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TB deaths in England & Wales, 1900-91
0
20
40
60
80100
120
140160
180
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
T
B d e a
t h s
/ 1 0 0 , 0
0 0 / y e a r
why ? 100?
why the decline -slowly?
why the increase?
why the faster decline?
when will it end?
who are the 100?
what happened before 1900?
will it keep going down?
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Progress towards
2005 and 2015 targets forglobal TB control
Millennium Development
GoalsTB Monitoring & Evaluation
WHO Geneva Stop TB DepartmentStop TB Department
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MILLENNIUM DEVELOPMENTGOALS (2015)
– Eradicate poverty and hunger – Universal primary education –
Empower women – Reduce child mortality – Improve maternal health –
Combat HIV/AIDS, malaria and otherdiseases
– Environmental sustainability –
Global partnership for development
S t o pT BD
e p ar t m en
t
S t o pT BD
e p ar t m en
t
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9m cases annually>1/3 in populous India and China
10 000 to 99 999
100 000 to 999 999
1 000 000 or more
< 1 000
1 000 to 9 999
No Estimate
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WorldHealth Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
© WHO 2002Stop TB DepartmentStop TB Department
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Highest TB rates per capita are in Africalinked to HIV/AIDS
25 to 49
50 to 99
100 to 299
< 10
10 to 24
300 or more
No Estimate
per 100 000 population
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WorldHealth Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
© WHO 2002Stop TB DepartmentStop TB Department
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TB cases falling in 6/9 regionsof the world
0
50
100
150
200
1990 1992 1994 1996 1998 2000 2002 2004
I n c i d e n c e r a
t e ( / 1 0 0 K / y r )
SE Asia
W Pacific
Latin America
E Mediterranean
C Europe
Est Mkts
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TB cases have been rising inAfrica and E Europe
0
100
200
300
400
500
1990 1992 1994 1996 1998 2000 2002 2004
I n c i d e n c e r a
t e ( / 1 0 0 K / y r )
Africa - high HIV
Africa - low HIV
Eastern Europe
incidence falling
rise in incidence slowing
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5 targets for global TB controlMILLENNIUM DEVELOPMENT GOALS
"to have halted and begun to reverseincidence.."
Implementation (DOTS) Indicator 24 (target year 2005)Case detection 70% (> 6 m diagnosed)Treatment success 85% (> 5 m cured DOTS)
Impact Indicator 23 (target year 2015 cf 1990) Prevalence 50% of ≈ 300/100K Deaths 50% of ≈ 30/100K
(< 1m deaths)
S t o pT BD
e p ar t m en
t
S t o pT BD
e p ar t m en
t
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• Data from 200countries annually
• 80+ millionpatients since 1980• 17 million patientson DOTS
• …and '000s of provinces, districts,counties, oblasts• ≈US$ 5 bn 2001-5
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DOTS treatment success close totarget for 1.4m patients in 2002
0
20
40
60
80
100
1994 1995 1996 1997 1998 1999 2000 2001 2002
T r e a
t m e n
t s u c c e s s
( % )
High-burdencountriesWorld
Target 85%
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Reasons for failure:Treatment outcomes are worst in
Africa and Europe
0 10 20 30 40
Africa
Americas
E Med
Europe
SE Asia
W Pacific
Percent of cohort
Died
Failed
Defaulted
Transfered
Not Evaluated
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>17m DOTS patients since 1995≈US$ 5 bn 2001-5
0
10
20
30
40
50
60
70
80
1990 1995 2000 2005 2010 2015 Year
C a s e
d e
t e c t i o
n r a
t e ,
s m e a r - p o s
i t i v e c a s e s
( % )
average rate of
progress 1995-2000
accelerated progress:target 2005
Target 70%
DOTS begins
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Regional progress towards 70% case detection:Europe low , SE Asia accelerating , Americas high
0
10
20
30
40
50
60
70
1994 1996 1998 2000 2002 2004 2006
C a s e
d e
t e c
t i o n r a
t e ( s m
+ , %
)
Americas
Africa
W Pacific
World
SE Asia
E Med
Europe
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65% of missing cases are in8 countries
20
16
8.86.0 5.1 4.9
3.3 3.0
0
100
200
300
400
500
I n d i a
C h i n a
I n d o n
e s i a
N i g e r i a
B a n g l a d
e s h
P a k i s t a
n
E t h i o p i a
R u s s
i a
C a s e s n o
t f o u n
d b y
D O T S
p r o
g r a m m e s ( t h
o u s a n
d s ) percent of missing cases
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Dynamics of pulmonary TB inPeru 1980-2000
100
120
140
160
180
200
220
1980 1985 1990 1995 2000
P u
l m o n a r y
T B c a s e s
/ 1 0 0
, 0 0 0DOTS 1990
PTB falling at 6%/yr
case finding
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Decline in TB incidence in theMaldive Islands
decline 9%/yr
decline 10%/yr
0
20
40
60
80
100
1994 1996 1998 2000 2002 2004
C a s e n
o t i f c i a t i o n r a
t e ( / 1 0 0 K / y r )
new smear+all TB
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DOTS reduces prevalence of culture+TB by 37% in less than a decade in China
0
50
100
150
200
250
1990 2000
P r e v a
l e n c e c u
l t u r e + T B / 1 0 0
, 0 0DOTSOther
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Progress towards MDGs in Indonesiaprevalence rate fell 4%/yr 1980-2004?
36%
55%
29%
42%
0
100
200
300
400
500
600
Sumatera Java-Bali KTI (East) National
S m e a r + p r e v a l e n c e
/ 1 0 0 K
1980 regional surveys
1990 (under)estimate
2004 national survey
% fall 1990-2004
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"Model DOTS Project" reduces TBprevalence in south India
source: TRC Chennai
0
1000
2000
68-70
71-73
73-75
76-78
79-81
81-83
84-86
99-01
01-03
Year
P r e v a l e n c e / 1 0
0 K Male C+
Male S+
Female C+
Female S+
fall ~10%/yr
in MDP
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Trends in TB death registrations
0
200
400
600
800
1000
1200
1985 1990 1995 2000
G e o m e
t r i c m e a n n u
m b e r o
f d e a t h s
Former Soviet Union
Central Europe
Industrialized
Latin America
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Impact of drugs on TB case fatality:Enlgand & Wales
0
50
100
150
200
250
300
350
400
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
C a s e n o
t i f i c a t i o n s o r
d
e a
t h s
/ 1 0 0
, 0 0 0 / y e a r
0
0.1
0.2
0.3
0.4
0.5
0.6
D e a
t h s
/ c a s e s
deathscasescase fatality
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Prevalence and death rates arefalling, but not fast enough
0
100
200
300
400
1990 1992 1994 1996 1998 2000 2002 2004
I n c i d e n c e o r p r e v a
l e n c e
r a t e ( p e r
1 0 0
, 0 0 0 )
0
5
10
15
20
25
30
35
M o r t a
l i t y r a
t e
( p e r
1 0 0
, 0 0 0
p e r y r )
MDG targets
Prevalence
Deaths
Incidence
inc HIV+
exc HIV+
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Global TB control in 2005MILLENNIUM DEVELOPMENT GOALS
Target 8: incidence rising at 1% per year
Implementation (DOTS) Indicator 24 (2002-3/target 2005)Case detection 45/70%Treatment success 82/85%
Impact (DOTS and…) Indicator 23 (2003/1990, target 2015) Prevalence 240/309 (per 100K)Deaths 24/28 (per 100K/yr)
S t o pT BD
e p ar t m
en
S t o pT BD
e p ar t m
en