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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
00 0
00 p
opul
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.
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.
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
00 0
00 p
opul
atio
n
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
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.
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
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.
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
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.
%
Per
cent
age
of H
IV a
mon
g no
tifie
d TB
cas
es
AR
T co
vera
ge fo
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