WHO targets: The Republic must strengthen its tuberculosis (TB) control measures if it is to meet a World Health Organisation (WHO) target to eliminate the infectious disease globally by the year 2050, the Health Protection Surveillance Centre (HPSC) has said. And relatively high rates of meningitis caused by TB mean we cannot end the BCG vaccination programme for young babies.
Final figures for TB in 2003, which the HPSC has just published, show 407 cases of TB were notified to it, representing a rate of 10.4 cases per 100,000 of the population. The rate has fallen from 18.2 cases per 100,000 people in 1991. There were six deaths from the disease in 2003.
"While there has been a marked decline in TB since the 1950s when there were almost 7,000 cases annually, the disease is still endemic. We cannot be complacent," said Dr Joan O'Donnell, specialist in public health with the HPSC.
"We need to strengthen our control systems and measures if we want to reduce TB rates even further. We would like TB rates to decline to meet global targets."
The WHO's Stop TB Strategy aims to reduce the global burden of TB disease by half in 2015 relative to 1990 levels. It wants the global incidence of TB to be less than one per million population by 2050 so that the disease will then be eliminated as a global public health problem.
Strengthening TB controls in the State will mean having sufficient public health personnel in place to ensure thorough tracing of patients who have been in contact with a TB patient to prevent spread of the disease. In addition, the need to monitor treatment directly for six to nine months in some TB patients will require greater numbers of staff.
There were eight cases of TB meningitis reported in 2003, with two of the cases occurring in children aged under five. The age specific incidence rate for TB meningitis for children under 14 years was 2.9 per 100,000, over nine times greater than the rate at which Sweden discontinued routine neonatal BCG vaccinations in 1975. Current TB meningitis rates are in excess of the threshold recommended by the International Union against TB and lung disease for the cessation of routine BCG vaccination.
Dr O'Donnell confirmed that when the number of cases of TB meningitis goes below this threshold, a new policy involving the selective vaccination of high-risk groups is likely to replace the practice of giving BCG to all babies under three months.
However, she emphasised that BCG vaccine is especially effective at preventing TB meningitis and disseminated TB (disease that has spread throughout the body) in children under five.