GTBR13_cover M_spine20_5 91355 9789241564656 Eng

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Warning: This report is out-of-date. In particular, entire

time-series of TB disease burden estimates are updated

every year. For the latest data and analysis, please see

the most recent edition of the global TB report.

Global

tuberculosis

report

2013

WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail:

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the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning

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Cover design by Tom Hiatt, Western Pacic Regional Oce and Irwin Law, WHO headquarters. e front cover illustrates the latest status of

global progress for ve indicators that are part of the Millennium Development Goals framework. ese are the incidence rate of tuberculosis

disease per 100 000 population per year, the prevalence of tuberculosis disease per 100 000 population, the tuberculosis mortality rate per 100

000 population per year, the case detection rate (the number of cases detected and reported to national tuberculosis programmes divided by

the estimated incidence) and the treatment success rate for new TB patients started on treatment. Each pair of shapes represents both the most

recent level of the indicator and a baseline year against which progress is measured. For incidence (green and dark orange), prevalence (grey and

pink) and mortality (light orange and light blue), the top of the combined height of each pair of shapes shows the level in 1990. e lower of the

two shapes in each pair shows the level in 2012. For the case detection rate, the combined height of each pair of shapes (dark blue and brown)

shows the level in 2012 and the lower of the two shapes (dark blue) illustrates the level in 1995. For the treatment success rate (red and yellow),

the combined height of each pair shows the level in 2011 and the lower of the two shapes (red) shows the level in 1995. More information about

these indicators and progress towards global targets are provided in Chapter 2 and Chapter 3 of the Global Tuberculosis Report 2013.

Printed in France

WHO/HTM/TB/2013.11

WHO Library Cataloguing-in-Publication Data

Global tuberculosis report 2013.

1.Tuberculosis – epidemiology. 2.Tuberculosis, Pulmonary – prevention and control. 3.Tuberculosis – economics.

4.Tuberculosis, Multidrug-Resistant. 5.Annual reports. I.World Health Organization.

ISBN 978 92 4 156465 6 (NLM classication: WF 300)

iiiGLOBAL TUBERCULOSIS REPORT 2013

Contents

Abbreviations iv

Acknowledgements v

Executive summary ix

Chapter 1. Introduction 1

Chapter 2. The burden of disease caused by TB 6

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Chapter 4. Drug-resistant TB 45

Chapter 5. Diagnostics and laboratory strengthening 59

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Chapter 7. Financing 75

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Annexes

1. Methods used to estimate the global burden of disease caused by TB 99

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4. Key indicators for the world, WHO regions and individual countries 145

iv GLOBAL TUBERCULOSIS REPORT 2013

Abbreviations

ACSM Advocacy, Communication and Social

Mobilization

ACTG AIDS Clinical Trials Group

ADR adverse drug reactions

AFB acid-fast bacilli

AIDS acquired immunodeciency syndrome

ARI annual risk of infection

ART antiretroviral therapy

BCG Bacille-Calmette-Guérin

BRICS Brazil, Russian Federation, India, China,

South Africa

CDR case detection rate

CEM cohort event monitoring

CFR case fatality rate

CFU colony-forming units

CPT co-trimoxazole preventive therapy

CBC community-based care

DOTS the basic package that underpins the Stop

TB Strategy

DR-TB drug-resistant tuberculosis

DRS drug resistance surveillance

DST drug susceptibility testing

DS-TB drug-susceptible tuberculosis

DTLC District TB and Leprosy Coordinator

EBA early bactericidal activity

ECDC European Centre for Disease Prevention and

Control

ERR electronic recording and reporting

EU European Union

FDA Food and Drug Administration

FIND Foundation for Innovative New Diagnostics

GDP gross domestic product

GLC Green Light Committee

GLI Global Laboratory Initiative

GNI gross national income

HBC high-burden country

HIV human immunodeciency virus

HR Hazard ratio

ICD-10 International Classication of Diseases

(10th revision)

IDRI Infectious Disease Research Institute

IGRA interferon-gamma release assay

IPAQT Initiative for Promoting Aordable, Quality

TB Tests

IPT isoniazid preventive therapy

IRR incidence rate ratio

LED light-emitting diode

LPA line-probe assay

LTBI latent TB infection

MDG Millennium Development Goal

MDR-TB multidrug-resistant tuberculosis

MNCH maternal, newborn and child health

NAAT nucleic acid amplication test

NAP national AIDS programme

NFM new funding model

NTP national tuberculosis [control] programme

OECD Organisation for Economic Co-operation and

Development

OR Operational research

PAL Practical Approach to Lung health

PCR polymerase chain reaction

PDA personal digital assistant

PEPFAR US President’s Emergency Plan for AIDS Relief

POC point of care

PPM public–private mix

QMS quality management system

rGLC Regional Green Light Committee

RNTCP Revised National TB Control Programme

[India]

rRNA ribosomal ribonucleic acid

RR relative risk

RR-TB rifampicin-resistant tuberculosis

SD standard deviation

SITT Integrated Tuberculosis Information System

SRL supranational reference laboratory

STAG-TB Strategy and Technical Advisory Group for TB

TAG Treatment Action Group

TB tuberculosis

TB-MAC TB Modelling and Analysis Consortium

TB-TEAM Tuberculosis Technical Assistance Mechanism

TBVI Tuberculosis Vaccine Initiative

TFM transitional funding mechanism

TST tuberculin skin test

UHC universal health coverage

UN United Nations

UNAIDS Joint United Nations Programme on HIV/AIDS

UNITAID international facility for the purchase of

diagnostics and drugs for diagnosis and

treatment of HIV/AIDS, malaria and TB

USAID United States Agency for International

Development

UNPD United Nations Population Division

VR vital registration

WHO World Health Organization

XDR-TB extensively drug-resistant tuberculosis

ZN Ziehl Neelsen

vGLOBAL TUBERCULOSIS REPORT 2013

Acknowledgements

is global tuberculosis (TB) report was produced by a core

team of 15 people: Annabel Baddeley, Anna Dean, Han-

nah Monica Dias, Dennis Falzon, Katherine Floyd, Inés

Garcia, Philippe Glaziou, Tom Hiatt, Irwin Law, Christian

Lienhardt, Linh Nguyen, Charalambos Sismanidis, Hazim

Timimi, Wayne van Gemert and Matteo Zignol. e team

was led by Katherine Floyd. Overall guidance was provided

by the Director of the Global TB Programme, Mario Ravi-

glione.

e data collection forms (long and short versions)

were developed by Philippe Glaziou and Hazim Timimi,

with input from sta throughout the WHO Global TB

Programme. Hazim Timimi led and organized all aspects

of data management. Inés Garcia and Andrea Pantoja

conducted all review and follow-up of nancial data. e

review and follow-up of all other data was done by a team

of reviewers. is included Annabel Baddeley, Annemieke

Brands, Andrea Braza, Katsura Danno, Anna Dean, Han-

nah Monica Dias, Dennis Falzon, Wayne van Gemert, Soleil

Labelle, Knut Lönnroth, Linh Nguyen, Salah Ottmani,

Hazim Timimi, Fraser Wares and Matteo Zignol at WHO

headquarters; Amal Bassili from the Eastern Mediterra-

nean Regional Oce; and Suman Jain, Sai Pothapregada,

Nino Mdivani, Eliud Wandwalo and Mohammed Yassin

from the Global Fund. Data for the European Region were

collected and validated jointly by the WHO Regional Oce

for Europe and the European Centre for Disease Preven-

tion and Control (ECDC); we thank in particular Encarna

Gimenez, Vahur Hollo and Csaba Ködmön from ECDC for

providing validated data les and Andrei Dadu from the

WHO Regional Oce for Europe for his substantial con-

tribution to follow-up and validation of data for all Euro-

pean countries. Review of TB/HIV data was undertaken in

collaboration with Michel Beusenberg, Chika Hayashi, Lisa

Nelson and Michelle Williams from the WHO HIV depart-

ment. Victoria Bendaud, Josephine Dy, and Taavi Erkkola

from UNAIDS managed the process of data collection from

national AIDS programmes, provided a TB/HIV dataset

and worked closely with WHO sta to review and validate

TB/HIV data.

Philippe Glaziou and Charalambos Sismanidis prepared

estimates of TB disease burden and associated gures and

tables (Chapter 2), with support from Tom Hiatt. Particular

thanks are due to Carel Pretorius (Futures Institute), who

worked closely with Philippe Glaziou on analyses and relat-

ed estimates of TB mortality among HIV-positive people,

as well as to Dennis Falzon for coordinating a systematic

review that was used to produce estimates of mortality

related to multidrug-resistant TB (MDR-TB) and to Harish

Nair and Luciana Brondi from the University of Edinburgh

for conducting this review. Tom Hiatt prepared all gures

and tables on TB notication and treatment outcome data

(Chapter 3). Anna Dean, Dennis Falzon and Matteo Zignol

analysed data and prepared the gures and tables related to

drug-resistant TB (Chapter 4), with input from Charalam-

bos Sismanidis. Tom Hiatt and Wayne van Gemert prepared

gures and tables on laboratory strengthening and the roll-

out of new diagnostics (Chapter 5). Annabel Baddeley, Kat-

sura Danno, Tom Hiatt and Linh Nguyen analysed TB/HIV

programmatic data and prepared the associated gures and

tables (Chapter 6). Inés Garcia and Andrew Siroka analysed

nancial data, and prepared the associated gures and

tables (Chapter 7). Christian Lienhardt, Christopher Gilpin

and Karin Weyer prepared the gures on the pipelines for

new TB drugs, diagnostics and vaccines (Chapter 8), with

input from the respective Working Groups of the Stop TB

Partnership. Tom Hiatt coordinated the nalization of all

gures and tables and was the focal point for communica-

tions with the graphic designer.

e writing of the main part of the report was led by

Katherine Floyd, with contributions from Dennis Falzon,

Philippe Glaziou, Irwin Law, Ikushi Onozaki, and Charalam-

bos Sismanidis (Chapter 2); Hannah Monica Dias, Wayne

van Gemert, Haileyesus Getahun, omas Joseph, Mukund

Uplekar and Lana Tomaskovic (Chapter 3); and Inés Gar-

cia and Christian Gunneberg (Chapter 7). Chapter 4, on

drug-resistant TB, was prepared by Anna Dean, Dennis Fal-

zon and Matteo Zignol, with input from Katherine Floyd,

Philippe Glaziou and Charalambos Sismanidis. Chapter 5,

on diagnostics and laboratory strengthening, was prepared

by Wayne van Gemert, with input from Christopher Gilpin,

Fuad Mirzayev and Karin Weyer. Chapter 6 was prepared by

Annabel Baddeley, Haileyesus Getahun, Linh Nguyen and

Katherine Floyd. Chapter 8, on research and development,

was led by Christian Lienhardt, with inputs from Chris-

topher Gilpin, Karin Weyer and Katherine Floyd. Chapter

8 was carefully reviewed by the chairs and secretariats of

the Working Groups of the Stop TB Partnership. Particular

thanks are due to Michael Brennan, Uli Fruth and Jennifer

Woolley (new vaccines); Daniela Cirillo (new diagnostics);

and Barbara Laughon and Mel Spigelman (new TB drugs).

e report team is also grateful to Emily Bloss (US Centers

for Disease Control and Prevention) and Hillary Kipru-

to (WHO Country Oce, Kenya) for their contributions

to content related to strengthening of TB surveillance in

Chapter 2, including a case study of the introduction of

vi GLOBAL TUBERCULOSIS REPORT 2013

electronic recording and reporting in Kenya; to Rajendra

Yadav and Masami Fujita (WHO Country Oce, Cambodia)

for their contribution to an analysis of the integration of

TB, HIV and mother and child health services in Cambodia

(Chapter 6); and to various internal and external reviewers

for useful comments and suggestions on advanced drafts

of chapter text.

e special supplement on the “Countdown to 2015” that

accompanies the global report was prepared by Anna Dean,

Hannah Monica Dias, Katherine Floyd, Irwin Law, Mario

Raviglione, Diana Weil and Karin Weyer, with valuable

inputs from many people at global, regional and country

levels. We thank in particular Sai Pothapregada and Eliud

Wandwalo from the Global Fund, who facilitated discus-

sions with and inputs from many Fund Portfolio Managers.

Annex 1, which explains methods used to produce esti-

mates of the burden of disease caused by TB, was written

by Philippe Glaziou and Charalambos Sismanidis with

very helpful input from Carel Pretorius. We thank Colin

Mathers of the WHO Mortality and Burden of Disease team

for his careful review. e country proles that appear in

Annex 2 and the regional proles that appear in Annex 3

were prepared by Hazim Timimi. Annex 4, which contains

a wealth of global, regional and country-specic data from

the global TB database, was prepared by Tom Hiatt and

Hazim Timimi.

We thank Pamela Baillie in the Global TB Programme’s

monitoring and evaluation team for impeccable admin-

istrative support, Doris Ma Fat from the WHO Mortality

and Burden of Disease team for providing TB mortality

data extracted from the WHO Mortality Database, and

Peter Ghys, Mary Mahy and Karen Stanecki (UNAIDS) for

providing epidemiological data that were used to estimate

HIV-associated TB mortality.

e entire report was edited by Tim France (Inis Com-

munication). We thank him for his excellent work. We also

thank, as usual, Sue Hobbs for her excellent work on the

design and layout of this report. Her contribution, as in

previous years, was greatly appreciated.

e principal source of nancial support for WHO work

on global TB monitoring and evaluation is the United States

Agency for International Development (USAID), without

which it would be impossible to produce the Global Tuber-

culosis Report. Production of the report was also supported

by the governments of Japan and the Republic of Korea. We

acknowledge with gratitude their support.

In addition to the core report team and those mentioned

above, the report beneted from the input of many sta

working in WHO regional and country oces and hundreds

of people working for national TB programmes or within

national surveillance systems who contributed to the

reporting of data and to the review of report material prior

to publication. ese people are listed below, organized by

WHO region. We thank them all for their invaluable contri-

bution and collaboration, without which this report could

not have been produced.

Among the WHO sta not already mentioned above, we

thank in particular Khurshid Alam Hyder, Daniel Kibuga,

Rafael López Olarte, André Ndongosieme, Wilfred Nkhoma

and Henriette Wembanyama for their major contribution

to facilitation of data collection, validation and review.

9*1staHHinregionalandcoWntr[oHßces

WHO African Region

Harura Adamu, Boubacar Ould Abdel Aziz, Esther Aceng,

Inacio Alvarenga, Balde Amadou, Ayodele Awe, Sanni Baba-

tunde, Bazie Babou, Nayé Bah, Marie Barouan, Abera Bekele,

Norbert Bidounga, Gaël Claquin, Augusto da Cruz Claudi-

na, Peter Clement, Noel Djemadji, Ismael Hassen Endris,

Amos Omoniyi Fadare, Louisa Ganda, Boingotlo Gasen-

nelwe, Patrick Hazangwe, Joseph Imoko, Michael Jose,

Joel Kangangi, Katherine Lao, Nzuzi Katondi, Bah Keita,

Daniel Kibuga, Hillary Kipruto, Désiré Aristide Komangoya

Nzonzo, Sharmila Lareef-Jah, Frank Lule, Mwendaweli

Maboshe, Mbemba Leonard, Richard Mbumba, Julie Mug-

abekazi, André Ndongosieme, Denise Nkezimana, Wilfred

Nkhoma, Nicolas Nkiere, Ghislaine Nkone Asseko, Ishmael

Nyasulu, Laurence Nyiramasarabwe, Samuel Ogiri, Daniel

Olusoti, Amos Omoniyi, Chijioke Osakwe, Felicia Owu-

su-Antwi, Philips Patrobas, Kalpeshsinh Rahevar, Bacary

Sambou, Kefas Samson, Neema Simkoko, Desta Tiruneh,

Alexis Tougordi, Henriette Wembanyama.

WHO Region of the Americas

Monica Alonso Gonzalez, Angel Manuel Alvarez, Luis

Gerardo Castellanos, Gerardo de Cossio, Rachel Eersel,

Marcos Espinal, Ingrid García, Mirtha Del Granado, Rosa-

linda Hernández, Vidalia Lesmo, Rafael López Olarte,

Wilmer Marquiño, ais dos Santos, Alfonso Tenorio, Jorge

Victoria, Anna Volz.

WHO Eastern Mediterranean Region

Mohamed Abdel Aziz, Ali Akbar, Samiha Baghdadi, Amal

Bassili, Najwa El Emam, Hamida Khattabi, Aayid Munim,

Ghulam Nabi Kazi, Ali Reza Aloudel, Gabriele Riedner,

Karam Shah, Sindani Ireneaus Sebit, Bashir Suleiman,

Rahim Taghizadeh.

WHO European Region

Martin van den Boom, Brenda van den Bergh, Andreea

Cassandra Butu, Silvu Ciobanu, Pierpaolo de Colombani,

Andrei Dadu, Irina Danilova, Masoud Dara, Jamshid

Gadoev, Gayane Ghukasyan, Sayohat Hasanova, Arax Hov-

hannesyan, Saliya Karymbaeva, Mehmet Kontas, Kristin

Kremer, Dmitriy Pashkevich, Valiantsin Rusovich, Bog-

dana Shcherbak-Verlan, Javahir Suleymanova, Szabolcs

Szigeti, Melita Vujnovic.

WHO South-East Asia Region

Mohammad Akhtar, Vikarunnesa Begum, Erwin Coore-

man, Deki, Khurshid Alam Hyder, Navaratnasingam

Janakan, Kim Tong Hyok, La Win Maung, Jorge Luna, Par-

tha Mandal, Amaya Maw-Naing, Giampaolo Mezzabotta,

viiGLOBAL TUBERCULOSIS REPORT 2013

Bo Myint, Ye Myint, Eva Nathanson, Rajesh Pandav, Razia

Pendse, Sri Prihatini, K Rezwan, Rim Kwang Il, Hwang Kum

Ryong, Mukta Sharma, Aminath Shenalin, Achuthan Nair

Sreenivas, Chawalit Tantinimitkul, Wangchuk Lungten.

9*19GUVGTP2CEKßE4GIKQP

Shalala Ahmadova, Niño Dayanghirang, Asaua Faasino,

Salu Failauga, Ogtay Gozalov, Cornelia Hennig, Tom Hiatt,

Tauhid Islam, Narantuya Jadambaa, Ridha Jebeniani, Sung

Hye Kim, Miwako Kobayashi, Woo-Jin Lew, Katsunori

Osuga, Khanh Pham, Fabio Scano, Jacques Sebert, Cathari-

na van Weezenbeek, Rajendra Yadav, Dongbao Yu.

National respondents who contributed to

reporting and verißcation oH data

WHO African Region

Abdou-Salam Abderemane, Ouédraogo Adama, Abdelra-

him Barka Abderramane, Jean Louis Abena Foe, Soane

Alihalassa, Arlindo Amaral, Kouamé Amenan, Séverin

Anagonou, Younoussa Assoumani, Georges Bakaswa, Ada-

ma Marie Bangoura, Jorge Noel Barreto, Ballé Boubakar,

Victor Bonkoungou, Frank Adae Bonsu, Miguel Camara,

Evangelista Chisakaitwa, Ernest Cholopray, Nkemdilim

Chukwueme, Catherine Cooper, Swasilanne da Silva, B. de

Sousa Bandeira, Isaias Dambe, Davi Kokou Mawulé, Serge

Diagbouga, Aicha Diakité, Awa Helene Diop, Sicelo Dlami-

ni, emba Dlamini, addée Ndikumana, Oumou Fofana,

Susan Gacheri, Evariste Gasana, Michel Gasana, Sandile

Ginindza, Martin Gninafon, Nii Nortey Hanson-Nortey,

Adama Jallow, Saa Kamara, Madou Kane, Henry Kanyer-

ere, Nathan Kapata, Biruck Kebede, Kerram Aziza, Deogra-

tias Kibambazi, Patrick Konwuloh, Jacquemin Kouakou,

Popaul Kulonga, Rossin Lebeke, Lillian Ishengoma, Llang

Bridget Maama-Maime, Marcel Lougue, Maxime Lunga,

Ghislaine Mabeluanga Tshitenge, Jocelyn Mahoumbou,

Angelo Makpenon, David Mametja, Ivan Manhiça, Tseliso

Marata, Farai Mavhunga, Mba Bekolo Frenk José Mathieu,

Salem Salem Mohameden, Louine Morel, Youwaoga Isidore

Moyenga, James Mpunga, Frank Mugabe, Kenneth Mugi-

sha, Cliord Munyandi, Lindiwe Mvusi, Aboubacar Mzem-

baba, Ronald Ncube, Fulgence Ndayikengurukiye, Yvon

Martial Ngana, Antoine Ngoulou, Lourenço Nhocuana,

Blasdus Franz Njako, Emmanuel Nkiligi, M Nkou, Josh-

ua Obasanya, Davidson Ogunade, Hermann Ongouo,

Abdelhadi Oumar, Issoufou Ousmane, Maria Conceição

Palma, Victor Pereira, ato Raleting, Sahondra Jeanine

Randriambeloson, Rujeedawa Mohammed Fezul, Samey

Agbenyegan, Charles Sandy, Kebba D Sanneh, Marie Sarr

Diouf, Mineab Sebhatu, Mamie Shoma, Angele Shoma

Matota, René Simalo, Joseph Sitienei, Nicholas Siziba,

Philippe Takongo, Celstino Francisco Teixeira, Mohamed

Abdallahi Traoré, Nassiama Traoré, Kassim Traoré, Alie

Wurie, Eucher Dieudonné Yazipo, Ranivomahefa Myrienne

Bakoliarisoa Zanajohary, Abbas Zezai, Eric Ismaël Zoun-

grana.

