Taiwan Tuberculosis Control - CDC
Taiwan Tuberculosis Control Report 2009 Edited by Centers for Disease Control, Department of Health, R.O.C. (Taiwan) Chief Editor: Steve HsuͲSung Kuo Associate Editors WenͲYi Shi, Ting Lin, JihͲHaw Chou, YingͲHwei Chen, JenͲHsiang Chuang ChinͲHui Yang, KweiͲFeng Wang, PeiͲChun Chan Executive Editors ShiangͲLin Yang, HsiuͲYun Lo, ChengͲYi Lee Published by Centers for Disease Control, Department of Health, R.O.C. (Taiwan)
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Foreword Contens Editorial NotesChapter 1Chapter 2Chapter 3
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ForewordForeword Tuberculosis (TB) is one of the most important infectious diseases in the world. It was estimated by the World Health Organization (WHO) in 2007 that there were more than 9 million new cases of TB globally, and more than half of these new cases occurred where we live, Asia (55%). With regard to the number of deaths, approximately 1.76 million people worldwide died of TB in 2007. In recent years, with the global menace created by increasing cases of HIV and MDRͲTB, the prevention of TB has faced severe challenges. Taiwan has been engaged in TB prevention for more than fifty years. Although for nearly a decade, both the incidence and death rates of TB in Taiwan have gradually declined, it is still an infectious disease with the largest number of annual confirmed cases and deaths among all notifiable infectious diseases. According to the statistics of 2007, there were 14,480 new TB cases (63.2 people per 100,000 population), and 783 TB deaths (3.4 people per 100,000 population). Both the incidence and death rates decreased by 6%, as compared with that in 2006. In 2008, there were 14,265 (62.0 people per 100,000 population) new TB cases and 762 TB deaths (3.3 people per 100,000 population). Overall, both incidence and death rates decreased, as compared with that in 2007. However, when compared with the U.S., Japan, and Singapore, the decline in the number of new TB cases in Taiwan is not as significant. As for the detection rate (77%) and treatment success rate (67%) of new TB smearͲpositive cases, even though the detection rate has met the WHO standards (70%), the treatment success rate remains well below the WHO standard (85%), which indicates that the tracking and management of TB cases needs to be further strengthened. With the global increase in HIV and MDRͲTB cases, as in other countries, Taiwan will face challenges in TB prevention. Although the government is devoted to the promotion of strategies, such as DOTS and DOTSͲPlus, TB prevention work still requires the cooperation and implementation of all health units to achieve the goal of halving the I
2 0 0 9 Taiwan Tuberculosis Control Reportcurrent TB incidences within a decade. This annual report records all statistics relevant to the epidemiology of TB in Taiwan and some of the mortality rates of TB incidences of 2008. In order to ensure the contents of this report are comprehensive, we welcome any comments and suggestions from the public. Steve HsuͲSung Kuo DirectorͲGeneral Centers for Disease Control II
--------------------------------ⅡEditorial -------12.DefiniƟons of Tuberculosis Cases and Treatment Outcomes------93.EsƟmated Incidence and Prevalence of TB----------------------------134.TB Epidemiology and -155.Case ------------------------316.Sites of extra-pulmonary 17.Treatment Outcomes of New TB t Outcomes of New Smear-posiƟve TB Cases----------1179.EsƟmated TB -----------14710.Country ------------------151III
