Epidémiologie de la tuberculose à la Réunion,
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1 Epidémiologie de la tuberculose à la Réunion, N. Baroux 1, Dr E. D Ortenzio 1 1/ CIRE Réunion-Mayotte
2 Nombres estimés de nouveaux cas, 2006 Estimated number of new TB cases (all forms) No estimate or more TOP 5 : Inde, Chine, Indonésie, Afrique du Sud, Nigéria The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved
3 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the Wor ld Health Or ganization concerning the legal status of any country, terr itor y, city or area or of its authorities, or concerning the delimitation of its frontiers or boundar ies. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved Incidence estimée, 2006 Estimated new TB cases (all forms) per population No estimate or more
4 Incidence/ dans l ouest de l océan indien
5 Cas déclarés de tuberculose maladie par région, 2006 (nombre de cas et taux) ,3 30, ,3 Nombre de cas Taux pour Nombre de cas 8,6 8,5 8,5 8,4 7,2 6,9 6,3 6,3 6,2 6,1 6,0 6,0 5,9 5,8 5,7 5,2 5,2 5,2 5,1 4,6 4,1 3,8 3,8 3,8 25,0 Taux pour ,0 15,0 10,0 5,0 Guyane Ile de France Provence Alpes Cotes d'azur Rhone Alpes Bretagne Bourgogne Centre Haute Normandie Réunion Picardie Pays Loire Aquitaine Alsace Nord Pas de Calais Guadeloupe Corse Languedoc Roussillon Lorraine Basse Normandie Auvergne Franche-Comté Champagne Ardennes Limousin Midi-Pyrénées. Martinique Poitou-Charente 0 0,0 Source: InVS, d éclaration obligatoire de tuberculose 11/03/2008
6 Objectif Décrire les caractéristiques épidémiologiques à la Réunion: - des cas de tuberculose maladie (TM) > des cas d infections tuberculeuses latentes (ITL) > enfant de moins de 15 ans déclarées > 2003 (date de la mise à DO)
7 Méthode: Recueil des données Periode : - DO de la tuberculose reçues à la DRASS - Validées par l Institut de Veille Sanitaire (InVS) Periode : - CNR des mycobactéries et de la résistance des mycobactéries aux antituberculeux Période : - CepiDC-Inserm Période 2000 à 2006 pour la France métropolitaine
8 Méthode: Définition de cas cas confirmé de TM - confirmation bactériologique de la maladie cas probable de TM - signes cliniques et/ou radiologiques compatibles avec une TM - mise en route d un traitement antituberculeux standard cas d une ITL chez un enfant de moins de 15 ans - intradermo réaction (IDR) à 5U positive sans signe clinique ni para clinique
9 Méthode: Définition de la résistance Multirésistance - résistance à au moins l isoniazide et la rifampicine Ultrarésistance : - multirésistants - résistants à une fluoroquinolone et à au moins un des trois médicaments injectables de deuxième intention (capréomycine, kanamycine, amikacine)
10 Caractéristiques épidémiologiques de la tuberculose maladie à la Réunion,
11 Résultats (1) Évolution du nombre de cas de TM et du taux d incidence, Réunion, Taux d incidence à la Réunion (pour ) Taux d incidence en France métropolitaine (pour ) Nombre année de cas Total
12 Résultats (2) Évolution des taux d incidence à la Réunion Taux d'incidence pour La Réunion La Réunion (données non validées) France métropolitaine Année 9 7
13 Résultats (3) Répartition par classe d âge et sexe Classe d âge Nombre de cas Homme Femme Sexe ratio 0-14 ans , ans ,6 + de 40 ans ,0 Total ,4 Age médian : 45 ans ; Extrême [0-94] < 2 ans : 5 cas [2-5] ans : 15 cas [6-10 ] : 6 cas [11-14] : 14 cas 0-14 ans : n=40 (8,1%)
14 Résultats (4) Répartition par classe d âge et sexe Taux d'incidence pour ans Taux d'incidence pour ans Année plus de 40 ans Année 25 Taux d'incidence pour La Réunion France métropolitaine Année
15 Résultats (5) Autres caractéristiques Nationalité : 93%de francais Pays de naissance : - France : 82% - Afrique (hors Afrique du Nord) : 14% Résidence en collectivité : 4 % SDF : 3 cas
16 nombre de cas Résultats (6): Antécédent et localisation de la tuberculose maladie Antécédent de traitement tuberculose : 6% Localisation : - TM pulmonaire : 82% - TM extra-pulmonaire : 18% pulmonaire 401 localisation pleurale autre localisation ganglionnaire autre ganglionnaire hilaire osteoarticulaire genitale meningée urinaire
17 Résultats (7): Résistance et cas confirmés 423 souches envoyées au CNR entre 2000 et 2006 > 8 multirésistantes Évolution des taux d incidence des cas confirmés de TM Taux d'incidence pour Année
18 taux pour Taux de mortalité (/100000) dus à la TM 14,0 12,0 10,0 8,0 6,0 4,0 2,0 0,0 12 Résultats (8) : Mortalité décès maladie 8 7 1,8 0, année Baisse du taux de mortalité entre 2003 et enfant < 5 ans en 2003 Source : Inserm-CepiDC Taux de mortalité Nombre de décès (/ ) , , , , , ,6 TOTAL 50 1,1
19 Conclusion Incidence moyenne faible : - 8/ à la Réunion - 246/ à Madagascar - 22/ à Mayotte Faible incidence VIH Accès aux soins plus favorables Maladie lié à la pauvreté Vaccination Position géographique Echanges commerciaux ou de voyageurs fréquents Maintenir un niveau d incidence faible Bonne prise en charge Bon dépistage autour des cas
20 Epidémiologie de la tuberculose à la Réunion, N. Baroux 1, Dr E. D Ortenzio 1 1/ CIRE Réunion-Mayotte
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