WHO Region of the Americas

Christian Acosta, Shalauddin Ahmed, Valentina Antonie-

ta Alarcon Guizado, Xochil Alemán de Cruz, Kiran kumar

Alla, Valeria Almanza Torrez, Mirian Alvarez, Raúl Álva-

rez, Aisha Andrewin, A. Alister Antoine, Chris Archibald,

Carlos Alberto Marcos Ayala Luna, Wiedjaiprekash Bale-

sar, Draurio Barreira, Patricia Bartholomay, Soledad Bel-

trame, María del Carmen Bermúdez, Lynrod Brooks, Marta

Calona de Abrego, Martín Castellanos Joya, Jorge Castillo

Carbajal, Kenneth Castro, Judith Cazares, Gemma Chery,

Carlos Cuadra, Ofelia Cuevas, D’Auvergne Cleophas, Jose

Davy, Cecilia de Arango, Eva de Weever-Lista, Camille Dele-

veaux, Dy-Juan De Roza, Roger Duncan, España Cedeño

Mercedes, Manuel Salvador España Rueda, Fernandez

Hugo, Cecilia Figueroa Benites, Victor Gallant, Julio Garay

Ramos, Sarita Aguirre García, Izzy Gerstenbluth, Margar-

ita Godoy, Roscio Gómez, Ilse Maria Góngora Rivas, Sil-

vino González, Yaskara Halabi, Kevin Harvey, Dorothea

Hazel, Maria Henry, Tania Herrera, Carla Jeries, Dihad-

enys Lemus Molina, Athelene Linton, Maria Josefa Llanes

Cordero, Marvin Andres Maldonado Rivera, Maldonado

Saavedra Andrea, Marcelino Belkys, Eva Martìnez, María

de Lourdes Martínez Olivares, Zeidy Mata Azofeifa, Joan

McLeod-Simon, Timothy McLaughlin-Munroe, Roque

Miramontes, Leilawatie Mohammed, Jeetendra Mohanlall,

Ernesto Moreno, Francis Morey, Willy Morose, Michael

Owen, Cheryl Peek-Ball, Janelle Pickering, Tomasa Por-

tillo, Irad Potter, Manohar Singh Rajamanickam, Dottin

Ramoutar, Anna Esther Reyes Godoy, Paul Ricketts, Jorge

Rodriguez De Marco, Myrian Román, Nilda de Romero,

Carolyn Russell, Wilmer Salazar, Deborah Stijnberg, Sutton

Jackurlyn, Torres Clarita, Maribelle Tromp, William Turn-

er, Melissa Valdez, Daniel Vázquez, Nestor Vera, Michael

Williams, David Yost, Oritta Zachariah.

WHO Eastern Mediterranean Region

Fadhil Abbas, Mohammad S Abouzeid, Khaled Abu Ruh-

man, Nadia Abu Sabra, Ahmadi Shahnaz, Mohamed Redha

Al Lawati, Al Saidi Fatmah, Samia Ali Alagab, Abdelbary

Abdullah Ahmed Al-Hammadi, Abdullatif Al-Khal, Saeed

Al Saar, Kifah Alshaqeldi, Bahnasy Samir, Bennani Ken-

za, Kinaz Cheikh, Walid Daoud, Mohamed Furjani, Amal

Galal, Dhikrayet Gamara, Assia Haissama Mohamed, Hiba

Kamal Hamad Elneel, Kaalthoom Hassan, Hawa Hassan

Guessod, Lou Joseph, Onwar Otien Jwodh Chol, Basharat

Khan, Joseph Lasu, Sayed Daoud Mahmoodi, Khadi-

ga Adam Mohammed, Mokhtar Alaa, Mulham Mustafa,

Nasehi Mahshid, Ejaz Qadeer, Mohammad Khalid Seddiq,

Sghiar Mohammed, Mohemmed Tabena, Tamara Tayeb,

Najib Abdul aziz Abdullah abit, Seddik Walha, Yaacoub

Hiam.

WHO European Region

Abildaev Tleukhan Shildebaevich, Mokhonim Abdulloeva,

Ibrahim Abubakar, Rag Abuzarov, Nurhan Albayrak,

Natavan Alikhanova, Avtandil Alisherov, Ewa Augustynowicz-

viii GLOBAL TUBERCULOSIS REPORT 2013

Kopeć, Ekkehardt Altpeter, Laura Anderson, Delphine

Antoine, Trude Margrete Arnesen, Rusudan Aspindzelash-

vili, Andrei Astrovko, Elizabeta Bachiyska, Anna Ivanovna

Barbova, Yana Besstraschnova, Venera Lazarevna Bismil-

da, Oktam Ikramovich Bobokhojaev, Olivera Bojovic, Eric

C. Böttger, Bonita Brodhun, Noa Cedar, Daniel Chemtob,

Domnica Ioana Chiotan, Ana Ciobanu, Nico Cioran, Andra

Cirule, ierry Comolet, Radmila Curcic, Manfred Danilo-

vitš, Edita Davidaviciene, Hayk Davtyan, Pava Dimitrijevic,

António Diniz, Francis Drobniewski, Raquel Duarte, Mlad-

en Duronjic, Connie Erkens, Jennifer Fernandez Garcia,

Lyalya Gabbasova, Viktor Gasimov, Lárus Jón Guðmunds-

son, Gennady Gurevich, Walter Haas, Hasan Hazi, Evg-

eny Hanyukov, Armen Hayrapetyan, Peter Helbling, Sven

Honer, Daniela Homorodean, Jahongir Jurakhonovich

Ismoilov, Mamuka Japaridze, Vincent Jarlier, Soledad

Jiménez Pajares, Jerker Jonsson, Abdullat Kadyrov, Gul-

mira Kalmambetova, Dmitry Klymuk, Maria Korzeniewska-

Kosela, Ainura Koshoeva, Košnik Mitja, Gabor Kovacs,

Tiina Kummik, Nino Lomtadze, Stevan Lučić, Jasminka

Maglajllic, Turid Mannsåker, Mathys Vanessa, Rafail Meh-

diyev, Rukije Mehmeti, Donika Mema, Vladimir Milanov,

Alvard Mirzoyan, Gjyle Mulliqi, Gulnora Murmusaeva,

Seher Musaonbasioglu, Ucha Nanava, Zdenka Novakova,

Joan O’Donnell, Analita Pace Asciak, Clara Palma Jordana,

Elena Pavlenko, Olga Pavlova, Monique Perrin, Edita Pim-

kina, Monika Polanova, Georgeta Gilda Popescu, Gordana

Radosavljevic Asic, Bozidarka Rakocevic, omas Rendal,

Vija Riekstina, Jerome Robert, Elena Rodríguez Valín, Tom

Rogers, Elena Romancenco, Kazimierz Roszkowski-Sliz,

Sabine Rüsch-Gerdes, Branislava Savic, Gérard Scheiden,

Hasia Kaidar Shwartz, Anabela Silva, Girts Skenders, Cath-

rine Slorbak, Erika Slump, Hanna Soini, Ivan Solovic, Dick

van Soolingen, Flemming Stenz, Sergey Sterlikov, Jana

Svecova, Svetina Šorli Petra, Silva Tafaj, Talevski Stefan,

Odorina Tello Anchuela, Mirzagaleb Tillyashaykhov, Aida

Ustamujic, Gulnoz Uzakova, Tonka Varleva, Piret Viiklepp,

Cveta Vragoterova, Gerard de Vries, Jiri Wallenfels, Wan-

lin Maryse, Pierre Weicherding, Aysegul Yildirim, Zakoska

Maja, Oksana Zalutskaya, Ilona Zemanová, Manca Žolnir

Dovč, Hasan Zutic.

WHO South-East Asia Region

Shina Ahmed, Aminath Aroosha, Choe Kum Song,

Emdadul Hoque, RS Gupta, Sirinapha Jittimanee, Suksont

Jittimanee, Niraj Kulshrestha, Constantino Lopes, an-

dar Lwin, Dyah Erti Mustikawati, Tin Zar Naing, Chawet-

san Namwat, Md Nuruzzaman Haque, Nirupa Pallewatta,

Rajendra Prasad Pant, Kiran Rade, Dyah Armi Riana, Che-

wang Rinzin, Sudath Samaraweera, Gamini Senevirathne,

Janaka ilakarathne, Sabino Viegas, Bimal Kumar Yadav.

9*19GUVGTP2CEKßE4GIKQP

Paul Aia, Cecilia Teresa T. Arciaga, Nemia Bainivalu, Chris-

tina Bareja, Risa J. Bukbuk, Cheng Shiming, Phonenaly

Chittamany, Chou Kuok Hei, Nese Ituaso Conway, Du

Xin, Mayleen J. Ekiek, Fanai Saen, Rangiau Fariu, Ludovic

Floury, Louise Fonua, Jiloris Frederick Dony, Anna Marie

Celina Garn, Go Un-Yeong, Shakti Gounder, Anie Hary-

ani Hj Abdul Rahman, Noel Itogo, Tom Jack, Seiya Kato,

Khin Mar Kyi Win, Lamar Daniel, Leo Lim, Liza Lopez,

Sakiusa Mainawalala, Henri-Pierre Mallet, Tan Eang Mao,

Markleen Tagaro, Sera Moa, Suzana Mohd Hashim, Nguy-

en Binh Hoa, Nguyen Viet Nhung, Nou Chanly, Ochirbat

Batbayar, Connie Bieb Olikong, Park Yoon-Sung, Nukutau

Pokura, Waimanu Pulu, Purev Nasanjargal, Rabauliman

Marcelina, Bereka Reiher, Bernard Rouchon, Temilo Seono,

Tokuaki Shobayashi, Vita A. Skilling, Grant Storey, Phan-

nasinh Sylavanh, Kenneth Reuee Tabutoa, Tam Cheuk

Ming, Kyaw u, Tieng Sivanna, Tong Ka Io, Rosalind Vian-

zon, Wang Yee Tang, Wang Lixia.

ixGLOBAL TUBERCULOSIS REPORT 2013

Executive summary

Tuberculosis (TB) remains a major global health problem.

In 2012, an estimated 8.6 million people developed TB and

1.3 million died from the disease (including 320000 deaths

among HIV-positive people).1 e number of TB deaths is

unacceptably large given that most are preventable.

Nearly 20 years after the WHO declaration of TB as a

global public health emergency, major progress has been

made towards 2015 global targets set within the context

of the Millennium Development Goals (MDGs). Two years

ahead of the deadline, the Global Tuberculosis Report 2013

and accompanying supplement Countdown to 2015 assess

progress towards the 2015 targets and the top priority

actions needed to achieve and/or move beyond them.

C17N6&19N 61  key ßndings

On track:

e rate of new TB cases has been falling worldwide for

about a decade, achieving the MDG global target. TB

incidence rates are also falling in all six WHO regions.

e rate of decline (2% per year) remains slow.

Globally by 2012, the TB mortality rate had been reduced

by 45% since 1990. e target to reduce deaths by 50%

by 2015 is within reach.

Two WHO regions have already achieved the 2015 tar-

gets for reduced incidence, prevalence and mortality: the

Region of the Americas and the Western Pacic Region.

Of the 22 high TB burden countries (HBCs) that account

for about 80% of the world’s TB cases,2 seven have met

all 2015 targets for reductions in TB incidence, preva-

lence and mortality. Four more HBCs are on track to do

so by 2015.

Off track:

By 2012, the level of active TB disease in the community

(prevalence) had fallen by 37% globally since 1990. e

target of a 50% reduction by 2015 is not expected to be

achieved.

e African and European regions are currently not on

track to achieve the mortality and prevalence targets.

Among the 22 HBCs, 11 are not on track to reduce inci-

dence, prevalence and mortality in line with targets.

Reasons include resource constraints, conict and insta-

bility, and generalized HIV epidemics.

Progress towards targets for diagnosis and treatment

of multidrug-resistant TB (MDR-TB) is far o-track.

Worldwide and in most countries with a high burden of

MDR-TB, less than 25% of the people estimated to have

MDR-TB were detected in 2012.

Many countries have made considerable progress to

address the TB/HIV co-epidemic. However, global-

level targets for HIV testing among TB patients and

provision of antiretroviral therapy (ART) to those who

are HIV-positive have not been reached.

Five priority actions required to accelerate progress

towards 2015 targets:

1. Reach the missed cases. About 3 million people who

developed TB in 2012 were missed by national notica-

tion systems. Key actions needed to detect people with

the illness and ensure that that they get the right treat-

ment and care include: expanded services (including

rapid tests) throughout health systems bolstered by the

support of nongovernmental organizations, community

workers and volunteers to diagnosis and report cases;

intensied collaboration with public hospitals and pri-

vate health facilities who are treating patients but not

reporting; instituting mandatory notication of cases in

more countries; and better data compilation.

2. Address MDR-TB as a public health crisis. In high

MDR-TB burden countries, increased capacity to diagnose

MDR-TB must be matched with supplies of quality drugs

and scaled-up country capacity to deliver eective treat-

ment and care. is will require high-level political will

and leadership and more collaboration among partners,

including drug regulatory authorities, donor and techni-

cal agencies, civil society and the pharmaceutical industry.

3. Accelerate the response to TB/HIV. e top prior-

ity is to increase coverage of ART for HIV-positive TB

patients towards the 100% target. Expanded coverage of

TB preventive treatment among people living with HIV

is the second priority.

4. Increase nancing to close all resource gaps. An

estimated US$7–8 billion per year is required for a full

response to the TB epidemic in low- and middle-income

countries in 2014 and 2015 (excluding research and

development for new TB diagnostics, drugs and vac-

cines). Funding in 2013 is about US$6 billion. Increas-

es in both domestic and donor nancing are needed to

close the gap of up to US$ 2 billion per year, including

via the full replenishment of the Global Fund in 2013.

Progress remains fragile and could be reversed without

adequate funding.

5. Ensure rapid uptake of innovations. e fast uptake

of new tools and strategies for better diagnosis, treat-

ment and prevention of all forms of TB can be accelerated

by country-specic operational research and translation

of ndings into policy and practice.

xGLOBAL TUBERCULOSIS REPORT 2013

ADDITIONAL FINDINGS

e report is based primarily on data provided by WHO’s

Member States. In 2013, data were reported by 178 Mem-

ber States and a total of 197 countries and territories that

collectively have more than 99% of the world’s TB cases.

Burden of disease

e current global picture of TB shows continued

progress, but not fast enough.

An estimated 1.1 million (13%) of the 8.6 million peo-

ple who developed TB in 2012 were HIV-positive. About

75% of these cases were in the African Region.

Globally in 2012, an estimated 450 000 people devel-

oped MDR-TB and there were an estimated 170 000

deaths from MDR-TB .

Most TB cases and deaths occur among men, but TB

remains among the top three killers of women world-

wide. ere were an estimated 410 000 TB deaths among

women in 2012, including 160 000 among HIV-positive

women. Half of the HIV-positive people who died from

TB in 2012 were women. Of the estimated 8.6 million new

TB cases worldwide in 2012, 2.9 million were women.

ere were an estimated 530 000 TB cases among

children (under 15 years of age) and 74000 TB deaths

(among HIV-negative children) in 2012 (6% and 8% of

the global totals, respectively).

e majority of cases worldwide in 2012 were in the

South-East Asia (29%), African (27%) and Western Pacif-

ic (19%) regions. India and China alone accounted for

26% and 12% of total cases, respectively.

e TB incidence rate at country level ranges substan-

tially, with around 1000 or more cases per 100 000 peo-

ple in South Africa and Swaziland, and fewer than 10

per 100000 population in parts of the Americas, several

countries in western Europe, Japan, Australia and New

Zealand.

TB detection and treatment outcomes

Millions of people access eective TB care each year

but “missed cases” hold back gains.

Between 1995 and 2012, 56 million people were success-

fully treated for TB in countries that had adopted WHO’s

global TB strategy, saving 22 million lives.

In 2012, 6.1 million cases of TB were notied to national

TB programmes (NTPs). Of these, 5.7 million were peo-

ple newly diagnosed in 2012 and 0.4 million were previ-

ously diagnosed TB patients whose treatment regimen

was changed.

In 2011, the treatment success rate continued to be high

at 87% among all new TB cases.

Notications of TB cases have stabilized globally. In

2012, about 66% (5.7 million) of the estimated 8.6 mil-

lion people who developed TB were notied as newly

diagnosed cases.

About 75% of the estimated 2.9 million missed cases

– people who were either not diagnosed or diagnosed but

not reported to NTPs – were in 12 countries. In order of

total numbers, these were India (31% of the global total),

South Africa, Bangladesh, Pakistan, Indonesia, China,

Democratic Republic of the Congo, Mozambique, Nige-

ria, Ethiopia, the Philippines and Myanmar.

Xpert® MTB/RIF, a rapid molecular diagnostic test,

is being rapidly adopted by countries to detect TB and

rifampicin-resistant TB. By end June 2013, 1402 testing

machines and 3.2 million test cartridges had been pro-

cured by 88 of the 145 countries eligible for concessional

prices.

Treatment success rates for TB remain lowest in the

European Region, where in 2011 only 72% of new cases

were successfully treated.

MDR-TB and XDR-TB detection and treatment outcomes

Undetected cases and treatment coverage gaps con-

stitute a public health crisis.

Globally in 2012, data from drug resistance surveys and

continuous surveillance among notied TB cases sug-

gest that 3.6% of newly diagnosed TB cases and 20% of

those previously treated for TB had MDR-TB. e high-

est levels of MDR-TB are found in eastern Europe and

central Asia, where in some countries more than 20%

of new TB cases and more than 50% of those previously

treated for TB have MDR-TB.

A total of 94000 TB patients eligible for MDR-TB treat-

ment were detected in 2012: 84000 people with con-

rmed MDR-TB (i.e. resistance to both rifampicin, the

most powerful TB drug, and isoniazid), plus 10 000

with rifampicin resistance detected using Xpert MTB/

RIF. is was a 42% increase in detected cases eligible

for treatment compared with 2011. e largest increases

between 2011 and 2012 were in India, South Africa and

Ukraine.

Just over 77000 people with MDR-TB were started on

second-line treatment in 2012, equivalent to 82% of

the 94 000 newly detected cases that were eligible for

treatment globally. Treatment coverage gaps for detect-

ed cases were much larger in some countries, especially

in the African Region (51% enrolled in treatment), and

widened in China, Pakistan and South Africa.

At least one case of extensively drug-resistant TB (XDR-

TB) had been reported by 92 countries by the end of

2012. On average, an estimated 9.6% of MDR-TB cases

have XDR-TB.

Globally, only 48% of MDR-TB patients in the 2010

cohort of detected cases were successfully treated,

reecting high mortality rates and loss to follow-up. A

treatment success rate of 75% or more for patients with

MDR-TB was achieved in 34 of 107 countries.

xiGLOBAL TUBERCULOSIS REPORT 2013

Addressing TB-HIV

TB-HIV collaborative services are expanding, but

global targets are not yet in sight.

e main interventions to reduce the burden of HIV in

TB patients are HIV testing and provision of ART and

cotrimoxazole preventive therapy (CPT) to those found

to be HIV-positive. e main interventions to reduce TB

among people living with HIV are regular screening for

TB among people in HIV care and provision of isoniazid

preventive therapy (IPT) to those without active TB who

meet eligibility criteria (estimated at 50% of those newly

enrolled in HIV care).

Progress in the implementation of TB/HIV interven-

tions was further consolidated in 2012. Globally, 46%

of TB patients knew their HIV status (up from 40% in

2011). In the African Region that has the highest TB/

HIV burden, 74% of TB patients knew their HIV status

(up from 69% in 2011). Among the 41 countries with the

highest TB/HIV burden, more than 85% of TB patients

knew their HIV status in 15 countries, and in 7 of these

countries over 90% of patients knew their HIV status.

e coverage of ART among TB patients who were

known to be HIV-positive reached 57% in 2012, up from

49% in 2011. As in the past few years, about 80% of HIV-

positive TB patients were treated with CPT.

In 2012, 4.1 million people enrolled in HIV care were

reported to have been screened for TB, up from 3.5 mil-

lion in 2011. Of the reported 1.6 million people newly

enrolled in HIV care in 2012, 0.5 million (31%) were

provided with IPT.

6$ßPCPEKPI

International donor funding and more domestic

investments are essential.

Of the US$ 7‒8 billion per year required in low and

middle-income countries in 2014 and 2015, about two

thirds is needed for the detection and treatment of drug-

susceptible TB, 20% for treatment of MDR-TB, 10%

for rapid diagnostic tests and associated laboratory

strengthening, and 5% for collaborative TB/HIV activ-

ities.

Growth in domestic and international donor funding

has been clearly documented since 2002. ere is capac-

ity to further increase domestic funding, especially in

BRICS (Brazil, the Russian Federation, India, China and

South Africa) that have almost 50% of global TB cases.

International donor funding reported by NTPs amount-

ed to US$ 0.8 billion in 2013, about three-quarters of

which was from the Global Fund. To close resource gaps,

at least US$1.6 billion is needed in both 2014 and 2015.

International donor funding is crucial in many coun-

tries, accounting for more than 50% of total funding in

the group of 17 HBCs excluding BRICS, and in all low-

income countries. e proportion is even higher in some

individual countries.

Research and development

New TB diagnostics, medicines and vaccines are cru-

cial to end the global TB epidemic.

More than 50 companies are involved in development of

new diagnostic tests.

10 new or repurposed TB drugs are in late phases of clin-

ical development. In late 2012, bedaquiline became the

rst novel TB drug approved in 40 years. In June 2013,

WHO issued interim guidance for its use in treatment

of MDR-TB.

ere are 10 vaccines for TB prevention and two immu-

notherapeutic vaccines in the pipeline. In early 2013,

results from a Phase IIb proof-of-concept study of one of

the preventive vaccine candidates were published. While

ecacy was not superior to the Bacille-Calmette-Guérin

(BCG) vaccine alone, the study demonstrated that a

trial of a novel TB vaccine is feasible in a high TB burden

setting.

Short, eective and well-tolerated treatments for latent

TB infection, a point-of-care diagnostic test, and an

eective post-exposure vaccine are needed to help end

the global TB epidemic.

1 e estimated number of TB deaths among HIV-positive people

in 2011 was 336000. Estimates of TB deaths among HIV-positive

people for the entire period 1990‒2012 were updated in 2013 using

the Spectrum software, which has been used for more than a decade

to produce estimates of the burden of disease caused by HIV. In

2013, a TB module in Spectrum was available for the rst time for

use in the country consultations on HIV burden estimates that are

organized by UNAIDS every two years. Estimation of the number

of TB cases living with HIV, and of the number of TB deaths among

HIV-positive people, was integrated into this process.

2 e 22 HBCs are Afghanistan, Bangladesh, Brazil, Cambodia,

China, the Democratic Republic of the Congo, Ethiopia, India,

Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, the

Philippines, the Russian Federation, South Africa, ailand, Ugan-

da, the United Republic of Tanzania, Viet Nam and Zimbabwe.

1GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

Introduction

Tuberculosis (TB) remains a major global health problem.

It causes ill-health among millions of people each year and

ranks as the second leading cause of death from an infec-

tious disease worldwide, after the human immunode-

ciency virus (HIV). e latest estimates included in this

report are that there were 8.6 million new TB cases in 2012

and 1.3 million TB deaths (just under 1.0 million among

HIV-negative people and 0.3 million HIV-associated TB

deaths). Most of these TB cases and deaths occur among

men, but the burden of disease among women is also high.

