Global Tuberculosis Report -- 2012.pdf

More documents

Recommendations

Info

Executive SummaryThe World Health Organization (WHO) Global TuberculosisReport 2012 provides the latest information and analysisabout the tuberculosis (TB) epidemic and progress in TBcare and control at global, regional and country levels. Itis based primarily on data reported by WHO’s MemberStates in annual rounds of global TB data collection. In2012, 182 Member States and a total of 204 countries andterritories that collectively have more than 99% of theworld’s TB cases reported data.Key findings● Progress towards global targets for reductions inTB cases and deaths continues. The MillenniumDevelopment Goal (MDG) target to halt and reversethe TB epidemic by 2015 has already been achieved.New cases of TB have been falling for several years andfell at a rate of 2.2% between 2010 and 2011. The TBmortality rate has decreased 41% since 1990 and theworld is on track to achieve the global target of a 50%reduction by 2015. Mortality and incidence rates arealso falling in all of WHO’s six regions and in mostof the 22 high-burden countries that account for over80% of the world’s TB cases. At country level, Cambodiademonstrates what can be achieved in a lowincomeand high-burden country: new data show a45% decrease in TB prevalence since 2002.● However, the global burden of TB remains enormous.In 2011, there were an estimated 8.7 millionnew cases of TB (13% co-infected with HIV) and 1.4million people died from TB, including almost onemillion deaths among HIV-negative individuals and430 000 among people who were HIV-positive. TB isone of the top killers of women, with 300 000 deathsamong HIV-negative women and 200 000 deathsamong HIV-positive women in 2011. Global progressalso conceals regional variations: the African andEuropean regions are not on track to halve 1990 levelsof mortality by 2015.● Access to TB care has expanded substantiallysince the mid-1990s, when WHO launched a new globalTB strategy and began systematically monitoringprogress. Between 1995 and 2011, 51 million peoplewere successfully treated for TB in countries that hadadopted the WHO strategy, saving 20 million lives.● Progress in responding to multidrug-resistantTB (MDR-TB) remains slow. While the number ofcases of MDR-TB notified in the 27 high MDR-TB burdencountries is increasing and reached almost 60 000worldwide in 2011, this is only one in five (19%) of thenotified TB patients estimated to have MDR-TB. In thetwo countries with the largest number of cases, Indiaand China, the figure is less than one in ten; scale-upis expected in these countries in the next three years.● There has been further progress in implementingcollaborative TB/HIV activities (first recommendedby WHO in 2004). These saved an estimated1.3 million lives between 2005 and the end of 2011.In 2011, 69% of TB patients were tested for HIV in theAfrican Region, up from 3% in 2004. Globally, 48% ofthe TB patients known to be living with HIV in 2011were started on antiretroviral therapy (ART); coverageneeds to double to meet WHO’s recommendation thatall TB patients living with HIV are promptly started onART. Kenya and Rwanda are top performers in HIVtesting and provision of ART.● Innovations in diagnostics are being implemented.The roll-out of Xpert MTB/RIF, a rapid moleculartest that can diagnose TB and rifampicin resistancewithin 100 minutes, has been impressive. Betweenits endorsement by WHO in December 2010 and theend of June 2012, 1.1 million tests had been purchasedby 67 low- and middle-income countries; South Africa(37% of purchased tests) is the leading adopter. A41% price reduction (from US$ 16.86 to US$ 9.98) inAugust 2012 should accelerate uptake.