TB
Global tuberculosis report 2015
WHO
20th Edition October 2015 :: 204 pages
ISBN 978 92 4 156505 9
Overview
This is the twentieth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care, control and research at global, regional and country levels using data reported by over 200 countries that account for more than 99% of the world’s TB cases. In this 2015 edition, particular attention is given to assessment of whether 2015 global TB targets set in the context of the Millennium Development Goals were achieved worldwide and at regional and country levels.
The four annexes of the report include an explanation of how to access and use the online global TB database, one-page profiles for 22 high TB-burden countries, one page regional profiles for WHO’s six regions, and tables that show estimates and data for key indicators for all countries for the latest year…
Executive summary [excerpt]
Background
The year 2015 is a watershed moment in the battle against tuberculosis (TB). It marks the deadline for global TB targets set in the context of the Millennium Development Goals (MDGs), and is a year of transitions: from the MDGs to a new era of Sustainable Development Goals (SDGs), and from the Stop TB Strategy to the End TB Strategy. It is also two decades since WHO established a global TB monitoring system; since that time, 20 annual rounds of data collection have been completed.
Using data from 205 countries and territories, which account for more than 99% of the world’s population, this global TB report documents advances in prevention, diagnosis and treatment of the disease. It also identifies areas where efforts can be strengthened.
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Main findings and messages
The advances are major: TB mortality has fallen 47% since 1990, with nearly all of that improvement taking place since 2000, when the MDGs were set.
In all, effective diagnosis and treatment of TB saved an estimated 43 million lives between 2000 and 2014.
The MDG target to halt and reverse TB incidence has been achieved on a worldwide basis, in each of the six WHO regions and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases. Globally, TB incidence has fallen by an average of 1.5% per year since 2000 and is now 18% lower than the level of 2000.
This year’s report describes higher global totals for new TB cases than in previous years, but these reflect increased and improved national data rather than any increase in the spread of the disease.
Despite these advances and despite the fact that nearly all cases can be cured, TB remains one of the world’s biggest threats.
In 2014, TB killed 1.5 million people (1.1 million HIV-negative and 0.4 million HIV-positive). The toll comprised 890,000 men, 480,000 women and 140 000 children.
TB now ranks alongside HIV as a leading cause of death worldwide. HIV’s death toll in 2014 was estimated at 1.2 million, which included the 0.4 million TB deaths among HIV-positive people.1
Worldwide, 9.6 million people are estimated to have fallen ill with TB in 2014: 5.4 million men, 3.2 million women and 1.0 million children. Globally, 12% of the 9.6 million new TB cases in 2014 were HIV-positive.
To reduce this burden, detection and treatment gaps must be addressed, funding gaps closed and new tools developed.
In 2014, 6 million new cases of TB were reported to WHO, fewer than two-thirds (63%) of the 9.6 million people estimated to have fallen sick with the disease. This means that worldwide, 37% of new cases went undiagnosed or were not reported. The quality of care for people in the latter category is unknown.
Of the 480,000 cases of multidrug-resistant TB (MDR-TB) estimated to have occurred in 2014, only about a quarter of these – 123,000 – were detected and reported.
Although the number of HIV-positive TB patients on antiretroviral therapy (ART) improved in 2014 to 392,000 people (equivalent to 77% of notified TB patients known to be co-infected with HIV), this number was only one third of the estimated 1.2 million people living with HIV who developed TB in 2014. All HIV-positive TB cases are eligible for ART.
Funding gaps amounted to US$ 1.4 billion for implementation of existing interventions in 2015. The most recent estimate of the annual funding gap for research and development is similar, at about US$ 1.3 billion.
From 2016, the goal is to end the global TB epidemic by implementing the End TB Strategy. Adopted by the World Health Assembly in May 2014 and with targets linked to the newly adopted SDGs, the strategy serves as a blueprint for countries to reduce the number of TB deaths by 90% by 2030 (compared with 2015 levels), cut new cases by 80% and ensure that no family is burdened with catastrophic costs due to TB…
[Report excerpt p.112]
8.3 New vaccines to prevent TB
The slow decline in TB incidence globally (Chapter 2) and the persistent threat of MDR-TB both highlight the critical need for new effective TB vaccines. It is estimated that at least US$ 8 billion is required each year for TB diagnosis and treatment using currently available interventions (Chapter 7).
