Epidemiologia della tubercolosi · Estimated new TB cases (all forms) per 100 000 population Global Tuberculosis Control. WHO Report 2002. WHO/CDS/TB/2002.295 Russia 22 high-burden

1

Epidemiologia della tubercolosi

Sorveglianza della tubercolosi nelle strutture sanitarie e socio-assistenziali

Parma, 19 maggio 2006

Bianca Maria Borrini

Dipartimento Sanità Pubblica – AUSL di Parma

La tubercolosi nel mondo

2

Tuberculosis notification rates, 2004

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved

0 - 2425 - 4950 - 99100 or moreNo report

Notified TB cases (new and relapse) per 100 000 population

Estimated number of new TB cases, 2004

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved

0 - 9991000 - 999910 000 – 99 999100 000 - 999 999

No estimate1 000 000 or more

Estimated number of new cases (all forms)

3

Estimated TB incidence rates, 2004

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved

0 - 2425 - 4950 - 99100 - 299

No estimate300 or more

Estimated new TB cases (all forms) per 100 000 population

Global Tuberculosis Control. WHO Report 2002. WHO/CDS/TB/2002.295

Russia

22 high-burden countries

CambodiaChinaPhilippinesVietnam

AfghanistanPakistan

EthiopiaDR CongoKenyaMozambique NigeriaS. AfricaTanzania UgandaZimbabwe

BangladeshIndiaIndonesia Myanmar Thailand

Brazil

4

Estimated HIV prevalence in new adult TB cases

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved

HIV prevalence in TB cases, 15-49 years (%)

0 - 45 - 1920 - 4950 or moreNo estimate

La tubercolosi in Europa

5

Geographic areas, Europe

EuroTB

European Union (EU, solid blue)AustriaBelgiumCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalSlovakiaSloveniaSpainSwedenUnited Kingdom

Non-EU (blue hatch)AndorraIcelandIsraelMonacoNorwaySan MarinoSwitzerland

AlbaniaBosnia & HerzegovinaBulgariaCroatiaMacedonia, F.Y.RRomaniaSerbia & MontenegroTurkey

ArmeniaAzerbaijanBelarusGeorgiaKazakhstanKyrgyzstanMoldova, Republic ofRussian FederationTajikistanTurkmenistanUkraineUzbekistan

TB notification rates per 100,000 population Europe, 2003

EuroTB

6

TB notification rates by geographic area, Europe, 1996-2003

EuroTB* excluding Bosnia & Herzegovina

0

20

40

60

80

100

120

1996 1997 1998 1999 2000 2001 2002 2003

TB cases / 100,000

East

Centre

EU & West

Percentage change in TB notification rates, EU & West*, 1999-2003

EuroTB* Excluding countries with <60 cases notified in 2003 (Andorra, Cyprus, Iceland, Luxembourg, Malta, Monaco, San Marino)

SloveniaCzech Republic

HungaryGermany

DenmarkFinland

AustriaPortugalSlovakiaSwitzerland

SwedenPoland

NetherlandsIreland

EstoniaSpain

BelgiumLatvia

FranceIsrael

LithuaniaItaly

United KingdomNorway

Greece

-12% -10% -8% -6% -4% -2% 0% 2% 4% 6% 8% 10%% change

7

Proportion of TB cases of foreign origin, Europe, 2003

EuroTB

TB cases by geographic origin, EU & West*, 1996-2003

EuroTB* Austria, Belgium, Denmark, Estonia, Finland, France, Germany, Iceland, Israel, Netherlands, Norway, Slovakia, Slovenia, Sweden and Switzerland

0

3 000

6 000

9 000

12 000

15 000

18 000

21 000

1996 1997 1998 1999 2000 2001 2002 2003

TB casesNationals

Foreigners

Unknown

8

Proportion of pulmonary TB cases by geographic area, Europe, 2003*

EuroTB* Dots indicate mean for area, lines indicate country range. Excluding countries with respiratory classification: Belarus, Bulgaria, San Marino, Serbia & Montenegro, Spain, Tajikistan, Ukraine.

0%

20%

40%

60%

80%

100%

EU & West Centre East

% cases

Multi-drug resistance (MDR), new cases, 2003*

* countries with nationwide-representative data and with more than 60 new cases reported§ countrywide survey, 2001 EuroTB

02468

10121416

Estonia

Lithu

ania

Latvi

aIsr

ael

Switzerl

and

Sweden

Austria

German

y

Netherl

ands

Irelan

d

Slovak

ia

Finlan

d

United

Kingdo

m(ex

cl. Sco

tland

, 200

2)

Belgium

Croatia

Sloven

ia

Czech

Repub

lic

Bosnia

& Herz

egov

ina(F

ed.)

