TUBERCULOSIS

Chapter 3 :: TB disease burden
:: KEY FACTS AND MESSAGES
Global targets and milestones for reductions in the burden of
TB disease in the period 2016–2035 have been set as part of
the Sustainable Development Goals (SDGs) and WHO’s End
TB Strategy.
The first milestones of the End TB Strategy, set for 2020, are
a 35% reduction in the absolute number of TB deaths and a
20% reduction in the TB incidence rate, compared with levels
in 2015. To reach these milestones, the TB incidence rate
needs to be falling by 4–5% per year globally by 2020 and
the proportion of people with TB who die from the disease
(the case fatality ratio or CFR) a needs to be reduced to 10%
globally by 2020.
A substantial acceleration in the current rate of progress in
reducing the burden of TB disease, based on all elements of
the End TB Strategy, is required to bring these milestones
within reach.
Globally, the absolute number of TB deaths (excluding TB
deaths among HIV-positive people b ) and the TB incidence
rate have fallen since 2000. The number of TB deaths fell
from 1.8 million in 2000 to 1.4 million in 2015. However, the
global rate of decline in the TB incidence rate was only 1.5%
from 2014 to 2015 and the CFR in 2015 was 17%. TB is one
of the top 10 causes of death worldwide and caused more
deaths than HIV in 2015.
Worldwide in 2015, there were an estimated 10.4 million
incident TB cases. An estimated 62% of these cases were
male, and 90% of cases were adults. Six countries accounted
for 60% of the global total: India, Indonesia, China, Nigeria,
Pakistan and South Africa. The rate of progress in these
countries will have a major influence on whether or not the
2020 global milestones are achieved.
Estimates of the burden of TB disease in India have been
revised substantially upwards for the period 2000–2015,
compared with those published in previous reports. This
follows accumulating evidence from surveys and routinely
collected TB notification data that previous estimates of
cases and deaths were too low. As the country with the
highest burden of TB disease in the world, these revisions
have had a major impact on the global estimates. The
estimates for India are still considered as interim, pending a
national TB prevalence survey scheduled for 2017/2018.
An estimated 11% of incident TB cases in 2015 were HIVpositive.
The proportion was highest in countries in the WHO
African Region, and exceeded 50% in parts of southern
Africa. In addition to the 1.4 million TB deaths among HIVnegative
people, there were 0.4 million deaths from TB
among HIV-positive people b in 2015.
Variation in the CFR in 2015, from under 5% in a few
countries to more than 20% in most countries in the WHO
African Region, shows considerable inequalities among
countries in access to TB diagnosis and treatment that need
to be addressed. If everyone with TB had a timely diagnosis
and access to high-quality treatment, the CFR would be low
in all countries.
Following WHO guidance issued in May 2016, all cases
of rifampicin-resistant TB (RR-TB), including those with
multidrug-resistant TB (MDR-TB), should be treated with a
second-line MDR-TB treatment regimen. Globally in 2015,
there were an estimated 480 000 new cases of MDR-TB and
an additional 100 000 people with rifampicin-resistant TB
who were also newly eligible for MDR-TB treatment; India,
China and the Russian Federation accounted for 45% of
these cases.
Until national notification and vital registration systems (with
standard coding of causes of death) of high coverage and
quality are present in all countries, national TB prevalence
surveys will continue to provide the best method for directly
measuring the burden of TB disease and identifying actions
required to reduce that burden in an important subset
of countries. In recent years, there has been enormous
progress in implementing such surveys, with 22 completed
between 2009 and August 2016. In this report, estimates of
TB incidence were derived from prevalence surveys for 20
countries with 62% of the world’s TB cases.
a
The CFR can be approximated as the number of TB deaths divided
by the number of incident cases in the same year.
b
When an HIV-positive person dies from TB disease, the underlying
cause is classified as HIV in the International Classification of
Diseases system (ICD-10).
GLOBAL TUBERCULOSIS REPORT 2016 :: 15