Epidemiology of TB in the Western Pacific Region

Transcription

1 Epidemiology of TB in the Western Pacific Region First Asia-Pacific Region Conference IUATLD Kuala Lumpur August 3, 27

2 Tuberculosis notification rates, 25 Notified TB cases (new and relapse) per 1 population No report or more 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 World Health 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 26. All rights reserved

3 Notification rates in WPR 8 7 All forms trend +14.5%/yr Rates per 1, population Smear positive trend +19.4%/yr

4 8 Rates per 1, population All forms trend +22%/yr New smear +ve trend +3%/yr China Rates per 1, population All forms trend +2.4%/yr New smear +ve trend +5.7%/yr Philippines

5 3 Rates per 1, population All forms trend +1%/yr New smear +ve trend +4%/yr Cambodia All forms trend ~%/yr Rates per 1, population New smear +ve trend -.6%/yr Việt Nam

6 Trends in notifications in Malaysia 7 6 Rates per 1, population All forms trend ~%/yr New smear +ve trend -.6%/yr

7 Contributions to the global increase in the number of new smearpositive cases notified under DOTS made by high-burden countries, China India Indonesia Bangladesh Pakistan Russian Federation Myanmar Brazil Philippines DR Congo Cambodia Afghanistan Thailand Nigeria Mozambique Uganda UR Tanzania Kenya South Africa Zimbabwe Viet Nam Ethiopia

8 Estimated global prevalence, mortality and incidence rates, Prevalence Mortality 125 Incidence

9 Trends in estimated TB incidence rates (all forms, black lines), and the annual change in incidence rates (red lines), for nine subregions and the world, Established Market Economies Central Europe Latin America Incidence rate (per 1 /year) Change in incidence rate (% per year) Change in incidence rate (% per year) Incidence rate (per 1 /year) Change in incidence rate (% per year) Incidence rate (per 1 /year) Eastern Mediterranean South- East Asia Western Pacific Incidence rate (per 1 /year) Change in incidence rate (% per year) Change in incidence rate (% per year) Incidence rate (per 1 /year) Change in incidence rate (% per year) Incidence rate (per 1 /year) Eastern Europe Africa - low HIV Incidence rate (per 1 /year) Change in incidence rate (% per year) Incidence rate (per 1 /year) Change in incidence rate (% per year) Africa - high HIV Incidence rate (per 1 /year) Change in incidence rate (% per year)

10 Average age of men (gray circles) and women (orange circles) aged years (left) and 55 years (right) with sputum smear-positive TB, notified under DOTS, Viet Nam (15-54 years) 7 Viet Nam ( 55 years) China (15-54 years) 7 China ( 55 years)

11 Smear-positive case detection rate by DOTS programmes, by WHO region, AFR AMR EMR EUR SEAR WPR Global

12 Case Detection Rates in WPR countries with a high burden of TB Papua New Guinea Cambodia Lao PDR Philippines China Mongolia Viet Nam

13 CDR in WPR countries with an intermediate burden of TB Rep. Korea China, Hong Kong SAR Japan Malaysia China, Macao SAR Singapore Brunei Darussalam 5 1

14 Treatment success rates in high (HBC) and intermediate (IBC) TB burden countries HBC IBC Papua New Guinea Lao PDR Philippines Mongolia Cambodia Viet Nam China Malaysia Japan Brunei Darussalam China, Hong Kong SAR Rep. Korea Singapore China, Macao SAR

15 Regional progress towards 21 targets 2 25 Target 21 Change (%) Rate of change / yr (%) Prevalence Deaths

16 Annual % change notification rates by age and gender in Viet Nam 8 4 Annual percentage change total Men Women Total

17 Situation in the Pacific

18 Estimated TB Incidence Rate per 1, pop (all forms) CNMI to 49 Guam Marshall Islands 5 to 99 1 to 199 Palau Federated States of Micronesia Kiribati Kiribati 2 and over Papua New Guinea Nauru Tuvalu Kiribati Solomon Islands Vanuatu Fiji Wallis Et Futuna Tokelau Samoa American Samoa Cook Islands French Polynesia New Caledonia Tonga Niue Pitcairn Islands

19 Reported cases/1, Slow fall in incidence but improved smear+ diagnosis all TB: trend -2.%/yr smear+ TB: trend +.5%/yr y = e.52x

20 Disease burden in 2 Pacific Island Countries and Territories Number of incident cases (rate) Case detection rate (all) Case detection rate s(+) Prevalence rate (s(+)) Number of deaths (rate) 1975 (67) 71% 68% 87 (37) 323 (11)

