Kai Blöndal "Tuberculosis in Estonia with special emphasis on drug-resistant tuberculosis: Notification rate, disease recurrence and mortality" | University of Tartu

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Lossi 36, 51003 Tartu
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    Raekoja plats 2, 20307 Narva
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Ravila 19, 50411 Tartu
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    Jakobi 5–205, 51005 Tartu
Faculty of Science and Technology
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Vanemuise 46–208, 51014 Tartu
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Support Units
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Other Units
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  • View all other units

Contacts of UT units

Faculty of Arts and Humanities
Faculty phone: 
+372 737 5341
Faculty address: 
Jakobi 2, rooms 116–121, 51005 Tartu
  • Dean's Office
    Faculty phone: 
    + 372 737 5341
    Faculty address: 
    Jakobi 2, rooms 116–121, 51005 Tartu
  • Institute of History and Archaeology
    Faculty phone: 
    +372 737 5651
    Faculty address: 
    Jakobi 2, 51005 Tartu
  • Institute of Estonian and General Linguistics
    Faculty phone: 
    +372 737 5221
    Faculty address: 
    Jakobi 2, 51005 Tartu
  • Institute of Philosophy and Semiotics
    Faculty phone: 
    +372 737 5314
    Faculty address: 
    Jakobi 2, rooms 309–352, 51005 Tartu
  • Institute of Cultural Research
    Faculty phone: 
    (+372) 737 5223
    Faculty address: 
    Ülikooli 16, 51003 Tartu
  • School of Theology and Religious Studies
    Faculty phone: 
    +372 737 5301
    Faculty address: 
    Ülikooli 18–310, 50090 Tartu
  • College of Foreign Languages and Cultures
    Faculty address: 
    J. Liivi 4, 50409, Tartu
  • Viljandi Culture Academy
    Faculty phone: 
    +372 435 5232
    Faculty address: 
    Posti 1, 71004 Viljandi
Faculty of Social Sciences
Faculty phone: 
+372 737 5957
Faculty address: 
Lossi 36, 51003 Tartu
  • Dean's Office
    Faculty phone: 
    + 372 737 5900
    Faculty address: 
    Lossi 36, 51003 Tartu
  • Institute of Education
    Faculty phone: 
    +372 737 6440
    Faculty address: 
    Salme 1a–29, 50103 Tartu
  • Johan Skytte Institute of Political Studies
    Faculty phone: 
    +372 737 5582
    Faculty address: 
    Lossi 36–301, 51003 Tartu
  • School of Economics and Business Administration
    Faculty phone: 
    +372 737 6310
    Faculty address: 
    Narva mnt 18, 51009 Tartu
  • Institute of Psychology
    Faculty phone: 
    +372 737 5902
    Faculty address: 
    Näituse 2, 50409 Tartu
  • School of Law
    Faculty phone: 
    +372 737 5390
    Faculty address: 
    Näituse 20–324, 50409 Tartu
  • Institute of Social Studies
    Faculty phone: 
    +372 737 5188
    Faculty address: 
    Lossi 36, 51003 Tartu
  • Narva College
    Faculty phone: 
    +372 740 1900
    Faculty address: 
    Raekoja plats 2, 20307 Narva
  • Pärnu College
    Faculty phone: 
    +372 445 0520
    Faculty address: 
    Ringi 35, 80012 Pärnu
Faculty of Medicine
Faculty phone: 
+372 737 5326
Faculty address: 
Ravila 19, 50411 Tartu
  • Dean's Office
    Faculty phone: 
    +372 737 5326
    Faculty address: 
    Ravila 19, 50411 Tartu
  • Institute of Biomedicine and Translational Medicine
    Faculty phone: 
    +372 737 4210
    Faculty address: 
    Biomeedikum, Ravila 19, 50411 Tartu
  • Institute of Pharmacy
    Faculty phone: 
    +372 737 5286
    Faculty address: 
    Nooruse 1, 50411 Tartu
  • Institute of Dentistry
    Faculty phone: 
    +372 731 9856
    Faculty address: 
    Raekoja plats 6, 51003 Tartu
  • Institute of Clinical Medicine
    Faculty phone: 
    +372 737 5323
    Faculty address: 
    L. Puusepa 8, 50406 Tartu
  • Institute of Family Medicine and Public Health
    Faculty phone: 
    +372 737 4190
    Faculty address: 
    Ravila 19, 50411 Tartu
  • Institute of Sport Sciences and Physiotherapy
    Faculty phone: 
    +372 737 5360
    Faculty address: 
    Jakobi 5–205, 51005 Tartu
Faculty of Science and Technology
Faculty phone: 
+372 737 5820
Faculty address: 
