

Year

-110 -

1- • all I

1

-+-newS+1 I

Niue

24. REPUBLIC OF PALAU


• Epidemiology: The number of new cases fluctuates 3-38 in these 15 years and that of sputum positive cases is less than 10.

• Programme: No manual nor written policy was available in 1992.

Case finding: Both passive (85%) and contact tracing (8%).

Laboratory: Sputum smear is done but the positivity in 1987-1991 was 0.7%(16/2325). Among the 86 cases registered in 1987-1991, only 61 cases were examined for smear and 8 cases were diagnosed without smear nor X ray.

Regimen: SCC (9 month) since 1987.

BCG: Not done since 1983.

Recording and reporting: No system.

• Achievement:

Regimen: In reality, no standardization (1-48 weeks treatment).

Treatment outcome: Completed: about 80%, transferred out: 11 %, dead: 6%, (1983-86). But due to the poor recording, the cohort analysis for cases in 1989-1991 was impossible.

• Reference:

(1) Fu, Q.Y. Report on a field visit. WHO, Oct. 1988.

(2) Pacific morbidity and mortality monthly. Department of State, USA, VoL3 No.2, Feb. 1991.


(4) Annual statistics report. Bureau of Health Services, 1987.

(5) Valeza, F. Mission report. WHO, Aug. 1992.

- III -

Palau Palau




1975 20 18 153.8 138.5

1976 5 4 38.5 30.8

1977 7 5 50 35.7 1 7.1

1978 14 12 100 85.7 1 7.1

1979 9 8 64.3 57.1 0 0

'1980 17 15 10 113.3 100 66.7 0 0

1981 10 7 5 66.7 46.7 33.3 1 6.7

1982 17 10 2 141.7 83.3 16.7 1 8.3

1983 14 12 6 100 85.7 42.9 1 7.1

1984 20 13 153.8 100 1 7.7

1985 26 23 4 216.7 191.7 33.3 2 16.7

1986 13 11 0 92.9 78.6 0 0 0

1987 38 35 4 271.4 250 28.6 3 21.4

1988 17 17 121.4 121.4

1989 3 3 25 25

1990

1991 6 50

1992

1993 25 25 8 0 156.3 156.3 50 3 18.8

1994 41 37 11 0 256.3 231.3 68.8 0 0


-112 -

Palau


500,----------------,

400

300 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

200

100

• o~-+--+_~~~~~~~_+~~~

1975 1980 1985 1990

Year


50r---------------~

40

30

20

10

O~~~~*_~_+~~~~~~~_T_A

1975 1980 1985 1990

Year

-113 -

Palau

__ all

-+-newS+

25. PAPUA NEW GUINEA


• Epidemiology: The number of newly registered cases fluctuates between 2500 and 4 000 in these 15 years and it was 2 497 in 1990. The incidence rate has been between 80-100/100 000. The number of TB death has also been fluctuating around 250. The proportion of pulmonary tuberculosis to all cases is about 70% and that of sputum positive cases to pulmonary cases is about 40 %. These numbers in reports are smaller than those of actually detected cases because of insufficient reports from the provinces.

• Programme: Since 1978, NTP has been decentralized.

Organization: At the provincial level, Provincial TB Officer runs the vertical programme. But the integration into PHC has been gradually taking place through District Health Officers. The cases are supervised in health centers, health subcenters, and local aid posts.

Case finding: Passive and contact tracing.

Laboratory: All the provincial hospitals, most of the health centres and some of the sub-health centres have the laboratories with microscopy. Those laboratories are supervised by the Central Public Health Laboratory at Portmoresby and the College of Allied Health Science. The national Quality Assurance Programme is conducted for the quality control of smear examination. In 1992 the result was acceptable (false positive: 7 %, False negative: 3 %).

Treatment: Treatment is provided free of charge at hospitals, urban clinics, health centres and sub-health centres. It is a principle that the intensive phase is conducted on in-patient basis and continuation phase is on ambulatory basis.

Regimen: Until 1986, standard regimen was 2SHT (in hospital) + 16SH (intermittent and ambulatory). But by 1989, SCC has been introduced to all provinces.

Intensive Phase: 2HRZE, Continuation Phase: 4H2R2 All medicines are single preparations.

BCG: Primary vaccination to infants and re-vaccination at school.

Training and Supervision: In service training is given.

- 114 -

Recording and reporting: The treatment facilities keep the treatment card. Monthly report comes from the treatment facilities to the provinces. and from province to MOH. Monthly reports provide tabulated number of newly treatment started cases and discharged cases. It also provides individual information on newly registered cases including smear and culture results.

• Achievement:

Sputum examination: Among the 1877 pulmonary TB cases reported newly in 1992. only 24% were smear positive and 36 % were diagnosed without sputum examination.

Case finding: 75%: passive, 23%: contact examination

Treatment outcome: Cohort study is not conducted routinely. Out of 2961 cases discharged in 1991, 1898 cases completed the treatment. 747 were lost.

BCG: Coverage of primary vaccination was 50-60% in 1986, and that of re-vaccination was small.

• Reference:

(I) Nagpaul, D.R. Assignment report. WHO, Sept. 1989.

(2) Fu, Q.Y. Notes on a field visit. WHO, Dec. 1986.

(3) Handbook Health Statistics PNG. Department of Health. Division of PHS, 1988.

(4) Tuberculosis Annual Summary. 1989.

(5) Information from Dr. Pahum(Office of the Secretary for Health, April 1991).

(6) National Health Plan. Department of Health, 1986-90.

(7) Nagpaul, D.R. Assignment report. WHO, Aug. 1990.

(8) Onozaki, I. Assignment report. WHO, 1993.

- 115 -

Papua New Guinea Papua New Guinea




1975

1976 1782 64.8

1977 2212 1638 852 79 58.5 30.4

1978 2446 1773 903 84.3 61.1 31.1

1979 2232 1695 883 77 58.4 30.4 213 7.3

1980 2525 1801 967 842 60 32.2 274 9.1

1981 2418 1749 867 78 56.4 28 252 8.1

1982 2742 1876 942 83.1 56.8 28.5 222 6.7

1983 2954 1997 870 84.4 57.1 24.9 254 7.3

1984 3505 2435 1061 106.2 73.8 32.2 308 9.3

1985 3678 2356 870 108.2 69.3 25.6 285 8.4

1986 2877 1931 606 84.6 56.8 17.8 169 5

1987 3235 2168 839 89.9 602 23.3 191 5.3

1988 4261 2984 1273 118.4 82.9 35.4 249 6.9

1989 3396 2491 951 871 63.9 24.4 238 6.1

1990 2497 1756 611 675 47.5 16.5 210 5.7

1991 3401 2402 489 895 63.2 12.9

1992 2540 2141 65.1 54.9 168 4.3

1993 5516 4132 812 104 1345 100.8 19.8 187 4.6

1994 5335 3918 573 300 130.1 95.6 14 163 4


-116 -

Papua New Guinea


200~--------------------------__

150 - - - - - .. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -.