Denmark

Norway

% MDR

9

La tubercolosi in Italia

10

< 4

4-6,9

7-9,9

Incidenza dei casi notificati di

tubercolosi polmonare

Anno 2002

Incidenza per 100.000 abitanti

Ministero della Salute

> 10

La tubercolosi in Emilia-Romagna

11

Tassi di incidenza (x 100.000) di tubercolosi polmonare ed extrapolmonare.

Emilia-Romagna e Italia. Periodo 1990-2004

0,0

2,0

4,0

6,0

8,0

10,0

12,0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000 20

0120

0220

0320

04

tass

o in

cide

nza

x 10

0000

abi

tant

i

TB extrapolmonare RER TB polmonare RERTB extrapolmonare ITA TB polmonare ITA

Casi di tubercolosi notificati. Emilia-Romagna. Periodo 1996-2004

0

50

100

150

200

250

300

350

400

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

TB polmonare TB extrapolmonare

12

Incidenza per

100.000 abitanti

5,5-6,9

7,0-8,5

>=10,0 Tasso medio annuo RER 7,4 – Casi totali 436; polmonari 296

Incidenza annuale di tubercolosi polmonare per AUSL. Emilia-Romagna. Periodo 2001–2002

8,6-9,9

Incidenza per

100.000 abitanti

5,5-6,9

7,0-8,5

>=10,0 Tasso medio annuo RER 7,9 – Casi totali 477; polmonari 321

Incidenza annuale di tubercolosi polmonare per AUSL. Emilia-Romagna. Periodo 2003–2004

8,6-9,9

13

Tassi di incidenza della tubercolosi per classi di età Emilia-Romagna. Periodo 1996-2004

0

5

10

15

20

25

30

1996 1997 1998 1999 2000 2001 2002 2003 2004

Casi n

otificat

i pe

r 10

0.00

0 ab

.

0-14 15-24 25-44 45-64 65+

Casi di tubercolosi distinti per luogo di nascita. Emilia-Romagna. Periodo 1996-2004

0

50

100

150

200

250

300

350

400

450

500

1996 1997 1998 1999 2000 2001 2002 2003 2004

N. ca

si

Italiani Non italiani

14

Casi di tubercolosi (%) notificati in cittadini nati all’estero Emilia-Romagna. Periodo 1996-2004.

10,014,0 13,0

19,323,0 21,3

28,230,3

40,737,9

45,246,4

05

101520253035404550

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004Anno di notifica

%

Casi di tubercolosi notificati in cittadini nati all’estero per anni di residenza in Italia.

Emilia-Romagna. Anno 2004

0

10

20

30

40

50

60

70

<2 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20 24

Anni di residenza in Italia

Casi

Not

ifica

ti

15

00,5

1

1,52

2,53

3,54

4,5

1996 1997 1998 1999 2000 2001 2002 2003 2004

Anno di notifica

Casi

per

100

.000

ab.

Casi notificati con esame diretto dell’espettorato positivo per 100.000 abitanti.

Emilia-Romagna. Periodo 1996-2004.

Respiratoria17%

Intestinale5%

Linfonodale29%

Osteo-Articolare

8%Meningi-SNC3%

Genito-Urinaria

17%

Altri organi21%

Proporzione delle sedi anatomiche nei casi di tubercolosi extrapolmonare. Emilia-Romagna.

Periodo 1996-2001

16

0,0 2,0 4,0 6,0 8,0 10,0 12,0 14,0 16,0 18,0 20,0

Contatto con malato di TB

Esiti di TB

Grave immunodeficienza acquisita

Infezione recente

Operatore sanitario/sociale

Ospite/personale istituti di detenzione

Patologie

Tossicodipendenza/alcolismo

Totale

Non italiani

Italiani

Presenza di fattori di rischio nei casi di tubercolosi. Emilia-Romagna. Periodo 1996-2001.

La tubercolosi in Provincia di Parma

17

0

5

10

15

20

25

30

35

40

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

num

ero

casi

Polmonare Extrapolmonare

Casi notificati di TB polmonare ed extrapolmonare.Provincia di Parma. Periodo 1987-2003

0

2

4

6

8

10

12

14

1996 1997 1998 1999 2000 2001 2002 2003RER - Extra p o lmo nare RER - Po lmo nareRER - To tale Parma - Extra p o lmonareParma - Po lmo nare Parma - To tale

Incidenza della tubercolosi in Provincia di Parma e in Regione. Periodo 1996-2003

18

0

5

10

15

20

25

1996 1997 1998 1999 2000 2001 2002 2003

0-14 15-24 25-44 45-64 65+

Incidenza della tubercolosi per classi di età. Provincia di Parma. Anni 1996-2003.