epidemiological status of tb (region of the americas, 2004)

Epidemiological Status of TB (Americas, 2004) 1

Pan AmericanHealthOrganization

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Epidemiological Status of TB (Region of the Americas, 2004)

Regional Program on Tuberculosis



Estimated Global Burden of TB (2002)Estimated Global Burden of TB (2002)

World population 6 billion

Population infected with M. TB 1.9 billion

People ill with TB 16 million

New cases annually 8.2 million

Deaths per year 1.8 million

Yearly deaths from TB/HIV 230,000

98% of all deaths from TB take place in developing countries.



Global Status of Expansion of DOTS/TAES Strategy, 2002

Global Status of Expansion of DOTS/TAES Strategy, 2002

o Multi-resistance to anti-tubercular drugs (MDR-TB) en 63 of the 72 countries surveyed from 1994–1999.

o 73.4% (155 out of 210) of the countries are currently applying DOTS/TAES.

o 61% of the world population has access to the DOTS/TAES strategy.

o 60% of all new infectious, contagious cases (Pulm Bk+) were detected using DOTS/TAES.

o Compared to 1999, there has been an increase of 143,000 Bk+ cases reported using DOTS/TAES (2000–2001). With this increase, goals should be reached by 2013. The search for Bk+ cases would have to be increased by 330,000 yearly to reach the goals by 2005.

o Multi-resistance to anti-tubercular drugs (MDR-TB) en 63 of the 72 countries surveyed from 1994–1999.

o 73.4% (155 out of 210) of the countries are currently applying DOTS/TAES.

o 61% of the world population has access to the DOTS/TAES strategy.

o 60% of all new infectious, contagious cases (Pulm Bk+) were detected using DOTS/TAES.

o Compared to 1999, there has been an increase of 143,000 Bk+ cases reported using DOTS/TAES (2000–2001). With this increase, goals should be reached by 2013. The search for Bk+ cases would have to be increased by 330,000 yearly to reach the goals by 2005.



0

10

20

30

40

50

60

70

80

1990 1995 2000 2005 2010 2015

Year

Cases r

ep

ort

ed

usin

g D

OTS

(%

)

Average progress

2013 goal

Progress sped up:2005 goal

WHO goal = 70%

Start of DOTS 1991

Forecast for Case Detection Using DOTS/TAES

Forecast for Case Detection Using DOTS/TAES

Source: WHO.



• Cases still on the upswing in Africa and the former USSR. • TB/HIV and MDR-TB are being treated as a problem but are

far from being resolved.• Each country knows its own limitations best when it comes

to controlling disease. • Weakness in public-health systems: communities,

primary care, prisons, city governments, social-security systems.

• Lack of participation on the part of the private sector.

End Result: At the global level, we are still in no position to reach our goals by 2005.

• Cases still on the upswing in Africa and the former USSR. • TB/HIV and MDR-TB are being treated as a problem but are

far from being resolved.• Each country knows its own limitations best when it comes

to controlling disease. • Weakness in public-health systems: communities,

primary care, prisons, city governments, social-security systems.

• Lack of participation on the part of the private sector.

End Result: At the global level, we are still in no position to reach our goals by 2005.

TB in 2003: Where are we?TB in 2003: Where are we?



• Impact of HIV on TB.• MDR-TB.• Weakness in health systems:

– Community health-workers unutilized. – Private doctors uninvolved. – Primary-care services respond insufficiently. – Prison system unassociated with DOTS/TAES.

• Impact of HIV on TB.• MDR-TB.• Weakness in health systems:

– Community health-workers unutilized. – Private doctors uninvolved. – Primary-care services respond insufficiently. – Prison system unassociated with DOTS/TAES.

Current Global Challenges for TB Control

Current Global Challenges for TB Control



Trend for TB and BAAR(+) Cases in the Region, 1990–2002

Trend for TB and BAAR(+) Cases in the Region, 1990–2002

0

50,000

100,000

150,000

200,000

250,000

300,000

0

50,000

100,000

150,000

200,000

250,000

300,00029–31 / 100,000 pop.29–31 / 100,000 pop.

15–17 / 100,000 pop.15–17 / 100,000 pop.



Reporting of TB Cases by Category (Region of the Americas, 2002)

Reporting of TB Cases by Category (Region of the Americas, 2002)

Category No. of cases

% Rate * 100,000

All types 223,057 100,0 26,2

BAAR (+) 122,717 55,0 14,4

BAAR (-) 38,990 17,5 4,6

No BAAR 18,889 8,5 2,2

Extra Pulm 31,239 14,0 3,7

Relapses 11,222 5,0 1,3Source: Annual reports from national TB programs in the countries.



Reporting of TB Cases by Gender(Region of the Americas, 2002)

Reporting of TB Cases by Gender(Region of the Americas, 2002)

58%

42%

Male Female

58%

42%

Male Female



Burden of TB(Region of the Americas, 2002)

Burden of TB(Region of the Americas, 2002)

75%

Total: 223,057

Haiti

Dom. Rep.

