The document summarizes epidemiological data on tuberculosis (TB) in Italy and globally. It notes that the TB notification rate in Italy decreased by 7.7% from 2007 to 2012. In 2012, 58.3% of Italian TB cases were in foreign-born individuals and the rate of multi-drug resistant TB was 3%. Globally in 2012, there were an estimated 8.6 million incident TB cases and 1.3 million deaths, with South-East Asia and Africa accounting for most cases and deaths. Major ongoing challenges include TB/HIV co-infection, multi-drug resistant TB, and improving detection of "missing" TB cases.

1. Epidemiologia
della
tubercolosi
1°
Convegno
Interdisciplinare
Milano,
21-­‐22
Marzo
2014
GLOBAL TB
PROGRAMME
Alberto
Ma4eelli
Global
TB
Programme
World
Health
Organiza7on
Geneva,
Switzerland

2. TB
no8fica8on
rate
Italy
2007
-­‐
2012
Source
ECDC/EURO
TB
report
2014
2007
2008
2009
2010
2011
2012
Δ
N
Rate
N
Rate
N
Rate
N
Rate
N
Rate
N
Rate
Italy
4525
7.7
4418
7.4
4244
7.1
4692
7.8
3521
5.8
3142
5.2
-­‐7.7
Δ =
VariaGon
2007-­‐2012
In
2012
TB
incidence
(reported)
=
5.2/100,000
TB
prevalence
(es8mated)
=
9.4/100,000
TB
mortality
=
0.7/100,000
%
in
foreign
borne
58.3%
%
MDR
(from
surveillance)
3%

3. Tuberculosis
in
Italy
-­‐
2012
Source
ECDC/EURO
TB
report
2014

4. Tuberculosis
in
Italy
-­‐
2012
Source
ECDC/EURO
TB
report
2014
New
pulmonary
confirmed
cases
650/1,035
62.8%
All
laboratory
confirmed
cases
677/3,142
21.5%
(this
trend
is
decreasing)
Italy
does
not
provide
data
on:
• Treatment
outcome
• HIV
co-­‐infec8on
• Drug
resistance

5. Es8mated
number
of
cases
Es8mated
number
of
deaths
1.3
million*
• 74.000
in
children
• 410.000
in
women
8.6
million
• 0.5
m
in
children
• 2.9
m
in
women
450,000
All
forms
of
TB
Mul8drug-­‐resistant
TB
HIV-­‐associated
TB
1.1
million
(13%)
320,000
Source:
WHO
Global
Tuberculosis
Report
2013
*
Including
deaths
aSributed
to
HIV/TB
The
global
burden
of
TB
-­‐2012
170,000

6. South-­‐East
Asia
39%
Western
Pacific
19%
Africa
27%
E.
Mediterranean
8%
Europe
4%
Americas
3%
38%
in
India
+
China
26%
in
India
Ref:
Global
TB
Control
Report
2013
Es8mated
TB
incidence
rate,
2012

7. Es8mated
TB
mortality
rate,
2012
*
* Deaths among HIV-positive people are excluded

8. Global
incidence,
prevalence
and
mortality
rates
2012
vs
2015
targets
Falling 2.2% per year,
2010-2011
37% decline since 1990 45% decline since 1990
Target Target
Incidence Prevalence Mortality
MDG achieved/on track Not on track Target within reach
Rateper100,000population
1990 2010 1990 2015 1990 2015
0
50
100
150
100
0
200
300
0
10
20
30
Falling 2% per year

9. TB
cases
and
deaths,
1990–2012:
achievements
of
control
efforts
with
available
tools
(absolute
numbers)
Mortality
Total
mortality
peaked
early
2000s
at
1.8
million
1.3
million
in
2012
5
Incidence
peaked
at
9
million
in
early
2000s
8.6
million
in
2012
Incidence
Ref:
Global
TB
Control
Report
2013

10. GLOBAL TB
PROGRAMME
Ref:
Global
TB
Control
Report
2013
Global Progress on impact – 2000 - 2012

11. Current
major
challenges
at
global
level
TB/HIV co-infection
Multi drug-resistant TB
The «missing» cases

12. 8.6
5.7
Global
no8fica8ons
Es8mated
incidence
The
case
detec8on/no8fica8on
gap,
2012
Nearly
3
million
TB
cases
either
not
no8fied
or
not
detected
NO
elimina8on
without
“capturing”
them
2.9
million
missed
Ref:
Global
TB
Control
Report
2013

13. Percentage
of
new
TB
cases
with
MDR-­‐TB
Globally
3.6%
(95%
CI:
2.1–5.1%)
Ref:
Global
TB
Control
Report
2013

14. Percentage
of
previously
treated
TB
cases
with
MDR-­‐TB
Globally
20.2%
(95%
CI:
13.3–27.2%)
GLOBAL TB
Ref:
Global
TB
Control
Report
2013

15. MDR-­‐TB,
2012
~ 300,000
MDR-TB
cases among
notified
pulmonary TB
patients
~ 450,000 incident cases
~ 680,000 prevalent cases
80% in 12 countries
2/3 in top 5
56% in top 3
GLOBAL TB
PROGRAMME

