KOCH-METSCHNIKOW-FORUM МEЧНИКОВ-КОХ-ФОРУМ XX Congreso Internacional sobre Tuberculosis UITB-216 November 21 and 22, 216 Epidemiological trends of TB in Eastern Europe TB and migration Timo Ulrichs Koch-Metschnikow-Forum, Vice President and Head of the Tuberculosis Section; Akkon University for Human Sciences Tuberculosis in Germany 1
Tuberculosis in Germany (Ref.: From a talk by Robert Koch, Sitzung der Akademie der Wissenschaften zu Berlin am 7. April 191) Tuberculosis in Germany Erkrankungen/1. Einwohner 1 8 6 4 2 1,4 1,4 9,2 9,3 2,7 2,3 9,8 8,7 2,4 8,9 7,9 2,2 8,2 7,3 2, 7,3 6,5 1,7 6,8 6,1 1,6 6,2 6,1 5,8 5,5 5,4 5,3 1,5 1,1 1,3 Gesamt Erwachsene Kinder 21 22 23 24 25 26 27 28 29 21 Meldejahr * Ref.: Robert Koch Institute 2
TB burden in the WHO European Region, 29 42 new cases and 46 deaths 49 new cases and 7 deaths every hour Global TB control report, 21 TB burden in the WHO European Region, 29 42 estimated, 33 notified* (5.6% of the global burden in 29) 46 deaths due to TB Majority of TB patients (87%) and deaths (92%) were from the 18 high priority countries (HPC) of the Region. Highest case detection rate (78%) and lowest treatment success rate (7%) among all the Regions TB risk factors in Europe HIV: 6 15% Smoking: 21 29% Diabetes: 14 15% Alcohol: 14 35% Global TB control report, 21, TB surveillance in Europe, report 29 3
Even with the fastest decline in TB incidence in the world, nearly 1 Europeans fall ill every day New TB cases estimated to occur per year: 34. Estimated total number of TB patients in the Region: over 44. Since 25, new TB cases have been falling at an average rate of 5.2% per year WHO European Region has fastest decline of TB incidence in the world TB notification trend reflects true reduction in spread of the disease and is strongly influenced by improvements in high-priority countries. 9 WHO European Region, 198-214 Rate per 1 population 8 7 6 5 4 3 2 1 58,9 37 3,5 12,2 Notification (18 High-priority countries) Estimated incidence (53 Member States) Notification rate (53 Member States) Notification (European Union/European Economic Area (EU/EEA)) Source: European Centre for Disease Prevention and Control / WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 216. Stockholm: European Centre for Disease Prevention and Control; 216 4
Less wealthy countries are the most affected More TB Estimated TB incidence rate per 1, population TB incidence rate, GDP per capita and estimated new and relapses caseload in 53 MSs of WHO European Region, 214 18 MDA 16 KGZ 14 12 1 8 TJK UKR GEO AZE LTU 6 UZB BIH BLR TKM LVA 4 IRL ARM SRB BGR TUR POL PRT EST DEU ESP FRA GBR 2 MLT SVK CZE SVN ITA CYP ISRANDFIN NLDDNK CHE MNE GRC NOR ISL MKD HRV HUN AUT BEL SWE 8 8. 8. Gross Domestic Product per capita (current US$, 214) ROU RUS KAZ More wealth TB burden is unequally distributed 83% of incident TB cases 92% of TB deaths 99.5% of MDR-TB cases 88% of TB/HIV coinfections occur in the 18 high-priority countries in the Region Estimated TB incidence per 1 population, WHO European Region, 214 Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 216. Stockholm: European Centre for Disease Prevention and Control; 216. 18 high-priority countries: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan. 5
The transmission of MDR-TB is continuing Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 216. Stockholm: European Centre for Disease Prevention and Control; 216. MDR-TB detection and treatment have much improved since the start of the MDR-TB Action Plan 211-215 Baseline before the endorsement of MAP Achievements during period of MAP implementation 6
TB notification by origin, EU/EEA, 25-214 Under-detection of TB among children remains a challenge in the WHO European Region Adults 45619 Detected 32% Undetected 15% 1 85% 263381 21 68% Children 9% of all new TB cases in 214 were children Whereas most cases among adults are detected, the contrary happens for children 7
HIV co-infection among TB patients continues to rise in the WHO European Region Proportion of HIV co-infection among TB patients in WHO European Region, 26-214 HIV and TB create a deadly synergy 9 8 7,8 8, Between 26 and 214 HIV- TB co-infection increased from 2.8% to 8.% with annual average increase of 13% % HIV among TB cases 7 6 5 4 3 2 2,8 2,8 3,4 4,8 6, 6,3 6,1 1 26 27 28 29 21 211 212 213 214 Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 216. Stockholm: European Centre for Disease Prevention and Control; 216. Effectiveness of TB treatment remains one of the biggest challenges for the WHO European Region Only 3 in 4 newly registered TB patients notified in the region is successfully treated % 1 9 8 7 6 5 4 3 2 1 Treatment success rate of all new and relapse, WHO Regions, 199 and 213 67 AFR AMR EMR EUR SEAR WPR Global 76 1995 213 8
Effectiveness of TB treatment remains one of the biggest challenges for the WHO European Region 1 8 % 6 Treatment success rate of all new and relapse, WHO Regions, 199 and 213 76 67 4 2 AFR AMR EMR EUR SEAR WPR Global 1995 213 Only 1 in 2 patients with MDR-TB or HIV co-infection has the chance of being cured For patients with XDR TB the chance of cure is below 3% TB treatment is even more challenging among previously treated, HIV co-infected and M/XDR-TB patients Comparison of treatment outcome of TB patients by history, HIV status and drug resistance, WHO European Region 6, 7,2 5,8 5,2 13,1 7,1 11, 75,8 11, 57,7 4,1 7,4 2,9 2,8 46,7 8, 13,5 16,4 13,4 48,7 11,6 12,9 24,1 24,1 27,4 New&relapse Retreated HIV positive RR/MDR XDR Success Died Failed Lost to follow-up Not evaluated 9
TB Action Plan for the WHO European Region, 216-22 Vision: An end to the TB epidemic Goal: To stop the spread of drugsusceptible and drug-resistant TB by achieving universal access to prevention, diagnosis and treatment in all Member States of the WHO European Region. Targets: 35% reduction in TB deaths 25% reduction in TB incidence rate 75% treatment success rate among the MDR-TB patient cohort To reach targets we need to: Scale-up rapid diagnosis Expand patient-centred care Introduce shorter and more effective treatment regimens including new medicines Expand preventive therapy and research for new tools Boost intersectoral approach to address inequities TB control challenges in the WHO European Region Economic recession, poverty and socially vulnerable groups (homeless, unemployed, alcohol-dependent) Health systems: poorly developed or under reform, leading to ineffective TB control M/XDR-TB: the highest rates in the world in EUR HIV epidemic: growing (mainly through injecting drugs users) TB in prisons: penitentiary system very large with poor TB services Migration (East to West, South to North, internal migration) 1
Koch-Metschnikov-Forum Contact: Timo Ulrichs Head of Section Tuberculosis Ulrichs@KMForum.eu 11