Guidelines on the Prevention and Control of Tuberculosis in Ireland

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<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCAge and sexAs in other developed countries, more TB cases are notified annually in males than females in Ireland andthe rate is consistently higher in males across all age groups. There were 280 (60.2%) notifications for malesin 2006, giving a male to female ratio of 1.5:1. The median age of cases was 45 years (range 0 to 93 years)in 2006. As reflected in other European countries, the majority of foreign-born cases occur in younger agegroups. In 2006, the majority (83.2%) of foreign-born cases occurred in those aged 15 to 44 years (median31 years). Over one-third (39.1%) of Irish cases occurred in persons aged 55 years and older in the sameyear. 19Ethnicity and place of birthSince 1998, the number of foreign-born cases has tripled, while Irish born case numbers have declinedoverall. In 2006, the crude rate of TB in the indigenous population was 8.3 per 100,000 and 26.3 per100,000 in the foreign-born. Approximately, two-thirds (63.2%) of all cases notified in 2006 were Irish born.Of those born outside Ireland, 37% were born in Asia and 36% in Africa. 19Drug resistanceBetween 2001 and 2006, 10 to 27 cases per annum were resistant to at least one front-line anti-TB therapy.Of these an average of two cases had MDR-TB. In 2006, four cases of MDR-TB were reported. 19 In 2005,the first reported case of XDR-TB was detected in Ireland. 201.4 Surveillance of TBClinical notification of TB was introduced in 1948 17 and the Infectious Diseases Regulations 1981 asamended by the Infectious Diseases (Amendment) (No. 3) Regulations 2003 (S.I. No. 707 of 2003)extended the scope of this legislation. 21 From 2004, it became mandatory for clinical directors oflaboratories to notify a case of TB to the regional director of public health (DPH) under their role as medicalofficer of health (MOH). 21The 2003 amendment also made reporting of outbreaks a mandatory requirement. 21 The legislationdescribes outbreaks as “an unusual cluster or changing pattern of illness” which is defined as anaggregation of health events, grouped together in time or space that is believed or perceived to begreater than could be expected by chance. This may apply to a geographic area, facility or a specificpopulation group. This definition relates to cases of TB disease only and not to cases of LTBI. LTBI is not anotifiable disease.Case definitionsA decision of the European Commission (Decision No. 2002/253/EC) specified the case definitions tobe applied by Member States for the purposes of submitting data for the epidemiological surveillanceand control of communicable disease. 22 In April 2008, the above decision was amended (Decision No.2008/426/EC) updating these case definitions. 23 The updated standardised European case definitions areused for notification of TB in Ireland (table 1.5). 23-5-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCTable 1.5: EU standardised case definitions for notification of a TB case 23TUBERCULOSIS (Mycobacterium tuberculosis complex)Clinical CriteriaAny person with the following two:• Signs, symptoms and/or radiological findings consistent with active tuberculosis in any siteAND• A clinician’s decision to treat the patients with a full course of anti-tuberculosis therapyOR• A case discovered post-mortem with pathological findings consistent with active tuberculosisthat would have indicated anti-tuberculosis antibiotic treatment had the patient beendiagnosed before dying.Laboratory CriteriaLaboratory criteria for case confirmationAt least one of the following two:• Isolation of Mycobacterium tuberculosis complex (excluding Mycobacterium bovis-BCG)from a clinical specimen• Detection of M. tuberculosis complex nucleic acid in a clinical specimen AND positivemicroscopy for acid-fast bacilli or equivalent fluorescent staining bacilli on light microscopy.Laboratory criteria for a probable caseAt least one of the following three:• Microscopy for acid-fast bacilli or equivalent fluorescent staining bacilli on light microscopy• Detection of M. tuberculosis complex nucleic acid in a clinical specimen• Histological appearance of a granuloma.Epidemiological Criteria: Not applicable.Case ClassificationPossible case: Any person meeting the clinical criteriaProbable case: Any person meeting the clinical criteria and the laboratory criteria for aprobable caseConfirmed case: Any person meeting the clinical criteria and the laboratory criteria for aconfirmed case.Recommendation:Case definitions specified by the European Commission should be applied for the purposesof notification and submission of data for epidemiological surveillance and disease control.These case definitions are available on the Health Protection Surveillance Centre (HPSC)website at www.hpsc.ie/hpsc/NotifiableDiseases/CaseDefinitions/.Patients with pulmonary TB are further subdivided into sputum smear positive and sputum smear negativecases.-6-
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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