Vanemuise 46–208, 51014 Tartu
  • Dean's Office
    Faculty phone: 
    +372 737 5820
    Faculty address: 
    Vanemuise 46–208, 51003 Tartu
  • Institute of Computer Science
    Faculty phone: 
    +372 737 5445
    Faculty address: 
    Narva mnt 18, 51009 Tartu
  • Estonian Marine Institute
    Faculty phone: 
    +372 671 8902
    Faculty address: 
    Mäealuse 14, 12618 Tallinn
  • Institute of Physics
    Faculty address: 
    W. Ostwaldi 1, 50411 Tartu
  • Institute of Chemistry
    Faculty phone: 
    +372 737 5261
    Faculty address: 
    Ravila 14a, 50411 Tartu
  • Institute of Mathematics and Statistics
    Faculty phone: 
    +372 737 5860
    Faculty address: 
    Narva mnt 18, 51009 Tartu
  • Institute of Molecular and Cell Biology
    Faculty phone: 
    +372 737 5027
    Faculty address: 
    Riia 23, 23b–134, 51010 Tartu
  • Tartu Observatory
    Faculty phone: 
    +372 737 4510
    Faculty address: 
    Observatooriumi 1, Tõravere, 61602 Tartumaa
  • Institute of Technology
    Faculty phone: 
    +372 737 4800
    Faculty address: 
    Nooruse 1, 50411 Tartu
  • Institute of Ecology and Earth Sciences
    Faculty phone: 
    +372 737 5835
    Faculty address: 
    Vanemuise 46, 51003 Tartu
Institutions
  • Library
    Faculty phone: 
    +372 737 5702
    Faculty address: 
    W. Struve 1, 50091 Tartu
  • Youth Academy
    Faculty phone: 
    +372 737 5581
    Faculty address: 
    Uppsala 10, 51003 Tartu
  • Institute of Genomics
    Faculty phone: 
    +372 737 4000
    Faculty address: 
    Riia 23b, 51010 Tartu
  • Museum
    Faculty phone: 
    +372 737 5674
    Faculty address: 
    Lossi 25, 51003 Tartu
  • University of Tartu Natural History Museum and Botanical Garden
    Faculty phone: 
    +372 737 6076
    Faculty address: 
    Vanemuise 46, 51003 Tartu
Support Units
  • Administrative Office
    Faculty phone: 
    +372 737 5606
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Centre for Entrepreneurship and Innovation
    Faculty phone: 
    +372 737 4809
    Faculty address: 
    Narva mnt 18, 51009, Tartu
  • University Office in Tallinn
    Faculty phone: 
    +372 737 6600
    Faculty address: 
    Teatri väljak 3, 10143 Tallinn
  • Estates Office
    Faculty phone: 
    +372 737 5137
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Finance Office
    Faculty phone: 
    +372 737 5125
    Faculty address: 
    Jakobi 4, 51005 Tartu
  • Grant Office
    Faculty phone: 
    +372 737 6215
    Faculty address: 
    Raekoja plats 9, 51004 Tartu
  • Information Technology Office
    Faculty phone: 
    +372 737 6000, IT-help: +372 737 5500
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Human Resources Office
    Faculty phone: 
    +372 737 5145
    Faculty address: 
    Ülikooli 18, rooms 302 and 304, 50090 Tartu
  • Internal Audit Office
    Faculty address: 
    Ülikooli 18-244, 51005 Tartu
  • Marketing and Communication Office
    Faculty phone: 
    +372 737 5687
    Faculty address: 
    Ülikooli 18, rooms 102, 104, 209, 210, 50090 Tartu
  • Office of Academic Affairs
    Faculty phone: 
    +372 737 5620
    Faculty address: 
    Ülikooli 18, 50090 Tartu
  • Procurement Office
    Faculty phone: 
    +372 737 6632
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Rector's Strategy Office
    Faculty phone: 
    +372 737 5600
    Faculty address: 
    Ülikooli 18, 50090 Tartu
  • Student Council
    Faculty address: 
    Ülikooli 18b, 51005 Tartu
  • University of Tartu Press
    Faculty phone: 
    +372 737 5945
    Faculty address: 
    W. Struve 1, 50091 Tartu
Other Units
  • University of Tartu Academic Sports Club
    Faculty phone: 
    +372 737 5371
    Faculty address: 
    Ujula 4, 51008 Tartu
  • Tartu Student Village
    Faculty phone: 
    +372 740 9959
    Faculty address: 
    Narva mnt 25, 51013 Tartu
  • Tartu Students’ Club
    Faculty phone: 
    +372 730 2400
    Faculty address: 
    Kalevi 24, 51010 Tartu
  • Tartu University Hospital
    Faculty address: 
    L. Puusepa 1a, 50406 Tartu
  • University of Tartu Foundation
    Faculty phone: 
    +372 737 5852
    Faculty address: 
    Ülikooli 18, 50090 Tartu
  • View all other units