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Editorial NotesEditorial Notes1. This annual report covers geographic regions of Taiwan, Penghu, Kinmen, and Matzu. In order to coordinate WHO’s “Stop TB Strategy” and meet the international standard indicator, this annual report includes data information of other countries that are summarized from the 2009 WHO Tuberculosis Annual Report. 2. The statistical data on tuberculosis in Taiwan was derived from the “National Surveillance Network of Communicable Disease” for analysis. 3. All suspect tuberculosis cases are required to report to CDC in Taiwan according to the Law, and for comparison with other countries, the definition of tuberculosis cases in this annual report is consistent with the WHO definition; namely, it is the number of confirmed tuberculosis cases. 4. The incidence and prevalence rates of tuberculosis listed in the WHO annual report for every country are “burden estimates”. The eighth and ninth chapters of this annual report are based on the formulas recommended by the WHO to estimate the incidence and prevalence rates of tuberculosis in Taiwan. 5. Information concerning case notification, burden estimation, and statistical information of tuberculosis collected in this annual report are confirmed cases in 2007, in comparison with cases in the WHO annual report. Analysis of treatment outcome focuses on the cohort of 2006. 6. The information regarding country profiles on tuberculosis includes DOTS covering cases in the area for statistical analysis. The DOTS of WHO standard procedure have been adopted in Taiwan since April 1, 2006. Information in this annual report concerning 2006 statistical cohort is based on cases covered by DOTS. V
2 0 0 9 Taiwan Tuberculosis Control Report7. The population for denominator of the incidence rate is based on the midͲyear population reported in the “Demographic Statistical Annual Report of the Republic of China”, which was published by Ministry of Interior in June 2007. 8. The symbol “ͲͲ” listed in tables of this annual report indicates that there is no number reported. 9. The Date of publication of this annual report is scheduled four months after the WHO tuberculosis annual report was made public. VI
SummaryDefinitions of Tuberculosis Cases and TreatmentOutcomesEstimated Incidence and Prevalence of TBChapter 1Chapter 2Chapter 3
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SummarySummary1. Incidence surveillanceȐ1ȑʳThe TB case incidence in Taiwan in 2005-2008 was 16,472 (72.5per 100,000 population), 15,378 (67.4 per 100,000 population),14,480 (63.2 per 100,000 population), and 14,265 (62.0 per100,000 population), respectively. As a whole, the TB incidencedecreased. The incidence rates of 2005-2008 and 2007-2008decreased by 14.5% and 1.9%, respectively. In terms of region,northern region, Kao-ping region, and eastern region showed adecrease in the incidence rates for two consecutive years. In termsof county/city, Keelung City, Lianchiang County, Hsinchu City,Hsinchu County, Nantou County, Chiayi County, Kaohsiung City,Kaohsiung County, and Hualien County, showed a decrease in theincidence rates for two consecutive years.Ȑ2ȑʳThe case notification in Taiwan in 2007 was 15,126 ( 14,480 newcases and 646 relapse ). Among the new cases, the percentageof new smear-positive pulmonary tuberculosis cases was 42%,which was still rather low when comparing to the 57% (2007)among global smear-positive pulmonary tuberculosis cases. Thepercentage of culture-positive cases in Taiwan were higher thenthe global average rate reported in the 2009 WHO TuberculosisAnnual Report but still lower then other developed countriesincluding United States.Ȑ3ȑʳW ith regard to the incidence rate of all forms of TB in 2007,eastern region ranked the first (105 per 100,000 population),followed by Kao-ping region (81 per 100,000 population), andsouthern region (65 per 100,000 population). In terms ofcounty/city, the three jurisdictions of the highest incidence rateswere Hualien County (114 per 100,000 population), PingtungCounty (95 per 100,000 population), and Taitung County (92 per3
