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Transcript of Global TB Report 2009
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WHO RepORt 2009
Gb Tbecss CtEpidEmioloGy, STraTEGy, FinanCinG
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Wod Hah Oazao 2009
a ghts eseve. pbcts the W Heth ogzt c be bte WHo pess, W Heth ogzt, 20 avee a, 1211
Geev 27, Swtze (te.: +41 22 791 3264; x: +41 22 791 4857; e-: [email protected]). reqests ess t ece tste
WHo bcts whethe se cec stbt sh be esse t WHo pess, t the bve ess (x: +41 22 791 4806;
e-: [email protected]).
The esgts ee the esett the te ths bct t the exess whtseve the t
the W Heth ogzt cceg the eg stts ct, tet, ct e ts thtes, cceg the ett ts
tes bes. dtte es s eeset xte be es whch thee t et be geeet.
The et secc ces cet ctes cts es t tht the e ese ecee b the W Heth
ogzt eeece t thes s te tht e t ete. Es sss excete, the es et cts e
stgshe b t ct ettes .
a esbe ects hve bee tke b the W Heth ogzt t ve the t cte ths bct. Hweve, the b-
she te s beg stbte wtht wt k, ethe exesse e. The essbt the teett se the te
es wth the ee. i evet sh the W Heth ogzt be be ges sg ts se.
Cve esg b T Htt, WHo St TB detet. o the estte 9.3 ew cses TB tht cce 2007, 1.4 (15%) wee ecte
wth HiV. The WHo ac reg ccte 79% these HiV-stve TB cses, we b the WHo Sth-Est as reg (11%). i the bsece
te tetet, the tt te HiV-stve TB cses s hgh. Hweve, ths te c be sgct ece ve-tte HiV testg s
e vbe t TB tets tevets sch s e tetv the e e vbe t thse wh e HiV-stve. The cve ges t cht shwg the etve ctbt ctes (be ts) WHo egs (gee ts) t the gb be HiV-stve TB.
desge b ghcs
pte Swtze
WHo lb Ctgg--pbct dt
Gb tbecss ct : eeg, stteg, cg : WHo et 2009.
1.Tbecss, p evet ct. 2.Tbecss, p eeg. 3.Cst ess.
4.Tetet tce. 5.nt heth gs gzt stt. 6.Fcg, Heth.
7.Sttstcs. i.W Heth ogzt.
iSBn 978 92 4 156380 2 (nlm cssct: WF 300)
WHo/HTm/TB/2009.411
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 iii
Co
ackwegeets
abbevts
Ky oins 1
Inroducion 5
Char 1. eidmioogy 6
Gs, tgets cts TB ct 6
TB cece, evece tt 7
icece 7
pevece 12
mtt 12S gess tws mdG St TB ptesh ct tgets 14
ivg eseet gess tws the 2015 ct tgets: the WHo Gb Tsk Fce
TB ict meseet 16
meseet cece 16
meseet evece 19
meseet tt 20
Stts ct eseet HBCs t the e 2008 20
Cse tcts 22
Tt cse tcts 22
Cse tcts sggegte b sex 22
Cse etect tes 23
Cse etect te, sces (doTS -doTS ges) 23
Cse etect te, doTS ges 26
otces tetet doTS ges 27
new se-st ve cses 27
re-tetet cses 29
Cs tetet tces HiV-stve HiV-egtve TB tets 30
pgess tws echg tgets cse etect tetet sccess 30
S 32
Char 2. Sragy 34
dt ete t WHo 2008 35doTS exs ehceet 35
doTS cvege bes tets tete 35
ptc ctet 37
E cse etect thgh qt-sse bcteg 37
Stze tetet wth sevs, tet st 40
dg s geet sste 41
mtg evt 41
aess TB/HiV, mdr-TB, the ees vebe ts 43
Cbtve TB/HiV ctvtes 43
dgss tetet mdr-TB 49
p vebe ts 54
Ctbte t heth sste stegtheg bse heth ce 54
itegt heth ce 54
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ivWHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
aget wth be g cg ewks 55
H esce eveet 55
iect ct 55
pctc ach t lg Heth 56
Egge ce ves 57
pbcvte x ches 57
itet Sts Tbecss Ce 58Ewe ee wth TB, ctes thgh tesh 58
avcc, cct sc bzt 58
Ct tct TB ce 58
ptets Chte Tbecss Ce 58
Ebe te esech 58
S 59
Char 3. Financing 60
dt ete t WHo 2008 60
nTp bgets, vbe g g gs 60
Hgh-be ctes 60
a ctes 63
Tt csts TB ct 64
Hgh-be ctes 64
a ctes 67
Css wth the Gb p 69
Hgh-be ctes 69
a ctes 69
Bgets csts e tet 71
Exetes ce wth vbe g chges the be tets tete 72
Gb F cg 74
Hgh-be ctes 74a ctes 74
Fg gs the gb c css 75
S 77
Concusions 78
Ann 1. profs o high-burdn counris 79
Ann 2. Mhods
dt cect vect vevew 173
Eeg svece 174
ieett the St TB Stteg 180
Fcg 181
Ann 3. th So tB Sragy, cas rors, ramn oucoms and simas o tB burdn 187
Ext tes 188
S b WHo eg 191
ac 197
The aecs 217
Este metee 237
Ee 249
Sth-Est as 269
Weste pcc 281
Ann 4. Survys o ubrcuosis disas and avaiabiiy o dah rgisraion daa a WHO,
by counry and yar 301
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 v
Ackowdm
Ths et ws ce b ce te 15 ee: rche Bqeez, l Bc, a Beebch, aeeke Bs,
Ke Cce, des Fz, Kthee F, phe Gz, Chst Gebeg, T Htt, meh Hsse, ae p-
tj, mk uek, Cthee Wtt abg Wght. ove ct ws ve b l Bc Kthee
F.
The t cect ws evee b meh Hsse Cthee Wtt, wth t vet the st.
meh Hsse gze e eett sects t geet (cg cect, g, v-
t, evew w- wth ctes), wth st T Htt. ae ptj is Gc ccte evew
w- the c t tht e esete Chte 3, aex 1 aex 3. rche Bqeez, aeeke
Bs, des Fz, Chst Gebeg, meh Hsse, abg Wght mtte Zg evewe t ctb-
te t et w- essges t ete t eeg eett the St TB Stteg, the
ests whch e Chtes 1 2 aexes 1 3. dt the Ee reg wee cecte v-te jt b WHo the Ee Cete dsese pevet Ct, gec the Ee u bse
Stckh, Swee.
ret wtg ws e b Kthee F, phe Gz mk uek. K Begst, l Bc, yg-
ae Ch, des Fz, G Gg, Chst Gebeg, meh Hsse, Kt lth, pee-yves nv, iksh
ozk, Fb Sc, l Veebt, K Wee, abg Wght mtte Zg ctbte text tc sects
Chte 2. a Beebch ae ptj ve t t ce evew Chtes 1 3, esectve. H-
eess Geth, p n, m rvge d We ve t t ce evew vs sects the
et. Ke Cce ete the ete et.
phe Gz, meh Hsse Cthee Wtt se svece eegc t ee the
ges tbes Chte 1. meh Hsse se t bt eett the St TB Stteg ee
the ges tbes Chte 2, wth st des Fz, Chst Gebeg T Htt. ae ptjse the c t ee the ges tbes Chte 3, wth st is Gc.
The ct es tht e aex 1 wee esge b aeeke Bs, phe Gz, ae Ge, meh
Hsse, ae ptj Cthee Wtt. The ct ws e b meh Hsse (eeg stteg)
ae ptj (cg), wth st T Htt ae Gx. it t tc sects the es ws
ve b rche Bqeez, is Gc, yg-ae Ch, Kthee F, G Gg, Heess Geth, mgzt
Gzesk, Wesek Jkbwk, de Kbg, Kt lth, iksh ozk, Sh ott, agc S, mk
uek, pete v me, l Veebt abg Wght. aeeke Bs cte the evew these es b
ctes.
Kthee F, phe Gz ae ptj ee aex 2 (eths). T Htt ee aex 3 (ke stts-
tcs egs v ctes), wth st meh Hsse. a Beebch ee ses exstg
e sves the evece tbecss (TB) sese the vbt tt t vt egstt
sstes, whch e esete aex 4.
i t t the ce et te the st ete bve, the et beete the t thes t the
W Heth ogzt (WHo) the Jt ute nts pge HiV/aidS (unaidS), tc t c-
ect evew. ag thse ste bew, we thk tc a Bss, ae d, Khsh a He, de
Kbg, re lez-ote, msk ot agc S the j ctbt t t cect evew.
WHO hadquarrs Gnva and UNAIDS. pe Be, Vct Bg, Ee Gws, Eest J, rbet
mt, F mzev as re.
WHO Arican Rgion. aee awe, r Cht, The Cet, ntkt dthe, Jseh ik, Je Kgg,
Bh Ket, de Kbg, mwewe mbshe, Vess mgwe, ishe ns, We nkh, agc S,
nee Skk Heette Web.
WHO Rgion o h Amricas. r aeg, ab Beett, mth e G, Jh Ehebeg, mee Fcs,
re lez-ote, r rgez-Cz y Sv.
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viWHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
WHO easrn Mdirranan Rgion. i a, Sh Bgh, a Bss, yk Eg, Sev Hsev,
Kek ib, rh Jebe, Wsq Kh, a m, Se K Shh, akh Set, iees S, Bsh Se
Khe St.
WHO euroan Rgion. pe e Cb, ae d, lcc dt, neet Eg, aj Ge, Sbste iz,
Bhtg Kev, S mtc, dv mece, r St, Gbg Tsgt, mt v e B, rsvch Vet,
Ee ysv rch Zesks.
WHO Souh-eas Asia Rgion. mhe akht, Ew Ce, ae de mck, peet dew, Khsh aHe, Hs Kge, pth p m, Fs meht, n n, Sv Sh, K S i, Sbt Thsetk, Fse
Wes S Wsvth.
WHO Wsrn pacifc Rgion. Ce Heg, G mezzbtt, lh nge, Kts osg, msk ot,
Jcqes Sebet, Be Ts, Jhh Tsg, pete V me, mche Vts, rje yv l yhg.
The se ths et s t ve cehesve -t-te ssesset the TB eec gess
ct the sese t gb, eg ct eves. Ths ss s bse t bt tcts TB cses
the tces tetet ( svece sstes) s we s t ete t the eett cg the St
TB Stteg. dt e se b t TB ct ge ges wh e wk svece, stteg
cg ctes. These ee e ste aex 3, we thk the the vbe ctbt
cbt.
The c sce c st WHos wk tg evtg TB ct s the ute Sttes
agec itet deveet, wtht whch t w be ssbe t ce ths et. dt cect -
ss e s ste b g the gveets ast, Beg, C, dek, F, Fce, Ge,
ie, it, J, lxebg, the nethes, nw, Swee, Swtze the ute Kg s we s b ct-
bts the Ee u, the Ee Css, the B & me Gtes Ft. We ckwege wth
gtte the st these geces.
F, we thk Se Hbbs he exceet wk the esg t ths et. Se hs wke wth the St TB
detet ths ject es, he ctbt s get ecte. as s, he fexbt ecec
gtee tht ths et s bshe 24 mch, W TB d.
