A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions

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dc.contributor.authorHermans, Sabineen_ZA
dc.contributor.authorJr, C Robert Horsburghen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.date.accessioned2015-11-23T12:31:05Z
dc.date.available2015-11-23T12:31:05Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: Cape Town has one of the highest TB burdens of any city in the world. In 1900 the City of Cape Town, New York City and London had high mortality of tuberculosis (TB). Throughout the 20th century contemporaneous public health measures including screening, diagnosis and treatment were implemented in all three settings. Mandatory notification of TB and vital status enabled comparison of disease burden trajectories. METHODS: TB mortality, notification and case fatality rates were calculated from 1912 to 2012 using annual TB notifications, TB death certifications and population estimates. Notification rates were stratified by age and in Cape Town by HIV status (from 2009 onwards). RESULTS: Pre-chemotherapy, TB mortality and notification rates declined steadily in New York and London but remained high in Cape Town. Following introduction of combination chemotherapy, mean annual case fatality dropped from 45-60% to below 10% in all three settings. Mortality and notification rates subsequently declined, although Cape Town notifications did not decline as far as those in New York or London and returned to pre-chemotherapy levels by 1980. The proportional contribution of childhood TB diminished in New York and London but remained high in Cape Town. The advent of the Cape Town HIV-epidemic in the 1990s was associated with a further two-fold increase in incidence. In 2012, notification rates among HIV-negatives remained at pre-chemotherapy levels. CONCLUSIONS: TB control was achieved in New York and London but failed in Cape Town. The TB disease burden trajectories started diverging before the availability of combination chemotherapy in 1952 and further diverged following the HIV epidemic in 1990. Chemotherapy impacted case fatality but not transmission, evidenced by on-going high childhood TB rates. Currently endemic TB results from high on-going transmission, which has been exacerbated by the HIV epidemic. TB control will require reducing transmission, which is inexorably linked to prevailing socio-economic factors.en_ZA
dc.identifier.apacitationHermans, S., Jr, C. R. H., & Wood, R. (2015). A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions. <i>PLoS One</i>, http://hdl.handle.net/11427/15303en_ZA
dc.identifier.chicagocitationHermans, Sabine, C Robert Horsburgh Jr, and Robin Wood "A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/15303en_ZA
dc.identifier.citationHermans, S., Horsburgh Jr, C. R., & Wood, R. (2015). A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions. PloS one, 10(8), e0135179. doi:10.1371/journal.pone.0135179en_ZA
dc.identifier.ris TY - Journal Article AU - Hermans, Sabine AU - Jr, C Robert Horsburgh AU - Wood, Robin AB - BACKGROUND: Cape Town has one of the highest TB burdens of any city in the world. In 1900 the City of Cape Town, New York City and London had high mortality of tuberculosis (TB). Throughout the 20th century contemporaneous public health measures including screening, diagnosis and treatment were implemented in all three settings. Mandatory notification of TB and vital status enabled comparison of disease burden trajectories. METHODS: TB mortality, notification and case fatality rates were calculated from 1912 to 2012 using annual TB notifications, TB death certifications and population estimates. Notification rates were stratified by age and in Cape Town by HIV status (from 2009 onwards). RESULTS: Pre-chemotherapy, TB mortality and notification rates declined steadily in New York and London but remained high in Cape Town. Following introduction of combination chemotherapy, mean annual case fatality dropped from 45-60% to below 10% in all three settings. Mortality and notification rates subsequently declined, although Cape Town notifications did not decline as far as those in New York or London and returned to pre-chemotherapy levels by 1980. The proportional contribution of childhood TB diminished in New York and London but remained high in Cape Town. The advent of the Cape Town HIV-epidemic in the 1990s was associated with a further two-fold increase in incidence. In 2012, notification rates among HIV-negatives remained at pre-chemotherapy levels. CONCLUSIONS: TB control was achieved in New York and London but failed in Cape Town. The TB disease burden trajectories started diverging before the availability of combination chemotherapy in 1952 and further diverged following the HIV epidemic in 1990. Chemotherapy impacted case fatality but not transmission, evidenced by on-going high childhood TB rates. Currently endemic TB results from high on-going transmission, which has been exacerbated by the HIV epidemic. TB control will require reducing transmission, which is inexorably linked to prevailing socio-economic factors. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0135179 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions TI - A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions UR - http://hdl.handle.net/11427/15303 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15303
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0135179
dc.identifier.vancouvercitationHermans S, Jr CRH, Wood R. A century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions. PLoS One. 2015; http://hdl.handle.net/11427/15303.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Hermans et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherNew Yorken_ZA
dc.subject.otherHistory of tuberculosisen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherPublic and occupational healthen_ZA
dc.subject.otherChemotherapyen_ZA
dc.subject.otherInfectious disease controlen_ZA
dc.titleA century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventionsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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