100

50 .. - - - - - - - - - - - .. - - - - - - - - - .. - .. - - - - - - - - - - - - -

0~~~4-~~4-~-+~~~~~~

1975 1980 1985 1990

Year


10r------------------------------,

8

6

4

2 --- .-------------.---------.

0+-~_+~+_~_+~4_+_~_+4_+-~~

1975 1980 1985 1990

Year

-117 -

Papua New Guinea

___ all

~newS+

26. PHILIPPINES


• Epidemiology: The number of new cases has been increasing and the incidence rate has been almost stable since 1978. The number of smear positive or cavitary cases were 96 674 in 1993. With further 30 241 cavitary and 42 625 non cavitary X-ray positive cases were newly put on treatment in 1993. The average incidence rate in late 1980s was highest in WPR. The mortality rate has been decreasing and was 45.9 in 1993. The prevalence rate of bacillary positive and smear positive cases were 8.6/1000 and 6.6/1000 respectively in 1983 prevalence survey.

• Programme: The tuberculosis control programme (TBCS) is fully integrated into the general health system.

Organization: The Tuberculosis Control Service in the Department of Health supervises national programme. 15 Regional, 76 Provincial and (about 1000) District and 23 000 Rural Health Unit (RHU) Tuberculosis Coordinators (not full time for TB, doctors and nurses) supervise the programme at each level. Most periphery unit for treatment is 120 000 Barangay Health Stations (BHS).

Case finding: Passive by direct sputum smear is emphasized. Microscopy center exists in the RHUs. Midwives in the BHS are trained to refer symptomatic persons to RHU with microscopes. If symptomatic case is sputum smear negative twice and the symptom persists after symptomatic treatment, then chest X-ray is taken. Active case finding was strengthened in 1990-1993.

Regimen: SCC(2HRZ/4HR) to smear positive or cavitary case: SM + INH for 12 month to other X-ray positive. Relapse cases were expected to be treated with 4 drugs (HRZE) in limited area like Manila only, but the patient interview about previous history of treatment leaves points to be improved.

Drug supply: For SCC drugs, done by TBCS. About SCC drugs, there is no shortage.

Recording and Reporting: There is a guideline of recording but no register book printed. Reporting form requests about the cross sectional information about the number of IN and OUT and its reason and only the number of follow up smear examination by the follow up month. So exact cohort analysis seems to be difficult.

- 118 -

• Achievement:

Case finding: The number of new cases increased to about 200 ()()() in late 1980s, which is probably due to the improvement of case finding activities. About half are sputum smear positive.

Laboratory: The sputum microscopy service covers 94 % of the whole country.

Treatment outcome: Completed: 85%, dead: 1.7%, lost: 6.9% by the TBCS report. But the review of register books by WHO mission shows that the real completion rate is lower than the report.

• Reference:

(I) Philippines Health Statistics. Health Intelligence Service, MOH, 1986.

(2) Annual report. Department of Health, 1988.

(3) Tripathy, S.P. Assignment report. WHO, June-July 1989.

(4) Tuberculosis Control Service Annual report. Department of Health, 1989.

(5) Valeza, F.S. Report in Sturbridge meeting, Department of Health, 1990.

(6) Italian Assistance to the National TB Control Program: Plan of Action.

(7) Tripathy, S.P. Assignment report. WHO, May 1991.

(8) Annual report. Department of Health: NTP: 1990

(9) Mission report. Evaluation mission, WHO, Feb. 8 - March 11, 1993.

(10) personal communication with Dr. Texon (acting director of TBCS, DOH,1994).

- 119 -

Philippines Philippines




1975 133537 133537 314.1 314.1 29436 69.2

1976 148057 148057 338.4 338.4 31386 71.7

1977 107108 107108 238 238 31805 70.7

1978 118587 118587 260.5 260.5 28398 62.4

1979 108813 108813 233.6 233.6 28221 60.6

1980 112307 112307 17275 233.5 233.5 35.9 28798 59.9

1981 116821 116821 19006 235.9 235.9 38.4 27317 55.2

1982 104715 104715 20676 204.2 204.2 40.3 28309 55.2

1983 106300 106300 18657 204.2 204.2 35.8 25580 49.1

1984 151863 151863 21291 284.4 284.4 39.9 27320 51.2

1985 151028 151028 39571 276.3 276.3 72.4 31650 57.9

1986 153129 153129 50624 273.5 273.5 90.4 30604 54.7

1987 163740 163740 72150 278.8 278.8 122.9 28697 48.9

1988 183113 183113 63655 308 308 107.1

1989 217272 217272 97070 361.5 361.5 161.5

1990 317008 317008 515.6 515.6

1991 207371 207371 329.7 329.7 22814 36.3

1992 236172 236172 377.5 377.5

1993 174189 174189 92279 268.8 268.8 142.4

1994 180044 180044 87401 272 272 132


-120 -

Philippines


500~----------------------*---~

400

300

200

100

O~~~~+-~~~~~~~~~~

1975 1980 1985 1990

Year


100~----------------------------~

80 - - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - .- - - - - - - - -

60

40 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -• 20 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- _. - - - - - - -

O+-~-+~~+-~-+~+-~-+-r~+-~

1975 1980 1985 1990

Y.ar

-121 -

Philippines

.....-all

-+-newS+

27. REPUBLIC OF KOREA


• Epidemiology: The number and rate of new cases detected during one year are decreasing in these 10 years and were 49886 and 113/1 00 000 respectively in 1993. The number of bacillary positive cases detected has been also decreasing these 8 years and was 24597 in 1993. According to the 6th prevalence survey in 1990, the prevalence rate was 18/1000 (for all), 2.4/1000 (for bacteriologically confirmed), 1.5/1000 (for smear positive), and the ARI was estimated to be 0.76% with 6.4% annual reduction rate. 15% of culture positive new cases are resistant to at least one drug (13 % were resistant to INH), and it was 17 % in 1985 and 31 % in 1980.

• Programme: NTP was developed since 1962. NTP covers pulmonary cases only.

Organization: At the central level, Infectious Diseases Division, Ministry of Health and Social Affairs is responsible for the programme. At the provincial level. each city or provincial government has a supervisory medical officer. Patients are basically detected, treated and registered at Health Centers staffed with a microscopist and TB worker, or at Health Subcenters staffed with TB aids, under the supervision of City/province TB supervisory team. Patients receive medicine and follow up from HCs or Health Subcenters.

