The document discusses tuberculosis (TB) in Europe on World TB Day. It notes that while new TB cases are declining by 5% yearly, efforts need to be strengthened to eliminate TB by 2050. Nearly 1000 new cases still occur daily, and Europe is not on track to halve TB mortality by 2015. Multidrug- and extensively drug-resistant TB remain a major problem, with over half of new cases not being detected or successfully treated. The document calls for putting patients at the center of care, developing new drugs with shorter treatment times, improving diagnostics, and increasing funding to eliminate TB in Europe by 2050.

1. World TB Day
24 March 2014
World TB Day
24 March 2014
Boost efforts to eliminate tuberculosis
by 2050!
©CarlCordonnier

2. World TB Day
24 March 2014
There is an urgent need for new anti-
tuberculosis (TB) medicines with shorter
and more effective treatment regimens
and we must reach all patients, not only
half of them and “half-way”.
For the first time in 40 years, new TB
drugs have become available and are in
clinical trials – but their scope is limited
to specific groups of patients.
A key objective for new treatments
should be to reduce treatment time from
two years to two weeks, putting patients
at the centre of care in the spirit
of Health 2020.
Zsuzsanna Jakab
WHO Regional Director for Europe

3. European strategic action plan on
antibiotic resistance
2011–2016
Dr Guenael Rodier
Director, Division of Communicable Diseases, Health
Security
and Environment
A milestone for Europe
Consolidated action plan on
multidrug-resistant TB
2011–2015

4. World TB Day
24 March 2014
New TB cases down by 5% yearly in Europe, but not
enough to reach the elimination goal
• Diagnosis and treatment
scaled up to reach all
patients with multidrug-
resistant TB
• Decline in new TB cases
of 47 000 between 2011
and 2012
Greater action is required to eliminate TB globally, and
address the emergence and spread of its resistant forms
©CarlCordonnier

5. World TB Day
24 March 2014
Still nearly 1000 new TB cases a day: 1 in 10 dies
• Estimated total of TB
patients in the Region:
over 500 000
• New TB cases estimated to
occur per year: 353 000
• Deaths: 35 000, mostly in
the eastern part of the
Region
©CarlCordonnier

6. World TB Day
24 March 2014
Europe not on track to halve TB mortality by 2015
(Millennium Development Goal 6)
Targets for decline of TB
incidence and prevalence likely
to be achieved
TB incidence
TB prevalence
TB mortality


3.9
2.3 = target
4.6
43 39.4
37 = target
71
Source: Global Tuberculosis report 2013. WHO/HTM/TB/2013.11

7. World TB Day
24 March 2014
• Estimated total of new
M/XDR-TB cases yearly:
76 400
• M/XDR-TB patients diagnosed:
only 33 400
• Successful-treatment rate for
MDR-TB patients: under 50%
(target is 75%)
Multidrug- and extensively drug-resistant TB
(M/XDR-TB): biggest burden in the Region
76 400
65 000
85%
33 400
44%
49%
Estimated
number of
M/Xdr-TB cases
M/XDR-TB
cases target for
detection
M/XDR-TB
cases detected
Treatment
success rate of
MDR-TB cohort
Core indicators for monitoring the
implementation of the M/XDR-TB action
plan, WHO European Region, 2012
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.
Stockholm: European Centre for Disease Prevention and Control; 2014.
Estimated
number of
M/XDR-TB cases

8. World TB Day
24 March 2014
Challenge of M/XDR-TB in the European Region
• Over half of the countries
with the highest rate of
M/XDR-TB in the world are
in the eastern part of the
European Region.
• Almost half of all previously
treated TB patients develop
M/XDR-TB.
3.6
16.0
2.3
9.2
9.4
11
11
13
14
20
22
23
23
23
24
26
35
20
45
23
31
43
32
44
56
32
50
56
55
49
62
62
68
69
0 20 40 60 80
Global average
European Region average
Bulgaria
Georgia
Armenia
Latvia
Lithuania
Tajikistan
Ukraine
Estonia
Azerbaijan
Kazakhstan
Russian Federation
Uzbekistan
Republic of Moldova
Kyrgyzstan
Belarus
%
MDR among TB cases (%),
WHO European Region, 2012
Previously
treated cases
New cases
Source: Global Tuberculosis report 2013. WHO/HTM/TB/2013.11