In 2012, there were an estimated 2.9 million cases and

410 000 TB deaths among women, as well as an estimat-

ed 530 000 cases and 74 000 deaths among children.1 e

number of TB deaths is unacceptably large given that most

are preventable if people can access health care for a diag-

nosis and the right treatment is provided. Short-course reg-

imens of rst-line drugs that can cure around 90% of cases

have been available for decades.

ese large numbers of cases and deaths notwithstand-

ing, 20 years on from the 1993 World Health Organization

(WHO) declaration of TB as a global public health emergen-

cy, major progress has been made. Globally, the TB mortal-

ity rate (deaths per 100 000 population per year) has fallen

by 45% since 1990 and TB incidence rates (new cases per

100 000 population per year) are falling in most parts of

the world. In the 18 years since the launch of a new inter-

national strategy for TB care and control by WHO in the

mid-1990s (the DOTS strategy) and the subsequent global

rollout of DOTS and its successor (the Stop TB Strategy,2

Box 1.2), a cumulative total of 56 million people were suc-

cessfully treated for TB between 1995 and 2012, saving

approximately 22 million lives.

e overarching goal of the Stop TB Strategy is to achieve

2015 global targets (shown in Box 1.2) for reductions in

the burden of disease caused by TB. e target set within

the United Nations (UN) Millennium Development Goals

(MDGs) is that TB incidence should be falling by 2015

(MDG Target 6.c). Besides incidence, four other TB indi-

cators are included in the MDG monitoring framework:

the prevalence rate, the mortality rate, the case detection

rate (the number of notied cases divided by the estimated

number of incident cases in the same year, expressed as a

percentage), and the treatment success rate (the percentage

BOX 1.1

Basic facts about TB

TB is an infectious disease caused by the bacillus

Mycobacterium tuberculosis. It typically affects the

lungs (pulmonary TB) but can affect other sites as well

(extrapulmonary TB). The disease is spread in the air when

people who are sick with pulmonary TB expel bacteria,

for example by coughing. In general, a relatively small

proportion of people infected with M. tuberculosis will

develop TB disease; however, the probability of developing

TB is much higher among people infected with HIV. TB is

also more common among men than women, and affects

mostly adults in the economically productive age groups.

The most common method for diagnosing TB worldwide

is sputum smear microscopy (developed more than 100

years ago), in which bacteria are observed in sputum

samples examined under a microscope. Following recent

breakthroughs in TB diagnostics, the use of rapid molecular

tests for the diagnosis of TB and drug-resistant TB is

increasing, as highlighted in Chapter 5 and Chapter 8

of this report. In countries with more developed laboratory

capacity, cases of TB are also diagnosed via culture methods

(the current reference standard).

Without treatment, TB mortality rates are high. In studies

of the natural history of the disease among sputum smear-

positive/HIV-negative cases of pulmonary TB, around 70%

died within 10 years; among culture-positive (but smear-

negative) cases, 20% died within 10 years.a

'HHGEVKXGFTWIVTGCVOGPVUYGTGßTUVFGXGNQRGFKPVJG

U6JGOQUVGHHGEVKXGßTUVNKPGCPVK6$FTWITKHCORKEKP

became available in the 1960s. The currently recommended

treatment for new cases of drug-susceptible TB is a six-

OQPVJTGIKOGPQHHQWTßTUVNKPGFTWIUKUQPKC\KFTKHCORKEKP

GVJCODWVQNCPFR[TC\KPCOKFG6TGCVOGPVUWEEGUUTCVGUQH

QTOQTGHQTPGYECUGUCTGTGIWNCTN[TGRQTVGFVQ9*1

by Member States (Chapter 3). Treatment for multidrug-

TGUKUVCPV6$/&46$FGßPGFCUTGUKUVCPEGVQKUQPKC\KFCPF

rifampicin (the two most powerful anti-TB drugs) is longer,

and requires more expensive and more toxic drugs. For most

RCVKGPVUYKVJ/&46$VJGEWTTGPVTGIKOGPUTGEQOOGPFGF

by WHO last 20 months, and treatment success rates are

much lower (Chapter 4(QTVJGßTUVVKOGKPHQWTFGECFGU

new TB drugs are starting to emerge from the pipeline and

combination regimens that include new compounds are

being tested in clinical trials, as discussed in Chapter 8.

There are several TB vaccines in Phase I or Phase II trials

(Chapter 8). For the time being, however, a vaccine that is

effective in preventing TB in adults remains elusive.

a 6KGOGTUOC'9GVCN0CVWTCNJKUVQT[QHVWDGTEWNQUKUFWTCVKQPCPF

HCVCNKV[QHWPVTGCVGFRWNOQPCT[VWDGTEWNQUKUKP*+8PGICVKXGRCVKGPVU

A systematic review. PLoS ONEG

1 e estimated number of deaths among children excludes TB

deaths in HIV-positive children, for which estimates are not yet

available. Further details are provided in Chapter 2.

2 Raviglione M, Uplekar M. WHO’s new Stop TB strategy. e Lancet,

2006, 367: 952–5.

2GLOBAL TUBERCULOSIS REPORT 2013

BOX 1.2

The Stop TB Strategy at a glance

THE STOP TB STRATEGY

VISION A TB-free world

GOAL To dramatically reduce the global burden of TB by 2015 in line with the Millennium Development Goals

(MDGs) and the Stop TB Partnership targets

OBJECTIVES ■ Achieve universal access to high-quality care for all people with TB

■ 4GFWEGVJGJWOCPUWHHGTKPICPFUQEKQGEQPQOKEDWTFGPCUUQEKCVGFYKVJ6$

■ Protect vulnerable populations from TB, TB/HIV and drug-resistant TB

■ Support development of new tools and enable their timely and effective use

■ Protect and promote human rights in TB prevention, care and control

TARGETS ■ /&)6CTIGVE*CNVCPFDGIKPVQTGXGTUGVJGKPEKFGPEGQH6$D[

■ 6CTIGVUNKPMGFVQVJG/&)UCPFGPFQTUGFD[VJG5VQR6$2CTVPGTUJKR

¿TGFWEGRTGXCNGPEGQHCPFFGCVJUFWGVQ6$D[EQORCTGFYKVJCDCUGNKPGQH

¿GNKOKPCVG6$CUCRWDNKEJGCNVJRTQDNGOFGßPGFCUECUGRGTOKNNKQPRQRWNCVKQPRGT[GCT

COMPONENTS

1. Pursue high-quality DOTS expansion and enhancement

C 5GEWTGRQNKVKECNEQOOKVOGPVYKVJCFGSWCVGCPFUWUVCKPGFßPCPEKPI

b. Ensure early case detection, and diagnosis through quality-assured bacteriology

E 2TQXKFGUVCPFCTFK\GFVTGCVOGPVYKVJUWRGTXKUKQPCPFRCVKGPVUWRRQTV

d. Ensure effective drug supply and management

e. Monitor and evaluate performance and impact

2. Address TB/HIV, MDR-TB, and the needs of poor and vulnerable populations

a. Scale up collaborative TB/HIV activities

D 5ECNGWRRTGXGPVKQPCPFOCPCIGOGPVQH/&46$

c. Address the needs of TB contacts, and of poor and vulnerable populations

3. Contribute to health system strengthening based on primary health care

C *GNRKORTQXGJGCNVJRQNKEKGUJWOCPTGUQWTEGFGXGNQROGPVßPCPEKPIUWRRNKGUUGTXKEGFGNKXGT[CPFKPHQTOCVKQP

b. Strengthen infection control in health services, other congregate settings and households

c. Upgrade laboratory networks, and implement the Practical Approach to Lung Health

F #FCRVUWEEGUUHWNCRRTQCEJGUHTQOQVJGTßGNFUCPFUGEVQTUCPFHQUVGTCEVKQPQPVJGUQEKCNFGVGTOKPCPVUQHJGCNVJ

4. Engage all care providers

a. Involve all public, voluntary, corporate and private providers through public–private mix approaches

b. Promote use of the International Standards for Tuberculosis Care

5. Empower people with TB, and communities through partnership

C 2WTUWGCFXQECE[EQOOWPKECVKQPCPFUQEKCNOQDKNK\CVKQP

b. Foster community participation in TB care, prevention and health promotion

c. Promote use of the Patients’ Charter for Tuberculosis Care

6. Enable and promote research

a. Conduct programme-based operational research

b. Advocate for and participate in research to develop new diagnostics, drugs and vaccines

GLOBAL TUBERCULOSIS REPORT 2013

of TB patients who are successfully treated).  e Stop TB

Partnership adopted the MDG target and in addition set

global targets to halve TB prevalence and death rates by

2015 compared with their levels in 1990.  e scale at which

interventions included in the Stop TB Strategy need to be

implemented to achieve the 2015 targets for reductions in

disease burden, and the associated funding requirements,

have been described in Global Plans developed by the Stop

TB Partnership.  e latest plan covers the period 2011–

2015 and has a price tag of US$47 billion.1

As the MDG target year of 2015 approaches, work on a

post-2015 development framework is assuming increasing

prominence. In June 2013, a high-level panel established

by the UN Secretary General to provide recommendations

about the content of a post-2015 development framework,

including possible goals and targets, submitted its report.2

One of the twelve proposed goals for 2030 is to “Ensure

healthy lives”, under which a suggested target is to “Reduce

the burden of disease from HIV/AIDS, TB, malaria, neglect-

ed tropical diseases and priority noncommunicable diseas-

es”. Important themes within the report are building on

the MDGs and equity, and for health speci cally the impor-

tance of steady progress towards universal health coverage

(UHC) is highlighted.

In line with the development of a post-2015 develop-

ment framework and in response to a request from Member

States, WHO began the process of developing a post-2015

global TB strategy in 2012. Following a series of consulta-

tions between June 2012 and July 2013, the draft strategy

includes the goal of ending the global TB epidemic by 2035,

with corresponding global targets for major reductions

in TB cases and deaths by 2035 and milestones for 2020,

2025 and 2030. Achieving the proposed targets is based on

three strategic pillars: integrated, patient-centred TB care

1 The Global Plan to Stop TB, 2011–2015. Geneva, World Health

Organization, 2010 (WHO/HTM/STB/2010.2). Available at

http://www.stoptb.org/assets/documents/global/plan/TB_

GlobalPlanToStopTB2011-2015.pdf

2 http://www.un.org/sg/management/beyond2015.shtml

and prevention; bold policies and supportive systems; and

intensi ed research and innovation. It is anticipated that

the strategy will be reviewed by the WHO Executive Board

in January 2014 and discussed at the World Health Assem-

bly in May 2014.

In the context of global TB strategies and targets, WHO

has published a global TB report every year since 1997

(Figure 1.1).  e main aim of the report is to provide a

comprehensive and up-to-date assessment of the TB epi-

demic and progress in prevention, diagnosis and treatment

of the disease at global, regional and country levels, based

primarily on data that are reported by countries and terri-

tories to WHO in annual rounds of global TB data collec-

tion (Box 1.3).  is 2013 global TB report is the eighteenth

in the series of annual reports, and uses data reported by a

total of 197 countries and territories including 178 Member

States that account for over 99% of the world’s estimated

cases of TB (Table 1.1). With just over two years remaining

before the end of 2015, a special feature of this 2013 global

report is that it is accompanied by a supplement focused on

the ‘Countdown to 2015’ (Box 1.4).

 e main part of the report contains seven major chap-

ters. Each chapter is intended to stand alone, but links to

other chapters are highlighted where appropriate.

Chapter 2 contains the latest estimates of the burden of

disease caused by TB and assessment of progress towards

the 2015 targets at global, regional and country levels. Esti-

mates for women and children speci cally are given par-

ticular attention. Following new analytical and modelling

work in 2013, the chapter also contains new estimates of

the number of cases of and deaths from MDR-TB and of

HIV-related TB mortality.  e latest status of e orts to

improve measurement of TB cases and deaths at country

level, with guidance and support from the WHO Global

Task Force on TB Impact Measurement, is described.

Chapter 3 presents data on the numbers of cases noti-

 ed to NTPs and reported to WHO and their treatment

outcomes, including breakdowns of TB cases by type, sex

and age. Recent progress in increasing the reporting of

cases by private sector providers through engagement of

FIGURE 1.1

Seventeen annual WHO global TB reports, 1997–2012

1997: First report:

epidemiology and

surveillance

2002: Added ﬁ nancing and

strategy for 22 high-burden

countries (HBCs)

July 2009: Online data collection introduced

December 2009: Short update to 2009 report in transition

to earlier reporting of data and report publication

2003: Financing

and strategy

(all countries)

1310_0237_PM_003.indd 31310_0237_PM_003.indd 3 28/10/13 13:1528/10/13 13:15

4GLOBAL TUBERCULOSIS REPORT 2013

large hospitals in ve countries, the contribution of com-

munity health workers and volunteers to the referral of TB

cases and treatment support in 13 countries, and strikingly

high notication rates in prisons in parts of the European

Region, are highlighted.

Chapter 4 focuses on drug-resistant TB. e rst part

of the chapter covers progress in drug resistance surveil-

lance and associated estimates of the absolute number and

proportion of TB patients that have MDR-TB and exten-

sively drug-resistant TB (XDR-TB). e second part of the

chapter presents and discusses the latest data on the pro-

BOX 1.3

Data collected in the 2013 round of global TB data collection

&CVCYGTGTGSWGUVGFQPVJGHQNNQYKPIVQRKEU6$ECUGPQVKßECVKQPUCPFVTGCVOGPVQWVEQOGUKPENWFKPIDTGCMFQYPUD[6$ECUG

type, age, sex and HIV status; an overview of services for the diagnosis and treatment of TB; laboratory diagnostic services;

drug management; monitoring and evaluation; surveillance and surveys of drug-resistant TB; management of drug-resistant TB;

collaborative TB/HIV activities; TB infection control; engagement of all care providers in TB control; the budgets of national TB

EQPVTQNRTQITCOOGU062UKPCPFWVKNK\CVKQPQHIGPGTCNJGCNVJUGTXKEGUJQURKVCNK\CVKQPCPFQWVRCVKGPVXKUKVUFWTKPI

treatment; and NTP expenditures in 2012. A shortened version of the online questionnaire was used for high-income countries (that

KUEQWPVTKGUYKVJCITQUUPCVKQPCNKPEQOGRGTECRKVCQHÜ75aaKPCUFGßPGFD[VJG9QTNF$CPMa and/or low-incidence

EQWPVTKGUFGßPGFCUEQWPVTKGUYKVJCPKPEKFGPEGTCVGQHECUGURGTaRQRWNCVKQPQTECUGUKPVQVCN

Countries reported data using an online web-based system (www.stoptb.org/tme). The system was opened for reporting on 14

/CTEJYKVJCFGCFNKPGQH/C[HQTCNN9*1TGIKQPUGZEGRVVJG4GIKQPQHVJG#OGTKECU/C[CPFVJG'WTQRGCP4GIKQP

/C[%QWPVTKGUKPVJG'WTQRGCP7PKQPUWDOKVPQVKßECVKQPFCVCVQCU[UVGOOCPCIGFD[VJG'WTQRGCP%GPVTGHQT&KUGCUG2TGXGPVKQP

and Control (ECDC). Data from the ECDC system were uploaded into the WHO online system.

Data were reviewed, and followed up with countries where appropriate, by a team of reviewers from WHO (headquarters and

TGIKQPCNQHßEGUCPFVJG)NQDCN(WPFVQ(KIJV#+&56WDGTEWNQUKUCPF/CNCTKCVJG)NQDCN(WPF8CNKFCVKQPQHFCVCD[TGURQPFGPVU

was also encouraged via a series of in-built, real-time checks of submitted data as well as a summary report of apparent

inconsistencies or inaccuracies (this report can be generated at any time within the online system). Following corrections and

updates by countries, the data used for the main part of this report were the data available in July 2013. Annex 4 was produced on

1 October, by which time additional data had been reported by a few European countries.b

Besides the data reported through the standard TB questionnaire, data about screening for TB among people living with HIV and

RTQXKUKQPQHKUQPKC\KFRTGXGPVKXGVJGTCR[+26VQVJQUGYKVJQWVCEVKXG6$YGTGEQNNGEVGFD[VJG*+8FGRCTVOGPVKP9*1CPFVJG,QKPV

United Nations Programme on HIV/AIDS (UNAIDS). The data were jointly validated and imported into the global TB database.

a. JVVRFCVCYQTNFDCPMQTICDQWVEQWPVT[ENCUUKßECVKQPU

b. For this reason, there may be slight discrepancies between the main part of the report and Annex 4.

TABLE 1.1

Reporting of data in the 2013 round of global TB data collection

9*14')+10145'61(%17064+'5

%17064+'5#0&6'44+614+'5 /'/$'456#6'5

07/$'4 07/$'46*#64'2146'&&#6# 07/$'4 07/$'46*#64'2146'&&#6#

#HTKECP4GIKQP 46 45 46 45

'CUVGTP/GFKVGTTCPGCP4GIKQP 23 23 22 22

'WTQRGCP4GIKQPa54 42 53 41

4GIKQPQHVJG#OGTKECU 46 46 35 35

5QWVJ'CUV#UKC4GIKQP 11 11 11 11

9GUVGTP2CEKßE4GIKQP 36 30 27 24

High-burden countries (HBCs)b22 22 22 22

World 216 197 194 178

a Countries that did not report by the deadlines were mostly low-incidence countries in Western Europe.

b 6JG*$%UCTG#HIJCPKUVCP$CPINCFGUJ$TC\KN%CODQFKC%JKPCVJG&GOQETCVKE4GRWDNKEQHVJG%QPIQ'VJKQRKC+PFKC+PFQPGUKC-GP[C/Q\CODKSWG/[CPOCT0KIGTKC

2CMKUVCPVJG2JKNKRRKPGUVJG4WUUKCP(GFGTCVKQP5QWVJ#HTKEC6JCKNCPF7ICPFCVJG7PKVGF4GRWDNKEQH6CP\CPKC8KGV0COCPF<KODCDYG

grammatic response to MDR-TB, including the coverage of

testing for drug resistance among new and previously treat-

ed TB patients, the number of cases detected with MDR-

TB and enrolled on treatment, and treatment outcomes.

Chapter 5, on TB diagnostics and laboratory strength-

ening, covers three topics. ese are policy developments

between mid-2012 and mid-2013, the status of laboratory

capacity and incorporation of WHO guidance into national

policy in 2012, and recent progress in strengthening labo-

ratories and associated diagnostic capacity. e latest data

on the roll out of the rapid molecular test Xpert MTB/RIF

5GLOBAL TUBERCULOSIS REPORT 2013

BOX 1.4

Special supplement on the Countdown to 2015

The MDGs were established by the UN at the turn of the

21st century, with targets set for 2015 (www.un.org/

millenniumgoals). Designed to drive progress worldwide

and endorsed by all countries, the targets have been the

focus of international and national development efforts

for more than a decade. TB was included as part of MDG

6. In addition to TB targets and indicators that are part of

the MDG framework, targets for the response needed to

CFFTGUUVJGURGEKßEEJCNNGPIGUQH/&46$CPFVJG6$*+8

co-epidemic have been set for 2015 in the Global Plan to

Stop TB 2011–2015.

With just over two years remaining before the target dead-

line of the end of 2015, this 2013 global TB report is accom-

panied by a special supplement called Countdown to 2015.

The supplement provides an overview of progress towards

the 2015 targets set within the MDG framework and for the

TGURQPUGVQ6$*+8CPF/&46$URGEKßECNN[CPFVJGVQR

priority actions needed to either move beyond or accelerate

towards these targets. Snapshots are provided globally,

TGIKQPCNN[CPFHQTVJG*$%UVJCVJCXGCDQWVQHVJG

world’s TB cases and that have received greatest attention at

the global level since 2000. The snapshots are based on the

data presented in the main chapters of the report and the

annexes, complemented by recommendations from recent

programme reviews, published literature, and discussions

with experts at global, regional and national levels.

since it was recommended in 2010 and two multinational

projects (EXPAND-TB and TBXpert) are included.

Chapter 6 contains the most recent data on progress

in implementing collaborative TB/HIV activities to joint-

ly address the epidemics of TB and HIV. ese include HIV

testing for TB patients, provision of antiretroviral therapy

(ART) to HIV-positive TB patients, intensied screening

for TB among people living with HIV and treatment for

those without active TB with IPT.

Chapter 7 assesses nancing for TB care and control.

Funding requirements for a full response to the global TB

epidemic up to 2015, which were updated in early 2013 as

part of preparatory work undertaken to inform the replen-

ishment of the Global Fund, are presented rst. Key nd-

ings from a study of long-term trends (2002–2011) using

data compiled in the WHO annual rounds of data collection

and recently published in e Lancet Global Health are then

summarized, followed by a detailed analysis of new data

reported in 2013.

Chapter 8 discusses research and development for new

TB diagnostics, drugs and vaccines. After years of stagna-

tion, considerable progress has occurred in the past decade

and the development pipelines as of mid-2013 are described

and discussed.

e report also has four annexes. Annex 1 explains the

methods used to produce estimates of the burden of disease

caused by TB. Annex 2 contains country proles for the 22

HBCs that collectively account for about 80% of the world’s

TB cases (proles for all countries are available online1).

Annex 3 contains regional proles. Annex 4 consists of

summary tables that provide data on key indicators for the

world, the six WHO regions and individual countries.

1 www.who.int/tb/data

6GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

The burden of disease caused by TB

e burden of disease caused by TB can be mea-

sured in terms of incidence (dened as the num-

ber of new and relapse cases of TB arising in a

given time period, usually one year), prevalence

(dened as the number of cases of TB at a giv-

en point in time) and mortality (dened as the

number of deaths caused by TB in a given time

period, usually one year).

is chapter presents estimates of TB inci-

dence, prevalence and mortality (absolute num-

bers and rates) between 1990 and 2012 and (for

prevalence and mortality) forecasts up to 2015

(in sections 2.1–2.3). ese data are used to

assess progress towards achieving the global

targets for reductions in TB disease burden set

for 2015: that incidence should be falling (MDG

Target 6.c) and that prevalence and death rates

should be halved by 2015 compared with 1990

(Box 1.2 in Chapter 1). Key aspects of the meth-

ods used to produce the estimates are provided

at the beginning of each section.1 Estimates of

the number of incident TB cases among people

living with HIV, the number of incident cases

of MDR-TB, mortality due to MDR-TB and TB

deaths disaggregated by HIV status are includ-

ed in the relevant sections. Estimates are pre-

sented globally, for the six WHO Regions, and

at country level with particular focus on the 22

HBCs. In response to increasing demand and

global attention, special consideration is given

to estimates of TB disease burden among wom-

en and children. Updates to data sources and

methods used to produce estimates of TB dis-

ease burden compared with those published in

2012 are highlighted in Box 2.1.

ere is uncertainty in all estimates of the

burden of disease caused by TB. Section 2.4

proles eorts to improve measurement of this

burden under the umbrella of the WHO Glob-

al Task Force on TB Impact Measurement. e

recent and unprecedented progress in imple-

menting national TB prevalence surveys is

summarized and expanding eorts to strength-

en surveillance of cases and deaths via noti-

cation and vital registration (VR) systems are

described.

