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Public Health Weekly Report 2020; 13(12): 654-668

Published online March 19, 2020

© The Korea Disease Control and Prevention Agency

Results of the 2019 Pilot Project on the Tuberculosis (TB) Screening for Residents in Chok Bang (Shabby One-room) in South Korea

Park AhYoung, Shin JeeYeon, Kong Insik, On JinHee, Oh KeunYoung, Choi HongJo

Division of TB & HIV/AIDS Control, Center for Disease Prevention, KCDC; Korean National Tuberculosis Association; Department of Preventive Medicine, College of Medicine, Konyang University

*교신저자 : insik.kong@korea.kr, 043-719-7310

This is an Open Access aritcle distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Sections

The Korea Centers for Disease Control and Prevention (KCDC) conducted a tuberculosis (TB) screening pilot project in 2019 in local regions. The aim was to develop screening and treatment protocols for strengthening TB management among homeless people. Homeless people have a high risk of developing and spreading TB to socially and economically vulnerable populations.
Out of the 500 people targeted for the project, 483 participated. As a result of chest X-ray examinations (482) and sputum examinations (141), 3 TB patients (621 people per 100,000 population) were found. This is about 12 times higher than the incidence of TB in the general population (51.5 per 100,000 people, based on 2018 data), and about 4 times higher than the incidence of TB in the elderly population, which accounts for 46 percent of the country's new TB patients (163 per 100,000 people, based on 2018 data). The results of each test were abnormal findings rate of chest X-ray 20.1% (97/482), smear-positive 0.7% (1/141), culture-positive 2.1% (3/141), tuberculosis-polymerase chain reaction(PCR) test-positive 2.1% (3/141), Xpert MTB/RIF test-negative 100% (1/1), and the rapid resistance and drug susceptibility tests were both resistant 66.7% (2/3). The 3 patients who were diagnosed with TB were medical care recipients and ineligible for health insurance. They were 40-50-year-old Korean males with histories of smoking, drinking, and underlying diseases. As patients with no TB history, 2 patients were diagnosed with extensive drug resistance and isoniazid monoresistance TB.
For the early detection and successful treatment of individuals living on the periphery of society, which is a blind spot for TB prevention management, it is essential to secure access to examinations with mobile chest X-ray equipment and to create a treatment support environment by providing housing and living expenses for confirmed TB patients. The KCDC plans to expand and promote TB screening projects nationwide for the homeless and residents of Chok Bang in 2020 and will strengthen the treatment support system, including housing costs and food support linked to local governments' welfare projects.

Key words Tuberculosis (TB), Chok Bang, Residents, Homeless, Mass Screening, X-Rays, Sputum, Incidence

Sections
Table 1. General characteristics of screening participants and tuberculosis (TB) patients
VariablesScreening participantsTB patients
n(%)n(%)
Total483(100.0)3(100.0)
Sex
Male415(85.9)3(100.0)
Female68(14.1)--
Nationality
Korean472(97.7)3(100.0)
Non-Korean11(2.3)--
Age
< 408(1.7)--
40-4410(2.1)--
45-4940(8.3)1(33.3)
50-5462(12.8)1(33.3)
55-5980(16.6)1(33.3)
60-6493(19.3)--
65-6982(17.0)--
70-7443(8.9)--
75-7933(6.8)--
≥ 8032(6.6)--
Type of insurance
Health insurance(work)32(6.6)--
Health insurance(district)89(18.4)--
Medical care(type 1)310(64.2)1(33.3)
Medical care(type 2)9(1.9)--
Unqualified person23(4.8)2(66.7)
Missing20(4.1)--
TB symptoms
Yes172(35.6)1(33.3)
No311(64.4)2(66.7)
TB history
Yes33(6.8)--
No182(37.7)1(33.3)
Unknown268(55.5)2(66.7)
Underlying disease
Yes147(30.4)2(66.7)
No336(69.6)1(33.3)
Smoking
Yes345(71.4)3(100.0)
No111(23.0)--
Unknown27(5.6)--
Drinking
Yes256(53.0)3(100.0)
No227(47.0)--
Recent contact with TB patients
Yes2(0.4)--
No35(7.2)--
Unknown446(92.3)3(100.0)
Level of daily activity
Normal454(94.0)3(100.0)
Physically disabled25(5.2)--
Bed-ridden4(0.8)--
TB screening for the past year
Yes262(54.2)2(66.7)
No211(43.7)1(33.3)
Unknown10(2.1)--