A recent modelling study showed that developing at least one new TB vaccine over the next 10–15 years would cost about US$ 0.8–1 billion, approximately 1% of diagnosis and treatment costs, and that an adolescent and adult vaccine with 60% efficacy delivered to 20% of the population-at-risk could avert as many as 30–50 million new cases of TB by 2050.1
Recent modelling also indicates that targeting adolescents will prevent morbidity and mortality in infants and young children, and is a more effective strategy to protect them from TB than direct vaccination of infants with a similar vaccine.2
The potential for an adult/adolescent vaccine to have a meaningful impact on the global TB epidemic, compared with the limited impact of an infant vaccine, has shifted the focus of TB vaccine development. The new paradigm emphasises the development of a diverse pipeline of new TB vaccine candidates that target the prevention of active TB in these older age groups.
Scientific advances have also enabled the pursuit of more sophisticated approaches to vaccine design. The global pipeline of TB vaccine candidates in clinical trials is more robust than at any previous period in history, now including recombinant BCGs, attenuated M. tuberculosis strains, recombinant viral-vectored platforms, protein/adjuvant combinations, and mycobacterial extracts.
The status of the pipeline for new vaccines in August 2015 is shown in Figure 8.4. These vaccines aim either to prevent infection (pre-exposure) or to prevent primary progression to disease or reactivation of latent TB (post-exposure). Further details are provided below…
1 Aeras, TB Vaccine Research and Development: A Business Case for Investment.
Rockville: Aeras; 2014. Available at: http://bit.ly/1EodJBj
2 White, R. Indirect effects in infants on the force of TB disease from vaccinating
adolescents and adults. London: TB Modelling Group, TB Centre, Centre
for the Mathematical Modelling of Infectious Diseases; 2015.
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Aeras [to 31 October 2015]
http://www.aeras.org/pressreleases
Aeras Responds to the WHO’s Report on Threat of TB Epidemic
Rockville, MD, October 28, 2015 – The World Health Organization (WHO) released its Global Tuberculosis Report 2015 today, announcing that tuberculosis (TB) caused 1.5 million deaths in 2014, and HIV/AIDS caused 1.2 million deaths last year1.
“While we applaud the progress made to date, with an estimated 9.6 million people fighting active disease and 1.5 million people dying from TB in 2014, it is essential that the appropriate resources are invested in research and development to create the new drugs, diagnostics, and vaccines we desperately need to arrest this global epidemic,” said Aeras CEO Jacqueline E. Shea, Ph.D. “Governments and other funders must dramatically increase the level of resources available for this urgent research.” According to the WHO, there is a $1.3 billion yearly funding gap for TB research and development2.
The WHO’s report also points to the serious threat of dangerous strains of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. In 2014, nearly half a million people developed MDR-TB2. Extensively drug-resistant TB has been reported in 105 countries, representing almost 10 percent of all MDR-TB cases2. Today’s report underscores the urgency of increased funding for TB R&D, warns Dr. Shea. “A new, effective vaccine is essential to ending the TB epidemic,” she adds. “There are so many scientific avenues worthy of further exploration that could be pursued with the appropriate resources, including new vaccine approaches; shorter, faster drug regimens; and improved diagnostics.”
The WHO’s announcement follows the End TB Strategy adopted by the World Health Assembly in 2014 and the United Nations’ recently affirmed Sustainable Development Goals, which include a target to reduce the number of TB deaths by 90% by 2030. “This simply cannot be achieved with the current tools we have to fight this epidemic,” Dr. Shea cautions. “Now is the time for global R&D funders to prioritize TB R&D.”
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PATH [to 31 October 2015]
http://www.path.org/news/index.php
Announcement | October 29, 2015
PATH scientist: new tools can better detect tuberculosis
Report calls for faster validation
Last week, UNITAID released its Tuberculosis Diagnostics Technology and Market Landscape report, co-authored by PATH scientist Dr. David Boyle, who oversees the PATH Diagnostics Program Tuberculosis (TB) Portfolio. The report, now in its fourth edition, reviews current and potential technologies and critical market challenges to improved access to better TB diagnostics.
vaccines and global health :: ethics and policy 