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 vii
Aao
aCSm vcc, cct sc
bzt
aFB c-st bc
aFr WHo ac reg
aFro WHo reg oce ac
aidS cqe ecec se
amr WHo reg the aecs
amro WHo reg oce the aecs
ari sk ect
arT tetv theBmu bsc geet t
BraC Bgesh r avceet Cttee
CpT c-txze evetve the
CTBC ct-bse TB ce
dHiS dstct Heth it Stwe
doT ect bseve tetet
doTS the bsc ckge tht es the
St TB Stteg
drS g esstce svece sve
dST g sscetbt testg
ECdC Ee Cete dsese pevet
Ct
Emr WHo Este metee reg
Emro WHo reg oce the Este
metee
EnrS Eectc nt rec Sste
EQa exte qt ssce
Eur WHo Ee reg
Euro WHo reg oce Ee
FdC xe-se cbt ( FdC t-TB g)
FidEliS F ivtve doTS Exs,ge b the u
Find Ft ivtve new dgstcs
GdF Gb TB dg Fct
GlC Gee lght Cttee
Gli Gb lbt ittve
Gb F The Gb F t ght aidS, Tbecss
m
Gb p Gb p t St TB, 20062015
Gni gss t ce
HBC hgh-be ct whch thee e 22
tht cct xte 80%
ew TB cses sg ech e
HiV h ecec vs
Hrd h esce eveet
iCd-10 itet Sttstc Cssct
dseses
iEC t, ect, cct
ipT sz evetve the
irr cece te t
iSTC itet Sts Tbecss Ce
Kap kwege, tttes ctce
mdG me deveet G
mdr tg esstce (esstce t, t est,sz c)
mdr-TB tg-esstt tbecss
nGo gveet gzt
nrl t eeece bt
nTp t tbecss ct ge
eqvet
oemrS oe mec recs Sste
pal pctc ach t lg Heth
ppm pbcpvte mx
ppp pbcpvte pteshs
rdBmS et tbse geet sste
SCC sht-cse chethe
SEar WHo Sth-Est as reg
SEaro WHo reg oce Sth-Est as
Srl st eeece bt
Srln st eeece bt etwk
TB tbecss
TBTEam TB Techc assstce mechs
unaidS Jt ute nts pge
HiV/aidS
uniTaid tet ct the chse gs t tet HiV/aidS, TB
uSaid ute Sttes agec itet
deveet
WHa W Heth asseb
WHo W Heth ogzt
WHo-CHoiCE CHosg itevets tht e Cst-
Eectve
Wpr WHo Weste pcc reg
Wpro WHo reg oce the Weste pcc
Xdr-TB TB cse b mdr sts tht e s
esstt t fqe , t est,e sec-e jectbe get (kc,
kc / cec)
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 1
Ky o
1. Ths et s the 13th et gb ct
tbecss (TB) bshe b the W Heth og-
zt (WHo) sees tht stte 1997. its
se s t ve cehesve -t-te
ssesset the TB eec gess ct-
g the sese t gb, eg ct eves, the ctext gb tgets set 2015. rests e
bse t ete t WHo v ts st-
TB t cect 2008 the t
tht wee cecte eve e 1996 t 2007. The
196 ctes tetes tht ete t 2008
cct 99.6% the ws estte be
TB cses 99.7% the ws t.
2. The tgets gb TB ct e () tht the
cece TB sh be g b 2015 (mdG T-
get 6.c), () tht TB evece eth tes sh
be hve b 2015 ce wth the eve 1990,() tht t est 70% cet se-stve cses
sh be etecte tete doTS ges
(v) tht t est 85% cet se-stve
cses sh be sccess tete. The test t
sggest () tht the cece te hs bee g
sce 2004, () tht evece eth tes w be
hve t est thee sx WHo egs b 2015 c-
e wth bsee 1990, bt tht these tgets
w t be cheve the w s whe, () tht
the cse etect te eche 63% 2007 (v)
tht the tetet sccess te eche 85% 2006.
o tve es ts essetes t 2009 e omS et tte
ttbecese s e e s e ste Web q c-esss:
ls ts ces e e e 2009 e omS sbe tbecss se ee
cst e e st web qe se c s bj:
www.who.//cao/oa_o/2009/ky_o/
3. Gb, thee wee estte 9.27 cet
cses TB 2007. Ths s cese 9.24
cses 2006, 8.3 cses 2000 6.6
cses 1990. mst the estte be cses
2007 wee as (55%) ac (31%), wth
s ts cses the Este meteereg (6%), the Ee reg (5%) the reg
the aecs (3%). The ve ctes tht k st
t th tes tt bes cses 2007 e
i (2.0 ), Ch (1.3 ), ies (0.53
), nge (0.46 ) Sth ac (0.46
). o the 9.27 cet TB cses 2007,
estte 1.37 (15%) wee HiV-stve; 79%
these HiV-stve cses wee the ac reg
11% wee the Sth-Est as reg.
4. athgh the tt be cet cses TB s
cesg bste tes s est tgwth, the be cses e ct s g. The
te ece s sw, t ess th 1% e e. Gb,
tes eke t 142 cses e 100 000 t
2004. i 2007, thee wee estte 139 cet
cses e 100 000 t. icece tes e -
g ve the sx WHo egs (the excet s the
Ee reg, whee tes e xte st-
be).
5. Thee wee estte 13.7 evet cses
TB 2007 (206 e 100 000 t), ecese
13.9 cses (210 e 100 000 t) 2006.
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6. a estte 1.3 eths cce g HiV-
egtve cet cses TB (20 e 100 000 -
t) 2007. Thee wee t 456 000 eths
g cet TB cses wh wee HiV-stve; these
eths e csse s HiV eths the itet-
Sttstc Cssct dseses (iCd-10). The
456 000 eths g HiV-stve cet TB cses
eqte t 33% HiV-stve cet cses TB
23% the estte 2 HiV eths 2007.
7. pevece tt tes e g gb
sx WHo egs. The reg the aecs s
we s the Este metee Sth-Est as
egs e tck t cheve the St TB ptesh
tgets hvg evece eth tes b 2015,
ce wth bsee 1990. The Weste pcc
reg s tck t hve the evece te b 2015,
bt the tt tget be w sse. ne-
the the evece the tt tgets w be et
the ac Ee egs. The g betwee
evece tt tes 2007 the tgets
these tw egs ke t ke tht 1990 ev-
ece eth tes w be hve b 2015 the
w s whe.
8. The estte bes HiV-stve TB cses
eths 2007 e xte be the bes
bshe b WHo evs es. Ths es t e
tht the be HiV-stve TB cses the -
be TB eths g HiV-stve ee be
betwee 2006 2007. new t tht bece v-
be 2008, tc ve-tte HiV
testg the ac reg, wee se () t estte
the bes cses eths 2007 () t
evse evs esttes the bes cses
eths tht h cce ee es. The bes
HiV-stve TB cses eths e estte t hve
eke 2005, t 1.39 cses (15% c-
et cses) 480 000 eths.
9. The test esttes the bes HiV-stve TB
cses eths wee bse, s s, esttes
HiV evece the gee t bshe b
the Jt ute nts pge HiV/aidS,
unaidS. The ew t tht bece vbe 2008
wee ect eseets the t TB cses
tht e cecte wth HiV 64 ctes (
15 ctes 2007). These 64 ect eseets
sggest tht HiV-stve ee e bt 20 tes
e ke th HiV-egtve ee t eve TB
ctes wth geeze HiV eec (ce
wth evs estte sx), betwee 26 37
tes e ke t eve TB ctes whee HiV
evece s we (ce wth evs estte
30). These hghe esttes wee se t estte thebe HiV-stve TB cses ctes whch
ect eseets wee t vbe.
10. Thee wee estte 0.5 cses tg-
esstt TB (mdr-TB) 2007. Thee e 27 ctes
( whch 15 e the Ee reg) tht cct
85% sch cses. The ctes tht k st
t th tes tt bes mdr-TB cses e
i (131 000), Ch (112 000), the rss Fee-
t (43 000), Sth ac (16 000) Bgesh
(15 000). B the e 2008, 55 ctes tet-
es h ete t est e cse extesve g-
esstt TB (Xdr-TB).
11. The WHo Gb Tsk Fce TB ict meseet
hs ce ecets bt hw t ese
gess ecg tes TB cece, evece
tt (the thee j cts ct).
These ce sstetc ss t sb-
t tct t cbe wth ve s-
vece sstes t ese cece, sves the
evece TB sese 21 gb cs ctes
betwee 2008 2015, stegtheg vt
egstt sstes t ese TB tt g
the cses eth. ieett Tsk Fce
ecets s ecess t ve eseet
gess tws the gb tgets set 2015 s
we s t ese gess TB ct sbseqet
es.
12. The St TB Stteg s WHos ecee ch
t ecg the be TB e wth gb tgets.
The sx j cets the stteg e: se
hgh-qt doTS exs ehceet; ess
TB/HiV, mdr-TB, the ees vebe
ts; ctbte t heth sste stegtheg
bse heth ce; egge ce v-
es; ewe ee wth TB, ctes thgh
tesh; ebe te esech. The St
TB pteshs Gb p t St TB, 20062015 sets
t the sce t whch the tevets ce the
St TB Stteg ee t be eete t cheve the
2015 tgets.
13. i 2007, 5.5 TB cses wee te b doTS -
ges (99% tt cse tcts). Ths ce
2.6 se-stve cses. The cse etect te
ew se-stve cses e doTS (tht s, the e-
cetge estte cet cses tht wee te
tete doTS ges) ws 63%, s
cese 62% 2006 bt st 7% sht the t-
get 70% st set 2000 ( te eset t 2005)
b the W Heth asseb (WHa) 1991. The tget
ws et 74 ctes tw egs the reg
the aecs (73%) the Weste pcc reg
(77%). The Sth-Est as reg (69%) st et
the tget. The cse etect te ws 60% the Est-
e metee reg, 51% the Ee reg 47% the ac reg.
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 3
14. Gb, the te tetet sccess ew se-
stve cses tete doTS ges 2006
eche the tget 85% st set b the WHa 1991.
Thee egs the Este metee (86%), West-
e pcc (92%), Sth-Est as (87%) egs
et the tget, s 59 ctes. The tetet sc-
cess te ws 75% the ac reg the reg
the aecs, 70% the Ee reg.
15. i 20062007, the Weste pcc reg 36 c-
tes et bth the tget cse etect te t
est 70% the tget tetet sccess te
t est 85% ew se-stve cses. The Sth-
Est as reg s cse t chevg bth tgets.
Ke bece the st ct sb-Sh ac t
cheve bth tgets.
16. Thee hs bee j gess eetg teve-
ts sch s testg TB tets HiV vg
c-txze evetve the (CpT) tetv- the (arT) t HiV-stve TB tets. Gb,
1 TB tets (16% te cses) kew the
HiV stts 2007. The getest gess HiV testg
ws the ac reg, whee 0.5 TB tets
(37% te cses) kew the HiV stts
2007. o the 250 000 HiV-stve TB tets, 0.2 -
wee ee CpT 0.1 wee stte
arT. i bth cses, ges wee hghe th thse
ete t WHo evs es.
17. deste the gess tht hs bee e wth scg
cbtve TB/HiV ctvtes, gess HiV testgs tcg gess the vs CpT arT.
The be HiV-stve TB tets beg tete
wth CpT arT s s ce wth the 0.3 -
TB tets kw t be HiV-stve, se
st ce wth the estte 1.4 HiV-s-
tve TB cses ( wh e t etecte doTS
ges, gve cse etect te 47%). Cse
etect doTS ges s we s cbtve
TB/HiV ctvtes ee t be exe t ese tht
() e ee kw the HiV stts () tht
thse wh e HiV-stve, wth wtht TB, hve
ccess t te te tetet ce.
18. Gb, jst e 30 000 cses mdr-TB wee t-
e t WHo 2007, st b Ee ctes
Sth ac. Ths ws 8.5% the estte gb
tt se-stve cses mdr-TB. o the te
cses, 3681 wee stte tetet jects -
ges ve b the Gee lght Cttee (GlC),
e ths kw t be ecevg tetet cc-
g t tet gees. Ths s eqvet t 1%
the estte gb tt se-stve cses
mdr-TB. The be tets stte tetet
GlC-ve jects ges s execte
t cese t 14 000 2009, eqvet t
4% the se-stve cses mdr-TB estte t
exst gb. T eet the tgets set the Gb p,
gss tetet mdr-TB ee t be
sce , esec the thee ctes tht cct
57% gb cses: Ch, i the rss
Feet.
19. dgstc tetet sevces TB e tegte
t heth ce st ctes.20. nt s TB ct e ge wth t-
heth stteges e th h the 22 hgh-
be ctes (HBCs). mst nTps e s vvg
the stes, sscts sttts the
eveet the s. Wth eewe ehss
heth sste stegtheg, thee s stg bss
cse cbt ke cheges sch s sst-
be cg, h esce eveet, ect
ct heth t sstes.
21. The ctbt bcvte x (ppm) ttves
t etect tetet TB cses s ct tqt st ctes, bt exes sch s pk-
st the phes (whee bcvte te-
shs ccte 19% 8% tcts
2007, esectve) stte the tet t ctb-
te t cese cse etect. The ctbt c-
tes t gss tetet TB s s h t
qt. m ctes eqe gce st
t esg, eet evte vcc, c-
ct sc bzt ctvtes (aCSm).
22. a tt uS$ 3.0 b s vbe TB ct
2009 94 ctes tht ete t, whchcct 93% the ws TB cses: ths tt,
87% s g gveets (cg s), 9%
s g Gb F gts 4% s g
s the th the Gb F. mst the
vbe g s the Ee reg (uS$ 1.4 b -
, st the rss Feet), we b the
ac reg (uS$ 0.6 b) the Weste pcc
reg (uS$ 0.3 b). The g gs ete b
these 94 ctes t t uS$ 1.2 b 2009.
