This document summarizes the global burden of tuberculosis (TB) in 2011. Some key points: - An estimated 1.4 million people died from TB that year, with over 80% of TB/HIV co-infections occurring in Africa. - TB incidence rates were highest in Africa, linked to high HIV infection rates. People living with HIV are 20-40 times more likely to develop active TB. - About 630,000 cases of multi-drug resistant TB were estimated, with over 60% occurring in 5 countries: India, China, Russia, Philippines, and Pakistan. - 500,000 women and 65,000 children died from TB in 2011, and 10 million children were left orphaned

1. Giornata
Mondiale
della
Tubercolosi
Milano,
14
March
2013
Photo: Riccardo Venturi
Dr
Mario
C
Raviglione
Director
Stop
TB
Department

2. Overview
ü Burden
of
TB,
TB/HIV,
MDR-­‐TB
ü Strategy
and
targets
ü Impact
of
intervenEons,
and
progress
in
control
and
care

3. Estimated number
of cases
Estimated number
of deaths
1.4
million*
(1.3–1.6
million)
8.7
million
(8.3–9.0
million)
630,000
(460,000-­‐790,000)
out
of
~12
million
prevalent
TB
cases
All
forms
of
TB
MulFdrug-­‐resistant
TB
HIV-­‐associated
TB
1.1
million
(13%)
(1.0–1.2
million)
430,000
(400,000–460,000)
Source:
WHO
Global
Tuberculosis
Report
2012
*
Including
deaths
aUributed
to
HIV/TB
The
Global
Burden
of
TB
-­‐2011
Unknown,
but
probably
>
150,000

4. Incidence
rates,
2011
Highest
rates
in
Africa,
linked
to
high
rates
of
HIV
infecEon
~80%
of
HIV+
TB
cases
in
Africa
Per
100
000
populaEon
≥300
150–299
50–149
0–24
25–49

5. TB/HIV
co-­‐infecEon:
80%
of
burden
in
Africa
ü 80%
of
all
TB/HIV
cases
are
in
Africa
ü TB
leading
cause
of
death
in
PLHIV
ü ¼
of
PLHIV
worldwide
die
due
to
TB.
ü PLHIV
infected
with
TB
20-­‐40
Emes
more
likely
to
develop
acEve
TB.
ü Untreated,
TB
in
PLHIV
leads
to
death
in
weeks

6. The
boundaries
and
names
shown
and
the
designaFons
used
on
this
map
do
not
imply
the
expression
of
any
opinion
whatsoever
on
the
part
of
the
World
Health
OrganizaFon
concerning
the
legal
status
of
any
country,
territory,
city
or
area
or
of
its
authoriFes,
or
concerning
the
delimitaFon
of
its
fronFers
or
boundaries.
DoUed
lines
on
maps
represent
approximate
border
lines
for
which
there
may
not
yet
be
full
agreement.
©
WHO
2012.
All
rights
reserved
EsEmated
number
of
MDR-­‐TB
Cases,
2011
>60%
of
all
cases
are
in
5
countries
Russian
FederaEon
44,000
(14%
of
global
MDR
burden)
India
66,000
(21%
of
global
MDR
burden)
China
61,000
(20%
of
global
MDR
burden)
Philippines
11,000
(4%
of
global
MDR
burden)
Pakistan
10,000
(3%
of
global
MDR
burden)
South
Africa
8,100
Based
on
old
survey
data

7. Who
carries
the
burden
of
tuberculosis?
TB
linked
to
HIV
infecEon,
malnutriEon,
alcohol,
drug
and
tobacco
use,
diabetes
…mostly,
the
most
vulnerable
Migrants,
prisoners,
minoriEes,
refugees
face
risks,
discriminaEon
&
barriers
to
care
500,000
women
and
65,000
children
die
of
TB
each
year;
10
million
“TB”
orphans
TB
spreads
in
poor,
crowded
&
poorly
venElated
seangs

8. Francesco
I
had
tuberculosis!
…El Cardenal tiene una salud frágil, consecuencia de una tuberculosis
que lo atacó cuando era un niño y le dejó secuelas: le falta la parte
superior alveolar del pulmón derecho… Sin embargo, físicamente es
fuerte. El mismo se esfuerza para no ser menos que los demás y practica
natación…