2 0 0 9 Taiwan Tuberculosis Control Report100,000 population). In terms of age, the incidence rate was thehighest in the group over the age of 65 (52%), and the rateincreased with age.Ȑ4ȑʳW ith regard to the incidence rate of smear-positive TB in 2007,eastern region ranked the first (53 per 100,000 population),followed by Kao-ping region (32 per 100,000 population). In termsof county/city, those with the highest notification rate ofsmear-positive TB were as follows: Hualien County (57 per 100,000population), Taitung County (47 per 100,000 population), andPingtung County (47 per 100,000 population). In terms of age, thenotification rate was the highest in the group over the age of 65(50%), and the rate increased with age.Ȑ5ȑʳAs to gender, the incidence rates of males, in all forms of TB andsmear-positive TB, were 2-3 times higher than those of females in2007. Regardless of gender, incidence rate also increased with age.Ȑ6ȑʳTaiwan CDC has six regional branch offices (Taipei region, northernregion, central region, southern region, Kao-ping region, andeastern return). Most cases were reported in Taipei region (4,232),followed by Kao-ping region (3,020), and eastern region is the last(608). In terms of county/city, most cases mainly were reported inTaipei County (2,283), followed by Taipei City (1,280), KaohsiungCity (1,079), Kaohsiung County (1,066), Taoyuan County (1,054),and Pingtung County (1,054). Among those were jurisdictionswhich reported exceeded 1,000 new cases in 2007.Ȑ7ȑʳBy adopting the WHO formula to estimate the TB burden based onthe surveillance data information in Taiwan, the estimatedincidence rate of TB in 2007 was 85 per 100,000 population, andthe estimated incidence rate of smear-positive cases was 32 per100,000 population. According to the estimated incidence rate,the TB burden of each county/city was lower, as compared with4the numbers in 2006. The top three counties/cities with the higher
Summaryburden of estimated incidence rate were Hualien County,Kaohsiung County, and Pingtung County.2. Prevalence surveillanceȐ1ȑʳThe estimated prevalence rate of TB in Taiwan in 2007 was 111 per100,000 population and the region with the largest number ofcases was Taipei. The estimated prevalence rate was lower thanthat of Malaysia (121 per 100,000 population) and Rep. of Korea(126 per 100,000 population); however, it was still higher thanthat of developed countries, such as the US (3 per 100,000population), Singapore (27 per 100,000 population), and Japan (28per 100,000 population).Ȑ2ȑʳThe prevalence rate of HIV among new TB cases in Taiwan wasЉ1% (0.6%), which was lower than that of European andAmerican countries in 2007. As to county/city, the prevalence rateof HIV in new TB cases in Taichung City was higher than that ofother counties and cities.3. Mortality surveillanceȐ1ȑʳThe number of TB cause of death in 2005 - 2008 was 970 ( 4.3per 100,000 population), 832 (3.6 per 100,000 population), 783(3.4 per 100,000 population), and 762 (3.3 per 100,000population), respectively. As a whole, the mortality of TBdecreased from 2005 to 2008. The moralities from 2005 to 2008decreased by 23.3% and 2.9%, respectively. In terms of region, themortality of TB in central region and region decreased for twoconsecutive years. As regard of county/city, the mortality in MiaoliCounty, Changhua County, Pingtung County, Kaohsiung City,Taitung County and Hualien County decreased for two consecutive5
2 0 0 9 Taiwan Tuberculosis Control Reportyears.（2） The crude death rate of TB in Taiwan in 2007 was 3.3 per 100,000populaƟon. Among all TB deaths, 618 cases were males, while 165cases were females; the male to female raƟo was 3.7: 1.0, whichindicated that the death rate of males was 5.3 per 100,000populaƟon and that of females was 1.5 per 100,000 populaƟon.（3） As to age, the death rate increased with the age. Among 783 TBdeaths in 2007, 81% of them were in the group of the age over 65.（4） With regard to county/city, the death rates in eastern region andKao-ping region were higher in 2007. The three counƟes/ciƟeswith the highest death rate were Taitung City (8.1 per 100,000populaƟon), Hualien County (7.8 per 100,000 populaƟon), andPingtung County (8.2 per 100,000 populaƟon).4. Case detecƟon surveillance（1） The detecƟon rate of all forms of TB cases in Taiwan in 2007 was74% and the detecƟon rate of sputum smear-posiƟve TB cases was77%, which both achieved the objecƟve value (70%) set by theWHO.5. Treatment outcomes surveillance（1） The treatment success rate of all forms of new TB cases in a12-month cohort study in 2006 was 70.4%, and the death rate was18.6%. Among all regions, central region had the highest treatmentsuccess rate (72.8%), while eastern area had the lowest (63.0%).（2） For the smear-posiƟve TB cases in 2006 and the treatmentoutcome of 12-month cohort study, the 2009 WHO TuberculosisAnnual Report indicates that the globally success rate was 84.3%6
