World TB Day
24 March 2014
World TB Day24 March 2014
Boost efforts to eliminate tuberculosis by 2050!
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World TB Day
24 March 2014
There is an urgent need for new anti-tuberculosis (TB) medicines with shorter and more effective treatment regimens and we must reach all patients, not only
half of them and “half-way”.
For the first time in 40 years, new TB drugs have become available and are in clinical trials – but their scope is limited
to specific groups of patients.
A key objective for new treatments should be to reduce treatment time from two years to two weeks, putting patients
at the centre of care in the spirit of Health 2020.
Zsuzsanna JakabWHO Regional Director for Europe
European strategic action plan on antibiotic resistance
2011–2016
Dr Guenael RodierDirector, Division of Communicable Diseases, Health
Security and Environment
A milestone for Europe
Consolidated action plan on multidrug-resistant TB
2011–2015
World TB Day
24 March 2014
New TB cases down by 5% yearly in Europe, but not enough to reach the elimination goal
• Diagnosis and treatment scaled up to reach all patients with multidrug- resistant TB
• Decline in new TB cases of 47 000 between 2011 and 2012
Greater action is required to eliminate TB globally, and address the emergence and spread of its resistant forms
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World TB Day
24 March 2014
Still nearly 1000 new TB cases a day: 1 in 10 dies
• Estimated total of TB patients in the Region:over 500 000
• New TB cases estimated to occur per year: 353 000
• Deaths: 35 000, mostly in the eastern part of the Region
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World TB Day
24 March 2014
Europe not on track to halve TB mortality by 2015 (Mi l lennium Development Goal 6)
Targets for decline of TB incidence and prevalence likely
to be achieved
TB incidence
TB prevalence
TB mortality
3.9
2.3 = target
4.6
43
5.0% / year
39.4
37 = target71
Source: Global Tuberculosis report 2013. WHO/HTM/TB/2013.11
World TB Day
24 March 2014
• Estimated total of new M/XDR-TB cases yearly: 76 400
• M/XDR-TB patients diagnosed: only 33 400
• Successful-treatment rate for MDR-TB patients: under 50%
(target is 75%)
Multidrug- and extensively drug-resistant TB (M/XDR-TB): biggest burden in the Region
76 400
65 00085%
33 40044%
49%
Core indicators for monitoring the implementation of the M/XDR-TB ac-
tion plan, WHO European Region, 2012
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.Stockholm: European Centre for Disease Prevention and Control; 2014.
Estimated number of
M/XDR-TB cases
World TB Day
24 March 2014
Challenge of M/XDR-TB in the European Region
• Over half of the countries with the highest rate of M/XDR-TB in the world are in the eastern part of the European Region.
• Almost half of all previously treated TB patients develop M/XDR-TB.
Global average
European Region average
Bulgaria
Georgia
Armenia
Latvia
Lithuania
Tajikistan
Ukraine
Estonia
Azerbaijan
Kazakhstan
Russian Federa-tion
Uzbekistan
Republic of Moldova
Kyrgyzstan
Belarus
0 10 20 30 40 50 60 70 80
3.6
16
2.3
9.2
9.4
11
11
13
14
20
22
23
23
23
24
26
35
20
45
23
31
43
32
44
56
32
50
56
55
49
62
62
68
69
MDR among TB cases (%), WHO European Region, 2012
Previously treated cases
New cases
%
Source: Global Tuberculosis report 2013. WHO/HTM/TB/2013.11
World TB Day
24 March 2014
TB burden unequally distributed among countries
•85% of TB cases found in the 18 high-priority countries for TB control in the Region
• Rate of TB cases in these
countries: almost 8 times higher than in the rest of the Region
1980
1985
1990
1995
2000
2004
2007
2012
0
10
20
30
40
50
60
70
80
90
32
39
62
11
TB notification rate, WHO European Region, 1980–2012
Notification rate (all countries)
Estimated incidence (all countries)
Notification rate (18 high priority countries)
Notification rate (EU countries)
Cas
es p
er
100
000
popu
latio
n
18 high-priority countries (85% of all TB cases): Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan.
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.Stockholm: European Centre for Disease Prevention and Control; 2014.
World TB Day
24 March 2014
TB can affect everyone, but is mainly linked to migration, social marginalization and imprisonment
• 7.2% of the new TB cases in the Region are reported in prisoners
• Prisoners have 26 times the risk of falling sick with TB of the general population
© Maxim Dondiuk
World TB Day
24 March 2014
Leading killer among people living with HIV
• People living with HIV/AIDS have
up to 34 times greater risk of TB co-infection.
• About 13 000 TB cases with HIV co-infection were detected in the
Region – 70% of the estimated total.
• Less than two thirds were offered antiretroviral treatment.
2006 2007 2008 2009 2010 2011 20120
1
2
3
4
5
6
7
2.8 2.83.4
4.8
6.0 5.46.1
Percentage of HIV among notified TB, WHO European Region, 2012%
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.Stockholm: European Centre for Disease Prevention and Control; 2014.
World TB Day
24 March 2014
One in three TB patients is not cured
• 1 untreated person with TB or M/XDR-TB can infect 10–15 other people
yearly. 10% of them develop the disease.
• Anti-TB regimens are complex, toxic and inefficient in curing M/XDR-TB.
• Adequate TB treatment will prevent M/XDR-TB.
• The key objective of TB control is to reduce treatment time to less
than 2 weeks.
66.1
7.9
8.4
5.7
11.9
Treatment outcomes (%) of new pulmonary laboratory-confirmed cases, WHO European Region, 2011
Successfully treated
Died
Failures
Defaulters
Not evaluated
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.Stockholm: European Centre for Disease Prevention and Control; 2014.
World TB Day
24 March 2014
Prevent the development of M/XDR-TB
Scale up access to effective treatment
Scale up access to early diagnosis
Improve infection control
Strengthen surveillance
Expand management capacity of the programmes
Address the needs of special populations
Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis
World TB Day
24 March 2014
120 000 lives and US$ 12 billion could be saved by implementing the Consolidated Action Plan
The goal is to contain the spread of drug-resistant TB by:• decreasing M/XDR-TB cases
among previously treated cases by
20 percentage points;
• detecting 85% (or 225 000) of M/XDR-TB patients; and
• successfully treating at least 75%
(127 000) of them.
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World TB Day
24 March 2014
Eliminating TB by 2050 requires putting patients at the centre of care
• Early diagnosis and full treatment for all patients
• Move from hospital to ambulatory care
• New TB drugs, with shorter and more effective treatment regimen
• New diagnostics and vaccines
• Less stigma and more equity
• More funds, better used
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World TB Day
24 March 2014
Thank you(www.euro.who.int/tuberculosis)
World TB Day24 March 2014
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