Epidemiological Status of TB (Region of the Americas, 2004)
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Transcript of Epidemiological Status of TB (Region of the Americas, 2004)
Epidemiological Status of TB (Americas, 2004) 1
Pan AmericanHealthOrganization
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Epidemiological Status of TB (Region of the Americas, 2004)
Regional Program on Tuberculosis
Epidemiological Status of TB (Americas, 2004) 2
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Epidemiological Status of TB (Americas, 2004) 3
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Estimated Global Burden of TB (2002)Estimated Global Burden of TB (2002)
World population 6 billion
Population infected with M. TB 1.9 billion
People ill with TB 16 million
New cases annually 8.2 million
Deaths per year 1.8 million
Yearly deaths from TB/HIV 230,000
98% of all deaths from TB take place in developing countries.
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Global Status of Expansion of DOTS/TAES Strategy, 2002
Global Status of Expansion of DOTS/TAES Strategy, 2002
o Multi-resistance to anti-tubercular drugs (MDR-TB) en 63 of the 72 countries surveyed from 1994–1999.
o 73.4% (155 out of 210) of the countries are currently applying DOTS/TAES.
o 61% of the world population has access to the DOTS/TAES strategy.
o 60% of all new infectious, contagious cases (Pulm Bk+) were detected using DOTS/TAES.
o Compared to 1999, there has been an increase of 143,000 Bk+ cases reported using DOTS/TAES (2000–2001). With this increase, goals should be reached by 2013. The search for Bk+ cases would have to be increased by 330,000 yearly to reach the goals by 2005.
o Multi-resistance to anti-tubercular drugs (MDR-TB) en 63 of the 72 countries surveyed from 1994–1999.
o 73.4% (155 out of 210) of the countries are currently applying DOTS/TAES.
o 61% of the world population has access to the DOTS/TAES strategy.
o 60% of all new infectious, contagious cases (Pulm Bk+) were detected using DOTS/TAES.
o Compared to 1999, there has been an increase of 143,000 Bk+ cases reported using DOTS/TAES (2000–2001). With this increase, goals should be reached by 2013. The search for Bk+ cases would have to be increased by 330,000 yearly to reach the goals by 2005.
Epidemiological Status of TB (Americas, 2004) 5
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1990 1995 2000 2005 2010 2015
Year
Cases r
ep
ort
ed
usin
g D
OTS
(%
)
Average progress
2013 goal
Progress sped up:2005 goal
WHO goal = 70%
Start of DOTS 1991
Forecast for Case Detection Using DOTS/TAES
Forecast for Case Detection Using DOTS/TAES
Source: WHO.
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• Cases still on the upswing in Africa and the former USSR. • TB/HIV and MDR-TB are being treated as a problem but are
far from being resolved.• Each country knows its own limitations best when it comes
to controlling disease. • Weakness in public-health systems: communities,
primary care, prisons, city governments, social-security systems.
• Lack of participation on the part of the private sector.
End Result: At the global level, we are still in no position to reach our goals by 2005.
• Cases still on the upswing in Africa and the former USSR. • TB/HIV and MDR-TB are being treated as a problem but are
far from being resolved.• Each country knows its own limitations best when it comes
to controlling disease. • Weakness in public-health systems: communities,
primary care, prisons, city governments, social-security systems.
• Lack of participation on the part of the private sector.
End Result: At the global level, we are still in no position to reach our goals by 2005.
TB in 2003: Where are we?TB in 2003: Where are we?
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• Impact of HIV on TB.• MDR-TB.• Weakness in health systems:
– Community health-workers unutilized. – Private doctors uninvolved. – Primary-care services respond insufficiently. – Prison system unassociated with DOTS/TAES.
• Impact of HIV on TB.• MDR-TB.• Weakness in health systems:
– Community health-workers unutilized. – Private doctors uninvolved. – Primary-care services respond insufficiently. – Prison system unassociated with DOTS/TAES.
Current Global Challenges for TB Control
Current Global Challenges for TB Control
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Epidemiological Status of TB (Americas, 2004) 9
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Trend for TB and BAAR(+) Cases in the Region, 1990–2002
Trend for TB and BAAR(+) Cases in the Region, 1990–2002
0
50,000
100,000
150,000
200,000
250,000
300,000
0
50,000
100,000
150,000
200,000
250,000
300,00029–31 / 100,000 pop.29–31 / 100,000 pop.
15–17 / 100,000 pop.15–17 / 100,000 pop.
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Reporting of TB Cases by Category (Region of the Americas, 2002)
Reporting of TB Cases by Category (Region of the Americas, 2002)
Category No. of cases
% Rate * 100,000
All types 223,057 100,0 26,2
BAAR (+) 122,717 55,0 14,4
BAAR (-) 38,990 17,5 4,6
No BAAR 18,889 8,5 2,2
Extra Pulm 31,239 14,0 3,7
Relapses 11,222 5,0 1,3Source: Annual reports from national TB programs in the countries.
