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Tuberculosis

TB infection and TB disease

• TB is a lung disease that spreads through the air, just like a common cold. When an infectious person sneezes, coughs or even talks, TB germs - known as bacilli - enter the air. The bacilli can remain in the air for several hours, particularly in crowded and poorly ventilated areas.
• Although a third of the world's population is infected with tuberculosis, only one in 10 get active TB. Physical stress, old age and HIV/AIDS can increase the likelihood of developing active TB, which usually affects the lungs.
• Symptoms of TB typically include weight loss, night sweats, fever and cough. A person with the disease, particularly those who tested positive with sputum smear are infectious. Microscopic examination of sputum is the standard diagnostic tool for TB. It specifically detects infectious pulmonary TB cases using three sputum samples collected from deep in the chest for testing.
• Left untreated, a person with TB can infect an average of 10 to 15 people per year.

TB situation

1. Global

• One third of the world's population is currently infected with the TB bacillus.
• Every year, a total of 100 million people get infected with the TB bacilli worldwide, some 8 million develop active (infectious) TB and 2 million will die.
• TB is the leading killer among infectious diseases. It accounts for 1 in 4 of adult preventable deaths.
• Every year, a total of 100 million people get infected with the TB bacilli worldwide, some 8 million develop active (infectious) TB and 2 million will die.
• About 1.9 people develop TB each year in the Region. The Region accounts for around a quarter of all TB cases in the world.
• Almost 70% of the cases are in the 15-54 age group, the most economically productive segment of the population.
• In 2004, around 1.2 million TB cases were reported, of which around 580,000 were smear-positive cases (infectious cases).
• Nine out of 10 TB cases in the Region are found in the seven countries with a high burden of TB: Cambodia, China, Lao People's Democratic Republic, Mongolia, Papua New Guinea, Philippines and Viet Nam.
• Countries with intermediate burden of TB include Brunei, Hong Kong (China), Japan, Republic of Korea, Macau (China), Malaysia and Singapore (with estimated prevalence rate of TB all forms between 39 and 133 per 100 000 population).

• TB is the leading killer among infectious diseases. It accounts for 1 in 4 of adult preventable deaths.

2. Western Pacific Region

WHO’s Western Pacific Region encompasses 37 countries and areas with a total population of 1.7 billion.

• Almost 70% of the cases are in the 15-54 age group, the most economically productive segment of the population.
• In 2004, around 1.2 million TB cases were reported, of which around 580,000 were smear-positive cases (infectious cases).
• Nine out of 10 TB cases in the Region are found in the seven countries with a high burden of TB: Cambodia, China, Lao People's Democratic Republic, Mongolia, Papua New Guinea, Philippines and Viet Nam.
• Countries with intermediate burden of TB include Brunei, Hong Kong (China), Japan, Republic of Korea, Macau (China), Malaysia and Singapore (with estimated prevalence rate of TB all forms between 39 and 133 per 100 000 population).

Table 1. Estimated Incidence Rates of TB (all forms) in selected countries in the world (2005)

Progress in TB Control in the Western Pacific Region

The data for 2005 are expected to show that the intermediate targets of TB control of detecting 70% of the estimated cases, at least 85% of the detected cases are successfully treated and 100% of the population have access to DOTS (directly observed therapy, short-course) services have been met. Strong political commitment in countries and areas, effective partnerships and sound technical guidance laid the foundation for this success. The Region is now better placed to reach the regional goal to halve the prevalence and mortality due to TB by 2010 compared to 2000 levels.

Table 2. Progress in TB control based on TB indicators

The new Strategic Plan to Stop TB in the Western Pacific 2006 - 2010

This new Strategic Plan to Stop TB in the Western Pacific 2006-2010 builds on the good progress achieved in the Region so far. TB control in the Region enters a new phase, in which the focus is towards reducing the burden of TB by one half by 2010, contributing the achievement of the TB-related Millennium Development Goals. This Strategic Plan has been developed in the context of the new global Stop TB Strategy providing a roadmap towards achieving the 2010 regional goal. The Strategic Plan provides clear strategies to improve the quality DOTS implementation, ensure equitable access to TB services, and deal with the emerging threats of multidrug-resistant TB and TB-HIV co-infection. The Strategic Plan sets measurable targets to monitor progress towards achieving the goal. The plan will guide countries and areas in further developing and implementing their national five-year TB control plans for 2006-2010.

The cost of TB control and funding gap for 2006 - 2010

The implementation of the regional Strategic Plan will require US$ 2.2 billion over the next five years. It is estimated that only about 70% of this amount is currently being met by financing from Member States and partners. Filling the gap of US$ 637 million will require intense resource mobilization efforts over the next five years.

Vision, goal and targets

The vision of TB control in the Region is to eliminate TB as a public health problem. The regional goal, which was set by the Regional Committee of the Western Pacific Region in 2000 is to reduce the prevalence and mortality by one half by 2010, relative to 2000.

The Strategic Plan to Stop TB in the Western Pacific 2006-2010 sets four regional core targets which are: a) beyond 70% case detection; b) at least 90% of identified MDR-TB patients are provided with second-line anti-TB drugs; c) at least 90% of identified TB patients with HIV, who are eligible for antiretroviral treatment are provided with anti-retroviral treatment; and d) at least 90% of health facilities outside the TB programme are involved in delivering high quality DOTS services.

Emerging issues

• Multi-drug resistant TB – TB bacilli can develop resistance to one or more anti-TB drugs. This results from inconsistent or partial treatment of TB. A serious problem arises when TB becomes resistant to at least isoniazid or rifampicin, a condition known as multidrug-resistant TB or MDR-TB. This is very difficult and expensive to treat, costing 200 times more than non-MDR cases. The problem is a serious threat to TB control. Hotspots (i.e. areas with high MDR) have been identified at the global level. In some parts of the Region, as many as 1 in 10 of the new cases are multidrug-resistant. WHO estimates that China has the world's largest MDR-TB epidemic, approximately 25% of the world's MDR-TB cases.
• TB-HIV co-infection –HIV/AIDS and TB form a deadly combination. Most people with HIV/AIDS in the Region die of TB. TB is the most common opportunistic infection in people with AIDS. AIDS is partly responsible for the global increase in TB cases especially in many African countries. In the Region, TB associated with HIV is a growing threat in the Region. The prevalence of HIV infection among TB was estimated to be 13% in Cambodia and 4% in Viet Nam in 2004. In other countries affected by HIV, particularly China and Malaysia, the TB-HIV epidemic is concentrated in specific areas or population groups.
• Management of TB in the private sector – While TB diagnosis and treatment is offered free at public facilities, more work is needed to involved private clinics and hospitals in delivering good quality TB services. TB patients do not always go to a public facility providing TB services, and regrettably, private facilities do not always have adequate treatment supervision and treatment is often costly. As a result patients do not get adequate treatment, thus risking the development of resistance. In several countries, there is widespread misuse of second-line anti-TB drugs in facilities outside the TB programme, including private and general hospitals. This results to drug resistance being amplified.