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World Health OrganizationOffice for the Western Pacific Region

TuberculosisControlIn the WHO Western Pacific Region

2002 Report


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Part I

COMMENTARY

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TUBERCULOSIS CONTROL IN THE WHO WESTERN PACIFIC REGION 2002

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COMMENTARY

This report follows the Tuberculosis Control in the WHO Western Pacific Region2000 report and is based on case notification and treatment outcome datasupplied by national control programmes to WHO, using a standard data

collection form.1

The aim of this report is to present progress in tuberculosis control in the WesternPacific Region, and in particular, in implementing the WHO directly observed treatment,short-course (DOTS) strategy.2 Last year’s report3 noted that tuberculosis was still apublic health problem in the Region with 49 notified cases per 100 000 population(823 421 new cases, among whom 393 801 were smear-positive).

The ratio of detected to estimated cases in the Region was 44%, far below the WHOtarget of 70%. The reported total regional population coverage of DOTS (proportionof the population with access to DOTS) was 67%, unchanged compared with theprevious year. However, the proportion of newly detected patients enrolled in DOTSin the Region increased, from 69% of all new cases in 1999 to 74% in 2000, and from78% of new smear-positive cases in 1999 to 85% in 2000. DOTS enrollment ratesremained unchanged between 1999 and 2000 in the People’s Republic of China(henceforth, China), but increased sharply in the Philippines, from 22% in 1999 to75% in 2000 (all cases) and from 28% in 1999 to 75% in 2000 (smear-positive cases).The regional cure and success rates in DOTS areas were 93% and 95%, respectively,well above the WHO 85% cure rate target.

1 Review of tuberculosis case notificationOnly three Pacific island countries (PICs) with a total population size of43 000 did not report tuberculosis case notification for 2000 to WHO. In total,804 579 cases (all types) and 384 755 smear-positive cases were notified for 2000.Regional case notification rates per 100 000 population were 49 (all types) and 23(smear-positive) and did not show any significant difference from the previous year’srates (Table 1). China contributes 58% of the total number of notified cases in theRegion.

Regional casenotification ratesper 100 000population were49 (all types) and23 (smear-positive) and didnot show anysignificantdeparture from theprevious year’srates.

1 World Health Organization. WHO Report 2001, Global Tuberculosis Control. WHO Geneva 2001.

2 World Health Organization. WHO Tuberculosis Programme: Framework for Effective Tuberculosis Control. WHO Geneva 1994: WHO/TB/94.179.

3 World Health Organization. Tuberculosis Control in the WHO Western Pacific Region 2000. WHO/WPRO 2001.

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The notification rate per 100 000 (all types) varied from 250 in Kiribati to 0 in Tokelau,with eight countries reporting a rate greater than 100, and nine countries reporting arate lower than 25 (mostly Pacific island countries). In most large countries with a highburden of tuberculosis, the notification of new smear-positive cases was close to thatof the previous year.

Case notification (all cases) increased until 1999 in China (356 364 cases in 1995,471 359 in 1999 and 463 373 in 2000), Viet Nam until 2000 (55 739 cases in 1995 to89 792 cases in 2000), Malaysia (11 778 cases in 1995 to 15 057 in 2000), Papua NewGuinea (8041 cases in 1999 and 12 121 cases in 2000), while it decreased in thePhilippines and the Republic of Korea. In other countries, case notification has fluctuatedover the past six years, as was the case with Hong Kong, China (which showed a sharpdecrease from 7512 cases in 1999 to 5141 in 2000), and Mongolia (Table 1).

The proportion of smear-positive cases among all notified cases varied from 100% insome Pacific island countries (with great variations due to small overall figures), to alow 14% in Singapore, 16% in the Federated States of Micronesia, 19% in Papua NewGuinea, and 24% in Australia and Hong Kong, China. Such low proportions in thelatter countries may be attributed to differences in case definitions (for instance, somecountries, such as New Caledonia, notify latent tuberculosis), low utilization ofmicroscopy services or imperfections in the tuberculosis information system.

The regional proportion of smear-positive cases among cases enrolled in DOTS (55%)was higher than the proportion among cases not enrolled in DOTS (28%). This mayreflect tuberculosis control programme improvements since sputum smear examinationsare considered the standard diagnosis of pulmonary tuberculosis under DOTS.

Extrapulmonary tuberculosis was not reported in China nor in the Republic of Korea,while it represented more than 40% of notified cases in Australia, Kiribati and NewZealand (Table 3).

In total, 51% of new smear-positive cases occurred in the most economically productive15-45 year old age group (Figure 5). About 33% of the regional notified smear-positivecases were female (sex ratio M/F = 2). The regional sex ratio (M/F) was 0.8 in the 0-14year old age group, 1.3 in the 15-24 year old age group, and increased in the older agegroups.

HIV and tuberculosis data were reported by 12 countries and areas. HIV seroprevalencein newly detected tuberculosis cases was 7.9% in Cambodia; 4.9% in Malaysia; 3.0%in Fiji; 1.2% in New Zealand; 1.0% in Papua New Guinea and the Commonwealth ofthe Northern Mariana Islands; 0.5% in Hong Kong, China and Macao, China; 0.3% inSingapore; and 0% in Brunei Darussalam, French Polynesia and Mongolia.

2 Estimates of TB case detection rates

WHO Western Pacific Regional Office, in collaboration with the WHO GlobalTuberculosis Programme, Geneva, conducted a workshop on tuberculosis estimates in


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1977.4 The goal of the workshop was to evaluate the availability and reliability oftuberculosis data in participating countries and derive country specific estimates ofmorbidity and mortality for the disease. Based on data arising out of the workshop, areport, Global Burden of Tuberculosis, was published in 1999. The estimates presentedhere are for the year 2000, updated from that article. Methods used to update theestimates are presented in the Global Tuberculosis Report 2001.

It was estimated that the incidence of tuberculosis in the Region was 1 975 899 in2000 (compared to 1 880 849 in 1999), of whom 858 494 were smear-positive(841 564 in 1999). Case detection rates were thus 41% (all cases) and 45% (smear-positive), compared to 44% and 47%, respectively, in 1999 (Table 2). The smallerestimates along with a decrease in case notification led to a substantial reduction of thecase detection rate of smear-positive cases in several countries, including Cambodia(from 57% in 1999 to 44% in 2000), Japan (79% in 1999 to 57% in 2000), and thePhilippines (71% in 1999 to 60% in 2000). Estimates should be treated cautiouslysince a lot of uncertainty is attached to them.

3 Review of DOTS implementationDOTS has proven to be an effective control strategy for tuberculosis since the early1990s. Certain factors that can aggravate the epidemiological situation of tuberculosis,such as population growth, urbanization and the HIV epidemic, are emergingsimultaneously. Therefore, there is an urgent need to expand DOTS, especially incountries with a high prevalence of tuberculosis.

In 1999, the number of countries implementing a strategy consistent with DOTScontinued to increase, reaching 128 (61%) in 1999. By the end of that year, 83% of theworld’s population was living in countries that had adopted DOTS and about 45% ofthe global population had access to DOTS. The documented treatment success ratesunder DOTS varied from 71% in Africa to more than 95% in the Western PacificRegion.

Out of the 34 countries and areas in the Region that submitted data for the year 2000,the number stating that a non null percentage of the population was living in geographicareas served by DOTS units was 28, compared to 22 the previous year and 18 in 1998.Despite this significant increase in the number of countries implementing the DOTSstrategy, the reported total regional population coverage of DOTS (proportion of thepopulation with access to DOTS) was 67%, unchanged from the previous year (Table10), reflecting slow scaling up of DOTS expansion in several large countries (DOTScoverage in China increased from 64% in 1999 to only 68% in 2000).

However, the proportion of newly detected patients enrolled in DOTS in the Regionincreased, from 69% of all new cases in 1999 to 74% in 2000, and from 78% of newsmear-positive cases in 1999 to 85% in 2000 (Table 10). DOTS enrollment ratesremained unchanged between 1999 and 2000 in China, but increased sharply in the

4 Dye C., Scheele S., Dalin P., et al. Global Burden of Tuberculosis. Estimated Incidence, Prevalence,and Mortality by Country. JAMA 1999; 282: 677-686.

It was estimatedthat the incidenceof tuberculosis inthe Region was1 975 899 in 2000(compared to1 880 849 in1999), of whom858 494 weresmear-positive.

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Philippines, from 22% in 1999 to 75% in 2000 (all cases) and from 28% in 1999 to75% in 2000 (smear-positive cases). It should be noted that these comparisons between1999 and 2000 are limited by changes over time in the number of reporting countries,and in the definitions applied regarding DOTS coverage and enrollment rates.

To evaluate the outcome of treatment, the cure rate and success rate of smear-positivecases is used (see definitions of treatment outcomes, Annex 1). Reporting of treatmentoutcome is often the most inaccurate section of the annual tuberculosis report sent bycountries and areas. Totals are often inconsistent with the sum of all categories (whichshould be mutually exclusive), the number of registered patients is often very differentfrom the number of notified patients as taken from the previous year’s report, or fromthe updated section of the previous year’s report that is supplied at the end of thestandardized notification forms.

In 1999, 393 801 new smear-positive cases were notified to WHO (updated figuresfor 1999 were reported by several countries in the 2000 report, and the regional updatedfigure for 1999 totaled 411 219). But in 2000, it was also reported that only 312 049were registered during the year 1999 for treatment evaluation, i.e. 76% of the updatednumber of newly detected smear-positive cases for 1999 (Table 11). One of the sevenhigh burden countries did not report completed treatment figures but rather regroupedcompleted and cured into the cured category.

The regional cure rate and success rate in DOTS areas were 91% and 96%, respectively,well above the WHO target cure rate of 85% (Table 11). The regional death rate wasonly 2% in DOTS areas. Country success rates in DOTS areas were mostly similar tothose reported the previous year. Treatment outcome for non-DOTS areas concernedonly a small number of notified smear-positive cases (29 690 cases were reported in2000) as registered in 1999 for treatment evaluation, of whom 19 878 were in China,whereas the notified number from the previous year’s report was 86 898 [23 901 inChina]) (Table 12). In the Philippines, 52 896 smear-positive cases were notified innon-DOTS areas in 1999, but none of them were notified in 2000 as registered fortreatment outcome analysis. Furthermore, only 34% of cases notified in non-DOTSareas in 1999 were smear-positive, as compared to 54% in DOTS areas, a differenceprobably related to an inadequate or insufficient use of laboratory services in non-DOTSareas in many countries, those services being crucial to the determination of treatmentoutcomes. Therefore, any analysis of treatment outcomes involving non-DOTS areas or

using non-DOTS areas as a comparison group is probably afflicted by major biases.

