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Introduction
Tuberculosis (TB) is contagious and spreads through the air when an infected person coughs, spits or sneezes. The disease is found everywhere in the world and is more prevalent in devel-oping countries although there seems to be a growing of reported cases, especially in the pres-ence of HIV. Belize has a National Tuberculosis Program which is a Preventative Health Program focusing on eliminating the disease through Information, Education and Communication; Diagnosis and Treatment, Contact Tracing and Surveillance. Data are obtained from all surveillance sites and each case is manage according to our TB standard operating manual and guidelines. Tuberculosis in Belize has not shown a greater number of cases as has been noted in other countries and while under reporting may be a determining factor, the National Programme is now doing an active case finding of TB cases in order to properly document those under de-tected and/or under reported cases.
NATIONAL SUMMARY OF THE TB EPIDEMIC IN BELIZE
TUBERCULOSIS SURVEILLANCE IN BELIZE
Total Relapse Tuberculosis Cases up to 4th quarter for 2009 06
Total Co-infection Cases reported up to 4th quarter for 2009 17
Total New Tuberculosis Cases reported up to 4th quarter for 2009 82
Total Reported Tuberculosis Cases up to 4th quarter for 2009 89
Tuberculosis Incidence Rate for the year 2008 per 100,000 population 24.6
Total deaths related to Tuberculosis up to 4th quarter 2008 15
Percentage of death from Tuberculosis up to 4th quarter 2008 1.2
Total deaths related to Tuberculosis up to 4th quarter for 2009 14
Percentage of death from Tuberculosis up to 4th quarter 2009 0.9
Total Reported Tuberculosis Cases up to 4th quarter for 2008 88
Total New Tuberculosis Cases reported up to 4th quarter for 2008 83
Total Relapse Tuberculosis Cases up to 4th quarter for 2008 05
Total Co-infection Cases reported up to 4th quarter for 2008 18
Tuberculosis Incidence Rate up to 4th quarter for 2009 per 100,000 population 26.7
Note: There was one default case, Belize District for 2009.
OVERVIEW The overall number of TB cases has shown an endemic pattern but of stable character as it oscil-lates over a mean of about 20 to 25 new cases per quarter, when compared to an annual mean it falls between 85 to 100 new cases. . The first quarter of 2009 was no different as 20 new cases were reported almost doubling that of 2008.The male population continues to be the predominat-ing sex in regards to new TB cases for a 65.2%. The number of males being diagnosed with HIV/TB is the same, when compared to those are diagnosed with TB. As the year progressed the ap-pearance of relapse showed a similar nature to that of the previous year with 6 new cases being defined as such.. The co-infection rate has shown no variation and the male sex continues to be those who are more affected. The number of cases reported has little variation when compared to the previous year for a total of 15 in 2009 and 17 in 2008 respectively. As always we need to stress that these figures represent the patients who are HIV positive or were diagnosed as HIV positive when they made their debut with TB disease, vice versa it also reflects those with Tb who later tested positive for HIV. Five deaths were reported in the first quarter for a representation of 1.6 % at the end of the year this more than doubled with 14 new deaths due to TB. The outcome of fewer deaths when com-pared to last year can be attributed to rapid and diagnosis with effective treatment. The number of total deaths represents 0.9% of all the deaths reported for the year 2009. The Belize, Stann Creek, Toledo, and Cayo District’s continue to be the major areas where TB is being found as LTBI or active TB disease. These four District’s represent 91.0% of the total new infections for the year end. This may be particularly so due to the greater number of new cases be-ing diagnosed in the Belize district a for a total of 50.6% and being treated at Chest Clinic. Fifty eight percent of all new case were in the age group of 20-49 years, which constitutes the eco-nomic active population in our country; this also represents a targeted group for future screening activities. It is clearly evident that TB will continue to be a health problem as the major areas that have been affected in our country continue to have the same number of cases, which yearns for a more active stance in the fight against TB for active case finding. The advent and presence of HIV in our soci-ety contributes to such numbers as well as the problem of migrants and lack of adherence that has introduced MDRTB and XDRTB in our societies. Hence the effort to curb and decrease the num-ber of cases, with adherence being the fundamental aspect will be needed; this is where the intro-duction of FDC by the programme is essential. As we move on we must remember the lack of human resource that we face as it contributes nega-tively to the programme effectivity at all levels. A first step in re-enforcing or strengthening the programme further is the introduction of FDC drugs, the indication of culture for all new case whether sputum positive or negative and DST for all cases as part of our operational plans in order to meet the Millennium Development t goals set for 2015.
