香港卫生署 2021防痨及胸肺科服务年报

AnnualReport

Tuberculosis&ChestService

2021

DepartmentofHealth

HongKongSpecialAdministrativeRegion

CONTENT

-i-

ChapterPage

I.Preface

1

II.Tuberculosis&ChestService

7

III.TuberculosisinHongKong

9

Appendix1TBNotification&DeathRateofTuberculosis(AllForms)from1947-202110

Appendix2TBNotificationRate(AllForms)from1951-2021

12

Appendix3CrudeDeathRateduetoTuberculosis(AllForms)from1910-2021

13

Appendix4(a)Tuberculosis(AllForms)NotificationandRatebySexandAge202114

Appendix4(b)PulmonaryTuberculosisNotificationbySexandAge2021

15

Appendix4(c)PulmonaryTuberculosisNotificationRatebySexandAge2021

16

Appendix5TuberculosisNotificationRatebySexandAge2011,2020and202117

Appendix6NotificationofTBbyTBTypes,SexandAge2021

18

Appendix7Tuberculosis(AllForms)DeathsandRatebySexandAge2021

19

Appendix8TuberculosisMortalityRatebySexandAge2011,2020and2021

20

Appendix9TuberculosisDeathsbyTBTypes,SexandAge2021

21

Appendix10TuberculosisMortalityfrom1950-2021

22

Appendix11TopTenCausesofDeathinHongKong2021

24

Appendix12(a)SourcesofTuberculosisNotificationfrom2011-2021

25

Appendix12(b)BreakdownofTuberculosisNotificationfromH.A.Hospitals2021

26

Appendix13

TuberculosisNotificationandNotificationRatebyDistrictCouncil

Districts2021

27

Appendix14

EstablishmentandStrengthofTuberculosisandChestService

28

Appendix15

TotalAttendanceatChestClinicsfrom2011-2021

29

Appendix16

NumberofDoctorSessions,CasesSeenbyDoctorandPatient/Doctor

Session2021

30

Appendix17

DiagnosisandCharacteristicsofPatientsAttendingChestClinics2021

31

Appendix18(a)

ClassificationofDiseasesofFirstAttendersin2021accordingtoInternational

32

ClassificationofDiseasesCode

Appendix18(b)CharacteristicsofActiveRespiratoryTuberculosisinFirstAttendersatChest33

Clinicsfrom2019-2021

Appendix19(a1)RateofDrug-resistantTuberculosis:Amongcasesregisteredduringtheperiod34

JanuarytoDecember2021(DatafromPHLC)

-ii-

ChapterPage

Appendix19(a2)RateofDrug-resistantTuberculosis:Amongcaseswithdateofstarting35

treatmentduringtheperiodJanuarytoDecember2021

Appendix19(b1)Trendofanti-TBdrug-resistancefrom2002-202136

Appendix19(b2)TrendofOverallanti-TBdrug-resistancefrom2002-202137

Appendix19(c)MDR-TBandXDR-TBfrom2011-202038

Appendix19(d)RevisedDefinitionofExtensivelyDrug-resistantTuberculosissince202139

Appendix20(a)TreatmentReturn2021–ServiceRegimen

40

Appendix20(b)

TreatmentReturn2021–OtherRegimens

41

Appendix21(a)

SchemeforInvestigationofCloseContacts(Household)inthe

Tuberculosis&ChestService,DepartmentofHealth

45

Appendix21(b)

Figure1:Generalschemafortargetedscreeningofhouseholdcontactsof

smear-positivepulmonaryTBpatients

Figure2:Targetedscreeningofhouseholdcontactsagedbelowoneyear

Figure3:Targetedscreeningofhouseholdcontactsagedbetween1to11

46

47

48

Appendix21(c)

