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Despite global progress in preventing and controlling tuberculosis (TB), reducing worldwide burden has fallen short of the World Health Organization's (WHO) End-TB elimination target (1). However, in most high-burden countries, [...]

Objective To estimate of the number of children younger than 5 years who were household contacts of people with tuberculosis and were eligible for tuberculosis preventive treatment in 2017. Methods To estimate the number of eligible children, we obtained national values for the number of notified cases of bacteriologically confirmed pulmonary tuberculosis in 2017, the proportion of the population younger than 5 years in 2017 and average household size from published sources. We obtained global values for the number of active tuberculosis cases per household with an index case and for the prevalence of latent tuberculosis infection among children younger than 5 years who were household contacts of a tuberculosis case through systematic reviews, meta-analysis and Poisson regression models. Findings The estimated number of children younger than 5 years eligible for tuberculosis preventive treatment in 2017 globally was 1.27 million (95% uncertainty interval, UI: 1.24-1.31), which corresponded to an estimated global coverage of preventive treatment in children of 23% at best. By country, the estimated number ranged from less than one in the Bahamas, Iceland, Luxembourg and Malta to 350 000 (95% UI: 320 000-380 000) in India. Regionally, the highest estimates were for the World Health Organization (WHO) South-East Asia Region (510 000; 95% UI: 450 000-580 000) and the WHO African Region (470 000; 95% UI: 440 000-490 000). Conclusion Tuberculosis preventive treatment in children was underutilized globally in 2017. Treatment should be scaled up to help eliminate the pool of tuberculosis infection and achieve the End TB Strategy targets. Objectif Estimer le nombre d'enfants de moins de 5 ans qui etaient en contact avec des membres de la famille atteints de tuberculose et qui etaient eligibles a un traitement preventif de cette maladie en 2017. Methodes Pour estimer le nombre d'enfants eligibles, nous nous sommes procure, a partir de diverses publications, les valeurs nationales correspondant au nombre de cas signales de tuberculose pulmonaire confirmee par des analyses bacteriologiques en 2017, a la part de la population agee de moins de 5 ans en 2017 et a la taille moyenne des familles. Nous nous sommes procure, au moyen d'une revue systematique, d'une meta-analyse et de modeles de regression de Poisson, les valeurs mondiales correspondant au nombre de cas de tuberculose active par foyer avec cas de reference et a la prevalence de l'infection tuberculeuse latente chez les enfants de moins de 5 ans qui etaient en contact avec un membre de la famille atteint de tuberculose. Resultats Le nombre estime d'enfants de moins de 5 ans eligibles a un traitement preventif de la tuberculose dans le monde en 2017 etait de 1,27 million (intervalle d'incertitude de 95%, II: 1,24-1,31), soit une couverture mondiale de traitement preventif chez les enfants estimee a 23% au mieux. Par pays, le nombre estime allait de moins d'un aux Bahamas, en Islande, au Luxembourg et a Malte a 350 000 (II 95%: 320 000-380 000) en Inde. Au niveau des regions, les estimations les plus elevees se retrouvaient dans la Region OMS de l'Asie du Sud-Est (510 000; II 95%: 450 000-580 000) et la Region africaine de l'OMS (470 000; II 95%: 440 000-490 000). Conclusion Au niveau mondial, le traitement preventif de la tuberculose chez les enfants etait sous-utilise en 2017. Il faudrait intensifier le recours au traitement afin d'eliminer les foyers de tuberculose et d'atteindre les objectifs de la Strategie de l'OMS pour mettre fin a la tuberculose. Objetivo Estimar el numero de ninos menores de cinco anos que tuvieron contacto con personas con tuberculosis en sus hogares y que eran elegibles para el tratamiento preventivo de la tuberculosis en 2017. Metodos Para estimar el numero de ninos elegibles, se obtuvieron valores nacionales para el numero de casos notificados de tuberculosis pulmonar bacteriologicamente confirmada en 2017, la proporcion de la poblacion menor de 5 anos en 2017 y el tamano promedio del hogar de fuentes publicadas. Se obtuvieron valores globales para el numero de casos de tuberculosis activa