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Chapter 11 : Tuberculosis—a World Health Organization Perspective

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Abstract:

One of the main goals of the DOTS- based programs was the interruption of transmission of through early detection using sputum smear microscopy and the cure of infectious tuberculosis (TB) cases through short-course chemotherapy (SCC). This chapter describes progress and challenges in implementing the Stop TB strategy, built around DOTS, through the Global Plan to Stop TB 2006-2015. The global burden of TB is also presented in terms of incidence, prevalence, mortality, human immunodeficiency virus (HIV)-related TB, and drug- resistant TB, specially MDR- TB and extensively drug-resistant TB (XDR- TB). The chapter reviews progress towards the achievement of the 2015 TB related Millennium Development Goals (MDG) and the Stop TB Partnership targets of halving prevalence and mortality compared to 1990 levels. Full scale-up of collaborative activities between the HIV and TB national programs aiming to reduce the burden of HIV among people infected with and vice versa will be critical to accelerate TB control in the region. The sequencing of the genome in 1998 was probably the turning point for the realization that the development of new tools against TB could be within reach, as new frontiers were to open in the field of basic TB research. The global progress in implementation of the Stop TB strategy via the Global Plan to Stop TB and progress in the development of new and improved TB control tools indicate some cause for optimism regarding future prospects for controlling the global TB epidemic.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11

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Infectious Diseases
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Immune Systems
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Figures

Image of Figure 1.
Figure 1.

Estimated TB incident cases, 2008.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 2.
Figure 2.

Estimated TB incident rates, 2008.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 3.
Figure 3.

Estimated HIV prevalence in new TB cases, 2008.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 4.
Figure 4.

Treatment success globally and by WHO region.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 5.
Figure 5.

Trends in estimated incidence rates (black) and notification rates (gray) in nine subregions, 1990 to 2008.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 6.
Figure 6.

HIV testing for TB patients, 2003 to 2008. Shown are numbers (bars) and percentages (line) of notified new and retreatment TB cases for which the HIV status (HIV positivity in black) of the patient was recorded in the TB register. The numbers under the bars are the numbers of countries reporting data, followed by the percentages of total estimated HIV-positive TB cases accounted for by reporting countries.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 7.
Figure 7.

Gap between GLC-approved treatments and revised Global Plan, 2006 to 2015.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Image of Figure 8.
Figure 8.

Funding for TB control by source of funding for 22 HBCs and 96 other countries, 2006 to 2010.

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Tables

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Table 1.

Goals, targets, and indicators for TB control

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
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Table 2.

The Stop TB strategy

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
Generic image for table
Table 3.

Summary of TB estimates in 2008 by WHO region

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11
Generic image for table
Table 4.

TB case notifications and rates by WHO region, 2008

Citation: Espinal M, Raviglione M. 2011. Tuberculosis—a World Health Organization Perspective, p 182-204. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch11

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