World TB Day 2015, 24 March 2015

1. World TB Day 2015
World TB Day
24 March 2015

2. World TB Day 2015
MDR-TB is still ravaging the
European Region, making it the most
affected area of the entire world. Only
50% of MDR-TB patients are found
and half of them successfully cured.
This calls for a considerable scaling
up of access to safe, rational and
efficient new TB drugs, as well as
innovations on rapid diagnosis and
care centred on the needs of patients.
This is what the new global End TB
Strategy and the European
consolidated action plan advocate for.
Zsuzsanna Jakab
WHO Regional Director for Europe

3. World TB Day 2015
Even with the fastest decline in TB incidence in the
world, nearly 1000 Europeans fall ill every day
• New TB cases estimated to
occur per year: 360 000.
• Estimated total of TB patients
in the Region:
over 460 000.
• Since 2001, new TB cases
have been falling at an average
rate of 4.5% per year.
©CarlCordonnier

4. World TB Day 2015
Declining trend in TB incidence
• TB notification trend reflects true reduction in spread of the disease and
is strongly influenced by improvements in high-priority countries.
• Member States with highest TB incidence are those with a more
pronounced decline (up to 9%).
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.
Stockholm: European Centre for Disease Prevention and Control; 2015.
WHO European Region, 1980-2013
64.0
39.7
31.9
10.6
0
20
40
60
80
1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013
Notification (18 High-priority
countries)
Estimated incidence (53
Member States)
Notification rate (53 Member
States)
Notification (European
Union/European Economic
Area (EU/EEA))
Rateper100000population

5. World TB Day 2015
• 84% of incident and
85% of prevalent TB
cases
• 90% of mortality
caused by TB
• 99.5% of MDR-TB;
• 90% of TB/HIV co-
infections
occur in the 18 high-
priority countries in the
Region
TB burden unequally distributed among countries
18 high-priority countries: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan,
Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan,
Ukraine, Uzbekistan.
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.
Stockholm: European Centre for Disease Prevention and Control; 2015.
Estimated TB incidence per 100 000 population, WHO European Region,
2013

6. World TB Day 2015
Multi-drug TB burden
9.1
8.7 8.5 8.4
‐
5.0
10.0
Baseline 2012 2014
Estimated number of all MDR-TB cases
per 100 000 population, WHO European
Region
• Absolute number of
estimated MDR-TB cases
appears to be decreasing.
• However, less than 50% of
estimated cases are
detected.
• 1 untreated person with TB
or M/XDR-TB can infect
10–15 people each year,
and 10% of them will
develop the disease.
Casesper100000population

7. World TB Day 2015
Percentage of MDR-TB is still on the rise
Percentages of notified MDR among TB
cases, WHO European Region, 2007–2013
9.8% 10.4%
11.9%
13.2% 13.3%
15.0%
16.9%
38.3%
33.9%
38.5%
48.6% 47.7% 47.1% 48.0%
0%
10%
20%
30%
40%
50%
60%
2007 2008 2009 2010 2011 2012 2013
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.
Stockholm: European Centre for Disease Prevention and Control; 2015.
MDR among new cases
MDR among previously treated cases

8. World TB Day 2015
Impressive improvement in coverage of
treatment for MDR-TB, 2009–2013
In 2013, all notified MDR-TB
patients started second-line
MDR treatment (including
cases detected in previous
years).
In 2009 only 60% of those
detected had been put on
treatment.
40% increase in MDR-TB
detection since 2009.
28 456
33 957 34 184
36 877
39 924
17 169
27 324
34 210
39 865
45 079
0
5 000
10 000
15 000
20 000
25 000
30 000
35 000
40 000
45 000
50 000
2009 2010 2011 2012 2013
MDR cases notified
MDR cases enrolled in treatment
Cases