● The development of new drugs and new vaccinesis also progressing. New or re-purposed TB drugsand novel TB regimens to treat drug-sensitive or drugresistantTB are advancing in clinical trials and regulatoryreview. Eleven vaccines to prevent TB are movingthrough development stages.● There are critical funding gaps for TB care andcontrol. Between 2013 and 2015 up to US$ 8 billionper year is needed in low- and middle-income countries,with a funding gap of up to US$ 3 billion peryear. International donor funding is especially criticalto sustain recent gains and make further progress in35 low-income countries (25 in Africa), where donorsprovide more than 60% of current funding.● There are also critical funding gaps for researchand development. US$ 2 billion per year is needed;the funding gap was US$ 1.4 billion in 2010.GLOBAL TUBERCULOSIS REPORT 2012 1
Additional highlights by topicBurden of diseaseGeographically, the burden of TB is highest in Asia andAfrica. India and China together account for almost 40%of the world’s TB cases. About 60% of cases are in theSouth-East Asia and Western Pacific regions. The AfricanRegion has 24% of the world’s cases, and the highest ratesof cases and deaths per capita.Worldwide, 3.7% of new cases and 20% of previouslytreated cases were estimated to have MDR-TB.India, China, the Russian Federation and South Africahave almost 60% of the world’s cases of MDR-TB. Thehighest proportions of TB patients with MDR-TB are ineastern Europe and central Asia.Almost 80% of TB cases among people living with HIVreside in Africa.Estimating the burden of TB in children (aged less than15) is difficult; estimates are included in the report for thefirst time. There were an estimated 0.5 million cases and64 000 deaths among children in 2011.Case notifications and treatment successIn 2011, 5.8 million newly diagnosed cases were notifiedto national TB control programmes (NTPs) and reportedto WHO, up from 3.4 million in 1995 but still only twothirdsof the estimated total of 8.7 million people who fellill with TB in 2011.Notifications of TB cases have stagnated in recent years.New policy measures, including mandatory case notificationby all care providers via an electronic web-basedsystem in India, could have a global impact on the numberof TB cases notified in future years. Intensified effortsby NTPs to engage the full range of care providers usingpublic-private mix (PPM) initiatives are also important;in most of the 21 countries that provided data, 10–40% ofnotifications were from non-NTP care providers.Globally, treatment success rates have been maintainedat high levels for several years. In 2010 (the latestyear for which treatment outcome data are available), thetreatment success rate among all newly-diagnosed caseswas 85% and 87% among patients with smear-positivepulmonary TB (the most infectious cases).Responding to drug-resistant TBMeasurement of drug resistance has improved considerably.Data are available for 135 countries worldwide (70%of WHO’s 194 Member States) and by the end of 2012 willbe available from all 36 countries with a high burden ofTB or MDR-TB.Extensively drug-resistant TB, or XDR-TB, has beenreported by 84 countries; the average proportion of MDR-TB cases with XDR-TB is 9.0%.The target treatment success rate of 75% or higher forpatients with MDR-TB was reached by only 30 of 107countries that reported treatment outcomes.Scaling up TB-HIV collaborationGlobally, 40% of TB patients had a documented HIV testresult and 79% of those living with HIV were providedwith co-trimoxazole preventive therapy in 2011.Interventions to detect TB promptly and to preventTB among people living with HIV, that are usually theresponsibility of HIV programmes and general primaryhealth-care services, include regular screening for TBand isoniazid preventive therapy (IPT) for those withoutactive TB. The number of people in HIV care who werescreened for TB increased 39% (2.3 million to 3.2 million)between 2010 and 2011. Nearly half a million peoplewithout active TB were provided with IPT, more thandouble the number started in 2010 and mostly the resultof progress in South Africa.Research and development to accelerate progressResearch to develop a point-of-care diagnostic test for TBand MDR-TB continues, and other diagnostic tests are inthe pipeline.Today, standard treatment for TB patients lasts sixmonths and the regimen for most patients with drugresistantTB takes 20 months. Treatment for MDR-TB iscostly and can have serious side-effects. Of the 11 anti-TBdrugs in clinical trials, two new drugs are being evaluatedto boost the effectiveness of MDR-TB regimens. A novelregimen that could be used to treat both drug-sensitiveTB and MDR-TB and shorten treatment duration hasshown encouraging results in clinical trials.There is no effective vaccine to prevent TB in adults.Progress in the past decade means that it is possible that atleast one new vaccine could be licensed by 2020.Financing for TB care and controlAbout US$ 1 billion per year of international donor fundingis needed for TB care and control (excluding TB/HIVinterventions) in low and middle-income countries from2013 to 2015, double existing levels. Up to an additionalUS$ 1 billion per year is needed for TB/HIV interventions,mostly for ART for HIV-positive TB patients.National contributions provide the bulk of financingfor TB care and control in Brazil, the Russian Federation,India, China and South Africa (BRICS). However, theyremain insufficient for scaling up the diagnosis and treatmentof MDR-TB; BRICS account for about 60% of theworld’s estimated cases of MDR-TB.The Global Fund provides almost 90% of internationaldonor funding for TB.2 GLOBAL TUBERCULOSIS REPORT 2012
Page 2 and 3: GLOBALTUBERCULOSISREPORT2012
Page 4 and 5: ContentsAbbreviationsivAcknowledgem
Page 6 and 7: AcknowledgementsThis report on glob
Page 8 and 9: WHO Western Pacific RegionShalala A
Page 12 and 13: CHAPTER 1IntroductionBOX 1.1Basic f
Page 14 and 15: TABLE 1.1 Targets for the scale-up
Page 16 and 17: TABLE 1.2 Reporting of data in the
Page 18 and 19: BOX 2.1Uncertainty in estimates of
Page 20 and 21: TABLE 2.2 Estimated burden of disea
Page 22 and 23: FIGURE 2.5 Estimated TB incidence r
Page 24 and 25: FIGURE B2.2.1Reporting of notificat
Page 26 and 27: FIGURE 2.8Estimated TB incidence ra
Page 28 and 29: FIGURE 2.11 Countries (in blue) for
Page 30 and 31: FIGURE 2.12 Trends in estimated TB
Page 32 and 33: ● producing and widely disseminat
Page 34 and 35: FIGURE 2.16 Progress in global cove
Page 36 and 37: BOX 2.6Efforts by the Task Force to
Page 38 and 39: CHAPTER 3TB case notificationsand t
Page 40 and 41: BOX 3.1 1Definitions of TB casesDef
Page 42 and 43: TABLE 3.3 Contribution of public-pr
Page 44 and 45: BOX 3.4Integrating community-based
Page 46 and 47: TABLE 3.4 Estimates of the case det
Page 48 and 49: TABLE 3.5 Treatment success for new
Page 50 and 51: CHAPTER 4Drug-resistant TBKEY FACTS
Page 52 and 53: FIGURE 4.2 Percentage of new TB cas
Page 54 and 55: BOX 4.1Frequencies of resistance to
Page 56 and 57: FIGURE 4.6 Number of MDR-TB cases e
Page 58 and 59: FIGURE 4.7Notified cases of MDR-TB
Page 60 and 61:
egimens globally, providing more su
Page 62 and 63:
5.1 Funding for TB care and control
Page 64 and 65:
TABLE 5.2 NTP budgets, available fu
Page 66 and 67:
FIGURE 5.5Trends in domestic and do
Page 68 and 69:
FIGURE 5.6Domestic funding as a per
Page 70 and 71:
FIGURE 5.8Cost per TB patient succe
Page 72 and 73:
FIGURE 5.10 Total cost and unit cos
Page 74 and 75:
● The 14 countries not included i
Page 76 and 77:
on public health by an external Exp
Page 78 and 79:
evised as a result of the introduct
Page 80 and 81:
TABLE 6.2 Incorporation of WHO poli
Page 82 and 83:
FIGURE 6.3The Supranational Referen
Page 84 and 85:
of TB disease by 65%, irrespective
Page 86 and 87:
FIGURE 7.3Percentage of TB patients
Page 88 and 89:
BOX 7.1Accelerating progress in pro
Page 90 and 91:
TABLE 7.2 Assumptions used to estim
Page 92 and 93:
FIGURE 8.1 The development pipeline
Page 94 and 95:
sputum specimens and TB isolates fr
Page 96 and 97:
cal trial sites and building labora
Page 98:
new TB vaccine candidate. A Phase I
Page 102 and 103:
This annex explains the methods tha
Page 104 and 105:
2011. On average, 15 data points we
Page 106 and 107:
may suffer from biases. These biase
Page 108 and 109:
TABLE A1.3Parameter estimates used
Page 110 and 111:
5. Estimates of TB prevalence, 1990
Page 112:
the Republic of Moldova, Romania, t
Page 116 and 117:
AFGHANISTANPopulation 2011 32 milli
Page 118 and 119:
BRAZILPopulation 2011 197 millionHI
Page 120 and 121:
CHINAPopulation 2011 1 348 millionH
Page 122 and 123:
ETHIOPIAPopulation 2011 85 millionH
Page 124 and 125:
INDONESIAPopulation 2011 242 millio
Page 126 and 127:
MOZAMBIQUEPopulation 2011 24 millio
Page 128 and 129:
NIGERIAPopulation 2011 162 millionH
Page 130 and 131:
PHILIPPINESPopulation 2011 95 milli
Page 132 and 133:
SOUTH AFRICAPopulation 2011 50 mill
Page 134 and 135:
UGANDAPopulation 2011 35 millionHIG
Page 136 and 137:
VIET NAMPopulation 2011 89 millionH
Page 138:
ANNEX 3Regional profiles
Page 141 and 142:
WHO REGION OF THE AMERICASPopulatio
Page 143 and 144:
WHO EUROPEAN REGIONPopulation 2011
Page 145 and 146:
WHO WESTERN PACIFIC REGIONPopulatio
Page 148 and 149:
SUMMARY BY WHO REGIONTable A4.1 Est
Page 150 and 151:
MORTALITY (EXCLUDING HIV) PREVALENC
Page 152 and 153:
NEW AND RELAPSENOTIFICATION RATE aY
Page 154 and 155:
-% OF TB PATIENTS WITHKNOWN HIV STA
Page 156 and 157:
AFRICAN REGIONTable A4.1 Estimates
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
INCIDENCE (INCLUDING HIV) INCIDENCE
Page 164 and 165:
NEW AND RELAPSENOTIFICATION RATE aY
Page 166 and 167:
NEW AND RELAPSENOTIFICATION RATE a1
Page 168 and 169:
TREATMENT SUCCESS (%) a1995-2010YEA
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 176 and 177:
YEARTOTALCONFIRMEDCASES OFMDR-TB aE
Page 178 and 179:
MALEYEAR 0-14 15-24 25-34 35-44 45-
Page 180 and 181:
REGION OF THE AMERICASTable A4.1 Es
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
% OF COHORTTREATMENT SUCCESS (%) a1
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
MALEFEMALEYEAR 0-14 15-24 25-34 35-
Page 204 and 205:
EASTERN MEDITERRANEAN REGIONTable A
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
EUROPEAN REGIONTable A4.1 Estimates
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Page 248 and 249:
SOUTH-EAST ASIA REGIONTable A4.1 Es
Page 250 and 251:
Page 252 and 253:
Page 254 and 255:
Page 256 and 257:
Page 258:
SMEAR LABS % OF SMEARPER 100K LABS
Page 261 and 262:
Estimates of mortality, prevalence
Page 263 and 264:
YEARPOPULATION(MILLIONS)MORTALITY (
Page 265 and 266:
YEARPOPULATION(MILLIONS)INCIDENCE (
Page 267 and 268:
YEARPOPULATION(MILLIONS)INCIDENCE (
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
SMEAR LABS % OF SMEARPER 100K LABS
show all

Global Tuberculosis Report -- 2012.pdf

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?