Summary(for 2006 cohort), which reached the Millennium DevelopmentGoal (MDG) (85%) set by the WHO. In Taiwan, the treatmentsuccess rate of smear-posiƟve cases in a 12-month cohort studywas 67%. Although it was higher than that in Japan (53%) and theUS (64%), sƟll was lower than that in Singapore (84%), and had notreached the goal set by the WHO.（3） The death rate of smear-posiƟve TB cases in a 12-month cohortstudy in Taiwan in 2006 was 22.3%, which was higher than that ofEuropean countries, the U.S., and Singapore. However, it wasapproximate to that of Japan (21%). Comparing with Singapore(death rate: 14%), which shares the similar demographic structurewith Taiwan; the death rate was sƟll rather high.7
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Definitions of Tuberculosis Cases and Treatment OutcomesDefinitions of tuberculosis cases and treatmentoutcomesITEMDEFINITIONSCASE OF TUBERCULOSISA patient in whom tuberculosis has beenconfirmed by bacteriology or diagnosed by aclinician.A patient with positive culture for theMycobacterium tuberculosis complex. Incountries where culture is not routinelyavailable, a patient with one sputum smearpositive for acid-fast bacilli (AFB ) is alsoconsidered a definite case.A patient with tuberculosis disease involvingthe lung parenchyma.A patient with one or more initial sputumsmear examinations (direct smear microscopy)AFB .A patient with pulmonary tuberculosis notmeeting the above criteria for smear-positivedisease. Diagnostic criteria should include: atleast two sputum smear examinationsnegative for AFB; and radiographicabnormalities consistent with activepulmonary tuberculosis; and no response to acourse of broadspectrum antibiotics (except ina patient for whom there is laboratoryconfirmation or strong clinical evidence of HIVinfection); and a decision by a clinician to treatwith a full course of antituberculosischemotherapy; or positive culture but negativeAFB sputum examinations.A patient with tuberculosis of organs otherthan the lungs (e.g. pleura, lymph nodes,abdomen, genitourinary tract, skin, joints andbones, meninges). Diagnosis should be basedon one culture-positive specimen, orhistological or strong clinical evidenceconsistent with active extrapulmonary disease,DEFINITE CASEPULMONARY CASESMEAR-POSITIVEPULMONARY CASESMEAR-NEGATIVEPULMONARY CASEEXTRAPULMONARY CASE9
2 0 0 9 Taiwan Tuberculosis Control ReportITEMNEW CASERE-TREATMENT CASECUREDCOMPLETED TREATMENTDIEDFAILEDDEFAULTEDTRANSFERRED OUTSUCCESSFULLY TREATED10DEFINITIONSfollowed by a decision by a clinician to treatwith a full course of antituberculosischemotherapy. A patient in whom bothpulmonary and extrapulmonary tuberculosishas been diagnosed should be classified as apulmonary case.A patient who has never had treatment fortuberculosis or who has taken antituberculosisdrugs for less than one month.A patient previously treated for TB, who isstarted on a re-treatment regimen a erprevious treatment has failed (treatment a erfailure), who returns to treatment havingpreviously defaulted (see below; treatmenta er default), or who was previously declaredcured or treatment completed and isdiagnosed with bacteriologically positive(sputum smear or culture) TB (relapse).A patient who was initially smear-positive andwho was smear-negative in the last month oftreatment and on at least one previousoccasion.A patient who completed treatment but didnot meet the criteria for cure or failure. Thisdefinition applies to pulmonary smear-positiveand smear-negative patients and to patientswith extrapulmonary disease.A patient who died from any cause duringtreatment.A patient who was initially smear-positive andwho remained smear-positive at month 5 orlater during treatment.A patient whose treatment was interrupted for2 consecutive months or more.A patient who transferred to another reportingunit and for whom the treatment outcome isnot known.A patient who was cured or who completed