por hogar con un caso indice y para la prevalencia de infeccion de tuberculosis latente entre los ninos menores de 5 anos que estaban en contacto con un caso de tuberculosis en el hogar mediante las revisiones sistematicas, el metanalisis y los modelos de regresion de Poisson. Resultados El numero estimado de ninos menores de 5 anos elegibles para el tratamiento preventivo de la tuberculosis en 2017 a nivel mundial fue de 1,27 millones (intervalo de incertidumbre del 95 %, IU: 1,24-1,31), lo que corresponde a una cobertura mundial estimada de tratamiento preventivo en ninos del 23 % en el mejor de los casos. Por pais, el numero estimado oscila entre menos de uno en las Bahamas, Islandia, Luxemburgo y Malta y 350 000 (95 % UI: 320 000-380 000) en la I ndia. A nivel regional, las estimaciones mas elevadas correspondieron a la Region de Asia Sudoriental de la Organizacion Mundial de la Salud (OMS) (510 000; IC del 95 %: 450 000-580 000) y a la Region Africana de la OMS (470 000; IC del 95 %: 440 000-490 000). Conclusion El tratamiento preventivo de la tuberculosis en los ninos fue utilizado muy poco a nivel mundial en 2017. El tratamiento debe ampliarse para ayudar a eliminar el conjunto de infecciones de tuberculosis y alcanzar los objetivos de la Estrategia de Fin a la Tuberculosis. [phrase omitted], Introduction The management of latent tuberculosis infection is a critical component of the World Health Organization's (WHO's) End TB Strategy. Given that between a quarter and a third of the [...]

Tuberculosis (TB) is an ancient disease, but not a disease of the past. After disappearing from the world public health agenda in the 1960s and 1970s, TB returned in the early 1990s for several reasons, including the emergence of the HIV/AIDS pandemic and increases in drug resistance. More than 100 years after the discovery of the tubercle bacillus by Robert Koch, what is the status of TB control worldwide? Here, we review the evolution of global TB control policies, including DOTS (directly observed therapy, short course) and the Stop TB Strategy, and assess whether the challenges and obstacles faced by the public health community worldwide in developing and implementing this strategy can aid future action towards the elimination of TB., 'The struggle [against tuberculosis] has caught hold along the whole line and enthusiasm for the lofty aim runs so high that a slackening is no longer to be feared. If [...]

Objective To present a global update of drug-resistant tuberculosis (TB) and explore trends in 1994-2010. Methods Data on drug resistance among new and previously treated TB patients, as reported by countries to the World Health Organization, were analysed. Such data are collected through surveys of a representative sample of TB patients or surveillance systems based on routine drug susceptibility testing. Associations between multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection and sex were explored through logistic regression. Findings In 2007-2010, 80 countries and 8 territories reported surveillance data. MDR-TB among new and previously treated cases was highest in the Russian Federation (Murmansk oblast, 28.9%) and the Republic of Moldova (65.1%), respectively. In three former Soviet Union countries and South Africa, more than 10% of the cases of MDR-TB were extensively drug-resistant. Globally, in 1994 to 2010 multidrug resistance was observed in 3.4% (95% confidence interval, CI: 1.9-5.0) of all new TB cases and in 19.8% (95% CI: 14.4-25.1) of previously treated TB cases. No overall associations between MDR-TB and HIV infection (odds ratio, OR: 1.4; 95% CI: 0.7-3.0) or sex (OR: 1.1; 95% CI: 0.8-1.4) were found. Between 1994 and 2010, MDR-TB rates in the general population increased in Botswana, Peru, the Republic of Korea and declined in Estonia, Latvia and the United States of America. Conclusion The highest global rates of MDR-TB ever reported were documented in 2009 and 2010. Trends in MDR-TB are still unclear in most settings. Better surveillance or survey data are required, especially from Africa and India. [TEXT NOT REPRODUCIBLE IN ASCII.] Surveillance de la resistance aux medicaments antituberculeux dans le monde: une analyse actualisee, 2007-2010 Objectif Presenter une mise a jour globale de la tuberculose (TB) pharmacoresistante et explorer les tendances de 1994 a 2010. Methodes Les donnees relatives a la resistance