Tuberc Respir Dis.  2019 Jul;82(3):194-200. 10.4046/trd.2018.0063.

A Pilot Project of Systematic Tuberculosis Screening in the Elderly in a South Korean Province

• Kim H
• Kim HJ
• Oh KH
• Oh HW
• Choi H

• KMID: 2450896
• DOI: http://doi.org/10.4046/trd.2018.0063

Abstract

BACKGROUND
Tuberculosis (TB) is a major infectious disease in South Korea causing substantial disease burden, particularly in the elderly. This study aimed to identify the case detection rate of mobile TB screening for the elderly conducted in the Jeollanam-do region and to analyze risk factors of active TB.
METHODS
We screened the elderly population (≥65 years old) in Jeollanam-do from August to December 2017. Chest radiography was performed for all participants. Participants with TB presumptive signs were asked to submit sputum specimen(s). Sputum smear, culture, and polymerase chain reaction analyses were performed. Cascade analysis, chi-squared tests, and Fisher exact tests were used to evaluate screening performance.
RESULTS
In total, 12,402 participants were screened, and 211 (1.7%) were suspected to have active TB; 181 of the suspected patients (85.8%) underwent sputum smear test, and 16 (8.8%) patients were confirmed to have TB. The TB prevalence among the elderly was bacteriologically confirmed to be 129 per 100,000 individuals, which was similar to national TB notification data for the same age groups. The proportion of active TB cases increased with age, and differed based on sex and past TB history. However, TB-related symptoms, comorbidity status, and TB screening history within 12 months were not predictive of active TB.
CONCLUSION
This study identified that the prevalence rate was similar to national TB notification data from the same age groups. Periodic, community-based, systematic TB screening among the elderly population is recommended.

Keyword

Tuberculosis; Thorax; Radiography; Pilot Projects; Mass Screening; Asian Continental Ancestry Group; Aged

MeSH Terms

Aged*
Asian Continental Ancestry Group
Communicable Diseases
Comorbidity
Humans
Jeollanam-do
Korea
Mass Screening*
Pilot Projects*
Polymerase Chain Reaction
Prevalence
Radiography
Risk Factors
Sputum
Thorax
Tuberculosis*

Figure

• 

  Figure 1 Cascade analysis of tuberculosis (TB) screening project involving the elderly who live in the Jeollanam-do region. PCR: polymerase chain reaction.

Reference

1. World Health Organization. Global tuberculosis report 2017 [Internet]. Geneva: World Health Organization;2017. cited 2018 Jul 30. Available from: http://www.who.int/tb/publications/global_report/en/.

2. Rajagopalan S. Tuberculosis and aging: a global health problem. Clin Infect Dis. 2001; 33:1034–1039.

3. Korea Centers for Disease Control and Prevention. Infectious diseases surveillance yearbook, 2016 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2017. cited 2018 Jul 30. Available from: https://www.cdc.go.kr/CDC/info/CdcKrInfo0302.jsp?menuIds=HOME001-MNU1132-MNU1138-MNU0038.

4. Korea Centers for Disease Control and Prevention. Annual report on the notified tuberculosis in Korea, 2016 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2018. cited 2018 Jul 30. Available from: https://www.cdc.go.kr/CDC/info/CdcKrInfo0302.jsp?menuIds=HOME001-MNU1132-MNU1138-MNU0038.

5. Ananthakrishnan R, Kumar K, Ganesh M, Kumar AM, Krishnan N, Swaminathan S, et al. The profile and treatment outcomes of the older (aged 60 years and above) tuberculosis patients in Tamilnadu, South India. PLoS One. 2013; 8:e67288.

6. Bennett DE, Courval JM, Onorato I, Agerton T, Gibson JD, Lambert L, et al. Prevalence of tuberculosis infection in the United States population: the national health and nutrition examination survey, 1999-2000. Am J Respir Crit Care Med. 2008; 177:348–355.