9. World TB Day 2015
Success of TB treatment in WHO
European Region, 2008–2013
0
10
20
30
40
50
60
70
80
New laboratory-
confirmed TB cases
New and relapsed
TB cases*
Previously treated
TB cases (excluding
relapsed cases)
Laboratory-
confirmed MDR-TB
cases
Treatment success rate in 2013:
• 76% in new and
relapsed TB cases.
• 57% in previously
treated TB cases.
• 46% in MDR-TB
cohort, lower than
previous year.
%
Source: European Centre for Disease Prevention and Control/WHO Regional Office for
Europe. Tuberculosis surveillance and monitoring in Europe 2015. Stockholm: European
Centre for Disease Prevention and Control; 2015.
* Since 2012, the case definition has changed from new laboratory-
confirmed TB cases to new and relapsed TB cases

10. World TB Day 2015
People of productive age carry the
heaviest burden of TB disease
People aged 25–44
years are predominant
(44%) among new TB
cases registered, affecting:
• households’ economic
well-being;
• national economies
through the direct loss of
productivity.
0
10
20
30
40
50
60
70
80
90
100
0–4 5–14 15–24 25–44 45–64 > 64Casesper100000population
Years
Age distribution of new and relapsed TB
cases in the WHO European Region,
2013
EU/EEA countries All countries 18 High-priority countries
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.
Stockholm: European Centre for Disease Prevention and Control; 2015.

11. World TB Day 2015
Fewer TB patients living with HIV are being offered
antiretroviral treatment
• More TB cases with HIV
co-infection detected in
the Region – about
17 096, or 81.4% of the
estimated total.
• Notable decrease in
antiretroviral therapy
(ART) coverage from
62.3% in 2012 to 53.8%
in 2013.
2.8 2.8
3.4
4.8
6.4
5.4
6.1
7.8
44.2
62.3
53.8
0
10
20
30
40
50
60
70
0
1
2
3
4
5
6
7
8
9
2006 2007 2008 2009 2010 2011 2012 2013
%
Percentage of HIV among notified cases
of TB, WHO European Region, 2013
Percentage of HIV among notified TB cases ART coverage
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.
Stockholm: European Centre for Disease Prevention and Control; 2015.
%
PercentageofHIVamongnotifiedTBcases
ARTcoverageforTB/HIVpatients

12. World TB Day 2015
TB in the penitentiary
sector
• 6.4% of the burden of new TB
cases originate in prisons
• Nearly 1 in every 1000
inmates develops TB
• Risk of becoming ill with TB in
prison is 23 times higher than
in the general population
• The WHO collaborating centre
on prevention and control of
TB in prisons was established
in 2014 (Azerbaijan) Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015.
Stockholm: European Centre for Disease Prevention and Control; 2015.
Overall TB notification rate (all TB) per 100 000
penitentiary inmates, WHO European Region, 2013

13. World TB Day 2015
Consolidated Action Plan to Prevent and
Combat M-/XDR-TB, 2011–2015
Key progress:
• Scaled up good practices and
patient-centred models of care
• Boosted partnership and civil
society involvement
• Improved collaboration with other
sectors and ministries in line with
Health 2020
• Introduced new diagnostic
procedures and approaches to
improve TB laboratory diagnosis
National MDR-TB plans finalized by almost all
high burden MDR-TB countries

14. World TB Day 2015
Priorities for ultimate elimination of TB
• More rapid diagnosis and complete
treatment for all patients
• Expanded patient-centred care
models
• Further shift from inpatient to
ambulatory care
• New TB drugs, with shorter and
more effective treatment regimens
• Research for new diagnostics and
vaccines
• More equity and reduced stigma
• More funds, better used
©CarlCordonnier

15. World TB Day 2015
Development of new TB Action Plan for
the WHO European Region, 2016–2020
Pillars of the End TB
Strategy:
1. integrated, patient-
centred care and
prevention
2. bold policies and
supportive systems
3. intensified research and
innovation
Specific targets for the
WHO European Region
until 2020:
35% reduction in TB
deaths
25% reduction in TB
incidence rate
75% treatment success
rate among MDR-TB
patients

16. World TB Day 2015
Thank you
(www.euro.who.int/tuberculosis)
World TB Day
24 March 2015
©CarlCordonnier