4 Anti-tuberculosis drug resistanceIn the Region, 12 out of 37 countries and areas joined WHO and the InternationalUnion Against Tuberculosis and Lung Disease (IUATLD) global project on anti-tuberculosis drug resistance surveillance (DRS) and 10 countries completed at leastthe first survey on drug resistance between 1995 and 2001. Drug resistance to anydrug was found among newly diagnosed tuberculosis cases in all countries surveyed inthe Western Pacific Region, with a population adjusted mean of 19.4% ranging from4.8% to 32.9%, indicating rigorous transmission of drug resistant Mycobacteriumtuberculosis occurs in the Region (Table 13).

The regional curerate and successrate in DOTSareas were 91%and 96%,respectively, wellabove the WHOtarget cure rate of85%. The regionaldeath rate wasonly 2% in DOTSareas.


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Adjusted mean prevalence of MDR-TB was 2.6% among new cases, ranging from0.1% to 5.3% and it was found to be a serious level — 6.3% to 9.1% — in someprovinces of China when MDR-TB of retreatment cases are included (Table 15).Significantly higher resistance was found against isoniazid (INH) in five countrieswhen compared with the others in the Region, while streptomycin (SM) resistanceoutnumbered or equaled INH resistance in six countries or provinces. Mono-resistanceto INH and SM was common among new cases but much less among retreatmentcases. The third most common resistance was found against rifampicin (RMP) andmost of these cases were associated with INH resistance. Ethambutol (EMB) resistancewas low.


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Part II

TABLES

TAB

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Tuberculosis case notification 1 Latest notification of tuberculosis by country, 11

1999-2000

2 Case detection rates of tuberculosis by country 12

3 Tuberculosis cases notified by type in 2000 13

4 Trend of notified tuberculosis cases (all types) 14

5 Trend of notified cases (new smear-positive cases) 15

6 Trend of tuberculosis notification rates per 100 000 16population (all types)

7 Trend of tuberculosis notification rates per 100 000 17population (smear-positive cases)

8 Age and sex distribution of new sputum smear-positive 18

tuberculosis cases in DOTS and non-DOTS areascombined, 2000, by country

9 Age and sex distribution of new sputum smear-positive 19

tuberculosis rates in DOTS and non-DOTS areascombined in the Western Pacific Region, 2000

DOTS coverage and treatment outcomes10 DOTS coverage reported by country, 2000 21

11 Treatment outcome of new smear-positive cases 22registered in 1999 in DOTS areas

12 Treatment outcome of new smear-positive cases 23registered in 1999 in non-DOTS areas

Anti-tuberculosis drug resistance13 Anti-tuberculosis drug resistance in new cases 25

14 Anti-tuberculosis drug resistance(%) in retreatment 26new and retreatment cases

15 Anti-tuberculosis drug resistance (%) in new and 26

retreatment cases

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Pop. Case Notification, 1995-1999 Case Notification, 2000

Countries (x 1000) All Cases Number Rate/100 000

Number*

1995 1996 1997 1998 1999 All New All New

2000 Types** Smr + Types** Smr +

a d e f g h I j k l

American Samoa 57 5 0 6 4 3 3 2 5 4

Australia 19 157 1073 1073 1145 899 1073 1043 251 5 1

Brunei Darussalam 338 140 149 198 267 307 84 91 25

Cambodia 12 014 14 603 14 857 15 629 16 946 19 266 18 891 14 822 157 123

China 1 236 722 356 364 414 480 448 053 464 559 471 359 463 373 213 766 37 17

Cook Islands 17 0 0 1 3 1 1 6 6

Fiji 840 203 200 171 166 192 144 62 17 7

French Polynesia 230 83 86 91 105 93 59 29 26 13

Guam 154 114 114 95 89 69 54 42 35 27

Hong Kong, China 6796 6212 6501 7072 7673 7512 5141 1240 76 18

Japan 126 920 43 078 42 122 42 190 44 016 40 800 39 384 11 853 31 9

Kiribati 84 253 32 276 253 210 54 250 64

Republic of Korea 47 733 42 117 39 315 33 215 34 661 32 075 21 782 8216 46 17

Lao PDR 5287 830 1440 1923 2153 2434 2234 1526 42 29

Macao, China 438 402 570 575 465 422 449 133 103 30

Malaysia 22 203 11 778 12 691 13 539 14 115 14 908 15 057 8156 68 37

N. Mariana Islands 69 48 51 93 97 66 75 27 109 39

Marshall Islands 61 51 59 103 51 41 34 11 56 18

Micronesia FS 115 172 126 107 123 100 91 15 79 13

Mongolia 2380 2780 3457 2987 2915 3348 3109 1389 131 58

Nauru 12 2 0 9 6 2 4 4 33 33

New Caledonia 211 111 127 100 104 83 86 38 41 18

New Zealand 3843 391 352 321 365 447 344 74 9 2

Niue 2 0 0 0 0 0 0 0 0 0

Palau 19 19 5 15 15 32

Papua New Guinea 5131 8041 5087 7977 11 291 12 189 12 121 2267 236 44

Philippines 76 348 119 186 165 453 195 767 162 360 145 807 128 495 67 056 168 88

Pitcairn Islands (***) 0

Samoa 170 45 31 32 22 31 43 13 25 8

Singapore 3263 1889 1951 1977 2120 1805 1728 248 53 8

Solomon Islands 410 352 306 316 281 289 303 109 74 27

Tokelau 2 0 0 0 0 0 0 0 0 0

Tonga 100 22 22 21 30 22 24 15 24 15

Tuvalu 10 36 18 0 0

Vanuatu 200 79 126 184 178 120 152 63 76 32

Viet Nam 76 900 55 739 74 711 77 938 87 468 88 879 89 792 53 169 117 69

Wallis and Futuna 14 4 4 14 14 0 0

WPR TOTAL 1 648 250 751 951 942 831 834 722 839 121 843 990 804 579 384 755 49 23

* Data updated in the 2000 country report. ** All types includes new smear-positIve, relapse, smear-negative and extrapulmonary tuberculosis cases.

*** No data on tuberculosis are available.

Table 1: Latest notification of tuberculosis by country, 1999-2000

Out of 37 countries and areas, 34 reported to WHO in 2000, compared to 30 in 1999. There was a 4.7%decrease in the regional total number of notified cases (all types) between 1999 and 2000 and a 2.3%decrease in the regional total number of notified smear-positive cases between 1999 and 2000. In 2000,58% of notified newly detected tuberculosis cases were in China. Population data came from the countrytuberculosis reports for 2000.

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Countries Notified Cases Estimated Cases Case Detection Rates (%)

All types Smear + All types Smear + All types Smear +

American Samoa 3 2 23 11 13 18

Australia 1043 251 1525 685 68 37

Brunei Darussalam 307 84 199 89 154 94

Cambodia 18 891 14 822 74 921 33 490 25 44

China 463 373 213 766 1 364 851 583 936 34 37

Cook Islands 1 1 7 3 14 33

Fiji 144 62 281 126 51 49

French Polynesia 59 29 81 36 73 81

Guam 54 42 135 61 40 69

Hong Kong, China 5141 1240 6250 2809 82 44

Japan 39 384 11 853 45 927 20 665 86 57

Kiribati 210 54 72 32 292 169

Republic of Korea 21 782 8216 28 887 12 970 75 63

Lao PDR 2234 1526 8457 3806 26 40

Macao, China 449 133 972 437 46 30

Malaysia 15 057 8156 24 719 11 074 61 74

N. Mariana Islands 75 27 63 28 119 96

Marshall Islands 34 11 44 20 77 55

Micronesia FS 91 15 106 48 86 31

Mongolia 3109 1389 5463 2458 57 57

Nauru 4 4 4 2 100 200

New Caledonia 86 38 187 84 46 45

New Zealand 344 74 403 181 85 41

Niue 0 0 1 0 0

Palau 17 7

Papua New Guinea 12 121 2267 12 597 5656 96 40

Philippines 128 495 67 056 249 404 112 146 52 60

Pitcairn Islands (***)

Samoa 43 13 55 25 78 52

Singapore 1728 248 1920 862 90 29

Solomon Islands 303 109 388 175 78 62

Tokelau 0 0 1 0 0

Tonga 24 15 34 15 71 100

Tuvalu 4 2 0 0

Vanuatu 152 63 171 77 89 82

Viet Nam 89 792 53 169 147 725 66 476 61 80

Wallis and Futuna 5 2 0 0

WPR TOTAL 804 533 384 755 1 975 899 858 494 41 45

Table 2: Case detection rates of tuberculosis by country

The revision of estimates along with a decrease in case notification led to a substantial decrease ofthe case detection rate of smear-positive cases in several countries (see commentary). Estimates areto be taken cautiously since a lot of uncertainty is attached to them.


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American Samoa 63 2 66.7 100.0 0 100.0 0 0.0 1 33.3 3

Australia 19 157 251 27.3 45.6 17 48.6 283 30.8 369 40.1 920

Brunei Darussalam 338 84 31.7 15 37.4 166 54.1 42 307

Cambodia 12 014 14 822 78.5 88.5 814 93.4 1108 5.9 2147 11.4 18 891

China 1 236 722 213 766 50.0 50.0 19 664 54.6 194 488 45.4 0 427 918

Cook Islands 17 0 0.0 0.0 0 0.0 1 100.0 0 0.0 1

Fiji 840 62 43.1 59.6 0 59.6 42 29.2 40 27.8 144

French Polynesia 230 29 49.2 59.2 1 61.2 19 32.2 10 16.9 59

Guam 154 42 77.8 87.5 1 89.6 5 9.3 6 11.1 54

Hong Kong, China 6797 1240 34.0 39.4 120 43.2 1787 48.9 504 13.8 3651

Japan 126 920 11 853 31.6 39.0 1367 43.5 17 195 45.9 7046 18.8 37 461

Kiribati 84 54 28.0 62.1 3 65.5 30 15.5 106 54.9 193

Republic of Korea 47 733 8216 37.7 37.7 2262 48.1 11 304 51.9 0 0.0 21 782

Lao PDR 5287 1526 68.3 74.3 91 78.7 437 19.6 180 8.1 2234

Macao, China 438 133 40.8 48.2 12 52.5 131 40.2 50 15.3 326

Malaysia 22 203 8156 54.2 59.7 0 59.7 5517 36.6 1384 9.2 15 057

N. Mariana Islands 69 27 36.0 42.2 0 42.2 37 49.3 11 14.7 75

Marshall Islands 61 11 29.7 39.3 0 39.3 17 45.9 9 24.3 37

Micronesia FS 115 15 29.4 31.9 3 38.3 29 56.9 4 7.8 51

Mongolia 2380 1389 44.7 61.8 126 67.4 732 23.5 862 27.7 3109

Nauru 12 4 100.0 100.0 0 100.0 0 0.0 0 0.0 4

New Caledonia 211 38 44.7 67.9 4 75.0 14 16.5 29 34.1 85

New Zealand 3843 74 24.3 42.3 7 46.3 94 30.8 130 42.6 305

Niue 2 0 0 0 0 0

Palau 18

Papua New Guinea 5130 2267 23.6 38.9 915 54.6 2647 27.6 3768 39.3 9597

Philippines 76 348 67 056 52.2 52.2 8578 58.9 52 858 41.1 0 0.0 128 492

Pitcairn Islands 0.046

Samoa 170 13 33.3 48.1 0 48.1 14 35.9 12 30.8 39

Singapore 3263 248 19.6 22.6 55 27.6 795 62.9 165 13.1 1263

Solomon Islands 410 109 36.0 45.8 1 46.2 128 42.2 65 21.5 303

Tokelau 2 0 0 0 0 0

Tonga 100 15 62.5 71.4 1 76.2 5 20.8 3 12.5 24

Tuvalu 11

Vanuatu 200 63 41.4 50.8 5 54.8 56 36.8 28 18.4 152

Viet Nam 76 900 53 169 59.2 69.4 5493 76.5 17 993 20.0 13 137 14.6 89 792

Wallis and Futuna 15

Total 1 648 257 384 734 50.5 52.5 39 555 57.9 307 932 40.4 30 108 3.9 762 329

Table 3: Tuberculosis cases notified by type in 2000

Pop Pulmonary Extra- Total(x1000) Sputum positive Sputum negative pulmonary all

New Relapse % of all % out of types % out of SS+ out total

% out new of all % out of of total pulm. pulm. total

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Tonga

Samoa

New

Zealand

New

Caledonia

Nauru

N. M

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Lao PDR

Kiribati

Hong Kong, C

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Fiji

Cook Islands

Brunei Darussalam

1977 7 1251 257 95 67 7191 89 245 97 10 264 8 1075 608 7 2212 107 108 36 2760 355 62 150 222 855