Definitions of Tuberculosis Cases and Treatment OutcomesITEMDEFINITIONSTreatment.NOT EVALUATEDPatient still on treatment at 12 months and didnot meet any other outcome during treatment.Reference：Global Tuberculosis Control, WHO Report 2009.11
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Estimated Incidence and Prevalence of TBEstimation of the Incidence and Prevalence Rate of Tuberculosis1.The WHO Tuberculosis Annual Report suggests the calculation ofthe incidence rate by the following method(s), based on the datainformation obtained for the individual country:(1) incidenceɨcases notifications/proportion of cases detected(2) incidenceɨprevalence/duration of condition(3) incidenceɨannual risk of infection Sty'blo coefficient(4) incidenceɨdeaths/proportion of incident cases that die2.This annual report adopts the fourth formula concerning theestimation of incidence rate for the burden of tuberculosis inTaiwan, which uses the tuberculosis death rate reported by theDepartment of Health in 2007 (death rate number of death due totuberculosis in the same year /mid-year population) divided byfatality rate (fatality rate number of death among new confirmedcases of tuberculosis in 2007/new confirmed cases in 2007).3.In regard to the estimation of prevalence rate for the burden oftuberculosis in Taiwan, this annual report adopts the formula tomultiply the estimated incidence rate by the duration of condition.4. Each country adopts a different coefficient to calculate the durationof condition (ranging from 0.5 to 3.5). After literature review andreferring to data from other countries, this annual report adopts theformula to multiply the estimated incidence rate by 1.3 year, inorder to estimate the prevalence rate of tuberculosis in Taiwan.Reference:1. http://www.who.int/tb/en/2. Dye C et al. Global burden of tuberculosis: estimated incidence,prevalence and mortality by country. Journal of the American MedicalAssociation, 1999, 282:677-686.13
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TB Epidemiology and SurveillanceChapter 4
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TB Epidemiology and SurveillanceIncidence and percent change of new TB cases, 2005-20082005 (baseline)20072008Percent change Percent changeof cases,of aipei Area4,46461.44,23257.63,98053.9-10.8-12.2Taipei City1,38652.91,28048.71,17844.9-15.0-15.2Taipei County2,37163.72,28360.42,14756.3-9.4-11.7Yilan County36178.135176.236078.2-0.30.0Kinmen County1014.82632.92530.1150.0102.7Keelung -50.0-50.0Northern Area1,88357.31,69850.41,60647.1-14.7-17.7Miaoli 454.81,02252.5-7.9-11.7Hsinchu City18948.618145.613433.3-29.1-31.5Hsinchu County25253.323848.419639.2-22.2-26.4Central Area3,07669.72,70860.92,77462.2-9.8-10.8Taichung City57956.454551.959155.72.1-1.2Taichung County95362.381352.583653.8-12.3-13.6Nantou County52697.842178.838371.9-27.2-26.5Changhua County1,01877.392970.796473.4-5.3-5.1Southern Area2,67178.02,21464.72,32568.0-13.0-12.8Tainan City45359.938150.047161.44.02.5Tainan County87378.975067.876769.4-12.1-12.1Yunlin County72999.254675.158180.2-20.3-19.2Chiayi City14453.117062.314553.00.7-0.2Chiayi County47284.736766.436165.6-23.5-22.5Kao-Ping Area3,62296.73,02080.62,98779.7-17.5-17.6Pingtung County1,061118.084795.088499.6-16.7-15.6Kaohsiung City1,23881.91,07971.11,00966.2-18.5-19.1Kaohsiung County1,300104.81,06685.61,06185.3-18.4-18.6Penghu County2325.02830.43335.543.542.4Eastern Area756128.6608105.0593103.1-21.6-19.8Taitung County276115.221591.6233100.1-15.6-13.1Hualien County480137.8393114.1360105.2-25.0-23.7Lienchiang CountyTaoyuan CountyRate indicates per 100 000 population17
2 0 0 9 Taiwan Tuberculosis Control ReportIncidence by sex and percent change of new cases, 2007-200820072008AllMaleFemaleAllMaleFemaleNumber RateNumber RateNumber RateNumber RateNumber RateNumber 83584.74,43038.9Taipei ,30835.1Taipei Taipei 9336.3Yilan inmen County2632.91638.11027.02530.11943.2615.4Keelung 117.3249.0220.3234.900.0Northern 27.3Miaoli 454.873775.531733.51,02252.572073.030231.4Hsinchu City18145.612361.85829.313433.38542.34924.4Hsinchu ral 39.3Taichung hung ntou hanghua inan an nlin Chiayi City17062.311182.25942.914553.09368.85237.6Chiayi Ping 3450.7Pingtung Kaohsiung Kaohsiung County nghu County2830.42552.536.73335.52552.2817.8Eastern Taitung ualien .0Lienchiang CountyTaoyuan CountySouthern AreaRate indicates per 100 000 population18
