Wtbd 2015 final_eng

World TB Day 2015

World TB Day24 March 2015

World TB Day 2015

MDR-TB is still ravaging the European Region, making it the most affected area of the entire world. Only

50% of MDR-TB patients are found and half of them successfully cured.

This calls for a considerable scaling up of access to safe, rational and efficient new TB drugs, as well as

innovations on rapid diagnosis and care centred on the needs of patients.

This is what the new global End TB Strategy and the European

consolidated action plan advocate for. Zsuzsanna Jakab

WHO Regional Director for Europe

World TB Day 2015

Even with the fastest decline in TB incidence in the world, nearly 1000 Europeans fall ill every day

• New TB cases estimated to occur per year: 360 000.

• Estimated total of TB patients in the Region:over 460 000.

• Since 2001, new TB cases have been falling at an average rate of 4.5% per year.

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World TB Day 2015

Declining trend in TB incidence• TB notification trend reflects true reduction in spread of the disease and

is strongly influenced by improvements in high-priority countries.• Member States with highest TB incidence are those with a more

pronounced decline (up to 9%).

Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.Stockholm: European Centre for Disease Prevention and Control; 2015.

WHO European Region, 1980-2013

64.0

39.7

31.9

10.6

0

20

40

60

80

1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013

Notification (18 High-priority countries)

Estimated incidence (53 Member States)

Notification rate (53 Member States)

Notification (European Union/European Economic Area (EU/EEA))R

ate

per 1

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00 p

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atio

n

World TB Day 2015

• 84% of incident and 85% of prevalent TB cases

• 90% of mortality caused by TB

• 99.5% of MDR-TB;• 90% of TB/HIV co-

infectionsoccur in the 18 high-priority countries in the Region

TB burden unequally distributed among countries

18 high-priority countries: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan.


Estimated TB incidence per 100 000 population, WHO European Region, 2013

World TB Day 2015

Multi-drug TB burden

9.1 8.7 8.5 8.4

‐

5.0

10.0

Baseline 2012 2014

Estimated number of all MDR-TB cases per 100 000 population, WHO European

Region

• Absolute number of estimated MDR-TB cases appears to be decreasing.

• However, less than 50% of estimated cases are detected.

• 1 untreated person with TB or M/XDR-TB can infect 10–15 people each year, and 10% of them will develop the disease.

Cas

es p

er 1

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World TB Day 2015

Percentage of MDR-TB is still on the risePercentages of notified MDR among TB

cases, WHO European Region, 2007–2013

9.8% 10.4% 11.9% 13.2% 13.3%15.0%

16.9%

38.3%

33.9%

38.5%

48.6% 47.7% 47.1% 48.0%

0%

10%

20%

30%

40%

50%

60%

2007 2008 2009 2010 2011 2012 2013


MDR among new cases

MDR among previously treated cases

World TB Day 2015

Impressive improvement in coverage of treatment for MDR-TB, 2009–2013

In 2013, all notified MDR-TB patients started second-line MDR treatment (including cases detected in previous years).

In 2009 only 60% of those detected had been put on treatment.

40% increase in MDR-TB detection since 2009.

28 456

33 957 34 18436 877

39 924

17 169

27 324

34 210

39 865

45 079

0

5 000

10 000

15 000

20 000

25 000

30 000

35 000

40 000

45 000

50 000

2009 2010 2011 2012 2013

MDR cases notifiedMDR cases enrolled in treatment

Cas

es

World TB Day 2015

Success of TB treatment in WHO European Region, 2008–2013

0

10

20

30

40

50

60

70

80New laboratory-confirmed TB cases

New and relapsedTB cases*

Previously treatedTB cases (excludingrelapsed cases)

Laboratory-confirmed MDR-TBcases

Treatment success rate in 2013:

• 76% in new and relapsed TB cases.

• 57% in previously treated TB cases.

• 46% in MDR-TB cohort, lower than previous year.

%

Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015. Stockholm: European Centre for Disease Prevention and Control; 2015.

* Since 2012, the case definition has changed from new laboratory-confirmed TB cases to new and relapsed TB cases

World TB Day 2015

People of productive age carry the heaviest burden of TB disease

People aged 25–44years are predominant (44%) among new TB cases registered, affecting:• households’ economic

well-being;• national economies

through the direct loss of productivity.

0102030405060708090

100

0–4 5–14 15–24 25–44 45–64 > 64C

ases

per

100

000

pop

ulat

ion

Years

Age distribution of new and relapsed TB cases in the WHO European Region,

2013

EU/EEA countries All countries 18 High-priority countries


World TB Day 2015

Fewer TB patients living with HIV are being offeredantiretroviral treatment

• More TB cases with HIV co-infection detected in the Region – about 17 096, or 81.4% of the estimated total.

• Notable decrease in antiretroviral therapy (ART) coverage from 62.3% in 2012 to 53.8%in 2013.

2.8 2.8 3.44.8

6.45.4 6.1

7.8

44.2

62.3

53.8

0

10

20

30

40

50

60

70

0

1

2

3

4

5

6

7

8

9

2006 2007 2008 2009 2010 2011 2012 2013

%

Percentage of HIV among notified cases of TB, WHO European Region, 2013

Percentage of HIV among notified TB cases ART coverage


%

Per

cent

age

of H

IV a

mon

g no

tifie

d TB

cas

es

AR

T co

vera

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r TB

/HIV

pat

ient

s

World TB Day 2015

TB in the penitentiary sector

• 6.4% of the burden of new TB cases originate in prisons

• Nearly 1 in every 1000 inmates develops TB

• Risk of becoming ill with TB in prison is 23 times higher than in the general population

• The WHO collaborating centreon prevention and control of TB in prisons was established in 2014 (Azerbaijan) Source: European Centre for Disease Prevention and Control/WHO Regional

Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.Stockholm: European Centre for Disease Prevention and Control; 2015.

Overall TB notification rate (all TB) per 100 000 penitentiary inmates, WHO European Region, 2013

World TB Day 2015

Consolidated Action Plan to Prevent and Combat M-/XDR-TB, 2011–2015

Key progress:

• Scaled up good practices and patient-centred models of care

• Boosted partnership and civil society involvement

• Improved collaboration with other sectors and ministries in line with Health 2020

• Introduced new diagnostic procedures and approaches to improve TB laboratory diagnosis

National MDR-TB plans finalized by almost all high burden MDR-TB countries

World TB Day 2015

Priorities for ultimate elimination of TB

• More rapid diagnosis and complete treatment for all patients

• Expanded patient-centred care models

• Further shift from inpatient to ambulatory care

• New TB drugs, with shorter and more effective treatment regimens

• Research for new diagnostics and vaccines

• More equity and reduced stigma• More funds, better used

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World TB Day 2015

Development of new TB Action Plan for the WHO European Region, 2016–2020

Pillars of the End TB Strategy:1. integrated, patient-

centred care and prevention

2. bold policies and supportive systems

3. intensified research and innovation

Specific targets for the WHO European Region until 2020:

35% reduction in TB deaths

25% reduction in TB incidence rate

75% treatment success rate among MDR-TB patients

World TB Day 2015

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

World TB Day24 March 2015

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Health & Medicine

Wtbd 2015 final_eng