1978 8 1292 230 183 78 64 6623 80 629 40 10 441 6 1107 595 14 2446 118 587 59 2964 411 89 131 68 650 294 647

1979 2 1542 216 30 205 81 71 7903 76 455 94 81 910 442 11 094 4 1123 542 9 2232 108 813 58 2800 452 71 7 184 11 821 308 161

1980 2 1457 196 37 210 73 55 8065 70 916 146 89 803 1101 11 168 6 1160 108 474 17 2525 112 307 59 2710 266 64 33 178 43 062 346 1981981 6 1386 285 10 180 58 41 7729 65 867 187 98 532 585 10 970 26 7 1094 128 448 10 2418 116 821 49 2425 313 49 18 92 43 506 353 240

1982 6 1270 245 8158 98 654 19 163 48 49 7527 63 940 193 11 894 75 12 67 1325 107 437 17 2742 104 715 43 2179 324 0 45 12 173 51 206 355 645

1983 8 1219 276 7572 117 557 29 185 66 48 7301 62 021 127 91 572 455 11 634 74 15 73 1514 161 415 14 2954 106 300 41 2065 302 50 23 171 43 185 457 427

1984 12 1299 256 10 241 151 564 20 165 73 54 7843 61 521 111 85 669 671 10 577 58 12 75 1652 144 402 20 3505 151 863 37 2143 337 0 54 9 188 43 875 534 450

1985 5 1088 238 10 145 226 899 36 230 75 37 7545 58 567 103 87 169 571 10 569 64 15 66 2994 104 359 26 3678 151 028 1952 377 2 49 32 124 46 941 611 088

1986 8 906 212 10 325 265 095 17 199 79 49 7432 56 690 129 88 789 420 10 735 16 37 60 2819 98 320 13 2877 153129 1760 292 35 27 131 47 557 650 2561987 9 907 189 9106 313 604 16 173 63 34 7269 56 496 110 87 419 389 11 068 49 32 97 2433 74 296 38 3235 163 740 29 1616 334 9 24 22 90 55 505 714 475

1988 13 954 126 10 691 362 114 15 162 64 41 7021 54 357 208 74 460 320 10 944 27 11 77 2538 111 295 17 4261 183 113 29 1666 372 1 14 24 118 52 463 766 627

1989 5 952 128 7906 367 799 1 218 58 75 6704 53 112 121 70 012 274 10 686 28 7 68 2233 110 303 3 3396 217 272 37 1617 488 35 25 144 52 270 796 087

1990 15 1016 143 6501 375 481 1 252 59 40 6510 51 821 68 63 904 343 10 873 1659 130 348 2497 317 008 44 1591 382 1 23 23 140 47 536 888 409

1991 2 950 10 903 376 246 210 49 6283 50 612 57 864 1951 329 11 059 1611 140 335 6 3401 207 371 309 19 16 234 54 509 784 409

1992 1011 16 148 12 240 83 6534 48 956 100 48 070 994 294 11 420 67 52 111 1516 140 317 2 2540 236 172 26 1512 364 1 23 30 147 56 594 4 433 4801993 4 991 160 13 270 344 218 6 82 70 6537 47 437 46 999 1905 318 12 075 61 151 1418 149 274 1 25 5516 174 189 49 1722 367 32 28 114 52 994 711 162

1994 15 112 363 804 4 225 89 94 6319 44 590 253 38 155 1135 349 11 708 46 171 1730 4 132 352 2 41 5335 180 044 45 1677 332 0 23 19 152 51 763 11 723 716

1995 5 1073 0 14 603 356 364 0 203 83 114 6212 43 078 0 42 117 830 402 11 778 48 51 172 2780 2 111 391 0 19 276 119 186 45 1889 306 0 22 36 79 55 739 4 658 018

1996 0 1073 140 14 857 414 480 0 200 86 114 6501 42 122 327 39 315 1440 570 12 691 51 59 126 3457 0 127 352 0 5 222 165 453 31 1951 316 0 22 126 74 711 780 925

1997 6 1145 149 15 629 448 053 0 171 91 95 7072 42 190 32 33 215 1923 575 13 539 93 103 107 2987 9 100 321 0 15 235 195 767 32 1977 281 0 21 184 77 938 14 842 924

1998 4 899 198 16 946 464 559 1 166 105 89 7673 44 016 276 34 661 2153 465 14 115 97 51 123 2915 6 104 365 0 15 215 162 360 22 2120 289 0 30 18 178 87 468 14 841 7881999 3 1073 267 19 266 471 359 3 192 93 69 7512 40 800 253 32 075 2434 422 14 908 66 41 100 3348 2 83 447 1 32 255 145 807 31 1805 281 0 22 120 88 879 830 976

2000 3 1043 307 18 891 463 373 1 144 59 54 5141 39 384 210 21 782 2234 449 15 057 75 34 91 3109 4 86 344 0 0 12 121 128 495 43 1728 303 0 24 152 89 792 804 506

Palau

Philippines

Solomon Islands

Cam

bodia

American Sam

oa

Viet Nam

Wallis and Futuna

Singapore

Mongolia

Micronesia FS

Marshall Islands

Malaysia

Macao, C

hina

China

Table 4: Trend of notified tuberculosis cases (all types)

Papua New

Guinea

Niue

Australia

Tokelau

Republic of Korea

Japan

Guam

French Polynesia

Total

Vanuatu

Pitcairn Islands

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○

○○○○○○○○○○○○○○○○○○○○○○○

TU

BE

RC

ULO

SIS

CO

NT

RO

L IN T

HE

WH

O W

ES

TE

RN

PA

CIF

IC R

EG

ION

20

02

15

Palau

Philippines

Mongolia

Micronesia FS

Marshall Islands

Macao, C

hina

Republic of

Korea

American Sam

oa

China

Malaysia

N. Mariana Islands

Papua New

Guinea

PitcairnIslands

Australia

Nauru

New

Caledonia

New

Zealand

Niue

Japan

Fiji

Brunei Darussalam

Hong Kong, C

hina

Cam

bodia

Solomon Islands

Tokelau

Wallis and Futuna

Samoa

Singapore

Tonga

Tuvalu

Vanuatu

Viet Nam

Total

1977 881 145 41 13 373 22 6050 852 1285 182 29 57 22 917

1978 741 101 32 13 198 4 6313 903 1375 174 41 52 22 934

1979 807 114 41 12 806 21 34 633 6622 883 1197 184 28 52 57 388

1980 0 765 111 52 12 291 10 38 211 6819 5 10 967 17 275 1266 153 32 23 59 78 049

1981 6 723 97 39 12 214 34 43 868 6766 0 4 5 867 19 006 32 1062 174 18 10 34 33 243 118 2021982 3 690 5801 19 236 98 32 12 649 17 46 735 7320 11 6 11 34 2 942 20 676 30 998 176 25 3 49 33 014 148 558

1983 6 596 5316 25 628 79 48 13 010 14 45 688 7251 3 6 32 60 6 870 18 657 25 860 130 23 7 55 32 612 150 982

1984 9 634 5507 38 367 82 52 13 277 42 561 6660 28 7 18 1061 21 291 20 992 155 25 3 55 30 426 161 230

1985 2 583 5235 53 078 99 48 4142 13 808 48 515 6682 4 8 14 363 69 4 870 39 571 949 155 23 3 51 34 217 208 493

1986 5 8715 60 949 86 49 4110 13 745 49 083 6653 5 4 10 320 66 0 606 50 624 839 101 18 5 36 30 381 226 410

1987 3 7173 75 45 4042 14 405 45 066 6924 22 18 271 55 4 839 72 150 740 115 12 7 26 34 530 186 5221988 8246 65 44 3918 14 592 39 040 6718 276 62 1273 63 655 794 137 7 7 46 39 486 178 366

1989 5842 76 43 3768 14 710 33 968 133 6711 234 40 951 97 070 823 149 2 39 35 095 199 654

1990 5132 83 3670 15 498 30 700 124 6774 185 37 611 840 117 16 7 30 728 94 522

1991 8507 63 34 3564 15 285 28 790 526 140 6752 128 33 489 88 17 5 35 865 100 286

1992 536 12 910 90 184 4 75 40 15 540 17 736 459 158 6754 21 14 19 92 32 2 841 130 0 17 5 84 38 659 184 3121993 1 557 68 9560 84 898 4 39 53 2429 15 210 9916 630 765 108 6954 12 8 87 35 91 0 8 812 92 279 21 155 16 2 41 36 534 267 476

1994 11 058 104 729 1 60 38 40 14 777 18418 375 752 171 6861 22 15 200 2 42 61 0 11 573 87 401 18 861 114 0 17 1 62 35 613 2 282 061

1995 5 11 101 153 276 0 73 37 65 1677 14 367 5211 754 478 141 6688 14 10 9 455 2 33 78 0 9 652 95 768 15 455 109 0 9 0 30 37 550 0 334 912

1996 0 88 12 065 194 365 0 71 37 59 1774 12 867 14411 420 886 258 7271 26 12 14 769 0 35 90 0 4 652 86 695 9 519 103 0 14 50 48 911 379 208

1997 6 171 83 12 686 224 546 0 66 41 54 1943 13 571 50 9957 1234 325 7496 21 25 9 1171 14 37 83 0 7 1195 80 163 14 436 113 0 11 66 50 016 1 405 611

1998 4 203 81 13 865 232 406 1 74 34 64 2091 11 935 5210 359 1494 276 7802 26 11 14 1356 6 31 106 0 2107 69 476 7 482 121 0 16 0 38 54 889 409 427

1999 3 285 100 15 744 230 626 0 65 40 47 2020 12 909 59 9559 1719 244 8207 15 17 20 1513 2 30 94 1 20 1914 73 373 17 465 352 0 10 43 53 805 413 318

2000 2 251 84 14 822 213 766 1 62 29 42 1240 11 853 54 8216 1526 133 8156 27 11 15 1389 4 38 74 0 2267 67 056 13 248 109 0 15 63 53 169 384 736

Table 5: Trend of notified tuberculosis cases (new smear positive cases)

Cook Islands

French Polynesia

Guam

Kiribati

Lao PDR

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○


16

Tabl

e 6:

Tre

nd

of tu

be

rcu

losi

s n

otif

ica

tion

ra

tes

pe

r 1

00

00

0 p

op

ula

tion

(a

ll ty

pe

s)

1976

40.0

9.9

207.