23. The tt uS$ 4.2 b eqe ee-
tt ct s these 94 ctes 2009s st doTS (uS$ 3 b, 72%). The the
j cets e mdr-TB (uS$ 0.5 b, 12%;
76% the tt mdr-TB s ccte b the
rss Feet Sth ac), cbtve
TB/HiV ctvtes (uS$ 120 , 3%) aCSm
(uS$ 100 , 2%). The eg 11% ces
ppm, sves the evece TB sese, c-
t-bse TB ce vet scees ctv-
tes.
24. i the 22 HBCs whee 80% the ws TB cses cc,
tt uS$ 2.2 b s vbe 2009, scese uS$ 27 ce wth 2008 bt sb-
stt bve the uS$ 1.2 b tht ws set
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4WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
TB ct 2002 (whe WHo beg c t-
g TB ct). mst the cese g sce
2002 hs ce estc g Bz, Ch
the rss Feet, exte cg
the Gb F. The HBCs ete cbe g
g uS$ 0.50.7 b 2009 (the ge efects
cett bt the eve g vc
gveets Sth ac) .
25. The tt uS$ 2.9 b eqe eet-
t ct s the 22 HBCs 2009 s st
doTS (uS$ 2 b, 69%). The the j c-
ets e mdr-TB (uS$ 0.4 b, 14%; 88%
ths tt s ccte b the rss Feet
Sth ac), TB/HiV (uS$ 90 , 3%)
aCSm (uS$ 70 , 2%). The eg 12%
ces ppm, sves the evece TB sese,
ct TB ce vet scees ctv-
tes.
26. o the uS$ 2.2 b vbe the 22 HBCs 2009,
88% s HBC gveets, 8% (uS$ 169 )
s the Gb F 4% (uS$ 94 ) s
gts sces the th the Gb F.
The stbt g sces s eet whe the
rss Feet Sth ac e exce: the
gveet ctbt t vbe g s t
70%, the Gb F ctbt ceses t 19%
gts sces beses the Gb F cct
11%.
27. The g betwee the vbe g ete b
the 22 HBCs 2009 the g eqeets
these ctes ccg t the Gb p 2009 s
uS$ 0.8 b. The g betwee the vbe g
ete b the 94 ctes wth 93% gb cses
2009 the g eqe these ctes
2009 ccg t the Gb p s uS$ 1.6 b.
mst the ext g eqe ccg t the
Gb p s mdr-TB gss tetet
the Sth-Est as Weste pcc egs (st
i Ch), doTS cbtve TB/
HiV ctvtes ac.
28. The gb be TB s g sw, t est
thee sx WHo egs e tck t cheve gb
tgets ecg the be cses eths
tht hve bee set 2015. Hweve, whe cesg
bes TB cses hve ccess t hgh-qt t-
TB tetet s we s t ete tevets sch
s arT, estte 37% cet TB cses e t
beg tete doTS ges, t 96% c-
et cses wth mdr-TB e t beg gse
tete ccg t tet gees, the j-
t HiV-stve TB cses t kw the HiV st-
ts the jt HiV-stve TB tets wh
kw the HiV stts t hve ccess t arT. T
cceete gess gb TB ct, these bes
ee t be ece sg the ge tevets
ches ce the St TB Stteg.
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 5
Ths et s the 13th et gb ct
tbecss (TB) bshe b the W Heth ogz-
t (WHo) sees tht stte 1997. its se
s t ve cehesve -t -te ssesset
the TB eec t et gess ctg the
sese t gb, eg ct eves, the ctext
gb tgets set 2015. The c tgets e tht
the cece TB sh be g b 2015 (mdG Tget
6.c), tht TB evece eth tes sh be hve b
2015 ce wth the eve 1990, tht t est 70%
cet se-stve cses sh be etecte tete doTS ges, tht t est 85% ew s-
t se-stve cses sh be sccess tete.1,2,3,4
rests e bse t ete t WHo v ts
st TB t cect 2008 the t
tht wee cecte ech e 19962007. The 196 ctes
tetes tht ete t 2008 cct 99.6%
the ws estte TB cses 99.7% the ws
t.
The et s stcte thee j chtes.
CHApter 1 cses eeg. it ces WHos
test esttes the eegc be TB (c-ece, evece tt) , cse tcts ete
2007, esttes the cse etect te ew se-
stve cses s we s tes cse betwee 1995
(whe ebe tg beg) 2007, tetet
tces betwee 1994 2006 ew e-tetet
cses. ptc ttet s gve t tw tcs. The st s
te esttes the bes TB cses eths
g HiV-stve ee, whch hve bee evse sb-
stt ws sg ew t tht bece vbe
2008. The sec s ecet ecets bt hw
t ve eseet the eegc be
TB tg gess tws ct tgets (.e.
ects cece, evece tt) 2009
ws, whch hve bee e b WHos Gb Tsk Fce
TB ict meseet.
CHApter 2 ses gess eetg WHos
St TB Stteg, whch s esge t cheve the gb
tgets set 2015.5 The stteg ws che 2006
s bt the ts the doTS stteg, the
tet-ecee ch t TB ct v-
cte b WHo the -1990s t 2005. The sx j
cets the stteg (doTS eett; ess-
g TB/HiV, mdr-TB the ees vebets; ctbtg t heth-sste stegtheg
bse heth ce; eggg ce ves;
eweg ee wth TB, ctes; -
tg esech) e esse t. Wheeve ssbe,
css e e wth the tgets scg te-
vets tht wee set the St TB pteshs Gb
p t St TB. Exes hw eet cets
the stteg c be eete bse ecet ct
exeece whch hve we cbt e s hgh-
ghte. These ce scg bcvte cbt
pkst, tetet tg-esstt TB (mdr-TB)
Est ltv, tcg eectc ecg
etg m, vs tetv tet-
et (arT) ac.CHApter 3 ses cg TB ct. The t
esete ce the bgets t TB ct -
ges (nTps), vbe g g gs
these bgets, betwee 2002 (whe ebe tg
beg) 2009; esttes the tt csts TB ct,
whch ce nTp bgets s the csts sscte wth
se gee heth-sste st stcte tht e
s t ce nTp bgets; css g
ees set t the Gb p wth ctes ssessets
the g ees; e tet csts bgets;
exetes ce wth vbe g chges the be tets tete. pgess wth g
bgetg TB ct the ssbe cseqeces
the gb c css tht evee 2008 e s
hghghte.
The t the et es wth s the
j ccss thee chtes (COnClusiOns).
The ee the et cssts exes. These
ce ct es the 22 hgh-be ctes
(Annex 1), ext eths (Annex 2), ct-
secc t 19902007 (Annex 3), s
the ctes whee sves the evece TB sese
hve bee ccte e e the ctes
whch tt t vt egstt sstes e v-
be cet WHo tbse (Annex 4).
1 The me deveet Gs e escbe t stts..g/s
2 rest WHa44.8. Tbecss ct ge. i: Handbook oresolutions and decisions o the World Health Assembly and the ExecutiveBoard. Ve iii, 3 e. (19851992). Geev, W Heth ogz-t, 1993 (WHa44/1991/rEC/1).
3 Stop Tuberculosis Initiative. Report by the Director-General. Ft-thW Heth asseb. Geev, 1520 m 2000 (a53/5, 5 m2000).
4 de C et . Tgets gb tbecss ct. International Journal
o Tuberculosis and Lung Disease, 2006, 10:460462.5 rvge mC, uek mW. WHos ew St TB Stteg. Lancet, 2006,
367:952955.6 The Global Plan to Stop TB, 20062015. St TB ptesh WHo.
Geev, W Heth ogzt, 2006 (WHo/HTm/STB/2006.35).
iodco
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6WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
L CHapTEr 1
edmooy
WHo hs ssesse the stts the TB eec gess
ct the sese eve e sce 1997. Ths ssess-
et hs ce esttes TB cece, evece
tt ( 1990 ws); ss cse tcts
( 1995) tetet tces ( 1994)
200 ( 212) ctes tetes, wg the stt
ebe ecg etg 1995; ss
gess tws the gb tgets cse etect
tetet sccess estbshe b the W Heth asseb
(WHa) 1991. Sce 2006, WHo hs s ssesse gess
tws chevg the ct tgets ete t cece,evece tt tht hve bee set 2015 wth
the ewk the me deveet Gs (mdGs)
b the St TB ptesh.
Ths chte ves WHos test ssesset the stts
the TB eec gess tws chevg the gb
tgets sg t ete b 196 ctes tetes
(cctg 99.6% the ws estte be TB
cses 99.7% the ws t) 2008 s we
s t ete evs es. it s stcte seve
j sects. The st ees the gb tgets c-
ts TB ct set 2005, 2015 2050. The secsect esets the test esttes TB cece, ev-
ece tt, cg esttes 2007 the
e sce 1990, scsses whethe the w s whe
secc egs e tck t ech the 2015 mdG
St TB ptesh tgets. The esttes TB cece
tt ce tt tes t evs bshe
esttes the bes HiV-stve TB cses eths.
Bg the sec sect, the th sect ves
vevew ecet ecets the WHo Gb
Tsk Fce TB ict meseet bt hw t ese
gess tws the 2015 ct tgets. These ece-
ts cs stegtheg svece ( cses
eths) ctes eetg sves the
evece TB sese 21 gb cs ctes. recet
exes hw the ecets c be e c-
tce e ve. The th sect esets TB tct
t 2007, cg e we sete. The
th sect ces the test esttes the cse etect
te, the sxth sect ets tetet tces 2006,
the seveth sect ssesses eg ct g-
ess tws chevg the tgets bth cse etect
tetet sccess. The chte es wth s the
ests ccss.The eths se t ce the ests esete ths
chte e exe Annex 2. Thght ths chte,
tc ttet s gve t the 22 hgh-be ctes
(HBCs) tht cectve cct 80% cet TB cses
gb. at t e ve HBCs Annex 1
ctes Annex 3.
1.1 Goas, args and indicaorsor tB conro
The gb tgets cts TB ct wee eve-
e wth the ewk the mdGs s we s b the
St TB ptesh the WHa (tAble 1.1).1,2 The ct
tgets e t ht beg t evese the cece TB b
2015 t ece b 50% evece tt tesb 2015 etve t 1990 eves. The cece tget s t
mdG Tget 6.c, whe the tgets ecg evece
eth tes wee bse est the e 2000
eetg the G Eght (G8) stze ctes,
he okw, J. The tce tgets t cheve
cse etect te ew se-stve cses t est
70% t ech tetet sccess te t est 85%
sch cses wee st estbshe b the WHa 1991.
Wth the mdG ewk, these cts wee ee s
the t cses etecte ce e doTS. The
tte g etg TB, ee s the ccece ess th 1 cse e t e e b 2050, ws
set b the St TB ptesh.
The St TB Stteg,3 che b WHo 2006, sets
t the j tevets tht sh be eete t
cheve the mdG, St TB ptesh WHa tgets.
These e ve t sx b cets: () sg
hgh-qt doTS exs ehceet; () ess-
g TB/HiV, mdr-TB the ees vebe
ts; () ctbtg t heth-sste stegtheg
bse heth ce; (v) eggg ce ves;
(v) eweg ee wth TB, ctes thgh
tesh; (v) ebg tg esech. The
Gb p t St TB, che b the St TB ptesh
2006, sets t hw, t wht sce, the St TB Stteg
sh be eete ve the ece 20062015, the
g eqeets.2 Ths es tht t t the t-
gets shw tAble 1.1, the Gb p s ces t
tgets (g eqe e e) tt tgets (
exe, the be tets wth mdr-TB wh sh be
1 de C et . Tgets gb tbecss ct. International Journalo Tuberculosis and Lung Disease, 2006, 10:460462.
2 The Global Plan to Stop TB, 20062015: actions or lie towards a world
ree o tuberculosis. Geev, W Heth ogzt, 2006 (WHo/HTm/STB/2006.35).
3 The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals. Geev, W Heth ogz-t, 2006 (WHo/HTm/TB/2006.368).
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 7
tete ech e, be TB tets t be teste HiV,
be HiV-stve TB tets wh sh be ee
tetv the (arT)) .
Ths chte cses the ve c cts tht
e se t ese the ct tces TB ct:
cece, evece eths (ct cts),
cse etect tetet sccess tes (tce c-
ts). a ss gess tws chevg the tgets
s ve CHApter 2 CHApter 3.
