Guidelines on the Prevention and Control of Tuberculosis in Ireland
Guidelines on the Prevention and Control of Tuberculosis in Ireland
Guidelines on the Prevention and Control of Tuberculosis in Ireland
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<str<strong>on</strong>g>Guidel<strong>in</strong>es</str<strong>on</strong>g> <strong>on</strong> <strong>the</strong> Preventi<strong>on</strong> <strong>and</strong> C<strong>on</strong>trol <strong>of</strong> <strong>Tuberculosis</strong> <strong>in</strong> Irel<strong>and</strong> 2010HSE/HPSCForeword<strong>Tuberculosis</strong> rema<strong>in</strong>s a significant cause <strong>of</strong> morbidity <strong>and</strong> mortality worldwide. In 2008, an estimated 8.9to 9.9 milli<strong>on</strong> new cases <strong>and</strong> 1.7 milli<strong>on</strong> deaths were reported globally. In Irel<strong>and</strong>, <strong>the</strong> <strong>in</strong>cidence <strong>of</strong> TBhas fallen significantly from a high <strong>of</strong> 230 notificati<strong>on</strong>s per 100,000 populati<strong>on</strong> <strong>in</strong> 1952 when records firstbegan to a low <strong>of</strong> 9.7 per 100,000 <strong>in</strong> 2001. The <strong>in</strong>cidence has rema<strong>in</strong>ed relatively stable s<strong>in</strong>ce <strong>the</strong>n with arate <strong>of</strong> 11.3 per 100,000 <strong>in</strong> 2007 <strong>and</strong> an <strong>in</strong>cidence rate <strong>of</strong> 8.0/100,000 <strong>in</strong> <strong>the</strong> <strong>in</strong>digenous Irish populati<strong>on</strong><strong>in</strong> 2007.The HIV epidemic has had a significant impact <strong>on</strong> TB rates globally as <strong>in</strong>dividuals with TB <strong>and</strong> HIV<strong>in</strong>fecti<strong>on</strong> are more likely to develop active TB disease dur<strong>in</strong>g <strong>the</strong>ir lifetime than those who are HIVnegative. Drug resistance, <strong>in</strong>clud<strong>in</strong>g multidrug-resistant TB <strong>and</strong> extensively drug-resistant TB toge<strong>the</strong>rwith <strong>the</strong> <strong>in</strong>creas<strong>in</strong>g number <strong>of</strong> TB-HIV co-<strong>in</strong>fected patients is also challeng<strong>in</strong>g TB c<strong>on</strong>trol. The WorldHealth Organizati<strong>on</strong> proposes to reduce <strong>the</strong> global <strong>in</strong>cidence <strong>of</strong> active TB to less than 1 case per milli<strong>on</strong>populati<strong>on</strong> by 2050 <strong>and</strong> thus elim<strong>in</strong>ate TB as a global public health problem. This <strong>of</strong>fers a challenge toimprove TB c<strong>on</strong>trol <strong>in</strong> Irel<strong>and</strong>.The first guidel<strong>in</strong>es for <strong>the</strong> management <strong>and</strong> c<strong>on</strong>trol <strong>of</strong> TB <strong>in</strong> Irel<strong>and</strong> were published <strong>in</strong> 1996. All <strong>the</strong>secti<strong>on</strong>s from <strong>the</strong> orig<strong>in</strong>al guidel<strong>in</strong>es have been updated <strong>and</strong> a new secti<strong>on</strong> <strong>on</strong> <strong>in</strong>fecti<strong>on</strong> preventi<strong>on</strong> <strong>and</strong>c<strong>on</strong>trol has been added. The recommendati<strong>on</strong>s <strong>in</strong> <strong>the</strong>se guidel<strong>in</strong>es are based <strong>on</strong> a review <strong>of</strong> <strong>in</strong>ternati<strong>on</strong>alliterature <strong>and</strong> an extensive c<strong>on</strong>sultati<strong>on</strong> process with relevant pr<strong>of</strong>essi<strong>on</strong>als.I would like to thank all <strong>the</strong> members <strong>of</strong> <strong>the</strong> committee for <strong>the</strong>ir <strong>in</strong>valuable c<strong>on</strong>tributi<strong>on</strong> to this report <strong>and</strong>also to acknowledge <strong>the</strong> work <strong>and</strong> commitment pr<strong>in</strong>cipally <strong>of</strong> Dr Joan O’D<strong>on</strong>nell who was ably assistedby Ms Sheila D<strong>on</strong>l<strong>on</strong>, Dr. Lorra<strong>in</strong>e Hickey, Dr. Abaigeal Jacks<strong>on</strong>, Dr. Kate O’D<strong>on</strong>nell, Mr. Noel Gibb<strong>on</strong>s<strong>and</strong> Dr. Margaret O’Sullivan <strong>in</strong> produc<strong>in</strong>g this report.Dr. Dar<strong>in</strong>a O FlanaganChairpers<strong>on</strong>, Nati<strong>on</strong>al TB Advisory Committee.February 2010-viii-