TUBERCULOSIS

WHO Global Tuberculosis Report 2012

51 million people successfully treated, 1995-2011

20 million lives saved through DOTS and the Stop TB Strategy, 1995-2011

Slow progress in MDR-TB case detection and treatment access

TB SITUATION AND ACCESS TO CARE

TB CARE 8.7 million people fell ill with TB in 2011, including 1.1 million cases among people with HIV. In 2011, 1.4 million people died from TB, including 430 000 among people who were HIV-positive. TB is one of the top killers of women worldwide, half a million women died from TB in 2011. The TB mortality rate has decreased 41% since 1990. In 2011, 5.8 million newly diagnosed cases were notified to national TB control programmes (NTPs). This is still only two-thirds of the estimated total of 8.7 million people who fell ill with TB in 2011. Cambodia provides a new success story in TB care and control and demonstrates what can be achieved in a lowincome and high-burden country with recommended approaches. New data show a 45% decrease in TB prevalence between 2002 and 2011. TB/HIV CO-INFECTION An estimated 1.3 million lives were saved globally between 2005 and 2011 by implementing collaborative TB/HIV activities. Globally, 48% of the TB patients known to be living with HIV in 2011 were started on antiretroviral therapy (ART). MULTIDRUG-RESISTANT TB In 2011, there were an estimated 310 000 cases of multidrug-resistant TB (MDR-TB) among notified TB patients with pulmonary TB. Almost 60% of these cases were in India, China and the Russian Federation. The number of MDR-TB cases notified in the 27 high MDR-TB burden countries doubled between 2009 and 2011, and reached about 60 000 worldwide. This is only one in five (19%) of the MDR-TB cases estimated to exist among notified TB patients. In the two countries with the largest number of estimated cases, the figure is less than one in ten.

NEW DIAGNOSTICS The roll-out of Xpert MTB/RIF, a rapid molecular test that can diagnose TB and rifampicin resistance within 100 minutes has been impressive. Between its endorsement by WHO in December 2010 and the end of June 2012, 1.1 million tests had been purchased by 67 low- and middle-income countries; South Africa with 37% of purchased tests, is the leading adopter.

RESEARCH AND DEVELOPMENT

New or re-purposed TB drugs and novel TB regimens to treat drug-sensitive or drug-resistant TB are advancing in clinical trials and regulatory review. Eleven vaccines to prevent TB are moving through development stages.

FINANCING FOR TB CARE AND CONTROL

Between 2013 and 2015 up to US$ 8 billion per year is needed in low- and middle-income countries to implement existing interventions, with a funding gap of up to US$ 3 billion per year. The funding gap for research and development was US$1.4 billion in 2010.

FUNDS AND GAPS US$ 3 BILLION GAP

www.who.int/tb

*2014-2015 investment by national governments in low and middle income countries is projected using IMF forecasts of GDP per capita; Global Fund and other grants are assumed constant at 2013 levels.

World on track to achieve 2015 targets for reductions in incidence and mortality, but Africa and Europe not on track for 50% mortality decline.

TUBERCULOSIS
ADDITIONAL FACTS
INCIDENCE
Incidence rate all forms of TB

WHO Global Tuberculosis Report 2012

PREVALENCE
Prevalence rate

MORTALITY
Mortality rate

Global target Incidence rate HIV positive TB

Global target

Progress towards global targets for reductions in TB cases and deaths

TB EPIDEMIC AND RESPONSE Tuberculosis (TB) is contagious and airborne. It ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV).
The Millennium Development Goal (MDG) target to halt and reverse the TB epidemic by 2015 has already been achieved. New cases of TB have been falling since 2006 and fell at a rate of 2.2% in 2011. At least half a million children became ill with TB and an estimated 64 000 children died of TB in 2011. Worldwide, 3.7% of new cases and 20% of previously treated cases were estimated to have MDR-TB. The highest proportions of TB patients with MDR-TB are in eastern Europe and central Asia. Extensively drug-resistant TB, or XDR-TB, has been identified in 84 countries; the average proportion of MDR-TB cases with XDR-TB is 9%. Almost 80% of TB cases among people living with HIV reside in Africa. Access to TB care has expanded substantially since the mid-1990s, when WHO launched a new global TB strategy and began systematically monitoring progress. Between 1995 and 2011, 51 million people were successfully treated for TB saving 20 million lives. Notifications of TB cases have stagnated in recent years. New policy measures such as mandatory case notification and intensified efforts by NTPs to engage the full range of care providers using public-private mix (PPM) initiatives are critical to increase the number of TB cases notified in future years. In most of the 21 countries that provided data, 1040% of notifications were from non-NTP care providers. In 2010, the treatment success rate among all newlydiagnosed cases was 85% and among patients with smearpositive pulmonary TB (the most infectious cases) it was 87%.

ENHANCING TB/HIV COLLABORATION In 2011, 69% of TB patients were tested for HIV in the African Region, up from 3% in 2004. The number of people in HIV care who were screened for TB increased 39% between 2010 and 2011. Nearly half a million people were provided with isoniazid preventive therapy in 2011, more than double the number started in 2010. Though there is significant progress in providing ART for TB patients known to be living with HIV (48%); coverage needs to double to meet WHOs recommendation that all TB patients living with HIV are promptly started on ART. RESPONDING TO DRUG-RESISTANT TB The target treatment success rate of 75% or higher for patients with MDR-TB was reached by only 30 of 107 countries that reported treatment outcomes. Measurement of drug resistance has improved considerably. Data are available for 135 countries worldwide (70% of WHOs 194 Member States). SCALING UP RESEARCH AND DEVELOPMENT Research to develop a new point-of-care diagnostic test for TB and MDR-TB continues, and other diagnostic tests are in the pipeline. At US$ 630 million in 2010, funding for TB research and development falls far short of the annual target of US$ 2 billion specified in the Global Plan to Stop TB 20112015. TB INVESTMENTS AND GAPS International donor funding is especially critical to sustain recent gains and make further progress in 35 low-income countries (25 in Africa), where donors provide more than 60% of current funding. National contributions provide the bulk of financing for TB care and control in Brazil, the Russian Federation, India, China and South Africa (BRICS). However, they remain insufficient for scaling up the response to MDR-TB.

The WHO Stop TB Department together with WHO regional and country offices: develops policies, strategies and standards; supports the efforts of WHO Member States; measures progress towards TB targets and assesses national programme performance, financing and impact; promotes research; and facilitates partnerships, advocacy and communication.
World Health Organization 2012