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Chart 1: New versus Relapse Cases by Sex Belize: January to December, 2008
Table No. 1 New & Relapse Tuberculosis Reported Cases by District & Sex
January - December 2008
Table No. 2 New & Relapse Tuberculosis Reported Cases by District & Sex
January - December 2009
District
New Cases Relapse Cases
Male Female Total Male Female Total
Corozal 3 0 3 0 0 0
Orange Walk 2 1 3 1 1 2
Belize 32 13 45 1 0 1
Cayo 2 4 6 2 0 2
Stann Creek 9 3 12 0 0 0
Toledo 4 9 13 1 0 1
Total 52 30 82 5 1 6 Source: The Epidemiology Unit, MOH
Note: There was a default case Belize District for 2009
District New Cases Relapse Cases
Male Female Total Male Female Total Corozal 2 0 2 0 0 0 Orange Walk 3 0 3 0 0 0
Belize 35 8 43 2 0 2 Cayo 6 7 13 1 0 1 Stann Creek 9 7 16 0 0 0 Toledo 2 4 6 1 1 2 Total 57 26 83 4 1 5
Source: The Epidemiology Unit, MOH
Chart 3: TB/HIV Co-infection Cases by Sex Belize: January to December, 2008
Chart 4: TB/HIV Co-infection Cases by Sex Belize: January to December, 2009
88%
12%
MF
94%
6%
M
F
Table No. 3 TB/HIV Co-Infection Cases by District & Sex
January - December 2008 & 2009
Table No. 4 TB/HIV Co-infection Cases by Age-Group & Sex
January - December 2008 & 2009
District 2008 2009
Male Female Total Male Female Total Corozal 1 0 1 1 0 1 Orange Walk 1 0 1 0 0 0 Belize 10 1 11 12 2 14 Cayo 1 0 1 0 0 0 Stann Creek 4 0 4 1 0 1 Toledo 0 0 0 1 0 1 Total 17 1 18 15 2 17 Source: The Epidemiology Unit, MOH
Age Group 2008 2009
M F T M F T <1 0 0 0 0 0 0 1 - 4 0 0 0 0 1 1 5 - 9 0 0 0 0 1 1 10 - 14 0 0 0 1 0 1 15 - 19 2 0 2 0 0 0 20 - 24 1 0 1 2 0 2 25 - 29 1 0 1 1 0 1 30 - 34 1 0 1 0 0 0 35 - 39 3 0 3 1 0 1 40 - 44 3 1 4 4 0 4 45 - 49 3 0 3 3 0 3 50 - 54 1 0 1 2 0 2 55 - 59 0 0 0 1 0 1 60 - 64 1 0 1 0 0 0 65+ 1 0 1 0 0 0 Total 17 1 18 15 2 17 Source: The Epidemiology Unit, MOH
Table No. 5 Total Reported Tuberculosis Cases by District & Sex
January - December 2008 & 2009
Table No. 6 Total Tuberculosis Reported Cases by Age & Sex
January - December 2008 & 2009
District 2008 2009
Male Female Total Male Female Total Corozal 2 0 2 3 0 3
Orange Walk 3 0 3 3 2 5 Belize 37 8 45 34 13 47
Cayo 7 7 14 4 4 8 Stann Creek 9 7 16 9 3 12 Toledo 3 5 8 5 9 14 Total 61 27 88 58 31 89 Source: The Epidemiology Unit, MOH
Age Group 2008 2009 M F T M F T
<1 0 0 0 0 0 0 1 - 4 0 0 0 0 1 1 5 - 9 1 0 1 1 1 2 10 - 14 0 0 0 1 1 2 15 - 19 2 1 3 2 1 3 20 - 24 6 4 10 5 1 6 25 - 29 6 0 6 5 2 7 30 - 34 6 0 6 4 7 11 35 - 39 7 3 10 6 1 7 40 - 44 8 3 11 6 5 11 45 - 49 4 2 6 8 2 10 50 - 54 5 2 7 4 2 6 55 - 59 3 2 5 4 2 6 60 - 64 4 2 6 3 0 3 65+ 8 8 16 9 5 14 Dk/Ns 1 0 1 0 0 0 Total 61 27 88 58 31 89
Source: The Epidemiology Unit, MOH
Table No. 7 Total Cases of Reported Tuberculosis by Age and District
January - December 2008
Age Group 2008
Corozal Orange Walk Belize Cayo Stann
Creek Toledo Total
<1 0 0 0 0 0 0 0 1 - 4 0 0 0 0 0 0 0 5 - 9 0 0 1 0 0 0 1 10 - 14 0 0 0 0 0 0 0 15 - 19 0 0 3 0 0 0 3 20 - 24 0 0 6 3 0 1 10 25 - 29 0 0 4 1 1 0 6 30 - 34 0 1 4 1 0 0 6 35 - 39 0 0 6 3 1 0 10 40 - 44 1 1 5 0 4 0 11 45 - 49 0 0 3 1 2 0 6 50 - 54 0 0 4 0 3 0 7 55 - 59 0 0 1 1 1 2 5 60 - 64 1 0 3 0 0 2 6 65+ 0 1 4 4 4 3 16 Dk/Ns 0 0 1 0 0 0 1 Total 2 3 45 14 16 8 88
Table No. 8 Total Cases of Tuberculosis by Age and District
January - December 2009
Age Group 2009
Corozal Orange Walk Belize Cayo Stann
Creek Toledo Total
<1 0 0 0 0 0 0 0 1 - 4 0 0 1 0 0 0 1 5 - 9 0 0 1 0 1 0 2 10 - 14 0 0 1 0 1 0 2 15 - 19 0 0 1 1 1 0 3 20 - 24 0 0 4 0 1 1 6 25 - 29 0 0 5 0 1 1 7 30 - 34 0 0 9 2 0 0 11 35 - 39 1 1 1 1 1 2 7 40 - 44 1 2 3 1 1 3 11 45 - 49 1 0 6 1 1 1 10 50 - 54 0 2 3 0 0 1 6 55 - 59 0 0 4 1 0 1 6 60 - 64 0 0 2 0 0 1 3 65+ 0 0 6 1 4 3 14 Dk/Ns 0 0 0 0 0 0 0 Total 3 5 47 8 12 14 89
The Epidemiology Unit extends an invitation to the public and to all those
working together in health, to provide any feedback or future recommendations
for the improvement of our quarterly Tuberculosis Report. All
recommendations or feedback can be sent to the following email addresses
below.
1. [email protected] - National Coordinator, TB - MOH
2. [email protected] - Director HIV/AIDS program , MOH
3. [email protected] - National Epidemiologist, MOH
4. [email protected] - Surveillance Officer, MOH