Table 2. Examination results of screening participants and tuberculosis (TB) patients
VariablesScreening participantsTB patients
n(%)n(%)
Chest x-ray
Total482(100.0)3(100.0)
Normal354(73.4)--
Need treatment＊2(0.4)--
Observation required†19(3.9)3(100.0)
Inactive TB‡76(15.8)--
Other diseases suspected31(6.4)--
Sputum smear
Total141(100.0)3(100.0)
Negative140(99.3)3(100.0)
Positive1(0.7)--
Sputum culture
Total141(100.0)3(100.0)
Negative125(88.7)--
Positive3(2.1)3(100.0)
MIX1(0.7)
NTM§7(5.0)--
Pollution5(3.5)--
TB-PCR test‖
Total141(100.0)3(100.0)
Negative137(97.2)2(66.7)
Positive3(2.1)1(33.3)
NTM§1(0.7)--
Xpert MTB/RIF test
Total1(100.0)
Negative1(100.0)
Positive--
Rapid detection of INH/RIF resistance
Total3(100.0)
Sensibility1(33.3)
Resistance**2(66.7)
Drug sensitivity test
Total3(100.0)
Sensibility1(33.3)
Resistance††2(66.7)

＊ 'Active pulmonary tuberculosis' or 'exudative pleural effusion' which is presumed to be tuberculous, suggesting the treatment of tuberculosis, sputum examination for confirmation

† Any suspicion of 'active tuberculosis' or 'suspected tuberculosis', the final diagnosis of the doctor is necessary, including the additional tuberculosis test including sputum examination and the clinical findings of the patient in public health centers and medical institutions

‡ Pulmonary tuberculosis has developed in the past but has remained healed and remains traces of fibrotic changes

§ Nontuberculous mycobacteria (NTM)

‖ M. tuberculosis-polymerase chain reaction (TB-PCR)

M. tuberculosis (MTB) / Rifampin (RIF)

** Case 1: INH, Case 2: INH, RIF

†† Case 1: INH, Case 2: INH, RIF, EMB, PZA, RFB, Km, Am, S, Lfx, Mfx, Ofx, Pto

Figure 1. Tuberculosis (TB) screening procedure

Figure 2. Photographs of tuberculosis (TB) screening in Chok Bang (Shabby One-room)

Figure 3. Protocol for the management of tuberculosis (TB) screening and treatment of homeless people

References

Sections
  1. World Health Organization(WHO). Global Tuberculosis Report 2019 (2019).
  2. 보건복지부 질병관리본부. "결핵 신규환자 2만 6433명으로 전년 대비 6.4% 감소, 65세 이상 어르신 결핵환자는 전체의 45.5%". 보도자료. 2019.3.21.
  3. 보건복지부 질병관리본부. 결핵예방관리 강화대책, 결핵예방관리 강화대책 세부실행과제 (2019).
  4. 대한결핵협회. "쪽방촌 거주자 결핵검진 통해 결핵환자 3명 발견". 보도자료. 2019.11.7.
  5. 김희진. 한국에서의 결핵현황. 대한내과학회지 2012;82(3):257-262.
    Self
  6. Christie Y J, et al. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5:e152.
    Pubmed KoreaMed CrossRef
  7. Hsien Ho L, et al. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med 2007;4:e20.
    Pubmed KoreaMed CrossRef
  8. Sun Ha J, et al. Smoking and Risk of Tuberculosis Incidence, Mortality, and Recurrence in South Korean Men and Women. American Journal of Epidemiology 2009;170(12):1478-1485.
    Pubmed KoreaMed CrossRef
  9. Lonnroth K, et al. Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public Health 2008;8:289.
    Pubmed KoreaMed CrossRef
  10. Dias M, et al. Tuberculosis among the homeless: should we change the strategy?. Int J Tuberc Lung Dis 2017;21(3):327-332.
    Pubmed CrossRef
  11. Bamrah S, et al. Tuberculosis among the homeless, United States, 1994-2010. Int J Tuberc Lung Dis 2013;17(11):1414-1419.
    Pubmed KoreaMed CrossRef
  12. Centers for Disease Control and Prevention(CDC). Prevention and control of tuberculosis among homeless persons recommendations of the advisor y council for the elimination of tuberculosis. Recommendations and Reports 1992;41(RR-5):001.
  13. Jit M, et al. Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation. BMJ 2011;343:d5376.
    Pubmed KoreaMed CrossRef

Epidemiology and Surveillance

Public Health Weekly Report 2020; 13(12): 654-668

Published online March 19, 2020

Copyright © The Korea Disease Control and Prevention Agency.

