Limited impact of tuberculosis control in Hong Kong: attributable to high risks of reactivation disease

Vynnycky, E; Borgdorff, MW; Leung, CC; Tam, CM; Fine, PEM; (2008) Limited impact of tuberculosis control in Hong Kong: attributable to high risks of reactivation disease. Epidemiology and infection, 136 (7). pp. 943-952. ISSN 0950-2688 DOI:

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Over 50% of the global burden of tuberculosis occurs in South East Asia and the Western Pacific. Since 1950, notification rates in high-income countries in these settings have declined slowly and have remained over ten-fold greater than those in Western populations. The reasons for the slow decline are poorly understood. Using an age-structured model describing the incidence of Mycobacterium tuberculosis infection and disease applied to notification data from Hong Kong, we illustrate that in Hong Kong, a high prevalence of M. tuberculosis infection among older individuals and a high risk of disease through reactivation (e.g. up to 17-fold greater than that estimated for infected males in the United Kingdom) may explain this slow decline. If this feature of the epidemiology of tuberculosis is widespread, the WHO directly observed treatment short-course (DOTS) strategy may have a smaller impact in Asia in the short term than has been-implied by recent predictions, all of which have been based on disease risk estimates derived from Western Europe. As a result, it may be difficult to meet the targets for tuberculosis control, which have been prescribed by the UN Millennium Development Goals.

Item Type: Article
Keywords: Adult, Age Factors, Aged, Communicable Disease Control, methods, Hong Kong, epidemiology, Humans, Incidence, Male, Middle Aged, Recurrence, Risk Factors, Tuberculosis, epidemiology
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: TB Centre
PubMed ID: 17678555
Web of Science ID: 259198600010


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