Consolidated Action Plan to Prevent and Combat TB and M/XDR-TB

Dr Roberto Bertollini, Chief Scientist Dr Masoud Dara, TB and M/XDR-TB programme manager

Brussels, 22 March 2012

Robert Koch and the tuberculosis bacterium under the electron microscope

2 |

Outline

• The epidemiological picture : trends and emerging factors • A growing threat MDR and XDR-TB • The WHO/EURO Action Plan to Prevent and Combat MDR-TB (MAP) • Research on vaccine development within the MAP • Conclusions and next steps

Global and WHO European Region TB burden

• about 4.7% contribution to the Global TB burden •

418 000 new TB and 60 000 deaths

(47 and 6.7 per 100 000 respectively)

Koch identified tubercle bacillus Death rate for Tuberculosis, 1860-1960, United States, Source: US Bureau of the Census, Historical Statistics of the United States; Colonial Times to 1970 (Washington, D.C: Government Printing Office, 1975), Part 1 pp58,63. Note: Data between 1860 and 1900 for Massachusetts only. Streptomycin introduced Vaccination available

Percentages of notified TB cases of foreign origin among all TB cases, WHO European Region, 2010

Determinants of TB

TB is particularly linked

migration

, and

imprisonment

Identification of the geographic origin of patients was significantly better in western countries Overall TB notification rate (all TB) per 100,000 inmates, the WHO European Region, 2010 Average = 280/100000 Identification of the imprisonment status of patients was significantly better in eastern countries

Notification of new and relapses, rate per 100 000 population; WHO European Region, 1980-2010 100 80 60 40 20 Notification rate, European Region Notification rate, 18 high priority countries * Notification rate, 27 EU countries ** 0 1980 1985 1990 1995 2000 Note: ** excluding Bulgaria and Romania entering to EU in 2007 2005

Source: Global tuberculosis database, WHO. Accessed on 10 October 2011 4.9

2010

71.6

34.61

* 18 high priority countries Armenia Azerbaijan Belarus Bulgaria Estonia Georgia Kazakhstan Kyrgyzstan Latvia Lithuania Moldova Romania Russian Fed.

Tajikistan Turkey Turkmenistan Ukraine Uzbekistan

Ten thousand children with TB in 2010 WHO European Region

one dot = one child

Treatment success rates, WHO Regions, new, previously treated and MDR cohorts

Treatment outcomes of New pulmonary laboratory confirmed in other WHO regions, 2010 reporting year

100% 90% 80%

7 6 1 6 10 8 1 5 3 5 1 3 1 5 2 4 3 1 2

70%

93 88 88

60%

80 76

50% 40% AFR AMR Not evaluated EMR SEAR Defaulted

Source: the Global TB control 2011 report

WPR Failed

Treatment outcomes, WHO European Region 2010 reporting year 4.3

6.1

7.3

6.7

11.3

14.1

11.3

9.0

23.7

13.0

9.3

68.7

11.3

56.3

47.6

Died New pulmonary lab.confirmed

Re-treated lab confirmed MDR-TB cohort Successfully treated

Source: TB surveillance and monitoring in Europe, report 2012

Percentage of estimated MDR-TB among new and previously treated TB cases, 15 hi-MDR burden countries, average by Region and Global, 2010 Previously TB treated cases New TB cases Source: WHO Global TB report 2011

Percentages of TB cases with HIV infection among all TB cases tested to HIV, WHO European Region, 2006-2010

5 4 6

%

3 2 1 0

increasing by 20% per year in the last 5 years

2,8 2,5 2,8 2,6 3,6 3,2 2006 2008 2007 EUR 4,8 4,6 2009 18HPC 5,5 5,4 2010

Overview of the Action Plan to Prevent and Combat MDR-TB (MAP)

Goal

To contain the spread of drug-resistant TB by achieving universal access to prevention, diagnosis and treatment of M/XDR-TB in all Member States of the WHO European Region by 2015

Targets

• To decrease by 20 percentage points the proportion of MDR-TB among previously treated patients by end 2015 • To diagnose at least 85% of estimated MDR-TB patients by 2015 • To treat successfully at least 75% of notified MDR-TB patients by 2015

Action Plan to Prevent and Combat MDR-TB (MAP) • Prompt diagnosis including newly endorsed molecular diagnostic techniques • Equitable access to adequate treatment • Health system approach to MDR-TB prevention and control • Emphasis on involvement of civil society organizations • Identifying and addressing social determinants • Working in partnership, twinning of cities/programmes • Robust monitoring framework, accountability and follow-up • Including neglected aspects (e.g. palliative care, surgery)

Expected achievements of the Action Plan

• •

225 000 MDR-TB patients diagnosed 127 000 MDR-TB patients treated successfully Expected achievements due to the implementation of the action plan, 2011 – 2015

Estimated MDR TB cases emerging 75 436 71 478 60 756 60 756 • •

250 000 MDR-TB cases averted 13 000 XDR-TB cases averted

MDR-TB cases, detected 45567 •

120 000 lives and 12 US$ billion saved with 5 US$ billion investment

28 887 MDR-TB patients enrolled on treatment 17 913 MDR-TB patients succesifully treated 10512 2011 2012 2013 2014 2015

Joint launch of the Action Plan to Prevent and Combat MDR-TB

Moscow, MDG 6 Summit, October 10, 2011

Currently available TB vaccine

• Bacille Calmette-Guérin (BCG) – the only vaccine so far available against TB – was first used in 1921. • Limited efficacy for protection against the disease • Cannot be administered to people living with HIV • It can only protect, to some extent, against the severe form of TB in children • Not proven to be useful in adults

Action Plan to Prevent and Combat MDR-TB (MAP)

•

Strategic direction 4

To foster regional and international collaboration for the development of new diagnostic tools, medicines and vaccines against TB

•

Activity 6.4.3

The Regional Office and partners will advocate the continuous involvement of European research institutes in the development of new diagnostic tools, medicines and vaccines, and basic research on TB and drug-resistant TB.

Next steps

•

Despite financial crisis, ensure funds are available for Universal Access to TB and MDR-TB diagnosis and treatment

• Comprehensive national MDR-TB response plans in line with the Regional Action Plan in 2012. Health system audits to identify bottlenecks and propose solutions • Foster partnership and cooperation on development of new vaccines and medicines • High Level visits to ensure commitment to implementation of MAP • Yearly progress report (WHO/ECDC annual monitoring & surveillance report) • Interagency steering group involving civil society organizations for follow-up of MAP

Conclusions

• TB is a significant public health problem in Europe both within and outside the EU • MDR and XDR-TB are major threats which can jeopardize progress and hamper the possibility of effective treatment • The economic crisis through the impact on social conditions and welfare may reverse progress • Need to invest on TB treatment and control and on research on vaccine development