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Reporting of TB Cases by Gender(Region of the Americas, 2002)
Reporting of TB Cases by Gender(Region of the Americas, 2002)
58%
42%
Male Female
58%
42%
Male Female
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Burden of TB(Region of the Americas, 2002)
Burden of TB(Region of the Americas, 2002)
75%
Total: 223,057
Haiti
Dom. Rep.
Mexico
Honduras
Ecuador
Peru
Bolivia
Brazil
Nicaragua
Peru
Brazil
50%
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Estimated TB Incidence Rate(Latin America, 2003)
Estimated TB Incidence Rate(Latin America, 2003)
Estimated Incidence Rate per 100,000 pop.
> 85 >50-84 25-49 <24
Bolivia Dominican Republic Ecuador Guatemala Guyana Haiti Honduras Nicaragua Peru
Bahamas Brazil Colombia El Salvador Panama Paraguay Suriname
Argentina Belize Chile Mexico Uruguay Venezuela
English Caribbean Costa Rica Cuba Canada Jamaica Puerto Rico USA
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Prevalence of HIV Infection among Patients with TB
(selected countries of the Americas, 2002)
Prevalence of HIV Infection among Patients with TB
(selected countries of the Americas, 2002)
NY 1997 26%
MEX1990-1994 3.1%
GUT20008.0%
ELS20024.4% NIC
2002 2.5%
HON 2002
6.0%
ARG 1995
2.2%
URU 1997
0.7%
Rio de Janeiro - BRA 1995-1998
35.6%
Source: Reports from TB control programs.
* Caribbean Epidemiology Centre (CAREC).
English-speaking Caribbean (2001)*
BAH 40%BEL 12.8%GUY 30.8%JAM 30%SUR 31.1%TRT 52.8%
DOR 1997 17%
PER2002 1.99%
CR 2002
8.9%
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Prevalence of TB/AIDS
Source: Reports from national TB programs.
Country Year% TB cases
among PLWHA Type of AIDS epidemic
El Salvador2002 11.5 Concentrated
Guyana 2000 13.7 Generalized
Haití 1999 63.8 Generalized
Honduras 2002 9 Generalized
Nicaragua 2002 2.5 Concentrated
Panama 2002 24.8 Generalized
Peru 2001 34.2 Concentrated
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Status of Prevalence of HIV/AIDS among TB Patients in the
English-Speaking Caribbean
Status of Prevalence of HIV/AIDS among TB Patients in the
English-Speaking Caribbean
Country No cases TBSeroprevalence
HIV% of patients with
HIV testBahamas * 42 40.5 100Belize 119 11.7 100Guyana * 422 30.8 47Jamaica 101 30 79Suriname 92 31.1 66Trinidad & Tobago 179 52.8 58* 2001 data from CAREC. Source: CAREC.
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Anti-TB Drug-Resistance
Studies(Americas, 1999–2002)
Surveys completedSurveys in progressNo survey project
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USA 1.2%
CUBA 0.3%
PERU 3.0%
PR2.5%
NIC 1.2%
R.DOM 6.6%
ARG
1.8%
URU
0.01%
BRA 0.9%
(MDR-TB < 3%)
MDR in Initial Resistance to Anti-TB Drugs
(Americas, 1994–2002)
CHI 0.6%
BOL 1.2%
CAN 1.2%
COL 1.47%
VEN 0.3%
MEX 3 estados 2.4%
ECU 5.0%
ELS0.3%
HON 1.8%
(MDR-TB =< 1%)
(MDR-TB >= 3%)
No data
GUA 3.7%
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Figures on Resistance and MDR (by type and country, Americas, 1994 –2002)
Source: PAHO/WHO Registries.
CountriesIR 1994-2002 or Countries
AR 1994-2002 or
Partialresistance Global
Partialresistance Global MDR
Bolivia 1996 23.9 Bolivia 1996 42.1 4.7Brazil 1995 8.6 Brazil 1995 14.4 5.4Mexico 1997 14.1 Mexico 1997 41.1 22.4
Nicaragua 1997 15.6 Nicaragua 1997 - - Puerto Rico 1997 11.3 Puerto Rico 1997 58.3 16.7
Dom. Rep. 1994 40.6 Rep. Dom. 1994 52.1 19.7Uruguay 1997 1.7 Uruguay 1997 93.8 6.3
Venezuela 1998 7.3 Venezuela 1998 26.9 3.8Chile 2001 10 Chile 2001 20.6 3.4
Colombia 1999 13.4 Colombia 1999 - - Cuba 2000 5 Cuba 2000 15.8 2.6Ecuador* 2002 23.4 Ecuador 2002 52.6 24.8
El Salvador 2001 6.5 El Salvador 2001 37 7
Honduras* 2002 17.2 Honduras* 2002 41.4 6.9Peru 1999 18 Peru 1999 23.5 12.3
Argentina 1999 10.2 Argentina 1994 22.8 9.4Paraguay* 2002 17 0 Paraguay 2002 21 4Guatemala 2002 40 3.7 Guatemala 2002 52.4 22.8
Acquired Resistance (AR)
Resistance Resistance
MDR
1.20.9
Initial Resistance (IR)
2.4
1.22.5
6.60
0.30.7
0.5
3
1.8
0.36.6
0.3
1.8