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Annual Congress of Malaysian Thoracic Society PP 5 An Age-Structured Mathematical Tuberculosis Transmission Model As Tool For Outbreak Modelling And Control In Malaysia Nurhuda Ismail 1, 2 , Awang M Bulgiba 2 , Nicolaas J D Nagelkerke 3 , Omar Awang 2 1 University of Technology MARA Sungai Buluh Campus, Selangor, Malaysia 2 University of Malaya, Kuala Lumpur, Malaysia 3 United Arab Emirates University, Al-Ain, United Arab Emirates Infectious diseases such as HIV/AIDS, tuberculosis and dengue continue to be public health threats in Malaysia. The burden on infectious diseases is increasing with new emerging diseases such as SARS and H1N1. With current lack of response, human capacity and resources, as well as serious adverse effects on probable promising interventions, we seek to find if applications of mathematical modelling in infectious disease outbreak modelling and control would complement the current conventional epidemiological and interventional studies resulting in greater impact on reducing incidence. Our study aims to develop an agestructured tuberculosis model and subsequently apply the use of infectious disease modelling to study the progression of latent tuberculosis infection, and to assess the impact of current and possible interventions on reducing incidence. We review tuberculosis pathophysiology and its transmission dynamic that best reflects reality at present which includes primary infection, endogenous reactivation and exogenous reinfection using deterministic compartmental models with SEIR structure and the ordinary differential equation system. We take into account its unique characteristics on heterogeneity, age and gender. A deterministic compartmental age-structured tuberculosis model is developed. Model equilibria and stabilities are reached and analyzed. Model fitting, probabilistic sensitivity testing and uncertainty analysis are performed. Epidemic thresholds known as reproduction numbers for the model are determined. This tuberculosis model best fits the Malaysian environment and characteristics may be used further for outbreak modelling and control simulations, as well as for disease and economic burden estimates and prediction. Its comparability and reliability is further discussed. 67
Annual Congress of Malaysian Thoracic Society PP 6 Are tuberculosis treatment outcome categories missing something? A case report from Malaysia Atif M 1 , Sulaiman S A S 1 , Ali I 2 , Muttalif A R 3 , Shafie A A 1 1 University Sains Malaysia, Penang, Malaysia 2 Hospital Pulau Penang, Penang, Malaysia 3 Institute of Respiratory Medicine, Kuala Lumpur, Malaysia Objective This case report necessitates elaboration of World Health Organisation (WHO) recommended tuberculosis (TB) treatment outcome categories and points out rational use of antihistamines. Case description A 24 year university student with history of productive cough was registered as sputum smear positive case of pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti-tuberculosis drugs, which was treated with chlorpheniramine (4mg) tablet. Patient missed 28 doses of anti-tuberculosis drugs in the continuation phase claiming that he was very busy in his studies and assignments. Upon questioning, he further explained that he was quite healthy after five months and unable to concentrate on his studies after taking he prescribed medicines. His treatment was stopped after six months, based on clinical improvement. Discussion Two major reasons, false perception of being completely cured and side effects associated with anti-TB drugs, might be responsible for non-adherence. Non-sedative antihistamines like fexofenadine, cetirizine or loratadine should be preferred over first generation antihistamines (chlorpheniramine) in patients with a lifestyle that requires concentration during the day. This patient had not completed the full course of chemotherapy, which is preliminary requirement for a case to be classified as “cured” or “treatment completed”. However, this patient had not defaulted for two consecutive months. Therefore, according to WHO outcome classification, this patient can neither be classified as “cured”, “treatment completed” nor as “defaulter”. Conclusion By applying WHO recommended “Patient Centered Approach”, we can reduce the risk of of non-adherence. A close friend, classmate or family member may be selected as a treatment supporter to ensure adherence to treatment. Antihistamines must be used rationally according to patient’s lifestyle. Further elaboration of WHO treatment outcome categories is required for appropriate classification of patients with similar characteristics. 68
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