Case finding: Sputum examination and X-ray to symptomatic cases, contacts and for screening of high risk group. Active case finding with MMR and contact tracing are also made.

Laboratory: Sputum collections are done at facilities with microscopes and also in subcenters where health workers collect sputum and send them to health centers. Sputum examination is done at HCs. Besides, suspected cases by X-ray are examined with culture examination at the 12 Provincial TB Centers (branches of KNT A). The sensitivity test is made at the Korean Institute of Tuberculosis (KIT) in Seoul.

Regimen: Since 1990, 2HRZE/4HRE or 2HRZS/4HR or 9HRE or 6HRS/3HR or 6HES+6HE+6H (for smear positive cases): 2HRZE/4HRE or 6HRE or 2HRS +4HR or 2SHE+ IOHE or 2SHP+ IOHP (for smear negative cases). Re-treatment cases are treated at health centers on the basis of the sensitivity test result for example 12REZ (H resistant), 6RZK +6RZ(H,E resistnt) and so on. Cases resistant both to INH and RFP are treated in provincial hospitals or chest clinics in KNT A (Korean national tuberculosis association).

BCG: Primary to the preschool children and the 1st year primary school children without BCG scars. Revaccination to 6th year primary school children with negative tuberculin.

Training and supervision: National Institute of Health and Korean Tuberculosis Association give training to the TB service personnel.

• Achievement:

- 122 -

Case ~ndi~g: In 1993, 7248 cases were discovered with sputum smear exammatlOn case finding programme, other 10700 cases were discovered with X ray case finding programme and also positive with sputum smear and with other 6548 cases were found to be negative with ZN smear but positive with f1uorecent microscopes or cultures. Total 24597 positive and 25289 negative cases are discovered and also more than 30 000 cases are put on observation.

Regimen: The cases treated with 6 months regimen is increasing (16734 cases in 1993)

Treatment outcome: In 1990-1993, among those who were treated with 6-9 months regimen and whose cohort analysis is done, more than 80 % of the caes completed treatment (in 1993 6 months regimen 6161715=86% and cure was 5951715=82.8%, and in 1993 9 months regimen 230/287=80% completion and 223/287=77% cure) and the proportion of drop out has been decreasing (6 months regimen in 1991. 27/358=7.5% to 331715=4.6% in 1993) But those who were treated with 12-18 months regimen, the proportion of completion is 60-80% in 1986-1993.

Supervision: 33 health centers among 267 were reviewed in 1993.

• Reference:

(I) National Tuberculosis Control Program of Korea. Korean Institute of Tuberculosis(KIT), 1994.

(2) National Tuberculosis Control Program of Korea, KIT, 1994.

(3) Report on the 6th Tuberculosis Prevalence Survey. KIT, 1990.

(4) personal communication with Dr. Sang Jae Kim(KlT, 1991-1994).

(5) personal communication with Dr. Sung lin Kim (KNTA, 1995).

(6) personal communication with Dr. Y. P. Hong (Director, KIT, 1995).

- 123 -

Republic of Korea Republic of Korea




1975

1976

1977

1978

1979 81910 81910 34633 217.8 217.8 92.1

1980 89803 89803 38211 235.6 235.6 100.2

1981 98532 98532 43868 254.5 254.5 113.3 5212 13.5

1982 46735 118.8 6865 17.5

1983 91572 91572 45688 229.2 229.2 114.4 7106 17.8

1984 85669 85669 42561 211.1 211.1 104.9 6772 16.7

1985 87169 87169 48515 211.5 211.5 117.7 6274 15.2

1986 88789 88789 49083 212.1 212.1 117.2 5872 14

1987 87419 87419 45066 207.7 207.7 107.1 5321 12.6

1988 74460 74460 39040 177.4 177.4 93 4676 11.1

1989 70012 70012 33968 165.2 165.2 80.2 4382 10.3

1990 63904 63904 30700 149.3 149.3 71.7

1991 57864 57864 28790 134 134 66.7

1992 48070 48070 17736 110.3 110.3 40.7 4082 9.4

1993 46999 46999 16630 1695 106.7 106.7 37.7

1994


-124 -

Republic of Korea


500 -,------------------,

400 -

300 .

200 . -~ _ ......... -----......

100

O~-__ ~~~~+_~_+~+_~_r~ 1975 1980 1985 1990

Ye.r


50r--------------------~

40

30

20

10 - - .. - .. ~-- .. --A-.-

o ~~~_r~+_~_+~~+_~_+~~~ 1975 1980 1985 1990

Year

-125 -

blie ofK.orea

___ all

-+-newB+

28. WESTERN SAMOA


• Epidemiology: The ARI is estimated to be 0.7% (1988 Dr. Lin). Since 1987, the number of new cases has increased and the number and incidence rate of new cases was 49 and 30/1()() 000 respectively in 1993. Among the 139 cases between 1987 and 1990. 123 cases were pulmonary tuberculosis and 48 of these were smear positive. No case of meningitis or miliary tuberculosis was reported in 1970s and 1980s.

• Programme: There are 11 health personnel in the TB/Leprosy Control Section at the central level. No full time staff for TB in district hospitals. health centers, and subcenters and all the symptomatic persons are referred to the National Hospital TB and Leprosy.

Case finding: Passive and semi-active.

Laboratory: Sputum smear examinations are done in National Hospital and Tuasivi District Hospital and most of the sputum specimens are sent to the National Hospital (about 100 specimens per month) but because there is only I technician in the National hospital. the quality control is not done. Culture examination was done until 1987 and restarted in 1992 under technical assistance of New Zealand.

Regimen: Since 1983, RFP has been used. Now 6 months reigmen is used (2HRZ4HR). Initial 2 month are hospitalized (national hospital) and 4 month are ambulatory (national hospital district hospitals) Intermittant regimen for continuation phase. twice weekly.

Monitoring treatment: At 2 and 6 months. smear and X ray follow up is done. One follow up after cure is also recommended.

BCG: Primary vaccination to the newborn babies under EPI and re-vaccination is also done.

• Achievement:

Case finding: Since 1982, case finding activities are practically centralized to the Chest Clinic and the National Hospital in Apia. In 1983-85, those who were detected in district hospitals and health centers were 12 % of all and those detected in private clinics were also 12 %.

- 126 -

Treatment outcome: Cure rate: 95%, abandoned: 5%, in 1987-90 (smear positive). But the sputum examination of the patients treated in the district hospital is incompletely done.

BCG: Coverage of primary vaccination is 90%.