444

.380

.958

.217

6.2

86.8

505.

588

.8 6

5.4

76.3

19.7

38.

5 6

4.8

338.

452

.012

2.7

153.

574

.422

0.6

115.

3

1977

22.6

8.8

43.1

68.4

81.7

156.

378

.417

3.2

80.2

29.

671

.219

.6 5

0.0

79.

023

8.0

23.4

118.

717

1.5

68.1

151.

5

1978

25.8

9.0

133.

030

.155

.376

.214

0.9

70.2

71.

479

.7 2

1.4

71.4

19.2

100.

0 8

4.3

260.

537

.812

5.9

192.

194

.712

8.4

133.

8

1979

6.3

10.6

120.

716

6.7

33.0

55.5

68.3

161.

366

.016

2.1

217.

882

.8 1

4.3

70.2

17.5

64.

3 7

7.0

233.

636

.711

7.5

204.

574

.710

0.0

162.

8 2

2.5

1980

6.3

9.9

106.

020

5.6

33.1

49.0

51.4

158.

160

.624

3.3

235.

641

0.8

81.2

19.

470

.7 7

7.7

15.3

113.

3 8

4.2

233.

536

.711

2.3

117.

768

.847

1.4

154.

8 8

0.2

1981

18.2

9.3

147.

7 5

8.8

27.8

38.7

37.3

148.

656

.030

6.6

254.

519

6.3

77.8

152.

9 2

1.9

65.1

89.

514

.5 6

6.7

78.

023

5.9

31.4

99.

313

4.3

52.1

225.

076

.7 7

9.3

1982

17.1

8.4

122.

511

8.2

9.6

105.

624

.831

.248

.514

4.8

54.0

321.

782

.044

1.2

37.

5 9

3.1

77.0

72.

313

.714

1.7

83.

120

4.2

27.4

88.

212

9.6

0

.045

.515

0.0

139.

5 9

1.4

1983

23.5

7.9

110.

410

6.7

11.5

161.

127

.639

.542

.513

7.8

52.0

208.

222

9.2

149.

778

.343

5.3

45.

510

0.0

85.5

111.

013

.010

0.0

84.

420

4.2

25.5

82.

511

6.6

48.1

287.

513

3.6

75.

6

1984

34.3

8.4

95.

214

2.2

14.4

105.

323

.645

.645

.414

5.2

51.5

179.

021

1.1

217.

269

.630

5.3

34.

3 8

5.2

91.3

94.

712

.215

3.9

106.

228

4.4

22.7

84.

412

5.3

0

.056

.311

2.5

144.

6 7

5.3

1985

13.9

6.8

106.

313

7.1

21.4

180.

032

.446

.930

.813

7.2

48.5

163.

521

1.5

145.

766

.632

0.0

53.

6 7

2.5

161.

8 6

9.3

11.2

216.

710

8.2

276.

3 7

6.3

139.

610

0.0

49.5

400.

0 9

4.7

77.

9

1986

22.2

5.7

93.

813

5.9

25.2

85.

027

.544

.140

.213

5.1

46.6

201.

621

2.1

100.

766

.6 8

0.0

127.

6 6

3.8

148.

4 6

6.2

9.7

92.

9 8

4.6

273.

5 6

8.0

102.

136

.133

7.5

97.

0 7

7.0

1987

24.3

5.6

80.

411

6.7

29.6

94.

123

.137

.127

.212

9.8

46.5

169.

220

7.7

94.

066

.113

6.1

106.

710

3.2

124.

8 4

8.1

9.0

271.

4 8

9.9

278.

918

.0 6

1.8

115.

645

0.0

25.3

275.

0 6

2.1

85.

5

1988

35.1

5.8

52.

313

5.3

33.0

88.

222

.333

.933

.112

3.2

44.6

315.

217

7.4

72.

164

.5 7

1.1

25.

6 7

9.4

126.

9 6

9.4

8.9

121.

411

8.4

308.

018

.0 6

2.9

121.

6 5

0.0

14.6

300.

0 7

8.7

81.

7

1989

13.5

5.7

98.

833

.1

5.0

29.5

32.2

59.5

115.

643

.217

7.9

165.

2 5

9.6

61.6

73.

7 1

7.5

71.

610

9.5

68.

8 8

.9 2

5.0

87.

136

1.5

21.8

60.

215

2.5

29.2

312.

5 9

0.0

80.

9

1990

31.9

6.0

55.

9 7

9.3

33.1

5.

934

.133

.331

.811

2.2

41.9

100.

014

9.3

75.

960

.879

.0 7

9.3

10.2

67.

551

5.6

27.2

58.

912

0.1

50.

023

.228

7.5

95.

9 7

2.0

1991

4.2

5.6

129.

832

.728

.127

.110

6.5

40.8

134.

045

.4 6

9.6

60.3

74.9

83.

8 9

.9 5

0.0

89.

532

9.7

93.

919

.020

0.0

156.

0 8

0.5

1992

5.8

187.

8 7

0.6

31.8

44.9

110.

839

.314

0.9

110.

322

.6 7

7.2

60.8

145.

710

6.1

102.

869

.2 8

1.9

9.1

66.

7 6

5.1

377.

516

.2 5

3.7

109.

0 5

0.0

23.0

375.

0 9

6.1

81.

928

.6

1993

7.8

5.6

56.

314

2.7

28.8

31.

639

.448

.611

2.7

38.1

106.

741

.4 8

2.8

62.7

119.

615

1.0

63.9

85.

1 7

.8 5

0.0

156.

313

4.5

268.

829

.3 6

1.7

103.

732

.731

1.1

73.

1 7

4.3

45.7

1994

151.

630

.1 2

1.1

28.7

41.4

64.0

109.

035

.732

8.6

105.

524

.0 8

7.7

59.4

97.

917

1.0

76.9

36.4

74.

210

.110

0.0

256.

313

0.1

272.

026

.6 5

9.5

90.

7

0.0

23.5

211.

1 9

2.1

71.

078

.645

.5

1995

9.3

5.9

145.

729

.2

0.0

25.9

37.7

76.0

95.

634

.4 9

3.8

17.0

91.

458

.5 7

8.7

92.

713

9.8

112.

918

.2 6

1.3

11.0

0

.011

1.8

186.

917

5.7

27.3

56.

8 8

1.0

0

.022

.427

6.9

46.

7 7

5.5

28.6

40.8

1996

0.0

5.9

46.

714

4.6

33.6

0.

025

.138

.674

.5 9

9.2

33.6

408.

8 8

6.8

28.6

129.

561

.710

4.1

103.

510

0.0

137.

50.

0 6

9.0

5.6

0

.0 2

9.4

115.

623

8.8

18.7

57.

7 8

0.8

0

.022

.4 7

2.4

99.

447

.9

1997

10.3

6.3

48.

514

8.6

36.0

0.

021

.140

.160

.910

7.0

33.6

39.

5 7

2.7

37.0

130.

764

.414

3.1

174.

6 8

2.3

116.

381

.8 5

3.8

8.8

0

.0 8

8.2

177.

327

6.8

19.0

57.

5 6

9.6

0

.021

.210

3.4

101.

893

.351

.3

1998

6.3

4.9

63.

315

7.6

37.0

5.

020

.246

.355

.311

5.0

35.0

340.

6 7

5.2

40.2

105.

765

.813

8.6

83.

6 9

1.8

111.

154

.5 5

0.5

9.9

0

.024

5.5

225.

012

.9 6

0.7

69.

3

0.0

30.3

161.

9 9

7.8

112.

350

.8

1999

4.7

5.8

83.

417

5.4

37.2

15.

023

.040

.342

.111

1.6

32.3

297.

6 6

9.0

44.1

95.

968

.1 8

9.2

65.

1 7

3.0

124.

918

.2 3

9.5

12.0

50.

017

7.8

259.

019

8.1

18.0

51.

0 6

1.1

0

.022

.0 6

4.2

112.

249

.6

2000

5.3

5.4

90.

815

7.0

37.5

5.

917

.125

.735

.1 7

5.6

31.0

250.

0 4

5.6

42.3

102.

567

.810

8.7

55.

7 7

9.1

130.

633

.3 4

0.8

9.0

0

.0

0.0

236.

216

8.3

25

.3 5

3.0

73.

9

0.0

24.0

7

6.0

116.

8

48.8

Tabl

e 4:

Tre

nd

of

no

tifie

d c

ase

s (a

ll ty

pe

s)

Solomon Islands

Tabl

e 4:

Tre

nd

of

no

tifie

d c

ase

s (a

ll ty

pe

s)

Palau

Philippines

Tokelau

Wallis and Futuna

Mongolia

Micronesia FS

Marshall Islands

Macao, China

Republic ofKorea

Malaysia

N. Mariana Islands

Papua New Guinea

Pitcairn Islands

Samoa

Singapore

Tonga

Tuvalu

Vanuatu

Viet Nam

Total

Nauru

New Caledonia

New Zealand

Niue

Japan

Hong Kong, China

Kiribati

Lao PDR

American Samoa

China

Australia

Fiji

Brunei Darussalam

Cambodia

Cook Islands

French Polynesia

Guam


17

Philippines

Solomon Islands

Malaysia

N. Mariana Islands

Papua New Guinea

New Caledonia

New Zealand

Niue

Brunei Darussalam

Hong Kong, China

Cambodia

1976

7.2

20.9

30.9

11.9

41.8

52.9

59.4

93.5

24.4

69.1

1977

6.2

24.3

29.5

11.7

39.3

47.3

30.4

55.3

87.9

31.9

57.6

1978

5.2

16.6

22.7

11.5

7.1

48.2

31.1

58.4

81.3

43.6

51.0

1979

5.6

18.4

28.1

11.1

36.2

92.

149

.430

.550

.283

.329

.546

.0

1980

0.0

5.2

17.5

34.9

10.5

16.7

100.

249

.616

.166

.732

.2 3

5.9

52.4

67.7

34.4

328.

651

.3

1981

18.2

4.9

15.0

26.0

10.4

55.7

113.

348

.0 0

.012

.533

.328

.0 3

8.4

20.5

43.5

74.7

19.2

125.

028

.360

.6

1982

8.6

4.5

84.