ExaminationofContactsintheChestClinics2021

49

Appendix22(a)SchemeforBCGAdministrationinHongKong2021

50

Appendix22(b)BCGVaccinationsatBirth2021

51

Appendix23TuberculosisandChestBedsinPublicServices2021

52

Appendix24AnnualAdmissionstoChestHospitalsfromGovernmentChestClinics53

2012-2021

Appendix25HIVSurveillanceAmongTBPatients

54

Appendix26Numberof‘Confirmed’casesofTBinHealthCareStaffNotifiedtoLabour55

Department1999-2021

Appendix27TreatmentoutcomesofCohortsofTBPatients

56

IV.Pneumoconiosis

57

Appendix1NewCasesofSuspectedPneumoconiosis/Mesotheliomaattendingthe58

PneumoconiosisClinicinHongKong1956-2021

Appendix2AgeDistributionofPneumoconiosisPatientsconfirmedin2021

60

Appendix3

OccupationDistributionofPneumoconiosisPatientsconfirmedin2021

61

Appendix4

PneumoconiosisPatientsconfirmedin2021byDurationofExposuretoDust

61

Appendix5

PneumoconiosisPatientsconfirmedin2021byDegreeofIncapacity

62

CONTENT

-iii-

ChapterPage

Appendix6PneumoconiosisPatientsconfirmedin2021ClassifiedbyRadiological63

Appearance

Appendix7HistoryofTuberculosis(TB)amongPatientswithPneumoconiosis64

confirmedin2021

Appendix8PneumoconiosisPatientsconfirmedin2021byOtherParticulars

64

ADDENDUM

65

V.Otherfindings

66

Annex1(a)TBAmongChineseNewImmigrants

67

Annex1(b)TBNotificationsandEstimatedRateAmongChineseNewImmigrants68

bySexandAgefrom2017-2021

Annex2(a)TBNotificationsandRate(AllCases)bySexandAgefrom2017-202169

Annex2(b)Trendofage-specificTBNotificationRatefrom1970-2021

70

Annex3TB-HIVRegistry

71

Annex4CrudeandStandardisedDeathRateandNotificationRate2001-202176

Annex5HBsAgSeroprevalenceSurveyAmongTBPatientsSeenatChest

77

Clinics2021

Supplement78

—NotificationFormofTBunderthePreventionandControlofDisease

Ordinance(Cap.599)–DH1A(s)(Rev.Jul2008)

—DenotificationFormofTB

—NotificationFormofOccupationalDiseasesundertheOccupationalSafety

andHealthOrdinance(Cap.509)–LD483(Rev.8.2.2005)

—ProgrammeRecordForm–DH2417

I.Preface

GlobalEpidemiology

Tuberculosis(TB),alongstandinginfectiousdiseasethataffectspeopleirrespectiveofageandsex,iscurableandpreventable.In2021,itwasestimatedthat10.6millionpeoplefellillwithTB,including6millionmen,3.4millionwomenand1.2millionchildren.Forthemortality,atotalof1.6millionpeoplediedfromTB(including187000peoplewithHIV).Worldwide,TBisthe13thleadingcauseofdeathand

thesecondleadinginfectiouskillerafterCOVID-19.

In2021,thelargestnumberofnewTBcasesoccurredintheWorldHealthOrganization(WHO)South-EastAsianRegion,with45%ofnewcases,followedbytheWHOAfricanRegion,with23%ofnewcasesandtheWHOWesternPacificwith18%.The30highTBburdencountriesaccountedfor87%of

newTBcases.