16. MDR-­‐TB
cases
detected
and
started
on
treatment
94,000
Enrolled on treatment
77,000
Detected among notified Doubling in detection and
treatment, 2009‒2012
Increasing gap between
detection and treatment
Still large detection gap:
§ About 1 in 3 TB patients
with MDR-TB detected
§ About 1 in 4 on treatment
GLOBAL TB
PROGRAMME

17. 92
countries
no8fied
at
least
one
case
of
XDR-­‐TB
Ref:
Global
TB
Control
Report
2013

18. Treatment
outcome
of
all
MDR-­‐TB
cases
(including
XDR-­‐TB)
ager
36
months,
EU/EEA
countries,
2007–2009
Van
der
Werf,
Eurosurveillance
2014

19. The
case
of
Mumbai
and
the
“TDR-­‐TB
outbreak”
Udwadia
ZF,
Amale
RA,
Ajbani
KK,
Rodrigues
C.
Totally
drug-­‐resistant
tuberculosis
in
India.
Clin
Infect
Dis.
2012
Feb
15;54(4):579–81.

20. DRAFT
Post-­‐2015
TB
Strategy
at
a
glance
§ A
WORLD
FREE
OF
TB
§ Zero
deaths,
disease
and
suffering
due
to
TB
§ End
the
Global
TB
Epidemic
§ 95%
reduc8on
in
TB
deaths
(compared
with
2015)
§ 90%
reduc8on
in
TB
incidence
rate
(<10/100,000)
§ 75%
reduc8on
in
TB
deaths
(compared
with
2015)
§ 50%
reduc8on
in
TB
incidence
rate
(<
than
55/100,000)
§ No
affected
families
face
catastrophic
costs
due
to
TB
VISION:
GOAL:
TARGETS
FOR
2035:
MILESTONES
FOR
2025:

21. Integrated,
pa8ent-­‐
centered
TB
Care
and
Preven8on
Early
diagnosis
of
TB
including
universal
drug-­‐suscep7bility
tes7ng
;
systema7c
screening
of
contacts
and
high-­‐risk
groups
Treatment
of
all
forms
of
TB
including
drug
-­‐resistant
TB,
and
pa7ent
support
Collabora7ve
TB/HIV
ac7vi7es
and
management
of
co-­‐morbidi7es
Preven7ve
treatment
for
high-­‐risk
groups
and
vaccina7on
of
children
Bold
policies
and
suppor8ve
systems
Government
stewardship
,
commitment,
and
adequate
resources
for
TB
care
and
control
with
monitoring
and
evalua7on
Engagement
of
communi7es
,
civil
society
organiza7ons,
and
all
public
and
private
care
providers
Universal
health
coverage
policy;
and
regulatory
framework
for
case
no7fica7on,
vital
registra7on,
quality
and
ra7onal
use
of
medicines,
and
infec7on
control
Social
protec7on,
poverty
allevia7on,
and
ac7ons
on
other
determinants
of
TB
Intensified
Research
and
Innova8on
Discovery,
development
and
rapid
uptake
of
new
tools,
interven7ons
and
strategies
Opera7onal
research
to
op7mize
implementa7on
and
impact,
and
promote
innova7ons
Targets:
95%
reduc8on
in
deaths
and
90%
reduc8on
in
incidence
(<
10
cases
/
100,000
popula8on)
by
2035
Post-­‐2015
Global
TB
Strategy
Proposed
Pillars

22. Integrated,
Pa8ent-­‐centred
Care
and
Preven8on
A.
Early
diagnosis
of
TB
including
universal
drug
suscep8bility
tes8ng;
systema8c
screening
of
contacts
and
high-­‐risk
groups
B.
Treatment
of
all
people
with
TB
including
drug-­‐resistant
TB,
and
pa8ent
support
C.
Collabora8ve
TB/HIV
ac8vi8es;
and
management
of
co-­‐morbidi8es
D.
Preven8ve
treatment
for
persons
at
high-­‐risk
and
vaccina8on
for
TB
PILLAR
I
AND
COMPONENTS
New additions to or enhancements of the current strategy are shown in yellow

23. Bold
Policies
and
Suppor8ve
Systems
A.
Poli8cal
commitment
with
adequate
resources
for
TB
care
and
preven8on
B.
Engagement
of
communi8es,
civil
society
organiza8ons,
and
public
and
private
care
providers
C.
Universal
health
coverage
policy;
and
regulatory
frameworks
for
case
no8fica8on,
vital
registra8on,
quality
and
ra8onal
use
of
medicines,
and
infec8on
control
D.
Social
protec8on,
poverty
allevia8on
and
ac8ons
on
other
determinants
of
TB
PILLAR
II
AND
COMPONENTS
New additions to or enhancements of the current strategy are shown in yellow

24. Intensified
Research
and
Innova8on
A.
Discovery,
development
and
rapid
uptake
of
new
tools,
interven8ons,
and
strategies
B.
Research
to
op8mize
implementa8on
and
impact,
promote
innova8ons
PILLAR
III
AND
COMPONENTS
New additions to or enhancements of the current strategy are shown in yellow

25. Projected acceleration of TB incidence decline
to target levels
Business
as
usual
Op8mize
current
tools,
pursue
universal
health
coverage
and
social
protec8on
Introduce
new
vaccine,
new
prophylaxis
Average
-­‐10%/year
-­‐5%/year
Current
trend:
-­‐2%/year
Average
-­‐17%/year

26. Thank you