1 Global and Regional Tuberculosis (TB) update ACSM workshop, Amman, Jordan April 13-17, 2008 Dr. Sevil Huseynova.

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Global and Regional Tuberculosis (TB) update

ACSM workshop, Amman, Jordan April 13-17, 2008

Dr. Sevil Huseynova

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What is TB?

One of the oldest disease known Usually a respiratory disease due to infection by Mycobacterium tuberculosis. Mode of spread

TB Patient Cough infect others

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How big TB problem is?Leading infectious killer in the world Globally: 2.1 billion infected

9.2 million cases & 1.7 million deaths a year 0.7M cases & 0.2M deaths in HIV+ 500K people a year become infected with MDR-TB

25% of all avoidable deaths in economically productive age groups are due to TB.

Regionally: 180M infected 560,000 cases & 110,000 deaths a year

Yet it is completely curable and is (relatively) inexpensive to cure.

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Estimated TB incidence rate, 2006

Estimated new TB cases (all forms) per 100 000 population

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2006. All rights reserved

No estimate

0-24

50-99

300 or more

25-49

100-299

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Estimated HIV prevalence in new TB cases, 2006

No estimate

0–4

20–49

50 or more

5–19

HIV prevalence in TB cases, (%)

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2006. All rights reserved

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> 100

Incidence rate (/100 000)

50-100

< 20

Bahrain

Palestine

20-50

Estimated TB incidence rate in EMR

WHO Global TB Report 2007

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How to fight against TB?

Global Plan to Stop TB Comprehensive plan to

achieve 70/85 & MDG (2006-2015)

Activities & Cost USD 56 Billion for world USD 3.1 Billion for EMR

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Global Plan to Stop TB: Goals, Targets and Strategies for TB control

MILLENIUM DEVELOPMENT GOAL 6

Combat HIV/AIDS, malaria and other diseases

Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Indicator 23: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels

Prevalence 50% of ≈ 300/100K Deaths 50% of ≈ 30/100K (< 1m deaths) Indicator 24: proportion of TB cases detected and cured under DOTS Case detection 70% (> 6 m diagnosed) Treatment success 85% (> 5 m cured DOTS)

By 2050: The global incidence of active TB will be less than 1 case per million population per year (Stop TB Partnership).

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DOTS status in 2006: countries close to targets

99 countries reported treatment success rates 70% or over and DOTS detection rates 50% or over 32 countries (including 2 countries out of range of graph) have reached both targets.

Benin

Venezuela

Vanuatu

Uruguay

Turkmenistan

Turkey

Tunisia

Thailand

TFYR Macedonia

Sri Lanka

South Africa

Somalia

Slovenia

Singapore

Samoa

Romania

Qatar

Puerto Rico

Portugal

Poland

Philippines

Peru

Nicaragua

Nepal

Myanmar

Morocco

Mongolia

Mexico

Marshall Islands Maldives

Malaysia

Madagascar

Lithuania

Liberia

Lebanon

Latvia

Lao PDR

Kyrgyzstan

Kiribati

Kenya

Kazakhstan

JordanIran (islamic republic of)

Indonesia

India

Iceland

Honduras

Haiti

Guam

Georgia

French Polynesia

Fiji

Estonia

El Salvador

Egypt

DR Congo

DPR Korea

Dominican Republic

Czech Republic

Cuba

Costa Rica

China, Macao SAR

China

Cameroon

Cambodia

Bulgaria

Brunei Darussalam

Brazil

Bosnia & Herzegovina

Bolivia

Bhutan

Belize

Bangladesh

ArmeniaAngola

Algeria

Afghanistan

70

80

90

100

50 60 70 80 90 100 110 120

DOTS case detection rate (new smear-positive, %)

Tre

atm

ent

succ

ess

(%)

Target zone

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The components of the Stop TB Strategy (2006-2015)

1. DOTS expansion and enhancement2. Addressing TB/HIV, MDR-TB and

other challenges3. Contributing to health system

strengthening4. Engaging all care providers5. Empowering patients, and

communities6. Enabling and promoting research

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WHO Stop TB Strategy & “DOTS”

Care for TB patients & community participation in TB control

Diagnosis by laboratory (sputum examination)

6 month treatment with >95% efficacy Strategy to involve private sector &

community e.g. cure rate is above 85% in most EMR

countries

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What are the challenges in TB care?

1. Low health priority2. Limited resources (human and financial)3. Low case detection and Treatment

adherence, Drug resistance Stigma and discrimination Poverty Wars and conflicts HIV/AIDS and TB Mobile population and migration