• Reference:

(1) Fu, Q.Y. Notes on field visit. WHO, Feb. 1985.

(2) Monthly report of notifiable diseases. Dec. 1988.

(3) CHIP. 1989.

(4) Jittinandna A. Mission report. WHO, 7 July - 2 August 1991.

- 127 -

Samoa Samoa




1975 51 34 9 6

1976 79 52 21 13.8

1977 36 23.4 11 7.1

1978 59 37.8 10 6.4

1979 58 36.7 6 3.8

1980 59 36.6 6 3.7

1981 49 41 32 31.4 26.3 20.5 11 7.1

1982 43 43 30 27.4 27.4 19.1 5 3.2

1983 41 38 25 25.5 23.6 15.5 5 3.1

1984 37 30 20 22.7 18.4 12.3 5 3.1

1985

1986

1987 29 18

1988 29 18 5 3.1

1989 37 21.8

1990 44 27.2 1 0.6

1991

1992 26 24 2 16.1 14.9 1.2 2 1.2

1993 49 45 21 0 29.3 26.9 12.6 4 2.4

1994 45 44 18 1 26.6 26 10.7 10 5.9


-128 -

Samoa


100~------------------------~ 90 --80 70 60 ------------------------------------

50 40 30 20 10 0-~--4-~~~~~~--4_~~~

1975 1980 1985 1990

Ye.r


50~--------------------------~

40

30

20 -

10

0~_+~+_~ __ 4_~--~~~ __ ~~

1975 1980 1985 1990

Ye.r

-129 -

Samoa

r~ l~news+1

29. SINGAPORE


• Epidemiology: The number and rate of new cases has steadily decreased until 1990 and were 1 841 and 68/100 000 respectively in 1991. All bacillary cases are examined for drug susceptability test and among resident new cases (855), resistance to H:4%, R:0.8%, and among non resident new cases (116), resistance to H:14.8%, R:1.7%.

• Programme:

Case finding: Passive, contact tracing and active (high risk group).

Laboratory: Sputum smear microscopy, culture examination, BACTEC and sensitivity test are routinely done. About 30% are S+ and 30 % are S-C + cases.

Regimen: 2HRZS/4HR or 2HREI7HR. 6 months regimen is used principally as supervised (whole course or partly) treatment.

BCG: Primary vaccination to infants. Re-vaccination to school entrants without BCG scars and to primary and secondary school leavers with negative tuberculin ( < lOmm).

Chemoprophylaxis: Done.

Reporting system: Computerized system has been set up since 1986 and now under way upon Dbase IV. TB database is linked to HIV notification registry.

• Achievement:

Treatment result: For the cohort who started treatment in 1990, 600 cases who were treated under Department TB Control were analyzed. Cure: 89%, Die: 3%, Default: 3% Relapse: 1 %.

• Reference:

(1) Tuberculosis Statistics. Tan Tock Sen Hospital, Ministry of Health: Singapore, 1988, 1989, 1990.

(2) Annual report. Ministry of Health, 1989.

(3) Singapore Demographic Bulletin. National Registration Department, 1990.

(4) CHIP. 1990.

(5) Mori, T. Assignment report. WHO, 1992.

- 130-

Singapore Singapore


Number of Newly Notified Cases Rate of Newly Notified Case~ Deaths


1975 3097 2973 1424 136.9 131.4 62.9 420 18.6

1976 2813 2684 1361 122.7 117.1 59.4 358 15.6

1977 2760 2628 1285 118.7 113 55.3 340 14.6

1978 2964 2795 1375 125.9 118.7 58.4 318 13.5

1979 2800 2637 1197 117.5 110.6 50.2 331 13.9

1980 2710 2562 1266 112.3 106.1 52.4 240 9.9

1981 2425 2269 1062 99.3 92.9 43.5 221 9

1982 2179 2029 998 88.1 82.1 40.4 207 8.4

1983 2065 1927 860 82.5 77 34.4 224 9

1984 2143 1987 992 84.4 78.2 39.1 163 6.4

1985 1952 1781 949 76.3 69.6 37.1 177 6.9

1986 1760 1570 839 68 60.7 32.4 177 6.8

1987 1616 1499 740 61.8 57.4 28.3 177 6.8

1988 1666 1543 794 62.9 58.3 30 164 6.2

1989 1617 1492 823 60.2 55.6 30.7 132 4.9

1990 1591 1450 840 58.9 53.7 31.1 110 4.1

1991

1992 1512 1382 841 53.7 49 29.8 98 3.5

1993 1722 1610 61.7 57.6 99 3.5

1994 1677 1564 861 170 59.4 55.4 30.5


-131 -

Singapore

NotIfIcatIon .. (per 100 000)

200r-------------------~------_,

150 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --

100

50 r--. ............... ..-

• O+-i_+_+_-+-I-+_+_+_t-+-+-_+_+-+-+-_+_+-+-l

1975 1980 1985 1990

Vea,


50.-----------------------------~

40 ----------------------------------------

30 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

20 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -"a....... -"

1 0 - - - - - =-- -~-"",--- --'" - - --- ------ ------------- --0~+_+~_+_+_~_+_+__+_~_+_+__+_~_+4

1975 1980 1985 1990

Vea,

-132 -

--.-new B+

30. SOLOMON ISLANDS


• Epidemiology: The number of newly registered cases fluctuates between 300-400 since 1975 and was 333 in 1994. The proportion of pulmonary TB to all is about 70% and in 1994, 12 miliary TB and 10 TB meningitis were detected. The number of sputum positive cases has been decreasing from 180 in late 1970s to about 110 in late 1980s and is almost stable recently (118 in 1994).

• Programme: The Tuberculosis and Leprosy Unit in the Ministry of Health and Medical Services is responsible for national TB control programme with central registration system. District level has the full-time TB coordinator. Activity of case finding and holding is integrated into primary health care system. The TB control manual is under revision.

Case finding: Passive and contact examination.

Laboratory: The smear (at hospitals) and culture (at central laboratory) examinations are done. The cross check of slides is rarely done. Sensitivity test can be done in Australia.

Regimen: SCC (2HRZSI7H2S2 or 7HZ) and under revision.

Hospitalization: Most of the cases are admitted to the hospital for the first 2 months.

• Achievement:

Treatment outcome: For the cohort of S+ cases who started treatment in 1993, Completion: 85%, defaulted: 4%, T/O: 8% and dead: 8%.

BCG: Coverage is 83%(1991) and the number of meningitis and miliary TB is decreasing.

- 133 -

• Reference:

(1) Ishikawa, N. Assignment report. WHO, Aug. 1989.

