| BackgroundTuberculosis is a kind of chronic respiratory diseases caused by Mycobacterium tuberculosis, which is seriously endanger for the physical and mental health of the human since ancient times. It is one of the major public health problems in the world, and is listed as a Category B notifiable infectious disease in our country. After the mycobacterium tuberculosis was found by German R.Koch, streptomycin, rifampin anti-TB drugs have been brought forth, opening chemotherapy era. Since the mid of1980s, TB epidemic gradually increases in the world wide because of the extensive distribution and dissemination of the resistant tuberculosis epidemic.The report from the World Health Organization (WHO) showed that there are about20million global active tuberculosis, new annual cases of nearly10million and50million people infected with multidrug-resistant TB around the world.At present, epidemic in China is characterized by a high prevalence, high rate resistant to infection and rural epidemic higher than in urban. The investigation by the Fifth National Tuberculosis epidemiological survey in2010showed that the15-year-old and older TB prevalence is459/100000and the report registration rate of the infectious tuberculosis is66/100000. In the mid and west rural areas the prevention and control systems are not perfect and grassroots prevention is weak, so the TB epidemic varies from one region to another. In recent years, with the economic development, population flow is increasing, and it is estimated that China’s annual floating population of nearly150million, with the growth rate of5million a year. These may cause an increase of TB transmission and the chance of infection, and to some extent, had an impact on the tuberculosis epidemic that increase the degree of difficulty to the prevention and treatment of tuberculosis and bring new problems.Binzhou City, with a total population of about3.77million, is located in the northern part of Shandong Province, to the brink of Bohai Bay, in the lower reaches of the Yellow River. Because of the mainly plain terrain and convenient transportation, the economy is in a stage of rapid development but unbalanced economic development brings a large number of the population flow, which may cause regional prevalence of TB.Research purposesTo understand the tuberculosis epidemic characteristics in the Binzhou City, and to explore the occurrence regularity, to study TB drug resistance and trend for providing the basis for TB control strategy and developing TB chemotherapy in Binzhou city.Research Methods1Data SourceTB epidemic data of Binzhou City in2008-2011are from the data reported cases of tuberculosis of the TB Network Special Report subsystem of The Chinese Disease Prevention and Control Information System. The TB drug-resistant information derived from Tuberculosis Treatment Hospital of Binzhou City. Drug-resistant patient information is from the hospital information system. Population data is from the Public Security household registration system of Binzhou City.2Analysis methodsWith the methods of descriptive epidemiology, we analyzed the general epidemiologic characteristics and three distributions of the reported cases of tuberculosis in Binzhou City for4years and the mycobacterial culture susceptibility data of the same period in Binzhou City TB Prevention Hospital. The database was established by Epidata, statistical analysis is used by statistics software SPSS16.0and the schematic of the incidence of geographical of districts is drawed by geographic information system (GIS) software.3Sputum cultureModified Jensen medium was used in the Sputum cultures. Susceptibility was measured by the absolute concentration method. The determination of drugs are rifampin, isoniazid, streptomycin, ethambutol and amikacin with both high and low concentration for each drug.Results1. In2008-2011, it is reported a total of8239cases of new cases of tuberculosis in Binzhou City, with the average annual reported incidence rate of54.56/10million; registered 4783cases of smear-positive cases, with an average annual smear-positive rate of31.69/10million; smear-positive rate of58.1%.2. In2008-2011, the highest incidence of active tuberculosis and smear-positive tuberculosis report is in2009; the highest area are in Zhanhua County and Wudi County; areas of densely enterprise distribution, concentrated population and floating population in counties and cities are high. Significant difference of active tuberculosis and smear-positive tuberculosis between patients’ genders and among patients’age group are statistically significant. The male is more than female in active tuberculosis and smear-positive tuberculosis and the old people have a higher prevalence.3. Smear-rate differences between the two types of TB control agencies and the General Hospital medical institutions with significantly significance (χ2=1117.88,P=0.000).4. It is significant difference (P<0.05) with statistical significance among the4years in total resistance rates, MDR-rate and single-drug resistance rate, which the highest is in2009. It is significant difference (P<0.05) with statistical significance among the age group in total resistance rates, MDR-rate and single-drug resistance rate. The resistance rate was gradually increased with age in total resistance, streptomycin resistance rates and rifampicin resistance rates. It is Zhanhua County that is higher than other counties in total drug resistance rate, rifampicin resistance rates and streptomycin resistance rate with statistical significance (P <0.05).5There is significant difference (P<0.05) among the different occupations in the total resistance, resistance to rifampin, isoniazid-resistant and resistant to streptomycin with significant difference (P<0.05) with a statistical significance, which the lowest resistance rates is in student.Conclusion:1. Tuberculosis epidemic in Binzhou City is better than national average, but it is of epidemic grim in the province.2. Smear rate is lower in medical institutions than in TB prevention and control institutions in Binzhou City. Sputum culture and drug susceptibility censorship in all medical institutions are low.3. In2008-2011, the highest incidence is in2009; the highest area are in Zhanhua County and Wudi County in Binzhou City; areas of densely enterprise distribution, concentrated population and floating population in counties and cities are high. It is a high incidence in old people of all ages, followed by the20-year-old age group. Farmers are with a higher incidence than in other occupations.4. The resistance situation is grim in all counties of Binzhou City. The single resistance rate of Rifampicin and streptomycin and total resistance rate are gradually increased with age.Suggestions:1. To improve awareness of sputum and sputum levels in the general Hospital, increasing the detection rate of tuberculosis patients. To improve sputum culture and drug susceptibility submission rate, for better providing a basis for chemotherapy.2. To further strengthen the publicity of TB prevention and control for the high incidence counties such as of Zhanhua County and Wudi County.3. People who will be into the plant must have a routine physical examination and in the plant have regularly organize in intensive enterprises, large areas of population density.4. Special funds must be allocated by the new IICA for rural elderly for free chest X-ray and sputum smears.5. It is suggested that patients with serious lung lesions or merger extrapulmonary tuberculosis or in the regions of higher resistance rates especially resistant to rifampin rate must add a1-2kind of second-line anti-TB drugs. |
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