1.2 tB incidnc, rvanc and moraiy
1.2.1 icdc
Bse svece sve t ( Annexes 2, 3
4), WHo esttes tht 9.27 ew cses TB
cce 2007 (139 e 100 000 t), ce
wth 9.24 ew cses (140 e 100 000 t)
2006. o these 9.27 ew cses, estte 44%
4.1 (61 e 100 000 t) wee ew se-
stve cses ( tAble 1.2; Figure 1.1). i, Ch, i-
L tABle 1.1goa, a ad dcao o tb coo
HeAltH in tHe MillenniuM DevelOpMent gOAls
goa 6: Coma Hiv/AiDs, maaa ad oh da
Tget 6c: Ht beg t evese the cece the j seses
ict 6.9: icece, evece eth tes sscte
wth TBict 6.10: pt TB cses etecte ce edoTS
so tb pah a
B 2005: at est 70% ee wth st se-stve TB w be gse (.e. e the doTSstteg), t est 85% sccess tete.The tgets cse etect te t est70% tetet sccess te t est85% wee st set b the W Heth asseb WHo 1991.
B 2015: The gb be TB (e ct evece eth tes) w be ece b 50% etvet 1990 eves.
B 2050: The gb cece ctve TB w be ess th1 cse e t e e.
L tABle 1.2emad dmooca d o tb, 2007
inCidEnCE prEValEnCE morTaliTy
all FormS SmEar-poSiTiVE all FormS HiV-nEGaTiVE HiV-poSiTiVEHiV prEV.
pEr pEr pEr pEr pEr in inCidEnT
populaTion numBEr 100 000 pop numBEr 100 000 pop numBEr 100 000 pop numBEr 100 000 pop numBEr 100 000 pop TB CaSESb
1000s 1000s pEr yEar 1000s pEr yEar 1000s pEr yEar 1000s pEr yEar 1000s pEr yEar %
1 i 1 169 016 1 962 168 873 75 3 305 283 302 26 30 2.5 5.3
2 Ch 1 328 630 1 306 98 585 44 2 582 194 194 15 6.8 0.5 1.9
3 ies 231 627 528 228 236 102 566 244 86 37 5.4 2.4 3.0
4 nge 148 093 460 311 195 131 772 521 79 53 59 40 27
5 Sth a c 48 577 461 948 174 358 336 692 18 38 94 193 73
6 Bgesh 158 665 353 223 159 100 614 387 70 44 0.4 0.3 0.3
7 Eth 83 099 314 378 135 163 481 579 53 64 23 28 19
8 pkst 163 902 297 181 133 81 365 223 46 28 1.4 0.9 2.1
9 phes 87 960 255 290 115 130 440 500 36 41 0.3 0.3 0.3
10 dr Cg 62 636 245 392 109 174 417 666 45 72 6.0 10 5.9
11 rss Feet 142 499 157 110 68 48 164 115 20 14 5.1 3.6 16
12 Vet n 87 375 150 171 66 76 192 220 18 20 3.1 3.5 8.1
13 Ke 37 538 132 353 53 142 120 319 10 26 15 39 48
14 Bz 191 791 92 48 49 26 114 60 5.9 3.1 2.5 1.3 14
15 ur Tz 40 454 120 297 49 120 136 337 12 29 20 49 47
16 ug 30 884 102 330 42 136 132 426 13 41 16 52 39
17 Zbbwe 13 349 104 782 40 298 95 714 6.9 52 28 213 6918 Th 63 884 91 142 39 62 123 192 10 15 3.9 6.0 17
19 mzbqe 21 397 92 431 37 174 108 504 10 45 17 82 47
20 m 48 798 83 171 37 75 79 162 5.4 11 0.9 1.9 11
21 Cb 14 444 72 495 32 219 96 664 11 77 1.8 13 7.8
22 aghst 27 145 46 168 21 76 65 238 8.2 30 0.0 0 0
Hh-d co 4 201 761 7 423 177 3 245 77 11 301 269 1 058 25 339 8.1 14
aFr 792 378 2 879 363 1 188 150 3 766 475 357 45 378 48 38
amr 909 820 295 32 157 17 348 38 33 3.6 7.9 0.9 11
Emr 555 064 583 105 259 47 772 139 97 17 7.7 1.4 3.5
Eur 889 278 432 49 190 21 456 51 56 6.3 8.1 0.9 9.8
SEar 1 745 394 3 165 181 1 410 81 4 881 280 497 28 40 2.3 4.6
Wpr 1 776 440 1 919 108 859 48 3 500 197 276 16 15 0.8 2.7goa 6 668 374 9 273 139 4 062 61 13 723 206 1 316 20 456 6.8 15
icece evece esttes ce TB ee wth HiV.b pevece HiV cet TB cses ges.
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L FIGURe 1.1emad m o w tb ca, y coy, 2007
0999
10009999
10 00099 999
100 000999 999
1 000 000
No estimate
Estimated number ofnew TB cases (all forms)
L FIGURe 1.2emad tb cdc a, y coy, 2007
024
2549
5099
100299
300
No estimate
Estimated new TBcases (all forms) per100 000 population
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 9
es, nge Sth ac k st t th tes
the tt be cet cses; the estte bes
cses these the HBCs 2007 e s shw
tAble 1.2. as (the Sth-Est as Weste pcc
egs) ccts 55% gb cses the ac
reg 31%; the the thee egs (the aecs, E-
e Este metee egs) cct s
cts gb cses. The gte the TB be
wth ctes c s be exesse s the be c-
et cses e 100 000 t (Figure 1.2). ag
the 15 ctes wth the hghest estte TB cece
tes, 13 e ac, hee ke t hgh tes
HiV cect (Figure 1.3; Figure 1.4).
Incidence o TB among people inected with HIV
ag the 9.27 cet cses TB 2007, est-
te 1.37 (14.8%) wee HiV-stve (tAble 1.2).
Ths be, thgh be the estte 0.7
cses 2006 tht WHo bshe 2008,1 es t e
tht the be HiV-stve cses TB be betwee
2006 2007; the, ew t tht bece vbe -
g 2008 hve bee se t estte bth the be
HiV-stve TB cses 2007 t evse esttes the
be sch cses tht cce evs es. The
gb be cet HiV-stve TB cses s estte
t hve eke 2005, t 1.39 . i 2007, s e-
vs es, the ac reg ccte st (79%)
L FIGURe 1.3emad Hiv ac w tb ca, 2007
04
519
2049
50
No estimate
HIV prevalence in newTB cases, all ages (%)
0 200 400 600 800 1000 1200
Congo
Gabon
Cte dIvoire
Togo
Mozambique
Cambodia
Zambia
Sierra Leone
Lesotho
Botswana
Namibia
Zimbabwe
Djibouti
South Africa
Swaziland
Incidence (per 100 000 population per year)
L FIGURe 1.4F co wh h hh mad tb cdc a caa (a om; y a) ad cood cdca o Hiv-o tb ca (d a), 2007
1 Global tuberculosis control: surveillance, planning, fnancing. WHOreport 2008. Geev, W Heth ogzt, 2008 (WHo/HTm/TB/2008.393).
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10WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
HiV-stve TB cses, we b the Sth-Est
as reg ( i) wth 11% tt cses
(Figure 1.5). Sth ac ccte 31%
cses the ac reg.
as ee ets ths sees, the ew
esttes wee ce sg the test gb
esttes HiV evece g the gee
t ( ges) bshe b the Jt utents pge HiV/aidS (unaidS) .1 Thee
e tw ew ete chges t the t
eths se ths et. Fst , ect ese-
ets the evece HiV TB tets
wee vbe ch ge be
ctes ( ve-tte HiV testg
49 ctes sves sete svece
15 ctes). Sec, these ect ese-
ets sggest tht the sk eveg TB
HiV-stve ee ce wth HiV-egtve
ee (the cece te t, irr) s hgh-
e th evs estte ( exe, 20.6ce wth the evs estte 6 c-
tes wth hgh evece HiV the gee
t). new hghe esttes the irr
wee se t ce ect esttes the
be HiV-stve TB cses 104 ctes
whch ect eseets the evece
HiV TB tets wee t vbe.2 The ew
esttes sscte t eths e
sze bOx 1.1 exe eet Annex 2. Esttes ctes e
ce Annex 3.
Estimated incidence o MDR-TB
Esttes the be tg esstt TB
(mdr-TB) e esete b ct, sggegte
b se stts, Annex 3. mst the cet
t bt the t TB cses wth
mdr-TB ces g sscetbt testg
(dST) ses tets wh mdr-TB
s gse bc heth ctes e c-
ts ee b the WHo/iuaTld Gb pject
dg resstce Svece (drS).3 These c-
ts ce cete stsct ece
btes bse exte qt ssce(EQa) eqte ec eve tets
tetet hst. Sch t e vbe ew
e-tetet cses 113 102 ctes,
esectve. usg set we esbe, e-
eet vbes tht e ectve the eqe-
c mdr-TB (sch s gss t ce (Gni)
BOx 1.1
Rvising simas o h numbrs o tB cass and dahsamong HIV-osiiv o
Ths et ces esttes the bes HiV-stve TB cses eths
tht e sbstt hghe th thse bshe evs es. it s estt-
e tht, 2007, thee wee 1.37 cet cses HiV-stve TB (14.8%
tt cet cses) 456 000 eths TB g HiV-stve ee
(eqvet t 26% eths TB HiV-stve HiV-egtve ee, 23% estte 2 HiV-ete eths).1
These estte bes TB cses eths g HiV-stve ee
2007 e xte be thse bshe evs ets. Ths es t
e tht the bes HiV-stve TB cses TB eths g HiV-s-
tve ee be betwee 2006 2007. iste, ew t tht bece
vbe g 2008 hve bee se t estte bth () the bes HiV-
stve TB cses eths 2007 () t evse evs esttes the
bes cses eths tht cce ee es. The evse esttes
sggest tht the be HiV-stve TB cses eths eke 2005 t
1.39 cet cses (15.1% tt cet cses) 480 000 eths.
as evs ets ths sees, the esttes e bse the test gb
esttes HiV evece g the gee t ( ges) bshe
b the Jt ute nts pge HiV/aidS (unaidS).1 Wht s ew
ths et s tht ect eseets the evece HiV TB tets
wee vbe ch ge be ctes. These ect ese-
ets wee st ve-tte HiV testg TB tets (49 c-
tes, 13 ctes the evs e). pve-tte HiV testg
hs bee exe sce 20052006, tb ac ctes (see
s CHApter 2). F the 15 ctes, ect eseets wee vbe
sves sete svece ( tw ctes the evs e).
These 64 ect eseets wee se t estte the be cet HiV-
stve TB cses 64 ctes tht cct 32% the estte tt
1.37 HiV-stve TB cses.
These ect eseets ve stg evece tht the etve sk
eveg TB HiV-stve ee s ce wth HiV-egtve ee (the
cece te t, irr) s hghe th evs estte. The irr ws
estte s 20.6 (95% cece tev (Ci) 15.427.5) 2007 ctes
wth geeze HiV eec (.e. ctes whee the evece HiV s
bve 1% the gee t), s 26.7 (95% Ci 20.434.9) ctes
whee the evece HiV the gee t s betwee 0.1%
1%, 36.7 (95% Ci 11.6116) ctes whee the evece HiV
the gee t s ess th 0.1%. These irr esttes ce wth e-
vs esttes 6, 6 30, esectve.2 Hghe esttes e csstet
wth ects the esttes HiV evece the gee t
bshe 2007 b unaidS (whch b et e t cese ev-
s irr esttes gve eve HiV evece g TB tets)
wth evece tht the irr ceses s the HiV eec tes. The we
cece tevs these irrs stte tht ge cett es,
thgh the getest cett s ctes wth w HiV evece ththve s ct gb esttes. The ew irr ges wee se t
ce ect esttes the be HiV-stve TB cses 104 c-
tes whch ect eseets the evece HiV TB tets wee
t vbe.
T cese the ebt these esttes, the cvege HiV svece
g TB tets ees t be ve. Fthee, ect eths w
bece e betc s the cvege ct tetv the-
(arT) ceses. me t e eee, tc t HiV -
ges, t bette est the ct arT the cece TB.
1 htt://www.s.g/e/KwegeCete/HiVdt/Eeg/testEdt.s
2 These ee esttes the irr wee bse thgh evew the evececcte 20002001. See Cbett El et . The gwg be tbecss:gb tes tects wth the HiV eec. Archives o Internal Medicine,2003, 163:10091021.
1 htt://www.s.g/e/KwegeCete/HiVdt/Eeg/testEdt.s
2 unaidS es t ce esttes HiV evece thegee t the eg 44 ctes tet -es. F ths es, esttes the be HiV-stve
TB cses these ctes tetes wee t ce.3 Anti-tuberculosis drug resistance in the world, 4th report:
the WHO/IUATLD Global Project on Anti-tuberculosis DrugResistance Surveillance. Geev, W Heth ogzt,2008 (WHo/HTm/TB/2008.394).