(2) Fu, Q. Y. Notes on a field trip to Solomon Islands. WHO, Nov. 1985.

(3) Ministry of Health and Medical Services: National health plan 1986-1989.

(4) CHIP. 1990.

(5) SCC for Tuberculosis in South Pacific (from Papers for Workshop on MDT for Leprosy 6-10 March 1989).

(6) Guideline on Short Course Chemotherapy for Tuberculosis and Multidrug Therapy for Leprosy. TB and Leprosy Unit, Ministry of Health and Medical Services.

(7) TB & Leprosy Annual Report. TB & Leprosy unit, Ministry of Health and Medical Services, 1994.

- 134-

Solomon Islands Solomon Islands




1975 261 182 133 137.4 95.8 70

1976 307 228 187 153.5 114 93.5

1977 355 242 182 171.5 116.9 87.9

1978 411 289 174 192.1 135 81.3

1979 452 334 184 204.5 151.1 83.3

1980 266 183 153 117.7 81 67.7

1981 313 239 174 134.3 102.6 74.7

1982 324 249 176 129.6 99.6 70.4 11 4.4

1983 302 216 130 116.6 83.4 50.2 3 1.2

1984 337 256 155 125.3 95.2 57.6 1 0.4

1985 377 276 155 139.6 102.2 57.4

1986 292 207 101 102.1 72.4 35.3 2 0.7

1987 334 242 115 115.6 83.7 39.8 10 3.5

1988 372 282 137 121.6 92.2 44.8 10 3.3

1989 488 358 149 152.5 111.9 46.6 29 9.1

1990 382 257 117 120.1 80.8 36.8 25 7.9

1991 309 184 88 93.9 55.9 26.7 24 7.3

1992 364 260 130 109 77.8 38.9 24 7.2

1993 367 277 155 103.7 78.2 43.8 32 9

1994 332 236 114 90.7 64.5 31.1 23 6.3


-135 -

Solomon Islands


~~------------------------~ 450 400 350 300 250 200 150

1975 1980 1985 1990

Vear

Rate of T8 Death. (per 100 000)

10 r---------------------------~

8 ------

6 -----------------------

4

2

O~_+~+_~_r~~~~~_+~+_~

1975 1980 1985 1990

V •• r

-136 -

lomon Islands

___ all

-+-newS+

31. TOKELAU


There are 3 hospitals in 3 main islands and 4 doctors aU over the country.

• Epidemiology: There was a outbreak of9 cases in 1987 and in 1988-1993 only 6 case during these 6 years.

• Programme:

BCG: Given under EPI.

• Reference:

(1) Report of Administration of Tokelau. Government of New Zealand.

(2) CHIP. 1990.

(3) Annual Health Report. Tokelau, 1985.

(4) Annual Report on Health Services, 1987 1988.

- 137 -

Tokelau Tokelau




1975

1976

1977

1978

1979

1980

1981

1982 a a a a

1983

1984 a a a a

1985 2 100 a a

1986

1987 9 450 a a

1988 1 50 a a

1989

1990 1 50

1991

1992 1 a a 50 a a 0 a

1993 1994 a a a a a a a a


-138 -

Tokelau


500.---------------------------. 450 400 350

- - -- - - - - . - - - - - - - - - - - - - -II - - - - - - - - - - - - -

-------------------------------------

300 ------------------------250 200

1975 1980 1985 1990

Ye.r


5r-----------------------------~

4 ---- ---.--.----- ----------- - -----.. ----------

3

2

O~~~~~~~~~~~r+-r~._~

1975 1985

Veer

-139 -

Tokelau

-+-all ~newS+

32. TONGA


• Epidemiology: In 1987, a decrease of all new case in the national registry stagnated. Incidence of smear positive case has not changed for 10 years. In 1992, incidence of all case is 25 per 100 000. Incidence of sputum positive case is 20 per 100 000.

• PrograDlDle:

Organization: NTP is fully integrated into the general hospital activity. Medical officer of cODlDlunicable diseases has responsibility for NTP.

Case Finding: Case finding activity is done in only four hospitals, across the country. Chest X-ray is utilized as a method of screening. According to the findings with Chest X-ray, smear and culture examination are carried out.

Laboratory: The central laboratory at Vailoa hospital has culture facility. At other hospitals only smear examination is carried out. The slide check system has not been established.

Treatment: Only the hospitals provide the medicine even in the continuation phase.

Regimen: Short course chemotherapy is provided by all four hospitals. Since 1991, a nine month regimen is adopted.

Intensive phase: 2HRZ, fully supervised mostly with admission. Continuation phase:7HR, biweekly, fully supervised or 7HR, daily, unsupervised(four week supply)

Recording and Reporting: A National TB Registration is kept by cODlDlunicable disease section.

BCG: BCG is included in EPI. Twice direct vaccination is a principle. The first BCG is given at he birth in a hospital and a health centre. EPI team gives the second BCG to the school age children.

- 140-

• Achievement:

Treatment outcome: Completed: about 90% of new smear cases in 1989-1991. It is not routinely to assess the treatment results with sputum examination.

BCG: About 90% of the children are vaccinated.

Laboratory: In 1992 the laboratory at Vaiola hospital examined about 300 sputum specimens. The positive rate of smear examination is 9.7% in the laboratory. .

• Reference:

(I) Kwon, D. W. Assignment report. WHO, Aug. 1989.

(2) Fu, Q. Y. NOles on a field visit. WHO, March 1986.

(3) Report of the ministry of health for the year. MOH, 1987.

(4) CHIP. 1990.

(5) Onozaki I. Assignment report. WHO, 1993.

- 141 -

Tonga Tonga




1975 90 75 26 102.3 85.2 29.5

1976 67 55 22 74.4 61.1 24.4

1977 62 48 29 68.1 52.7 31.9

1978 89 76 41 94.7 80.9 43.6

1979 71 50 28 74.7 52.6 29.5

1980 64 54 32 68.8 58.1 34.4 11 11.8

1981 49 36 18 52.1 38.3 19.1 9 9.6

1982 45 35 25 45.5 35.4 25.3 5 5.1

1983 50 32 23 48.1 30.8 22.1 6 5.8

1984 54 33 25 56.3 34.4 26 5 5.2

1985 49 39 23 49.5 39.4 23.2 5 5.1

1986 35 30 18 36.1 30.9 18.6 8 8.2

1987 24 18 12 25.3 18.9 12.6 4 4.2

1988 14 12 7 14.6 12.5 7.3 2 2.1

1989 35 32 29.2 26.7

1990 23 23 16 23.2 23.2 16.2

1991 19 18 17 19 18 17

1992 23 18 17 23 18 17 1 1

1993 32 26 16 32.7 26.5 16.3 1 1

1994 23 18 17 23.5 18.4 17.3 2 2


-142 -

Tonga


200,-------------------------~ 180 - - .. -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -160 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -140 - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. - - - - - - - -120 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -100 80 60 40

20 ---O+---'--+--+-+-+--+--+-+-+--+--+-"'----+----+-l-+~

1975 1980 1985 1990

Vear


50,-----------------------------,

40 - - - - .. - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -

30

20 -. - - - - - - - - - - - - - - - - - - - - .

