World Health Assembly 63 Geneva, Suisse 16-17 May 2010 WORLD HEALTH EDITORS NETWORK Tracking Global...

World Health Assembly 63Geneva, Suisse

16-17 May 2010

WORLD HEALTH EDITORS NETWORKTracking Global Health News: building health literacy

Multi-Drug Resistant tuberculosis: update

on epidemic and response

Estimated number of

cases

Estimated number of

deaths

1.8 million

(range 1.6–2.3 million)

9.4 million(range 8.9–9.9 million)

440,000 (0.39-0.51 million)

All forms of TB

Multidrug-resistant TB (MDR-TB)

HIV-associated TB 1.4 million (15%)(1.3–1.6 million)

520,000(0.45–0.62 million)

The global burden of TB in 2008

150,000(0.05–0.27 million)

TB prevalence and mortality

On track everywhere except for Africa

Prevalence (all)

Ra

te p

er

10

0,0

00

150

200

250

300

targettargettargettargettargettargettargettargettargettargettargettargettargettargettargettargettargettargettarget

1990 1995 2000 2005Mortality (excl. HIV)

Ra

te p

er

10

0,0

00

20

25

30

35

40


1990 1995 2000 2005Prevalence (all)

Ra

te p

er

10

0,0

00

150

200

250

300



Ra

te p

er

10

0,0

00

20

25

30

35

40


1990 1995 2000 2005Prevalence (all)

Ra

te p

er

10

0,0

00

150

200

250

300



Ra

te p

er

10

0,0

00

20

25

30

35

40


1990 1995 2000 2005Prevalence (all)

Ra

te p

er

10

0,0

00

150

200

250

300



Ra

te p

er

10

0,0

00

20

25

30

35

40


1990 1995 2000 2005Prevalence (all)

Ra

te p

er

10

0,0

00

150

200

250

300



Ra

te p

er

10

0,0

00

20

25

30

35

40


1990 1995 2000 2005Prevalence (all)

Ra

te p

er

10

0,0

00

150

200

250

300



Ra

te p

er

10

0,0

00

20

25

30

35

40


1990 1995 2000 2005

1990 1995 2000 2005

Rat

e pe

r 10

0,00

0 po

pula

tion

150

145

140

135

130

125

120

Incidence rates falling globally after peak in 2004, but only at <1%/year

Peak in 2004

World as a whole on track to achieve MDG target 6.c

1995-2008: 15 years of progress through DOTS/Stop TB Strategy• 36 million patients cured in 1995-2008

• About 6 million deaths averted counterfactual 1995 care standards

• Case fatality rate halved from 7.6% to 4%

• Cure rate at its highest ever (87% in 2007-8)

• But….MDR-TB and XDR-TB are threatening these achievements

High-level policy changes are fundamental! World Health Assembly, May 2009…

In addition to proper basic control..

1. Remove financial barriers (UHC)2. Ensure well trained and sufficient

human resources3. Establish a network of labs where

rapid tests are also available4. Ensure availability of quality drugs5. Regulate the use of all anti-TB drugs6. Introduce infection control7. Establish proper surveillance8. Promote Research & Development9. Mobilize resources domestically and

internationallyDocument WHA 62.15, 2009

Definitions

MDR TB = Strains resistant to at least INH and RIF (most important 1st-line drugs)

XDR TB = MDR TB strains with additional resistance to any fluoroquinolone and any of the 3 injectable second-line drugs (amikacin, kanamycin, capreomycin)

MDR TB XDR TB

TB with any drug

resistance

M/XDR-TB 2010 global report on surveillance and response

440,000 MDR-TB casesestimated to have emerged in 2008

(3.6% of all incident TB cases globally)

150,000 MDR-TB casesestimated to have died in 2008

% MDR-TB among new TB cases,1994-2009

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 2010. All rights reserved

Australia, Democratic Republic of the Congo, Fiji, Guam, New Caledonia, Solomon Islands and Qatar reported data on combined new and previously treated cases.

