Why the tuberculosis incidence rate is not falling in New Zealand

Das, Dilip, Baker, Michael, Venugopal, Kamalesh and McAllister, Susan 2006, Why the tuberculosis incidence rate is not falling in New Zealand, New Zealand medical journal, vol. 119, no. 1243, pp. 1-11.

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Title Why the tuberculosis incidence rate is not falling in New Zealand
Author(s) Das, Dilip
Baker, Michael
Venugopal, Kamalesh
McAllister, Susan
Journal name New Zealand medical journal
Volume number 119
Issue number 1243
Start page 1
End page 11
Total pages 11
Publisher New Zealand Medical Association
Place of publication Christchurch, N. Z.
Publication date 2006-10-13
ISSN 0028-8446
Keyword(s) acquired immune deficiency syndrome
age distribution
antibiotic sensitivity
data analysis
disease surveillance
disease transmission
ethnic difference
human immunodeficiency virus infection
Summary Aims To assess the role of migration from high-incidence countries, HIV/AIDS infection, and prevalence of multi-drug resistant organisms as contributors to tuberculosis (TB) incidence in New Zealand (NZ) relative to ongoing local transmission and reactivation of disease.

Methods TB notification data and laboratory data for the period 1995 to 2004 and population data from the 1996 and 2001 Census were used to calculate incidence rates of TB by age and ethnicity, country of birth (distinguishing high and low -incidence countries), and interval between migration and onset of disease. Published reports of multi-drug-resistant TB for the period 1995 to 2004 were reviewed. Anonymous HIV surveillance data held by AIDS Epidemiology Group were matched with coded and anonymised TB surveillance data to measure the extent of HIV/AIDS coinfection in notified TB cases.

Results Migration of people from high-TB incidence countries is the main source of TB in NZ. Of those who develop TB, a quarter does so within a year of migration, and a quarter of this group (mainly refugees) probably enter the country with pre-existing disease. Rates of local TB transmission and reactivation of old disease are declining steadily for NZ-born populations, except for NZ-born Māori and Pacific people under 40. HIV/AIDS and multi-drug-resistant organisms are not significant contributors to TB incidence in NZ and there is no indication that their role is increasing.

Conclusion TB incidence is not decreasing in NZ mainly due to migration of TB infected people from high-incidence countries and subsequent development of active disease in some of them in NZ. This finding emphasises the importance of regional and global TB control initiatives. Refugees and migrants are not acting as an important source of TB for most NZ-born populations. Those caring for them should have a high level of clinical suspicion for TB.
Language eng
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©NZMA
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047390

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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