The original time series of pulmonary TB cases.

<p>The original time series of pulmonary TB cases.</p

Summer seasonal amplitude of pulmonary TB cases in Wuhan, 2004–2013.

<p>Abbreviation:SE,standard error;CI,confidence interval.</p>§<p>Two-tailed two dependent samples Student's <i>t</i>-test for difference in seasonal amplitudes.</p>¶<p>Kruskal-Wallis test for all pairwise multiple comparison among seasonal amplitudes.</p><p>Summer seasonal amplitude of pulmonary TB cases in Wuhan, 2004–2013.</p

The trend component of time series.

<p>The trend component of time series.</p

Spring seasonal amplitude of pulmonary TB cases in Wuhan, 2004–2013.

<p>Abbreviation:SE,standard error; CI,confidence interval.</p>§<p>Two-tailed two dependent samples Student's <i>t</i>-test for difference in seasonal amplitudes.</p>¶<p>Kruskal-Wallis test for all pairwise multiple comparison among seasonal amplitudes.</p><p>Spring seasonal amplitude of pulmonary TB cases in Wuhan, 2004–2013.</p

The seasonal component of time series.

<p>The seasonal component of time series.</p

Pulmonary TB cases in Wuhan, 2004–2013.

<p>Pulmonary TB cases in Wuhan, 2004–2013.</p

The Prevalence of Drug-Resistant Tuberculosis in Mainland China: An Updated Systematic Review and Meta-Analysis

<div><p>Background</p><p>In recent years, drug resistant tuberculosis (DR-TB) particularly the emergence of multi-drug-resistant tuberculosis (MDR-TB) has become a major public health issue. The most recent study regarding the prevalence of drug-resistant tuberculosis in mainland China was a meta-analysis published in 2011, and the subjects from the included studies were mostly enrolled before 2008, thus making it now obsolete. Current data on the national prevalence of DR-TB is needed. This review aims to provide a comprehensive and up-to-date assessment of the status of DR-TB epidemic in mainland China.</p><p>Methods</p><p>A systematic review and meta-analysis of studies regarding the prevalence of drug-resistant tuberculosis in mainland China was performed. Pubmed/MEDLINE, EMBASE, the Cochrane central database, the Chinese Biomedical Literature Database and the China National Knowledge Infrastructure Database were searched for studies relevant to drug-resistant tuberculosis that were published between January 1, 2012 and May 18, 2015. Comprehensive Meta-Analysis (V2.2, Biostat) software was used to analyse the data.</p><p>Results</p><p>A total of fifty-nine articles, published from 2012 to 2015, were included in our review. The result of this meta-analysis demonstrated that among new cases, the rate of resistance to any drug was 20.1% (18.0%–22.3%; n/N = 7203/34314) and among retreatment cases, the rate was 49.8% (46.0%–53.6%; n/N = 4155/8291). Multi-drug resistance among new and retreatment cases was 4.8% (4.0%–5.7%; n/N = 2300/42946) and 26.3% (23.1%–29.7%; n/N = 3125/11589) respectively. The results were significantly heterogeneous (p<0.001, I² tests). Resistance to isoniazid was the most common resistance observed, and HRSE (H: isoniazid; R: rifampicin; S: streptomycin; E: ethambutol) was the most common form for MDR among both new and retreatment cases. Different drug resistance patterns were found by subgroup analysis according to geographic areas, subject enrolment time, and methods of drug susceptibility test (DST).</p><p>Conclusions</p><p>The prevalence of resistance to any drug evidently dropped for both new and retreatment cases, and multi-drug resistance declined among new cases but became more prevalent among retreatment cases compared to the data before 2008. Therefore, drug-resistant tuberculosis, particularly multi-drug-resistant tuberculosis among retreatment TB cases is a public health issue in China that requires a constant attention in order to prevent increase in MDR-TB cases.</p></div

Flow chart depicting the study selection process.

<p>*The reasons including irrelevant topic, articles from Chinese non-scientific-key journals, review, insufficient data.</p

Proportion of tuberculosis cases by month of report.

<p>Month begins with January and is abbreviated by first letter. It shows that TB cases exhibit a peak in March and a trough in December across the entire study period.</p

Time series of tuberculosis report rate in Hubei Province, China between Jan 2004 and Dec 2011.

<p>Time series of tuberculosis report rate in Hubei Province, China between Jan 2004 and Dec 2011.</p