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STOA-AVIESAN Workshop June 19th 2012; European Parliament ; Bruxelles

STOA-AVIESAN Workshop June 19th 2012; European Parliament ; Bruxelles. EMERGING INFECTIOUS DISEASES: A CONTINUOUS CHALLENGE FOR EUROPE. A sustainable agenda for tuberculosis control and research Robert Loddenkemper Berlin. German Central Committee against Tuberculosis

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STOA-AVIESAN Workshop June 19th 2012; European Parliament ; Bruxelles

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  1. STOA-AVIESAN WorkshopJune 19th 2012; European Parliament; Bruxelles EMERGING INFECTIOUS DISEASES: A CONTINUOUS CHALLENGE FOR EUROPE A sustainableagenda fortuberculosiscontrolandresearch Robert Loddenkemper Berlin German Central CommitteeagainstTuberculosis European Respiratory Society

  2. 1970/80 it was assumedthat TB isnearlyvanquished In 1996 WHO declares TB an emergencyin the Europe Region „The returnofphthisis“ Die ZEIT 26.Nov. 2006

  3. The Global Burden of TB -2010 Estimated number of cases Estimated number of deaths 8.8 million (range: 8.5–9.2 million) 1.45 million (range: 1.2–1.6 million) All forms of TB 1.1 million (13%) (range: 1.0–1.2 million) 350,000 (range: 320,000–390,000) HIV-associated TB Multidrug-resistant TB (MDR-TB) 440,000 (range: 390,000–510,000) about 150,000

  4. Main causes for the global TB burden Demographic factors- population growth, age structure Increasing poverty, socioeconomic development-Quality of medical facilities  Situation in penitentiaries HIVepidemic: TB/HIV co-coinfection with TB Inefficient treatment:MDR/XDR tuberculosis Migration

  5. Eradication of Tuberculosis: Problem of LTBI • Active TB disease • 8,8 million new cases per year • - only “peak of iceberg” Latent TB Infection (LTBI) - the “hidden” epidemic - ~2 billion people

  6. Incidence of tuberculosis in Europe, 2010* Percentage of tuberculosis foreign-born cases among notified tuberculosis patients in Europe* 2010 418.000 (355-496.000) new cases Incidence 47 (40-55)/100.000 In 18 HPC : 87% of incidence *2012 ECDC-WHO Annual TB-Report In several EU/EEA countries >50% foreign-born cases

  7. Percentage of MDR-TB cases among tuberculosis patients with DST results in Europe, 2010(2012 ECDC-WHO Annual TB-Report) 13 top settings with highest % of MDR-TB among new cases, 2001-2010 (WHO Report 2011) EU/EEA: <3% of new cases Estonia : 18.6%, Latvia: 10.8% Tadjikistan: 57. 5% of new cases Ukraine : 79.4% of previously treated cases XDR-TB: 13.2% in Europe 12.2% in EU/EEA Kazakhstan: in up to 76.6%

  8. Percentage of tuberculosis/HIV co-infected patients in Europe, 2010* RussianFederation (new TB/HIV cases 1999-2009) In the EU >10% prevalence in Estonia , Ireland, Malta, the Netherlands, Portugal Outside EU high in Russian Federation, Moldova and Ukraine *2012 ECDC-WHO Annual TB-Report Frolova OP. AIDS 2010

  9. Treatment success rate of new MDR-TB cases in the EU/EEA, 2008 Estimated tuberculosis mortality in Europe, 2010 <60.000 (40-90.000) deaths Mortality 6.8 (5.4-8.3)/100.000 In 18 HPC : 94% of mortality 2012 ECDC-WHO Annual TB-Report

  10. TB control – where are we today? Smear-positive sputum: Insufficient for diagnosis of 50% of TB patients, notably HIV/Mtbcoinfected individuals. Vaccination: BCG protects toddlers but not their parents. Therapy: Rising incidences of MDR-TB and XDR-TB. Our inability to control TB is due to our neglect over the years. Better measures are needed. If we increase our research efforts today, new measures may become available in a decade. Robert Koch 1843 -1910 Albert Calmette 1863-1933 Camille Guérin 1872-1961 Selman Waksman 1888-1973 Stefan H.E. Kaufmann 2012

  11. Potential effects of new TB vaccines, diagnostics and drugs • Targets of Stop TB Partnership/WHO: • Reduce prevalence and mortality by half till 2015 as compared to 1990 • Eliminate TB by 2050 (annual incidence <1/million population • How can this be achieved until 2050?* • Pre-exposure vaccine: reduction of incidence by 39 – 52% • Drugs with shorter treatment time plus against MDR/XDR-TB: reduction by 10 – 27% • Rapid diagnosis: reduction by 13 – 42% • Combined: reduction by 70% • In addition new products targeted at LTBI required • *Abu-Raddadet al., PNAS, 2009 ; Kaufmann, Hussey & Lambert, Lancet 2010

  12. GeneXpert Xpert MTB (Rifampicin) The assay is fully automated with only 3 manual steps at the beginning: Addition of SR to raw sputum and 15 min later, after the sample has been inactivated and liquified, transfer to the Cartridge and in the instrument. All the rest is automated: Sample concentration, removal of inhibitors, ultrasonic lysis of cells and a nested real time PCR. Time-to-result: 1 h 45 min Courtesy of S. Rüsch-Gerdes

  13. Prevention is Better than Cure: Vaccination

  14. Prevention is Better than Cure: Research Ottenhoff THM et al. Tuberculosis 2012

  15. Prevention is Better than Cure: Research TB: costofresearch • Availablefundingforresearch & development in TB: ca. 500 million US$ • Requiredfundingforresearch & developmentofnewinterventionmeasuresagainst TB overthe next 10 years: ca. 2 billionUS$ annually (total ca. 20 billion US$ over10 years) TB: financiallosses • Total directandindirectcost: • >20 billion US$ annually!! Stefan H.E. Kaufmann 2012

  16. Prevention is Better than Cure: Research TB: costofresearch • Availablefundingforresearch & development in TB: ca. 500 million US$ • Requiredfundingforresearch & developmentofnewinterventionmeasuresagainst TB overthe next 10 years: ca. 2 billionUS$ annually (total ca. 20 billion US$ over10 years) TB: total directandindirectcost >20 billion US$ annually!! Stefan H.E. Kaufmann 2012

  17. Howtoimprovethe TB emergencysituation in the Europe Region? • Develop/update National TB controlprogrammes incl. forpenitentiarysystems • Commitmentofgovernments!! • ImplementStop TB strategy (DOTS and DOTS-plus) • AdressMDR-/XDR-TBandHIV/TBco-infection • Buildup high qualitylab capacity (resistancetesting) • Concentrate on high riskgroups • Researchanddevelopmentofnewtools (diagnostics, drugs, vaccines, biomarkers) • Operational research

  18. What may happen in the future? Investment in effective TB control incl. research Poverty,TB neglect, MDR/XDR, HIV • Aim of TB Partnership “Elimination of TB in 2050”looks rather utopic! • In the contrary, TB situation, at least in Eastern Europe, may even worsen!

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