Mexico

Honduras

Ecuador

Peru

Bolivia

Brazil

Nicaragua

Peru

Brazil

50%



Estimated TB Incidence Rate(Latin America, 2003)

Estimated TB Incidence Rate(Latin America, 2003)

Estimated Incidence Rate per 100,000 pop.

> 85 >50-84 25-49 <24

Bolivia Dominican Republic Ecuador Guatemala Guyana Haiti Honduras Nicaragua Peru

Bahamas Brazil Colombia El Salvador Panama Paraguay Suriname

Argentina Belize Chile Mexico Uruguay Venezuela

English Caribbean Costa Rica Cuba Canada Jamaica Puerto Rico USA



Prevalence of HIV Infection among Patients with TB

(selected countries of the Americas, 2002)

Prevalence of HIV Infection among Patients with TB

(selected countries of the Americas, 2002)

NY 1997 26%

MEX1990-1994 3.1%

GUT20008.0%

ELS20024.4% NIC

2002 2.5%

HON 2002

6.0%

ARG 1995

2.2%

URU 1997

0.7%

Rio de Janeiro - BRA 1995-1998

35.6%

Source: Reports from TB control programs.

* Caribbean Epidemiology Centre (CAREC).

English-speaking Caribbean (2001)*

BAH 40%BEL 12.8%GUY 30.8%JAM 30%SUR 31.1%TRT 52.8%

DOR 1997 17%

PER2002 1.99%

CR 2002

8.9%



Prevalence of TB/AIDS

Source: Reports from national TB programs.

Country Year% TB cases

among PLWHA Type of AIDS epidemic

El Salvador2002 11.5 Concentrated

Guyana 2000 13.7 Generalized

Haití 1999 63.8 Generalized

Honduras 2002 9 Generalized

Nicaragua 2002 2.5 Concentrated

Panama 2002 24.8 Generalized

Peru 2001 34.2 Concentrated



Status of Prevalence of HIV/AIDS among TB Patients in the

English-Speaking Caribbean

Status of Prevalence of HIV/AIDS among TB Patients in the

English-Speaking Caribbean

Country No cases TBSeroprevalence

HIV% of patients with

HIV testBahamas * 42 40.5 100Belize 119 11.7 100Guyana * 422 30.8 47Jamaica 101 30 79Suriname 92 31.1 66Trinidad & Tobago 179 52.8 58* 2001 data from CAREC. Source: CAREC.



Anti-TB Drug-Resistance

Studies(Americas, 1999–2002)

Surveys completedSurveys in progressNo survey project



USA 1.2%

CUBA 0.3%

PERU 3.0%

PR2.5%

NIC 1.2%

R.DOM 6.6%

ARG

1.8%

URU

0.01%

BRA 0.9%

(MDR-TB < 3%)

MDR in Initial Resistance to Anti-TB Drugs

(Americas, 1994–2002)

CHI 0.6%

BOL 1.2%

CAN 1.2%

COL 1.47%

VEN 0.3%

MEX 3 estados 2.4%

ECU 5.0%

ELS0.3%

HON 1.8%

(MDR-TB =< 1%)

(MDR-TB >= 3%)

No data

GUA 3.7%



Figures on Resistance and MDR (by type and country, Americas, 1994 –2002)

Source: PAHO/WHO Registries.

CountriesIR 1994-2002 or Countries

AR 1994-2002 or

Partialresistance Global

Partialresistance Global MDR

Bolivia 1996 23.9 Bolivia 1996 42.1 4.7Brazil 1995 8.6 Brazil 1995 14.4 5.4Mexico 1997 14.1 Mexico 1997 41.1 22.4

Nicaragua 1997 15.6 Nicaragua 1997 - - Puerto Rico 1997 11.3 Puerto Rico 1997 58.3 16.7

Dom. Rep. 1994 40.6 Rep. Dom. 1994 52.1 19.7Uruguay 1997 1.7 Uruguay 1997 93.8 6.3

Venezuela 1998 7.3 Venezuela 1998 26.9 3.8Chile 2001 10 Chile 2001 20.6 3.4

Colombia 1999 13.4 Colombia 1999 - - Cuba 2000 5 Cuba 2000 15.8 2.6Ecuador* 2002 23.4 Ecuador 2002 52.6 24.8

El Salvador 2001 6.5 El Salvador 2001 37 7

Honduras* 2002 17.2 Honduras* 2002 41.4 6.9Peru 1999 18 Peru 1999 23.5 12.3

Argentina 1999 10.2 Argentina 1994 22.8 9.4Paraguay* 2002 17 0 Paraguay 2002 21 4Guatemala 2002 40 3.7 Guatemala 2002 52.4 22.8

Acquired Resistance (AR)

Resistance Resistance

MDR

1.20.9

Initial Resistance (IR)

2.4

1.22.5

6.60

0.30.7

0.5

3

1.8

0.36.6

0.3

1.8

epidemiological status of tb (region of the americas, 2004)

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