TB Epidemiology and SurveillanceIncidence by age, 2007-2008Number of new cases, 2007Number of new cases, 2008Total 0-14 15-24 25-34 35-44 45-54 55-64 65Total 0-14 15-24 25-34 35-44 45-54 55-64 65Taiwan14,480 115 776 1,018 1,310 1,873 1,911 7,47714,265 112 753 1,043 1,279 1,782 1,845 7,451Taipei Area4,23226281364432592572 1,9653,98034277383358528544 1,856Taipei aipei 298927Yilan County35142124314939183360141716283748200Kinmen County26123420142501314214Keelung 0000Northern 787Miaoli 1371261085201,0229798912013398494Hsinchu City18131017162517931341191214171160Hsinchu County23821033273119116196032033292190Central Area2,70811138174195289323 1,5782,77418111161212316364 1,592Taichung City5453376547656226659133151648484274Taichung County8133604659100994468366456160104117443Nantou County4210112240404726138311018393853224Changhua 08118147257281 1,2872,3251792123156247286 1,404Tainan City3810221933605918847122332427262238Tainan County750114354478694415767103050448294457Yunlin County5463151122616836658111919335165393Chiayi City170061415251892145341114132377Chiayi County3672222030254222636111611232942239Kao-Ping Area3,02029109157254411477 1,5832,98717121200274374413 1,588Pingtung iung hsiung County 1,06673950941361495911,06194759103131148564Penghu County28123340153300265911Eastern Area60816415382113812225931339448310684224Taitung County21521825323225812333912164439110Hualien ng CountyTaoyuan CountySouthern AreaRate indicates per 100 000 population19
2 0 0 9 Taiwan Tuberculosis Control ReportIncidence by age, male, 2007-2008Number of new cases, male, 2007Number of new cases, male, 2008Total 0-14 15-24 25-34 35-44 45-54 55-64 65Total 0-14 15-24 25-34 35-44 45-54 55-64 65Taiwan9,98052409530833 1,299 1,431 5,4269,83561418560849Taipei 3801,388Taipei City83833455579310848875223859557090438Taipei 8Yilan County2412118223233133265797182540159Kinmen County1602222081900203113Keelung 00Northern aoli County169271015222588202188222722114Taoyuan County7371354895817939872053954788580379Hsinchu City123248111897185111695746Hsinchu County176241915241210014302923241471Central 097Taichung City3791254227475018740531934366358192Taichung County5561282140728131356932736418283297Nantou County30307162632351872720613272739160Changhua 991812209441,637135769981772151,008Tainan City2770141221414514433121319264646179Tainan County5304252630567631354991832315770332Yunlin County3831791745602443840147204248253Chiayi City111037918126293214781952Chiayi County27411392221271812800117142432192Kao-Ping 093Pingtung County59041217417011932760211725567980344Kaohsiung City6935223055108128345685234365989117348Kaohsiung County75952328591021094337416303173105104392Penghu County2512224014250013399Eastern Area4369223663786416441391929637761155Taitung County154110192724185516536613323075Hualien County282812173654461092486132350453180Lienchiang CountySouthern AreaRate indicates per 100 000 population201,249 1,347 5,351
TB Epidemiology and SurveillanceIncidence by age, female, 2007-2008Number of new cases, female, 2007Number of new cases, female, 2008Total 0-14 15-24 25-34 35-44 45-54 55-64 65Total 0-14 15-24 25-34 35-44 45-54 55-64 65Taiwan4,500 63367488477574480 2,0514,43051335483430533498 2,100Taipei Area1,391 i City4421385648675218042654045366669165Taipei County73998211110998872436938871197210375229Yilan County11021016917650957891012841Kinmen County10101200660111111Keelung City881710910133888010191241132Lienchiang County2100000100000000Northern Area49310496764665218545665355647031177Miaoli County56173578255224375229Taoyuan County3178304142452912230244035424818115Hsinchu City581695782249086512414Hsinchu County620614127716530111105719Central Area85276675727871483864941597480106495Taichung City16621223201812791860121728212682Taichung County2572322519281813326731825192234146Nantou County118046148127411114512111464Changhua County 311318211924291973005712152632203Southern Area63910465548766134368843554587071396Tainan City104087121914441400101316261659Tainan County2207182817301810221811218132524125Yunlin County1632825168122197151213917140Chiayi City59037676305213775425Chiayi County93191184154581154951047Kao-Ping g County2577132018313113728241527212825162Kaohsiung City386521374362501683241851294234159Kaohsiung County 3072162235344015832031728302644172Penghu County3001100180013202Eastern Area17271917193517581804201520292369Taitung County611865872668036312935Hualien County1116111114271032112417917171434Rate indicates per 100 000 population21