0-<3

3-<6

6-<12

12-<18

>=18

No data available

Subnational data only

28 settings with > 5% MDR-TB among new TB cases, 2001-2009

Indicates data presented in the M/XDR-TB 2010 global report on surveillance and response

Indicates data reported in an earlier phase of the project

Estimated absolute number ofMDR-TB cases, 2009

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 2010. All rights reserved

0-<4,000

4,000-<10,000

10,000-<40,000

approximately 100,000

Trends of MDR-TB cases in selected settings

Orel Oblast, Russian Federation

Tomsk Oblast, Russian Federation

New MDR-TB cases

0

10

20

30

40

50

1994 1996 1998 2000 2002 2004 2006 2008

Year

Cas

es n

otifi

ed

New MDR-TB cases

0

20

40

60

80

100

1994 1996 1998 2000 2002 2004 2006 2008

YearC

ases

not

ified


Estonia

New MDR-TB cases

0

20

40

60

80

100

1994 1996 1998 2000 2002 2004 2006 2008

Year

Cas

es n

otifi

ed

New MDR-TB cases

0

50

100

150

200

1994 1996 1998 2000 2002 2004 2006 2008

Year

Cas

es n

otifi

ed

Latvia


China, Hong Kong SAR United States of America

New MDR-TB cases

0

20

40

60

80

100

1994 1996 1998 2000 2002 2004 2006 2008

Year

Cas

es n

otifi

ed

Combined MDR-TB cases

0

100

200

300

400

500

1994 1996 1998 2000 2002 2004 2006 2008

YearC

ases

not

ified

Countries that had reported at least oneXDR-TB case by end March 2010

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 2009. All rights reserved

Argentina Canada India Lithuania Peru Slovenia United KingdomArmenia China Iran (Islamic Rep. of) Mexico Philippines South Africa United States of AmericaAustralia Colombia Ireland Mozambique Poland Spain UzbekistanAzerbaijan Czech Republic Israel Myanmar Portugal Swaziland Viet NamBangladesh Ecuador Italy Namibia Qatar SwedenBelgium Estonia Japan Nepal Republic of Korea TajikistanBotswana France Kenya Netherlands Republic of Moldova ThailandBrazil Georgia Latvia Norway Romania UkraineBurkina Faso Germany Lesotho Oman Russian Federation United Arab Emirates

Gap between GLC approved treatments and revised Global Plan, 2006-2015

5 10 12 25 30 50 63 10030

176

328

548

766

979

1187

1389

1582

0100200300400500600700800900

10001100120013001400150016001700

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Thou

sand

s

GLC

Global Plan

Expon. (GLC)

100,000 treatments are estimated to be approved in 2010 by GLC, about 80,000 treatments have been approved as of April 2010

National MDR/XDR-TB Response Plans

DR TB Response Plans in 27 High burden countries

5

8

14

0 2 4 6 8 10 12 14 16

Not initiated

Developed

Initiated

•Bangladesh •continuous surveillance for drug resistance

•China •first nationwide drug resistance survey conducted

•Ethiopia and Lesotho•introducing or using rapid diagnostic tests

•India•ambitious plan for national scale up

•Nepal and Romania •successful treatment outcomes

•South Africa •policy changes to enable access to treatment

Response in selected countries

Funding requirements 2009-2015 27 MDR-TB high-burden countries

Most of the funding required is in the European Region, followed by Asia. In Asia the funding is mainly required in China and India

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2009 2010 2011 2012 2013 2014 2015

US

$ b

illi

on

s

Africa

Asia

Europe0.7

1.3

1.7

2.1

3.0

3.7

4.4 10 x 2009 budget61x 2009 funding

High-level policy changes are fundamental! World Health Assembly, May 2009…

In addition to proper basic control..

1. Remove financial barriers (UHC)2. Ensure well trained and sufficient

human resources3. Establish a network of labs where

rapid tests are also available4. Ensure availability of quality drugs5. Regulate the use of all anti-TB drugs6. Introduce infection control7. Establish proper surveillance8. Promote Research & Development9. Mobilize resources domestically and

internationallyDocument WHA 62.15, 2009

World Health Assembly 63 Geneva, Suisse 16-17 May 2010 WORLD HEALTH EDITORS NETWORK Tracking Global...

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