PROGRESS IN GLOBAL TB CONTROL WITH SPECIAL REFERENCE TO EUROPE CHRIS DYE plus ~200 others WORLD HEALTH ORGANIZATION GENEVA

Tuberculosis in the world, 2002 People infected 2 billion New TB cases 8.6m (138/100K) New ss+ TB cases 3.8m Change incidence rate 0.4%/yr Prevalence HIV in new adult cases 12% Prevalence MDR in new cases 3.2% Deaths from TB (inc HIV) 1.8m (28/100K)

Most TB cases are in India and China < 1 000 1 000 to 9 999 10 000 to 99 999 100 000 to 999 999 1 000 000 or more 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 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 2002

Highest TB rates per capita are in Africa 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 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 2002

Tuberculosis in Europe, 2002 People infected 200 m New TB cases 481K (55/100K) New ss+ TB cases 215K (25/100K) Change incidence rate 0.4%/yr Prevalence HIV in new adult cases 4% Prevalence MDR in new cases 5% Deaths from TB (inc HIV) 76K (9/100K)

Estimated TB Incidence Number, All Forms, 2002

Estimated TB Incidence Rates, All Forms, 2002

Global targets for TB control MILLENNIUM DEVELOPMENT GOALS By 2005: 70% case detection, 85% cure By 2015: Halve prevalence and deaths

SURVEILLANCE REPORTS RECEIVED BY 3 OCTOBER 2003

Progress towards 70% case detection under DOTS 80 70 Target 70% 60 50 All smear+ cases Case detection rate (%) 40 Forecast 2002: 30 1.4m smear+ = 37% DDR 20 Smear+ cases DOTS 10 1990 1995 2000 2005 2010 2015 Year

Why are TB cases “undetected”? estimated TB cases all true TB cases cases presenting to health facilities cases presenting to public health facilities cases presenting to DOTS facilities cases correctly diagnosed by DOTS facilities diagnosed cases reported by DOTS facilities

Few Chinese patients diagnosed in, or transferred to, DOTS dispensaries Other Transfer Private clinics Diagnosis Town/village clinics TB hospitals Trad med units General hospitals TB dispensaries 50 100 150 200 Source: 2000 prevalence survey Number of patients

Improving case detection in China 627 patients with TB, seen by health services 100 90 80 70 60 50 Cumulative proportion TB patients (%) 40 30 20 10 Other clinics TB units Private General hospitals Township clinics Traditional medics TB hospitals misdiagnosed source: 2000 prevalence survey

Better treatment in DOTS dispensaries China 2000 prevalence survey 70 TB dispensaries 60 Other units 50 40 Percent patients 30 20 10 Regular Intermittent Interrupted

Dynamics of pulmonary TB in Peru 1980-2000 220 DOTS 1990 200 case finding 180 Pulmonary TB cases/100,000 160 140 120 PTB falling at 6%/yr 100 1980 1985 1990 1995 2000

DOTS reduces prevalence of TB by 37% over a decade in China 250 DOTS Other 200 150 Prevalence culture+ TB/100,000 100 50 1990 2000

WE’RE HALF WAY THERE but not in Europe... Case detection 36/70 Europe Treatment success 83/85

THE DATA CAN TELL US MORE THAN WE KNOW