Results of the 2019 Pilot Project on the Tuberculosis (TB) Screening for Residents in Chok Bang (Shabby One-room) in South Korea

Park AhYoung, Shin JeeYeon, Kong Insik, On JinHee, Oh KeunYoung, Choi HongJo

Division of TB & HIV/AIDS Control, Center for Disease Prevention, KCDC; Korean National Tuberculosis Association; Department of Preventive Medicine, College of Medicine, Konyang University

Correspondence to:*교신저자 : insik.kong@korea.kr, 043-719-7310

This is an Open Access aritcle distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The Korea Centers for Disease Control and Prevention (KCDC) conducted a tuberculosis (TB) screening pilot project in 2019 in local regions. The aim was to develop screening and treatment protocols for strengthening TB management among homeless people. Homeless people have a high risk of developing and spreading TB to socially and economically vulnerable populations.
Out of the 500 people targeted for the project, 483 participated. As a result of chest X-ray examinations (482) and sputum examinations (141), 3 TB patients (621 people per 100,000 population) were found. This is about 12 times higher than the incidence of TB in the general population (51.5 per 100,000 people, based on 2018 data), and about 4 times higher than the incidence of TB in the elderly population, which accounts for 46 percent of the country's new TB patients (163 per 100,000 people, based on 2018 data). The results of each test were abnormal findings rate of chest X-ray 20.1% (97/482), smear-positive 0.7% (1/141), culture-positive 2.1% (3/141), tuberculosis-polymerase chain reaction(PCR) test-positive 2.1% (3/141), Xpert MTB/RIF test-negative 100% (1/1), and the rapid resistance and drug susceptibility tests were both resistant 66.7% (2/3). The 3 patients who were diagnosed with TB were medical care recipients and ineligible for health insurance. They were 40-50-year-old Korean males with histories of smoking, drinking, and underlying diseases. As patients with no TB history, 2 patients were diagnosed with extensive drug resistance and isoniazid monoresistance TB.
For the early detection and successful treatment of individuals living on the periphery of society, which is a blind spot for TB prevention management, it is essential to secure access to examinations with mobile chest X-ray equipment and to create a treatment support environment by providing housing and living expenses for confirmed TB patients. The KCDC plans to expand and promote TB screening projects nationwide for the homeless and residents of Chok Bang in 2020 and will strengthen the treatment support system, including housing costs and food support linked to local governments' welfare projects.

Keywords: Tuberculosis (TB), Chok Bang, Residents, Homeless, Mass Screening, X-Rays, Sputum, Incidence

Body

General characteristics of screening participants and tuberculosis (TB) patients
VariablesScreening participantsTB patients
n(%)n(%)
Total483(100.0)3(100.0)
Sex
Male415(85.9)3(100.0)
Female68(14.1)--
Nationality
Korean472(97.7)3(100.0)
Non-Korean11(2.3)--
Age
< 408(1.7)--
40-4410(2.1)--
45-4940(8.3)1(33.3)
50-5462(12.8)1(33.3)
55-5980(16.6)1(33.3)
60-6493(19.3)--
65-6982(17.0)--
70-7443(8.9)--
75-7933(6.8)--
≥ 8032(6.6)--
Type of insurance
Health insurance(work)32(6.6)--
Health insurance(district)89(18.4)--
Medical care(type 1)310(64.2)1(33.3)
Medical care(type 2)9(1.9)--
Unqualified person23(4.8)2(66.7)
Missing20(4.1)--
TB symptoms
Yes172(35.6)1(33.3)
No311(64.4)2(66.7)
TB history
Yes33(6.8)--
No182(37.7)1(33.3)
Unknown268(55.5)2(66.7)
Underlying disease
Yes147(30.4)2(66.7)
No336(69.6)1(33.3)
Smoking
Yes345(71.4)3(100.0)
No111(23.0)--
Unknown27(5.6)--
Drinking
Yes256(53.0)3(100.0)
No227(47.0)--
Recent contact with TB patients
Yes2(0.4)--
No35(7.2)--
Unknown446(92.3)3(100.0)
Level of daily activity
Normal454(94.0)3(100.0)
Physically disabled25(5.2)--
Bed-ridden4(0.8)--
TB screening for the past year
Yes262(54.2)2(66.7)
No211(43.7)1(33.3)
Unknown10(2.1)--