KEY FACTS AND MESSAGES

■ The global burden of TB remains enormous. In 2012, there were an

GUVKOCVGFOKNNKQPKPEKFGPVECUGUQH6$CPFOKNNKQPRGQRNGFKGF

HTQOVJGFKUGCUGaFGCVJUCOQPIRGQRNGYJQYGTG*+8PGICVKXG

CPFaCOQPIRGQRNGYJQYGTG*+8RQUKVKXG#OQPIVJGUGFGCVJU

VJGTGYGTGCPGUVKOCVGFaHTQO/&46$CTGNCVKXGN[JKIJVQVCN

EQORCTGFYKVJaKPEKFGPVECUGUQH/&46$

■ Although the number of TB cases and deaths remains unnecessarily

large for a mostly curable disease, there has been major progress towards

global targets for reductions in the burden of disease. The 2015 MDG

target of halting and reversing TB incidence has been achieved, with

TB incidence falling globally for several years (2% per year in 2012).

Globally, the TB mortality rate has fallen by 45% since 1990 and the

Stop TB Partnership target of a 50% reduction by 2015 is within reach.

Mortality and incidence rates are falling in all six WHO regions and in

OQUVQHVJG*$%UVJCVCEEQWPVHQTQXGTQHVJGYQTNFÂU6$ECUGU

■ 6JKUKUVJGßTUV[GCTKPYJKEJGUVKOCVGUQH6$FGCVJUCOQPI*+8

positive people were produced using the UNAIDS Spectrum model,

leading to revisions to previously published estimates for the period

1990–2011. The estimated percentage of TB cases living with HIV

remains unchanged, at 13% globally in 2012.

■ Although most TB cases and deaths occur among men, the burden of

FKUGCUGKUJKIJCOQPIYQOGP+PCPGUVKOCVGFaYQOGP

FKGFHTQO6$aCOQPI*+8PGICVKXGYQOGPCPFaCOQPI

*+8RQUKVKXGYQOGP6JGTGYGTGCNUQCPGUVKOCVGFa6$FGCVJU

among HIV-negative children (estimates of HIV-associated mortality are

not yet available).

■ 6JG5QWVJ'CUV#UKCCPF9GUVGTP2CEKßE4GIKQPUEQNNGEVKXGN[

CEEQWPVGFHQTQHVJGYQTNFÂU6$ECUGUKP6JG#HTKECP4GIKQP

had approximately one quarter of the world’s cases, and the highest

rates of cases and deaths relative to population (255 incident cases per

aQPCXGTCIGOQTGVJCPFQWDNGVJGINQDCNCXGTCIGQH+PFKC

and China had the largest number of cases (26% and 12% of the global

VQVCNTGURGEVKXGN[5QWVJ#HTKECCPF5YC\KNCPFJCFVJGJKIJGUVKPEKFGPEG

rate per capita (about 1 new case for every 100 people each year).

■ The quality and coverage of data available to estimate TB disease

burden continues to improve. In 2012, data from vital registration

systems were used to estimate TB mortality in 121 countries (up from

EQWPVTKGUKPVJGTGJCUDGGPWPRTGEGFGPVGFRTQITGUUKPVJG

KORNGOGPVCVKQPQHPCVKQPCN6$RTGXCNGPEGUWTXG[UUKPEGCPFGHHQTVU

to improve the monitoring of TB incidence by strengthening routine

health information systems and implementing inventory studies to

measure under-reporting of diagnosed cases are expanding.

■ Five national TB prevalence surveys were implemented in 2012 (in

VJG)CODKC0KIGTKC4YCPFCVJG7PKVGF4GRWDNKEQH6CP\CPKCCPF

6JCKNCPFCPFCHWTVJGTßXGYKNNUVCTVQTDGEQORNGVGFKPKP)JCPC

+PFQPGUKC/CNCYK5WFCPCPF<CODKC6JGUGUWTXG[URTQXKFGCFKTGEV

OGCUWTGQHFKUGCUGDWTFGPQHVGPHQTVJGßTUVVKOGCPFYKNNDGWUGFVQ

WRFCVGGUVKOCVGUQHFKUGCUGDWTFGPQPEGTGUWNVUCTGßPCNK\GF6JG[CNUQ

provide rich data to inform programme policy and strategy.

1 A detailed description is provided in Annex 1.

7GLOBAL TUBERCULOSIS REPORT 2013

BOX 2.1

Updates to estimates of TB disease burden in this report and updates that are anticipated in the near future

Each year, new data become available for the estimation of TB disease burden. Periodically, new approaches to the use of

CXCKNCDNGFCVCCTGFGXGNQRGF6JKUDQZRTQXKFGUCUWOOCT[QHWRFCVGUVJCVYGTGOCFGKP7RFCVGUHQTURGEKßEEQWPVTKGU

VJCVCTGGZRGEVGFKPVJGPGCTHWVWTGRGPFKPIVJGßPCNK\CVKQPQHCPCN[UGUQHFCVCHTQOTGEGPVN[EQORNGVGFRTGXCNGPEG

surveys, are also highlighted.

UPDATES IN THIS REPORT

1. TB/HIV burden estimates

+PCPFHQTVJGßTUVVKOGGUVKOCVGU

of TB incidence among people living

with HIV and TB mortality among HIV-

positive people were generated using

the Spectrum software programme.a

Spectrum has been used for more than

a decade to produce estimates of the

burden of disease caused by HIV, to build

projections about the future course of the

HIV epidemic and to assess the potential

impact of interventions. A TB module was

developed in 2012 and 2013 through

a collaboration between the Futures

Institute, the TB Modelling and Analysis

Consortium (TB-MAC), UNAIDS and WHO.

It was initially tested in two regional

workshops held in Johannesburg, South

Africa (in March 2013) and subsequently in

a workshop for countries in western Africa.

The mathematical methods implemented

in Spectrum as well as the input data are

described in Annex 1. It is anticipated

that the TB module will be extended to

include projections of the future course of

the TB epidemic and the potential impact

of selected interventions, building on

existing estimates of TB disease burden

generated by WHO.

The updated estimates of TB

incidence among people living with HIV

published in this report are generally

very consistent with previously published

estimates, especially for countries with a

IGPGTCNK\GF*+8GRKFGOKECPFUVTQPI6$

HIV surveillance systems. The updated

time series of mortality estimates at global

NGXGNCPFHQTVJG#HTKECP4GIKQPKPFKECVG

a lower level of TB mortality among HIV-

positive people compared with estimates

published in 2012. As a result of the use of

5RGEVTWOEQWPVT[URGEKßEGUVKOCVGUQH6$

mortality among HIV-positive people that

are fully consistent with overall estimates

QH*+8OQTVCNKV[CTGCXCKNCDNGHQTVJGßTUV

time. These are shown in Annex 2 and in

QPNKPGEQWPVT[RTQßNGU

2. MDR-TB mortality and incidence

'UVKOCVGUQH/&46$OQTVCNKV[CPF

KPEKFGPEGYGTGNCUVRTQFWEGFKPCPF

published in a 2010 WHO report on the

/&46$GRKFGOKE#U[UVGOCVKENKVGTCVWTG

review of evidence about mortality

CUUQEKCVGFYKVJ/&46$YCUEQOOKUUKQPGF

by WHO in 2013. The results have been

used to produce global estimates of

/&46$KPEKFGPEGCPFOQTVCNKV[KP

6JGGUVKOCVGQHOQTVCNKV[FWGVQ/&46$

is slightly higher than before, but the

uncertainty interval greatly overlaps the

RTGXKQWUQPG6JGGUVKOCVGQH/&4

TB incidence is similar to the previous

estimate.

3. Newly reported data

There are relatively small changes to

estimates of TB incidence, mortality

and prevalence for many countries that

TGàGEVXKVCNTGIKUVTCVKQPFCVCTGRQTVGF

to WHO between mid-2012 and mid-

2013, updated WHO estimates of the

overall number of deaths (that provide

overall mortality envelopes), updates to

estimates of the burden of HIV-associated

6$CPFPGY6$PQVKßECVKQPFCVCKPENWFKPI

corrections made to historical data. In

most instances, changes are well within

the uncertainty intervals of previously

published estimates of TB burden and time

trends are generally consistent. Newly-

reported data are the reason for small

changes to estimates of the number of TB

deaths among women and children.

4. In-depth epidemiological reviews

In January 2013, estimates of TB burden

for Viet Nam were updated in close

consultation with the NTP and other

stakeholders. These resulted in changes

to estimates of the level of and trends in

TB incidence, prevalence and mortality

compared with those published in the

2012 global TB report. Updates drew on

new analyses from prevalence survey data,

GXKFGPEGCDQWVVJGKPàWGPEGQPVTGPFUKP

ECUGPQVKßECVKQPUQHKPETGCUGFTGRQTVKPIVQ

the NTP of cases diagnosed in the private

sector and prisons and new analyses of

DTQCFGTKPàWGPEGUQP6$FKUGCUGDWTFGP

such as economic growth, health system

performance and the coverage of health

insurance.

5. Inclusion of newly reported cases

without documented treatment

history in incidence estimates

+PRTGXKQWU[GCTUPQVKßGF6$RCVKGPVU

without any reported treatment history

were not considered as incident cases

(incident cases were the sum of new and

TGNCRUGECUGU+PVJKUTGRQTVPQVKßGFECUGU

for which the treatment history is unknown

are considered to be incident cases.

6JKUEJCPIGKULWUVKßGFHQTVYQTGCUQPU

ßTUVKPEQWPVTKGUHCEKPIRTQDNGOUYKVJ

incomplete documentation of treatment

history, the vast majority of such cases are

ßTUVGRKUQFGUQTTGNCRUGGRKUQFGUUGEQPF

WHO received several requests from NTPs

(or equivalent) to include all patients with

no documented treatment history in the

count of new and relapse episodes to avoid

understating the true burden of TB. This

change affects relatively few countries,

most of which are in western Europe.

UPDATES ANTICIPATED IN

THE NEAR FUTURE

Updates to estimates of disease burden

are expected in several countries that

have recently completed or will soon

complete national TB prevalence surveys.

6JGUGKPENWFGßXG*$%U+PFQPGUKC

Nigeria, Pakistan, Thailand and the United

4GRWDNKEQH6CP\CPKC#FFKVKQPCNEQWPVTKGU

KPENWFGVJG)CODKCCPF4YCPFCDQVJ

of which completed surveys in 2012,

and Ghana where a survey began in

March 2013. In addition to a prevalence

survey, an inventory study to estimate TB

underreporting was completed in Pakistan

in 2012 (see also section 2.4) and an

in-depth epidemiological review was

conducted in Thailand in August 2013.

A workshop for the six countries that had

completed surveys by July 2013

(i.e. the Gambia, Nigeria, Pakistan,

4YCPFC6JCKNCPFCPF7PKVGF4GRWDNKE

QH6CP\CPKCCUYGNNCUVJGKTVGEJPKECN

partners will be held at WHO headquarters

in November 2013, to conduct and

complete analyses of survey data.

Following this workshop, updates to

estimates of TB disease burden will be

possible. These updates will be made

CXCKNCDNGKPQPNKPGEQWPVT[RTQßNGUCPF

associated data sets.

In 2014, a thorough review of the

current epidemiological and modelling

methods used to estimate TB disease

burden will be conducted by the

WHO Global Task Force on TB Impact

Measurement. The recommendations may

result in some further updates in the 2014

global TB report.

a JVVRYYYHWVWTGUKPUVKVWVGQTIURGEVTWOCURZ

GLOBAL TUBERCULOSIS REPORT 2013

2.1 TB incidence

TB incidence has never been measured at national level

because this would require long-term studies among large

cohorts of people (hundreds of thousands) at high cost and

with challenging logistics. Notications of TB cases pro-

vide a good proxy indication of TB incidence in countries

that have both high-performance surveillance systems

(for example, there is little underreporting of diagnosed

cases) and where the quality of and access to health care

means that few cases (or a negligible number) are not diag-

nosed. In the large number of countries where these crite-

ria are not yet met, TB incidence can be estimated using

an inventory study (in which the level of underreporting

is assessed) combined with capture–recapture analysis to

estimate under-diagnosis, provided that certain assump-

tions are satised.1 To date, such studies have been under-

taken in only a few countries: examples include Egypt,

Iraq and Yemen (see section 2.4). e ultimate goal is to

directly measure TB incidence from TB notications in all

countries. is requires a combination of strengthened sur-

veillance, better quantication of underreporting (i.e. the

number of cases that are missed by surveillance systems)

and universal access to health care. A TB surveillance check-

list developed by the WHO Global Task Force on TB Impact

Measurement denes the standards that need to be met

for notication data to provide a direct measure of TB inci-

dence (further details in section 2.4).

For most countries, incidence estimates are currently

based on notication data combined with country consul-

tations in which in-depth analyses of the available surveil-

lance, survey and programmatic data are undertaken, and

expert opinion about the fraction of cases diagnosed but

not reported, or not diagnosed at all, is elicited and docu-

mented. e 96 countries (with 89% of estimated TB cases)

covered by such consultations since 2008 are shown in Fig-

ure 2.1. For remaining countries not covered in workshops

and in which notications do not provide a good proxy indi-

cation of TB incidence, estimates are based on extending

previously published time series, mortality data from VR

systems combined with evidence about the case fatality

rate, or ecological modelling (see Annex 1 for details).

In 2012, there were an estimated 8.6 million incident

cases of TB (range, 8.3million–9.0million) globally, equiv-

alent to 122 cases per 100000 population (Table 2.1, Table

2.2). e absolute number of incident cases is falling, albeit

slowly (Figure 2.2).

Most of the estimated number of cases in 2012 occurred

in Asia (58%) and the African Region (27%);2 smaller pro-

portions of cases occurred in the Eastern Mediterranean

Region (8%), the European Region (4%) and the Region of

FIGURE 2.1

Coverage of country consultations on estimates of TB disease burden, 2008–2013

1 An inventory study can be used to measure the number of cases that are diagnosed but not reported, but using results to estimate the total

number of incident cases using capture–recapture methods requires that certain conditions are met. ese are explained in a guide on inven-

tory studies recently published by WHO, which is available at: www.who.int/tb/publications/inventory_studies/en/index.html

2 Asia refers to the WHO Regions of South-East Asia and the Western Pacic.

9GLOBAL TUBERCULOSIS REPORT 2013

TABLE 2.1

Estimated epidemiological burden of TB, 2012. Numbers in thousands.a

POPULATION

/146#.+6;bHIV-POSITIVE

6$/146#.+6; 24'8#.'0%' INCIDENCE HIV-POSITIVE

INCIDENT TB CASES

BESTcLOW HIGH BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH

Afghanistan  11 4.6 20   0.3 110 54  56 47 67 0.3 0.2 0.5

Bangladeshd154 695 70 29 130   0.1 670 340 1 100 350 290 410 0.2 0.2 0.3

$TC\KN  4.9 4.6 5.2 2.5 2.2 3 120 51 210 92 76 110 16 13 19

Cambodia  9.3 4.3 16 0.6 0.4 0.7 110 96 130 61 52 70 2.7 2.3 3.1

China 1 377 065 44 43 46 1.2 0.9 1.5 1 400 1 200 1 600 1 000  1 100 7.3 6.4 

&4%QPIQ 65 705 36 16 64 6.3 5.5   200 620 210 190 250 16 14 19

Ethiopia 91 729 16 12 21 5.6 4.6 7.3 210 170 250 230 170 290 23 17 30

Indiae 270 170 390 42 37   1 900 3 900 2 200 2 000 2 400 130 120 140

Indonesia  67 30 120 2.1  37303501 200460 540 7.5 5.6 9.7

Kenya  9.5 5.4 15 7.7 6.6  130 71 210 120 110 120 45 44 47

/Q\CODKSWG 25 203 13 1 41 45 35 53 140  340 140 96 190   110

Myanmar 52 797 25 12 44 4.6  5.3 260 200 320 200 170 230 19 16 21

Nigeria  27 1.6  19 11 25 270 43 710   310 46 21 

Pakistan 179 160 62 27 110 1.2  1.3 670 320 1 100 410 340 490  3.1 4.6

Philippines 96 707 23 22 25 0.1  0.1 450 390 500 260 210 310 0.5 0.4 0.6

4WUUKCP

Federation 143 170 19  20  1.5 2.2 170 73 320 130 110 150 9.3 7.9 11

South Africa  31 3.7   75 100 450 160  530 430 630 330 270 390

Thailand  9.2  17 2.2 1.9  110 47 190  66 95 12 10 14

Uganda 36 346 4.7  12 9.2 12 64 24 120 65 53 79 35  42

746CP\CPKC  6.1 3.2 9.9 7    45 140 79 74  32 30 34

Viet Nam 90 796  12 25 2.1  2.7 200  370 130 99 170 9.3 6.9 12

<KODCDYG 13 724 4.6 0.2 16  15 20 59 13 140 77 60 97 55 42 69

High-burden

countries 4 432 959 780 630 940 270 250 280 9 600 8 200 11 000 7 000 6 700 7 400 880 810 960

#(4  230 160 310 250 230 270 2 700 2 100 3 300 2 300 2 100 2 500  760 910

#/4 961 103 19 16 21 6.4 5.6 7.2 390 300 490  260 300 31  34

'/4 616 591 100 63 150 4.2  4.7 1 100 730 1 600 670 590 750 11 10 12

'74 904 540 36 35 36 3.9 3.4 4.4 510  650 360 340 390 19 17 21

5'#4  450 330 590 51 46 56  3 700 6 100 3 400 3 200 3 700 170 160 

924  110 96 120  4.2 5.4 2 400 2 100 2 600 1 600 1 500  24 21 27

Global 7 053 684 940 790 1 100 320 300 340 12 000 11 000 13 000 8 600 8 300 9 000 1 100 1 000 1 200

a 0WODGTUHQTOQTVCNKV[RTGXCNGPEGCPFKPEKFGPEGUJQYPVQVYQUKIPKßECPVßIWTGU6QVCNU*$%UTGIKQPCNCPFINQDCNCTGEQORWVGFRTKQTVQTQWPFKPI

b /QTVCNKV[GZENWFGUFGCVJUCOQPI*+8RQUKVKXG6$ECUGU&GCVJUCOQPI*+8RQUKVKXG6$ECUGUCTGENCUUKßGFCU*+8FGCVJUCEEQTFKPIVQ+%&CPFCTGUJQYPUGRCTCVGN[KPVJKU

table.

c Best, low and high indicate the point estimate and lower and upper bounds of the 95% uncertainty interval.

d Estimates of TB disease burden have not been approved by the NTP in Bangladesh and a joint reassessment (by the NTP and WHO) will be undertaken following completion of

the national TB prevalence survey scheduled for 2014.

e 'UVKOCVGUHQT+PFKCJCXGPQV[GVDGGPQHßEKCNN[CRRTQXGFD[VJG/KPKUVT[QH*GCNVJ(COKN[9GNHCTG)QXGTPOGPVQH+PFKCCPFUJQWNFVJGTGHQTGDGEQPUKFGTGFRTQXKUKQPCN

10 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 2.2

Estimated epidemiological burden of TB, 2012. 4CVGURGTRQRWNCVKQPGZEGRVYJGTGKPFKECVGFa

POPULATION

(THOUSANDS)

/146#.+6;b*+8215+6+8'6$/146#.+6; 24'8#.'0%' INCIDENCE *+824'8#.'0%'+0

INCIDENT TB CASES (%)

BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH

Afghanistan  37 15  0.3  1.1   595  156 226 0.55 0.41 

Bangladeshc154 695 45 19     434  721 225     

$TC\KN  2.5 2.3 2.6 1.3 1.1 1.5 59 25 107 46  55 17.3 17.1 17.4

Cambodia  63 29 110  2.7 4.7 764 645  411 353 474 4.34 4.21 4.44

China 1 377 065 3.2 3.1 3.3   0.1 99  113 73 64  0.73 0.73 0.73

&4%QPIQ 65 705 54 24 97 9.7  12 576 301  327  375 7.66 7.65 7.66

Ethiopia 91 729  13 23 6.1 5 224  272 247  321 10.2 10.1 10.2

Indiad 22 14 32 3.4 3 3.9 230 155 319 176 159 193 5.95 5.93 5.97

Indonesia  27 12  0.9 0.7 1.2 297 144 506  153 220 1.65 1.65 2.33

Kenya  22 13 34  15 21 299 164 475 272 261    

/Q\CODKSWG 25 203 53 3.9 163 177  209 553 111 1 340 552  753 59.7 59.6 

Myanmar 52 797  23   7.3 10  377 616 377 322 435 9.33 9.32 9.33

Nigeria  16 0.9 51 11 6.7 15 161 25 420  50  25.2  25.7

Pakistan 179 160 34 15 61 0.7 0.5  376  641 231 190 276 0.92  0.96

Philippines 96 707 24 22 26 0.1  0.1 461 405 520 265 219 316   

4WUUKCP

Federation 143 170 13 13 14 1.2 1 1.5 121 51 221 91 77 106 7.14 7.03 7.25

South Africa  59 7 164  144 192  305  1 000  1 190 63.0 62.9 63.0

Thailand  14  25 3.3 2.9 4.2 159 71  119  142 15.2 15.2 15.3

Uganda 36 346 13 2.3 33 25 22 32 175 67 334 179 145 216 53.2 52.9 53.3

746CP\CPKC  13  21 15 12 17 176 95  165 154 175 41.2 41.2 41.3

Viet Nam 90 796 20 13 27 2.4 2 2.9   410 147 109 192 6.97 6.94 6.99

<KODCDYG 13 724 33 1.2 117 132 111 147 433 92 1 030 562 434 706 70.9 70.7 71.4

High-burden

countries 4 432 959 18 14 21 6 5.6 6.4 216 186 248 159 151 166 7.37 7.35 7.40

#(4  26  35  26 30 303 239 373 255 235 275 36.6 34.7 

#/4 961 103 1.9 1.7 2.2 0.7 0.6 0.7 40 31 51 29 27 31 11.4  14.4

'/4 616 591 16 10 24 0.7 0.6    256 109 96 122  1.34 2.52

'74 904 540 3.9 3.9 4 0.4 0.4 0.5 56 42 72 40  43 5.26  6.93

5'#4  25  32  2.5 3.1 264 203 333  174 200 4.94 4.31 5.62

924   5.2 6.4 0.3 0.2 0.3  115 142   95 1.49 0.92 

Global 7 053 684 13 11 16 4.6 4.3 4.8 169 149 190 122 117 127 12.8 11.6 14.0

a Best, low and high indicate the point estimate and lower and upper bounds of the 95% uncertainty interval.

table.

c Estimates of TB disease burden have not been approved by the NTP in Bangladesh and a joint reassessment (by the NTP and WHO) will be undertaken following completion of

the national TB prevalence survey scheduled for 2014.

d 'UVKOCVGUHQT+PFKCJCXGPQV[GVDGGPQHßEKCNN[CRRTQXGFD[VJG/KPKUVT[QH*GCNVJ(COKN[9GNHCTG)QXGTPOGPVQH+PFKCCPFUJQWNFVJGTGHQTGDGEQPUKFGTGFRTQXKUKQPCN

11GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.2

Estimated absolute numbers of TB cases and deaths

(in millions), 1990–2012

a *+8CUUQEKCVGF6$FGCVJUCTGENCUUKßGFCU*+8FGCVJUCEEQTFKPIVQ+%&

2.5

5.0

7.5

10.0

1990 1995 2000 2005 2012

Millions

All TB cases

HIV-positive TB cases

TB incidence

0.5

1.0

1.5

2.0

1990 1995 2000 2005 2012

Millions

TB deaths among HIV-negative people

TB deaths among HIV-positive peoplea

TB deaths

the Americas (3%). e 22 HBCs that have been given high-

est priority at the global level since 2000 (listed in Table

2.1 and Table 2.2) accounted for 81% of all estimated inci-

dent cases worldwide. e ve countries with the largest

number of incident cases in 2012 were India (2.0 million–

2.4 million), China (0.9 million–1.1 million), South Africa

(0.4 million–0.6 million), Indonesia (0.4 million–0.5 mil-

lion) and Pakistan (0.3 million–0.5 million); these and the

other ve countries that make up the top ten in terms of

numbers of cases are highlighted in Figure 2.3. India and

China alone accounted for 26% and 12% of global cases,

respectively. Of the 8.6 million incident cases, an estimat-

ed 0.5 million were children and 2.9 million (range, 2.7–

3.1 million) occurred among women (Box 2.2).

e 8.6 million incident TB cases in 2012 included

1.0 million–1.2 million (12–14%) among people living with

HIV, with a best estimate of 1.1 million (13%) (Table 2.1,

Table 2.2). e proportion of TB cases co-infected with HIV

was highest in countries in the African Region (Figure 2.4).