1 1

.914

.920

.810

.728

.311

8.8

50.5

64.

718

.815

.323

.016

.728

.6 4

0.3

19.1

40.4

70.4

25.3

37.

539

.559

.0

1983

17.7

3.9

74.

9 2

.511

.828

.710

.923

.011

4.4

48.8

17.

718

.243

.841

.442

.924

.9 3

5.8

15.5

34.4

50.2

22.1

87.

543

.057

.1

1984

25.7

4.1

76.

5 3

.711

.732

.511

.110

4.9

43.8

147.

420

.020

.532

.2 3

9.9

12.3

39.1

57.6

26.0

37.

542

.352

.2

1985

5.6

3.7

70.

7 5

.013

.930

.075

.311

.411

7.7

42.1

20.

028

.615

.419

.62.

233

.325

.6 7

2.4

37.1

57.4

23.2

37.

538

.956

.7

1986

13.9

114.

7 5

.811

.927

.474

.711

.311

7.2

41.3

25.

013

.810

.616

.82.

0 0

.017

.8 9

0.4

32.4

35.3

18.6

62.

526

.749

.2

1987

8.1

92.

010

.026

.572

.211

.910

7.1

41.3

61.

119

.213

.91.

728

.623

.312

2.9

28.3

39.8

12.6

87.

517

.953

.2

1988

104.

48.

923

.368

.712

.0 9

3.0

39.6

13.8

1.9

35.4

107.

130

.044

.8 7

.3 8

7.5

30.7

61.5

1989

73.

010

.323

.965

.012

.0 8

0.2

28.9

38.7

11.5

25.0

24.4

161.

530

.746

.6 2

5.0

24.4

54.3

1990

62.

611

.263

.312

.5 7

1.8

27.4

37.9

8.8

22.6

16.5

31.1

36.8

16.2

87.

546

.6

1991

101.

3 8

.418

.860

.412

.3 6

6.7

12.2

29.6

36.9

6.2

19.8

12.9

26.8

17.0

62.

553

.0

1992

3.1

150.

1 7

.723

.5 9

.921

.612

.5 4

0.7

10.4

41.5

36.1

45.

728

.617

.6 4

.218

.7 1

.229

.838

.90.

017

.0 6

2.5

54.9

56.0

1993

2.0

3.2

23.9

102.

8 7

.121

.118

.836

.841

.912

.212

8.6

37.

716

.628

.136

.623

.5 8

.0 3

.920

.02.

6 0

.050

.019

.814

2.4

12.6

43.8

16.3

22.

226

.351

.216

.6

1994

110.

9 8

.7 5

.3 7

.817

.727

.211

.823

9.0

41.

215

.943

.034

.8 4

6.8

15.0

8.9

18.

223

.61.

7 0

.068

.814

.013

2.0

10.7

30.5

31.2

0.0

17.4

11.

137

.648

.914

.317

.5

1995

9.3

0.0

0.0

110.

712

.6 0

.0 9

.316

.843

.325

.811

.5 6

6.7

26.

2 9

.833

.333

.2 2

3.0

18.2

7.3

18.5

18.

218

.22.

250

.052

.938

.414

0.2

9.1

13.7

28.8

0.0

9.2

17.8

50.9

19.6

1996

29.3

117.

415

.8 0

.0 8

.916

.638

.627

.110

.318

0.0

25.

217

.658

.635

.3 5

3.1

21.1

11.1

30.6

0.

019

.01.

4 0

.023

.514

.812

5.7

5.4

15.3

26.3

0.0

14.3

28.7

65.1

21.7

1997

10.3

0.9

27.0

120.

618

.1 0

.0 8

.218

.134

.629

.410

.8 6

1.7

21.

823

.873

.935

.7 3

2.3

42.4

6.9

45.6

127.

319

.92.

3 0

.041

.226

.611

3.3

8.3

12.7

28.0

0.0

11.1

37.1

65.3

22.9

1998

6.3

1.1

25.9

129.

018

.5 5

.0 9

.015

.039

.831

.3 9

.5 6

2.7

22.

527

.962

.736

.4 3

7.1

18.0

10.4

51.7

54.

515

.02.

9 0

.045

.8 9

6.3

4.1

13.8

29.0

0.0

16.2

0

.020

.970

.523

.7

1999

4.7

1.5

31.3

143.

418

.2 0

.0 7

.817

.328

.730

.010

.2 6

9.4

20.

631

.155

.537

.5 2

0.3

27.0

14.6

56.5

18.

214

.32.

550

.011

1.1

40.7

99.

7 9

.913

.176

.50.

010

.023

.067

.923

.5

2000

3.5

1.3

24.9

123.

417

.3 5

.9 7

.412

.627

.318

.2 9

.3 6

4.3

17.

228

.930

.436

.7 3

9.1

18.0

13.0

58.4

33.

318

.01.

9 0

.0 0

.044

.2 8

7.8

7

.6 7

.626

.60.

015

.0

31.5

69.1

0.0

23.3

Palau

Tokelau

Wallis and Futuna

Mongolia

Micronesia FS

Marshall Islands

Macao, China

American Samoa

China

Samoa

Singapore

Tonga

Tuvalu

Vanuatu

Viet Nam

Total

Australia

Nauru

Japan

Fiji

Cook Islands

French Polynesia

Guam

Kiribati

Lao PDR

Tabl

e c

ases

4:

Tre

nd

of

no

tifie

d c

ase

s (a

ll ty

pe

s)Ta

ble

7: T

ren

d o

f tu

be

rcu

losi

s n

otif

ica

tion

ra

tes

pe

r 1

00

00

0 p

op

ula

tion

(sm

ea

r-p

osi

tive

ca

ses)

Republic ofKorea

Pitcairn Islands

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○


18

In total, 33% of the regional notified smear-positive cases were female (sex ratio M/F = 2). The regional sexratio (M/F) was 0.8 in the 0-14 year old age group, 1.3 in the 15-24 group, and then increased in the older agegroups.

New SS+ males New SS+ females New SS+ males and females

0-14 15-24 25-34 35-44 45-54 55-64 >=65 Total 0-14 15-24 25-34 35-44 45-54 55-64 >=65 Total 0-14 15-24 25-34 35-44 45-54 55-64 >=65 Total

American Samoa 6 0 0 0 1 1 0 2 0 0 0 0 1 0 0 1 0 0 0 0 2 1 0 3

Australia 3 16 35 25 24 19 49 171 0 15 19 12 15 5 14 80 3 31 54 37 39 24 63 251

Brunei Darussalam 0 6 4 15 5 7 15 52 0 4 6 9 6 3 4 32 0 10 10 24 11 10 19 84

Cambodia 26 519 1323 1618 1456 1373 1058 7373 38 457 1157 1649 1798 1459 892 7450 64 976 2480 3267 3254 2832 1950 14 823

China 1131 19 111 29 399 25 206 25 593 21 429 21 771 143 640 1420 14 536 18 496 12 377 9899 7102 6296 70 126 2551 33 647 47 895 37 583 35 492 28 531 28 067 213 766

Cook Islands 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 1

Fiji 0 8 6 13 5 4 2 38 0 7 5 7 1 4 0 24 0 15 11 20 6 8 2 62

French Polynesia 1 3 3 4 4 4 3 22 1 4 1 0 1 0 0 7 2 7 4 4 5 4 3 29

Guam 2 1 6 6 9 6 9 39 0 3 1 2 5 2 2 15 2 4 7 8 14 8 11 54

Hong Kong, China 3 47 71 114 151 147 363 896 4 37 73 60 24 28 118 344 7 84 144 174 175 175 481 1240

Japan 2 246 572 676 1494 1509 3816 8315 5 222 464 213 292 384 1958 3538 7 468 1036 889 1786 1893 5774 11 853

Kiribati 2 9 3 3 3 8 2 30 2 5 6 3 4 1 3 24 4 14 9 6 7 9 5 54

Republic of Korea 19 821 1085 988 853 731 901 5398 25 546 544 393 220 295 795 2818 44 1367 1629 1381 1073 1026 1696 8216

Lao PDR 7 92 128 166 201 177 176 947 10 59 95 131 122 91 71 579 17 151 223 297 323 268 247 1526

Macao, China 0 10 8 25 22 9 17 91 0 10 4 6 6 3 13 42 0 20 12 31 28 12 30 133

Malaysia 32 694 1138 1177 908 814 891 5654 41 464 564 424 367 356 286 2502 73 1158 1702 1601 1275 1170 1177 8156

N. Mariana Islands 1 4 8 9 9 3 2 36 0 10 17 7 3 1 1 39 1 14 25 16 12 4 3 75

Marshall Islands 3 5 4 1 3 5 3 24 7 7 3 0 2 2 0 21 10 12 7 1 5 7 3 45

Micronesia FS 0 2 0 1 0 0 1 4 4 3 1 1 0 1 1 11 4 5 1 2 0 1 2 15

Mongolia 6 181 260 171 68 38 23 747 32 200 213 113 41 26 17 642 38 381 473 284 109 64 40 1389

Nauru 1 0 0 0 1 0 0 2 0 0 0 0 1 1 0 2 1 0 0 0 2 1 0 4

New Caledonia 1 1 3 4 2 3 4 18 1 8 1 1 3 2 4 20 2 9 4 5 5 5 8 38

New Zealand 0 6 5 6 8 10 7 42 1 6 6 5 0 4 10 32 1 12 11 11 8 14 17 74

Niue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Palau

Papua New Guinea 8 87 70 30 21 12 5 233 6 77 45 21 15 5 1 170 14 164 115 51 36 17 6 403

Philippines 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pitcairn Islands 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Samoa 0 3 1 1 1 2 1 9 0 2 1 1 0 0 0 4 0 5 2 2 1 2 1 13

Singapore 1 8 9 34 51 26 64 193 1 9 8 7 9 5 16 55 2 17 17 41 60 31 80 248

Solomon Islands 3 13 4 8 8 10 6 52 8 15 13 7 7 5 2 57 11 28 17 15 15 15 8 109

Tokelau 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Tonga 0 2 1 1 0 1 5 10 0 1 1 1 0 1 1 5 0 3 2 2 0 2 6 15

Tuvalu

Vanuatu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Viet Nam 51 2367 6147 8209 6713 5150 7712 36 349 64 1334 2320 2754 2594 2847 4907 16 820 115 3701 8467 10 963 9307 7997 12 619 53 169

Wallis and Futuna

WPR 1303 24 262 40 293 38 511 37 614 31 498 36 906 210 387 1670 18 041 24 064 18 204 15 437 12 633 15 412 105 461 2973 42 303 64 357 56 715 53 051 44 131 52 318 315 848

% ** 1 12 19 18 18 15 18 100 2 17 23 17 15 12 15 100 1 13 20 18 17 14 17 100

*Only data from DOTS areas were reported.

