Trend of application of World Health Organization control strategy of tuberculosis in Egypt

Abstract

World Health Organization (WHO) control policy for tuberculosis (TB) includes Bacillus Calmette-Guérin (BCG) vaccine at birth, case detection, and treatment of cases with directly observed therapy short-course (DOTS). This policy has been applied through the Ministry of Health and Population in Egypt for more than 30years. The controversies about the efficacy of the BCG vaccination against TB in adults initiate some suggestions for its discontinuation from compulsory vaccinations in countries with low incidence of TB. The present work aimed to study the trend of applying the WHO control policy for TB in Egypt among the Egyptian population throughout the last 20years (1992-2011). The documented database of the country, bibliographic review on MEDLINE, published studies and reports, WHO and EMRO databases that covered the period from 1992 to 2011 were used in this study. The incidence rate of all forms of TB (pulmonary and extrapulmonary) dropped by 50% from 34 cases to 17 cases per 100,000 population, as well as the prevalence rate declined by 60.6% from 71 cases per 100,000 population throughout the last 20years. Case detection and treatment success rates have increased throughout the studied period while it flat-lined over the past 6years which may need attention. The results of this study introduce an evidence-based recommendation for continuation of the WHO TB control policy in Egypt towards elimination of the disease.

A systematic review of BCG vaccination policies among high-risk groups in low TB-burden countries: implications for vaccination strategy in Canadian indigenous communities

“…However, given the possibility of incomplete coverage of high-risk children after suspension of mass vaccination, surveillance efforts should be strengthened [12]. Egypt d 1Mass vaccinationNo change - Mass vaccinationNAAt birthNA8.6NARoutine vaccination at birth continues to be considered beneficial (based on the significant correlation of BCG vaccine coverage with reduced TB incidence and TB-associated mortality) [45]. Saudi Arabia d 1Mass vaccinationNo change - Mass vaccinationNAAt birthNA9.3NARoutine vaccination continues, however, given the change of strains used for vaccination (from Pasteur 1173 P2 and Tokyo 172–1 to the Danish 1331 strain in 2005), more detailed population-based studies are recommended before the introduction of new strains in the future, with particular attention to the prevalence of host risk factors that contraindicate vaccination, such as immunodeficiency [9].…”

“…Common reasons cited for the shift from a universal to a targeted vaccination program were the low risk of infection among the general population and thus the high number of vaccinations needed to prevent one case in the context of low-incidence settings (for example, an estimated 21,699–25,125 vaccinations needed among the Norwegian adolescent population to prevent one case) [11, 34], and the concentration of the majority of cases among a specific risk group [36]. In countries where mass vaccination was deemed to still be justified, reasons for continuing mass vaccination included the low incidence of serious adverse events associated with the vaccine [28], and findings regarding a significant correlation of BCG vaccine coverage with reduced TB incidence and TB-associated mortality rates (in Egypt) [45].…”

“…)The 2011 Report found no increase in TB meningitis or miliary TB since the discontinuation of routine vaccination. However, due to the small population sizes of first nations communities, incidence rates easily fluctuate above or below the National Advisory Committee on Immunisation (NACI) cut-offs (see left) and therefore perhaps make these of limited use in determining appropriate vaccination policy. [45], 2014Egypt34 cases to 17 cases per 100,000 population (1992–2011)General Egyptian populationRoutine vaccination at birth (1992: 92%, 2006: 99%)There was a significant correlation between vaccine coverage and TB incidence, prevalence, TB-associated mortality, and TB associated under five mortality in 1992–2011: (R, p value): 0.74 < 0.0001, 0.86 < 0.0001, 0.86 < 0.0001, 0.77 < 0.0001. Current routine vaccination therefore remains effective. [31], 2006Finland6.6/100000 in 2004General Finnish populationRoutine vaccination at birth (98%)Targeted vaccination among high-risk groups (planned to begin 2008)BCG osteitis2 cases in 20026 cases in 2003- Children of immigrant families from high-incidence countries- Children of Finnish-born parents with a family history of TB- Children of families planning to stay for a prolonged period in a high-incidence country- Upon request by the parentIn Finland, most TB cases are among seniors (65 or older) and the Indigenous population (rather than among immigrants, as is the case in many other European countries). [46], 2007UKVaccination of all secondary school childrenTargeted BCG vaccination both in neonates and opportunistically in older children- Infants attending primary care in areas with a high incidence of TB Infants who:- Were born in an area with a high incidence of tuberculosis, or- Have one or more parents or grandparents who were bornin a high-incidence country (> 40 cases per 100,000 per year), or- Have a family history of tuberculosis in the past 5 years.…”

Tuberculosis in Upper and Lower Egypt before and after directly observed treatment short-course strategy: a multi-governorate study

“…Major progress in TB prevention and care followed the widespread implementation of directly observed treatment short-course (DOTS) strategy. Efforts must continue to pursue high-quality DOTS expansion and enhancement [4]. DOTS implies that a trained healthcare worker or other assigned individual provides prescribed anti-TB medications and watches the patient while taking each dose [5].…”

Comparative assessment of the condition of tuberculosis in countries of Iran, Turkey, Germany, Egypt, and Malaysia, 2018

“…During this period, the prevalence of TB decreased by 40% and the death rate from TB was reduced by 45%. 13 One of these goals is the end of the year 2030, the end of the TB epidemic, with the goal of reducing the incidence of tuberculosis by 90% and the death rate attributable to the TB of 95%. ; One of the goals of the end of the global epidemics of TB (END-TB) set for 2035 is to reduce 90% of the incidence of TB and 95% of the rate of death from TB.…”