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 11
e ct, the t e-tetet t ew tets, the
e te sscte wth st-e tetets), t s ssbe
t estte the eqec mdr-TB ctes whee t
hs t bee ese ect. The gee eths se
t ce these esttes e esete Annex 2, whe
Annex 3 ees whethe the ect ect eth ws
se ech ct.
i 2007, thee wee estte 9.27 st e-
ses TB t 1.16 sbseqet e-
ses TB (eses ccg tets wh h e
exeece t est e evs ese TB the st
wh h eceve t est e th t-TB tet-
et). ag these, 10.4 eses TB (st
sbseqet), estte 4.9% 511 000 wee cses
mdr-TB. o these, 289 000 wee g ew cses (3.1%
ew cses) 221 000 wee g cses tht hbee evs tete TB (19% evs tete
cses). o the 511 000 cet cses mdr-TB 2007,
349 000 (68%) wee se-stve. The ctes wth the
gest be cses mdr-TB, ke ecesg
e, e shw Figure 1.6.
Trends in incidence since 1990 and progresstowards MDG Target 6.c
F sees tct t sves (Annexes 2, 3
4), the gb cece TB e ct es t hve
eke 2004 s w ece (Figure 1.7; Figure1.8). Ths ek sbseqet ece w s t-
te t the te HiV evece the gee t
(Figure 1.7). The es wh the be cet cses
L FIGURe 1.5goahca do o mad m oHiv-o tb ca, 2007. F ech ct (e cces) WHo eg (ge cces), the be cet TB csessg ee wth HiV s shw s ecetge thegb tt sch cses.
DR Congo
Cte dIvoire
Mozambique
Zambia
Zimbabwe
South Africa
Russian Federation
1 2 5 10 20 50 90
Percentage of global estimated HIV-positive TB cases
AFR
SEAR
Nigeria
India
Kenya
Ethiopia
UR Tanzania
WPR
EUR
Uganda
AMR
Malawi
China
EMR
Indonesia
Thailand
Cameroon
Rwanda
L FIGURe 1.6Co wh h hh m o mad MDr-tbca, 2007. Hzt es ete 95% cece tevs.The sce esttes s g esstce svece sves(drS, e) eg ( ge).
DR Congo
Cte dIvoire
Mozambique
Zimbabwe
South Africa
Russian Federation
Nigeria
India
Kenya
Ethiopia
UR Tanzania
China
Indonesia
Thailand
Republic of Moldova
2000 10 000 50 000 100 000
Number of cases
BangladeshPakistan
Philippines
Kazakhstan
Ukraine
Uzbekistan
DPR Korea
Viet Nam
Tajikistan
Myanmar
Azerbaijan
Peru
Republic of Korea
Sudan
AfghanistanDRS
Model
L FIGURe 1.7emad cdc o tb ad ac o Hiv o hAca o mo acd y Hiv (Aca hh-Hiv) ,19902007
HIV prevalence in general population
Estimated TB incidence
Casesper100000population/year
200
250
300
350
400
1.5
2.0
2.5
3.0
3.5
Percentage
1990 1995 2000 2005
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12WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
bste tes s cesg (see bve), whe cece
tes e ct e g, s t gwth. i the a-
c, Este metee, Ee Sth-Est as
egs, the ece cece e ct s e th c-
este b ceses t sze.
Tes cece tes v g egs (Figure 1.9).
rtes e g seve e eegc sbegs
(see Annex 2 et the ctes ech sbe-
g), stbe Este Ee cesg ac c-
tes wth w evece HiV. ag the WHo egs,
cece s g sw egs excet the Ee
reg, whee t s xte stbe. Whe the te e-
s 19951999 20052007 e ce, the estte
vege te chge TB cece ( s) e 100 000
t ws stest ac ctes wth hgh HiV ev-ece the Este Ee sbeg (Figure 1.10).
The te t whch cece ws ecg swe the Ce-
t Ee sbeg , t esse extet, the Este
metee sbeg. i the the sbegs, cece
ws g t s te bth te es.
The cte the gb cece te eces
t esete the st tw ets ths sees.1 i ve-
e b the tg, the t shw tht mdG tget
6.c ws et b 2005 (cece tes eke 2004), we
he the tget te 2015.
1.2.2 pac
Thee wee estte 13.7 evet cses 2007
(206 e 100 000 t), sght ecese 13.9
2006 (tAble 1.2). o these 13.7 evet
cses, estte 687 000 (5%) wee HiV-stve. F
tes TB cece cbe wth ssts bt the
t sese eet cteges cse (Annex 2),
the gb evece TB s estte t hve bee ece
sce 1990 (Figure 1.8). Ths ece s ctst t the se
TB cece the 1990s, whch c be exe b
ecese the vege t sese s the ct
cses tete doTS ges cese, cbe wth
ctve sht t sese g HiV-stve
cses (whch hs t ceste cese the
cece HiV-stve TB cses).
reg tes TB evece 1990 t 2007 s
we s jects t 2015 (bse extt the
te 20052007) e shw Figure 1.11. pevece
hs bee ecg the Este metee reg, the
reg the aecs, the Sth-Est as reg the
Weste pcc reg sce 1990, egs e
tck t t est hve evece tes b 2015 (ev-ece hs e hve ce wth the 1990 eve
the reg the aecs). i the ac Ee
egs, evece tes cese sbstt g the
1990s, b 2007 wee st bve the 1990 eve the
ac reg jst bck t the 1990 eve the Ee-
reg. pjects cte tht ethe eg w ech
the tget hvg the 1990 evece te b 2015,
the ac reg t s ke tht evece w be
bck t 1990 eves b 2015. The g betwee the 2015 t-
gets cet evece tes these tw egs e
tht the w s whe s ke t eet the St TB
ptesh tget hvg the evece te b 2015.
1.2.3 Moay
a estte 1.32 HiV-egtve ee (19.7 e
100 000 t) e TB 2007, thee wee
t 456 000 TB eths g HiV-stve ee
(tAble 1.2).2 revss the estte be cet
cses TB tht e cecte wth HiV (seCtiOn 1.2.1;
bOx 1.1) ex wh the esttes TB eths g HiV-
stve ee e hghe th thse bshe 2008. 3
deths TB g HiV-stve ee cct 23%
the estte 2 HiV eths tht cce 2007(bOx 1.1).4
revss t esttes the be cet cses
TB tht e HiV-stve bee 2007 hve s e t w
L FIGURe 1.8goa a o tb cdc, ac ad moay,cd o wh Hiv, 19902007
Incidence (all forms, including HIV)
Cases
per100000
popu
lation/year
125
130
135
140
Prevalence (all forms, including HIV)
Casesper100000population
220
240
260
280
Mortality (including HIV)
Deathsper100000
population/year
27
29
30
31
28
1990 1995 2000 2005
1 Global tuberculosis control: surveillance, planning, fnancing. WHOreport 2007. Geneva, World Health Organization, 2007 (WHo/HTm/TB/2007.376); Global tuberculosis control: surveillance, planning,fnancing. WHO report 2008. Geev, W Heth ogzt,2008 (WHo/HTm/TB/2008.393).
2 Esttes TB eths HiV-stve HiV-egtve ee e e-sete sete becse TB eths HiV-stve ee e csses HiV eths the itet Sttstc Cssct dseses(iCd-10).
3 o the 456 000 TB eths g HiV-stve ee 2007, est-te 226 000 wee cses tht wee tete 230 000 wee tet-e cses.
4 htt://www.s.g/e/KwegeCete/HiVdt/Ee-g/testEdt.s
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 13
evss t esttes tt tes bee 2007 (bOx
1.1). F tes TB cece cbe wth ssts
bt cse tt tes g eet cteges cse
(Annex 2), the gb TB tt te (cg TB eths
HiV-stve ee) s estte t hve cese g
the 1990s; ths te ws evese the e 2000,
tt tes e w ece (Figure 1.8).
reg tes TB tt tes 1990 t 2007
s we s jects t 2015 (bse extt
the te 20052007) e shw Figure 1.12.
mtt tes hve bee ecg the Este mete-
e reg, the reg the aecs, the Sth-Est
as reg the Weste pcc reg sce 1990.The ece hs bee etve ste the reg the
aecs the Weste pcc reg, whe the ece
ws ste the Este metee Sth-Est as
egs te 2000. o these egs, thee e tck
t t est hve tt tes b 2015. i the Weste
pcc reg, the tt tget w be w sse
ess the cet te ece cceetes 2008. i
the ac Ee egs, tt tes cese
sbstt g the 1990s. athgh ths te hs bee
evese ( 2000 the Ee reg
2005 the ac eg), tt tes 2007 wee
st bve the 1990 eve the ac reg jst
bck t the 1990 eve the Ee reg. pjects
cte tht ethe eg w ece tt tes bck
t eve 1990 eves b 2015, w cet t hve
tt tes ce wth 1990. The g betwee the2015 tgets cet tt tes these tw egs
e tht the w s whe s ke t eet the St
TB ptesh tget hvg the tt te b 2015.
Cases(allforms)per100000p
opulation/year
1990 1995 2000 2005
400
350
Africa high-HIV
300
250
200
220
210
Africa low-HIV
200
190
180
50
45
Central Europe
40
35
30
100
90
Eastern Europe
80
70
60
20
18
High-income countries
16
14
12
109
108
Eastern Mediterranean
107
106
105
85
80
Latin America
75
70
65
200
195
South-East Asia
190
185
135
130
Western Pacific
125
120
170
160
150
50
60
55
50
1990 1995 2000 2005 1990 1995 2000 2005
L FIGURe 1.9td mad cdc a o, 19902007
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 15
L FIGURe 1.11po owad ach ha o ha ac y2015 comad wh h o1990, y WHO o.The -xsss stze evecetes, wth the bsee set t the1990 eve ech eg (bckhzt e) eg tgetsset t 50% the 1990 eve(e hzt e). Tes 20082015 e ecst sg exet egess estteevece tes ve the e20052007.
Standardized
prevalence
rate
1.4
1.2
1.0
0.8
0.4
AFR AMR EMR
1.2
0.8
1.0
0.6
EUR
0.9
0.8
1.0
0.7
0.6
SEAR
0.9
0.8
1.0
0.7
0.6
WPR
0.9
0.8
1.0
0.7
0.6
0.5
0.4
0.9
0.8
1.0
0.7
0.6
0.5
0.4
0.5
0.5
1 99 0 19 95 2 00 0 2 0 05 2 01 0 2010 1990 1995 200 0 20 05 2010 2010 19 9 0 19 9 5 2 0 00 2 00 5 2 01 0 2010
L FIGURe 1.12po owad ach h
a o ha moay omtb y 2015 comad wh h o 1990, y WHO o.The -xs ss stzett tes, wth the bseeset t the 1990 eve echeg (bck hzt e) eg tgets set t 50% the1990 eve (e hzt e).Tes 20082015 e ecstsg exet egess estte tt tes ve thee 20052007. mtt teseesete these ghs eexcg eths TB HiV-stve ee.
Standardizedmortalityrate
1.2
0.8
1.0
AFR AMR EMR
1.4
1.2
1.0
0.8
EUR
0.9
0.8
1.0
0.7
0.6
SEAR
0.9
0.8
1.0
0.7
0.6
WPR
0.9
0.8
1.0
0.7
0.6
0.5
0.9
0.8
1.0
0.7
0.6
0.5
0.5
0.5
19 90 19 9 5 2 0 00 2 00 5 2 01 0 2010 199 0 19 95 2000 2005 2010 2010 19 90 19 95 2 00 0 2 0 05 2 010 2010
0.6
0.6 0.4
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16WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
L tABle 1.3WHO ocy acka o ma a o tb cdc,ac ad moay, 20082015 ad yod
ga1. ive svece sstes t ce ( st ) cet
cses TB cse tct t t cct ( st )TB eths vt egstt sstes.
2. Stegthe t cct t t evte the TB eec t ese gess TB ct.
3. revew te ec the t, ssts tceths se t ce WHo esttes TB cece, evece tt tes.
4. ret b Tsk Fce whethe 2015 mdG St TB pteshtgets e cheve ( t) , sht te 2015.
Ma tb cdc a5. ase ec the ebt cvege cse tct
t sg st ewk, e t estte the ttbe cet TB cses tes cece tes.
6. Cet / vte TB tct t ctes wheeses sg the st ewk shw tht TB tct te cse x (ect ese) TB cece.
7. Css-vte esttes TB cece sg TB tt t vt egstt sstes.
Ma tb ac a8. Sve the evece TB sese 21 gb cs ctes
ccg t WHo gees Tsk Fce ecets.9. pce ect esttes TB evece bse esttes TB
cece the t TB sese ctes whee sves the evece TB sese e t eete.