** Indicates proportion of patients in specific age group out of total for each category (male, female, combined).

Table 8: Age and sex distribution of new sputum smear-positive tuberculosis cases in DOTS and non-DOTS areas combined, 2000, by country


19

Western Pacific Region Totals Rates

Males 0-14 1303 0.615-24 24 262 17.525-34 40 293 25.235-44 38 511 32.545-54 37 614 41.855-64 31 498 53.3 >=65 36 906 71.4Total 210 387 25.0

Females 0-14 1670 0.815-24 18 041 13.825-34 24 064 15.935-44 18 204 16.145-54 15 437 18.055-64 12 633 22.1 >=65 15 412 24.4Total 105 461 13.1

Males and Females 0-14 2973 0.715-24 42 303 15.725-34 64 357 20.635-44 56 715 24.545-54 53 051 30.255-64 44 131 37.9 >=65 52 318 45.5Total 315 848 19.1

Table 9: Age and sex distribution of new sputum smear-positive tuberculosis rates in DOTS and non-DOTS areas combined in the Western Pacific Region, 2000

Population figures used to calculate rates in this table were the 1998 estimates from Demographic Datafor Health Situation Assessment and Projections – 1998, WHO Geneva, 1998.


21

Table 10: DOTS coverage reported by country, 2000

Pop. Pop. Notified DOTS Notified DOTS EstimatedDOTS Case

Total Accessible All types* Enrollment New S+ Enrollment Incident Detection

Countries (x 1000) to DOTS(*2) DOTS non- Rate DOTS non- Rate New S+ Rate

(2000) (x 1000) (%) DOTS All Cases DOTS New S+ New S+ (%)

a b b/a c d c/(c+d) e f e/(e+f) g e/g

American Samoa 57 57 100 3 0 100 2 0 100 21 9

Australia 19 157 10 345 54 490 553 47 122 129 49 766 16

Brunei Darussalam 338 338 100 307 0 100 84 0 100 88 96

Cambodia 12 014 11 894 99 18 891 0 100 14 822 0 100 30 155 49

China 1 236 722 840 971 68 348 436 114 937 75 191 280 22 486 89 568 892 34

Cook Islands 17 17 100 1 0 100 0 0 6 0

Fiji 840 840 100 144 0 100 62 0 100 311 20

French Polynesia 230 230 100 59 0 100 29 0 100 85 34

Guam 154 154 100 54 0 42 0

Hong Kong, China 6796 6796 100 3685 1456 72 915 325 74 2786 33

Japan 126 920 45 691 36 15 397 23 987 39 4415 7438 37 16 500 27

Kiribati 84 84 100 210 0 100 54 0 100 31 174

Republic of Korea 47 733 0 0 0 21 782 0 0 8216 0 15 752 0

Lao PDR 5287 3701 70 1617 617 72 1526 0 100 3965 38

Macao, China 438 438 100 449 0 133 0

Malaysia 22 203 22 203 100 15 057 0 100 8156 0 100 11 102 73

N. Mariana Islands 69 69 100 75 0 100 27 0 100 28 98

Marshall Islands 61 61 100 34 0 100 11 0 100 24 45

Micronesia FS 115 115 100 91 0 100 15 0 100 43 35

Mongolia 2380 2380 100 3109 0 100 1389 0 100 2190 63

Nauru 12 12 100 4 0 4 0

New Caledonia 211 0 0 0 86 0 38

New Zealand 3843 3843 100 344 0 100 74 0 100 115 64

Niue 2 0 0 0 0 0 0 1 0

Palau 19 2 8 7 0

Papua New Guinea 5131 410 8 2534 9587 21 403 1864 18 5747 7

Philippines 76 348 68 713 90 96 371 32 124 75 49 991 17 065 75 107 651 46

Pitcairn Islands (**) 0.046 0

Samoa 170 170 100 43 0 100 13 0 100 68 19

Singapore 3263 3263 100 590 1138 34 105 143 42 718 15

Solomon Islands 410 410 100 303 0 100 109 0 100 152 72

Tokelau 2 0 0 0 0 0 0

Tonga 100 98 98 24 0 100 15 0 100 37 41

Tuvalu 10 0

Vanuatu 200 100 50 105 47 69 26 37 41 80 33

Viet Nam 76 900 76 746 100 89 792 0 100 53 169 0 100 65 365 81

Wallis and Futuna 14 0

WPR TOTAL(**) 1 648 250 1 100 151 67 598 219 206 314 74 326 993 57 741 85 832 685 39

* All types includes new smear-positive, relapse, smear-negative and extrapulmonary tuberculosis cases.

** In WPR Total, cases reported for years other than 2000 are not included in calculation.

DOTS case detection rate is the fraction of estimated cases notified under DOTS. A revision of the estimatesof new tuberculosis cases in the Region in 2000 and a decrease of case notification in some endemic countriesresulted in a decrease of case detection rates (ratio of notified cases to estimated cases) between 1999 and2000, although case notifications remained stable.

DO

TS

CO

VE

RA

GE

AN

D T

RE

ATM

EN

T O

UT

CO

ME

S

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○


22

Table 11: Treatment outcome of new smear-positive cases registered in 1999 in DOTS areas

(%) (%) (%) (%) (%) (%) (%) (%)

American Samoa 0 100 0 0 0 0 0 100

Australia 161 98 16 70 1 0 9 4 85

Brunei Darussalam 100 100 56 20 6 1 2 15 76

Cambodia 15 744 100 91 3 3 0 3 1 93

China 188 112 99 97 0 1 1 1 0 97

Cook Islands 0 100 40 40 0 0 0 20 80

Fiji 65 100 83 9 3 0 5 0 92

French Polynesia 40 100 85 0 3 0 13 0 85

Guam 69 100 67 28 0 0 4 1 94

Hong Kong, China 1536 100 71 7 5 7 5 4 78

Japan 4218 96 48 32 3 7 11 0 79

Kiribati 52 100 88 0 2 4 6 0 88

Republic of Korea

Lao PDR 1603 100 80 4 7 7 0 1 84

Macao, China 266 100 78 0 6 5 7 3 78

Malaysia 7602 100 11 0 8 0 84

N. Mariana Islands 15 100 80 0 0 0 7 13 80

Marshall Islands 17 100 82 0 18 0 0 0 82

Micronesia FS 19 74 100 29 0 0 7 0 129

Mongolia 1513 100 81 5 3 4 4 3 86

Nauru 2 100 50 0 0 50 0 0 50

New Caledonia

New Zealand

Niue 1 100 100 0 0 0 0 0 100

Palau 0

Papua New Guinea 480 95 44 26 26 0 2 4 69

Philippines 70 17 6 2 3 3 87

Pitcairn Islands

Samoa 13 131 82 12 0 0 6 0 94

Singapore 130 100 95 0 2 0 2 2 95

Solomon Islands 107 94 79 8 4 0 5 4 87

Tokelau

Tonga 10 100 50 30 0 0 20 0 80

Tuvalu

Vanuatu 24 100 71 17 4 0 8 0 88

Viet Nam 53 227 100 90 2 2 1 3 2 92

Wallis and Futuna

Total 312 049 100 91 5 2 1 2 1 96

Country Registered* Evaluated** Outcomes of Treatment

Cured Completed Transferred Treatment Treatment Defaulted Failed Died Out Success

The WHO target is an 85% cure rate. The target has been reached at the regional level.

* Registered for cohort analysis

** Percentage of evaluated cases among registered cases.


23

Table 12: Treatment outcome of new smear-positive cases registered in 1999 in non-DOTS areas

Country Registered* Evaluated** Outcomes of Treatment

Cured Completed Transferred Treatment Treatment Defaulted Failed Died Out Success

(%) (%) (%) (%) (%) (%) (%) (%)

American Samoa 0

Australia 131 93 20 62 5 0 11 2 83

Brunei Darussalam 0

Cambodia 0

China 19 878 99 85 0 4 8 1 2 85

Cook Islands 0

Fiji 0

French Polynesia 0

Guam 0

Hong Kong, China 484 20 9 29 6 1 44 11 38

Japan 7196 20 43 44 1 9 3 0 87

Kiribati 0

Republic of Korea 1804 100

Lao PDR 77 100 0 69 23 5 1 1 69

Macao, China 0

Malaysia 0

N. Mariana Islands 0

Marshall Islands 0

Micronesia FS 0

Mongolia 0

Nauru 0

New Caledonia 30 100

New Zealand 0

Niue 0

Palau 0

Papua New Guinea 0

Philippines 0

Pitcairn Islands 0

Samoa 0

Singapore 25 100 80 0 4 0 4 12 80

Solomon Islands 0

Tokelau 0

Tonga 0

Tuvalu 0

Vanuatu 19 0

Viet Nam 46 100 8 9 2 0 4 0 93

Wallis and Futuna 0

Total 29 690 79 81 16 7 11 3 5 97

Treatment outcomes reported in non-DOTS areas concern only 34% of cases that should havebeen analyzed.


25

No. of cases studied 1,479 1,009 806 4424 1374 2370 1001 179 980 641 630

Any drug resistance 17.9 17.6 14.8 12.2 10.3 10.6 4.8 11.2 4.8 32.9 10.2

1 drug resistance 9.7 9.8 8.2 8.5 7.6 6.8 4.2 8.4 4 19.5

2 drugs resistance 2.7 4.9 2 2.3 1.7 1.4 0.5 1.7 0.4 11.2

(without MDR)

3 drugs resistance 0.1 0.1 0.2 0.1 0.1 0.2 0 0 0.1 0

(without MDR)

MDR-TB 5.3 2.9 4.3 1.4 0.9 2.2 0.1 1.1 0.3 2.2 0

INH resistance Any DR 11.4 11.3 8.9 6.1 4.4 8.6 1.6 9.5 3.4 20.6 6.6

Mono 4.1 3.8 2.7 2.6 2 4.9 1 6.7 2.6 7.3 4.8

RMP resistance Any DR 7.1 3.8 6.3 1.6 1.4 3 0.5 1.1 0.4 3.3 0.6

Mono 1 0.6 1.6 0.05 0.2 0.7 0.4 0 0.1 0.9 0.5

SM resistance Any DR 9.1 12.2 8.8 8.2 7.5 3.1 3 2.8 1.9 23.9 4.8

Mono 4.1 5.4 3.7 5.3 5.2 1.2 2.4 1.1 1.3 11.1 3

EMB resistance Any DR 3.5 1.7 1.9 1.6 0.4 1.1 0.5 0.6 0.3 1.1 0.2

Mono 0.6 0.1 0.2 0.5 0.1 0.04 0.4 0.6 0 0.2 0

Table 13: Anti-tuberculosis drug resistance (%) in new cases*

Guangdong, C

hina

Cam

bodia

Singapore

Republic of K

orea

Hong K

ong, China

Shandong, C

hina

Country / province

Japan

Zhejiang, C

hina

Malaysia

New

Zealand

Viet N

am

* Available data from 10 countries surveyed.

