|Year : 2012 | Volume
| Issue : 4 | Page : 681-683
Global Tuberculosis Control 2011, WHO Report 2011
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
|Date of Web Publication||8-Nov-2012|
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Behera D. Global Tuberculosis Control 2011, WHO Report 2011. Indian J Med Res 2012;136:681-3
Global Tuberculosis Control 2011, WHO Report 2011 (World Health Organization, Geneva) 2011. 254 pages. Price: CHF 40.00 / US $ 48.00; in developing countries: CHF 28.00 / US$ 33.60
The World Health Organization (WHO) has been publishing annual reports on global control of tuberculosis (TB) every year since 1997. This is the 16 th Report in the series. This Report provides a comprehensive and up-to-date assessment of the TB epidemic and progress made in TB care and control at global, regional and country levels including financing TB prevention, care and control using data reported by 198 countries that account for over 99 per cent of the world's TB cases. The Report was produced by a core team of 14 experts. Overall guidance was provided by Dr Mario C. Raviglione, Director of the Stop TB Department, WHO.
The Report has seven chapters with 3 annexure. Some of the new information contained in this Report indicates that the absolute number of TB cases arising each year is estimated to be falling globally; evidence of dramatic reductions in TB cases and deaths in China between 1990 and 2010; estimates of how many children become orphans as a result of parental deaths caused by TB; better estimates of TB mortality due to the greater availability and use of direct measurements from vital registration systems and mortality surveys; an important update to estimates of TB cases and deaths in the Africa Region; discussion of how synergies between the work of the WHO Global Task Force on TB Impact Measurement and the new grant architecture of the Global Fund have the potential to substantially improve measurement of the burden of disease caused by TB; better data on the contribution of public-private and public-public mix (PPM) to TB notifications; analysis of the funding required to scale-up diagnosis and treatment of multidrug resistant B (MDR) in BRICS (Brazil, the Russian Federation, India, China and South Africa), other middle-income and low-income countries, combined with assessment of how donor funding could be better used to support this scale-up; data on the roll-out of Xpert MTB/RIF for the rapid diagnosis of TB and rifampicin-resistant TB following WHO's endorsement of the test in December 2010 and a chapter on the latest status of progress in developing new TB diagnostics, drugs and vaccines.
The introductory chapter (Chapter 1) provides general background on TB as well as an explanation of global targets for TB control, the WHO's Stop TB Strategy and the Stop TB Partnership's Global Plan to Stop TB 2011-2015. The chapter deals with the goals, targets and indicators for TB control and the Millennium Development Goals (MDGs) set for 2015. It also discusses about the Stop TB strategy and summarizes the main indicators, baselines, and targets set in the Global Plan to Stop TB 2011-15.
Chapter 2 deals with the burden of disease caused by tuberculosis. Before giving the numerical figures of incidence, prevalence and mortality, etc. it is made very clear about the uncertainties and difficulties in all such estimates of the true burden of the disease. With these limitations, the estimated burden of disease caused by TB in 2010 was 8.8 million (range 8.5-9.2 million) incident cases, 1.1 million (range 0.9-1.2 million) deaths from TB among HIV-negative people and an additional 0.35 million (range 0.32-0.39 million) deaths from HIV-associated TB. Further, important new findings at the global level are (i) The absolute number of TB cases has been falling since 2006 (rather than rising slowly as indicated in previous global reports). (ii) TB incidence rates have been falling since 2002 (two years earlier than previously suggested). (iii) Estimates of the number of deaths from TB each year have been revised downwards. (iv) In 2009 there were almost 10 million children who were orphans as a result of parental deaths caused by TB. (v) Updates to estimates of disease burden follow the completion of a series of consultations with 96 countries between 2009 and 2011, including China, India and 17 African countries in the past year, and much greater availability and use of direct measurements of TB mortality. Ongoing efforts to further improve measurement of TB cases and deaths under the umbrella of the WHO Global Task Force on TB Impact Measurement, including impressive progress on TB prevalence surveys and innovative work to strengthen surveillance, are summarized. At country level, dramatic reductions in TB cases and deaths have been achieved in China. Between 1990 and 2010, prevalence rates were halved, mortality rates fell by almost 80 per cent and TB incidence rates fell by 3.4 per cent per year. Methods used to measure trends in disease burden in China - nationwide prevalence surveys, a sample vital registration system and a web-based case notification system - provide a model for many other countries. Other results reinforce the findings of previous global reports. (vi) The world and all of WHO's six regions are on track to achieve the MDG target that TB incidence rates should be falling by 2015. (vii) TB mortality rates have fallen by just over a third since 1990, and the world as well as five of six WHO regions (the exception being the Africa Region) are on track to achieve the Stop TB Partnership target of halving 1990 mortality rates by 2015. (viii) The Stop TB Partnership target of halving TB prevalence rates by 2015 compared with 1990 is unlikely to be achieved globally, although the target has already been reached in the Region of the Americas and the Western Pacific Region is very close to reaching the target. (ix) There were 3.2 million (range 3.0-3.5 million) incident cases of TB and 0.32 million (range, 0.20-44 million) deaths from TB among women in 2010; and (x) About 13 per cent of TB cases occur among people living with HIV.
Chapter 3 deals with case notifications and treatment outcomes. In 2010, there were 5.7 million notifications of new and recurrent cases of TB, equivalent to 65 per cent (range 63-68%) of the estimated number of incident cases. India and China accounted for 40 per cent of the world's notified cases of TB in 2010, Africa for a further 24 per cent and the 22 high-TB burden countries (HBCs) for 82 per cent. At global level, the treatment success rate among new cases of smear positive pulmonary TB was 87 per cent in 2009.