Overall, 37% of TB cases were estimated to be co-infect-

ed with HIV in this region, which accounted for 75% of TB

cases among people living with HIV worldwide. In parts of

southern Africa, more than 50% of TB cases were co-infect-

ed with HIV (Figure 2.4).

Following a systematic review of evidence about mor-

tality caused by MDR-TB (

Box 2.3), global estimates of

the burden of MDR-TB were updated in 2013 (Box 2.1).

e best estimate is that there were 450000 (range,

300 000‒600 000) new cases of MDR-TB worldwide in

2012. is total includes cases of primary and acquired

MDR-TB.

e number of incident TB cases relative to population

(the incidence rate) varies widely among countries (Fig-

ure 2.5). e lowest rates are found predominantly in

high-income countries including most countries in west-

ern Europe, Canada, the United States of America, Japan,

Australia and New Zealand. In these countries, the inci-

dence rate per 100000 population is less than 10 cases per

FIGURE 2.3

Estimated TB incidence: top-ten countries, 2012

●

Myanmar

DR Congo

Ethiopia

Philippines

Bangladesh

Pakistan

Indonesia

South Africa

China

India

a. Incidence: absolute numbers

Millions

0.5 1.0 1.5 2.0 2.5

●

Rate per 100 000 population per year

Gabon

Timor-Leste

Mozambique

Zimbabwe

Djibouti

Lesotho

Namibia

Sierra Leone

South Africa

Swaziland

400 800 1200 1600

b. Incidence: rate per 100 000 population

12 GLOBAL TUBERCULOSIS REPORT 2013

BOX 2.2

The burden of TB disease among women and children

6JGDWTFGPQH6$OQTDKFKV[CPFOQTVCNKV[COQPIYQOGPFGßPGF

CUHGOCNGUCIGFÜ[GCTUCPFEJKNFTGPFGßPGFCURGQRNG

CIGF[GCTUKUNCTIGTVJCPQHVGPTGCNKUGF6JKUKUVJGUGEQPF

consecutive year in which the WHO global TB report highlights the

DWTFGPQHFKUGCUGCOQPIEJKNFTGPCPFHQTVJGßTUVVKOGKPENWFGU

estimates of the burden among women disaggregated by region

and HIV status.

There were an estimated 2.9 million new cases of TB and

aFGCVJUHTQOVJGFKUGCUGCOQPIYQOGPKP#OQPI

EJKNFTGPVJGTGYGTGCPGUVKOCVGFaPGYECUGUKPCPF

aFGCVJUCOQPIEJKNFTGPYJQYGTG*+8PGICVKXG/GVJQFU

used to produce these estimates and further details about results

are provided below. The estimates of TB morbidity and mortality

among children are slightly higher than those published in the

INQDCN6$TGRQTVTGàGEVKPIPGYUWTXGKNNCPEGFCVCVJCVUJQY

OQTG6$ECUGUDGKPIPQVKßGFCOQPIEJKNFTGPINQDCNN[CPFPGY84

data.

The burden of TB in women: estimates of TB incidence

and mortality, 2012

Incidence

4GIKQPCNGUVKOCVGUQHVJGYQOGPOGPTCVKQHQTPGYCNNECUGV[RGU

6$ECUGPQVKßECVKQPUKPYGTGIGPGTCVGFCPFCUUWOGFVQDG

the same as the ratio among incident TB cases in 2012 (see Annex

1 for further details). The resulting global and regional estimates

of incidence are shown in Table B2.2.1. Women account for

QHVJGVQVCNQHOKNNKQPKPEKFGPVECUGUKP6JG#HTKECP

CPF5QWVJ'CUV#UKCTGIKQPUCEEQWPVHQTQHVJGECUGUCOQPI

women.

TABLE B2.2.1

6QVCNPWODGTQHPGY6$PQVKßECVKQPUCNNECUGV[RGU

and estimated incident cases among women in 2012,

disaggregated by WHO region

WHO

REGION

NUMBER OF TB CASE

NOTIFICATIONS

ESTIMATED TB INCIDENCE

BEST ESTIMATE UNCERTAINTY INTERVAL

#(4 361 645  ¿

#/4 63 626 100 000 91 000–110 000

'/4 101 910  240 000–330 000

'74 79 279 120 000 110 000–130 000

5'#4 431 470 1 100 000 990 000–1 200 000

924 392 030 510 000 460 000–550 000

Global 1 429 960 2 900 000 2 700 000–3 100 000

Mortality

In total, there were an estimated 410 000 TB deaths among

women in 2012. This includes 250 000 (range, 210 000–290 000)

TB deaths among HIV-negative women (29% of all TB deaths

among HIV-negative adults) and 160 000 (range, 150 000–

170 000) HIV-associated TB deaths (50% of all HIV-associated

TB deaths). Newly reported data and a decrease in the overall TB

mortality envelope explain the decrease in the estimated number

QH6$FGCVJUCOQPIYQOGPEQORCTGFYKVJßIWTGUTGRQTVGFKP

previous years (see also Box 2.1).

/QTVCNKV[FCVCFKUCIITGICVGFD[CIGCPFUGZHTQO84U[UVGOU

were used to produce estimates of TB deaths among HIV-negative

CFWNVUHQTEQWPVTKGU84FCVCYGTGCXCKNCDNGHQTEQWPVTKGU

but for China, age and sex-disaggregated data were not available).

TB deaths were calculated for women and men, after adjustment

HQTKPEQORNGVGEQXGTCIGCPFKNNFGßPGFECWUGUUGGAnnex 1

HQTHWTVJGTFGVCKNU(QTEQWPVTKGUYKVJQWV84FCVCCPGEQNQIKECN

statistical model was used to predict the ratio of male to female

TB mortality. The model included a set of risk factors known to be

associated with TB mortality (GDP per capita, the percentage of

PGYECUGUYKVJ/&46$*+8RTGXCNGPEGKPVJGIGPGTCNRQRWNCVKQP

and the treatment success rate). Globally, there were 2.55 (range,

¿OCNGFGCVJUCOQPI*+8PGICVKXGCFWNVUHQTGXGT[

female death (Figure B2.2.14GIKQPCNFKHHGTGPEGUCTGGXKFGPV

(Table B2.2.2), with the African and South-East Asia regions

accounting for 69% of total deaths. The main limitation in the

OGVJQFUWUGFKUVJCVVJGEQWPVTKGUTGRQTVKPIWUCDNG84FCVC

were all middle- or high-income countries. Predictions for low-

income countries had to be extrapolated from these countries.

TB deaths among HIV-positive people were disaggregated

by sex using the assumption that the male to female sex ratio

is similar to the sex ratio of AIDS deaths estimated by UNAIDS.

Globally, the numbers of HIV-associated TB deaths were similar

among men and women (Figure B2.2.2). However, there were

striking regional variations (Table B2.2.2+PVJG#HTKECP4GIKQP

more deaths occurred among women than men, while in other

regions more deaths were estimated to have occurred among men.

TABLE B2.2.2

Estimated number of TB deaths among women in 2012,

disaggregated by WHO region

HIV-NEGATIVE HIV-POSITIVE

BEST

ESTIMATE

UNCERTAINTY

INTERVAL

BEST

ESTIMATE

UNCERTAINTY

INTERVAL

#(4  53 000–110 000 140 000 130 000–150 000

#/4 5 900 5 000–6 700 2 000 1 900–2 200

'/4 32 000 ¿ 1 400 1 300–1 600

'74 10 000 9 700–10 000 1 200 1 000–1 300

5'#4 93 000 65 000–120 000  16 000–20 000

924 26 000 24 000–29 000 1 200 1 000–1 300

Global 250 000 210 000–290 000 160 000 150 000–170 000

The burden of TB in children: estimates of TB

notißcations, incidence and mortality (among those HIV-

negative), 2012

6$PQVKßECVKQPUCPFKPEKFGPEG

6JGINQDCNPWODGTQHPGY6$ECUGPQVKßECVKQPUCOQPIEJKNFTGP

CIGF[GCTUKUGUVKOCVGFCVaKPTable

B2.2.3). This includes cases reported among children and an

estimate of the number of cases among children in countries that

FKFPQVTGRQTVPQVKßECVKQPUFKUCIITGICVGFD[CIG(QTEQWPVTKGU

that did not report age-disaggregated data (Figure B2.2.3), it

YCUCUUWOGFVJCVVJGTCVKQQHEJKNFVQCFWNVPQVKßGFECUGUYCUVJG

same (for each case type) as in those countries that did report

PQVKßECVKQPUFKUCIITGICVGFD[CIGCPCNVGTPCVKXGOGVJQFWUKPI

VJGCUUWORVKQPVJCVVJGTCVKQQHEJKNFJQQFVQCFWNVPQVKßECVKQP

rates was the same gave similar results). WHO does not request

age-disaggregated data for relapse cases or those reported as of

unknown case type, and the number of children in these categories

YCUCUUWOGFVQDG\GTQ

To estimate TB incidence among children, it was assumed that

the case detection rate for all ages at the global level in 2012 (best

13GLOBAL TUBERCULOSIS REPORT 2013

estimate 66%, range 64%–69%)

was the same for adults and

children. On this basis, TB incidence

among children is estimated at

530 000 (range, 510 000–550 000)

in 2012, equivalent to about 6%

QHVJGVQVCNPWODGTQHOKNNKQP

incident cases.

Limitations of the methods used

KPENWFG

The assumption that the case

detection rate is the same for

adults and children, in the

absence of any data on levels

of underreporting of diagnosed

cases for children and adults

separately.

The assumption that reported

cases were true cases of TB. Misdiagnosis is possible, especially

IKXGPVJGFKHßEWNVKGUQHFKCIPQUKPI6$KPEJKNFTGP

The proportion of cases among children may be different in

countries for which age-disaggregated data were not available.

However, reporting of cases disaggregated by age has been

improving and the number of countries not reporting age-

disaggregated data was relatively low in 2012.

Mortality among HIV-negative children

/QTVCNKV[FCVCTGRQTVGFVQ9*1HTQO84U[UVGOUVJCVYGTG

disaggregated by age were available for 120 countries. These data

were used to calculate TB death rates per 100 000 population

for children and adults, after adjustment for incomplete coverage

CPFKNNFGßPGFECWUGUUGGAnnex 1 for further details). For

EQWPVTKGUYKVJQWV84FCVCCPGEQNQIKECNUVCVKUVKECNOQFGNYCUWUGF

to predict the ratio of childhood to adult TB mortality rates. The

total number of deaths from TB among HIV-negative children was

estimated to be 74 000 (range, 59 000–90 000), equivalent to

CDQWVQHVJGVQVCNPWODGTQHa6$FGCVJUCOQPI*+8

negative people in 2012.

An estimate of TB mortality among HIV-positive children

KUPQVKPENWFGFKPVJKUTGRQTVFWGVQVJGFKHßEWNVKGUCTKUKPI

from the miscoding of HIV deaths as TB deaths. However, age

disaggregation of HIV-associated TB mortality will be one of the

future outcomes of the TB component of Spectrum (see Box 2.1).

Steps to improve estimation of

6$ECUGUCOQPIEJKNFTGPKPENWFG

a global consultation to further

develop analytical methods and

VQFGßPGCPFRTKQTKVK\GCEVKQPU

needed to obtain new data in

September 2013;

promotion of case-based

electronic recording and

reporting systems that facilitate

compilation and analysis of age-

disaggregated data;

nationwide inventory surveys

to measure underreporting of

childhood TB;

more contact-tracing studies and

the integration of TB activities

in maternal, newborn and child

JGCNVJUGTXKEGUVQßPFEJKNFJQQF

cases that might otherwise not

be diagnosed.

●

Global

WPR

SEAR

EUR

EMR

AMR

AFR

1234

Sex Ratio (M:F)

FIGURE B2.2.1

The male:female ratio for HIV-negative

6$FGCVJUCOQPICFWNVUCIGFÜ

[GCTUINQDCNN[CPFHQT9*1TGIKQPU

●

Global

WPR

SEAR

EUR

EMR

AMR

AFR

123

Sex Ratio (M:F)

FIGURE B2.2.2

The male:female ratio for HIV-

associated TB deaths among adults

CIGFÜ[GCTUINQDCNN[CPFHQT

WHO regions

Age disaggregation

All case types disaggregated

Only smear-positive cases disaggregated

No age disaggregation

No data reported

FIGURE B2.2.3

4GRQTVKPIQHPQVKßECVKQPFCVCFKUCIITGICVGFD[CIG

TABLE B2.2.3

New TB case notißcations in 2012, by case type and

age disaggregation

SMEAR-

POSITIVE

SMEAR-

NEGATIVEa

EXTRA-

PULMONARY

Total notißcations  1 935 971 

Countries disaggregating by age 2 551 136 1 597 530 

Countries not disaggregating

by age 17 653  

VQVCNPQVKßECVKQPU

disaggregated) (99%)  

Number of countries that report-

ed notißcations disaIIreIated by

aIe number of *BCsb

204 (22)  

Total childhood notißcations from

countries disaIIreIatinI by aIe 163 477 

Total estimated childhood

notißcations amonI all countries 349 000

a This includes reported cases for whom smear results were unknown or not done.

b #PCFFKVKQPCNPKPGEQWPVTKGUTGRQTVGF\GTQ6$ECUGUHQTCPFVJTGGEQWPVTKGU

had not reported data to WHO by July 2013.

14 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.4

Estimated HIV prevalence in new TB cases, 2012

HIV prevalence

in new TB cases,

all ages (%)

0–4

5–19

20–49

≥50

No data

Not applicable

FIGURE 2.5

Estimated TB incidence rates, 2012

Estimated new TB

cases (all forms) per

100 000 population

per year

0–9.9

10–19

20–49

50–124

125–299

300–499

≥500

No data

Not applicable

15GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.6

Global trends in estimated rates of TB incidence, prevalence and mortality. .GHV)NQDCNVTGPFUKPGUVKOCVGF

incidence rate including HIV-positive TB (green) and estimated incidence rate of HIV-positive TB (red%GPVTGCPFTKIJV

Trends in estimated TB prevalence and mortality rates 1990–2012 and forecast TB prevalence and mortality rates

¿6JGJQTK\QPVCNFCUJGFNKPGUTGRTGUGPVVJG5VQR6$2CTVPGTUJKRVCTIGVUQHCTGFWEVKQPKPRTGXCNGPEGCPF

mortality rates by 2015 compared with 1990. Shaded areas represent uncertainty bands. Mortality excludes TB deaths among

HIV-positive people.

Rate per 100 000 population per year

Incidence

1990 1995 2000 2005 2010

100

150

Prevalence

1990 1995 2000 2005 2010 2015

100

200

300

Rate per 100 000 population

Mortality

1990 1995 2000 2005 2010 2015

Rate per 100 000 population per year

FIGURE 2.7

Estimated TB incidence rates by WHO region, 1990–2012. 4GIKQPCNVTGPFUKPGUVKOCVGF6$KPEKFGPEGTCVGUgreen)

and estimated incidence rates of HIV-positive TB (red). Shaded areas represent uncertainty bands.

Rate per 100 000 population per year

1990 1995 2000 2005 2012 1990 1995 2000 2005 20121990 1995 2000 2005 2012

Africa The Americas Eastern Mediterranean

Europe South-East Asia Western Pacific

100

200

300

400

100

150

200

100

200

300

100

150

200

100000 population. Most countries in the Region of the

Americas have rates below 50 per 100000 population and

this is the region with the lowest burden of TB on average.

Most of the HBCs have rates of around 150‒300 cases per

100000 population (Table 2.2); HBCs with markedly lower

rates are Brazil and China, while rates are above 500 per

100000 population in Mozambique, South Africa and Zim-

babwe. Other countries in the top ten worldwide in terms of

incidence rates are mostly in Africa (Figure 2.3). In South

Africa and Swaziland, the best estimate is that at least 1 in

every 100 people (1000 or more per 100000 population)

develops TB each year.

Globally, the incidence rate was relatively stable from

1990 up to around 2001, and then started to fall (Figure

2.6), achieving the MDG target ahead of the 2015 deadline.

Between 2011 and 2012, the rate of decline was 2%. is

downward trend needs to be sustained to ensure that the

MDG target is met in 2015. Incidence rates are also declin-

16 GLOBAL TUBERCULOSIS REPORT 2013

ing in all of six WHO regions (Figure 2.7), fastest in the

European Region (6.5% per year) and slowest in the Eastern

Mediterranean and South-East Asia Regions (less than 1%

per year and 2% per year, respectively). Incidence rates have

been falling since the mid-1990s in the Eastern Mediterra-

nean Region and since around 2000 in the South-East Asia

Region; they peaked around 1997 in the European Region

and around 2002 in the African region, and have been fall-

ing since 1990 in the Region of the Americas and the West-

ern Pacic Region. e latest assessment for the 22 HBCs

suggests that incidence rates are falling in most countries

(Figure 2.8).

2.2 TB prevalence

In countries with a relatively high burden of TB (around

100 cases per 100000 population or more), the prevalence

of bacteriologically-conrmed pulmonary TB can be direct-

ly measured in nationwide population-based surveys using

sample sizes of around 50000 people. Survey results can be

FIGURE 2.8

Estimated TB incidence rates, 22 high-burden countries, 1990–2012. Trends in estimated TB incidence rates

(green) and estimated incidence rates of HIV-positive TB (red). Shaded areas represent uncertainty bands.

a Estimates of TB disease burden have not been approved by the national TB programme in Bangladesh and a joint reassessment will be undertaken following the completion

of the prevalence survey planned for 2014.

Rate per 100 000 population per year

100

200

300

100

200

300

400

500

250

500

750

1000

1250

100

150

200

100

200

300

400

250

500

750

1000

1250

250

500

750

1000

1250

100

150

200

250

500

750

1000

1250

100

200

300

200

400

600

200

400

600

100

200

300

400

200

400

600

200

400

600

800

100

200

300

100

200

300

100

200

300

400

100

200

300

400

100

150

250

500

750

1000

100

150

200

1990 1995 2000 2005 2012 1990 1995 2000 2005 2012

1990 1995 2000 2005 2012 1990 1995 2000 2005 2012 1990 1995 2000 2005 2012

Afghanistan BangladeshaBrazil Cambodia China

DR Congo Ethiopia India Indonesia Kenya

Mozambique Myanmar Nigeria Pakistan Philippines

Russian Federation South Africa Thailand Uganda UR Tanzania

Viet Nam Zimbabwe

1 TB prevalence surveys: a handbook. Geneva, World Health Organiza-

tion, 2011 (WHO/HTM/TB/2010.17). Available at www.who.int/

tb/advisory_bodies/impact_measurement_taskforce/resources_

documents/thelimebook/

used to produce a national estimate of TB prevalence that

includes all forms of TB. e cost of a survey usually rang-

es from US$1 to4 million, and comprehensive theoretical

and practical guidance on survey design, implementation,

analysis and reporting of results is available.1 Repeat sur-

veys conducted about every 10 years allow trends in disease

burden to be assessed. HBCs that have completed repeat

surveys in the last 10 years include Cambodia, China, the

Philippines and ailand, and repeat surveys are planned

in Myanmar and Viet Nam. Countries in which surveys

have been implemented or are planned in the near future

are shown in Figure 2.9. Between 2008 and 2017, an

unprecedented number of national TB prevalence surveys

have been or will be conducted (see also section 2.4).

In low- and medium-burden countries, sample sizes and

17GLOBAL TUBERCULOSIS REPORT 2013

costs become prohibitively large. If survey data are not

available, prevalence can be indirectly estimated as the

product of incidence and the average duration of disease,

but with considerable uncertainty (Annex 1). TB preva-

lence can be estimated only indirectly for most countries.

ere were an estimated 12 million prevalent cases

(range, 11million–13million) of TB in 2012 (Table 2.1),

equivalent to 169 cases per 100000 population (Table 2.2).

By 2012, the prevalence rate had fallen 37% globally since

1990. Current forecasts suggest that the Stop TB Partner-

ship target of halving TB prevalence by 2015 compared

with a baseline of 1990 will not be met worldwide (Figure

2.6). Regionally, prevalence rates are declining in all six

WHO regions (Figure 2.10). e Region of the Americas

halved the 1990 level of TB prevalence by around 2004,

well in advance of the target year of 2015, and the best

estimate suggests that the Western Pacic Region achieved

the 50% reduction target in 2012. Reaching the 50% reduc-

tion target by 2015 appears feasible in the South-East Asia

Region and also in the European Region with a relatively

small acceleration in the current rate of progress. e target

appears out of reach in the African and Eastern Mediterra-

nean Regions.

FIGURE 2.9

Countries in which national population-based surveys of the prevalence of TB disease have been

implemented using currently recommended screening and diagnostic methodsa since 1990 or are planned

in the near future: status in July 2013

a 5ETGGPKPIOGVJQFUKPENWFGßGNFEJGUV:TC[EWNVWTGKUWUGFVQEQPßTOFKCIPQUKU

b “National survey planned” means that a country has submitted at least a draft survey protocol and a budget to the WHO Global Task Force on TB Impact Measurement.

No national

survey planned

National survey

plannedb

National survey

ongoing

One national

survey completed

Repeat national survey

planned

≥1 repeat national survey

completed

Not applicable

2.3 TB mortality

TB mortality among HIV-negative people can be directly

measured using data from national VR systems, provided

that these systems have high coverage and causes of death

are accurately coded according to the latest revision of the

International classication of diseases (ICD-10). Sample VR

systems covering representative areas of the country (e.g.

as in China) provide an interim solution. Mortality surveys

can also be used to estimate deaths caused by TB. In 2012,

most countries with a high burden of TB lacked national or

sample VR systems and few had conducted mortality sur-

veys. In the absence of VR systems or mortality surveys, TB

mortality can be estimated as the product of TB incidence

and the case fatality rate, or from ecological modelling

based on mortality data from countries with VR systems.