9. Estimated
number of
cases
Estimated
number of
deaths
500,000
(470,000–510,000)
All forms of TB
(Children <15 yr)
* excluding deaths among HIV+ people
All forms of TB
(in women)
2.9 million
(range, 2.6–3.2 million)
500,000 *
(range, 400,000–600,000)
64,000*
(range, 58,000–71,000)
The
global
burden
of
TB
in
2011:
women
&
children
Estimated TB incidence rates, by country, 2010
TB cases
per 100 000
0–24
25–49
50–99
100–299
>=300
No estimate

10. The
global
response:
Stop
TB
Strategy
&
Global
Plan
To
save
lives,
prevent
suffering,
protect
the
vulnerable,
&
promote
human
rights
1. Pursue
high-­‐quality
DOTS
expansion
2. Address
TB-­‐HIV,
MDR-­‐TB,
and
needs
of
the
poor
and
vulnerable
3. Contribute
to
health
system
strengthening
4.
Engage
all
care
providers
5. Empower
people
with
TB
and
communiEes
6.
Enable
and
promote
research

11. Global
Progress
on
impact
ü
51
million
paEents
cured,
1995-­‐2011
ü
20
million
lives
saved
since
1995
ü
2015
MDG
target
on
track:
global
TB
incidence
rate
peaked
in
early
2000s
ü
BUT,
TB
incidence
declining
too
slowly,
1.4
million
people
sFll
dying,
MDR-­‐TB
response
slow,
gaps
in
financing

12. EsEmated
lives
saved
2005-­‐2010
through
collaboraEve
TB/HIV
intervenEons
CumulaFve
2005-­‐10=
910,000
(800,000
–
1,100,000)

13. What
are
the
challenges
in
2013
if
we
target
beher
care,
control
and
ulEmately
“eliminaEon"?
1. Funding
not
secure
at
system
and
individual
level:
TB
is
a
catastrophic
expenditure
for
the
poor
2. TB/HIV
major
impact
in
Africa,
especially
in
women
and
children
3. Weak
health
policies,
systems
and
services
4. Links
with
maternal
and
children
services
not
yet
a
rouEne
5. Un-­‐engaged
non-­‐state
pracEEoners,
NGOs,
FBOs
and
communiEes
6. MDR-­‐TB
care
and
cure
inadequate,
especially
among
PLHIV
7. Social
and
economic
determinants
maintaining
TB
8. Research
awakening
needed
for
new
diagnosEcs,
drugs
and
vaccines

14. Challenge:
TB
as
a
cause
of
maternal
and
child
morbidity
and
mortality
ü TB
causes
1-­‐16%
of
all
inferElity
and
15-­‐40%
of
tubal
inferElity
ü Facility
based
studies:
12-­‐14%
of
all
TB
cases
are
in
children
ü TB
prevenEon
for
child
contacts
not
pracEced
ü Studies
from
SS
Africa
and
India
showed:
– TB
as
a
cause
of
all
maternal
mortality:
6-­‐15%
– TB
as
a
cause
of
indirect
maternal
mortality:
15-­‐34%
References:
Khan
M
et
al,
AIDS
2001;
15:1857–63.
Ahmed
Y
et
al,
Int
J
Tuberc
Lung
Dis
1999;
3:675–80.
Panchabhai
TS
et
al,.
J
Postgrad
Med
2009;
55:8–11.
Menendez
C
et
al.
PLoS
Med
2008;
5:e44.

15. AcEon
for
MCH
services

16. CUAMM
posiEon
paper
…First
mothers
and
children
(with
TB)….
CUAMM
deciding
to
get
engaged
at
all
levels
in
the
fight
against
TB,
as
there
cannot
be
proper
maternal
and
child
care
in
Africa
without
addressing
asserFvely
TB
and
TB/HIV
Prepared
in
collabora:on
with
the
top
Italian
experts
in
TB

17. Many
thanks
to
all
for
choosing
to
Stop
TB!