THE GLOBAL EPIDEMIOLOGY OF TUBERCULOSIS WORLD HEALTH ORGANIZATION CHRIS DYE WORLD HEALTH ORGANIZATION GENEVA dyec@who.int

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

22 high-burden countries: 80% of all new cases 10000 1000 Estimated new TB cases ('000s) 100 10 India China Nigeria Kenya Brazil Indonesia Pakistan Ethiopia Thailand Uganda Philippines DR Congo Viet Nam Myanmar Bangladesh Zimbabwe Cambodia South Africa UR Tanzania Afghanistan Mozambique Russian Federation

Tuberculosis in the world, 2001 New TB cases 8.3m (137/100K) New ss+ TB cases 3.7m Change incidence rate 0.4%/yr Prevalence HIV in new cases 11% Prevalence MDR in new case 3.2% Deaths from TB 1.8m (29/100K) TB deaths attributable to HIV 12%

Tuberculosis in the African Region, 2001 estimates New TB cases 1, 857,000 (290) New ss+ TB cases 785,000 (185) Change incidence rate 3.9%/yr Prevalence HIV in new cases 38% Prevalence MDR in new cases 1.8% Deaths from TB 482,000 (75) TB deaths attributable to HIV 39%

Millennium Development Goals Goal 6 Millennium Development Goals Goal 6. Combat AIDS, malaria and other diseases Target 8. Have halted by 2015, and begun to reverse, the incidence of malaria and other major diseases Indicators 23. Prevalence and death rates associated with TB 24. Proportion of TB cases detected and cured under DOTS

Global targets for TB control  internationally agreed By 2005: “Going to scale” : 85% cure, 70% case detection (WHO) By 2010: Having an impact: 50% reduction in TB prevalence and deaths (G8)

Sources of data ordered by ease of measurement Cure: 6-month follow-up in DOTS cohorts (surveillance/monitoring) Case detection: DOTS case notifications (surveillance, surveys) Prevalence: number of existing sm+ cases (surveys) Deaths: number of deaths all forms of TB (surveys, vital registration)

Progress towards 70% case detection in DOTS areas? Asia

Progress towards 70% case detection in DOTS areas? Africa

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

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

This workshop will review: TB burden and trends by country Methods to assess TB morbidity and mortality; application of methods to national populations and to sub-populations Methods to assess case detection and cure rates; methods of analysing data to explain the results Progress towards the targets of 70% case detection and 85% cure, and the utility of these and other indicators (Some) methods to evaluate impact: incidence, prevalence, deaths

Day 1: data review by country Summary of available data describing TB burden and trends Summary of estimates of case detection rates, nationally and for sub-populations of special interest (e.g. by region, ethnic group, age, sex) Summary of treatment outcomes, nationally and for specific sub-populations Summary of impact of TB control (incidence, prevalence, deaths) Overview of outstanding analytical problems (from perspective of the NTP)

Day 2: surveys and estimates AM: Surveys of TB infection and disease PM: Methods for making estimates of TB incidence (prevalence, deaths) Day 3: analyses of surveillance data AM: Examples from EMR and elsewhere, based on standard and other indicators PM: Presentations of results by country