Examination results of screening participants and tuberculosis (TB) patients
VariablesScreening participantsTB patients
n(%)n(%)
Chest x-ray
Total482(100.0)3(100.0)
Normal354(73.4)--
Need treatment＊2(0.4)--
Observation required†19(3.9)3(100.0)
Inactive TB‡76(15.8)--
Other diseases suspected31(6.4)--
Sputum smear
Total141(100.0)3(100.0)
Negative140(99.3)3(100.0)
Positive1(0.7)--
Sputum culture
Total141(100.0)3(100.0)
Negative125(88.7)--
Positive3(2.1)3(100.0)
MIX1(0.7)
NTM§7(5.0)--
Pollution5(3.5)--
TB-PCR test‖
Total141(100.0)3(100.0)
Negative137(97.2)2(66.7)
Positive3(2.1)1(33.3)
NTM§1(0.7)--
Xpert MTB/RIF test
Total1(100.0)
Negative1(100.0)
Positive--
Rapid detection of INH/RIF resistance
Total3(100.0)
Sensibility1(33.3)
Resistance**2(66.7)
Drug sensitivity test
Total3(100.0)
Sensibility1(33.3)
Resistance††2(66.7)

＊ 'Active pulmonary tuberculosis' or 'exudative pleural effusion' which is presumed to be tuberculous, suggesting the treatment of tuberculosis, sputum examination for confirmation.

† Any suspicion of 'active tuberculosis' or 'suspected tuberculosis', the final diagnosis of the doctor is necessary, including the additional tuberculosis test including sputum examination and the clinical findings of the patient in public health centers and medical institutions.

‡ Pulmonary tuberculosis has developed in the past but has remained healed and remains traces of fibrotic changes.

§ Nontuberculous mycobacteria (NTM).

‖ M. tuberculosis-polymerase chain reaction (TB-PCR).

M. tuberculosis (MTB) / Rifampin (RIF).

** Case 1: INH, Case 2: INH, RIF.

†† Case 1: INH, Case 2: INH, RIF, EMB, PZA, RFB, Km, Am, S, Lfx, Mfx, Ofx, Pto.

Figure 1. Tuberculosis (TB) screening procedure

Figure 2. Photographs of tuberculosis (TB) screening in Chok Bang (Shabby One-room)

Figure 3. Protocol for the management of tuberculosis (TB) screening and treatment of homeless people

Fig 1.

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Figure 1.Tuberculosis (TB) screening procedure
Public Health Weekly Report 2020; 13: 654-668

Fig 2.

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Figure 2.Photographs of tuberculosis (TB) screening in Chok Bang (Shabby One-room)
Public Health Weekly Report 2020; 13: 654-668

Fig 3.

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Figure 3.Protocol for the management of tuberculosis (TB) screening and treatment of homeless people
Public Health Weekly Report 2020; 13: 654-668
General characteristics of screening participants and tuberculosis (TB) patients
VariablesScreening participantsTB patients
n(%)n(%)
Total483(100.0)3(100.0)
Sex
Male415(85.9)3(100.0)
Female68(14.1)--
Nationality
Korean472(97.7)3(100.0)
Non-Korean11(2.3)--
Age
< 408(1.7)--
40-4410(2.1)--
45-4940(8.3)1(33.3)
50-5462(12.8)1(33.3)
55-5980(16.6)1(33.3)
60-6493(19.3)--
65-6982(17.0)--
70-7443(8.9)--
75-7933(6.8)--
≥ 8032(6.6)--
Type of insurance
Health insurance(work)32(6.6)--
Health insurance(district)89(18.4)--
Medical care(type 1)310(64.2)1(33.3)
Medical care(type 2)9(1.9)--
Unqualified person23(4.8)2(66.7)
Missing20(4.1)--
TB symptoms
Yes172(35.6)1(33.3)
No311(64.4)2(66.7)
TB history
Yes33(6.8)--
No182(37.7)1(33.3)
Unknown268(55.5)2(66.7)
Underlying disease
Yes147(30.4)2(66.7)
No336(69.6)1(33.3)
Smoking
Yes345(71.4)3(100.0)
No111(23.0)--
Unknown27(5.6)--
Drinking
Yes256(53.0)3(100.0)
No227(47.0)--
Recent contact with TB patients
Yes2(0.4)--
No35(7.2)--
Unknown446(92.3)3(100.0)
Level of daily activity
Normal454(94.0)3(100.0)
Physically disabled25(5.2)--
Bed-ridden4(0.8)--
TB screening for the past year
Yes262(54.2)2(66.7)
No211(43.7)1(33.3)
Unknown10(2.1)--
Examination results of screening participants and tuberculosis (TB) patients
VariablesScreening participantsTB patients
n(%)n(%)
Chest x-ray
Total482(100.0)3(100.0)
Normal354(73.4)--
Need treatment＊2(0.4)--
Observation required†19(3.9)3(100.0)
Inactive TB‡76(15.8)--
Other diseases suspected31(6.4)--
Sputum smear
Total141(100.0)3(100.0)
Negative140(99.3)3(100.0)
Positive1(0.7)--
Sputum culture
Total141(100.0)3(100.0)
Negative125(88.7)--
Positive3(2.1)3(100.0)
MIX1(0.7)
NTM§7(5.0)--
Pollution5(3.5)--
TB-PCR test‖
Total141(100.0)3(100.0)
Negative137(97.2)2(66.7)
Positive3(2.1)1(33.3)
NTM§1(0.7)--
Xpert MTB/RIF test
Total1(100.0)
Negative1(100.0)
Positive--
Rapid detection of INH/RIF resistance
Total3(100.0)
Sensibility1(33.3)
Resistance**2(66.7)
Drug sensitivity test
Total3(100.0)
Sensibility1(33.3)
Resistance††2(66.7)