TB mortality among HIV-positive people is hard to measure

even when VR systems are in place because deaths among

HIV-positive people are coded as HIV deaths and contribu-

tory causes (such as TB) are often not reliably recorded. For

this 2013 report, country-specic estimates of TB deaths

among HIV-positive people were produced for the rst time

using the Spectrum software that has been used for HIV

burden estimates for over a decade (Box 2.1).

Until 2008, WHO estimates of TB mortality used

VR data for only three countries. is was substantially

improved to 89 countries in 2009; however most of the

data were from countries in the European Region and the

 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.10

Trends in estimated TB prevalence rates 1990–2012 and forecast TB prevalence rates 2013–2015, by WHO

region. 5JCFGFCTGCUTGRTGUGPVWPEGTVCKPV[DCPFU6JGJQTK\QPVCNFCUJGFNKPGUTGRTGUGPVVJG5VQR6$2CTVPGTUJKRVCTIGVQHC

50% reduction in the prevalence rate by 2015 compared with 1990. The other dashed lines show projections up to 2015.

Rate per 100 000 population

Africa The Americas Eastern Mediterranean

Europe South-East Asia Western Pacific

200

400

100

150

100

200

400

100

200

300

400

100

200

1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015

BOX 2.3

MDR-TB mortality – methods used to produce updated estimates

#URCTVQHCINQDCNTGRQTVQPVJG/&46$GRKFGOKECPFVJGINQDCNTGURQPUGKVYCUGUVKOCVGFVJCVVJGTGYGTGaFGCVJU

TCPIGa¿aHTQO/&46$KPa6JKUYCUVJGßTUVVKOG9*1RWDNKUJGFCINQDCNGUVKOCVGQH/&46$OQTVCNKV[CPF

given limitations in the available evidence, annual updates have not been attempted.

+PVJGQT[VJGPWODGTQHFGCVJUHTQO/&46$ECPDGGUVKOCVGFCUVJGRTQFWEVQHVQVCNFGCVJUHTQO6$VJGQXGTCNNRTQRQTVKQP

QH6$ECUGUVJCVJCXG/&46$CPFVJGTGNCVKXGTKUM44QHF[KPICOQPIRGQRNGYKVJ/&46$EQORCTGFYKVJVJQUGYKVJQWV

/&46$*QYGXGTYJKNGGUVKOCVGUQHVQVCN6$OQTVCNKV[CPFVJGRTGXCNGPEGQH/&46$JCXGDGGPCXCKNCDNGHQTUGXGTCN[GCTUHTQO84

FCVCKGHQTVQVCN6$FGCVJUCPFTGRTGUGPVCVKXGUWTXGKNNCPEGQTUWTXG[FCVCHQTVJGRTQRQTVKQPQHECUGUYKVJ/&46$CPGUVKOCVG

QHVJG44YCUPQV

+P9*1EQOOKUUKQPGFCU[UVGOCVKETGXKGYQHVJG44QHF[KPIHTQO/&46$EQORCTGFYKVJ6$6YGPV[ßXGUVWFKGUVJCV

KPENWFGFFCVCCDQWVOQTVCNKV[COQPIRCVKGPVUGPTQNNGFQPVTGCVOGPVHQT/&46$CPF6$YKVJQWV/&46$FWTKPICPFCHVGT

VTGCVOGPVYGTGKFGPVKßGF6JGUGCNNQYGFECNEWNCVKQPQHCINQDCNGUVKOCVGQHVJG44QHF[KPIHTQO/&46$TCPIG¿

6JGUVWFKGUJCFCDTQCFIGQITCRJKECNEQXGTCIGCPFKPENWFGFEQWPVTKGUYKVJDQVJJKIJCPFNQYDWTFGPUQH/&46$CPF*+8DWV

YGTGKPUWHßEKGPVVQGUVKOCVGTGIKQPURGEKßE44U

$CUGFQPVJGTGUWNVUQHVJGOGVCCPCN[UKUKVKUGUVKOCVGFVJCVINQDCNN[KPVJGTGYGTGaFGCVJUTCPIGa¿

aHTQO/&46$

a MultidruI- and eZtensiXely druI-resistant TB M:&4-TB 2010 Ilobal report on surXeillance and response (WHO/HTM/TB/2010.3). Geneva, World Health

1TICPK\CVKQP#XCKNCDNGCVJVVRYYYYJQKPVVDRWDNKECVKQPUGP

19GLOBAL TUBERCULOSIS REPORT 2013

Region of the Americas, which accounted for less than 10%

of the world’s TB cases. In 2011, the rst uses of sample

VR data from China and survey data from India enabled a

further major improvement to estimates of TB mortality.

For the current report, VR data of sucient coverage and

quality were available for 121 countries. Combined with

survey data from India and Viet Nam, this means that esti-

mates of TB mortality are based on direct measurements

of TB mortality in 123 countries (shown in Figure 2.11).

Collectively, these 123 countries account for 45% of the

estimated number of TB deaths globally. e parts of the

world where there are major gaps in the availability of VR

data are the African Region and parts of the South-East

Asia Region; in the latter, Indonesia is currently building a

sample VR system.

ere were an estimated 1.3 million TB deaths in 2012

(Table 2.1, Figure 2.2): 940000 among HIV-negative peo-

ple and 320 000 among HIV-positive people (TB deaths

among HIV-positive people are classied as HIV deaths in

ICD-10).1 ese deaths included 410000 among women and

74000 among children (Box 2.2). ere were approximate-

ly 170000 deaths from MDR-TB (range, 102000‒242000):

methods used to produce this new global estimate of MDR-

TB mortality are explained in Box 2.3.

Approximately 75% of total TB deaths occurred in the

African and South-East Asia Regions in 2012 (both includ-

ing and excluding TB deaths among HIV-positive people).

India and South Africa accounted for about one-third of

global TB deaths.

e number of TB deaths per 100000 population aver-

aged 13 globally in 2012 (

Table 2.2) and 17.6 when TB

deaths among HIV-positive people are included. ere is

considerable variation among countries (Figure 2.12),

ranging from under 1 TB death per 100 000 population

(examples include most countries in western Europe, Can-

ada, the United States of America, Australia and New Zea-

land) to more than 40 deaths per 100000 population in

much of the African Region as well as three HBCs in Asia

(Bangladesh, Cambodia and Myanmar).

Globally, mortality rates (excluding deaths among

HIV-positive people)2 have fallen by 45% since 1990; the

current forecast suggests that the Stop TB Partnership

target of a 50% reduction in TB mortality by 2015 com-

pared with a baseline of 1990 will be achieved (Figure 2.6).

Mortality rates are declining in all six WHO regions (Fig-

ure 2.13). e 2015 target has already been surpassed in

the Region of the Americas (since 2004) and the Western

Pacic Region (since 2002), and may have been reached in

the Eastern Mediterranean Region. Among the other three

regions, the South-East Asia Region appears best placed

to achieve the target. Mortality rates appear to be falling

in most of the 22 HBCs (Figure 2.14), although there is

considerable uncertainty about the level of and trends in

mortality in some countries, notably Mozambique, Nigeria,

South Africa and Zimbabwe.

FIGURE 2.11

Countries (in orange) for which TB mortality is estimated using measurements from vital registration (n=121)

systems and/or mortality surveys (n=2, India and Viet Nam)

1 International statistical classication of diseases and related health

problems, 10th revision (ICD-10), 2nd ed. Geneva, World Health

Organization, 2007.

2 Trends in TB mortality rates are restricted to TB deaths among

HIV-negative people, given that TB deaths among HIV-positive

people are classied as HIV deaths in ICD-10.

20 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.12

Estimated TB mortality rates excluding TB deaths among HIV-positive people, 2012

Estimated TB

deaths per

100 000 population

0–0.9

1–3.9

4–9.9

10–19

20–39

≥40

No data

Not applicable

FIGURE 2.13

Trends in estimated TB mortality rates 1990–2012 and forecast TB mortality rates 2013–2015, by WHO

region. Estimated TB mortality excludes TB deaths among HIV-positive people. Shaded areas represent uncertainty bands.a

6JGJQTK\QPVCNFCUJGFNKPGUTGRTGUGPVVJG5VQR6$2CTVPGTUJKRVCTIGVQHCTGFWEVKQPKPVJGOQTVCNKV[TCVGD[

compared with 1990. The other dashed lines show projections up to 2015.

a The width of an uncertainty band narrows as the proportion of regional mortality estimated using vital registration data increases or the quality and completeness of the vital

registration data improves.

2.5

5.0

7.5

1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015

Rate per 100 000 population per year

Africa The Americas Eastern Mediterranean

Europe South-East Asia Western Pacific

21GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.14

Trends in estimated TB mortality rates 1990–2012 and forecast TB mortality rates 2013–2015, 22 high-

burden countries. 'UVKOCVGF6$OQTVCNKV[GZENWFGU6$FGCVJUCOQPI*+8RQUKVKXGRGQRNG6JGJQTK\QPVCNFCUJGFNKPGU

represent the Stop TB Partnership target of a 50% reduction in the mortality rate by 2015 compared with 1990. The

other dashed lines show projections up to 2015.a Uncertainty is due to adjustments made to the mortality data from vital

registration systems that were reported by countries (mortality data from vital registration systems are represented by the “x”

symbol). Further explanation of methods is provided in Annex 1.

a The width of an uncertainty band narrows as the quality and completeness of vital registration

data improves.

b Estimates of TB disease burden have not been approved by the national TB programme in

Bangladesh and a joint reassessment will be undertaken following the completion of the

prevalence survey planned for 2014.

Afghanistan BangladeshbBrazil Cambodia China

DR Congo Ethiopia India Indonesia Kenya

Mozambique Myanmar Nigeria Pakistan Philippines

Russian Federation South Africa Thailand Uganda UR Tanzania

Viet Nam Zimbabwe

Rate per 100 000 population per year

100

150

100

1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015

1990 1995 2000 2005 2010 2015

100

200

100

200

300

100

2.5

5.0

7.5

100

200

300

100

150

200

100

150

2.4 Strengthening measurement of the

burden of disease caused by TB:

the WHO Global Task Force on TB Impact

Measurement

e estimates of TB incidence, prevalence and mortality

and their trend presented in sections 2.1–2.3 are based

on the best available data and analytical methods. None-

theless, there remains considerable scope to improve mea-

surement of the level of and trends in TB disease burden.

is nal section of the chapter describes the latest status

of eorts to improve measurement of the burden of dis-

ease caused by TB, under the umbrella of the WHO Global

Task Force on TB Impact Measurement. is task force was

established in 2006 and includes representatives from lead-

ing technical and nancial partners and countries with a

high burden of TB.1

At its second meeting in December 2007, the Global Task

Force on TB Impact Measurement dened three strategic

areas of work:2

strengthening surveillance towards the ultimate goal

of direct measurement of incidence and mortality from

notication and VR systems, respectively;

1 Many countries with a high burden of TB are engaged in the work of

the Task Force. Partners that are actively participating in the work

of the Task Force include the Centers for Disease Control and Pre-

vention in the USA, the European Centre for Disease Prevention

and Control, the Global Fund, Public Health England, the KNCV

Tuberculosis Foundation, the London School of Hygiene and Trop-

ical Medicine in the UK, the Research Institute for Tuberculosis in

Japan, the Union and the United States Agency for International

Development (USAID).

2 TB impact measurement: policy and recommendations for how to

assess the epidemiological burden of TB and the impact of TB control.

Geneva, World Health Organization, 2009 (Stop TB policy paper

no. 2; WHO/HTM/TB/2009.416). Available at www.who.int/tb/

publications/2009/impactmeasurementpolicy/

22 GLOBAL TUBERCULOSIS REPORT 2013

conducting surveys of the prevalence of TB disease in a

set of global focus countries that meet epidemiological

and other relevant criteria; and

periodic review and updating of the methods used to

translate surveillance and survey data into estimates of

TB incidence, prevalence and mortality.

In 2008 and 2009, methods were thoroughly reviewed and

updated by an expert group convened by the task force.

Updates were discussed and endorsed by the full task force

in March 2010. Current methods are described in detail in

Annex 1, and an updated review is planned in 2014 (Box

2.1). e following sections focus on the other two strate-

gic areas of work: strengthened surveillance and national

TB prevalence surveys. Further details are available on the

task force’s web site.1

2.4.1 Strengthening surveillance

Reasons for uncertainty in current estimates of TB inci-

dence include use of expert opinion about both the num-

ber of cases that are diagnosed but not reported to national

surveillance systems and the number of cases that are not

diagnosed at all (section 2.1). Major challenges in estimat-

ing TB mortality include the lack of VR systems of su-

cient coverage and quality in many countries, notably in

Africa and parts of Asia (Figure 2.11). e long-term goal

of directly measuring the level of and trends in TB disease

burden from routine surveillance data, using notication

data to measure TB incidence and VR data to measure TB

mortality, requires strengthened surveillance in many

countries. Countries for which more robust estimates of

mortality were available in 2012 are shown in Figure 2.11.

TB surveillance checklist of standards and benchmarks

Strengthening surveillance to move towards the goal of

direct measurement of TB incidence and mortality requires

a clear understanding of what a ‘model’ surveillance system

should look like and a method for assessing the current per-

formance of TB surveillance. Following considerable work

in 2011 and 2012, a TB surveillance checklist that denes

the standards and associated benchmarks that need to be

met for a country’s notication and VR data to be used as

a direct measure of TB incidence and mortality has been

developed (Box 2.4).

Use of the checklist began in January 2013 and it is being

applied in a growing number of countries (Figure 2.15) as

the basis for identifying what standards are already met

and the investments required to close remaining gaps.

is work is being undertaken in close collaboration with

the Global Fund so that use of the checklist is integrated

into the fund’s grant processes and ndings can inform

investments by the fund as well as national governments

and other partners (Box 2.5). With more than 100 low-

and middle-income countries receiving TB grants from the

Global Fund, this approach has great potential to make a

real dierence to TB surveillance worldwide. An initial list

of 25 priority countries has been dened.

Inventory studies to measure or estimate

TB underreporting

One of the standards in the TB surveillance checklist is

that all diagnosed cases of TB are reported to the national

surveillance system. e two benchmarks that must be sat-

ised are that TB reporting is a legal requirement, and that

≥90% of TB cases are reported to national health authori-

ties, as determined by a national-level investigation such as

an inventory study. To date, few countries have implement-

ed an inventory study but as the number doing so increas-

es, estimates of the level of and trend in TB incidence will

improve. Even when underreporting is considerable and

notication data are not a good proxy for TB incidence,

results from inventory studies can be used to quantify the

gap and obtain more precise estimates of disease burden

and provide valuable information about where eorts to

collaborate with public and private sector providers are

needed (see also Chapter 3, section 3.2.1). In 2012, the

Global Task Force on TB Impact Measurement completed a

guide on how to design and implement an inventory study,

and how to analyse and report results.2

In the past 10 years, inventory studies combined with

capture–recapture analysis have been implemented in the

Netherlands, the UK, French Guiana, Egypt, Iraq, Pakistan

and Yemen. Results from the study in Iraq are summarized

in Box 2.6.

Electronic recording and reporting of data

Several of the standards in the TB surveillance checklist

are about data quality. In all of the regional and country

workshops held between 2008 and 2013, it was evident that

it is much easier to assess the quality of TB surveillance

data in countries with case-based electronic recording and

reporting systems. Besides facilitating assessment of data

quality, electronic recording and reporting systems have

other major advantages compared to systems based solely

on paper-based recording and reporting. ese include:

Better programme and resource management, by

encouraging sta to use and act upon live data. is may

help to prevent defaulting from treatment and assist

with management of drug supplies (including avoidance

of stock-outs).

Improved surveillance by making it easier for facilities

not traditionally linked to the NTP, such as hospitals,

prisons and the private sector, to report TB cases, and by

reducing the burden of compiling and submitting data

through paper-based quarterly reports.

Analysis and use of data is facilitated, since data can be

readily imported into statistical packages. Results are

then available to decision-makers more quickly and it is

possible to detect outbreaks promptly.

1 www.who.int/tb/advisory_bodies/impact_measurement_

taskforce

2 Assessing tuberculosis underreporting through inventory studies. Gene-

va, World Health Organization, 2013 (WHO/HTM/TB/2012.12).

Available at: www.who.int/tb/publications/inventory_studies/en/

index.html

23GLOBAL TUBERCULOSIS REPORT 2013

BOX 2.4

The TB surveillance checklist of standards and benchmarks

A major goal of TB surveillance is to

provide an accurate measure of the

number of new TB cases and TB deaths

that occur each year, and to be able

to assess trends over time. In some

countries, TB surveillance already meets

the standards necessary to do this, but

in others there are important gaps. For

example, TB cases that are diagnosed

in the private sector are not reported

in many settings, and in many low- and

middle-income countries some people

with TB may not easily access health

care and therefore not be diagnosed

at all. Furthermore, a large number of

countries lack vital registration systems

with the geographical coverage and

quality required to accurately measure

deaths caused by TB (section 2.3). The

Checklist of standards and benchmarks

for TB surXeillance and Xital reIistration

systems was developed with the

HQNNQYKPIQDLGEVKXGU

To assess a national surveillance

system’s ability to accurately measure

TB cases and deaths.

To identify TB surveillance gaps in

national surveillance systems that

need to be addressed.

The outcomes of the checklist can

be used to identify countries with

surveillance systems that already provide

an accurate measure of the number of

TB cases and deaths that occur each

[GCTCPFVQFGßPGVJGCEVKQPUPGEGUUCT[

to strengthen surveillance in countries

KPYJKEJICRUCTGKFGPVKßGFa Countries

KPVJGHQTOGTECVGIQT[ECPDGEGTVKßGF

as having surveillance data that provide

a direct measure of TB incidence and/or

mortality.

The checklist was developed by a

team of experts in disease surveillance

in conjunction with expert advice

HTQOOGGVKPIUQTICPK\GFD[9*1KP

September 2011 and May 2012. The

checklist underwent two rounds of

ßGNFVGUVKPIKPGNGXGPEQWPVTKGU$TC\KN

China, Egypt, Estonia, Japan, Kenya,

the Netherlands, Thailand, Uganda, the

United Kingdom and the United States

of America.

The checklist is ten pages long

and has two parts. Part A consists of

eighteen questions that are used to

characterise the national TB surveillance

system; these provide the background

for part B, which consists of thirteen

standards and their associated

benchmarks. The standards are general

statements about the characteristics

VJCVFGßPGCJKIJRGTHQTOCPEG6$

surveillance system; nine standards

are related to the measurement of

TB cases and one is related to the

measurement of TB deaths. There are

three supplementary standards that can

be used to assess whether a country’s

surveillance system provides a direct

measure of the number of drug-resistant

TB cases, HIV-positive TB cases, and TB

cases among children. For each of the

VJKTVGGPUVCPFCTFUDGPEJOCTMUFGßPG

(in quantitative terms wherever possible)

the level of performance considered

UWHßEKGPVVQOGGVVJGTGURGEVKXG

standard. An accompanying user guide

explains the rationale for each standard

and associated benchmark(s), and the

methods that should be used to assess

whether the benchmarks and hence the

standard are met. Illustrative examples

are also provided in the user guide.

Based on a completed assessment

using the checklist, countries can

identify key actions needed to address

KFGPVKßGFICRUKPPQVKßECVKQPCPFXKVCN

registration systems. It is anticipated

that an assessment of TB surveillance

using the checklist would take place

GXGT[VJTGGVQßXG[GCTUDWVEQWNFCNUQ

be done more frequently.

Following the 2012

recommendations of the Global Fund’s

6GEJPKECN'XCNWCVKQP4GHGTGPEG)TQWR

and a collaborative agreement between

the fund and WHO, assessments of TB

surveillance using the checklist are

increasingly being integrated within

the fund’s grant mechanisms. As such,

assessments with the checklist should

be timed to coincide with programme

reviews, Global Fund grant renewals

and the development of the concept

notes required to access funding in

the fund’s new funding model (NFM)

NCWPEJGFKP4GUWNVUECPVJGPDG

used to develop or update monitoring

and evaluation investment plans that

can be supported through grants from

the Global Fund as well as by national

budgets and by other partners. This

collaborative effort with the Global

Fund has great potential to help

strengthen TB surveillance in more than

a hundred countries receiving grants

worldwide. Assessments in 15 high-

burden and high-impact countries are

DGKPIRTKQTKVK\GFKPCPF

by August 2013, a total of eleven

countries including eight of the fund’s

high-burden or high-impact countries

had completed the assessment (Figure

2.15).

The checklist and user guide

are available on the website of the

WHO Global Task Force on TB Impact

/GCUWTGOGPV

JVVRYYYYJQKPVVDCFXKUQT[ADQFKGU

KORCEVAOGCUWTGOGPVAVCUMHQTEGGP

a The checklist is not intended to assess a

U[UVGOÂUCDKNKV[VQHWNßNQVJGTRTQITCOOCVKE

requirements, e.g. patient care, delivery of

laboratory results, or drug management.

Higher quality data, since automated data quality checks

can be used and duplicate or misclassied notications

can be identied and removed (which is very dicult or

impossibleto do nationally with paper-based systems).

It is also easier to introduce new data items.

Identication of clusters of cases in space and time,

including clusters of drug-resistant cases, thus allowing

early investigation and containment of epidemics.

Countries that have national electronic case-based data-

bases of TB patients are shown in Figure 2.16. A recent

example of the implementation of a case-based electron-

ic recording and reporting system, in Kenya, is described

in Box 2.7. Recent guidance on electronic recording and

reporting for TB care and control, developed by WHO and

partners in 2011, is available on the task force’s website.1

1 Electronic recording and reporting for TB care and control. Geneva,

World Health Organization, 2013 (WHO/HTM/TB/2011.22).

Available at www.who.int/tb/publications/electronic_recording_

reporting

24 GLOBAL TUBERCULOSIS REPORT 2013

BOX 2.5

The TB surveillance checklist in Indonesia: from implementation to resource mobilization

A national assessment of the TB surveillance system in

Indonesia using the Checklist of standards and benchmarks for

TB surXeillance and Xital reIistration systems (see Box 2.4)

was undertaken in February 2013, linked to a national

programme review.

A thorough analysis of all available national, provincial

CPFFKUVTKEVNGXGNVKOGUGTKGUQH6$PQVKßECVKQPCPFQVJGT

available surveillance data was completed. A desk review of NTP

manuals, guidelines, policy and training documents, annual

reports, reporting forms and registers was conducted. Other

information was collected through interviews with NTP staff,

partners and other stakeholders.