The level of anti-tuberculosis drug resistance closely relates to the extent of use of the corresponding drugs inthe treatment of tuberculosis and with treatment efficiency (cure rate) in tuberculosis control programmes.Drug resistance increases when poor tuberculosis treatment programmes select out drug resistant mutantsand these are left to further transmit the resistant bacilli in the community. Anti-tuberculosis drug resistancesurveys conducted in 10 countries and areas showed that drug resistant tuberculosis was highly prevalent inthe Western Pacific Region. Drug resistance was found among newly diagnosed tuberculosis cases in allcountries surveyed with a population adjusted mean of 19.4%, ranging from 4.8% to 32.9%. Multidrugresistant tuberculosis (MDR-TB: resistance to at least INH and RMP) was 5.3% in Guangdong, China, andranged from 0.3% to 1.7% in other countries and areas.A

NT

I-T

UB

ER

CU

LOS

IS D

RU

G R

ES

ISTA

NC

E

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○


26

No. of cases studied 750 1642 1271 954 4632 1535 42 428 1017 200 1131 726

Any drug resistance 10.5 19.5 24.3 21.6 12.9 13.6 10.9 5 12 5.9 11.2

1 drug resistance 8 10.2 11.1 9.8 8.7 8.3 6.9 4.4 8 4.2

2 drugs resistance 0.5 2.8 6.6 2.3 2.3 2.1 1.5 0.5 2.5 0.8(without MDR)3 drugs resistance 0 0.2 0.3 0.4 0.1 0.3 0.2 0 0.5 0.1(without MDR)MDR-TB 2 6.4 6.3 9.1 1.8 2.9 2.3 0.1 1 0.8 0.4INH resistance Any DR 9.7 12.5 17.3 14.5 6.6 7.4 8.8 1.7 9.5 4.5 7.9

Mono 7.2 4 5 3.5 2.6 2.5 4.9 1.1 6.5 2.9 5.4RMP resistance Any DR 2.1 8.4 7.8 12.2 2 3.5 3.1 0.5 2 1.1 1

Mono 0.1 1.2 0.6 2.2 0.1 0.3 0.7 0.4 0 0.2 0.4SM resistance Any DR 1.9 9.9 16.8 11.7 8.6 9.3 3.2 3.1 3.5 1.7 5.1

Mono 0.5 4.4 5.5 3.8 5.4 5.5 1.2 2.6 1 1.1 2.8EMB resistance Any DR 0.3 4 3.5 4.2 1.8 2 1.2 0.5 1.5 0.3 0.1

Mono 0.1 0.5 0.1 0.3 0.5 0.1 0.04 0.4 0.5 0 0

Table 15: Anti-tuberculosis drug resistance (%) in new and retreatment cases*

Guangdong, C

hina

Cam

bodia

Singapore

Republic of K

orea

Hong K

ong, China

Shandong, C

hina

Country / province

Japan

Zhejiang, C

hina

Malaysia

New

Zealand

Australia


Table 14: Anti-tuberculosis drug resistance (%) in retreatment cases*

No. of cases studied 163 220 148 783 264 283 151 96

Any drug resistance 34.4 50 58.8 26.9 42.4 21.9 13.2 17.7

1 drug resistance 14.1 15.9 18.2 12.5 15.2 9.9 6

2 drugs resistance 3.7 13.6 4 4.8 5.3 4.5 2.6

(without MDR)

3 drugs resistance 0.6 0.9 1.4 0.3 2.3 0.4 0.7

(without MDR)

MDR-TB 16 19.5 35.1 9.6 19.7 7.1 4 3.1

INH resistance Any DR 22.7 40.5 44.6 17.4 33 17.3 11.9 16.7

Mono 3.7 9.5 7.4 3.8 6.8 6.7 5.3 9.4

RMP resistance Any DR 20.2 23.2 43.9 11.6 21.6 10.2 5.3 3.1

Mono 3.1 0.5 5.4 1.3 0.8 1.8 0.7 0

SM resistance Any DR 17.8 34.5 27.7 16.3 24.2 6.7 0 7.3

Mono 7.4 5.9 4.7 6.8 7.6 1.4 0 1

EMB resistance Any DR 8 10.5 16.9 6 15.2 3.5 0 0

Mono 0 0 0.7 0.6 0 0 0 0G

uangdong, China

Cam

bodia

Singapore

Republic of K

orea

Hong K

ong, China

Zhejiang, C

hina

Shandong, C

hina

Country / province

Japan



27

Part III

FIGURES

FIG

UR

ES

1 Latest notification rate, all types, per 100 000 29by country

2 Latest notification rate, new smear-positive cases, 30per 100 000, by country

3 Distribution of notified cases by major countries in 31the Western Pacific Region, 2000

4 Comparison of notification rates of new smear-positive 31cases in high burden countries in 1998, 1999 and 2000

5 New smear-positive pulmonary cases by age group, 32Western Pacific Region, 2000

6 New smear-positive pulmonary rates by age group, 32Western Pacific Region, 2000

7 Population with access to DOTS in high burden 33countries, 2000

8 DOTS enrolment rate of patients in high burden 33countries, 2000

9 Case detection by DOTS and non-DOTS in high 33burden countries, 2000

10 Treatment outcome under DOTS in high burden 34countries, 2000

11 Trends of DOTS implementation, 1995-2000 34

12 DOTS progress in high burden countries in the WPR 35

13 DOTS coverage by WHO Region 35

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The notification rate for the Region was 49 per 100 000 in 2000, varying in individual countries and areasfrom 0 (Tokelau) to 250 (Kiribati). The notification rate was higher than 100 in eight countries/areas andlower than 25 in nine countries/areas. In Pacific island countries with a small population, the annual numbersand rates of cases showed great fluctuation. The ranking of countries for 2000 was very close to that of theprevious year (with the notable difference that Palau, which ranked fourth in 1999, but did not report toWHO in 2000).

0

5

5

6

9

17

24

25

26

31

33

35

37

46

49

53

56

68

74

76

76

79

91

103

109

117

131

157

168

236

250

49.2

50.6

0 50 100 150 200 250 300

Tokelau

American Samoa

Australia

Cook Islands

New Zealand

Fiji

Tonga

Samoa

French Polynesia

Japan

Nauru

Guam

China

New Caledonia

Lao PDR

Republic of Korea

WESTERN PACIFIC REGION

Singapore

Marshall Islands

Malaysia

Solomon Islands

Hong Kong, China

Vanuatu

Micronesia FS

Brunei Darussalam

Macao, China

N. Mariana Islands

Viet Nam

Mongolia

Cambodia

Philippines

Papua New Guinea

KiribatiFigure 1:Latest notificationrate, all types, per100 000population, bycountry

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0

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4

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8

8

9

13

13

15

17

17

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18

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23

27

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32

33

37

39

44

58

64

69

88

123

23.7

0 20 40 60 80 100 120 140

Tokelau

Australia

New Zealand

American Samoa

Cook Islands

Fiji

Singapore

Samoa

Japan

French Polynesia

Micronesia FS

Tonga

Republic of Korea

China

New Caledonia

Marshall Islands

Hong Kong, China

WESTERN PACIFIC REGION

Solomon Islands

Guam

Lao PDR

Macao, China

Vanuatu

Nauru

Malaysia

N. Mariana Islands

Papua New Guinea

Mongolia

Kiribati

Viet Nam

Philippines

Cambodia

Brunei Darussalam

Figure 2 :Latestnotification rateof new smear-positive casesper100 000population, bycountry

The notification rate for the Region was 23 per 100 000, varying in individual countries and areas from 0(Tokelau) to 123 (Cambodia). The rates and ranking of countries are similar to those of the previous year.


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Others8%

Japan5%

3%

Viet Nam11%

China56%

18%Philippines

Republic of Korea

Total Notified Cases = 804 552

Figure 3:Distribution ofnotified cases bymajor countries inthe WesternPacific Region,2000

Five countries account for 92% of all notified cases, with China contributing 56%. These countries alsocontain 95% of the regional population.

0 20 40 60 80 100 120 140 160

Cambodia

Philippines

Viet Nam

Mongolia

Papua NewGuinea

Lao PDR

China

Western PacificRegion

Notification Rate in 1998



Figure 4:Comparison ofnotification ratesof new smear-positive cases inhigh burdencountries in 1998,1999 and 2000

The notification rate remained stable in the Region between 1998 and 2000.

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1%

13%

20%18%

17%14%

17%

0

5

10

15

20

25

30

0-14 15-24 25-34 35-44 45-54 55-64 65 orover

Age Group

Per

cent

Figure 5:New smear-positivepulmonary casesby age group,Western PacificRegion, 2000

A majority of the new tuberculosis smear-positive cases were in the most economically productive age group(15 to 45 years old).

Figure 6:New smear-positivepulmonary ratesby age group,Western PacificRegion, 2000

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10

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30

40

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60

70

80

0-14 15-24 25-34 35-44 45-54 55-64 >=65

Age Group (yrs.)

Rat

e pe

r 10

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MaleFemaleTotal

There were twice as many male tuberculosis patients reported as females. The number of patients was almostequal in females and males up to the age of 24, but after this age, male cases predominated, with the gapbetween the two sexes widening as the age increased. In contrast to the case distribution by age group (Figure5), the notification rate of new smear-positive cases increased with age. This tendency is more significant inmales, with the rate for those aged 65 and over being almost four times than that for the 15-24 age group.


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0

20

40

60

80

100

Cambodia Mongolia Viet Nam Lao PDR China Philippines Papua NewGuinea

WesternPacificRegion

Per

cent

Figure 7:Population withaccess to DOTS inhigh burdencountries, 2000

The population with access to DOTS reached high levels in most high burden countries in 2000, although itremained at a low level in Papua New Guinea.

0

20

40

60

80

100

Cambodia Lao PDR Viet Nam China Mongolia Papua NewGuinea

Philippines WesternPacific Region

All Types

NewSmear-Positive

Per

cent

Figure 8:DOTS enrolmentrate of patients inhigh burdencountries, 2000

DOTS enrolment rate was 100% in 17 countries/areas among the 34 that reported to WHO.

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10

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100

Viet Nam Philippines Mongolia Cambodia Papua NewGuinea

Lao PDR China WesternPacificRegion

Detection by Non-DOTS

Detection by DOTS(DOTS Detection Rate)

Per

cent

Figure 9:Case detection byDOTS and non-DOTS in highburden countries,2000

The DOTS detection rate is the fraction of estimated cases notified under DOTS. A revision of the estimatesof new tuberculosis cases in the Region in 2000 and a decrease of case notification in some endemic countriesresulted in a decrease of case detection rates (ratio of notified cases to estimated cases) between 1999 and2000, although case notifications remained stable. Viet Nam reached the 70% WHO target for case detectionwhereas most endemic countries showed an overall case detection rate lower than 50%.

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0102030405060708090

100

China PapuaNew

Guinea

Viet Nam Cambodia Mongolia Philippines Lao PDR WPR

Not Evaluated

Not Successful

Successful

Per

cent

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20

30

40

50

60

70

80

1995 1996 1997 1998 1999

DOTS Enrolment Rate(All Types)

Population with Accessto DOTS

10

Per

cent

Year

2000

Figure 10:Treatmentoutcome underDOTS in highburden countries,2000

Ten countries/areas reported a cure rate equal or greater than the 85% WHO target, and 16 countries/areasreported a success rate of 85% or more. Treatment outcome reports were inconsistent in several endemiccountries, particularly in non-DOTS areas.