1: --------,~--------.--. 1975 1980 1985 1990

Ve.r

-143 -

Tonga

..... all

~newS+

33. TUVALU

• Population: 9 ()()() in 1994

In the main island, there is the Princess Margaret Hospital with 4 doctors. In the other islands, dispensaries were under construction in 1988.

• Epidemiology: The numbers of new cases and sputum positive cases have been stable around 25 and 5 respectively for these 15 years.

• Programme: Registration is compulsory (at onset).

Case finding: Passive by X-ray and sputum smear.

Laboratory: Sputum smear examination is routinely done in the Princess Margaret Hospital.

Hospitalization: Both Sputum positive and X-ray positive cases are hospitalized.

Regimen: SHRZ/SHR

BCG: Primary vaccination at birth and re-vaccination to school entrants.

• Achievement:

Treatment outcome: Completed: 100%

BCG: Coverage is almost 100%.

Laboratory: positives).

• Reference:

In 1988, 116 specimens were examined (5

(1) Information from Dr. Salesa (Senior Medical Officer, Iune 1991)

(2) Information from Dr. Salesa (Feb. 1991)

(3) Chaulet, P. (WHO): Assignment report May 1988

(4) Health Division, Ministry of Social Services: Annual report 1990

(5) Health Division, Ministry of Social Services: Annual report 1987

- 144-

Tuvalu Tubalu




1975

1976

1977

1978

1979 7 5 100 71.4

1980 33 33 23 471.4 471.4 328.6 4 57.1

1981 18 15 10 225 187.5 125 6 75

1982 12 8 3 150 100 37.5 2 25

1983 23 18 7 287.5 225 87.5 4 50

1984 9 7 3 112.5 87.5 37.5 0 0

1985 32 25 3 400 312.5 37.5 4 50

1986 27 21 5 337.5 262.5 62.5 5 62.5

1987 22 14 7 275 175 87.5 5 62.5

1988 24 18 7 300 225 87.5 5 62.5

1989 25 19 2 312.5 237.5 25 3 37.5

1990 23 20 7 287.5 250 87.5 2 25

1991 16 13 5 200 162.5 62.5 2 25

1992 30 21 5 375 262.5 62.5 2 25

1993 28 11 2 311.1 122.2 22.2 0 0

1994 19 8 1 211.1 88.9 11.1 2 22.2


-145 -

Tuvalu


500~------------------------~

450 400 350 300 250 200 150 100 50 O~--~~----~_r __ ~----~~~

1975 1980 1985 1990

Year


100r----------------------------. 90 -----80 70 60 50 - - - -40 30 20 10 ------O~_+--+_~_r~~-+~+__+ __ ~~

1975 1980 1985 1990

Year

-146 -

Tubalu

~-] I--all I-+-news~

34. VANUATU


• Epidemiology: The numbers of new cases and sputum poslllve cases fluctuated (between 100-200 and 30-60 respectively) and increasing since 1987 and was 147 for all and 84 for smear positive cases. The incidence rate shows a similar tendency (1011100 000 for all and 58/100 000 for smear positive in 1992).

• Programme:

Organization: The District Health Officer is in charge of hospitals and health centers and dispensaries. Sputum is collected both at health centers and dispensaries.

Case finding: Passive and contact tracing.

Laboratory: Cross check of smear slides is not done. Culture examination is made for smear negative symptomatic cases since 1991.

Regimen: 2HRZS4HR since 1988.

Hospitalization: All cases are hospitalized for the first 2 month.

BCG: Primary to infants and re-vaccination to schoolchildren (at entrance and at leave).

Preventive chemotherapy: Not official policy.

• Achievement:

BCG: Coverage is more than 90% in 1989.

Laboratory: Smear examination was done to 90% of the pulmonary cases.

Supply: Well done in 1990.

• Reference:

(1) Information from Dr. George F Blue(Director of Health, 1990).

(2) Fu, Q.Y. Report on a field visit. WHO, June 1988.

(3) Fu, Q. Y. Report on a field visit. WHO, April 1986.

(4) Statistical and epidemiological report. Epidemiological Unit, MOH, 1988.

(5) Statistical and epidemiological report. Epidemiological Unit, MOH, 1986.

(6) TB Control Team. Assignment report. WHO, Oct.-Dec. 1982.

(7) Evans, C. Mission report. WHO, March 1990.

- 147 -

Vanuatu Vanuatu




1975 214 82 225.3 86.3

1976 214 67 220.6 69.1

1977 150 57 151.5 57.6

1978 131 109 52 128.4 106.9 51

1979 184 151 52 162.8 133.6 46

1980 178 159 59 154.8 138.3 51.3

1981 92 80 34 76.7 66.7 28.3

1982 173 137 49 139.5 110.5 39.5

1983 171 142 55 133.6 110.9 43 16 12.5

1984 188 163 55 144.6 125.4 42.3 22 16.9

1985 124 104 51 94.7 79.4 38.9 18 13.7

1986 131 112 36 97 83 26.7 21 15.6

1987 90 79 26 62.1 54.5 17.9 27 18.6

1988 118 94 46 78.7 62.7 30.7 12 8

1989 144 100 39 90 62.5 24.4 15 9.4

1990 140 95.9

1991 234 156 15 10

1992 147 135 84 96.1 88.2 54.9 14 9.2

1993 114 99 41 73.1 63.5 26.3 7 4.5

1994 152 119 62 92.1 72.1 37.6 5 3


-148 -

Vanuatu


500 r----------------,

450· 400 350

150 100 50

o ~-----------~--------~ 1975 1980 1985 1990

Year


Vanuatu

I~··--·-I

' ___ all !

: -+-newB+i ,

50-r-----------------------,

40

30

20

10 .

o~--------------------~

Year

-149 -

35. VIETNAM


• Epidemiology: Several tuberculin surveys were conducted in 1980s and ARI was estimated to be I % in the north, l.5% in the central, and 2% in the south (3.2% in Ho Chi Minh city and less than 2% in rural area). The numbers of new all cases and sputum positive cases have increased slightly in the 1980s and they were 52 994 and 36 534 respectively in 1993. Incidence rates of all cases and smear positive cases have been stable around 80 and 50 each per 100 000 respectively and is higher in the southern area. The primary drug resistance rate (at least to 1 drug) is 42.6% (Ho Chi Minh City 1991). HIV screening has started recently and until 1994, no HIV + TB case was detected in Hanoi but 8/1000 were HIV + in Ho Chi Ninh city.