Kai Blöndal "Tuberculosis in Estonia with special emphasis on drug-resistant tuberculosis: Notification rate, disease recurrence and mortality"

Date: 
31.05.2013 - 13:00 to 15:00

Supervisor: professor Alan Altraja (TÜ kopsukliinik) ja Mati Rahu (TAI)
Opponent: professor Peter F.O. Davies, MD, PhD (Liverpool Heart and Chest Hospital, Suurbritannia)

Summary:
Tuberculosis (TB) is an infectious disease caused by airborne bacillus Mucobacterium tuberculosis. TB and particularly the multidrug-resistant TB (MDR-TB) continues to be a major problem in Estonia, both at the level of individual patients, as well as at the national level. MDR-TB is a form of TB, where the usual anti-TB drugs are not effective. The extreme form of MDR-TB has been labeled extensively drug-resistant TB (XDR-TB). For treatment of M/XDR-TB, the use of so called second-line anti-TB drugs is necessary. Second-line anti-TB drugs are less effective than usual ant-TB drugs; they have more side effects and are approximately ten times more expensive. Due to the high proportion of M/XDR-TB among the TB cases, Estonia belongs to the group of 27 high-M/XDR-TB-burden countries in the world. By 1998, after the sharp socio-economic changes in 1990's, the TB notification rate almost doubled in Estonia. Furthermore, from 2000, the number of HIV-infected cases is increasing. This is particularly alarming because TB and HIV are known to fuel each other. Following an infection with TB bacilli, there is approximately 10% lifetime risk of developing TB disease among non-HIV-infected persons, whereas the risk of developing TB among HIV-positive persons is up to 510% annually. In 1998, the National TB Programme was established in Estonia to manage the rising TB and M/XDR-TB epidemic. In 2000, due to the high proportion of M/XDR-TB cases and the lack of expensive second-line anti-TB drugs, the National TB Programme applied to the Green Light Committee of the Stop TB Partnership for concessionally-priced high-quality drugs for treatment of M/XDR-TB. There is a concern that as the result of two colliding epidemics of TB and M/XDR-TB and HIV, the TB and M/XDR-TB epidemic will go out of control in Estonia, as well as internationally. After more than 10 years of implementation of the National TB Programme, it is important to evaluate the trend of TB and M/XDR-TB notification rate, disease recurrence and mortality, as well as the factors influencing them. This is necessary to further improve the management of TB and to provide better care to the patients. We found that from 1998, the TB and M/XDR-TB incidence has decreased in Estonia and that the decrease was in a close time relation to the establishment of the National TB Programme, growth of the wealth of the population and assuring the countrywide availability of the second-line anti-TB drugs. Meanwhile, the rising proportion of TB and HIV co-infected persons has increased during the last decade and this increase is anticipated to continue in the future. To avoid colliding TB and HIV and even worse, M/XDR-TB and HIV co-epidemic, it is crucial to decrease the TB incidence faster than it is currently done. Furthermore, to decrease TB incidence the time of infectiousness has to be decreased, which means that the patients have to be diagnosed earlier and treated promptly. We found that in Estonia, the treatment success of M/XDR-TB patients was 61.1%, which is lower than the World Health Organization recommended 75%. We concluded that the main reason for the low treatment success and therefore continuous spread of M/XDR-TB infection was an unacceptably high proportion (22.3%) of patients defaulting treatment. Furthermore, we found that the all-cause mortality among TB and M/XDR-TB patients was higher than that in the overall population. Particularly pronounced were deaths due to smoking and alcohol abuse, as well as due to HIV. The most vulnerable were foreign-born persons and persons with lower education. After the TB and M/XDR-TB patients had successfully completed the treatment, the mortality remains still higher In conclusion, in Estonia, the TB and M/XDR-TB epidemic is closely connected to the HIV epidemic and interlinked with the higher mortality due to the life-style factors, such as tobacco smoking and alcohol abuse, as well as social aspects, such as lower educational level, social marginalization and poverty. To improve the management of TB and M/XDR-TB in general and the treatment outcome of M/XDR-TB in particular, the TB-related service package should cover all the mentioned challenges.

Organizer: 
Location: 
Puusepa Street 8, Linkberg's auditorium
Event category: