Global Tuberculosis Report -- 2012.pdf

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TABLE 1.1 Targets for the scale-up of interventions for TB care and control set in the <strong>Global</strong> Plan to Stop TB 2011–2015PLAN COMPONENT AND INDICATORS2015 TARGETDiagnosis and treatment of drug-susceptible TBNumber of cases diagnosed, notifi ed and treated according to the DOTS approach (per year)6.9 millionTreatment success rate (in annual cohort) 90%Number of countries with ≥1 laboratory with sputum-smear microscopy services per 100 000 population 149Diagnosis and treatment of drug-resistant TBPercentage of previously treated TB patients tested for MDR-TB 100%Percentage of new bacteriologically-positive TB patients tested for MDR-TB 20%Number of countries among the 22 HBCs and 27 high MDR-TB burden countries with ≥1 culture laboratory per 5 million population 36Percentage of confi rmed cases of MDR-TB enrolled on treatment according to international guidelines 100%Number of confi rmed cases of MDR-TB enrolled on treatment according to international guidelines ∼270 000Treatment success rate among confi rmed cases of MDR-TB ≥75%Collaborative TB/HIV activitiesPercentage of TB patients tested for HIV 100%Percentage of HIV-positive TB patients treated with CPT 100%Percentage of HIV-positive TB patients treated with ART 100%Percentage of people living with HIV attending HIV care services who were screened for TB at their last visit 100%Percentage of people living with HIV attending HIV care services who were enrolled on IPT, among those eligible 100%Laboratory strengthening (additional to those above)Percentage of national reference laboratories implementing a quality management system (QMS) according to international standards ≥50%ART, antiretroviral therapy; CPT, co-trimoxazole preventive therapy; HBC, high TB burden country; HIV, human immunodefi ciency virus; IPT, isoniazid preventive therapy;MDR-TB, multidrug-resistant tuberculosiscomes with a price tag of US$ 47 billion. 1 The main indicatorsand associated targets for 2015 are summarized inTable 1.1.WHO has published a global report on TB every yearsince 1997 (Figure 1.1). The main aim of the report is toprovide a comprehensive and up-to-date assessment ofthe TB epidemic and progress made in prevention, careand control of the disease at global, regional and countrylevels, in the context of global targets and WHO’s recommendedstrategy for achieving these targets. This 2012edition – the 17th in the series – continues the tradition.It is based primarily on data compiled in annual rounds ofglobal TB data collection in which countries are requestedto report a standard set of data to WHO (Box 1.4). In2012, a total of 204 countries and territories that accountfor over 99% of the world’s estimated cases of TB reporteddata (Table 1.2).The report is structured in seven major chapters. Eachchapter is intended to stand alone, but links to otherchapters are highlighted where appropriate.Chapter 2 contains the latest estimates of the burden ofdisease caused by TB and assessment of progress towardsthe 2015 targets at global, regional and country levels.The chapter puts the spotlight on Cambodia as a new successstory in TB control at country level and for the firstBOX 1.3Goals, targets and indicators for TB controlMillennium Development Goals set for 2015■ Goal 6: Combat HIV/AIDS, malaria andother diseasesTarget 6c: Halt and begin to reverse the incidence of malariaand other major diseasesIndicator 6.9: Incidence, prevalence and death ratesassociated with TBIndicator 6.10: Proportion of TB cases detected and curedunder DOTSStop TB Partnership targets set for 2015 and 2050By 2015: Reduce prevalence and death rates by 50%,compared with their levels in 1990By 2050: Reduce the global incidence of active TB cases to
FIGURE 1.1 Sixteen annual WHO reports on TB in 15 years, 1997–20111997: First report:epidemiology andsurveillance2002: Added fi nancing andstrategy for 22 high-burdencountries (HBCs)2003: Financingand strategy(all countries)July 2009: Online data collection introducedDecember 2009: Short update to 2009 report in transitionto earlier reporting of data and report publicationBOX 1.4Data collected in WHO’s 2012 round of global TB data collectionData were requested on the following topics: TB case notifi cations and treatment outcomes, including breakdowns by case type, age, sex,HIV status and drug resistance status; an overview of services for the diagnosis and treatment of TB; laboratory diagnostic services; drugmanagement; monitoring and evaluation; surveillance and surveys of drug-resistant TB; management of drug-resistant TB; collaborativeTB/HIV activities; TB infection control; engagement of all care providers in TB control; the budgets of national TB control programmes(NTPs) in 2012 and 2013; utilization of general health services (hospitalization and outpatient visits) during treatment; and NTPexpenditures in 2011. A shortened version of the online questionnaire was used for high-income countries (that is, countries with a grossnational income per capita of ≥US$ 12 475 in 2011, as defi ned by the World Bank) 1 and/or low-incidence countries (defi ned as countrieswith an incidence rate of
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 10 and 11: Executive SummaryThe World Health O
Page 12 and 13: CHAPTER 1IntroductionBOX 1.1Basic f
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
