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Global TB Epidemiology Chris Dye

May 30, 2018

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Page 1: Global TB Epidemiology Chris Dye

8/14/2019 Global TB Epidemiology Chris Dye

http://slidepdf.com/reader/full/global-tb-epidemiology-chris-dye 1/24

Page 2: Global TB Epidemiology Chris Dye

8/14/2019 Global TB Epidemiology Chris Dye

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TB deaths in England & Wales, 1900-91

0

20

40

60

80100

120

140160

180

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990

T

B d e a

t h s

/ 1 0 0 , 0

0 0 / y e a r

why ? 100?

why the decline -slowly?

why the increase?

why the faster decline?

when will it end?

who are the 100?

what happened before 1900?

will it keep going down?

Page 3: Global TB Epidemiology Chris Dye

8/14/2019 Global TB Epidemiology Chris Dye

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Progress towards

2005 and 2015 targets forglobal TB control

Millennium Development

GoalsTB Monitoring & Evaluation

WHO Geneva Stop TB DepartmentStop TB Department

Page 4: Global TB Epidemiology Chris Dye

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MILLENNIUM DEVELOPMENTGOALS (2015)

– Eradicate poverty and hunger – Universal primary education –

Empower women – Reduce child mortality – Improve maternal health –

Combat HIV/AIDS, malaria and otherdiseases

– Environmental sustainability –

Global partnership for development

S t o pT BD

e p ar t m en

t

S t o pT BD

e p ar t m en

t

Page 5: Global TB Epidemiology Chris Dye

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9m cases annually>1/3 in populous India and China

10 000 to 99 999

100 000 to 999 999

1 000 000 or more

< 1 000

1 000 to 9 999

No Estimate

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 WorldHealth 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 2002Stop TB DepartmentStop TB Department

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Highest TB rates per capita are in Africalinked to HIV/AIDS

25 to 49

50 to 99

100 to 299

< 10

10 to 24

300 or more

No Estimate

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 WorldHealth 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 2002Stop TB DepartmentStop TB Department

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TB cases falling in 6/9 regionsof the world

0

50

100

150

200

1990 1992 1994 1996 1998 2000 2002 2004

I n c i d e n c e r a

t e ( / 1 0 0 K / y r )

SE Asia

W Pacific

Latin America

E Mediterranean

C Europe

Est Mkts

Stop TB DepartmentStop TB Department

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TB cases have been rising inAfrica and E Europe

0

100

200

300

400

500

1990 1992 1994 1996 1998 2000 2002 2004

I n c i d e n c e r a

t e ( / 1 0 0 K / y r )

Africa - high HIV

Africa - low HIV

Eastern Europe

incidence falling

rise in incidence slowing

Stop TB DepartmentStop TB Department

Page 9: Global TB Epidemiology Chris Dye

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5 targets for global TB controlMILLENNIUM DEVELOPMENT GOALS

"to have halted and begun to reverseincidence.."

Implementation (DOTS) Indicator 24 (target year 2005)Case detection 70% (> 6 m diagnosed)Treatment success 85% (> 5 m cured DOTS)

Impact Indicator 23 (target year 2015 cf 1990) Prevalence 50% of ≈ 300/100K Deaths 50% of ≈ 30/100K

(< 1m deaths)

S t o pT BD

e p ar t m en

t

S t o pT BD

e p ar t m en

t

Page 10: Global TB Epidemiology Chris Dye

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• Data from 200countries annually

• 80+ millionpatients since 1980• 17 million patientson DOTS

• …and '000s of provinces, districts,counties, oblasts• ≈US$ 5 bn 2001-5

Stop TB DepartmentStop TB Department

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DOTS treatment success close totarget for 1.4m patients in 2002

0

20

40

60

80

100

1994 1995 1996 1997 1998 1999 2000 2001 2002

T r e a

t m e n

t s u c c e s s

( % )

High-burdencountriesWorld

Target 85%

Stop TB DepartmentStop TB Department

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Reasons for failure:Treatment outcomes are worst in

Africa and Europe

0 10 20 30 40

Africa

Americas

E Med

Europe

SE Asia

W Pacific

Percent of cohort

Died

Failed

Defaulted

Transfered

Not Evaluated

Stop TB DepartmentStop TB Department

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>17m DOTS patients since 1995≈US$ 5 bn 2001-5

