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Chapter 12 : Tuberculosis—a World Health Organization Perspective

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Abstract:

Tuberculosis (TB) remains one of the major causes of human suffering and deaths, causing a pandemic of relevant proportions. However, great progress has been made in the fight against TB in the last two decades following the implementation and scale-up of World Health Organization (WHO) public health strategies. The TB elimination goal can be achieved by 2050, but joint efforts from the international community are required ( ). However, several challenges must be faced; in particular, the occurrence and spread of multidrug-resistant TB (MDR-TB), TB and human immunodeficiency virus (HIV) coinfection, the old-fashioned diagnostic, therapeutic, and preventive armamentarium, and the increasing prevalence of chronic conditions fueled by socioeconomic determinants could significantly hamper the elimination. A new comprehensive approach to fight TB, the End TB strategy, was introduced by the WHO in 2014. It is the third WHO public health strategy focused on TB, following the DOTS (“directly observed treatment, short course”) ( ) in 1993 and the Stop TB strategy in 2006 ( ). The great success of the first two successful WHO strategies was not sufficient to significantly reduce the annual TB incidence rate to achieve TB elimination by 2050 (i.e., incidence rate of less than one TB case per million population) globally. The principles behind the first WHO strategy were oriented to patient care and interruption of in the community, through early bacteriological case index detection and the cure of contagious pulmonary forms through a standardized therapy. At the beginning of the century, the widespread occurrence of cases involving TB/HIV coinfection and MDR-TB patients required a more tailored and comprehensive public health strategy (the Stop TB strategy) encompassing the DOTS elements and new tactics adapted to the new epidemiological scenario (e.g., universal access to care for all TB patients, engagement between the private and public sectors, and involvement of the civil society and patients’ organizations) in TB control efforts.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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Figure 1

Estimated TB incidence rates, 2015. Reprinted from reference , with permission.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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Figure 2

Estimated TB mortality rates in HIV-negative people, 2015. Reprinted from reference , with permission.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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Figure 3

Estimated number of deaths from HIV/AIDS and TB in 2015. Deaths from TB among HIV-positive people are shown in gray. For HIV/AIDS, the latest estimates of the number of deaths in 2015 that have been published by UNAIDS are available at http://www.unaids.org/en/resources/documents/2016/HIV_estimates_with_uncertainty_bounds_1990-2015. Deaths from TB among HIV-positive people are officially classified as deaths caused by HIV/AIDS in the International Classification of Diseases. Reprinted from reference , with permission.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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Figure 4

Estimated HIV prevalence in new and relapse cases, 2015. Reprinted from reference , with permission.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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Figure 5

Estimated new TB cases with MDR/RR-TB. Figures are based on the most recent year for which data have been reported, which varies among countries. Data reported before the year 2001 are not shown. Reprinted from reference , with permission.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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Figure 6

Percentage of previously treated TB cases with MDR/RR-TB. Figures are based on the most recent year for which data have been reported, which varies among countries. Data reported before the year 2001 are not shown. The high percentages of previously treated TB cases with MDR-TB in Bahamas, Bahrain, Belize, Bonaire-Saint Eustatius and Saba, French Polynesia, and São Tomé and Principe refer to only a small number of notified cases (range: 1 to 8 notified previously treated TB cases). Reprinted from reference , with permission.

Citation: Sotgiu G, Sulis G, Matteelli A. 2017. Tuberculosis—a World Health Organization Perspective, p 211-228. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0036-2016
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