Health minister says Tuberculosis can be defeated

Tuberculosis has re-emerged in undeveloped countries and although Malta is a low incidence country, more efforts are needed to eradicate the disease, health minister Godfrey Farrugia said.

Addressing a conference on tuberculosis (TB) at Mater Dei Hospital, the newly appointed health minister Godfrey Farrugia said that more education and training is required, however noted: "If we do work together we can eradicate tuberculosis from Malta within our lifetime."

He explained that Malta is a low TB incidence country with an average notification rate of 7.6 per 100,000 persons in 2012. Over the last ten years the incidence ranged from 1.8 to 12.9 per 100,000.

Farrugia said that the disease among Maltese citizens is very low and the majority of cases in Malta involve foreigners, with over two-thirds of TB cases in 2012 being foreigners.

He added that the national TB national strategy has been successful but needs to be strengthened.

These measures include free vaccination for schoolchildren, free specialized treatment, highly trained medical professionals, screening of foreigners and the screening of persons exposed to the disease.

"We must work hand in hand with NGOs, the Employment and Training Corporation, medical professionals and security forces and other persons who work with migrants," Farrugia said.

In 1993, the World Health Organisation (WHO) had declared TB as a 'global emergency'. Worldwide, TB is the second leading cause of death from communicable disease, being responsible for 1.7 million deaths in 2009.

Overall, one-third of the world's population is currently infected with the TB bacillus. Sub-Saharan Africa has the highest incidence per capita (over 350 cases per 100,000) but the greatest burden of disease occurs in South-East Asia.

Similar to other Western European countries, the TB notification and incidence rates in Malta have decreased steadily among Maltese persons in recent decades. Between 1995 and 2011, the TB rate in the Maltese population has significantly decreased, with the highest incidence occurring among the elderly, mainly due to reactivation of old TB.

The national strategy on TB, issued by the Health Department in 2012, showed that following the recent wave of immigration from the African subcontinent to Malta since 2002, an increasing number and proportion of TB cases were being detected among migrants.

The document noted that in 2011, 73% of total TB cases occurred in migrants and during the 2002 to 2011 period the TB rate in the migrant population significantly increased.

The report pointed out that the overall TB rate from 1995 to 2011 also increased significantly. The health department report said that the rise possibly reflected the rise in the immigrant rate, as the TB rate in the Maltese population decreased and is likely to be due to the recent large influx of immigrants from a high prevalence country.

Similar trends have been observed in many Western European countries which have undergone a large influx of immigration from countries with a high incidence of TB, like The Netherlands and Switzerland.

TB cases in migrants to Malta occurred most commonly in the younger age groups, with an average age of 26.5 years.  This can denote recent infection most likely imported from their country of origin, where TB is endemic. It may also reflect the age distribution of the migrants coming to Malta, 81% of whom were young adults, with ages ranging from 15 to 34 years.

The disease is transmitted by inhalation of infected airborne droplet nuclei produced by people with pulmonary or laryngeal TB during expiratory efforts like coughing and sneezing. Prolonged close contact with an infectious person is usually required for transmission of infection to occur.

TB is a treatable and curable disease. Active, drug-sensitive TB disease is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteers.

Since 1995, over 51 million people have been successfully treated and an estimated 20 million lives saved through use of DOTS and the Stop TB Strategy recommended by WHO and described below.