PPT Matteelli "Epidemiologia della TB"

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PPT Matteelli "Epidemiologia della TB"

  1. 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. 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. 3. Tuberculosis  in  Italy  -­‐  2012   Source  ECDC/EURO  TB  report  2014  
  4. 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. 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. 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. 7. Es8mated  TB  mortality  rate,  2012  *     * Deaths among HIV-positive people are excluded
  8. 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. 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. 10. GLOBAL TB PROGRAMME Ref:  Global  TB  Control  Report  2013   Global Progress on impact – 2000 - 2012
  11. 11. Current  major  challenges  at  global  level   TB/HIV co-infection Multi drug-resistant TB The «missing» cases
  12. 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. 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. 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. 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. 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. 17. 92  countries  no8fied  at  least  one  case  of  XDR-­‐TB   Ref:  Global  TB  Control  Report  2013  
  18. 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. 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. 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. 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. 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. 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. 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. 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. 26. Thank you

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