Regardingtheissueofmultidrug-resistantorrifampicin-resistantTB(MDR/RR-TB),itremainedtobeapublichealththreat.WHOupdatedthedefinitionofextensivelydrug-resistantTB(XDR-TB)in2021toTBcausedbyMycobacteriumtuberculosisstrainsthatfulfillthedefinitionofMDR/RR-TBandthatarealsoresistanttoanyfluoroquinoloneandatleastoneadditionalGroupAdrug(Bedaquilineorlinezolid).Globally,71%ofpeoplediagnosedwithbacteriologicallyconfirmedpulmonaryTBweretestedforrifampicinresistance.Amongthe2.4millioncasestested,141953cases(5.9%)ofMDR/RR-TBand25038cases(1.0%)ofpre-XDR-TBorXDR-TBweredetected.ItisestimatedthatonlyaboutoneinthreepeoplewithMDR/RR-TBreceivedtreatmentin2021.TheTBoutcomedatashowedaworldwidetreatmentsuccessrateofMDR/RR-TBpatientstobe60%in2019cohort.Bedaquiline-basedandalloral

regimensweremorewidelyadoptedbymostcountries.

TheEndTBStrategydefinesmilestonesasa35%reductioninthenumberofTBdeathsanda20%reductionintheTBincidenceratecomparedwithlevelsin2015.Thesemilestonessetfor2020havenotyetbeenreachedeithergloballyorinmostWHOregionsandcountries.TheoccurrenceofCOVID-19

pandemichassignificantlyhinderedtheprogressinreducingtheglobalburdenofTBdisease.

Localepidemiology

InHongKong,thenumberofTBnotificationsin2021was3716,andtheTBnotificationratewas50.1per100000.Thecorrespondingfiguresin2020were3656and48.9per100000.TBdeathsaccountedfor0.33%ofthetotalregistereddeathsinHongKongandstayedoutsidethetoptencausesof

deathin2021.ThedropinTBnotificationratein2020ascomparedwith2019withasubsequentrisein

TBnotificationsin2021waslikelyattributedtoCOVID-19pandemicwhichhadanimpactonTBdiagnosis

andtreatment.Asimilartrendwasalsoobservedworldwide.

Withthesuccessfulimplementationofpassivecase-finding,rapiddiagnosis,timelyinitiationofeffectiveanti-TBtreatmentanddirectlyobservedtreatment(DOT)inanambulatoryoutpatientsetting,theTBnotificationratedecreasedfromahistoricalpeakof697.2per100000in1952to50.1per100000in2021.InHongKong,theTBnotificationratedeclinedmoreslowlyinrecentyearsbecauseoftheageingpopulationandreactivationofTBfromthispooloflatentinfection.TacklingthechallengeofanageingpopulationappearstobeakeystepinfurtherreducingthelocalTBnotificationandTBdeathrates.Thelocalpreventivetreatmentfortargetedhouseholdcontactshasbeenextendedtothoseageunder65.However,despiteanincreasedaccessibilityofdiagnostictoolsinscreeninglatentTBinfection(LTBI)andtheheightenedawarenessoftheroleofpreventivetreatment,treatmentofLTBIisstillhamperedby

clients’acceptanceandanyadverseeventssuchashepatotoxicityinparticularamongtheolderagegroup.

ChallengesonTBControl

TheeffectofCOVID-19pandemicandvaccination

Inearly2020,theCOVID-19outbreakwasdeclaredaPublicHealthEmergencyofInternationalConcernbytheWHO.Alotofthemedicalresourceswereshiftedtocombatthisnovelcoronavirus.Thedailyactivitiesandthehealthseekingbehaviorofmostpeoplewerechanged.WiththeintroductionofCOVID-19vaccinesinHongKonginearly2021,peoplegraduallyresumedtheirdailyactivities.ThesechangeswerereflectedbytheincreasednumberofattendanceandtheslightriseinTBnotification

in2021.

AgeingPopulation

ThepopulationinHongKongrosefrom6.73millionto7.40millionfrom2001to2021.Ofwhich11.4%and20.2%wereaged65orabovein2001and2021respectively.Itisprojectedthatmorethanaquarterofthelocalpopulationwillbe65oraboveby2030.TheTBnotificationrateofthoseaged75orabovewerearound3timesthatofthegeneralpopulation.TheaverageageoftheTBdeathswas74.7in2021withmorethanthree-quartersofmortalitybeing65yearsoldorabove.ManagementofTBinelderlyischallengingastheyhave,ingeneral,morecomorbidities.Itisalsowellknownthattheymayexperienceadverseeffectssuchashepatotoxicitymorecommonlyduringanti-TBtreatment.Closemonitoringof

anyside-effectsduringtreatmentisofparamountimportance.