Ma tb moay a10. deve t vt egstt sstes t eb ec TB
eths.11. itte se vt egstt whee t vt egstt
sstes e t et vbe.12. pce ect esttes TB tt sg esttes TB
cece cse tt tes ctes wtht ebe
t se vt egstt sstes.
eaa h mac o tb coo13. Cct stes ec t evte the ct ct tes
TB cece, evece tt.
1.3 Imroving masurmn o rogrssowards h 2015 imac args:h WHO Goba task Forc on tBImac Masurmn
as exe seCtiOn 1.1, the ct tgets ecg
tes TB cece, evece tt e the cs
tet t ets t ct TB. de-
sttg whethe t the e cheve s j -
tce v ctes, the ute nts, WHo
the St TB ptesh, vet techc, c
eveet geces. The esttes TB cece,
evece tt the tes esete seC-
tiOn 1.2 e bse the best vbe t t-
c eths, bth whch wee evewe ese b
g exets -2008.1 netheess, wth bette
svece sstes, t sve t, e -eth
ss exstg svece gtc t
the eeet tc eths, these esttes
c be ve the e t 2015 ( be).Wth the excet Ete 2005, the st t-
we t-bse sves the evece TB
sese the ac reg wee etke betwee
1957 1961; ctes, sch sves hve eve
bee e (Annex 4). ntct sstes e estte
t cte 5070% cet cses st
ctes (seCtiOn 1.5), wth these sstes etg
c be cete (CHApter 2, seCtiOn 2.2.7). o 10%
the estte 1.5 TB-ttbtbe eths ( HiV-
egtve ee) 2005 wee ece vt egstt
sstes ete t WHo b agst 2008.2 The ges
the Sth-Est as Weste pcc egs, whch
cct 55% the ws TB cses, wee
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 17
t ssessg the qt cvege TB tct t.
Ths ch cssts thee ce cets (Figure
1.13). The st s ssesset the qt vbe
TB tct t; ths ces checkg the ceteess
etg (wth bechk tht 100% etg ts
sh et t ech qte) ssessg whethe thee
e cte scsse ecs. it s ces ss
the te exte csstec t sg t
sbt t. ite csstec es tht t
e csstet ve te sce (, t, tht vt
c be exe), whe exte csstec es tht t
e csstet wth exstg evece bt the eeg
TB ( exe, the t cses tht
e se-stve, the t e t ee cses) . The
ests the ss ceteess, cts, scs-
scts te exte csstec c be se s
the bss etg whee hw svece ees t
be stegthee.The sec cet the ewk cces ss
tes tct t, wth the ssessg the
extet t whch the efect tes tes TB cece
the extet t whch the efect chges the cts
(sch s gtc ets t tet e cses).
dstgshg betwee chges tht e e t cece
chges tht e e t the cts s cc whe
sg tct t t estte tes the tes TB
cece cse etect. The ss the sec
cet the ewk sh be se t etee
whethe te sees TB tcts e g x tes TB cece, the extet t whch the ee t
be jste the cts bee sg the s ese
tes TB cece. i TB tcts e g x
1 as eee t Figure 1.13. F ext, see Measuringprogress in TB control: WHO policy and recommendations [c e].Geev, W Heth ogzt, 2009 ( ess).
L FIGURe 1.13Famwok o mao ad mam o tb cdc ac daa
A daa aad com?
G cvege, wth ssg ets
n ctes
n scssct
dt te csstet
dt exte csstet
If not, iMprOveac ym
Do cha ocao o
m fc d cdc?
assess chges cse-g et cseets
assess chges TB etets
Exe hstc tc evets wth ssbect TB / etg
eaa dmoocatrenDs ad iMpACt otb coo
Do ocao
cd a cdtb ca?
Cteecte stes
a e t et whee cses best/sse
Css-vte esttes TB cece wth TBeths ece vt egstt sste
upDAte ma od
aoa, CertiFYo vAliDAte acdaa
tes TB cece, the c be se eb t ssess
whethe cece s g (mdG Tget 6.c) t.
Eve whe vbe tct t e cete
hgh qt, whe the e t be g x
tes TB cece, the e t scet t estte TB
cece bste tes. T ths, ss whethe
TB cses e beg cte c tct sstes
s eqe (s ws e st ctes whe the st
esttes the gb be TB wee ce 1997;
seeAnnex 2). The j ess wh cses e sse
c tct t hve bee ee the s-ce
e,1 ce bt es, ck tc-
t cses b bc vte ves, e cses
ccessg heth sevces t be ete s TB ssects
ck ccess t heth sevces. oet esech (sch
s cteecte stes) s we s stg evece
(sch s the kwege ctces heth-ce st
ete t et TB ssects, the extet t whch eg-ts bt tct cses e bseve -
t ccess t heth sevces) c be se t estte the
ct cses tht e ssg c tct
t. it s s ssbe t ssess the cvege tc-
t t, t css-vte esttes TB cece
ce sg the eths, b sg the be
TB eths ece vt egstt sstes.
The bjectve s tht the ests sg ths ewk
e se e tw ws. i cts TB svece
t e shw t be cse x TB cece, the t
w be cete vte s ect ese TB c-
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18WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
BOx 1.3
esimaing tB incidnc using caur-rcaur mhods: an am rom egyThe nTp Egt ce evece tht st TB cses hve ccess t heth-ce sevces ve b bc vte ctes s t
t-ct et esech ject the Este metee. The be TB cses exeecg sts seekg ce
bt t beg gse s theee execte t be w. netheess, whe tets e gse tete b ves tht e t
ke t the nTp, t s ke tht the e ece c tct t. Qtg the t cses tht e gse b
-nTp ves (the extet t whch thee s e-tct) theee w e ccte estte the tt be cses
the ct s we s the t tht e beg etecte b the nTp (the cse etect te).
T ssess the extet t whch cses wee beg sse c tct t t t te esttes TB cece the cse
etect te, the mst Heth Egt tgethe wth the WHo oce the Este metee eete cteecte
st 2008. St egstes stg TB cses wee tce t eesettve se -nTp heth ctes the
vte bc sects. The st cses these egstes ws the ce wth the st te cses the se e. usg
cteecte g-e es, the be cses sse b sces ws estte b cg () the be cses bseve
ech sce t eeet wth () the be c cses g sces (tht s, the ve cses). ases wee
etke the whe se st se-stve cses .
rd ma o tb cdc ey ad o caca aay
noTiFiCaTion daTa (2007) WHo oriGinal ESTimaTES (2007) WHo rEViSEd ESTim aTES (2007)
all CaSES SS+ CaSES all CaSES SS+ CaSES all CaSES SS+ CaSES
new TB cses 9 459 4 887 17 517 7 882 15 873 6 765
rtes (e 100 000 t/e) 13 6.5 24 10.5 21 9
Cse etect te (%) 54 62 60 72
F cteecte esttes t be v, cet cts st be et. i tc, thee e sces t sh be vbe t
w jstet eeeces g the sces t. Ths ws the cse Egt: the thee vbe sces wee the nTp egst,
the st egstes vte -nTp ves the st egstes bc -nTp ves.
Bse the st ests, the cse etect te se-stve cses ws evse ws t 72% ( 62%). The cse etect te
cses ws evse ws t 60% ( 54%). S stes the ctes whee ( st ) cses hve ccess t heth
sevces c s he t evse exstg TB esttes.
BOx 1.2
esimaing tB incidnc oowing in-dh anaysis o survianc and rogrammaic daa duringh riod 19962006: an am rom Knya
The cece TB Ke ws ect estte TB tct t 1997, s t gb et t estte the gb
eegc be TB. The estte ws bse exet ssesset tht the ecetge cet se-stve cses beg
te ws 57% (.e. 57% cse etect te). ut 2006, the te TB cece bee te 1997 ws sse t be the se s
the te TB tcts ( s TB cse).
Ke hs exeece geeze HiV eec sce the e 1980s sbstt ets t ve the qt cvege TB
gss tetet sevces wee e 2001 ws. Ths e t ct t setge the eect HiV (whch ects TB
cece) the eect ge ece TB tcts, whch t e t ct t estte the te TB cece.
Betwee Setebe 2006 decebe 2007, esttes the bste ve TB cece the te TB cece wee jt
evewe b WHo the nTp. Ths ws e the ctext ew evece ew ss. The j ew sces evece wee ()
t tes HiV-stve HiV-egtve TB tcts sete () ect ese the evece HiV g TB tets
() ecet sve the evece HiV the gee t (v) evece bt hw ge ece h chge
g the e 19962006. Bth () () bece vbe wg the tct exs ve-tte HiV
testg TB tets 2005. Evece bt ge ece g the e 19962006 ws ce g 2007. The
c cts se wee: the be heth ts whee TB gss ws vbe, the be heth ts whee TB tetet
ws vbe, the be nTp st t t, vc stct eve, nTp g. F these cts, thee ws
ce etsh wth tes TB tcts 2001 t 2006, whe HiV-ete t sggeste tht the HiV eec eke
2000 h t cse cese TB cece 2001 t 2006. i cbt, these ew t ve stg evece tht the
cese TB tcts te 2001 ws e t gtc veets ( t ceses TB cece). Ths e t wwevs the estte TB cece 2006, jstet the estte te TB cece, w evs the est-
te cse etect te (t 70%). The g estte TB cece ( cse etect) 1997 ws et chge.
T w ebe eseet tes TB cece 2007 ws, tg hgh tes HiV testg TB tets s esset.
Ths w w tes HiV-stve HiV-egtve TB tcts t be sete. Tes HiV-egtve TB tcts c be se t
ese chges cse-g. Cs tes HiV-stve HiV-egtve TB tcts c be se t ssess the ct
HiV TB cece. Ets t stegthe te svece, cg the tct ew ecg etg s exe
se eectc ecg etg sstes, hve beg.
F the ets, see mse J et . new eths esttg the tbecss cse etect te. Bulletin o the World Health Organization, 2009 ( ess).
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 19
ece. i cts svece t e t ce
ct cses, ths ct w be estte
se t te esttes cece ( b extes the
cse etect te). Fgs w s be se t et
the eses eee t stegthe svece s tht the
sts eqe t t be cete vte c
be et. recet exes hw eet cets the
ewk c be eete ctce e ve
bOx 1.2, bOx 1.3 bOx 1.4.
1.3.2 Mam o ac
Thee e tw eths esttg the evece
TB. The st s ect eseet sg css-sect
t-bse sve. Sch sves e esbe
the estte evece se-stve TB s
100 e 100 000 t e (thewse the se
sze eqe t ese evece wth scet ecs
s s ge tht sve s ctc tes cst
gstcs). Eve wth the gb vege 100 cses
e 100 000 t, se sze 200 000
bget uS$ 12 s s eqe. Sce
evece tc s e qck th TB cece
esse t ct ets, sees sves ccte
t etve we tevs ( exe, 10 es) c be
ve se ctg ge chges the eeg-
c be TB hgh-be hgh-cece ctes
(ecet exes HBCs ce Ch, whee sves
wee eete 1990 2000, wth th e
2010; the phes, whee sves wee e-
ete 1997 2007, wth th e 2017).
i ctes whee the be TB s we, evece c
s be estte ect s TB cece te b the
vege t sese (Annex 2).
athgh the tte g ctes s t e-
se gess TB ct sg te-cecte sve-
ce t, the Tsk Fce hs ete 21 ctes whee
twe t-bse sves the evece TB
sese g the e 20082015 e t the
BOx 1.4
esimaing tB incidnc using moraiy daa rom a via rgisraion sysm:an am rom Brazi
WHo esttes TB cece e bse tct t, sves the sk ect, sves the evece TB sese
cbe wth esttes the vege t sese, tt t vt egstt sstes cbe wth esttes the
cse tt te. Whee seve sces evece exst, getest weght s ttche t the st ebe t. F st ctes, cece
s ect estte TB cse tct t exet ssesset the ecetge cet TB cses beg te. Whe
cse-g ets t chge ch ve te, tes TB cece e te sse t tes TB cse tct tes
(Annex 2). ut 2005, these eths wee se t estte TB cece ts te Bz.
