Drug-Resistant Tuberculosis in Zhejiang Province, China, 1999–2008

Xiaomeng Wang, Qian Fu, Zhijun Li, Songhua Chen, Zhengwei Liu, Hugh Nelson, Qun Yang, Zhongwei Jia

, and Christopher Dye

Author affiliations: Center for TB Control in Zhejiang, Hangzhou, People’s Republic of China (X. Wang, S. Chen, Z. Liu); Capital Medical University, Beijing, People’s Republic of China (Q. Fu, Q. Yang); National Research Institute of Food and Fermentation Industries, Beijing (Z. Li); International SOS Clinic, Shekou, People’s Republic of China (H. Nelson); Peking University, Beijing (Z. Jia); World Health Organization, Geneva, Switzerland (C. Dye)

Abstract

To evaluate levels and trends in drug-resistant tuberculosis (TB) in Zhejiang Province, China, we conducted 1 survey in each of 3 years (1999, 2004, and 2008). We found that <5% of new cases were multidrug-resistant TB. The prevalence of multidrug-resistant TB has not increased in new or re-treated cases in this province.

In 2009, China reported results of a nationwide drug resistance survey, which found that 5.7% of new cases of tuberculosis (TB) and 25.6% of re-treated cases were infections with multidrug-resistant TB (MDR TB), i.e., resistance to isoniazid and rifampin (1). These results indicated that in 2008 in China, MDR TB developed in ≈100,000 persons, which is ≈25% of the total number of TB cases (440,000) and similar to that in India (1).

In China, in addition to the 2008 national survey of TB drug resistance and 10 annual national TB surveys, surveys of TB drug resistance have been conducted in several provinces (2–4). Zhejiang is one of the few provinces that have conducted a series of cross-sectional surveys from which we can evaluate the scale of the drug-resistance problem at one time point and changes over time.

Data from a sequence of surveys are vital in assessing evolution of resistance to TB drugs in China and ultimately in evaluating the effect of control measures. We report findings of 3 cross-sectional surveys, 1 each of which conducted in Zhejiang in 1999, 2004, and 2008. These surveys included prevalence of MDR TB among TB cases diagnosed in clinics, trends, and risk factors for resistance to isoniazid and rifampin singly and in combination.