Co-morbiditiesofTBpatients

Diabetesmellitus(DM)hasbeenrecognizedasthemostcommonTBcomorbidityinHongKong.ApreviouslocalstudyshowedthatDMpatientshadmoreextensivedisease,moreadverseeffectsfromtreatmentandlowersuccessratesascomparedwithnon-diabeticpatients.DMcontrolisanimportantfactoraffectingtheresponsetoanti-TBtreatment.ApartfromDM,HIVinfectionisanotherriskfactorforthedevelopmentofTB.In2021,theprevalenceofHIVco-infectionamongourTBpatientsremainedlowat0.9%.Inourservice,DMscreeningandHIVtestingareroutinelyofferedtoTBpatientsattending

chestclinics.

Multidrug-resistantandextensivelydrug-resistanttuberculosis

WHOimplementednewdefinitionsofpre-XDRandXDR-TBwitheffectfromJanuary2021onwards.Pre-XDR-TBisdefinedasTBcausedbyMycobacteriumtuberculosisstrainsthatfulfillthedefinitionofMDR/RR-TBandthatarealsoresistanttoanyfluoroquinolone,whereasXDR-TBisTBcausedbyMycobacteriumtuberculosisstrainsthatfulfillthedefinitionofMDR/RR-TBandthatarealsoresistanttoanyfluoroquinoloneandatleastoneadditionalGroupAdrug(CurrentGroupAdrugsarelevofloxacinormoxifloxacin,bedaquilineandlinezolid).Withalltheefforts,in2021,therateofMDR-TBinHongKongwaskeptatlowlevelat0.66%ofallcultureconfirmedTBcases.Therewasnocaseofextensivelydrug-resistantTB(XDR-TB).OwingtothetravelrestrictionsduringCOVID-19pandemic,theproblemofpopulationmovementandthepotentialcross-bordertransferofdrug-resistantTBwasnotsignificantin

2021.Yet,continuousvigilanceontheearlydiagnosisandtreatmentofdrug-resistantTBisimportant.

WayForward

Surveillanceandearlydetectionofdrug-resistantTB

ClosecollaborationwiththePublicHealthLaboratoryServicesBranchtomonitorthelocaldrugresistancepatternandregularreportingandsharingofdatawithWHOareimportantstrategiestomonitorthetrendofdrugresistanceinHongKongandourneighbouringcountries.TheDepartmentofHealthofHongKongSARwillcontinuetoobservethetrendofdrugresistanceratesandenhancethesurveillance.MoleculartestsforrapiddiagnosisofTBanddetectionofdrugresistanceamongsputumsmear-positivecasesandselectedsmear-negativecasesbeforetheavailabilityofculture-baseddrugsusceptibilityresults

areusefulwaysforearlydetectionandeffectivecontrolofdrug-resistantTB.

Effectiveanti-tuberculosistreatment

Effectivefirst-lineanti-TBtreatmentunderdirectlyobservedtherapyremainstobethecornerstoneofTB

control.Fordrug-resistantTB,thedevelopmentofnewdrugsandtheintroductionofrepurposedagents

inrecentyearsarebringingnewhopetothetreatmentofMDR-TBandXDR-TB.Since2019,therehasbeenanincreasinguseofbedaquiline,linezolidandclofazimineinadditiontolevofloxacinandcycloserineasthecompositionoftheindividualizedlongerMDR-TBregimenfortreatmentofMDR-TB.In2020,WHOrecommendedanewshorterall-oralbedaquiline-containingregimenof9-12monthsforaselectedgroupofMDR/RR-TBpatientswhohavenofluoroquinoloneresistanceandwithoutpreviousexposuretosecond-linedrugs(includingbedaquiline)forpatientswithMDR-TB.However,patient’stoleranceoftheshortregimenisstillachallenge.ForpatientswithMDR/RR-TBandadditionalfluoroquinoloneresistance,anew6-9monthsregimencomposedofbedaquiline,pretomanidandlinezolid(BPaL)hasbeen

conditionallyrecommendedunderoperationalresearchconditionsonly.