7. Ohmori M, Ishikawa N, Yoshiyama T, Uchimura K, Aoki M, Mori T. Current epidemiological trend of tuberculosis in Japan. Int J Tuberc Lung Dis. 2002; 6:415–423.

8. Tocque K, Bellis MA, Tam CM, Chan SL, Syed Q, Remmington T, et al. Long-term trends in tuberculosis: comparison of age-cohort data between Hong Kong and England and Wales. Am J Respir Crit Care Med. 1998; 158:484–488.

9. Wang L, Zhang H, Ruan Y, Chin DP, Xia Y, Cheng S, et al. Tuberculosis prevalence in China, 1990-2010; a longitudinal analysis of national survey data. Lancet. 2014; 383:2057–2064.

10. Park YK, Park YS, Na KI, Cho EH, Shin SS, Kim HJ. Increased tuberculosis burden due to demographic transition in Korea from 2001 to 2010. Tuberc Respir Dis. 2013; 74:104–110.

11. Kim JH, Yim JJ. Achievements in and challenges of tuberculosis control in South Korea. Emerg Infect Dis. 2015; 21:1913–1920.

12. Kim CH, Choi MH, No MS, Gwak MJ, Han JH, Ha ID, et al. Epidemiologic characteristics of incidence, death and spread of TB in South Korea [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2016. cited 2018 Oct 1. http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=2&research_id=1351000-201500304&leftMenuLevel=160&cond_research_name=%EA%B2%B0%ED%95%B5&cond_research_start_date=&cond_research_end_date=&pageUnit=10&cond_order=3.

13. World Health Organization. Systematic screening for active tuberculosis: an operational guide [Internet]. Geneva: World Health Organization;2015. cited 2018 Jul 30. Available from: http://www.who.int/tb/publications/systematic_screening/en/.

14. Choi HJ, Kim HJ, Oh KH, Chung HJ, Kim HY, Kim MH, et al. Development of a pilot model for tuberculosis management and care for socioeconomically vulnerable regions and groups [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2017. cited 2018 Oct 1. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?research_id=1351000-201600218.

15. Korean National Tuberculosis Association. Korean National Tuberculosis Association annual report 2016. Seoul: Korean National Tuberculosis Association;2017.

16. Dodd PJ, White RG, Corbett EL. Periodic active case finding for TB: when to look? PLoS One. 2011; 6:e29130.

17. Lorent N, Choun K, Thai S, Kim T, Huy S, Pe R, et al. Community-based active tuberculosis case finding in poor urban settlements of Phnom Penh, Cambodia: a feasible and effective strategy. PLoS One. 2014; 9:e92754.

18. Pronyk PM, Joshi B, Hargreaves JR, Madonsela T, Collinson MA, Mokoena O, et al. Active case finding: understanding the burden of tuberculosis in rural South Africa. Int J Tuberc Lung Dis. 2001; 5:611–618.

19. Prasad BM, Satyanarayana S, Chadha SS, Das A, Thapa B, Mohanty S, et al. Experience of active tuberculosis case finding in nearly 5 million households in India. Public Health Action. 2016; 6:15–18.

20. World Health Organization. The Stop TB strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals. WHO/HTM/TB [Internet]. Geneva: World Health Organization;2016. cited 2018 Jul 30. Available from: http://apps.who.int/iris/handle/10665/69241.

21. World Health Organization. Implementing the end TB strategy: the essentials. WHO/HTM/TB [Internet]. Geneva: World Health Organization;2015. cited 2018 Jul 30. Available from: http://www.who.int/tb/publications/2015/The_Essentials_to_End_TB/en/.

22. Kranzer K, Afnan-Holmes H, Tomlin K, Golub JE, Shapiro AE, Schaap A, et al. The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis. 2013; 17:432–446.

23. Lin YS, Yen YF. Determinants of mortality before start of and during tuberculosis treatment among elderly patients: a population-based retrospective cohort study. Age Ageing. 2015; 44:490–496.