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Epidemiologia della tubercolosi
1° Convegno Interdisciplinare Milano, 21-‐22 Marzo 2014
GLOBAL TB
PROGRAMME
Alberto Ma4eelli Global TB Programme
World Health Organiza7on Geneva, Switzerland
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%
Tuberculosis in Italy -‐ 2012
Source ECDC/EURO TB report 2014
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
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
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
Es8mated TB mortality rate, 2012 *
* Deaths among HIV-positive people are excluded
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
Rat
e pe
r 100
,000
pop
ulat
ion
1990 2010 1990 2015 1990 2015 0
50
100
150
100
0
200
300
0
10
20
30
Falling 2% per year
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
GLOBAL TB
PROGRAMME
Ref: Glob
al TB Co
ntrol Report 2
013
Global Progress on impact – 2000 - 2012
Current major challenges at global level
TB/HIV co-infection
Multi drug-resistant TB
The «missing» cases
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
Percentage of new TB cases with MDR-‐TB Globally 3.6% (95% CI: 2.1–5.1%)
Ref: Global TB Control Report 2013
Percentage of previously treated TB cases with MDR-‐TB Globally 20.2% (95% CI: 13.3–27.2%)
GLOBAL TB
PROGRAMME
Ref: Global TB Control Report 2013
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
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
92 countries no8fied at least one case of XDR-‐TB Ref: Global TB Control Report 2013
Treatment outcome of all MDR-‐TB cases
(including XDR-‐TB) ager 36 months, EU/EEA countries, 2007–2009
Van der Werf, Eurosurveillance 2014
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.
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:
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
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
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
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
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
Thank you