Figure 11:Trends of DOTSimplementation,1995-2000

Figure 11 shows the expansion of the regional DOTS implementation from 1995 to 1999. In terms ofpopulation, DOTS coverage has improved since the strategy began in 1991. Coverage was 67% in 2000,compared to 58% in 1998. The DOTS enrolment rate has also increased significantly to 74% for all types.However, the DOTS case detection rate of new smear-positive cases was only 39%, still short of the globaltarget of 70%. It is necessary to expand DOTS rapidly and to increase its population coverage and enrolmentrate, especially in high prevalence countries.


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0 20 40 60 80 100

DOTS detection rate

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tmen

t suc

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PNG

China

Lao PDR

Philippines

Cambodia

Mongolia

Viet Nam(%

)

(%)

Target zone

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400

600

800

1000

1200

1400

1600

1800

AFR AMR EMR EUR SEAR WPRWHO Region

Pop

ulat

ion

(�000

s)

Proportion ofPopulation withAccess to DOTS

Figure 12:DOTS progress inhigh burdencountries in theWestern PacificRegion

Treatment success refers to cohorts of patients registered in 1998 and 1999, and evaluated, respectively, bythe end of 1999 and 2000. DOTS detection rate is the fraction of estimated cases notified under DOTS.Arrows mark progress in high burden countries of the Region that have supplied notification for the last twoyears. Countries should enter the graph at top left, and proceed rightwards to the target zone.

Figure 13:DOTS coverageby WHO Region,2000

Each bar shows the population of the region, and the shaded portion of the bar shows the population coveredby DOTS. The number above each bar is the percent of the population covered.

Source: Global TBReport 2001. DOTScoverage in WPRreported in theGlobal TB Report2001 as reflected inFigure 12 is differentfrom reportedelsewhere in thisreport due to agreater number ofcountry reportsavailable at the timewhen this report wasprepared.

AFR: African Region; AMR: American Region; EMR: Eastern Mediterranean

Region; EUR: European Region; SEAR: South-East Asian Region; WPR:

Western Pacific Region.

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ANNEXES

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1 Definitions of tuberculosis cases 39

2 Data collection and major sources of information 43

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ANNEX 1 DEFINITIONS OF TUBERCULOSISCASES

A case of tuberculosis: A patient in whom tuberculosis has been bacteriologicallyconfirmed, or has been diagnosed by a clinician. Any person given treatment fortuberculosis should be recorded.

All types: The sum of new smear-positive pulmonary, relapse, new smear-negativepulmonary and extrapulmonary cases.

New smear-positive pulmonary: A patient who has never received treatment fortuberculosis or has taken anti-tuberculosis drugs for less than four weeks and who hasone of the following:

• Τwo or more initial sputum smear examinations positive for acid fast bacilli(AFB), or

• one sputum examination positive for AFB plus radiographic abnormalitiesconsistent with active pulmonary tuberculosis as determined by a treatingmedical officer; or

• one sputum specimen positive for AFB and at least one sputum that is culturepositive for AFB.

New smear-negative pulmonary: A case of pulmonary tuberculosis that does not meetthe above definition for smear-positive tuberculosis:

Extrapulmonary tuberculosis: Tuberculosis of organs other than the lungs: e.g., pleura,lymph nodes, abdomen, genito-urinary tract, skin, joints and bones, meninges, etc.Diagnosis should be based on one culture-positive specimen, or histological or strongclinical evidence consistent with active extrapulmonary tuberculosis, followed by adecision by a clinician to treat with a full course of anti-tuberculosis chemotherapy. (Apatient diagnosed with both pulmonary and extrapulmonary tuberculosis should beclassified as a case of pulmonary tuberculosis.)

Retreatment cases: Relapses, failures and defaulters.

Relapse: A patient previously treated for tuberculosis and declared cured or treatmentcompleted, and is diagnosed with bacteriologically positive (smear of culture)tuberculosis.

1 WHO, IUATLD, KNCV. Revised International Definitions in Tuberculosis Control. Int J Tuberc Lung Dis 2001; 5: 213-215.

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Definitions of treatment outcome

Cured: A patient who is sputum smear-negative in the last month of treatment and onat least one previous occasion.

Completed treatment: A patient who has completed treatment but who does not meetthe criteria to be classified as a cure or a failure.

Treatment success: The sum of patients who are cured and those who have completedtreatment.

Died: A patient who dies for any reason during the course of treatment.

Failure: A patient who, while on treatment, is sputum smear-positive at five monthsor later during the course of treatment.

Defaulted:A patient who has interrupted treatment for two consecutive months ormore.

Transferred out: A patient who has been transferred to another recording and reportingunit and for whom the treatment outcome is not known.

Not evaluated: Patients who did not have treatment outcome evaluated.

Note: In countries where culture is current practice, patients can be classifiedas cured or failure on the basis of culture results.

Indicators to assess treatment outcome

Cure rate: Proportion of cured cases out of all cases registered in a certain period(registered in 1999 and evaluated in 2000 in this report).

Treatment success rates: The sum of the proportion of patients who were cured andpatients who completed treatment out of all cases registered in a certain period (1999in this report). The global target is an 85% cure rate and a greater treatment successrate.

Cure rate and treatment success rate are expressed as a percentage of all registeredcases. To assess the quality of treatment programmes for new infectious cases, thenumber of new cases registered for treatment in 1999 (reported in 2001) is comparedto the number of cases notified as smear-positive in 1999 (reported in 2000). Thesenumbers should be the same. Differences may arise because National TuberculosisProgrammes do not compile data at the end of each calendar year, because diagnosesare incorrect, because patients are lost between diagnosis and the start of treatment, orbecause records are lost. Second, the fraction of registered cases was evaluated foroutcome. All registered cases should be evaluated. Third, data on the six standard,mutually exclusive outcomes of treatment are compiled. These figures are reported aspercentages of all registered cases, so that the possible outcomes plus the fraction of


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cases not evaluated sum to 100%. When a country states the number of patientsregistered for treatment, but gives no outcomes, no result is reported rather than zerotreatment success. Although treatment outcomes are expressed as percentages, theyare referred to as rates. The six possible outcomes plus the fraction of cases not evaluatedsum to 100%. Sometimes, countries state a number of registered cases that is less thanthe sum of the six outcomes (i.e. the number evaluated), or is missing. In such instanceswe take the denominator for treatment success to be the number evaluated or the numberof smear-positive cases notified in the previous year, whichever is greater. Datadescribing the outcome of retreatment were collected only from DOTS areas.

Case detection rate and DOTS detection rate

DOTS. The recommended strategy for tuberculosis control, comprising:

• government commitment to ensuring sustained, comprehensive tuberculosiscontrol activities;

• case detection by sputum smear microscopy among symptomatic patients self-reporting to health services;

• standardized short-course chemotherapy using regimens of six to eight months,for at least all confirmed smear-positive cases. Good case management includesdirectly observed treatment (DOT) during the intensive phase for all new sputumsmear-positive cases, the continuation phase of rifampicin-containing regimensand the whole retreatment regimen;

• a regular, uninterrupted drug supply of all essential anti-tuberculosis drugs; and• a standardized recording and reporting system that allows assessment of case-

finding and treatment results for each patient and of the tuberculosis controlprogramme’s performance overall.

Targets for tuberculosis control, established by the World Health Assembly:• To cure 85% of the sputum smear-positive tuberculosis cases detected; and• To detect 70% of the estimated new sputum smear-positive tuberculosis cases.

Case notifications represent only a fraction of the true number of cases arising in acountry because of incomplete coverage by effective NTP.

The estimated case detection rate is defined as:

Case detection rate (%) = Annual new smear-positive notifications (country) Estimated annual new smear-positive incidence (country)

DOTS detection rate refers to case detection under DOTS:

DOTS detection rate (%) = Annual new smear-positive notifications under DOTS Estimated annual new smear-positive incidence (country)

The case detection rate and DOTS detection rate are identical when a country has a100% DOTS enrolment rate.

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The denominators are derived from “Global Burden of Tuberculosis: EstimatedIncidence, Prevalence and Mortality by Country in 1997” published by Journal of theAmerican Medical Association (JAMA) in 1999 (Dye, C., S. Scheele, P. Doblin, V.Pathania and M.C. Raviglione).

Population with access to DOTS: The country’s population that has access to unitsimplementing DOTS.

DOTS Enrolment Rate (%): This indicates the proportion of cases enrolled in DOTSout of notified cases.

DOTS enrolment rate (all types) (%) =Annual notifications of all types under DOTS Total of annual notifications of all types

DOTS enrolment rate (New S+) (%) =

Annual notification of new smear-positive cases under DOTS Total of annual notifications of new smear-positive cases


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ANNEX 2 DATA COLLECTION AND MAJOR SOURCESOF INFORMATION

The WHO Western Pacific Region comprises 37 countries and areas with a 2000population of about 1.645 billion. The Region contains very large countries such asChina and Japan representing, respectively, 75% and 8% of the total regional population,while the 32 smallest countries account for 5% of the total population. Seven countrieshave a population of more than 10 million and six have a population of betweenone million and 10 million. Of the remaining 24 countries and areas with fewer thanone million inhabitants, 17 have a population of less than 200 000 and eight of 20 000or less. Countries and areas are scattered in the north, west, central and south Pacific.

The main information source for estimates of tuberculosis infection, disease and deathsis the article “Global Burden of Tuberculosis: Estimated Incidence, Prevalence andMortality by Country in 1997,” published in JAMA by WHO in 1999, using data fromWHO workshops in 1997 and updated in 2001. The source for the update was theGlobal Tuberculosis Control 2001.

The data collection forms were designed by the WHO Global Tuberculosis Programme,Geneva, and were completed and submitted to WHO Western Pacific Regional Officeby respondent countries in 2000. These were the main source of information ontuberculosis case notification and DOTS status. The Regional Office for the WesternPacific was responsible for verification of data submitted by each country. The 1995,1997 and 1998 editions of the Epidemiological Review of Tuberculosis in the WesternPacific Region, the 1999 and 2000 editions of Tuberculosis in WHO Western PacificRegion, published by WHO Regional Office for the Western Pacific, as well as theWHO Global Tuberculosis Control reports of 1997, 1998, 1999, 2000 and 2001 werealso used as sources.

The population figures for 1995-1999 were from the 1998 revision of DemographicData for Health Situation Assessment and Projections – 1998 (WHO, Geneva, 1998)and may differ from those of other sources. The population figures for 2000 wereprovided by the countries as part of their report on tuberculosis.

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WORLD HEALTH ORGANIZATIONRegional Office for the Western PacificStop TBUnited Nations Avenue1000 Manila, Philippines

Tel No: (63-2) 528-8001Fax No: (63-2) 521-1036E-mail: [email protected]: http://www.wpro.who.int

ISBN: 92 9061 012 3

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