0

10

20

30

40

50

60

70

80

1990 1995 2000 2005 2010 2015 Year

C a s e

d e

t e c t i o

n r a

t e ,

s m e a r - p o s

i t i v e c a s e s

( % )

average rate of

progress 1995-2000

accelerated progress:target 2005

Target 70%

DOTS begins

Stop TB DepartmentStop TB Department

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Regional progress towards 70% case detection:Europe low , SE Asia accelerating , Americas high

0

10

20

30

40

50

60

70

1994 1996 1998 2000 2002 2004 2006

C a s e

d e

t e c

t i o n r a

t e ( s m

+ , %

)

Americas

Africa

W Pacific

World

SE Asia

E Med

Europe

Stop TB DepartmentStop TB Department

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65% of missing cases are in8 countries

20

16

8.86.0 5.1 4.9

3.3 3.0

0

100

200

300

400

500

I n d i a

C h i n a

I n d o n

e s i a

N i g e r i a

B a n g l a d

e s h

P a k i s t a

n

E t h i o p i a

R u s s

i a

C a s e s n o

t f o u n

d b y

D O T S

p r o

g r a m m e s ( t h

o u s a n

d s ) percent of missing cases

Stop TB DepartmentStop TB Department

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Dynamics of pulmonary TB inPeru 1980-2000

100

120

140

160

180

200

220

1980 1985 1990 1995 2000

P u

l m o n a r y

T B c a s e s

/ 1 0 0

, 0 0 0DOTS 1990

PTB falling at 6%/yr

case finding

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Decline in TB incidence in theMaldive Islands

decline 9%/yr

decline 10%/yr

0

20

40

60

80

100

1994 1996 1998 2000 2002 2004

C a s e n

o t i f c i a t i o n r a

t e ( / 1 0 0 K / y r )

new smear+all TB

Stop TB DepartmentStop TB Department

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DOTS reduces prevalence of culture+TB by 37% in less than a decade in China

0

50

100

150

200

250

1990 2000

P r e v a

l e n c e c u

l t u r e + T B / 1 0 0

, 0 0DOTSOther

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Progress towards MDGs in Indonesiaprevalence rate fell 4%/yr 1980-2004?

36%

55%

29%

42%

0

100

200

300

400

500

600

Sumatera Java-Bali KTI (East) National

S m e a r + p r e v a l e n c e

/ 1 0 0 K

1980 regional surveys

1990 (under)estimate

2004 national survey

% fall 1990-2004

Stop TB DepartmentStop TB Department

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"Model DOTS Project" reduces TBprevalence in south India

source: TRC Chennai

0

1000

2000

68-70

71-73

73-75

76-78

79-81

81-83

84-86

99-01

01-03

Year

P r e v a l e n c e / 1 0

0 K Male C+

Male S+

Female C+

Female S+

fall ~10%/yr

in MDP

Stop TB DepartmentStop TB Department

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Trends in TB death registrations

0

200

400

600

800

1000

1200

1985 1990 1995 2000

G e o m e

t r i c m e a n n u

m b e r o

f d e a t h s

Former Soviet Union

Central Europe

Industrialized

Latin America

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Impact of drugs on TB case fatality:Enlgand & Wales

0

50

100

150

200

250

300

350

400

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990

C a s e n o

t i f i c a t i o n s o r

d

e a

t h s

/ 1 0 0

, 0 0 0 / y e a r

0

0.1

0.2

0.3

0.4

0.5

0.6

D e a

t h s

/ c a s e s

deathscasescase fatality

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Prevalence and death rates arefalling, but not fast enough

0

100

200

300

400

1990 1992 1994 1996 1998 2000 2002 2004

I n c i d e n c e o r p r e v a

l e n c e

r a t e ( p e r

1 0 0

, 0 0 0 )

0

5

10

15

20

25

30

35

M o r t a

l i t y r a

t e

( p e r

1 0 0

, 0 0 0

p e r y r )

MDG targets

Prevalence

Deaths

Incidence

inc HIV+

exc HIV+

Stop TB DepartmentStop TB Department

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Global TB control in 2005MILLENNIUM DEVELOPMENT GOALS

Target 8: incidence rising at 1% per year

Implementation (DOTS) Indicator 24 (2002-3/target 2005)Case detection 45/70%Treatment success 82/85%

Impact (DOTS and…) Indicator 23 (2003/1990, target 2015) Prevalence 240/309 (per 100K)Deaths 24/28 (per 100K/yr)

S t o pT BD

e p ar t m

en

S t o pT BD

e p ar t m

en