Global Epidemiology of Tuberculosis and Progress Toward Achieving Global Targets — 2017

Adam MacNeil, PhD; Philippe Glaziou, MD; Charalambos Sismanidis, PhD; Susan Maloney, MD; Katherine Floyd, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(11):263-266. 

In This Article

Abstract and Introduction

Introduction

Worldwide, tuberculosis (TB) is the leading cause of death from a single infectious disease agent[1] and the leading cause of death among persons living with human immunodeficiency virus (HIV) infection, accounting for approximately 40% of deaths in this population.[2] The United Nations' (UN) Sustainable Development Goals[3] and the World Health Organization's (WHO's) End TB Strategy[4] have defined ambitious targets for 2020–2035, including a 35% reduction in the absolute number of TB deaths and a 20% reduction in TB incidence by 2020, compared with 2015.[4] Since 2000, WHO has produced annual TB estimates for all countries.[1] Global and regional disease estimates were evaluated for 2017 to determine progress toward meeting targets. In 2017, an estimated 10 million incident cases of TB and 1.57 million TB deaths occurred, representing 1.8% and 3.9% declines, respectively, from 2016. Numbers of TB cases and disease incidence were highest in the WHO South-East Asia and Africa regions, and 9% of cases occurred among persons with HIV infection. Rifampicin-resistant (RR) or multidrug-resistant (MDR) (resistance to at least both isoniazid and rifampicin) TB occurred among 3.6% and 18% of new and previously treated TB cases, respectively (5.6% among all cases). Overall progress in global TB elimination was modest in 2017, consistent with that in recent years;[1] intensified efforts to improve TB diagnosis, treatment, and prevention are required to meet global targets for 2020–2035.

TB data are reported to WHO annually by 194 member states and are reviewed and validated in collaboration with reporting entities. For countries in which case notifications did not capture all incident cases that occurred within a year (based on a standardized checklist), special studies, including TB prevalence surveys[5] or inventory studies,[6] contributed to incidence estimates. For each country, 2017 disease incidence (per 100,000 HIV-negative persons and per 100 persons with HIV infection) and confidence intervals were estimated from 1) TB prevalence surveys; 2) notifications adjusted by a standard factor to account for underreporting, overdiagnosis, and underdiagnosis; 3) national inventory studies that measure the level of underreporting of detected TB cases, combined with capture-recapture modeling;[6] and 4) national case notification data supplemented with expert opinion about case-detection gaps. Among HIV-negative persons, TB mortality estimates were based on cause of death data from civil registration and vital statistics, mortality surveys, or the product of TB incidence and case fatality. Among persons with HIV infection, TB mortality was derived from the product of incidence among persons with HIV infection and case fatality.[1] Data on persons receiving TB preventive treatment, reported to WHO, were compared with estimates of eligible persons.

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