Evolution of Tuberculosis Control and Prospects for Reducing Tuberculosis Incidence, Prevalence, and Deaths Globally

Abstract

ContextThe United Nations Millennium Development Goals (MDGs) are stimulating more rigorous evaluations of the impact of DOTS (the WHO-recommended approach to tuberculosis control based on 5 essential elements) and other possible strategies for tuberculosis (TB) control.Objective To evaluate the prospects for detecting 70% of new sputum smearpositive cases and successfully treating 85% of these by the end of 2005, for reducing TB incidence, and for halving TB prevalence and deaths globally between 1990 and 2015, as specified by the MDGs.Data Sources TB case notifications from DOTS and non-DOTS programs and cohort treatment outcomes (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) reported annually to the World Health Organization (WHO) by up to 200 countries, TB death registrations, and prevalence surveys of infection and disease.Study Selection Case notification series that reflect trends in incidence, treatment outcomes from DOTS cohorts, death statistics from countries with WHO-validated vital registration systems, and national prevalence surveys of infection and disease. Data ExtractionCase reports, treatment outcomes, prevalence surveys, and death registrations from WHO's global TB database covering 1990-2003 to estimate TB incidence, prevalence, and death rates through 2015 for 9 epidemiologically different world regions.Data Synthesis TB incidence increased globally in 2003, but incidence, prevalence, and death rates were approximately stable or decreased in 7 of 9 regions. The exceptions were regions of Africa with low (Ͻ4% in adults 15-49 years) and high rates (Ն4%) of HIV infection. The global detection rate of new smear-positive cases by DOTS programs increased from 11% in 1995 to 45% in 2003 (with the lowest case-detection rates in Eastern Europe and the highest rates in the Western Pacific) and could reach 60% by 2005. More than 17 million patients were treated in DOTS programs between 1994 and 2003, with overall treatment success rates more than 80% since 1998. In 2003, overall reported treatment success was 82%, with much variation among regions. The highest rates were reported in the Western Pacific region (89%) and lowest rates in African countries with high and low HIV infection rates (71% and 74%, respectively), in established market economies (77%), and in Eastern Europe (75%). To halve the prevalence rate by 2015, TB control programs must reach global targets for detection (70%) and treatment success (85%) and also reduce the incidence rate by at least 2% annually. To halve the death rate, incidence must decrease more steeply, by at least 5% to 6% annually. ConclusionReduction of TB incidence, prevalence, and deaths by 2015 could be achieved in most of the world, but the challenge will be greatest in Africa and Eastern Europe.

Current Diagnosis and Management of Female Genital Tuberculosis

“…Tuberculosis continues to be a major health problem throughout the world affecting about 9.4 million people annually with about two million deaths [1,2]. Over 95 % of new TB cases and deaths occur in developing countries with India and China together accounting for 40 % of the world's TB burden.…”

“…Co-infection with human immunodeficiency virus (HIV), more liberal immigration from high risk to low risk areas due to globalization has been responsible for increased incidence all over the world. Multidrug resistant (MDR) and extreme-drug resistant TB (XDR), usually caused by poor case management, are a cause of serious concern [1,2]. World Health Organization (WHO) in a drastic step declared TB a global emergency in 1993 and promoted a new effective TB control called Directly Observed Treatment Short-course (DOTS) strategy with 70 % case detection rate and 85 % successfully treatment rates [3].…”

Evaluation of memory immune response to mycobacterium extract among household contact of tuberculosis cases

“…Tuberculosis (TB) is a major cause of morbidity and mortality worldwide, with 8-10 million new cases and 2-3 million deaths each year (1). Only a small fraction of infected individuals develop the disease and the vast majority remains disease-free (1).…”

“…Only a small fraction of infected individuals develop the disease and the vast majority remains disease-free (1).…”

Tuberculosis Induced Changes to the Osseous Cranial Base and its Potential Effect on Hearing

“…Both forms often demonstrate wide-ranging clinical effects throughout the body. Hearing loss, tinnitus, and vestibular problems, have been noted to occur in 32,000-240,000 individuals that develop TB (Dye et al, 2005;Thwaites and Tran, 2005;Lucente et al, 1978). The exact mechanisms of such complications are not completely understood but may include direct effects (drug toxicity on hair cells due to treatment) and/or indirect disturbances (e.g., loss of control of perilymph composition/pressure, altered cochlear blood flow, increased turbulent venous flow by means of cranial-base ossification).…”