Thein-patientmanagementofMDR-andXDR-TBissupportedbythechestunitsoftheGranthamHospitalandKowloonHospitalwhicharethetwodesignatedhospitalunitsunderHospitalAuthority(HA)forhospitalizationofMDR-andXDR-TBpatients.CloseliaisonwiththeHAcolleaguesismaintainedand

biweeklyjointcaseconferencesareconductedtofacilitatethemanagementofthesedifficultcases.

TuberculosisPreventiveTreatment(TPT)forLTBI

Targetedscreeningoffourmainhigh-riskgroupsisconductedlocally.Theyarehouseholdcontactsofsputumsmear-positivepatients,peoplewithsilicosis,peoplelivingwithHIVandpatientsinitiatinganti-tumournecrosisfactor(TNF)biologics.Tuberculinskintest(TST)and/ortheinterferongammareleaseassays(IGRA)arethescreeningtestsdeployed.ForTPT,six-to-nine-monthIsoniazid,12-weekweeklyrifapentineplusisoniazidregimengivenundersupervisionand4-monthrifampicinaretheregimenscommonlyoffered.ThecompletionrateofTPTrangedfrom80%toover90%withahighercompletion

rateamongcasesontheshorterTPTregimens.

NeonatalBCGvaccination

NeonatalBCGisroutinelygiveninHongKongatbirthwithahighcoveragerateof99.1%in2021.Ontheotherhand,theBCGrevaccinationprogrammeforprimaryschoolchildrenhasbeenstoppedsince

theschoolyearstartingfromSeptember2000.

Publichealthfunction

Inrecentyears,theDepartmentofHealthhasenhanceditspublichealthfunctionbysteppingupitslocalenforcementmeasurestocontainthespreadofTBwithinourcommunity.Fornon-compliantTBpatientsposingpublichealthhazards,wemayneedtoissuemedicalexaminationordersorisolationorderswithreferencetothePreventionandControlofDiseaseOrdinance(CAP599).Theyareoftentakenasalast

resortwhenallothernon-coercivemeasuressuchascounselling,educationandpsychosocialsupportfail.

Cross-jurisdictionnotificationhasalsobeenenhancedwhenmanagingTBcasesleavingHongKong.

Collaborationwithotherresearchparties

Tuberculosis&ChestService(TB&CS)hasbeenactivelycollaboratingwithotherlocalandoverseashealthauthoritiesandacademicsinconductingstudiesandresearcheswithanaimtofurtherimprovetheTBmanagement.CollaborationwithlocalexpertswasmadetoreviewinternationalguidelinesandlocalTBsituations.LocalguidelinesformanagementofLTBIinhouseholdcontacts,patientswithsilicosis,peoplelivingwithHIVandpatientsonanti-TNFbiologicswerepublishedinTB&CSwebsite.Inaddition,

regularacademicactivitieswereorganizedwiththehealthauthoritiesintheMainlandChinaandMacao.

HealthPromotion

Promotionofsmokingcessation

ThelinkbetweensmokingandTBhaslongbeenreported.StudiesshowedthattobaccosmokingincreasedtheriskofTBinfectionanddisease,negativelyinfluencedtheresponsetotreatmentandalsoincreasedtheriskofrelapse.IncollaborationwiththeTobaccoandAlcoholControlOffice,verybrief

adviceonsmokingcessationareactivelypractisedwhenservingclientsattendingchestclinics.

