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PPT Codecasa "Urban TB control"
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PPT Codecasa "Urban TB control"

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    PPT Codecasa "Urban TB control" PPT Codecasa "Urban TB control" Presentation Transcript

    • La TB nelle aree metropolitaneL.R. Codecasa, M. FerrareseCentro Regionale di Riferimento per il controllo dellaTBCIstituto Villa Marelli. AO Niguarda, Milano
    • The winter of our discontempt….(W. Shakespeare, Richard III)
    • TBC nelle grandi città europee 50Casi  x  100000 45 40 35 30 25 20 15 10 5 0 Londra Milano Rotterdam Barcellona Parigi
    • Trend incidenza TBC e media 2000 - 2010 25 Milano Lombardia ItaliaCasi  x  100.000 20 19,1 15 10 10,1 5 7,5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Incidenza nazionale stabile ma con: •  Differenze territoriali rilevanti •  Valori significativamente più elevati nelle aree metropolitane (ASL Milano, notifica il 40% dei casi regionali e il 9% dei casi nazionali di TBC)
    • Numero  casi  TBC  per  fascia  d’età  e  nazionalità  -­‐  2010     Negli  italiani  la  TBC  colpisce  sopra2u2o  gli  anziani,  negli  stranieri  l’età   giovane  –  adulta  con  picco  nella  fascia  30  –  39  anni      
    • TBC  in  stranieri     Area di provenienza 15% Casi TBC dal Sud 27% America- Quota ++ in rapporto ai residenti -- Quota femmine + 25% dei maschi 31% maschi   femmine  
    • RischioTBC  in  stranieri:  10  nazionalità  più  frequen@  a  confronto  con  le  presenze  sul  territorio   * Paesi di origine ad elevata incidenza TBC (≥ 100 casi x
    • "   Il numero dei casi anno è il 5% dei casi totali segnalati"   In media ogni mese viene segnalato 1 caso che frequenta collettività scolastiche"   La proporzione di bambini stranieri è simile a quella dei casi adultiL’andamento della TBC nei bambini non preoccupa, ma esistono nellapopolazione i fattori di rischio per lo sviluppo di micro-epidemie nellecomunità infantili
    • POLMONITE  BILATERALE?  " Perù,  13  anni  " Calo  ponderale  15  kg,   febbre,  tosse.  " RichiesO  anOcorpi   anOgliadina!  " QuanOferon  +  " Inviata  per  profilassi   con  isoniazide  " Esame  dire2o  posiOvo   per  BAAR+++  
    • ..e  il  fratellino!  
    • Le Regioni che hanno attivato la sorveglianza ed hanno inviato informazioni sugli esiti sono state Emilia-Romagna, Friuli Venezia Giulia, Lombardia, Marche, Piemonte, Toscana e Veneto, Regioni che rappresentavano il 71% dei casi di TBC notificati a livello nazionale nel 2007 Sono pervenute informazioni sugli esiti di 1.818 casi di TBC polmonare su 2.107. Esiti di trattamento TBC per pervenuti per Regione Anno 2007 D.G. Prevenzione Sanitaria Ufficio Malattie Infettive eFonte: La tubercolosi in Italia. Rapporto 2008 – www.salute.gov.it Profilassi Internazionale
    • Esi@  della  terapia  casi  di  TBC  2009   Non  pervenuto Sfavorevole Favorevole Cause  esito   sfavorevole   7,4 Perso  al  follow    up   (43%)   19,3   Trasferito  17  %   Decesso  17  %   Interro2o  15%   73,3 Fallimento/altro  8%   Obiettivo OMS: trattare con successo 85% dei casi Differenze significative degli esiti della terapia tra centri ospedalieri: Villa Marelli tratta con successo oltre il 90% dei malati
    • There is an increased drive to use awareness as a measure for TB control and toimprove the lack of knowledge, also in EU countries [55]. Mass TB awarenesscampaigns in general population may not be effective [56], but early suspicion ismore likely when knowledge about TB among is increased in the exposedpopulation, high-risk groups, staff working with high-risk groups and health careprofessionals
    • Infection control in community settings and big citiesInfection control (IC) is an essential component of TB control and prevention, includingWHO´s updated Stop TB strategy and the EU Standards of TB Care [65-73].Shortcomings in IC were major contributors to nosocomial outbreaks [74-76], even inEuropean TB reference. Poor ventilation and overcrowding have been drivers of TBtransmission in congregate settings such as homeless shelters, prisons and drugconsumption houses [78-80]. General IC principles for health care settings, describedin detail elsewhere [74, 81], can benefit these specific congregate venues. However,engeneering control activities may be difficult to implement in existing buildings andother measures, such as personal protective equipment for employees, cannot beexpected. New interest in IC has been awakened by the emergence of multi-drugresistant (MDR) and extensively-drug resistant (XDR) TB
    • Active case finding among urban high-risk groups should be complemented by tailoredopportunities for completion of the diagnostic process and treatment, e.g. through low-threshold public health "One-Stop-TB-Shops" with sufficient nursing, social and communityhealth care worker staff, clinical follow-up or admission to general hospitals or modern-daysanatoria, adequate legal frameworks for social support and protection and ensuringknowledge about and facilitating access to health care services. Contact-tracing may not befeasible or effective amongst all urban risk groups, but can be in specific populations, e.g.household or professional contacts [4, 12]. Indiscriminate radiographic screening ofimmigrants is described as inefficient and not cost-effective [9, 69, 98, 101, 103]. However,some interventions may be highly effective or cost-effective when targeted at specific urbanhigh-risk groups, e.g. homeless persons and prisoners
    • The contribution of DNA fingerprinting to the epidemiological standard data in thecontext of urban TB control have been described elsewhere, with an extensive list ofreferences [142]. Briefly, molecular indications for epidemiological links andidentification of risk factors for transmission are crucial for understanding the specificepidemiology of TB in big cities, allowing the detection of risk groups and informing(targeted) public health interventions [12, 19]. Since the 1990s DNA fingerprintingrevealed that a considerable proportion of TB in low-incidence countries was causedby recent transmission (including reinfection), in particular in urban areas, and notdue to late reactivation of infections acquired domestically or infections acquiredabroad. Molecular epidemiological studies identified factors for a higher risk ofclustering, reflecting the risk of infection, such as alcohol abuse, intravenous drug use(IDU), homelessness, or ethniticy [142]. They also confirmed high-risk sites for TBtransmission in big cities, e.g. congregate settings such as shelters for homelesspersons or prisons. Not sure this is the best way to phrase this but I was trying to puthere what is in the reco : that molecular tools complement the surveillance data
    • Sostenete  Stop  TB  Italia!   www.stoptb.it