National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery

Vysne Hagy, Slovakia

The Institute is located on thesouthern slope of the High Tatras at a height of 1,124 metres above the sea level. Its total area of 62 hectares is situated amides pine forests. The main building of the sanatorium is a nine-storied single block with a reinforced conceit skeleton. The material filling in the skeleton was specially evolved for the mountainous climate. The building is insulated by cork and its surface is covered by tiles.

The village of Vysne Hagy was founded by the rich noble family Mariassy at the end of the 19th century as their summer seat. All the complex was later bought by the count Kristian Hohenlohe von Oehringen and that time already wealthy aristocrats treated their simpler forms of lung diseases in this fresh mountain air. When tuberculosis epidemic reached its peak and in the therapeutic  hopelessness dawned a flash of hope only in climatic treatment in mountains this locality was chosen as the site suitable for construction of the sanatorium.

The realisation was taken by the Workers' social insurance. The project was worked out by the Prague enterprise Ing. Libra and Kahn in 1933. The construction of the huge object began in 1934. The main building of the sanatorium was situated in the altitude of 1,136 m on the big moraine extending from the Strbske Pleso to Tatranska Lomnica and it was the largest contemporary construction in Czechoslovakia at the time.

The main block of the sanatorium - in the form of a plane - is 270 m long. Its capacity is 180,000 cubic meters. It has 1,950 rooms with 3,000 doors and 2,500 windows. If somebody wanted to open all the windows he would have to pas 35 km and if for opening one window one minute is supposed this walk would last approximately 50 hours.

The National Institute enjoys a legal status of a highly-specialised expert institute, a specialised hospital. It provides complex institutional care health care. Performing of conservative and surgical diagnostics and treatment  in the field of pneumology and tuberculosis, and illnesses in the field of gynaecology, urology, ophthalmology and general surgery.

Address:

National Institute for TB, Lung Diseases and Thoracic Surgery, Vysoke Tatry

Phone: +421 52 4414 413

Fax: +421 52 4497 715

e-mail: hagy@hagy.sk

National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery, Vysne Hagy

History

A systematic approach to the treatment of TB started in Czechoslovakia in the middle of the 20^th century. National clinical practice guidelines on diagnostic, treatment and prevention of TB were put in place and are regularly updated to reflect updated recommendations of WHO since 1953. The recent updates took place in: 1994 – implementation of DOTS strategy, 1998 – implementation of new reporting system and in 2006 – new diagnostic methods for screening of TB infection. LTBI is carried out in contact of infectious TB patients, professional contacts of risk groups and persons with risk factor such as co-morbidity for break down to active disease. Latent TB infection is detected by tuberculin skin test and interferon gamma release assays. Persons with positive screening results undergo preventive therapy. The management of TB was not disrupted by political changes at the beginning of the 90ties, when Czecho-Slovakia was dissolved.

The national coordination centre for TB is located in the National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery, Vysne Hagy, High Tatras. A National TB Register with individualized data about TB patients is housed in the Institute since 1988 and MDR-unit was created in the Institute in 1998. The recording and reporting system was revised in 1998, since then, the national register records notifications of new TB cases and treatment outcomes as specified by WHO. There is a link between reports provided by the specialists on new TB cases and the fact finding reporting system of bacteriological laboratories on bacillary TB. All TB cases confirmed by positive bacteriological test are verified with the reporting system on bacillary TB and are registered in The National TB Register.

National TB control network in Slovakia

National TB Management Committee is an advisory body established by the Ministry of Health whose responsibility is to provide guidance on control and elimination of TB in Slovakia. The Ministry of Health endorsed legal framework for TB control which allows health care professionals to enforce isolation, diagnosis and treatment of non-compliant patients.

It is possible to admit all patients with suspected or confirmed TB to the general hospitals (or sanatoriums) where initial directly observed treatment (DOT) is provided. If the patient is found negative the initial and follow-up treatment is provided through the outpatient-clinics. There are 101 specialists for TB and lung diseases covering all territory of Slovakia and each citizen has the right to access them for consultation. Each general practitioner is familiar with the system of TB management and knows where to refer patients with suspected tuberculosis. In the case of drug resistant TB, especially MDR-TB, the patients are referred to the National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery, Vysne Hagy in High Tatras. The treatment of drug resistant TB must be supervised by health care personnel. If the thorax surgery must be performed it can be undertaken in one of the two specialized health care facilities – in Bratislava (Chest clinic of University hospital) or in Vysne Hagy (National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery).

The management of TB patients has been taught systematically to all the health care professionals since 1953. Health care professionals are expected to possess optimal clinical, microbiological and public health skills. However, in recent years additional skills in intercultural communication became essential too.

Statistics/Results

Implementation of the systematic approach to TB management and follow-up led to the reduction of TB cases in Slovakia from 1795 newly diagnosed cases of TB in 1993 to 732 cases – incidence 13,2/100.000 inhabitants in 2006. Today Slovakia has reached the elimination phase of TB epidemic. There are eight regions in Slovakia. The epidemiological situation in these eight regions is similar to the situation in Central and Eastern Europe. The lowest incidence is registered in the western part of the country (incidence in Bratislava region is 8,0) with increasing number of TB cases notified in northern and specially in eastern part of Slovakia (incidence in Presov region is 21,3).

The significant reduction of TB cases was also recorded in the group of culture positive patients compared to the group with the smear positive test. There were 375 culture positive cases recorded in 2006. However, it is also encouraging to see the reduction of smear positive cases in the last 5 years as they are the most contagious.

The reduction of TB cases in all age groups was observed during the course of the last 10 years. Nevertheless there is still two times more infected men than women. The distribution of TB cases in male population per age group shows the peak in the age groups of 45-55 and over 65, whereas amongst the female population, there is only one peak – in the age group over 65.

The group with the greatest risk in Slovakia is the Roma population (approximately 8% of the population). A special approach in assuring continuity of TB treatment was developed for this particular population i.e. TB Roma assistants operating in the Roma settlements were introduced to strengthen DOT. Monitoring the outcome of treatment is essential for evaluation of the yield of screening.

A small number of children with TB was registered in Slovakia (23 children in 2006 out of which 12 children were from the Roma ethnic group). This represents an incidence of 2,3/100.000 children. There is about 80% of pulmonary TB cases and 20% of extra pulmonary TB. In 2006 12 foreigners living in Slovakia was diagnosed with TB, 10 of them were refugees.

Prevention

TB prevention in Slovakia consists of BCC vaccination of all newborn children and revaccination of children from high risk group at the age of 11 years after negative tuberculin testing.

Conclusion

Slovakia has a functional system of TB management and it is expected it will continue bringing positive results towards TB elimination if the political commitment will endure. However with the decreasing number of patients requiring TB medication there is a growing concern that pharmaceutical companies will loose interest in marketing essential TB drugs. The shortages of these vital drugs would have dramatic consequences on the TB elimination process in Slovakia.