WorldTBDayandcommunitysupport

MeasurestoraisethepublicawarenessofTBandtomobilizesupportfromthecommunityareofgreatimportancetothesuccessofTBcontrol.Ithasbeenachievedthroughschooleducationandpublichealthtalks.DespitetheCOVID-19pandemic,aseriesofactivitieswereconductedtoechotheWorldTBDayof24March2021.ActivitiesincludedupdatingTBinformationonTB&CSwebsite,launchinganAnnouncementforPublicInterest(API)onTV,radio,andothermediaandpromotingtheWorldTBDay

viatheRTHKradioprogramme“Healthpedia”andanarticleinahealthcolumnofalocalnewspaper.

Withalltheseactivities,itishopedthatthehealthcareworkers,thepublicandallotherstakeholderswould

beabletojoinhandstofightagainstthisendemicdisease.

II.Tuberculosis&ChestService

Approximately80%ofnotifiedTBcasesaremanagedintheGovernmentTB&CS.In2021,atotalof56229persons(including9066newpatients)attendedchestclinicsandthetotalattendancewas525930.Thecorrespondingfiguresin2020were57022and427969.Theslightlyriseintotalattendancewas

attributedtoagradualresumptionofnormalactivitiesaftertheimplementationofCOVID-19vaccination.

ThediagnosesamongnewpatientsincludedactivepulmonaryTB(21.7%),activeTBofotherforms(8.0%),inactiveTB(2.1%),CXRscreeningandcontactexamination(31.2%),bronchitisnotspecifiedasacuteorchronic(1.3%),acuterespiratoryinfectionandpneumonia(2.4%),malignantneoplasmoftracheaandbronchus(0.8%)andotherrespiratorysymptomsordiseases(10.1%).Atotalof919hospitaladmissions

werearranged.

ForthePneumoconiosisClinic(theClinic),itcontinuedtoprovideafullrangeofoutpatientservicestopatientswithsuspectedorconfirmedpneumoconiosisandmesothelioma.ApartfromsupportingtheoperationofPneumoconiosisMedicalBoard(theBoard)inassessmentaspectunderthePneumoconiosisandMesothelioma(Compensation)Ordinance(theOrdinance),theClinicalsoprovidesservicesaddressingthepatients’diversifiedneedsintermsoftreatment,preventionandrehabilitation.In2021,124caseswithsuspectedpneumoconiosisormesotheliomawereexaminedbytheBoardundertheOrdinance,and93newpatients(67casesofsilicosis,6casesofasbestos-relatedlungdisease,19casesofmesotheliomaand1caseofbothasbestosisandmesothelioma)wereconfirmedbytheBoard.Uptotheendof2021,atotalof5363patientshadbeenconfirmedbytheBoardashavingpneumoconiosisand/ormesothelioma

undertheOrdinancewiththedateofdiagnosisonorafter1January1981.

III.TuberculosisinHongKong

Appendix1TBNotification&DeathRateofTuberculosis(AllForms)from1947-2021

Year

TBNotifications

Notification

Rate(3)

Numberof

Death(4)

Death

Rate(5)

Ratio(6)

(Death/

Notifications)x

100%

Number

Vietnameserefugees(1)

Chinese

immigrants(2)

