Global Epidemiology of Multidrug-Resistant Tuberculosis

Matteo Zignol, MD, MPH

18th Annual Meeting

The Union – North America Region

February 27, 2014

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Coverage of anti-TB drug resistance surveillance data

Percentage of MDR-TB in new and previously treated TB cases

Surveillance data on second-line drug resistance

Time trends in MDR-TB

MDR-TB in children and association with HIV

Notification and treatment outcomes of MDR-TB

Outline of the presentation

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Introduction: the global TB situation (I)

Estimated incidence, 2012

Estimated number of deaths, 2012

940,000* (0.8–1.1 million)

8.6 million (8.3–9.0 million)

450,000 (300,000–600,000)

All forms of TB

Multidrug-resistant TB

HIV-associated TB 1.1 million

(1.0–1.2 million)

320,000 (300,000–340,000)

Source: WHO Global Tuberculosis Report 2013 * Excluding deaths attributed to HIV/TB

170,000 (100,000–240,000)

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Introduction: the global TB situation (II)

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Global project on anti-TB drug resistance surveillance (I)

1st ed. DRS guidelines

Global Project launched

SRLN launched

2nd ed. DRS guidelines

1st global DRS report

2nd global DRS report

3rd ed. DRS guidelines

3rd global DRS report

4th global DRS report

4th ed. DRS guidelines

M/XDR-TB report

1994 1997 2000 2003 2004 2008 2009 2010 2013

2013 TB report

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Objectives:

To estimate the magnitude of drug resistance

To determine trends

Main technical partners:

Project hosted by WHO

SRLs, The Union, US CDC, KNCV, ECDC, RIT-Japan

Main donor Agencies:

USAID, The Global Fund, PEPFAR, BMGF

Global project on anti-TB drug resistance surveillance (II)

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Progress in global coverage of data on drug resistance surveillance, 1994–2012

Baseline data available from ≈70% of all countries globally (136/194)

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Percentage of new TB cases with MDR Global estimate: 3.6% (2.1-5.1)

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Percentage of previously treated TB cases with MDR Global estimate: 20.2% (13.3-27.2)

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Coverage of anti-TB drug resistance surveillance Second-line drugs: fluoroquinolones and injectable agents among MDR-TB

Year of most recent data

2005-2009

2010-2012

No data

Subnational data only

Not applicable

Baseline data available from ≈ 40% of all countries globally

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92 countries had notified at least one case of XDR-TB by the end of 2013

9.6% (8.1-11.2) of MDR-TB cases in countries with surveillance data have XDR-TB

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Time trends in MDR-TB, 1996-2012 (I)

Time trends data available from 88 countries and 10 territories worldwide for a total of 870 country-year data points

Time trends mostly from countries with continuous surveillance systems (i.e. diagnostic DST of all TB patients)

Repeating surveys challenging when using conventional laboratory methods

Molecular technologies represent way forward to increase survey frequency

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Time trends in MDR-TB, 1996-2012

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MDR-TB in children Proportion of MDR in children and adults with TB is similar

Eur Respir J. 2013; 42(3):701-7

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MDR-TB and HIV Positive association in 11 countries, 7 of them are in EEU

Eur Respir J. 2014; accepted, in press.

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MDR-TB cases estimated to occur among notified pulmonary TB cases, 2012

300,000 (220,000-380,000) MDR-TB cases estimated 60% of them occur in “BRICS” countries

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MDR-TB notification and enrolment, 2012

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Outcomes of MDR-TB treatment MDR-TB cohorts 2007-2010, global

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Conclusions

2013 WHO estimates:

450,000 incident MDR-TB cases

300,000 MDR-TB cases among notified pulmonary TB cases

Levels of MDR-TB highest in EEU but absolute numbers highest in "BRICS"

Need of more drug resistance surveillance data, particularly from Africa (western/central), India, and Russian Federation

Monitoring MDR-TB time trends difficult in countries relying on special surveys: need to use molecular technologies to increase survey frequency

~ 25% of the estimated MDR-TB patients reported to be put on treatment

~ 50% of MDR-TB patients on treatment reported to have successfully completed treatment

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Acknowledgments

Anna Dean, PhD

Dennis Falzon, MD