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Giornata Mondiale della Tubercolosi
Milano, 14 March 2013
Photo: Riccardo Venturi
Dr Mario C Raviglione Director Stop TB Department
Overview
ü Burden of TB, TB/HIV, MDR-‐TB
ü Strategy and targets
ü Impact of intervenEons, and progress in control and care
Estimated number of cases
Estimated number of deaths
1.4 million* (1.3–1.6 million)
8.7 million (8.3–9.0 million)
630,000 (460,000-‐790,000) out of ~12 million prevalent TB cases
All forms of TB
MulFdrug-‐resistant TB
HIV-‐associated TB 1.1 million (13%) (1.0–1.2 million)
430,000 (400,000–460,000)
Source: WHO Global Tuberculosis Report 2012 * Including deaths aUributed to HIV/TB
The Global Burden of TB -‐2011
Unknown, but probably > 150,000
Incidence rates, 2011
Highest rates in Africa, linked to high rates of HIV infecEon ~80% of HIV+ TB cases in Africa
Per 100 000 populaEon
≥300 150–299 50–149
0–24 25–49
TB/HIV co-‐infecEon: 80% of burden in Africa
ü 80% of all TB/HIV cases are in Africa
ü TB leading cause of death in PLHIV
ü ¼ of PLHIV worldwide die due to TB.
ü PLHIV infected with TB 20-‐40 Emes
more likely to develop acEve TB.
ü Untreated, TB in PLHIV leads to death
in weeks
The boundaries and names shown and the designaFons used on this map do not imply the expression of any opinion whatsoever on the part of the World Health OrganizaFon concerning the legal status of any country, territory, city or area or of its authoriFes, or concerning the delimitaFon of its fronFers or boundaries. DoUed lines on maps represent approximate border
lines for which there may not yet be full agreement. © WHO 2012. All rights reserved
EsEmated number of MDR-‐TB Cases, 2011 >60% of all cases are in 5 countries
Russian FederaEon 44,000
(14% of global MDR burden)
India 66,000
(21% of global MDR burden)
China 61,000
(20% of global MDR burden)
Philippines 11,000
(4% of global MDR burden)
Pakistan 10,000
(3% of global MDR burden)
South Africa 8,100
Based on old survey data
Who carries the burden of tuberculosis?
TB linked to HIV infecEon, malnutriEon, alcohol, drug and tobacco use, diabetes
…mostly, the most vulnerable
Migrants, prisoners, minoriEes, refugees face risks, discriminaEon & barriers to care
500,000 women and 65,000 children die of TB each year; 10 million “TB” orphans
TB spreads in poor, crowded & poorly venElated seangs
Francesco I had tuberculosis!
…El Cardenal tiene una salud frágil, consecuencia de una tuberculosis que lo atacó cuando era un niño y le dejó secuelas: le falta la parte superior alveolar del pulmón derecho… Sin embargo, físicamente es fuerte. El mismo se esfuerza para no ser menos que los demás y practica natación…
Estimated number of
cases
Estimated number of
deaths
500,000 (470,000–510,000)
All forms of TB (Children <15 yr)
* excluding deaths among HIV+ people
All forms of TB (in women)
2.9 million (range, 2.6–3.2 million)
500,000 * (range, 400,000–600,000)
64,000* (range, 58,000–71,000)
The global burden of TB in 2011: women & children Estimated TB incidence rates, by country, 2010
TB cases per 100 000
0–2425–4950–99100–299>=300No estimate
The global response: Stop TB Strategy & Global Plan
To save lives, prevent suffering, protect the vulnerable, & promote human rights
1. Pursue high-‐quality DOTS expansion
2. Address TB-‐HIV, MDR-‐TB, and needs of the poor and vulnerable
3. Contribute to health system strengthening
4. Engage all care providers
5. Empower people with TB and communiEes
6. Enable and promote research
Global Progress on impact
ü 51 million paEents cured, 1995-‐2011
ü 20 million lives saved since 1995
ü 2015 MDG target on track: global TB incidence rate peaked in early 2000s
ü BUT, TB incidence declining too slowly, 1.4 million people sFll dying, MDR-‐TB response slow, gaps in financing
EsEmated lives saved 2005-‐2010 through collaboraEve TB/HIV intervenEons
CumulaFve 2005-‐10= 910,000 (800,000 – 1,100,000)
What are the challenges in 2013 if we target beher care, control and ulEmately “eliminaEon"?
1. Funding not secure at system and individual level: TB is a catastrophic expenditure for the poor
2. TB/HIV major impact in Africa, especially in women and children
3. Weak health policies, systems and services
4. Links with maternal and children services not yet a rouEne
5. Un-‐engaged non-‐state pracEEoners, NGOs, FBOs and communiEes
6. MDR-‐TB care and cure inadequate, especially among PLHIV
7. Social and economic determinants maintaining TB
8. Research awakening needed for new diagnosEcs, drugs and vaccines
Challenge: TB as a cause of maternal and child morbidity and mortality
ü TB causes 1-‐16% of all inferElity and 15-‐40% of tubal inferElity
ü Facility based studies: 12-‐14% of all TB cases are in children
ü TB prevenEon for child contacts not pracEced
ü Studies from SS Africa and India showed: – TB as a cause of all maternal mortality: 6-‐15% – TB as a cause of indirect maternal mortality: 15-‐34%
References: Khan M et al, AIDS 2001; 15:1857–63. Ahmed Y et al, Int J Tuberc Lung Dis 1999; 3:675–80. Panchabhai TS et al,. J Postgrad Med 2009; 55:8–11. Menendez C et al. PLoS Med 2008; 5:e44.
AcEon for MCH services
CUAMM posiEon paper
…First mothers and children (with TB)…. CUAMM deciding to get engaged at all levels in the fight against TB, as there cannot be proper maternal and child care in Africa without addressing asserFvely TB and TB/HIV
Prepared in collabora:on with the top Italian experts in TB
Many thanks to all for
choosing to
Stop TB!