Tuberkulosdag, Folkhälsomyndigheten 1 Sept 2015 Knut Lönnroth, Global TB Programme, WHO Institutionen för Folkhälsovetenskap, KI
The Global Burden of TB - 2013 550,000 in children 3.3 m in women 510,000 in women 80,000 in children Source: WHO Global TB Report 2014
Estimated TB incidence rates, 2013 E. Mediterranean 8% Europe 4% Americas 3% South-East Asia 38% Africa 29% 34% in India + China 23% in India Western Pacific 18%
The End TB Strategy: 3 pillars and 4 Principles
Desired decline in global TB incidence rates to reach the 2035 targets
33 low-incidence countries and territories* (notification rate <10/100,000, 2012 data) *Population >300,000
Framework development Coordinated by WHO and ERS with the help of a writing group Building on existing national and regional frameworks 30 country representatives 26 additional representatives of research institutions and technical agencies, non-governmental and civil society organizations Writing group Prof. Ibrahim Abubakar. Public Health England, London, UK Mrs. Lia D Ambrosio. WHO Collaborating Centre for Tuberculosis, Italy Dr. Gerard De Vries. KNCV Tuberculosis Foundation, The Netherlands Dr. Roland Diel, University Hospital Schleswig Holstein, Germany Dr. Paul Douglas. Department of Immigration and Border Protection, Australia Mr. Marc-Andre Gaudreau. Public Health Agency of Canada, Canada Dr. Delia Goletti. National Institute for Infectious Diseases, Rome, Italy Dr. Phil LoBue. Division of TB Elimination, US CDC, USA Prof. GB Migliori,. WHO Collaborating Centre for Tuberculosis, Italy Dr. Howard Njoo. Public Health Agency of Canada, Canada Dr. Edilberto Ochoa. IPK Investigaciones Tuberculosis, Cuba Dr. Ivan Solovic. TB Department, National Institute for TB, Slovakia Dr Alistair Story. Find and Treat, London, United Kingdom Dr. Tamara Tayeb. National TB Control Programme, Saudi Arabia Dr. Marieke van den Werf. ECDC, Sweden Dr. Jean Pierre Zellweger. Swiss Lung Association, Switzerland
Definitions <100 cases (all forms) per million Low incidence <10 cases (all forms) per million Pre-elimination <1 case (all forms) per million Elimination
Observed vs. required annual rate of change to reach elimination 2035
Observed vs. required annual rate of change to reach elimination 2050
Incidence in 2035 if 90% reduction 2015-2035
Proposed target for low-incidence countries 90% reduction in each low-incidence country between 2015 and 2035 In line with the global strategy target Equivalent to "Reaching the pre-elimination phase in all current low-incidence countries by 2035" Can be combined with elimination target/vision by 2050
ACTION FRAMEWORK 8 priority actions for elimination in low-incidence countries Ensure political commitment, funding and stewardship for planning and essential services of high quality Address most vulnerable and hardto-reach groups Address special needs of migrants; cross-border issues Support global TB prevention, care and control Undertake screening for active TB and latent TB infection in high-risk groups and provide appropriate treatment Invest in research and new tools Ensure continued surveillance and programme monitoring & evaluation Optimize prevention and care of drug-resistant TB
Epidemiological characteristics High incidence Generalised (with social gradient) Important community transmission Many incident cases from recent transmission Relatively high burden among young people Dominant public health problem Poorly resourced health systems Low incidence Highly concentrated to risk groups Close to elimination in large parts of the population Low transmission Outbreaks in special groups LTBI relatively more important Migration impact Stronger health system but less TB visibility
TB in vulnerable and hard-to-reach groups Know your epidemic where is TB concentrated?: The poor Homeless Prisoners PLHIV Drug addicts / alcoholics Migrants (which?) Ethnic minorities / indigenous population Elderly Health care workers Immunocompromising diseases and treatments Know their risks and how to address them: 1. Risk of TB infection and disease better prevention 2. Access barriers improve early TB detection 3. Problems with adherence optimize outcomes Surveillance with case-based M&E Research
TB in foreign-born
ACTION FRAMEWORK 8 priority actions for elimination in low-incidence countries Ensure political commitment, funding and stewardship for planning and essential services of high quality Address most vulnerable and hardto-reach groups Address special needs of migrants; cross-border issues Support global TB prevention, care and control Undertake screening for active TB and latent TB infection in high-risk groups and provide appropriate treatment Invest in research and new tools Ensure continued surveillance and programme monitoring & evaluation Optimize prevention and care of drug-resistant TB
1. Ensure political commitment, funding and stewardship for planning and essential services of high quality
2. Address most vulnerable and hard-to-reach groups
3. Address special needs of migrants and crossborder issues
4. Undertake screening for active TB and LTBI in TB contacts and selected highrisk groups, and provide appropriate treatment
5. Optimize prevention and care of drug-resistant TB
6. Ensure continued surveillance and programme monitoring and evaluation, and case-based data management
7. Invest in research & new tools
8. Support global TB prevention, care, and control
FRAMEWORK available at: http://www.who.int/tb/publications/elimination_framework/en/ Lönnroth K, Migliori GB, Raviglione MR, et al. Towards tuberculosis elimination: An action framework for low-incidence countries. Eur Respir J 2015 2015; 45: 928 952