aux medicaments des nouveaux patients de TB et de ceux traites anterieurement, telles que rapportees par les pays a l'Organisation mondiale de la Sante, ont ete analysees. Ces donnees sont recueillies par des enquetes representatives aupres des patients ou des systemes de surveillance bases sur des tests systematiques de sensibilite. Les associations entre la tuberculose ultraresistante (TB-UR), le virus de l'immunodeficience humaine (VIH) et le sexe ont ete explorees par regression logistique. Resultats En 2007-2010, 80 pays et 8 territoires ont fourni des donnees de surveillance. Parmi les cas nouveaux et traites a nterieurement, la TB-UR etait la plus elevee dans la Federation de Russie (oblast de Mourmansk, 28,9%) et la Republique de Moldavie (65,1%), respectivement. Dans trois pays de l'ex-Union sovietique et en Afrique du Sud, plus de 10% des cas deTB-UR etaient ultra-resistants. Globalement, en 1994-2010, la multiresistance aux medicaments a ete observee chez 3,4% (intervalle de confiance 95%, IC: 1,9 a 5,0) de tous les nouveaux cas de TB et 19,8% (IC 95%: 14,4 a 25,1) des cas de TB traites anterieurement. Aucune association generale entre la TB-UR et l'infection au VIH (rapports de cotes, OR: 1,4, IC 95%: 0,7 a 3,0) ou le sexe (OR: 1,1, IC 95%: 0,8 a 1,4) n'a ete trouvee. Entre 1994 et 2010, les taux de TB-UR dans la population generale ont augmente au Botswana, en Republique de Coree et au Perou et diminue en Estonie, Lettonie et aux Etats-Unis d'Amerique. Conclusion Les taux mondiaux les plus eleves jamais signales de TBUR ont ete documentes en 2009 et 2010. Les tendances de la TB-UR sont encore peu claires dans la plupart des parametres. De meilleures donnees de surveillance ou d'enquete sont necessaires, surtout en provenance d'Afrique et d'Inde. [TEXT NOT REPRODUCIBLE IN ASCII.] Vigilancia de la resistencia a los medicamentos contra la tuberculosis en todo el mundo: analisis actualizado, 2007-2010 Objetivo Presentar una actualizacion global de la situacion de la tuberculosis (TB) resistente a los medicamentos y analizar las tendencias entre 1994 y 2010. Metodo Se analizaron los datos sobre la resistencia a los medicamentos entre los pacientes recien diagnosticados con TB y los que habian recibido tratamiento con anterioridad, en base a los informes que los paises remitieron a la Organizacion Mundial de la Salud. Dichos datos se recopilaron a traves de encuestas representativas a pacientes o mediante sistemas de vigilancia basados en pruebas rutinarias de sensibilidad a los medicamentos. A traves de una regresion logistica se analizaron las asociaciones existentes entre la tuberculosis multirresistente (TB-MDR), el virus de la inmunodeficiencia humana y el sexo. Resultados Entre 2007 y 2010, 80 paises y 8 territorios facilitaron sus datos de vigilancia. Los niveles mas elevados de TB-MDR entre los casos recien diagnosticados y previamente tratados se registraron en la Federacion de Rusia (Murmansk oblast, 28,9%) y la Republica de Moldova (65,1%), respectivamente. En tres de los paises de la antigua Union Sovietica y en Sudafrica, mas de un 10% de los casos de TB-MDR fueron extremadamente resistentes. Entre 1994 y 2010 se observo en todo el mundo una multirresistencia de un 3,4% (95% de intervalo de confianza, IC: 1,9-5,0) en todos los casos nuevos de TB y de un 19,8% (95% IC: 14,4-25,1) en los casos de TB previamente tratados. No se observaron asociaciones globales entre la TB-MDR y la infeccion por el VIH (cociente de posibilidades, OR: 1,4; IC del 95%: 0,7-3,0) ni con el sexo (OR: 1,1; IC del 95%: 0,8-1,4). Entre los anos 1994 y 2010, las tasas de TB-MDR en la poblacion general aumentaron en Botswana, la Republica de Corea y Peru y descendieron en Estonia, Letonia y Estados Unidos de America. Conclusion En 2009 y 2010 se registraron las tasas globales de MDR-TB mas altas de la historia. Las tendencias de TB-MDR siguen sin quedar claras en la mayoria de los entornos. Es necesaria una mejor vigilancia o mas datos procedentes de encuestas, especialmente en los casos de africa e India., Introduction Surveillance of resistance to drugs against tuberculosis (TB) is a cornerstone of any TB control programme. Surveillance data on drug resistance are needed to track the effectiveness of TB [...]

Objective To assess whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and to conduct the first global assessment of the lives saved [...]