1947

4855

-

-

277.4

1861

106.3

2.6

38.3

1948

6279

-

-

348.8

1961

108.9

3.2

31.2

1949

7510

-

-

404.4

2611

140.6

2.9

34.8

1950

9067

-

-

405.3

3263

145.9

2.8

36.0

1951

13886

-

-

689.0

4190

207.9

3.3

30.2

1952

14821

-

-

697.2

3573

168.1

4.2

24.1

1953

11900

-

-

530.7

2939

131.1

4.1

24.7

1954

12508

-

-

528.9

2876

121.6

4.4

23.0

1955

14148

-

-

568.1

2810

112.8

5.0

19.9

1956

12155

-

-

464.9

2629

100.6

4.6

21.6

1957

13665

-

-

499.4

2675

97.8

5.1

19.6

1958

13485

-

-

472.5

2302

80.7

5.9

17.1

1959

14302

-

-

482.0

2178

73.4

6.6

15.2

1960

12425

-

-

405.5

2085

68.0

6.0

16.8

1961

12584

-

-

397.2

1907

60.2

6.6

15.2

1962

14263

-

-

431.5

1881

56.9

7.6

13.2

1963

13031

-

-

380.9

1762

51.5

7.4

13.5

1964

12557

-

-

358.3

1441

41.1

8.7

11.5

1965

9927

-

-

275.9

1278

35.5

7.8

12.9

1966

11427

-

-

314.8

1515

41.7

7.5

13.3

1967

15253

-

-

409.7

1493

40.1

10.2

9.8

1968

9792

-

-

257.5

1483

39.0

6.6

15.2

1969

11072

-

-

286.5

1470

38.0

7.5

13.3

1970

10077

-

-

254.5

1436

36.3

7.0

14.3

1971

9028

-

-

223.2

1250

30.9

7.2

13.9

1972

8420

-

-

204.2

1312

31.8

6.4

15.6

1973

8152

-

-

192.2

1154

27.2

7.1

14.2

1974

8320

-

-

190.0

974

22.2

8.5

11.7

1975

8192

-

-

183.6

646

14.5

12.7

7.9

1976

7928

-

-

175.5

568

12.6

14.0

7.2

1977

7191

-

-

156.9

532

11.6

13.5

7.4

1978

6623

-

-

141.9

420

9.0

15.8

6.3

1979

7907

(498)

-

160.4

523

10.6

15.1

6.6

1980

8065

(712)

-

159.3

551

10.9

14.6

6.8

1981

7729

(254)

-

149.1

489

9.4

15.8

6.3

1982

7527

(112)

-

143.0

454

8.6

16.6

6.0

1983

7301

(73)

-

136.6

446

8.3

16.4

6.1

1984

7843

(69)

-

145.3

420

7.8

18.7

5.4

1985

7545

(59)

580

138.3

409

7.5

18.5

5.4

1986

7432

(46)

544

134.5

407

7.4

18.3

5.5

1987

7269

(41)

495

130.3

405

7.3

18.0

5.6

1988

7021

(121)

433

124.8

388

6.9

18.1

5.5

1989

6704

(226)

387

117.9

403

7.1

16.6

6.0

1990

6510

(288)

341

114.1

382

6.7

17.0

5.9

1991

6283

(281)

293

109.2

409

7.1

15.4

6.5

1992

6534

(309)

264

112.6

410

7.1

15.9

6.3

1993

6537

(264)

89

110.8

396

6.7

16.5

6.1

1994

6319

(230)

87

104.7

409

6.8

15.5

6.5

1995

6212

(175)

102

100.9

418

6.8

14.9

6.7

1996

6501

(88)

162

101.0

292

4.5

22.3

4.5

1997

7072

(34)

156

109.0

252

3.9

28.1

3.6

1998

7673

(7)

169

117.3

270

4.1

28.4

3.5

1999

7512

(5)

166

113.7

312

4.7

24.1

4.2

2000

7578

(7)

152

113.7

299

4.5

25.3

4.0

2001

7262

(0)

192

108.2

311

4.6

23.4

4.3

Appendix1TBNotification&DeathRateofTuberculosis(AllForms)from1947-2021cont'd

Year

TBNotifications

Notification

Rate(3)

Numberof

Death(4)

Death

Rate(5)

Ratio(6)

(Death/

Notifications)x

100%

Number

Vietnameserefugees(1)

Chinese

immigrants(2)

2002

6602

(0)

186

9