B 2005, the mst Heth Bz h get ve the TB tct sste the eth egstt cet the vtegstt sste. Ths ce exteg cvege bth sstes thght the ct, vtg t sstetc kg
ecs wth betwee the tw tbses. lkge ecs wth the TB tct tbse eett cees
t stgsh betwee ew e-tetet tse- ecs wee se t et cte ecs. Ths shwe tht tcts
h bee tc fte tht the ce te h bee eestte (see tbe bew). rev cte ecs cese the
g betwee the be ew TB cses te the be ew TB cses estte b WHo, hghghtg the ee evew
exstg esttes.
th c o mo dca cod om h daaa o tb ca ocao, 2005
dupliCaTES rEmoVEd nEW noTiFiEd CaSES noTiFiCaTion raTE CHanGE (%) CurEd (%) CHanGE (%)
BEForE aFTEr BEForE aFTEr BEForE aFTEr
19 064 81 330 74 113 44.2 40.2 -9.7 60.5 64.5 +6.7
Esttes TB cece Bz e w bse ss TB eths ece the vt egstt sste. The cse tt tews ccte b css-kg the cse-bse TB tct tbse the tt tbse. icece 2005 ws the estte
s the be TB eths the tt tbse ve b the cse tt te (estte s the be eths the tt
tbse ve b the be cses the tct tbse, wth te jstets the t ecs bth
sstes tht c be ke jstet the cvege TB tt ecs). Sce the tt t sste ws
jge b the c thtes t hve hghe cvege th the TB tct sste, sce t s ke tht the cse tt te h
chge ke ecet es, the te cece ve te ws estte b ssg tht the te the TB cece te ws the
se s the te the TB tt te 2001 t 2005. Ths sggeste tht cece ws g t te 3.3% e e. icece
bste tes es bee 2005 ws s bse ths te (see tbe bew).
Oa ad d WHO ma o tb cdc tb moay daa, 2005
noTiFiCaTionS oriGinal ESTimaTE oF inCidEnCE rEViSEd ESTimaTE oF inCidEnCE
new TB cses 74 113 111 050 95 408
icece tct te 40 60 51(e 100 000 t/e)
Cse etect te 69% 78%
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20WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
ses gb eg eseets gess
TB ct (Figure 1.14). The st ces 12 ac c-
tes s pkst bt e the e HBCs the
Sth-Est as Weste pcc egs (the excet
s i, whee sbt sves hve e bee e-
ete the sch sves e e). Ctes
wee seecte ccg t vs cte,1 cg the
estte evece se-stve TB, the she the
gb eg bes estte TB cses, the cse
etect te, HiV evece the gee t
the vbt ( t) t ee sve. Exst g
s g sves the cct techc
geces t ve ssstce wee s csee. mst
these ctes wee e ctte t the g
eett sves bee the cs the stevee b the Tsk Fce. Hweve, ths cs es
tht tc ets t st the sccess esg
eett sves these ctes e beg e
b the Tsk Fce ts tes. T te, these ets hve
ce wkshs t st 10 ctes (eght ac
ctes s pkst Th) t eve sve -
tcs csstet wth ecet gees,2 exet evew
tcs, cttg the vs vce bt Gb
F cts egg exstg gts,
ct sss.
1.3.3 Mam o moay
The best w t ese the be eths TB s
v t vt egstt sste whch eths e
ce ccg t the itet Sttstc Cssct
dseses (iCd-10), t e ve ceteess
ccc (see bOx 1.4 exe Bz). T
ke ths ssbe, ctes w ee t eve
vt egstt sste, sbstt stegthe exst-
g sste (see s Annex 4). i the ete, se
vt egstt cbe wth veb ts ve
te st. Whee ethe t se vt
egstt sstes exst, TB tt c be estte
sg esttes TB cece the cse tt te
(Annex 2).
1.3.4 sa o mac mam HbC a hd o 2008
The stts t the e 2008 the thee j cets ct eseet hghghte bve -eth -
ss te svece t; sves the evece
TB sese; ss tt ecs vt egs-
tt t sves s shw the 22 HBCs tAble
1.4.3 a -eth ss svece t ws ete
t hve bee etke b 12 ctes the st ve
es, thgh the extet t whch these ses wee
L FIGURe 1.14th 21 oa oc co wh a aoa ac o tb da y commdd h od 20082015 (d),ad dd o co m h ca (y)
1 F ext, see the Report o the second meeting o the WHOTask Force on TB Impact Measurement. Geneva, 67 December 2007.Geev, W Heth ogzt, 2007 (bshe).
2 W Heth ogzt (17 ths). Assessing tuberculosis preva-lence through population-based surveys. m, W Heth ogz-t, 2007.
3 dt the ctes wee ete bt eqe the vt bthe Tsk Fce secett.
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 21
L tABle 1.4Mam o cdc, ac ad moay cad o (20002007) ad ad (20082015)
in-dEpTH analySiS oF rouTinE prEValEnCE oF diSEaSE analySiS oF ViTal rEGiSTraTion daTa
SurVEillanCE daTa SurVEy (morTaliTy rECordS)
CarriEd ouT plannEd CarriEd ouT plannEd CarriEd ouT plannEd
1 i y y y, sbt y, sbt n n
2 Ch y y y y n n
3 ies y y y y y y
4 nge y y y n n
5 Sth ac y y y y
6 Bgesh n n y n n
7 Eth n n y n n
8 pkst n n y
9 phes n n y n n
10 dr Cg y y n n n n
11 rss Feet y y y y y y
12 Vet n y
13 Ke y y n y n n
14 Bz y n n y y
15 ur Tz y y y n n
16 ug y n n17 Zbbwe y y n n n y
18 Th y y y, sbt y n n
19 mzbqe y y n n n n
20 m y y y, sbt y n n
21 Cb n n y y n n
22 aghst n n n n n n
Hh-d co 12 14 10 14 4 5
ictes t t ve. nt sve ess thewse sece.b The st w the tbe shws the be ctes sweg es t ech qest.
e wth the ewk evee b the Tsk Fce 2008
(Figure 1.13) s t kw. Sch ses e e b
the 14 ctes, eg exceet tt t
( test) ths ewk ctce.
Sves the evece TB sese hve bee e-
tke the ve HBCs the Sth-Est as reg
(tw twe sves thee sbt sves)
HBCs the Weste pcc reg (
whch wee twe sves) betwee 2000 2007.
Wth the sves e e seve these e
HBCs,1 whch e g the 21 gb cs ctes
seecte b the Tsk Fce, the Sth-Est as Westepcc egs e tc we ce t ese ct
betwee 2000 2015. Ch s best ce t ese
whethe t the St TB ptesh tget hvg
evece betwee 1990 2015 s cheve, sce t hs
e ccte sves 1990 2000, wth th
sve e 2010. Beses the e HBCs the Sth-
Est as Weste pcc egs, the HBCs hve
ccte sve the evece TB sese sce
2000. netheess, sx the ac HBCs s we s pk-
st e g t eet sves betwee 2008
2010. Ths ces Eth; whe t the g st 21 ctes, sve ths ct w cseb
cese the she the t estte TB cses
svee the ac reg. ag the eg c-
tes shw Figure 1.14 (Gh, mw, mzbqe,
rw, Se lee Zb), excet mzbqe
Se lee hve s t eet sves sttg
2009 2010. i these e sves e t be sccess
eete, thee e seve j cheges tht ee t
be vece. These ce csg g gs2 es
cg X- eqet.
as e hghghte bve, ew HBCs hve se TB
tt sg t vt egstt sstes -
tt sves. The ctes whee tt t vt
egstt sstes hve bee se t qt TB eths
e Bz, the rss Feet Sth ac, wheies hs ccte tt sve. Ths ce
esttes the ee gee stegtheg t
t gee heth t sstes
ctes.
1 Ths ces sve e the phes 2017. The excetswhee te sves e t et e e Bgesh Vet n,whee eett twe sves ws ecet cet-e.
2 mst ctes hve ce sves Gb F ss. Hweve,
eveet st tcs hs shw tht the g eqestes te t w. regg exstg gts ct seet g s eqe. a ew ctes hve t et seceg t t the Gb F 9. The ee 9 cts s J 2009.
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22WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
L tABle 1.5Ca ocao, 2007
nEW CaSES % oF nEWrE-TrEaTmEnT pulmonary
nEW and rElapSE SmEar- SmEar-nEGaTiVE/ EXTra- CaSES EXCludinG CaSES SmEar-CaSES poSiTiVE unKnoWn pulmonary rElapSE oTHEr poSiTiVEb
WHolE WHolE WHolE WHolE WHolE WHolE WHolEdoTS CounTry doTS CounTry doTS CounTry doTS CounTry doTS CounTry doTS CounTry doTS CounTry
1 i 1 295 943 592 587 398 862 206 840 179 686 60
2 Ch 979 502 465 877 430 634 36 612 66 437 52
3 ies 275 193 160 617 102 613 8 048 467 61
4 nge 82 417 44 016 32 088 4 044 3 824 58
5 Sth ac 315 315 135 604 105 631 45 738 38 304 56
6 Bgesh 147 342 104 296 23 152 16 106 82
7 Eth 128 844 38 040 43 500 45 269 899 47
8 pkst 230 468 88 747 103 629 33 986 3 632 46
9 phes 140 588 86 566 49 422 1 513 1 988 64
10 dr Cg 99 810 66 099 10 968 18 737 2 406 548 86
11 rss Feet 127 338 33 103 73 560 11 704 87 586 31
12 Vet n 97 400 54 457 17 554 18 675 944 76
13 Ke 106 438 38 360 49 869 18 032 10 285 43
14 Bz 66 759 74 757 34 211 38 444 20 566 23 065 9 318 10 318 5 224 5 704 62 63
15 ur Tz 59 371 24 520 20 521 12 526 2 721 54
16 ug 40 909 21 303 13 713 4 460 703 61
17 Zbbwe 40 277 10 583 21 964 6 381 1 137 33 18 Th 54 793 28 487 17 156 7 485 62
19 mzbqe 37 651 18 214 13 064 5 020 393 58
20 m 129 081 42 588 41 826 40 002 4 466 50
21 Cb 35 601 19 421 7 120 8 412 894 73
22 aghst 28 769 13 213 8 251 6 227 62
Hh-d co 4 519 809 4 527 807 2 120 909 2 125 142 1 605 663 1 608 162 565 135 566 135 411 996 412 476 548 57 57
aFr 1 251 642 1 251 735 561 091 561 149 408 936 408 964 223 320 223 322 74 165 792 58 58
amr 208 419 218 426 114 307 119 838 52 053 55 041 31 389 32 564 10 462 11 045 688 704 69 69
Emr 375 857 378 895 155 558 155 572 135 441 136 865 75 299 76 898 4 338 131 53 53
Eur 322 132 350 529 97 156 105 288 154 365 165 777 45 094 53 623 121 936 127 354 57 416 39 39
SEa 2 007 111 2 007 193 972 390 972 441 622 776 622 795 295 857 295 866 194 733 194 736 218 220 61 61
Wpr 1 325 173 1 365 284 656 883 666 412 529 296 548 024 78 479 88 538 73 005 77 144 951 4 438 55 55
goa 5 490 334 5 572 062 2 557 385 2 580 700 1 902 867 1 937 466 749 438 770 811 478 639 488 782 2 837 6 701 57 57
ictes ze cses te e doTS; t cses te e -doTS. Cses t ce esewhee tbe.b Execte ecetge ew cses tht e se-stve s 6580%.
1.4 Cas noifcaions
1.4.1 toa ca ocao
The 196 ctes etg t WHo 2008 te 5.6
ew ese cses 2007, whch 2.6
(46%) wee ew se-stve cses ( tAble 1.5; Figure
1.15). o these tcts, 5.5 (99%) wee
doTS ges, cg 2.6 (47%) ew se-stve cses (s 99% tt tcts se-
stve cses). The ac reg (22%), Sth-Est as
reg (36%) Weste pcc reg (25%) tgethe
ccte 83% te ew ese cses
s ts ew se-stve cses 2007.
ag ew cses ete b doTS ges
( tAble 1.5), 57% wee ew se-stve (
65% execte).
a tt 37.3 ew ese cses, 18.1
ew se-stve cses, wee te b doTS
ges the 13 es betwee 1995 (whe ebe
ecg beg) 2007.
1.4.2 Ca ocao daad y
ntcts sggegte b sex wee ete ew -
se-stve TB cses doTS ges b
170 ctes. o 2.55 tcts (99.2% tt
tcts doTS es 98.3% tcts),
1.65 wee e 0.9 wee ee, gvg
e:ee t 1:8.
The stbt the e:ee t css ge
gs the e eegc sbegs s shw
Figure 1.16. F thse ge 14 es, e e th w-
e wee etecte wth TB gb. The e:ee t ws
csstet
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 23
etecte wth TB ctes whee the evece HiV
the gee t excees 1% (Figure 1.17).
The ess hghe TB tct tes e e
est. pssbe exts ce bgceeces betwee e we cet ge gs
tht ect the sk beg ecte s we s the sk
ect gessg t ctve sese, / eeces
the scet es e we tht fece the sk
exse t TB ccess t ce (gee eeces).