9. World TB Day
24 March 2014
TB burden unequally distributed among countries
• 85% of TB cases found in
the 18 high-priority countries
for TB control in the Region
• Rate of TB cases in these
countries: almost 8 times
higher than in the rest of the
Region
32
39
62
11
0
10
20
30
40
50
60
70
80
90
Casesper100000population
TB notification rate,
WHO European Region, 1980–2012
Notification rate (all countries)
Estimated incidence (all countries)
Notification rate (18 high priority countries)
Notification rate (EU countries)
18 high-priority countries (85% of all TB cases): Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia,
Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan,
Turkey, Turkmenistan, Ukraine, Uzbekistan.
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.
Stockholm: European Centre for Disease Prevention and Control; 2014.

10. World TB Day
24 March 2014
TB can affect everyone, but is mainly linked to
migration, social marginalization and imprisonment
• 7.2% of the new TB cases in
the Region are reported in
prisoners
• Prisoners have 26 times the
risk of falling sick with TB of
the general population
© Maxim Dondiuk

11. World TB Day
24 March 2014
Leading killer among people living with HIV
• People living with HIV/AIDS have
up to 34 times greater risk of TB
co-infection.
• About 13 000 TB cases with HIV
co-infection were detected in the
Region – 70% of the estimated
total.
• Less than two thirds were offered
antiretroviral treatment.
2.8
2.8
3.4
4.8
6.0 5.4
6.1
0
1
2
3
4
5
6
7
2006 2007 2008 2009 2010 2011 2012
%
Percentage of HIV among notified TB,
WHO European Region, 2012
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.
Stockholm: European Centre for Disease Prevention and Control; 2014.

12. World TB Day
24 March 2014
One in three TB patients is not cured
• 1 untreated person with TB or M/XDR-TB can infect 10–15 other people
yearly. 10% of them develop the disease.
• Anti-TB regimens are complex, toxic and inefficient in curing M/XDR-TB.
• Adequate TB treatment
will prevent M/XDR-TB.
• The key objective of TB
control is to reduce
treatment time to less
than 2 weeks.
66.1
7.9
8.4
5.7
11.9
Treatment outcomes (%) of new pulmonary
laboratory-confirmed cases,
WHO European Region, 2011
Successfully treated
Died
Failures
Defaulters
Not evaluated
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014.
Stockholm: European Centre for Disease Prevention and Control; 2014.

13. World TB Day
24 March 2014
Prevent the development of M/XDR-TB
Scale up access to effective treatment
Scale up access to early diagnosis
Improve infection control
Strengthen surveillance
Expand management capacity of the programmes
Address the needs of special populations
Consolidated Action Plan to Prevent and Combat
Multidrug- and Extensively Drug-resistant Tuberculosis

14. World TB Day
24 March 2014
120 000 lives and US$ 12 billion could be saved by
implementing the Consolidated Action Plan
The goal is to contain the spread
of drug-resistant TB by:
• decreasing M/XDR-TB cases
among previously treated cases by
20 percentage points;
• detecting 85% (or 225 000) of
M/XDR-TB patients; and
• successfully treating at least 75%
(127 000) of them.
©CarlCordonnier

15. World TB Day
24 March 2014
Eliminating TB by 2050 requires putting patients at the
centre of care
• Early diagnosis and full treatment
for all patients
• Move from hospital to ambulatory
care
• New TB drugs, with shorter and
more effective treatment regimen
• New diagnostics and vaccines
• Less stigma and more equity
• More funds, better used
©CarlCordonnier

16. World TB Day
24 March 2014
Thank you
(www.euro.who.int/tuberculosis)
World TB Day
24 March 2014
©CarlCordonnier