• Programme: Since 1986, a new NTP has been implemented.

Organization: National Institute of Tuberculosis and Respiratory Oiseases (NITRO) is under Ministry of Health and 44 provinces has provincial TB centers. Tuberculosis cases are primarily registered in TB unit in the district. 87 % of the whole population is not covered with NTP services.

Case finding: Passive with sputum smear.

Regimen: For new S+ cases, 2HRZE/6HE is the standard regimen since 1988 and about 30% are treated with this regimen and the rest are treated with 3SHZ/6SH.

BCG: Primary to infants since 1985 under EPI.

Laboratory: 500 Laboratories are with microscopes working for TB. Cross check for district microscopist is made in the provincial laboratory. Sensitivity test can be done in NITRO.

Training and Supervision: Training is given in the NITRO for bacteriologists and physicians and in the province for microscopists and assistant physicians. National supervising teams visit for monitoring every year.

• Achievement:

Treatment outcome: Cured: 70%, failure: 4%, completed without final examination: 11 %, absconded: 8%, dead: 4%, transferred: 3% for standard 9-month regimen in 1992.

Cured: 88 %, failure: 2 %, completed: 1 %, absconded: 3 %, dead 3 %, transferred 3 % for 6 months regimen in 1992.

- 150-

BCG: Coverage is about 80% for the newborns in 1986-1988.

Laboratory: 8S.% of districts had sputum smear facilities in 1986. 772 microscopists worked all over the country in 1989.

• Reference:

(1) Information from Dr. N.D. Huong (National Institute of Tuberculosis and Respiratory Diseases, July 1990).

(2) Huong, N.D. National tuberculosis control program in Viet Nam. 1990.

(3) Huong, N.D. New national control program in the 16 provinces of south of Viet Nam.

(4) Linh, Pham Duy (Pham Ngoc Thach Tuberculosis and Lung Center). Short course chemotherapy in 6 districts of Ho Chi Minh city.

(S) Linh, Pham Duy. Current tuberculosis control program in Ho Chi Minh city.

(6) Chaulet, P. Assignment report. WHO, May 1988.

(7) Information from Dr. Mori (RIT) based on his visit to Viet Nam in Dec. 1991.

(8) Chaulet, P. Mission report. WHO, Oct. 20- Nov. 6 1991.

(9) Onozaki, I. Mission report. WHO. Jan. 1995.

- lSI -

Viet Nam Viet Nam




1975 19514 41

1976 56272 115.3

1977

1978 68650 133.8

1979 11821 22.5

1980 43062 80.2

1981 43506 33243 79.2 60.6 1705 3.1

1982 51206 33014 91.4 59 2040 3.6

1983 43185 32612 75.6 57.1 1315 2.3

1984 43875 30426 75.3 52.2 1816 3.1

1985 46941 34217 77.8 56.7 1847 3.1

1986 47557 30381 77 49.2 1805 2.9

1987 55505 34530 85.5 53.2 2053 3.2

1988 52463 39486 81.7 61.5 1992 3.1

1989 52270 35095 80.9 54.3 1908 3

1990 47536 42326 30728 3627 72 64.1 46.6 1287 2

1991 54509 48247 35865 4112 80.5 71.3 53

1992 56594 50449 38659 4221 81.9 73.0 55.9 1439 2.1

1993 52994 50164 36534 3818 74.3 70.4 51.2 1536 2.2

1994


-152 -

Viet Nam


200 ,-------------------, 180 160 140 120 100 80 60 40 20 OL--_____________ ~-~

1975 1980 1985 1990

Year


5 r-----------------~

4

3·

2

o .L----' __ ---,-___________ ~---'

1975 1980 1985 1990

Year

-153 -

VietNam

:--.---~

i ___ all '

, -+-newS+' , L __ " __________ •

36. WALLIS AND FUTUNA


4 doctors worked in 1982.

• Epidemiology: The notification data fluctuates very much and needs investigation.

• Programme: No data is available on the epidemiology and the national programme of tuberculosis.

• Reference:

(1) CHIP. 1990.

- 154-

Wallis & Futuna Wallis & Futuna




1975

1976

1977

1978

1979 (3) 30

1980 (19) 190

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992 4 28.6

1993

1994 11 9 2 78.6 64.3 14.3 0 0


-155 -

Wallis & Futuna


100 .--------------------, 90 80 70 60 50 40

30

20

10

I

• ..

o L-________________ ~

1975 1980 1985 1990

Year


5.-----------------------,

4

3

2

o ~--~-~-~~--~----__.. 1975 1980 1985 1990

Year

-156 -

allis & Futuna

-+-all

-+-newS+'

Annex

Country/Area .Am. Samoa

Australia

Brunei Cambodia China Cook Is.

Fiji Fr. Polynesia Guam

lIong Kong

Japan Kiribati Lao PDR Macao

Malaysia N. Mariana Is. Marshall Is.

Micronesia

Mongolia

Naum

New Caledonia

New Zealand Niue

t'alau l'apua New Guinea Philippines Rep. of Korea

Samoa

Singapore

Solomon Is Tokelau

Tonga

Tuvalu

Vanuatu Viet Nam

Wallj" & Futuna Tolal

Sources of dala:

Population by Country

1975 0.03

13.9

0.156

0.(J19

0.569

0.132

0.076

4.5

111.57

0.054

11.9

0.013

1.42

0.007

0.133

3.1

0.004

0.013

2.696

42.52

35.28

0.15

2.263

0.19

0.088

0.006

0.095

47.6

0.009

278.5

1976 0.03

14

0.162

942

0.018

0.585

0.136

0.079

4.5

112.78

0.055

12.5

0.014

0.026

1.47

0.007

0.135

3.1 0.0(J4

0.013

2.75 I

43.75

35.86

0.152

2.293

0.2

0.09

0.006

0.097

48.8

0.009

1225.6

1977 0.031

14.2

0.167

6.8

952

0.018

0.597

0.139

0.082

4.6

113.87

0.056

3.5

12.8

0.014

0.027

151 (W07

0.136

3.1 O.0()4

0.014

2.8

4501

36.44

0.154

2.325

0.207

0.091

0.006

0.099

50

0.009

12508

197K 0.031

14.4

0.173

6.6

962

0.019

0.609

0.141

0.084

4.7

114.91

0.056

3.6

1),1

0.015

0.028

1.55

0.007

0.138

3.1

0.004

0.014

2.9

45.53

37.02

0.156

2.354

0.214

0.094

0.007

0.102

51.3

0.01

1265

1979 0.032

14.5

O.17?