21 log1 GDP per capita Fiji High TB case rates are associated with poverty Solomon Islands Marshall Islands Tuvalu R 2 =.57 Kiribati TB case notifications per 1,, 2-5

22 MDR-TB

23 All MDR-TB Cases by Regions Latin America, 11,31 Africa low HIV incidence, 1,449 Established Market Economies, 1,681 Central Europe, 1,462 Eastern Mediterranean Region, 18,33 Western Pacific Region, 152,18 Africa high HIV incidence, 48,141 Global burden: 424,23 cases Eastern Europe, 65,853 South-east Asia, 114,967

24 Situation in Western Pacific Region MDR-TB among new TB cases Cambodia (21).% Malaysia ( ).1% Singapore ( ).4% N Zealand ( ).6% Japan (1997).9% Mongolia (1999) 1.% China (Hongkong) ( ) 1.1% Korea ( ) 1.9% Viet Nam ( ) China (Henan) ( ) China (Liaoning) (1999) 2.3% 8.8% 1.4%.% 1.% 2.% 3.% 4.% 5.% 6.% 7.% 8.% 9.% 1.% 11.%

25 Situation in Western Pacific Region MDR-TB among previous treated TB cases Malaysia ( ) N Zealand ( ) Singapore ( ) Cambodia (21).%.8% 2.5% 3.1% China (Hongkong) ( ) 9.4% Korea ( ) Japan (1997) China (Liaoning) (1999) China (Henan) ( ) 15.3% 19.7% 24.4% 35.%.% 5.% 1.% 15.% 2.% 25.% 3.% 35.% 4.%

26 MDR-TB Situation in Western Pacific Region Cambodia China* Mongolia Philippines* Rep. Korea Viet Nam* WPR* New TB cases (%) (1999) Previously treated TB cases (%) (24) *Source: Zignol et al. JID 26, 194:

27 Portugal Republic of Korea Romania Russian Federation 39 Countries with XDR-TB: Confirmed Cases 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 WHO 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 25. All rights reserved Argentina Armenia Australia Azerbaijan Bangladesh Brazil Canada Chile Czech Republic Ecuador Estonia France Georgia Germany Norway Peru Poland Islamic Rep of Iran Israel Italy Slovenia Japan South Africa Latvia Spain Lithuania Thailand Mexico UK Netherlands USA New Zealand Viet Nam Based on MMWR March 26 data, and information provided to WHO Stop TB Department. Updated July 27 Hongkong, China Ireland

28 HIV-TB

29 Estimated HIV prevalence in new TB cases, 25 HIV prevalence in TB cases, years (%) No estimate or more 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 World Health 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 26. All rights reserved

30 Estimated HIV in incident TB IBC HBC Philippines Mongolia China Lao PDR Viet Nam Cambodia* Papua New Guinea Brunei Darussalam China, Hong Kong SAR Japan Rep. Korea Malaysia* Singapore* HIV in incident TB * estimate under revision source: WHO global report 27

31 TB and HIV in HCM City TB and HIV in HCM City Rate per 1, Percentage New SS+ All forms TB fatality rate TB/HIV

32 HIV is the most convincing explanation for changes in TB incidence rates by age and sex in Viet Nam Rapid increase in HIV+ TB in men and women yr old From 1999, 4% HIV infections occur in15-24 yrs old

33 HIV drives TB case fatality in Cambodia 12% S(+) case fatality rate (%) 1% 8% 6% 4% 2% R 2 =.37 p =.1 Rattanakiri Pailin Koh Kong Battambang Banteay Meanchey Kg Som Mondulkiri Phnom Penh % % 5% 1% 15% 2% 25% 3% % HIV in TB

34 Impact of HIV in TB Contributes to lack of decline in TB incidence in Viet Nam Impact on case fatality rates and TB mortality Increase in % smear negative pulmonary TB

35 Increasing Case Detection Contribution Public-Private Mix

36 Philippines: Additionality of PPM to Case Detection (from 23-24) 6% 5% 4% 3% 2% 1% % Tuguegarao CMS Davao Iloilo Cagayan Oroquieta All PPMD Units

37 Involvement of non-ntp public providers increases case detection notification Yogyakarta, Indonesia, 2-22 Number of new cases SS+ SS- EP SS+ SS- EP SS+ SS- EP Chest Clinics Hospitals Health centers

38 Contribution Private Sector in TB Surveillance in Korea (all TB, ) 4, Public Private 3, 2, 1,

39 Thank You