In November 2012, a pilot mobile TB screening programme was carried out among vulnerable groups by the London Find and Treat programme in collaboration with Safetynet Primary Care Network for Homeless People and Northdoc. No new cases of TB have been notified to the HSE as a result of this pilot screening programme. The WHO describes countries with an incidence of less than 10 cases per 100,000 population as low incidence countries. The annual notification rate of TB has declined in Ireland since 2007 when the rate was 11.3 per 100,000 (480 cases). In 2010 and 2011, the annual TB notification rates were 9.2 per 100,000 (420 cases in 2010 and 424 cases in 2011) which is the lowest rate recorded since surveillance of TB began in the 1950s and now categorises Ireland as a low incidence country. The number of TB notifications for 2012, up to the week ending 9 November, was 339, which represents a decrease of 49 cases compared to the same period in 2011 when there were 388 cases.
However, annual rates of TB remain high in parts of inner city Dublin and North Dublin ranging between 17 per 100,000 to 30 per 100,000 in some areas. However, LHO 7 (comprising mainly Dublin 1 and 7) has shown a decline in rates of TB from 2010 when the rate was 22.9 per 100,000 population (31 cases) to a rate of 14 per 100,000 (19 cases) in 2011. In 2011, a prison outbreak in Dublin increased the TB rate in that local area to 28/100,000. In addition, in Ireland tuberculosis is increased in other marginalised groups such as prisoners and those involved in substance misuse. Data from the World Health Organization indicate that TB notification rates always tend to be higher in inner-city locations than in the general population. This is reflected in all major cities worldwide. In 2010, the most commonly reported risk factors for TB reported in Ireland were being from a country of high TB endemicity (n=92, 43.8%), followed by substance misuse (n=32, 15.2%), contact with a case of TB (n=23, 11.0%) and co-morbidity with an immunosuppressive illness (n=27, 12.9%). Other risk factors reported included treatment with immunosuppressive medication (n=5, 2.4%), co-morbidity with diabetes (n=6, 2.9%) and treatment with antiTNF medications (n=4, 1.9%). Other TB risk factors reported included various co-morbidities (including malignancies, respiratory illness and auto-immune disorders), tobacco use, homelessness, previous history of TB and travel to areas of high endemicity.
In summary, the overall rate of tuberculosis continues to decline in the general population and particularly in the indigenous Irish general population. As in other low prevalence countries in Europe, the disease is more focussed in marginalised groups such as homeless people, prisoners, substance misusers and immigrants from countries of high endemicity. The number of cases of multidrug resistant TB (MDR-TB) notified in Ireland 1998-2010 is outlined in the following table:
|
Year
|
Total number of TB cases notified
|
MDR TB cases
|
|
1998
|
424
|
0
|
|
1999
|
469
|
2
|
|
2000
|
395
|
3
|
|
2001
|
381
|
2
|
|
2002
|
408
|
0
|
|
2003
|
407
|
1
|
|
2004
|
432
|
2
|
|
2005
|
450
|
2
|
|
2006
|
465
|
4
|
|
2007
|
480
|
7
|
|
2008
|
468
|
2
|
|
2009
|
479
|
1
|
|
2010
|
420
|
1
|
|
2011
|
424
|
N/A
|
Data taken from the annual reports of the national disease surveillance unit of the Health Protection Surveillance Centre, which are available at www.hpsc.ie/hpsc/A-Z/VaccinePreventable/TuberculosisTB/Epidemiology/SurveillanceReports.