Problem In 1999, a tuberculosis (TB) crisis was declared in the Western Pacific Region. Approach In response, WHO established the Stop TB Special Project, which sought to halve 2000 levels of TB prevalence and mortality by 2010 through first reaching the global 2005 TB targets. Local setting Particular issues in the region were low political commitment, inadequate numbers of staff (particularly of adequately trained staff) and a wide variation in TB burden between countries. Relevant changes WHO&apos;s leadership (especially the commitment of its Regional Director) and building of regional and national partnerships strengthened political and donor commitment. This accelerated the implementation of regional and national TB control plans, allowing the region to reach the 2005 targets for TB control. Lessons learned The experience in the Western Pacific Region demonstrated that WHO&apos;s leadership was pivotal in generating the political commitment necessary to accelerate actions on the ground. The region&apos;s investment in building partnerships and a motivated workforce was an important contribution towards achieving the 2005 global TB targets. Resume Problematique En 1999, une << crise de la tuberculose (TB) >> a ete declaree dans la Region du Pacifique Occidental. Demarche En reponse a cette situation, l&apos;OMS a mis en place un projet special Halte a la tuberculose, ayant pour objectif de diviser par deux d&apos;ici 2010 la prevalence de la TB et la mortalite due a cette maladie par rapport a la valeur de ces parametres pour l&apos;annee 2000, en realisant au prealable les objectifs mondiaux pour 2005 concernant la TB. Contexte local Les problemes particuliers a cette region sont le faible engagement des pouvoirs publics, le manque de personnel (et notamment de personnel correctement forme) et la grande variabilite de la charge de tuberculose entre les divers pays. Modifications pertinentes Le role mobilisateur joue par l&apos;OMS (et notamment l&apos;implication de son directeur regional) et l&apos;etablissement de partenariats regionaux et nationaux ont permis de renforcer l&apos;engagement des dirigeants politiques et des donateurs. Ces interventions ont accelere la mise en oeuvre des plans regionaux et nationaux de lutte antituberculeuse et la region a ainsi pu atteindre les objectifs pour 2005 en matiere de lutte contre la TB. Enseignements tires L&apos;experience acquise dans la Region du Pacifique Occidental a mis en evidence le role mobilisateur essentiel de l&apos;OMS pour obtenir l&apos;implication des dirigeants politiques necessaire a l&apos;acceleration des interventions sur le terrain. L&apos;effort de la region pour constituer des partenariats et la presence d&apos;une main d&apos;oeuvre motivee ont largement contribue a la realisation des objectifs pour 2005 en matiere de lutte contre la TB. Resumen Problema En 1999 se declaro una crisis de tuberculosis en la Region del Pacifico Occidental. Metodos En respuesta al problema, la OMS establecio el Proyecto Especial Alto a la Tuberculosis, con el objetivo de llegar a 2010 habiendo reducido a la mitad, respecto a 2000, las cifras de la prevalencia de tuberculosis y la mortalidad por esa causa, tras haber alcanzado antes las metas mundiales de 2005 para esa enfermedad. Contexto local Los problemas particulares de la region eran el bajo compromiso politico, la falta de personal (en especial de personal adecuadamente preparado) y la amplia variacion de la carga de tuberculosis entre paises. Cambios destacables El liderazgo de la OMS (especialmente el compromiso de su Director Regional) y la creacion de alianzas regionales y nacionales reforzaron el compromiso politico y de los donantes. Esto acelero la puesta en marcha de planes regionales y nacionales de lucha antituberculosa y permitio a la region alcanzar los objetivos de control de la tuberculosis fijados para 2005. Ensenanzas resultantes La experiencia adquirida en la Region del Pacifico Occidental demostro que el liderazgo de la OMS era fundamental si se queria generar el compromiso politico necesario para acelerar las intervenciones sobre el terreno. La inversion de la Region en la creacion de formulas de colaboracion y en una fuerza laboral motivada fue una contribucion importante para el logro de las metas mundiales de 2005 contra la tuberculosis. [TEXT NOT REPRODUCIBLE IN ASCI.], Background The Western Pacific Region bears a quarter of the world's tuberculosis (TB) burden, with an estimated two million incident cases annually. In 1999, only about 40% of the estimated [...]

Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that 'No TB affected families experience catastrophic costs due to TB.' High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection., This paper is part of the PLOS Universal Health Coverage Collection. Universal Access and Social Protection in the Post-2015 Global TB Strategy The WHO has developed a post-2015 global tuberculosis [...]