65

983.58

0,0)8

0.621

0.146

0.104

4.9

115.89

0.058

3.6

13.4

0.015

O.oz8

1.6 0.008

0.137

3.1

0.004

0.014

2.9

46.58

37.61

0.158

2.384

0.221

0.002

0.095

0.007

0.113

52.5

0.01

1291

1980 0.032

14.7

0.185

6.4

996.14

0.018

0.634

0.149

0.107

5.1

117.06

0.06

3.2

0.268

13.75

0.016

0.031

1.64

0.c)08

0.139

3.1 (J.()03

0.CJ15

3 48.1

38.12

0.161

2.414

0.226

0.002

0.093

0.007

0.115

53.7

0.01

1308.7

(million)

19RI 0.013

14.9

0.193

6.5

1008.5

0.017

0.647

0.15

0.11

5.2

117.65 (J.(J61

3.3

0.298

14.1

0.017

0.032

168

0.008

0.143

3.1

0.003 (J.(115

3.1

49.53

38.72

0.156

2.443

0.233

0.002

0.094

0.008

0.12

54.9

0.01

1326

19R2 0.035

15.2

0.2

6.9

1026.5

(J.018

0.657

0.154

0.101

5.2

118.45

0.06

18

0.386

14.5

0.017

0.032

0072

172

0.007

0.148

3.2

0.0(13

0.012

33

5128

3933

0.157

2.472

0.25

0.003

0.099

0.008

0.124

56

0.01

1350.4

19R] 0.034

15.4

0.25

7.1

1025

0.018

0.67

0.167

0.113

5.3

119.26

0.061

4.2

0.304

14.86

0.017 003]

0.073

177

0.008

0.145

3.2 O.U())

0.014

3.5

52.C16

39.95

0.161

2.502

0.259

Cl.002

0.104

0.008

0.128

57.1 0.01

1353.7

19R4 (1.(135

15.5 0.269

7.2

1051.6

0.019

0.7

0.16

0.119

5.4

119.49

0.062

4.3

0.309

15.2 0.019

0.035 (1.088

181

0008

0.152

3.3 (1.004

0.013

3.3

53.4

40.58

0.163

2.54

0.269

0.003

0.096

0.008

0.13

58.3

0.01

1384.5

19R5 0.036

15.9 0.224

7.4

1059.5

0.02

0.71

0.16

0.12

5.5

120.,6

0.063

3.6

0.392

15.88

0.02

0.028

0.091

185

0.008

O. I 5

3.2

0.003

0.012

3.4

54.67

41.21

0.16

2.558

0.27

0.002

0.099

0.008

0.131

60.3

0.012

1398.5

19R6 (J.()J(,

16

0.226

7.6

1054

0.02

0.723

0.179

0.122

5.5

121.67

0.064

3.7

0.417

16.11

0.02

0.029

0.094

19

0.008

0.148

3.3

0.003

0.014

3.4

55.98

4187

0.159

2.588

0.286

0.002

0.097

0.008

0.135

61.8

0.012

1398.2

1987 0.0]7

16.1

OD5

7.8

lfJ60

0.017

0.75

0.17

0.125

5.6

121.54

0.065

3.6

0.414

16.75

0.036

0.03

0.094

195 (J.(J08

0.154

3.3

0.003

0.014

3.6

58.72

42.08

0.161

2.613

0.289

0.002

0.095

0.008

0.145

64.9

0.014

14114

198R 0.037

16.4

0.241

7.9

1096.1 0,0) 7

0.727

0.189

0.124

5.7

122.03

0.066

3.9

0.444

16.96

0.038

0.043 0.097

2 0008

0.16

3.J

O.OOJ

0.014

J.6

59.46

4198

0.161

2.647

0.306

0.002

0.096

0.008

0.15

64.2

0.012

1449.2

1989 (J.(J)7

16.8

8

I I 11.9

0.02

0.74

0.18

0.126

5.8

122.93

0.068

4

0.46

17.35

0.038

0.04 0.095

2.04

0.009

0.16

J.4

0.00.1

0.012

3.9

60.1

42.38

0.17

2.685

0.32

0.002

0.12

0.008

0.16

64.6

0.014

14687

Dala for the years from 1982: population in WPR cOWltrieslareas (revised as of July 1995) excepl for data for 1993 and 1994 in Monglia., WPROIWHO Data for the years from 1975 to 1981: Demographic year book, UN Date for the years in 1993 and 1994 in Monglia: Annual report of NTP, Mongolia

1990 0.047

16.9 0.256

8.2

IU3.7

0.(J17

0.74

0.177

0.126

5.8

123.61

0.068

4.1

0.452

17.89

0.044

0.046

0.101

2.1

0.Cl09

0.164

3.4

O.OOJ

0.Cl12

3.7

6148

42.79

0.162

2.7

0.318

0.002

0.099

0.008

0.146

66

0.014

1495.4

1991 (J.()48

17.1

0.264

8.4

1149.6

0.017

0.748

0.181

0.127

5.9

124.11

0.Q7

4.3

0.473

18.3

0.045

0.048

0.104

2.15

0009

0.167

.l.4 0.00.1

0.012

3.8

62.9

43.18

0.162

2.754

0.329

0.002

0.1

0.008

0.15

67.7

0.014

1516.6

1992 0.c)51

17.4

0.272

8.6

1165.6

(J.017

0.756

0.185

0.139

5.9

124.49

0.071

4.4

0.381

18.72

0.046

0.049

0.108

2.19

0.009

0.171

3.5

0.00.1

0.013

3.9

62.57

43.57

0.161

2.818

0.334

0.002

0.1

0.008

0.153

69.1

0.014

1535.8

1993 O.(J51

17.6

0.284

9.3

0.019

0.758

0.208

0.144

5.8

124.54

0.077

4.6

0.384

19

0.046

0.051

0.1

2.22

0.01

0.175

3.5

0.002

0.016

4.1

64.8

44.06

0.167

2.793

0.354

0.002

0.098

0.009

0.156

71.3

0.014

376.73

1994 0.053

17.9

0.28

9.97

1208.8

0.cJ19

0.771

0.215

0.147

5.8

124.8

0.077

4.74

0.398

19.7

0.047

0.051

0.1

2.25 0.011

0.178

3.5

0.002

0.016

4.1

66.2

44.56

0.169

2.821

0366

0.002

0.098

0.009

0.165

72.9

0.014

1591.3