2 0 0 9 Taiwan Tuberculosis Control ReportIncidence of new smear-positive TB by age, 2007-2008Number of new smear-positive cases, 2007Number of new smear-positive cases, 2008Total 0-14 15-24 25-34 35-44 45-54 55-64 65Total 0-14 15-24 25-34 35-44 45-54 55-64 18037622,815Taipei Taipei City4771233533626126244511733334959253Taipei County93736374991711423858315557076148126351Yilan thern Area67313854861017531859134160848858257Miaoli County9403551814498205514121036Taoyuan County4301233357614720839533241515539174Hsinchu City670751087304504455522Hsinchu County82051114147316900101416425Central ng City19211319182021100186091316353182Taichung County2410141326393211725121219264032120Nantou County17204131719209914406520132278Changhua County41009162038442834132109194947277Southern Area87923339741281154889235264059117134542Tainan City14509517302262179051116303483Tainan Coun
Taiwan according to the Law, and for comparison with other countries, the definition of tuberculosis cases in this annual report is consistent with the WHO definition; namely, it is the number of confirmed tuberculosis cases. 4. The incidence and prevalence rates of tuberculosis listed in the WHO
genitourinary tuberculosis - laryngeal tuberculosis - lymph node tuberculosis - miliary tuberculosis - neurological tuberculosis - pericardial tuberculosis - tuberculosis in otorhinolaryngology - tuberculosis meningitis - tuberculosis pleu
388-78A-2481 Tuberculosis—Testing method—Required. 388-78A-2482 Tuberculosis—No testing. 388-78A-2483 Tuberculosis—One test. 388-78A-2484 Tuberculosis—Two step skin testing. 388-78A-2485 Tuberculosis—Positive test result. 388-78A-2486 Tuberculosis—Negative test result. 388-78A-2487 Tuberculosis—Declining a skin test.
K64931WW ClickSafe Security Anchor Adapter Kit 9.99 Taiwan K64995WW Security Slot Adapter Kit for Ultrabook 12.99 Taiwan K66103WW Portable Lock Box 49.99 Taiwan K67700US Partition Cable Anchor 19.99 Taiwan K67760WW CSA M3x10 Machine Screw Taiwan K67850WW Mounted Lock CSA 1.29 Taiwan K67853WW CSA Through-Hole, Only 0.49 Taiwan
Tibèkiloz (tuberculosis)30 Teve (tuberculosis)30 12, 30Maladi touse (tuberculosis) 30Maladi pwatrin (tuberculosis) Maladi ti kay ("little house illness")3, 31, 32 This nickname refers to the tradition of requiring a TB patient to sleep in quarters separate from their family. 31"Grow thin, spit blood" (tuberculosis)
LIANG Ben Chung-Pin Dermatologist Taipei, Taiwan LIAO Yi-Hua Dermatologist Taipei, Taiwan LIM Ting Song Aesthetic Physician Kuala Lumpur, Malaysia LIN Chrang-Shi Dermatologist Taipei, Taiwan LIN I-Yin Aesthetic Physician Taipei, Taiwan LIN Ian Aesthetic & Anti-Aging Physician Kaohsiung, Taiwan LIN Jeng-Hsien Dermatologist Kaohsiung, Taiwan .
The nurse's annual tuberculosis test was positive, and after a chest X-ray, medical exami-nation, and sputum laboratory results, the nurse was diagnosed with tuberculosis. The health department . required by law to notify state public health authori-ties of a case of tuberculosis disease. However, latent tuberculosis infection is not a .
Tuberculosis Surveillance Data Training—Report of Verified Case of Tuberculosis Instruction Manual, available from the CDC . worldwide. Physicians and other . health care providers are required by law to report TB cases to their state or local health department. Module 2— Epidemiology of Tuberculosis . 2 3. In 1953, when nationwide TB .
“Am I my Brother’s Keeper?” You Bet You Are! James 5:19-20 If every Christian isn’t familiar with 2 Timothy 3:16-17, every Christian should be. There the Apostle Paul made what most believe is the most important statement in the Bible about the Bible. He said: “All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in .