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TABLE 5.2 NTP budgets, available fu
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FIGURE 5.5Trends in domestic and do
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FIGURE 5.6Domestic funding as a per
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FIGURE 5.8Cost per TB patient succe
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FIGURE 5.10 Total cost and unit cos
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● The 14 countries not included i
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on public health by an external Exp
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evised as a result of the introduct
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TABLE 6.2 Incorporation of WHO poli
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FIGURE 6.3The Supranational Referen
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of TB disease by 65%, irrespective
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FIGURE 7.3Percentage of TB patients
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BOX 7.1Accelerating progress in pro
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TABLE 7.2 Assumptions used to estim
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FIGURE 8.1 The development pipeline
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sputum specimens and TB isolates fr
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cal trial sites and building labora
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new TB vaccine candidate. A Phase I
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This annex explains the methods tha
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2011. On average, 15 data points we
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may suffer from biases. These biase
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TABLE A1.3Parameter estimates used
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5. Estimates of TB prevalence, 1990
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the Republic of Moldova, Romania, t
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AFGHANISTANPopulation 2011 32 milli
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BRAZILPopulation 2011 197 millionHI
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CHINAPopulation 2011 1 348 millionH
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ETHIOPIAPopulation 2011 85 millionH
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INDONESIAPopulation 2011 242 millio
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MOZAMBIQUEPopulation 2011 24 millio
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NIGERIAPopulation 2011 162 millionH
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PHILIPPINESPopulation 2011 95 milli
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SOUTH AFRICAPopulation 2011 50 mill
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UGANDAPopulation 2011 35 millionHIG
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VIET NAMPopulation 2011 89 millionH
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ANNEX 3Regional profiles
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WHO REGION OF THE AMERICASPopulatio
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WHO EUROPEAN REGIONPopulation 2011
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WHO WESTERN PACIFIC REGIONPopulatio
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SUMMARY BY WHO REGIONTable A4.1 Est
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MORTALITY (EXCLUDING HIV) PREVALENC
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NEW AND RELAPSENOTIFICATION RATE aY
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-% OF TB PATIENTS WITHKNOWN HIV STA
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AFRICAN REGIONTable A4.1 Estimates
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INCIDENCE (INCLUDING HIV) INCIDENCE
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NEW AND RELAPSENOTIFICATION RATE aY
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NEW AND RELAPSENOTIFICATION RATE a1
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TREATMENT SUCCESS (%) a1995-2010YEA
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YEARTOTALCONFIRMEDCASES OFMDR-TB aE
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MALEYEAR 0-14 15-24 25-34 35-44 45-
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REGION OF THE AMERICASTable A4.1 Es
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% OF COHORTTREATMENT SUCCESS (%) a1
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MALEFEMALEYEAR 0-14 15-24 25-34 35-
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EASTERN MEDITERRANEAN REGIONTable A
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EUROPEAN REGIONTable A4.1 Estimates
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SOUTH-EAST ASIA REGIONTable A4.1 Es
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SMEAR LABS % OF SMEARPER 100K LABS
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Estimates of mortality, prevalence
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YEARPOPULATION(MILLIONS)MORTALITY (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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SMEAR LABS % OF SMEARPER 100K LABS
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