What is “burden”? DALY = YLL (death) + YLD (disability) For TB ~ 90% DALYs due to death death is why TB is among top 10 in “burden” league table

LOSS OF HEALTHY LIFE DUE TO TB

Decline in TB, Alaska 1950-73 Incidence or death rate/10K/year 6 5 4 3 cases 13%/yr 5 t = 5 yr 1/2 4 3 Incidence or death rate/10K/year 2 1 deaths 30%/yr -1 t = 2.3 yr 1/2 -2 1950 1955 1960 1965 1970 1975 source: Grzybowski Tubercle 1976

Impact of TB control on cases and deaths Netherlands 1950-94 6 5 4 incidence 7.0%/yr 3 CFR 15% 2 1 CFR 1.5% -1 -2 deaths 12.3%/yr -3 50 55 60 65 70 75 80 85 90 95 year

TB cases and deaths Uruguay, 1945-1995 GTB, 1997

Trends in TB death registrations 1200 Former Soviet Union 1000 Central Europe Industrialized 800 Latin America Geometric mean number of deaths 600 400 200 1985 1990 1995 2000

Impact of improved TB control: deaths reduced in Peru 20000 other defaulted DOTS 1991 15000 untreated Estimated number of deaths 10000 5000 87 88 89 90 91 92 93 94 95 96 97 98 99