boost efforts to elimiate tuberculosis by 2050

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.


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%


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


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.

© C

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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

© C

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World TB Day

24 March 2014

Thank you(www.euro.who.int/tuberculosis)

World TB Day24 March 2014

© C

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nnie

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boost efforts to elimiate tuberculosis by 2050

Health & Medicine