The TB surveillance system is based on quarterly reporting

QHPQVKßGFECUGUHTQOJGCNVJHCEKNKVKGUVQFKUVTKEVUVQRTQXKPEGU

CPFßPCNN[VQVJGPCVKQPCNNGXGN+VKUEWTTGPVN[VTCPUKVKQPKPI

to a web- and case-based electronic recording and reporting

U[UVGO6$ECUGFGßPKVKQPUYGTGEQPUKUVGPVYKVJKPVGTPCVKQPCN

IWKFGNKPGU6JGTGYGTGQWVQHFKUVTKEVUKPVJGEQWPVT[

that submitted all quarterly reports to the national level in

2011. The system produced externally but not internally

consistent data. Since TB reporting is not a legal requirement,

not all TB cases were reported to the NTP, but the level of

underreporting of cases from the private to the public sector

has not been measured nationally. There have been steady

improvements in access to health care, but it is still not at

CNGXGNUWHßEKGPVVQGPUWTGVJCVCNN6$ECUGUJCXGCEEGUUVQ

FKCIPQUKUCPFECTG#PCVKQPCNN[TGRTGUGPVCVKXG84U[UVGOYKVJ

standard coding of causes of death is being developed. Only

provincial level drug resistance surveys have been conducted

so far, and while HIV testing of TB cases was improving the

coverage remains low. Finally, childhood TB was diagnosed in

limited settings.

#EVKXKVKGUVQCFFTGUUVJGICRUVJCVYGTGKFGPVKßGFHTQO

VJGKORNGOGPVCVKQPQHVJGEJGEMNKUVYGTGFGßPGFUGGTable

B2.7.1). One of the top priorities is maintenance of the sample

84U[UVGOYJKEJEQUVU75¿RGTECRKVCKPVJGUCORNGF

CTGCUGSWKXCNGPVVQCDQWV75a¿OKNNKQPRGT[GCTHQTVJG

population of 5 million to be covered). For the other activities

in Table B2.7.1, the total budget requirement was estimated

VQDG75aOKNNKQPCOQPIYJKEJQPGVQRRTKQTKV[KFGPVKßGF

in the key recommendations arising from the 2013 programme

TGXKGYKUKORNGOGPVCVKQPQHCOCPFCVQT[PQVKßECVKQPRQNKE[

Through continuous consultations between the NTP, WHO and

VJG)NQDCN(WPFVJGßPCPEKPITGSWKTGFHQTVJGKPXGUVOGPVRNCP

YCUKFGPVKßGFCPFUGEWTGF

This example shows how the checklist can be used to

EQPFWEVCUVCPFCTFK\GFCUUGUUOGPVQH6$UWTXGKNNCPEGJKIJNKIJV

progress achieved as well as remaining gaps to be addressed,

and to secure funding for an investment plan to close the gaps

with support from the Global Fund.

TABLE B2.7.1

Investment plan for strengthening surveillance in

+PFQPGUKCDCUGFQPICRUKFGPVKßGFVJTQWIJVJG

implementation of the Checklist of standards and

benchmarks for TB surveillance and vital registration

systemsVQVCNDWFIGV75aOKNNKQPGZENWFKPI84

U[UVGOHWPFGFUGRCTCVGN[

Activity

■ 8KVCNTGIKUVTCVKQP84OCKPVCKPKPICPFUECNKPIWRVJGPCVKQPCNN[

TGRTGUGPVCVKXGUCORNG84U[UVGO

■ Inventory study to measure the level of underreporting

■ Capacity building for data management and statistical analysis –

VJTQWIJCVVGPFKPIEQWTUGUCPFGZVTCUVCHßPICVVJGEGPVTCNNGXGN

■ Implementation of the SerXice #Xailability and 4eadiness

#ssessment Tool and health facility data quality assessment

■ Assessment of the Integrated Tuberculosis Information System (SITT)

Phase 2 in 2014

■ +ORNGOGPVKPIOCPFCVQT[PQVKßECVKQPRQNKE[

■ Analysis of available mortality data

■ Drug resistance survey or sentinel surveillance

■ Nationally representative survey of HIV prevalence among TB

patients

■ Corrective actions required to compile all the reports from Papua

1 TB prevalence surveys: a handbook. Geneva, World Health Organiza-

tion, 2011 (WHO/HTM/TB/2010.17). Available at www.who.int/

tb/advisory_bodies/impact_measurement_taskforce/resources_

documents/thelimebook/

2.4.2 National surveys of the prevalence of

TB disease

Before 2007, few countries had implemented nationwide

prevalence surveys. In the 1990s, national surveys were

conned to China, Myanmar, the Philippines and the

Republic of Korea. Before 2009 and with the exception of

Eritrea in 2005, the last national surveys in the African

Region were undertaken between 1957 and 1961. From

2002 to 2008, there was typically one survey per year.

In 2007, WHO’s Global Task Force on TB Impact Mea-

surement identied 53 countries that met epidemiological

and other criteria for implementing a survey. A set of 22

global focus countries were selected to receive particular

support in the years leading up to 2015. e African coun-

tries were: Ethiopia, Ghana, Kenya, Malawi, Mali, Mozam-

bique, Nigeria, Rwanda, Sierra Leone, South Africa, Uganda,

the United Republic of Tanzania and Zambia. Countries in

Asia were: Bangladesh, Cambodia, China, Indonesia, Myan-

mar, Pakistan, the Philippines, ailand and Viet Nam.

Since early 2008, substantial eorts to support countries

to design, implement, analyse and report on surveys have

been made. Examples include development of updated guid-

ance,1 coordination of technical assistance, expert reviews

of protocols, organization of study tours and mid-term sur-

vey reviews, and global and regional workshops to support

survey design and implementation and to share results and

lessons learned among countries. As part of these eorts,

25GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.15

Countries (in orange) where the TB surveillance checklist of standards and benchmarks has been used:

status in August 2013

BOX 2.6

Inventory studies to estimate TB underreporting: an example from Iraq

Inventory studies compare the number of TB cases meeting

UVCPFCTFECUGFGßPKVKQPUKPCNNQTKPCUCORNGQHRWDNKECPF

RTKXCVGJGCNVJHCEKNKVKGUYKVJVJGTGEQTFUQH6$ECUGUPQVKßGF

to local and national authorities. This enables the level of

WPFGTTGRQTVKPIQHFKCIPQUGFECUGUVQDGSWCPVKßGF+PEGTVCKP

circumstances, the results from inventory studies can be

combined with a type of modelling called capture–recapture

analysis to estimate TB incidence. A WHO guide on the design

and implementation of inventory studies, and analysis and

reporting of results, was published in 2013.

The results from the survey in Iraq,a which was completed

in 2011, are illustrated below. The number of TB cases that

were detected by three types of health service providers

was studied during a three-month period in eight randomly

UGNGEVGFIQXGTPQTCVGUQWVQHCVQVCNQH6JGVQVCNPWODGT

QHFGVGEVGFECUGUYCU%CUGUVJCVYGTGFGVGEVGFDWVPQV

reported to the NTP accounted for 16% of total detected cases

i.e. the level of underreporting was 16%. Capture–recapture

modelling was used to estimate that an additional 473 cases

EQPßFGPEGKPVGTXCN¿JCFPQVDGGPFGVGEVGFD[

any of the three types of health providers. These results were

WUGFVQGUVKOCVGVJCVVJGTGYGTGCRRTQZKOCVGN[aKPEKFGPV

cases of TB in Iraq in 2011 (a downward revision compared with

previous estimates) and that about 60% of cases were being

detected (an upward revision from the previous best estimate

QH

The value of study results went beyond updates to estimates

QH6$KPEKFGPEG'ZCORNGUKPENWFG

NTP

(n=1673) Private

(n=649)

0 Public

(n=377)

 416 199

244 9

Updated estimates were crucial for the development of a

sound national strategic plan and to assess progress towards

the 2015 MDG target.

The national strategic plan includes interventions designed

VQCFFTGUUVJGECWUGUQHWPFGTTGRQTVKPIVJCVYGTGKFGPVKßGF

during the study.

The mapping of all health facilities delivering care to

chest-symptomatic patients in study areas (that covered

50% of the country) provided a foundation for sustained

engagement of all care providers through PPM initiatives.

a Huseynova S et al. Estimating tuberculosis burden and reporting in

TGUQWTEGNKOKVGFEQWPVTKGUCECRVWTGTGECRVWTGUVWF[KP+TCSInternational

,ournal of Tuberculosis and LunI &iseasea¿

FIGURE B2.6.1

Results from the 2011 inventory study in Iraq

26 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 2.16

Availability of national electronic case-based databases of TB patients, 2012

All TB patients

MDR-TB patients only

None

No data

Not applicable

FIGURE 2.17

Global progress in implementing national surveys of the prevalence of TB disease, actual (2002–2013)

and expected (2014–2017)

Number of surveys

Kenya



/Q\CODKSWG

South Africa

Uganda

Nigeria Ghana Bangladesh

Ethiopia Rwanda Malawi DPR Korea

Cambodia 746CP\CPKC Zambia Mongolia Myanmar

Philippines Pakistan Thailand Indonesia Nepal Philippines

Cambodia Malaysia Indonesia Eritrea Thailand Viet Nam Bangladesh Myanmar China Lao PDR Gambia Sudan Zimbabwe Viet Nam

2002 2003 2004 2005 2006 2007  2009 2010 2011 2012 2013 2014–

2015

2016–

2017

Global focus countries (GFC)

selected by WHO Global Task Force

on TB Impact Measurement

Asia – GFC Africa – GFC Non – GFC

the concept of Asia–Asia, Asia–Africa and Africa–Africa

(‘AA’) collaboration has been strongly promoted.

Following six years of substantial eort at country,

regional and global levels, unprecedented progress has

been achieved (Figure 2.17). If surveys are implemented

according to schedule, more than 20 surveys will be

implemented between 2011 and 2015. Five national TB

prevalence surveys were implemented in 2012 (Gambia,

Nigeria, Rwanda, the United Republic of Tanzania and

ailand) and a further ve w ill start or be completed in 2013

(Ghana, Indonesia, Malawi, Sudan and Zambia). ese

surveys provide an unbiased estimation of disease burden,

often for the rst time, and will be used to update estimates

of disease burden once results are nalized (Box 2.1).

Surveys are also providing a rich source of data to

inform programme policy and strategy. Although results

remain provisional pending nalization of analyses in late

2013 (Box 2.1), an excellent recent example is provided

by the 2012 survey in Nigeria (Box 2.8). For other recent

surveys, some country-specic reports are already public-

ly available (for example, from China, Cambodia, Ethiopia

and Myanmar) and others are in the pipeline. Papers for

peer-reviewed journals are also in preparation, from these

and other recent surveys.

WHO, together with countries and technical partners,

started preparing or planning global and regional synthe-

27GLOBAL TUBERCULOSIS REPORT 2013

BOX 2.7

Implementation of an innovative electronic surveillance and management system in Kenya

The NTP in Kenya has rolled out an innovative electronic

system to support surveillance and management, called TIBU

(which means cure in Swahili). In addition to running electronic

versions of its standard district TB registers, the TIBU system

makes use of the country’s extensive mobile communications

network and widespread use of mobile phones to make

RC[OGPVUVQ/&46$RCVKGPVUVJCVJGNRVQUWRRQTVVJGKT

VTGCVOGPVVJTQWIJVJGRQRWNCTaM-Pesa mobile payment system.

The system will also be used to manage drug supplies and

laboratory data and consumables.

At TIBU’s core is a national case-based database that stores

details about each individual patient episode of TB (including

ECUGUQH/&46$7UGTUCEEGUUVJGU[UVGOGKVJGTVJTQWIJCYGD

browser or by using an Android ‘app’. The NTP has given each

District TB and Leprosy Coordinator (DTLC) a tablet computer

VJCVTWPUVJG#PFTQKFQRGTCVKPIU[UVGOCPFKUßVVGFYKVJC

SIM card to connect to the internet through mobile telephone

networks. DTLCs can access the system during their regular

visits to all facilities providing TB diagnostic and treatment

services within their district and enter TB patient details into

the TIBU app during their visits to these facilities. Data are

transmitted directly to the national database via the mobile

network. Data remain stored on the tablet if no connection

is available at a facility and are subsequently transmitted to

the national database as soon as a connection is available.

TIBU automatically generates various reports, including

standard quarterly reports, charts and maps for all levels of the

administrative chain.

The NTP and developers work closely with other parts of the

Ministry of Health to ensure that TIBU complies with national

standards, such that it can communicate with the ministry’s

other health information systems.a TIBU uses Kenya’s national

facility coding scheme (JVVRYYYGJGCNVJQTMGHCEKNKVKGU

facilitytypes.aspx) and therefore the developers were able to

DWKNFCUGCONGUUNKPMVQVJGa-enya *ealth Information Systemb

VJCVRTQXKFGUFKUVTKEVRTQXKPEKCNCPFPCVKQPCNJGCNVJQHßEKCNU

YKVJKPFKECVQTUHQTOWNVKRNGJGCNVJCTGCUKPENWFKPI6$a6JKU

allows standard TB indicators to be automatically updated every

quarter in the ministry’s system.

TIBU has been developed in phases. Development was

initiated in 2007 and the original intention was to run the

system on personal digital assistants (PDAs). However, problems

with initial attempts to implement the system combined with

the rapid rise, availability and falling costs of Android-based

mobile devices, as well as the widespread adoption of mobile

phones, led to a decision to switch to the development of an

#PFTQKFaCRRaHQTWUGQPUOCTVRJQPGUCPFVCDNGVEQORWVGTU

Plans for future phases include extending coverage beyond TB

and leprosy to patients with asthma and other lung diseases,

integration with the laboratory management system and

eventually, if resources allow, roll out of tablets to over 4000

health care facilities where TB diagnostic and treatment

services are offered.

a In May 2013 the World Health Assembly adopted resolution WHA66.24 on

promoting such standardization and interoperability of health information

systems (JVVRCRRUYJQKPVIDGDYJCRFHAßNGU9*##A4GPRFHa

b Based on the open source DHIS2 platform JVVRYYYFJKUQTI

BOX 2.8

The 2012 national TB prevalence survey in Nigeria: programmatic implications

+ORNGOGPVCVKQPQHVJGßTUVGXGTPCVKQPCN6$RTGXCNGPEGUWTXG[KP0KIGTKCDGICPKP(GDTWCT[CPFßGNFCEVKXKVKGUEQXGTKPI

70 geographic clusters) were completed in October 2012. Nigeria became the second African country to successfully complete a

PCVKQPCNUWTXG[CEEQTFKPIVQEWTTGPV9*1IWKFGNKPGUHQNNQYKPI'VJKQRKCKP#VQVCNQHaRGQRNGCIGFÜRCTVKEKRCVGF

in the study.

Survey results included that 75% of previously undetected cases found during the survey had sputum smear-positive TB and

classic TB symptoms that met national screening criteria (this proportion was higher than in any other survey implemented since

%QORCTKUQPQHVJGPWODGTQHRTGXCNGPVECUGUQHURWVWOUOGCTRQUKVKXG6$YKVJPQVKßECVKQPFCVCHQTVJGUCOGCIGITQWR

UJQYGFCRTGXCNGPEGPQVKßECVKQPTCVKQQHCNUQJKIJGTVJCPKPCP[QVJGTUWTXG[KORNGOGPVGFUKPEG6JGUWTXG[CNUQ

illustrated that the burden of TB was geographically uneven, ranging from very low to extremely high levels among survey clusters.

An important conclusion already drawn from the survey results is that a top priority is to expand access to and improve the

quality of basic TB diagnostic and treatment services. If high-quality DOTS services were readily available, it would be expected that

DQVJVJGRGTEGPVCIGQHRTGXCNGPVECUGUYKVJV[RKECN6$U[ORVQOUCPFVJGRTGXCNGPEGPQVKßECVKQPTCVKQYQWNFDGOWEJNQYGT

#UGEQPFEQPENWUKQPKUVJCVURGEKßEHQEWUKUPGGFGFQPIGQITCRJKEÁJQVURQVUÂYJGTGVJGFKUGCUGDWTFGPKUJKIJGUV

ses of the main results and lessons learned from national

TB prevalence surveys in 2012. A paper that summarizes

the results and lessons learned from surveys conducted

1990–2012 in Asia is nearing completion and a similar

paper about recent surveys in Africa is planned. An overall

synthesis of the main implications of results from recent

prevalence surveys implemented in Asia and Africa for

post-2015 global TB policy and strategy is also in the pipe-

line. ese global and regional summaries will be widely

disseminated once available, starting in 2014.

 GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

TB case notißcations

and treatment outcomes

Routine recording and reporting of the numbers of TB

cases diagnosed and treated by NTPs and monitoring of

treatment outcomes was one of the ve components of

the global TB strategy (DOTS) launched by WHO in the

mid-1990s and it remains a core element of its successor,

the Stop TB Strategy (Chapter 1). With the standard de-

nitions of cases and treatment outcomes recommended by

WHO and associated recording and reporting framework

as a foundation, global monitoring of trends in case noti-

cations and treatment outcomes has been possible since

1995. e number of people diagnosed and treated for TB

and associated treatment outcomes is routinely monitored

by NTPs in almost all countries, which in turn report these

data to WHO in annual rounds of global TB data collection

(Chapter 1).

is chapter has four parts. Section 3.1 summarizes

the total number of people diagnosed with TB and noti-

ed by NTPs in 2012, including disaggregation by case

type, age and sex. e share of notications accounted for

by the prison sector in the European Region and the high

case notication rates among the prison population are

also highlighted. Section 3.2 presents and discusses the

contribution to total case notications of public–public

and public–private mix (PPM) initiatives in 29 countries

and of community-based care in 13 countries. Section 3.3

presents trends in notications between 1990 and 2012

and compares these with trends in estimated TB incidence.

Estimates of the ratio of notied:incident cases (an indica-

tor known as the case detection rate or CDR) are provided

for selected years. Section 3.4 describes the latest data on

treatment outcomes (for cases registered for treatment in

2011) as well as treatment outcomes achieved in each year

since 1995.

3.1 Case notißcations in 2012 by type

of disease, age and sex

e denitions of TB cases recommended by WHO until the

end of 2012, and that were used in the 2013 round of glob-

al TB data collection, are shown in Box 3.1. Although not

used in the global TB report this year, it should be highlight-

ed that after a two-year consultation process, WHO issued

updated guidance on denitions of cases and treatment

outcomes and an associated reporting framework in March

2013.1 ese updates were necessary to accommodate

KEY FACTS AND MESSAGES

■ +POKNNKQPECUGUQH6$YGTGPQVKßGFD[

062UCPFTGRQTVGFVQ9*1OKNNKQPYGTGKPFKXKFWCNU

newly diagnosed in 2012 and 0.4 million were previously

diagnosed TB patients whose treatment regimen was

EJCPIGF+PFKCCPF%JKPCCEEQWPVGFHQTQHPQVKßGF

cases of TB worldwide in 2012, African countries for 23%

CPFVJG*$%UHQT

■ +PVJGVTGCVOGPVUWEEGUUTCVGYCUCOQPI

CNNPGY6$ECUGUCPFCOQPIPGYECUGUQHURWVWO

smear-positive pulmonary TB (the most infectious cases).

Improvement in treatment outcomes is needed in the

'WTQRGCP4GIKQPYJGTGVJGVTGCVOGPVUWEEGUUTCVGKP

was 72% and 65% for new cases and new smear-positive

cases respectively.

■ The provision of diagnosis and treatment according

to the DOTS/Stop TB StrateIy has resulted in major

achievements in TB care and control. Between 1995 and

2012, 56 million people were successfully treated for TB

in countries that had adopted the DOTS/Stop TB StrateIy,

saving 22 million lives.

■ 0QVKßECVKQPUQH6$ECUGUJCXGUVCDKNK\GFKPTGEGPV

years, and in 2012 represented 66% (range, 64–69%) of

GUVKOCVGFKPEKFGPVECUGU6JGICRDGVYGGPPQVKßECVKQPU

and incident cases can be explained by a mixture of

underreporting of diagnosed TB cases (for example, failure

to notify cases diagnosed in the private sector) and under-

diagnosis due to poor access to health care and/or failure to

detect cases when people visit health care facilities. Major

efforts are needed to ensure that all cases are detected,

PQVKßGFVQPCVKQPCNUWTXGKNNCPEGU[UVGOUCPFVTGCVGF

according to international standards.

■ +POQUVPQVKßGF6$RCVKGPVUYGTG¿[GCTUQH

CIG%JKNFTGPCIGF[GCTUCEEQWPVGFHQTQHPQVKßGF

ECUGU6JGOCNGHGOCNGTCVKQYCUINQDCNN[TCPIKPIHTQO

1.0 to 2.1 among the six WHO regions.

1 Denitions and reporting framework for tuberculosis – 2013 revision

(WHO/HTM/TB/2013.2). Geneva, World Health Organization,

2013. (Available at www.who.int/iris/bitstream/10665/79199/1/

9789241505345_eng.pdf).

29GLOBAL TUBERCULOSIS REPORT 2013

diagnosis using Xpert MTB/RIF and other WHO-endorsed

molecular tests (Chapter 5), as well as oering an opportu-

nity to improve aspects of the existing (2006) framework,

such as inclusion of more comprehensive reporting of TB

cases among children. e updated denitions, which will

be used in WHO’s 2014 round of global TB data collection,

are summarized in Box 3.2.

In 2012, 6.1 million people with TB were notied to

NTPs and reported to WHO. Of these, 5.7 million had a new

episode of TB (shown as the total of new and relapse cases

in Table 3.1). Of these 5.7 million cases, 5.4 million had

TB for the rst time and 0.3 million were people who had a

recurrent episode of TB after being previously cured of the

disease. Besides a small number of cases whose history of

treatment was not recorded, the remaining 0.4 million had

already been diagnosed with TB but their treatment was

changed to a retreatment regimen.

