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Annual report Tuberculosis notifications in Australia, 2004 Table 8. National tuberculosis performance indicators, performance criteria and the current status of tuberculosis in Australia, 2003 and 2004 National TB Performance Indicator Performance criteria 2003 2004 Annual incidence of TB (per 100,000 population) Crude incidence Indigenous Australians
Tuberculosis notifications in Australia, 2004 Annual report tion with the Australian Government Department of Immigration, Multicultural and Indigenous Affairs and other organisations. Migrants need ready access to cost-free, non-threatening and culturally-appropriate TB assessment and treatment. People from Sudan, Somalia and Ethiopia were reported as high-incidence sub-populations in Australia in 2004, reflecting changes in the composition of Australia’s migrant intake. Tuberculosis clinics need to adapt to the specific cultural and social needs of these new patient populations. Community leaders in the new migrant populations must be identified and encouraged to assist with TB control efforts. These TB control measures have proved successful in other migrant populations in the past and are likely to succeed again. As Australia and other low-incidence countries move towards TB elimination, the overseas-born population will continue to account for a large proportion of incident cases. Additional measures, such as active case finding and increased detection and treatment of latent TB infection, should be considered in migrant populations with a high incidence of TB. Indigenous Australians are at increased risk of TB with incidence rates 8 times higher than among non-Indigenous Australian-born people in 2004. This disparity has remained evident for the last decade despite the efforts of TB control programs. Some of the known risk factors that explain the high incidence of TB in the Indigenous Australians are socioeconomic disadvantage), co-morbidities (such as diabetes and renal diseases), smoking, alcohol abuse and poor nutrition. 4 The comparison of the 2004 TB notification data against the National TB Performance Indicators demonstrates some progress toward achieving the goals of the National Strategic Plan for TB Control. The low incidence of TB among non-Indigenous Australian-born children (0.4 per 100,000 population) and absence of any reported cases among Indigenous Australian children are approaching the target incidence of less than 1 case per million. The success of TB treatment programs in Australia are reflected in the declining proportion of relapsed cases initially treated in Australia (1%), and the absence of any cases recorded as treatment failures (Table 8). Further action is required to reduce the incidence of TB in Indigenous communities to the same low rate as the non-Indigenous Australian-born population. The reporting of HIV status for TB cases remains at an unacceptable low level (34% in 2004). Despite incomplete reporting, 16 cases of HIV/TB co-infection were recognised in Australia in 2004 of whom 11 were overseas-born. Australian migrant intake includes people who come from countries where HIV and TB are prevalent. Privacy laws in some states confound efforts to collect information on the HIV status of TB patients. Alternative acceptable strategies must be found to obtain this essential public health information. In 2004, 23 TB cases occurred among health care workers of whom 20 were overseas-born. Health services in Australia are increasingly reliant upon attracting medical and nursing staff from overseas, including from countries where TB is prevalent. State TB services and staff induction programs should be aware of this trend and ensure that new employees are screened and followed-up appropriately for TB. In conclusion, easy access to effective TB treatment programs, contact tracing, and provision of health education in appropriate languages remain the essential elements for TB control. Australia also needs to remain alert to the growing global threat of TB and to contribute to TB control efforts in Southeast Asia and the Pacifi c region. References 1. Li J, Roche P, Spencer J, Bastian I, Christensen A, Hurwitz M, et al. Tuberculosis notifi cations in Australia, 2003. Commun Dis Intell 2004;28:464–473. 2. World Health Organization. Global Tuberculosis Control: surveillance, planning, fi nancing. Geneva: World Health Organization; 2005. 3. Communicable Diseases Network Australia. National Strategic Plan for TB Control in Australia Beyond 2000. March 2002. Available from: http://www.health. gov.au/internet/wcms/publishing.nsf/Content/cdapubs-other-tb_plan.htm/$FILE/tbstrat_plan.pdf 4. Krause V. Tuberculosis (TB). In: Couzos S, Murray R, editors. Aboriginal Primary Health Care: an evidencebased approach. Melbourne: Oxford University Press; 2003. p. 539–571. CDI Vol 30 No 1 2006 101
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