ABSTRACT
SETTING: The Korea Tuberculosis Surveillance (KTBS) network includes 248 health centres throughout the country, as well as other public and private health institutions. OBJECTIVE: To develop a web-based surveillance system for tuberculosis (TB) and to monitor implementation of the National TB Control Programme (NTP) on an ongoing basis. DESIGN: A TB notification form was developed with new case definitions, and standardised to obtain uniform essential information of the cases with ease and speed. Data collection, compilation, analysis and feedback were made available at every level of the health authority via the Internet without restrictions of time and space. RESULTS: The Internet-based surveillance system was successfully implemented across the country, providing real-time national figures of TB using different variables-patient, time, area, site and type of disease--and facilitating on-line evaluation of NTP implementation. CONCLUSION: The web-based surveillance system has been well established within the existing health infrastructure, providing real-time figures on the TB burden. However, it requires continued improvement of the quality of information and of case reporting activities.
Subject(s)
Internet , Population Surveillance/methods , Tuberculosis/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Korea/epidemiology , Male , Middle AgedABSTRACT
SETTING: Since the 1970s, Cambodia, a country of 10 million people in South East Asia, has experienced war, genocide and the virtual dismantling of the health system. It has a severe tuberculosis (TB) problem, with a new tuberculosis case notification rate, all forms, of about 150 per 100000 population and a tuberculosis programme, established in the early 1980s, achieving cure rates of only 40-50% in the last decade. OBJECTIVE: To describe the implementation of a DOTS programme (directly observed treatment with short-course chemotherapy) under difficult conditions and its rapid success on a nation-wide scale. DESIGN: The World Health Organisation's recommended strategy was implemented in a phased manner throughout the country from 1994. The resources for TB drugs and running costs came from 13 sources. The DOTS strategy was gradually introduced after training and with regular supervision into 120 TB units inside general public hospitals at provincial and district level, after a mapping exercise; 75% of tuberculosis cases, all forms, are hospitalized during the entire initial phase and 85% of the total number of tuberculosis cases received free food from the World Food Programme. RESULTS: Two and a half years after the start of the new programme, DOTS was implemented in 85% of all public hospitals. In 1996, case-detection rates had reached 127 smear-positive PTB (pulmonary tuberculosis) and 149 PTB all forms per 100000 inhabitants; 90% of all tuberculosis patients received DOTS. From January 1994 to June 1995, 4164 new cases started category 1 treatment (2ERHZ/6EH). Of these, 89% were cured or completed treatment, 5% defaulted, 3% died, 1% were treatment failures and 2% transferred out. CONCLUSION: The DOTS strategy can be successfully implemented in even very difficult conditions such as those found in Cambodia.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Aged , Antitubercular Agents/administration & dosage , Antitubercular Agents/economics , Cambodia/epidemiology , Cause of Death , Child , Costs and Cost Analysis , Cytodiagnosis , Disease Notification , Drug Administration Schedule , Drug Costs , Female , Financial Support , Food Services , Hospitalization , Hospitals, District , Hospitals, Public , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Patient Dropouts , Patient Transfer , Remission Induction , Sputum/microbiology , Treatment Failure , Tuberculosis, Pulmonary/economics , Tuberculosis, Pulmonary/epidemiology , World Health OrganizationABSTRACT
OBJECTIVE: To establish the usefulness of DNA fingerprinting for the epidemiology of Mycobacterium tuberculosis isolated from Korean tuberculosis patients. METHODS: Comparison of restriction fragment length polymorphism (RFLP) patterns produced by southern hybridization of PvuII-digested chromosomal DNA. RESULTS: IS6110-associated banding patterns of 41 isolates varied considerably, containing 1-13 copies. The RFLP pattern of the epidemiologically related M. tuberculosis isolates was identical in 8 of 10 groups of close contact patients. No noticeable differences in RFLP were observed between drug-sensitive and drug-resistant isolates. IS1081-containing restriction fragment analysis of 52 isolates showed 6 different banding patterns, and the C type was found dominant in Korea. Identification of G type M. tuberculosis, which has a 8.0 kb IS1081-containing PvuII fragment, is unusual because it has been observed only in M. bovis BCG so far. CONCLUSIONS: IS6110 was a very useful tool for tracing the transmission route of tuberculosis; IS1081 was also useful for subdividing M. tuberculosis into several groups.