The bsevt tht TB tct tes te t be e
eq betwee e we ctes wth hgh
evece HiV sts the hthess bgc -
eeces (tht c be essee b gc sess
e t HiV), bt the -bgc cts
tt e.
a tt 101 ctes ete tcts ew
cses ext TB sggegte b ge sex
(these ctes ccte 50% tt tcts
ext TB). Thee wee 195 002 e cses
180 310 ee cses, gvg e:ee t 1:1. The
t g ew ext tets s ch we
th the t se-stve TB tets (Figure 1.18);
estg the ess ths eece the -
gtc cts eqes the vestgt
esech.
i gee, thee s ee gee-bse ss t
vestgte the ge bgc, eegc, e-ghc, sc ecc vbes tht ect gee -
eets the cece tct TB.
1.5 Cas dcion ras
1.5.1 Ca dco a, a oc (DOts ado-DOts oamm)
The 2.6 ew se-stve cses te 2007
sces (tht s, doTS -doTS -
ges) eeset 64% the 4.1 estte cses
(tAble 1.2;tAble 1.6). Ths s s cese g-
e 63% 2006, wg sw cese 35% t
43% betwee 1995 2001 e cese
43% t 60% betwee 2001 2005 (Figure 1.19).
The veet tht cce betwee 2001 2007
ws ttbtbe st t ceses the bes ew
se-stve cses ete the Este metee,
Sth-Est as Weste pcc egs (tAble 1.6).
The cse etect te se-stve cses 2007( doTS -doTS ges) ws 70% the
Weste pcc reg (78%) the reg the ae-
cs (76%), we b the Sth-Est as reg (69%).
The ac reg h the west cse etect te (47%)
(tAble 1.6; Figure 1.20). The reg the aecs
the Ee reg ete the gest bes ew
se-stve cses tse doTS ges (Fig-
ure 1.20).
The 5.3 ew TB cses ( s) tht wee t-
e 2007 eeset 57% the 9.3 estte ew
cses. The cse etect te ew cses ws hghest
the Ee reg (75%), we b the reg
the aecs (71%) the Weste pcc reg (68%)
(Figure 1.20).
024
2549
5099
100
No report
Notified TB cases(new and relapse) per100 000 population
L FIGURe 1.15tco ocao a, y coy, 2007
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24WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
L FIGURe 1.16s ao (M/F) y a o dmooca o, 2007
Sexratio(M/F)
Africa high-HIV
1.6
1.4
1.2
1.0
0.8
Africa low-HIV Central Europe
Eastern Europe High-income countries Eastern Mediterranean
Latin America South-East Asia Western Pacific
1.8
1.4
1.2
1.0
0.8
1.6
5
3
2
1
4
0.6
1.4
1.2
1.0
0.8
4
3
2
1
3.0
2.0
1.5
1.0
3.5
2.5
1.8
1.4
1.2
1.0
2.0
1.6
3.0
2.0
1.5
1.0
3.5
2.5
2.5
2.0
1.5
1.0
4.0
014 1524 2534 3544 45 54 55 64 65+ 014 1524 2534 3544 4554 55 64 65+ 014 1524 2534 3544 4554 55 64 65+
Age (years)
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 25
L FIGURe 1.17Do o ao (M/F) od w ma-otb ca, y Hiv dmc h a oao. tho a do 95% codc a o h ma ao wh ach Hiv dmc . Hozoa adom jwa ad o daa o o dc o-o.
Sexratio(M/F)ofnewsmear-positiveTBcases
4
0
-2
1%
Estimated prevalence of HIV in general population
L FIGURe 1.18Do dy o ao (M/F) w ma-otb ca (d) ad w amoay tb ca (y). thca do h ma ao.
L tABle 1.6Ca dco a o w ma-o ca (%), 19952007a
doTS proGrammES WHolE CounTry
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 200 5 2006 2007
1 i 0.3 0.9 1.0 1.7 6.9 12 23 30 44 56 60 64 68 37 40 37 38 46 45 49 49 53 59 60 64 *
2 Ch 15 29 32 32 30 31 31 30 43 64 80 80 80 22 34 39 34 34 34 34 33 45 65 * * *
3 ies 1.3 4.4 7.4 12 19 20 21 30 37 53 66 73 68 12 * * * * * * * * * * * *
4 nge 11 11 11 11 12 12 12 11 15 17 18 20 23 * * * * * * 15 13 * * * * *5 Sth a c 6.8 23 66 63 60 71 77 75 72 77 78 3 75 90 119 95 78 70 72 77 78 75 * *
6 Bgesh 6.4 14 18 23 23 24 26 30 35 40 54 65 66 14 21 23 26 25 26 27 31 * * * * *
7 Eth 15 20 22 24 25 31 30 30 31 31 28 27 28 * 24 * * * * * * * * * * *
8 pkst 1.0 1.7 3.7 2.0 2.8 5.2 13 17 25 38 50 67 2.5 * 13 5.4 * 9.1 13 * * * * *
9 phes 0.4 0.4 2.9 9 18 44 52 57 64 69 71 75 75 85 78 75 64 65 59 * * * * * * *
10 dr Cg 40 47 43 53 50 47 49 47 53 59 60 59 61 42 * * * * * * * * * * * *
11 rss Fee t 0.5 1.1 1.0 1.8 5.0 5.6 7.5 9.5 15 34 45 49 77 74 67 63 31 37 37 40 43 47 49 48 *
12 Vet n 30 59 78 83 83 82 84 87 86 89 84 86 82 59 77 84 85 83 * * * * * * * *
13 Ke 58 60 56 60 60 53 61 63 65 68 70 72 72 * * * * * 58 * * * * * * *
14 Bz 3.8 3.7 7.0 7.4 8.9 17 43 51 64 69 73 73 73 66 72 73 70 76 75 82 82 82 78
15 ur Tz 61 60 57 58 56 52 51 48 49 51 50 50 51 * * * * * * * * * * * * *
16 ug 60 60 60 51 47 47 47 48 47 48 51 51 56 * * * * * * * * * * *
17 Zbbwe 55 49 45 44 42 36 36 32 32 27 43 54 60 * * * * * * * * * *
18 Th 0.3 5.2 22 41 48 76 68 74 74 77 74 72 58 48 37 * * * * * * * * * *
19 mzbqe 59 55 53 53 50 47 45 45 45 46 47 49 49 * * * * * * * * * * * * *
20 m 27 27 30 34 50 60 69 78 88 102 111 116 27 30 29 * * * 61 * * * * * *
21 Cb 40 34 44 48 54 50 48 57 62 62 68 62 61 * 43 * * * * * * * * * * *
22 aghst 4.2 12 11 18 29 39 37 45 52 63 64 * * * * * * * * * * *
Hh-d co 8.4 14 17 20 23 26 31 35 43 53 60 64 65 31 36 37 38 39 39 41 42 47 56 61 64 65
aFr 23 26 30 35 37 36 37 43 45 46 46 47 47 33 43 42 47 43 41 42 44 46 47 47 47 47
amr 26 26 29 33 36 43 42 45 49 57 62 72 73 68 69 74 71 73 73 73 74 74 76 76 78 76
Emr 12 10 12 19 21 25 27 32 34 39 46 52 60 25 27 24 34 32 27 30 32 34 39 46 52 60
Eur 2.6 3.5 4.6 11 11 12 14 22 24 26 37 53 51 64 63 58 58 46 47 43 43 53 48 50 58 55
SEar 1.4 4.0 5.5 8.0 14 18 26 33 44 55 62 67 69 28 29 29 30 37 38 42 45 50 57 62 67 69
Wpr 15 28 31 33 31 37 38 39 50 65 77 77 77 36 44 48 43 44 43 43 43 52 67 78 78 78
goa 11 16 18 22 25 28 32 37 44 52 58 62 63 35 40 40 41 42 42 43 45 49 56 60 63 64
ictes t vbe. Esttes es e eccte s ew t beces vbe techqes e ee, s the e thse bshe evs.
* n t t be doTS et, ethe becse ct s 100% doTS, becse -doT S et ws eceve.
1.2
1.0
0.8
0.6
0.4
0.2
0
density
0 1 2 3 4 5Sex t (m/F)
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26WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol
1.5.2 Ca dco a, DOts oamm
i 2007, ve 99% te cses se-stve
TB wee doTS ges the cse etec-
t te e doTS ws 63% (tAble 1.6; Figure
1.19). Ths ws s veet ce wth
2006. nt esttes the cse etect te
ew se-stve cses sggest tht 74 ctes
et the 70% tget 2007, w 78 2006
(Annex 3). at eg eve, the cse etect te
ws west the ac (47%) Ee (51%)
egs hghest the Weste pcc reg
(77%) (tAble 1.6; Figure 1.20; Figure 1.21). The
Weste pcc reg (sce 2005) the reg
the aecs (sce 2006) e the egs t hve
exceee the 70% tget, thgh the Sth-Est
as reg (t 69%) s jst sht. The tc
w ge cse etect e doTS the E-
e reg ce wth the cse etect te
( doTS -doTS ges) s TB 75% (Figure 1.20) s exe b tw cts:
cete geghc cvege doTS ck
ehss st se csc.1
The ct tht doTS ges the a-
c reg esec ee t ve cse etect
ces wth tt cvet. Ets t ssess
veets cse etect ths eg hve
bee hee b the w te cece
ke t the se HiV ect, sch tht t
hs bee ct t setge the eect bet-
te ge ece the HiV eec ceses cse tcts (see s seCtiOn
1.3 bOx 1.2). me -eth ses exstg
svece gtc t s we s t
thcg sves the evece TB s-
ese (tAble 1.4) cte tht cse etect s
hghe th stte ths et.
L FIGURe 1.19po owad h 70% ca dco a. () oe ccesk the be ew se-stve cses te e doTS19952007, exesse s ecetge estte ew cses ech e. Cse cces shw the tt be se-stve cseste (doTS -doTS) s ecetge estte cses.(b) as () , bt ew cses (excg eses).
Casedetectionrate,smear-positivecases(%)
0
10
20
30
40
50
60
70
80
0
10
20
30
40
50
60
70
80
Casedetectionrate,allnewcases(%)
1990 1995 2000 2005 2010 2015
1990 1995 2000 2005 2010 2015
WHO target
DOTSbegins
DOTSbegins
A
B
L FIGURe 1.20pooo o mad ca od d DOts (y oo o a) ad o-DOts (d oo o h a) 2007 o (a) wma-o ca ad () a w ca.The be te cses ( thss) s shw bve ech t ech b.
(a) New smear-positive
Casedetectionrate(%)
(b) All new cases
0.1
AFR AMR EMR EUR SEAR WPR AFR AMR EMR EUR SEAR WPR0
10
20
30
40
50
60
70
80
90
0
10
20
30
40
50
60
70
80
90
Casedetectionrate(%)
WHO region WHO region
WHO target
5.5
0.018.1
0.1
9.5
0.1
9.7
3.0
28
0.1
38
561 114 156 97 972 657 1195 199 366 297 1892 1265
1 Ctes the Ee reg et sbstt bes cses wh sese s gse b eths the thst se csc. These cses e t ecessse-egtve.
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GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 27
athgh cse etect ew se-stve cses
doTS ges ve gb betwee 2006
2007, the ceet betwee 2006 2007 ( ext
55 000 cses) ws ess th 1%, the sest ete -
cese sce 19951996 (tAble 1.6; Figure 1.19; Fig-
ure 1.22). mst the s cese etecte cses ws
ttbtbe t i pkst ( pkst ths s ke
t ctwe ets t eve sce teshs
betwee the nTp vte ves, s escbe e
CHApter 2), t esse extet nge
Sth ac (Figure 1.23). i the Sth-Est as reg,
the cceet cse-g te 2000 ws ttbt-
be st t gess Bgesh, i, ies
m. The Weste pcc reg s te b Ch-
, whee cse-g exe betwee 2002
2005; sbseqet, tte gess hs bee e (tAble
1.6; Annex 1).
Ch i ccte estte 27%
etecte ew se-stve cses 2007. ngeccte 10% etecte cses. These thee c-
tes e g eght HBCs tht tgethe ccte 57%
ew se-stve cses t etecte b doTS -
ges 2007 (Figure 1.24).
doTS ges etecte 5.2 ew cses
2007 (99% tcts) t tt 9.27
estte cses ( tAble 1.2;tAble 1.5). Ths s eqvet
t cse etect te ( ew cses) 56% 2007,
2% cese 54% 2006.
1.6 Oucoms o ramn in
DOtS rogramms1.6.1 nw ma-o ca
a tt 2.5 ew se-stve cses wee egstee
tetet doTS ges 2006, xte
the se be tht we