＊ 'Active pulmonary tuberculosis' or 'exudative pleural effusion' which is presumed to be tuberculous, suggesting the treatment of tuberculosis, sputum examination for confirmation.

† Any suspicion of 'active tuberculosis' or 'suspected tuberculosis', the final diagnosis of the doctor is necessary, including the additional tuberculosis test including sputum examination and the clinical findings of the patient in public health centers and medical institutions.

‡ Pulmonary tuberculosis has developed in the past but has remained healed and remains traces of fibrotic changes.

§ Nontuberculous mycobacteria (NTM).

‖ M. tuberculosis-polymerase chain reaction (TB-PCR).

M. tuberculosis (MTB) / Rifampin (RIF).

** Case 1: INH, Case 2: INH, RIF.

†† Case 1: INH, Case 2: INH, RIF, EMB, PZA, RFB, Km, Am, S, Lfx, Mfx, Ofx, Pto.

References

  1. World Health Organization(WHO). Global Tuberculosis Report 2019 (2019).
  2. 보건복지부 질병관리본부. "결핵 신규환자 2만 6433명으로 전년 대비 6.4% 감소, 65세 이상 어르신 결핵환자는 전체의 45.5%". 보도자료. 2019.3.21.
  3. 보건복지부 질병관리본부. 결핵예방관리 강화대책, 결핵예방관리 강화대책 세부실행과제 (2019).
  4. 대한결핵협회. "쪽방촌 거주자 결핵검진 통해 결핵환자 3명 발견". 보도자료. 2019.11.7.
  5. 김희진. 한국에서의 결핵현황. 대한내과학회지 2012;82(3):257-262.
    Self
  6. Christie Y J, et al. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5:e152.
    Pubmed KoreaMed CrossRef
  7. Hsien Ho L, et al. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med 2007;4:e20.
    Pubmed KoreaMed CrossRef
  8. Sun Ha J, et al. Smoking and Risk of Tuberculosis Incidence, Mortality, and Recurrence in South Korean Men and Women. American Journal of Epidemiology 2009;170(12):1478-1485.
    Pubmed KoreaMed CrossRef
  9. Lonnroth K, et al. Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public Health 2008;8:289.
    Pubmed KoreaMed CrossRef
  10. Dias M, et al. Tuberculosis among the homeless: should we change the strategy?. Int J Tuberc Lung Dis 2017;21(3):327-332.
    Pubmed CrossRef
  11. Bamrah S, et al. Tuberculosis among the homeless, United States, 1994-2010. Int J Tuberc Lung Dis 2013;17(11):1414-1419.
    Pubmed KoreaMed CrossRef
  12. Centers for Disease Control and Prevention(CDC). Prevention and control of tuberculosis among homeless persons recommendations of the advisor y council for the elimination of tuberculosis. Recommendations and Reports 1992;41(RR-5):001.
  13. Jit M, et al. Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation. BMJ 2011;343:d5376.
    Pubmed KoreaMed CrossRef

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