Between 1995 and 2010, 55 million TB patients were treated in programmes that had adopted the DOTS/Stop TB Strategy, and 46 million were successfully treated. These treatments saved almost 7 million lives. Less than 5 per cent of new and previously treated TB patients were tested for MDR-TB in most countries in 2010. The reported number of patients enrolled on treatment has increased, reaching 46, 000 in 2010. However, this was equivalent to only 16 per cent of the 290, 000 cases of MDR-TB estimated to exist among notified TB patients in 2010.
Issues on financing TB care and control has been dealt with in chapter 4. In 97 countries with 92 per cent of the world's TB cases funding from domestic and donor sources is expected to amount to US$ 4.4 billion in 2012, up from US$ 3.5 billion in 2006. Most of this funding is being used to support diagnosis and treatment of drug-susceptible TB, although funding for MDR-TB is growing and expected to reach US$ 0.6 billion in 2012. Countries report funding gaps amounting to almost US$ 1 billion in 2012.
Overall, domestic funding accounts for 86 per cent of total funding, with the Global Fund accounting for 12 per cent (82% of all international funding) and grants from other agencies for 2 per cent, but striking contrasts between BRICS and other countries are highlighted. BRICS invested US$ 2.1 billion in TB control in 2010, 95 per cent of which was from domestic sources and in the other 17 HBCs, total expenditures were much lower (US$ 0.6 billion) and only 51 per cent of funding was from domestic sources.
Most of the funding needed to scale up the treatment of MDR-TB towards the goal of universal access is needed in BRICS and other middle-income countries (MICs). If BRICS and other MICs fully finance the scale-up of treatment for MDR-TB from domestic sources, current levels of donor financing for MDR-TB would be almost sufficient to fund the scale-up of MDR-TB treatment in low-income countries.
Chapter 5 deals with new diagnostics and laboratory strengthening. The first data on the roll-out of Xpert MTB/RIF, a new rapid molecular test that has the potential to substantially improve and accelerate the diagnosis of TB and drug resistant TB, are presented. By June 30, 2011, six months after the endorsement of Xpert MTB/RIF by WHO in December 2010, 26 of the 145 countries eligible to purchase Gene Xpert instruments and Xpert MTB/RIF cartridges at concessional prices had done so. This shows that the transfer of technology to developing countries can be fast. The continued inadequacy of conventional laboratory capacity is also illustrated: (i) in 2010, eight of the 22 HBCs did not meet the benchmark of one microscopy centre per 100 000 population. and (ii) among the 36 countries in the combined list of 22 HBCs and 27 high MDR-TB burden countries, 20 had less than the benchmark of one laboratory capable of performing culture and drug susceptibility testing per five million population.
Overall, laboratory strengthening needs to be accelerated, as is currently happening in 27 countries through the EXPAND-TB project supported by UNITAID. The important issue of co-epidemics of TB and HIV has been dealt with in chapter 6. Progress in scaling up interventions to address the co-epidemics of TB and HIV has continued. In 2010, HIV testing among TB patients reached 34 per cent globally, 59 per cent in the African Region and ≥75 per cent in 68 countries. Almost 80 per cent of TB patients known to be living with HIV were started on cotrimoxozole preventive therapy (CPT) and 46 per cent were on antiretroviral therapy (ART) in 2010. A large increase in screening for TB among people living with HIV and provision of isoniazid preventive therapy to those without active TB disease occurred in 2010, especially in South Africa.
The topic of research and development is discussed for the first time in the Global Report and contained in chapter 7. There has been considerable progress in diagnostics in recent years, including the endorsement of Xpert MTB/RIF at the end of 2010; other tests including point-of-care tests are in the pipeline.
There are 10 new or repurposed TB drugs in clinical trials that have the potential to shorten the treatment of drug-susceptible TB and improve the treatment of MDR-TB. These drugs include AZD5847, TMC 207, OPD-67683, PA-824, Linezoid, Rifapentine, SQ-109, PNU-100480 and other Novel regimens. Results from three Phase III trials of 4-month regimens for the treatment of drug-susceptible TB are expected between 2012 and 2013, and results from two Phase II trials of new drugs for the treatment of MDR-TB are expected in 2012. There are nine vaccine candidates in Phase I or Phase II trials. It is hoped that one or both of the candidates currently in a Phase II trial will enter a Phase III trial in the next 2-3 years, with the possibility of licensing at least one new vaccine by 2020.
Annexure I discusses various methods used to estimate the burden of disease caused by TB and the merits and demerits of various methods. Annexure 2 gives the profiles of various countries of the world. Estimates presented for India have not yet been officially approved by the Ministry of Health & Family Welfare, Government of India and should therefore, be considered provisional. As per the Report, the estimated burden of TB for the year 2010 is as follows:
Total population: 1225
The incidence (including HIV): 2.3 million (2.0-2.5 millions) with a rate of 185 (167-205) per 100 000 population. The prevalence (including HIV) of TB is 3.1 million (2.0-4.6 million) and with a rate of 256 (161-373) per 100 000 population. Information about case notification, drug regimens, treatment success rate MDR-TB estimates amongst notified cases, MDR-TB reported cases, laboratories, TB HIV, CPT and ART for HIV-positive TB patients and financing has been given in the annexure. Annexure 3 deals with global, regional and country specific data for key indicators like burden of disease, incidence, notification and case detection rates, treatment outcomes in new smear cases and retreatment cases, HIV testing and provision of CPT, ART and isoniazid preventive therapy (IPT), testing of MDR-TB and number of confirmed cases of DMR TB and new smear positive case notifications by age and sex.
In view of the updated data and the various strategies being adopted to control TB at the global level, it is a useful book/reference for physicians, TB specialists, epidemiologists, public health experts and the administrators and policy makers.