Among people who were diagnosed with TB for the rst

time (new cases), 2.5 million had sputum smear-positive

pulmonary TB, 1.9 million had sputum smear-negative

pulmonary TB, and 0.8 million had extrapulmonary TB;

the remaining cases did not have a sputum smear done or

their case type was unknown (Table 3.1). India and China

accounted for 39% of the 5.7 million new and relapse cas-

es of TB that were notied in 2012 (23% and 16%, respec-

tively); the South-East Asia and Western Pacic Regions

in which these countries are respectively located together

accounted for 60% of such cases globally. African countries

TABLE 3.1

Case notißcations, 2012

TOTAL NOTIFIED

NEW CASES 4'64'#6/'06%#5'5

NEW AND

4'.#25'a

5/'#4215+6+8' 5/'#40')#6+8'

5/'#4016

DONE

':64#

27./10#4;

%#5'6;2'

UNKNOWN

27./10#4;

CASES

.#$14#614;

%10(+4/'&

2'4%'06#)'1(

27./10#4;

CASES

.#$14#614;

%10(+4/'& 4'.#25'

4'64'#6/'06

':%.4'.#25'

Afghanistan  13 319 4 740 2 665 6 906 702 13 319 62 1 049 197 

Bangladesh 173 619 106 790 24 451 0 30 549 0 106 790  3 065 4 936 

$TC\KN  40 152   10 297 11  70  7 633 75 122

Cambodia    015 290 0 64 446 73 

China  316 332 533 977 2 073 6 479 0 316 332 37  10 033 

&4%QPIQ 112 499 71 124 13 214 20 669 71 124  3 977 3 515 

Ethiopia 147 592 47 236 47 340 2 073  0 47 236 49  2 269 145 323

India   317 616 234 029 2 139 637 273 67 106 463 177 749 

Indonesia 331 424 202 319  15 697 202 319 66 5 942 2 600 

Kenya 99 149 36 937   15 934 0 36 937 50 3 419 6 162 

/Q\CODKSWG  20 951 19 797 5 542 0 20 951 51 1 451  47 741

Myanmar  42 909 73 042 0 20 661 0 42 909 37  6 979 141 170

Nigeria  52 901 32 972 4 432 52 901 62 2 513 5 035 

Pakistan 273 097 110 545 109 425 0 41 410 0 110 545 50 6 095 5 622 267 475

Philippines   115 263 0 3 270 0  45  19 409 216 199

4WUUKCP

Federation 149 921 27 467 59 019 1 039 10 017 0 41 123 47   105 753

South Africa   63 210 71 421 42 467 0  71   323 664

Thailand   17 537  b64  904 60 304

Uganda 47 211 24 916   5 143 0 24 916 65 1 334  44 663

746CP\CPKC   21 393 0 14 595 0  54 1 052 1 714 

Viet Nam 103 906 51 033 21 706  3 210 51 033 67 7 259 1 794 102 112

<KODCDYG  12 163 14 354 2 962 4 912 0 12 163 41 1 369 2 960 35 760

High-burden

countries 5 005 111 2 091 141 1 654 670 100 731 582 909 6 062 2 144 779 56 228 309 335 304 4 669 807

#(4 1 412 639 600 355 345 947 100 537 234 539 977 656 272 63 60 497 67 770 

#/4 232 695 122 606 35 606 14 564 34 400 1 669 132 070 76 9 949  

'/4  173 963 135 346  90 943 702 175 025 55  10 020 420 769

'74 337 167   6 257 39 029 30 112 577 55  67 662 269 505

5'#4 2 331 455   0 3 004 1 027 902 62 131 245 201 335 2 130 120

924 1 345 466 500 171 691 714 9 751 59 294  502 652 42 45 277 34 740 1 310 726

Global 6 090 211 2 541 283 1 913 682 139 632 796 508 9 669 2 606 498 57 283 361 395 389 5 694 822

Blank cells indicate data not reported.

a 0'9#0&4'.#25'KPENWFGUECUGUHQTYJKEJVJGVTGCVOGPVJKUVQT[KUWPMPQYP

b .#$14#614;%10(+4/'&FCVCHQT6JCKNCPFTGHGTVQUOGCTRQUKVKXGECUGUQPN[&CVCQPECUGUVJCVYGTGNCDQTCVQT[EQPßTOGFWUKPIQVJGTOGVJQFUYGTGPQVTGRQTVGF

30 GLOBAL TUBERCULOSIS REPORT 2013

accounted for 24% of new and relapse TB cases globally

(one quarter of these cases were from one country – South

Africa). e WHO Eastern Mediterranean and European

Regions and the Region of the Americas accounted for 16%

of new and relapse TB cases notied in 2012 (7%, 5% and

4%, respectively); combined, the 22 HBCs accounted for

82% of such cases.

Among the 22 HBCs, the percentage of new pulmonary

cases that were bacteriologically conrmed was highest in

Bangladesh (81%) and the Democratic Republic of the Con-

go (84%), and relatively low in China (37%), the Philippines

(45%), the Russian Federation (47%) and Zimbabwe (41%).

Almost all (96%) of the notications of new cases of

smear-positive pulmonary TB were disaggregated by age

and sex (Table 3.2); 88% were aged 15–64 years, 59% were

aged 15–45 years and 2% were children (aged <15 years).

e global male:female sex ratio was 1.9, but among HBCs

this varied from 0.5 in Afghanistan to 3.0 in Viet Nam.

Variation among countries may reect real dierences

in epidemiology as well as dierential access to or use of

health care services linked to the NTP.

Reporting of cases disaggregated by age and sex was

much less complete for new smear-negative pulmonary and

extrapulmonary cases. For example, data disaggregated by

age and sex according to the categories shown in Table 3.2

were not available for 11 HBCs. When the available data

for all new cases were combined, most cases (82%) were

aged 15–64 years, 55% were aged 15–45 years and 6% were

among children (<15 years); the male:female ratio was 1.7,

ranging from 1.0 to 2.1 among the six WHO regions. Fur-

ther eorts are needed to improve reporting of all cases dis-

aggregated by age and sex.

In the European Region, WHO and the European Cen-

tre for Disease Control and Prevention (ECDC) also request

countries to report notications in the civilian and prison

sectors separately. ese data show that notications in

the prison sector can be a considerable share of all cases,

and that case notication rates in the prison population

can be strikingly high. A summary of the latest data in the

European Region and selected countries, and an example of

success in reducing notication rates in the Russian Feder-

ation, are provided in Box 3.3.

BOX 3.1

WHO deßnitions of TB cases used until the end of 2012 (and in this global TB report)a

Deßnite case of TB A patient with Mycobacterium

tuberculosisEQORNGZKFGPVKßGFHTQOCENKPKECNURGEKOGP

either by culture or by a newer method such as molecular line

probe assay (LPA). In countries lacking laboratory capacity

to routinely identify M. tuberculosis, a pulmonary case with

one or more initial sputum specimens positive for acid-fast

DCEKNNK#($KUCNUQEQPUKFGTGFVQDGCÁFGßPKVGÂECUGRTQXKFGF

that there is functional external quality assurance with blind

rechecking.

Case of TB #FGßPKVGECUGQH6$FGßPGFCDQXGQTQPGKP

which a health worker (clinician or other medical practitioner)

has diagnosed TB and decided to treat the patient with a full

course of anti-TB treatment.

Case of pulmonary TB A patient with TB disease involving

the lung parenchyma.

Smear-positive pulmonary case of TB A patient with

one or more initial sputum smear examinations (direct smear

microscopy) AFB-positive; or one sputum examination AFB-

positive plus radiographic abnormalities consistent with active

pulmonary TB as determined by a clinician. Smear-positive

cases are the most infectious and thus of the highest priority

from a public health perspective.

Smear-negative pulmonary case of TB A patient with

pulmonary TB who does not meet the above criteria for smear-

RQUKVKXGFKUGCUG&KCIPQUVKEETKVGTKCUJQWNFKPENWFGCVNGCUV

two AFB-negative sputum smear examinations; radiographic

abnormalities consistent with active pulmonary TB; no response

to a course of broad-spectrum antibiotics (except in a patient

HQTYJQOVJGTGKUNCDQTCVQT[EQPßTOCVKQPQTUVTQPIENKPKECN

evidence of HIV infection); and a decision by a clinician to

treat with a full course of anti-TB chemotherapy. A patient with

positive culture but negative AFB sputum examinations is also a

smear-negative case of pulmonary TB.

Extrapulmonary case of TB A patient with TB of organs

other than the lungs (e.g. pleura, lymph nodes, abdomen,

genitourinary tract, skin, joints and bones, meninges).

Diagnosis should be based on one culture-positive specimen,

or histological or strong clinical evidence consistent with active

extrapulmonary disease, followed by a decision by a clinician

to treat with a full course of anti-TB chemotherapy. A patient

in whom both pulmonary and extrapulmonary TB has been

FKCIPQUGFUJQWNFDGENCUUKßGFCUCRWNOQPCT[ECUG

New case of TB A patient who has never had treatment for TB

or who has taken anti-TB drugs for less than one month.

Retreatment case of TB There are three types of retreatment

ECUGKCRCVKGPVRTGXKQWUN[VTGCVGFHQT6$YJQKUUVCTVGFQP

a retreatment regimen after previous treatment has failed

(treatment after failure); (ii) a patient previously treated for

TB who returns to treatment having previously defaulted; and

(iii) a patient who was previously declared cured or treatment

completed and is diagnosed with bacteriologically-positive

(sputum smear or culture) TB (relapse).

Case of multidrug-resistant TB (MDR-TB) TB that is

TGUKUVCPVVQVYQßTUVNKPGFTWIUKUQPKC\KFCPFTKHCORKEKP(QT

OQUVRCVKGPVUFKCIPQUGFYKVJ/&46$9*1TGEQOOGPFU

treatment for 20 months with a regimen that includes second-

line anti-TB drugs.

a See Treatment of tuberculosis Iuidelines, 4th ed. Geneva, World Health

1TICPK\CVKQP9*1*6/56$#XCKNCDNGCVJVVRYJSNKDFQE

YJQKPVRWDNKECVKQPUAGPIRFH

31GLOBAL TUBERCULOSIS REPORT 2013

BOX 3.2

WHO deßnitions of TB cases recommended for use starting in 2013 and that will be used in the 2014

global TB reporta

Bacteriologically conßrmed case of TB A patient from

whom a biological specimen is positive by smear microscopy,

EWNVWTGQT9*1CRRTQXGFTCRKFFKCIPQUVKEVGUVUWEJCU:RGTV

/6$4+(#NNUWEJECUGUUJQWNFDGPQVKßGFTGICTFNGUUQH

whether TB treatment is started.

Clinically diagnosed case of TB A patient who does not

HWNßNVJGETKVGTKCHQTDCEVGTKQNQIKECNN[EQPßTOGF6$DWVJCU

been diagnosed with active TB by a clinician or other medical

practitioner who has decided to give the patient a full course

QH6$VTGCVOGPV6JKUFGßPKVKQPKPENWFGUECUGUFKCIPQUGF

QPVJGDCUKUQH:TC[CDPQTOCNKVKGUQTUWIIGUVKXGJKUVQNQI[

CPFGZVTCRWNOQPCT[ECUGUYKVJQWVNCDQTCVQT[EQPßTOCVKQP

Clinically diagnosed cases subsequently found to be

bacteriologically positive (before or after starting treatment)

UJQWNFDGTGENCUUKßGFCUDCEVGTKQNQIKECNN[EQPßTOGF

Case of pulmonary TB #P[DCEVGTKQNQIKECNN[EQPßTOGFQT

clinically diagnosed case of TB involving the lung parenchyma

QTVJGVTCEJGQDTQPEJKCNVTGG/KNKCT[6$KUENCUUKßGFCU

pulmonary TB because there are lesions in the lungs.

Tuberculous intra-thoracic lymphadenopathy (mediastinal and/

or hilar) or tuberculous pleural effusion, without radiographic

abnormalities in the lungs, constitute a case of extrapulmonary

TB. A patient with both pulmonary and extrapulmonary TB

UJQWNFDGENCUUKßGFCUCECUGQHRWNOQPCT[6$

Case of extrapulmonary TB #P[DCEVGTKQNQIKECNN[EQPßTOGF

or clinically diagnosed case of TB involving organs other than

the lungs, e.g. pleura, lymph nodes, abdomen, genitourinary

tract, skin, joints and bones, meninges.

New case of TB A patient who has never been treated for TB

or has taken anti-TB drugs for less than 1 month.

Retreatment case of TB A patient who has been treated for

OQPVJQTOQTGYKVJCPVK6$FTWIUKPVJGRCUV4GVTGCVOGPV

ECUGUCTGHWTVJGTENCUUKßGFD[VJGQWVEQOGQHVJGKTOQUVTGEGPV

course of treatment into four categories.

1. 4elapse patients have previously been treated for TB, were

declared cured or treatment completed at the end of their

most recent course of treatment, and are now diagnosed

with a recurrent episode of TB (either a true relapse or a new

episode of TB caused by reinfection).

2. Treatment after failure patients have previously been

treated for TB and their most recent course of treatment

failed.

3. Treatment after loss to follow-up patients have previously

been treated for TB and were declared ‘lost to follow-up’

at the end of their most recent course of treatment (this

ECVGIQT[EQTTGURQPFUVQVJGÁFGHCWNVGFÂECVGIQT[FGßPGFKP

Box 3.1).

4. Other preXiously treated patients are those who have

previously been treated for TB but whose outcome after

their most recent course of treatment is unknown or

undocumented.

Case of multidrug-resistant TB (MDR-TB) #UFGßPGFKP

Box 3.1

Case of rifampicin-resistant TB (RR-TB) A patient with

TB that is resistant to rifampicin detected using phenotypic

or genotypic methods, with or without resistance to other

anti-TB drugs. It includes any resistance to rifampicin, whether

mono-resistance, multidrug resistance, polydrug resistance or

extensive drug resistance.

a &GßPKVKQPUCPFTGRQTVKPIHTCOGYQTMHQTVWDGTEWNQUKU¿TGXKUKQP9*1

*6/6$)GPGXC9QTNF*GCNVJ1TICPK\CVKQP#XCKNCDNGCV

YYYYJQKPVKTKUDKVUVTGCOAGPIRFH

3.2 Contribution of public–public and

public–private mix initiatives

and community-based TB activities to

TB case notißcations in 2012

 2WDNKE¿RWDNKECPFRWDNKE¿RTKXCVGOKZ22/

Ensuring proper diagnosis, standardized treatment and

prompt notication of all TB cases to NTPs requires collab-

oration with the full range of health care providers. Engag-

ing all care providers in TB care and control is component 4

of the Stop TB Strategy (Chapter 1). Its two subcomponents

are:

involving all public, voluntary, corporate and private

providers through PPM approaches; and

promoting the International Standards for Tuberculosis

Care.1

Many countries have scaled up PPM initiatives. Demon-

strating progress in terms of the contribution of non-NTP

providers to total case notications requires systematic

recording of the source of referral and place of TB treat-

ment locally, and reporting and analysis of aggregated data

nationally.2 In 2013, 73 countries reported summary data

to WHO, and data for 29 of these countries (including 14

HBCs) are shown in Table 3.3. In most of these countries,

PPM initiatives contributed about 10% to 40% of total noti-

cations.

Considering that the private medical sector in Africa is

much smaller compared with that in Asia, the contribution

of private-for-prot and not-for-prot providers in Ethio-

pia, Kenya, Nigeria and the United Republic of Tanzania is

noteworthy. Progress in parts of Asia is also noticeable –

almost every fourth case in Indonesia and the Philippines

was notied by non-NTP care providers in 2012. Large pub-

lic sector hospitals have contributed sizeable proportions of

cases in China and Indonesia as well as in the Philippines,

and engagement of large hospitals is one of the major strat-

egies required to improve detection and notication of TB

1 http://www.istcweb.org/ISTC_Documents.html

2 WHO recommends that the source of referral and the place of treat-

ment should be routinely recorded and reported.

32 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 3.2

TB case notißcations by age and sex, 2012

0'95/'#4215+6+8'%#5'5 ALL NEW CASESa

¿;'#45 ¿;'#45 ¿;'#45 Ü;'#45

% AGED



;'#45

/#.'

FEMALE

4#6+1 ¿;'#45 ¿;'#45 ¿;'#45 Ü;'#45

% AGED



;'#45

/#.'

FEMALE

4#6+1

Afghanistan   3 106 1 156 4 0.5 15 0.6

Bangladesh 966 56 209 34 674 14 941  1.9    20 602 3 1.6

$TC\KN  25 209 11 129 3 190 1 2.3  42 306 20 056 6 322 3 2.0

Cambodia 53 6 000 6 064 2 724  1.2 – –

China 1 091  110 614 65 960  2.5 5 625 397 615    2.2

&4%QPIQ  47 722 17 066  41.3 – –

Ethiopia – – 16 1.2

India 12 957    22.2 7 –

Indonesia 1 703 116 326 70 491 13 799  1.5 27 343 172 706 100 254 22 579 1.4

Kenya 996 29 779 5 114  31.6    3 994 7 1.4

/Q\CODKSWG –– 13–

Myanmar  24 076 14 405 4 090  1.9 – –

Nigeria   10 571 2 553 2 1.6 – –

Pakistan 3 947 66 901 29 149  41.1 10 1.0

Philippines 1 032 49 736 29 617 6 943 1 2.3 – 1.9

4WUUKCP(GFGTCVKQP  17 039    2.7   26 302 5 254 4 2.2

South Africa 2 650  24 964 4 151 2 1.3     13 1.2

Thailand 117 13 525 11 435 5 921  2.4 – –

Uganda 636  4 777 914 3  ––

746CP\CPKC 490  5 257 1 536 2  91.5

Viet Nam 142 23 310    3.0 – –

<KODCDYG 293   432 2 1.3 2 911 23 541 5 954   1.2

High-burden

countries 32 952 1 172 486 604 196 205 733 2 1.9 231 674 1 724 885 894 852 343 231 6 1.7

#(4 14 340    3 1.5 97 629 571 919 167 236  91.3

#/4 2 012 61 956 27 462  2 1.7 9 646   19 974 5 1.6

'/4 5 641    31.2  133 536 53 351 21 545 10 1.0

'74 325  24 440 7 355  2.4 10 042  60 455 20 575 5 1.9

5'#4 17 116 617 926 336 069 94 741 2 2.0  739 149 397 219 112 503 6 

924 2 693 230 572 172 377   2.4 13 945   195 965 1 2.1

Global 42 127 1 451 897 710 738 241 395 2 1.9 292 295 2 171 779 1 075 428 409 559 6 1.7

Blank cells indicate data that could not be reported for the age categories shown.

– indicates values that cannot be calculated.

a Numbers in each age category are only shown if data were reported for all four age categories for each category of TB case. For this reason, there are small discrepancies

between numbers presented in this table and in the tables that appear in Box 2.2 of Chapter 2.

cases. Experience from a project that was recently complet-

ed in ve countries is proled in Box 3.4.

Approaches to engage non-NTP care providers vary

according to the local context, but there are some import-

ant cross-cutting elements. One is provision of standard-

ized care by non-NTP providers according to national

guidelines, in return for provision of free anti-TB drugs,

supervision and quality assurance, and nancial or non-

nancial incentives by NTPs. A second is the use of the Inter-

national Standards for Tuberculosis Care, which facilitates the

use of best practices in TB diagnosis and treatment among

all care providers, especially those in the private sector. In

the European Region and the Region of the Americas, con-

tributions to case notications from public sector provid-

ers outside the purview of the Ministry of Health, such as

social security organizations and prison health services, are

relatively large.

33GLOBAL TUBERCULOSIS REPORT 2013

BOX 3.3

TB and prisons

As an airborne disease, TB thrives in the crowded, poorly-

ventilated environments found in prisons in many parts of the

world. Conditions of prison life including malnutrition and stress

can also contribute to a higher risk of developing TB disease,

and inadequate or inaccessible medical care can lead to poor

treatment outcomes and acquisition of resistance. Prisoners

FKURTQRQTVKQPCVGN[EQOGHTQOOCTIKPCNK\GFUQEKQGEQPQOKE

backgrounds – including substance users, homeless people,

people with mental illness, ethnic minorities, asylum seekers and

immigrants – and therefore often enter the prison system with

an existing high prevalence of TB infection or even with active

disease. Prisons also contribute to overall TB burden in that they

CTGPQVGPVKTGN[ENQUGFU[UVGOU6$ECPDGURTGCFVQRTKUQPUVCHH

and visitors, and at some point most prisoners are released into

the general population.

6JG9*1'WTQRGCP4GIKQPKUEWTTGPVN[VJGQPN[TGIKQPVJCV

systematically collects and analyses data from Member States

on the burden of TB in prisons.a As is likely the situation in

most countries around the world, the burden of TB in prisons in

European countries is disproportionately high and often makes

CEQPUKFGTCDNGEQPVTKDWVKQPVQQXGTCNNEQWPVT[ECUGPQVKßECVKQPU

0QVKßECVKQPTCVGUQHPGY6$ECUGUKPRTKUQPUKPCNNTGRQTVKPI

countries were multiple times higher than the rates found in

VJGIGPGTCNRQRWNCVKQPTGNCVKXGTKUMUTCPIKPIHTQOVQ

CPFYGTGQXGTRGTFGVCKPGGUKP#\GTDCKLCP

)GQTIKCCPF-[TI[\UVCPCPFRGT

detainees, respectively) in 2011. Among reporting countries, case

PQVKßECVKQPUHTQORTKUQPUCEEQWPVGFHQTQXGTQHPCVKQPCN

PQVKßECVKQPUQHPGY6$ECUGUKP)GQTIKCCPFVJG4WUUKCP

Federation (11%) in 2011. Given that some countries in the region

JCXGPQVDGGPCDNGVQTGRQTVFCVCQP6$PQVKßECVKQPUKPRTKUQPU

and that limited data are available on trends, the contribution of

6$PQVKßECVKQPUKPRTKUQPUVQQXGTCNN6$PQVKßECVKQPUKPVJGTGIKQP

is uncertain.

To reduce the burden of TB in prisons, a comprehensive

package of measures is required.b,c These include early diagnosis

using systematic screeningd and rapid diagnostics, proper

infection control, improved living conditions and nutrition,

supervised and complete TB treatment with appropriate drugs,

treatment of comorbidities including HIV, diabetes, hepatitis and

substance use disorders, and continuity of care in the public sector

when a prisoner under treatment is released.

6JG4WUUKCP(GFGTCVKQPYCUUWEEGUUHWNKPKPVTQFWEKPIUGXGTCN

OGCUWTGUVJCVUKIPKßECPVN[TGFWEGFVJGDWTFGPQH6$KPKVU

penitentiary system (Figure B3.3.1).e By reinforcing systematic

screening, improving infection control measures, strengthening

treatment, and building cooperation between the Ministry of

Justice, Ministry of Health institutions, and international partners,

6$PQVKßECVKQPTCVGUFGETGCUGFUJCTRN[HTQOECUGURGT

100 000 detainees in 1999 (i.e., TB was detected in 1 of 25

FGVCKPGGUKPVQECUGURGTFGVCKPGGUKP

6JGFGETGCUGUKPEGJCUDGGPITCFWCNTGàGEVKPIVJG

continuing challenges facing TB control in the penitentiary sector,

including rising rates of TB/HIV coinfection and drug-resistant

TB, as well as the continued concentration of socioeconomically

OCTIKPCNK\GFRGQRNGGPVGTKPIVJGRTKUQPU[UVGO1HPQVGKUVJG

JKIJGTPQVKßECVKQPTCVGHQWPFKPVJGRTGVTKCNFGVGPVKQPEGPVTGU

EQORCTGFYKVJEQTTGEVKQPCNHCEKNKVKGUKPEQORCTGFYKVJ

RGTFGVCKPGGUTGURGEVKXGN[TGàGEVKPIKPRCTVVJG

underlying high prevalence of TB infection and disease among

UQEKQGEQPQOKECNN[OCTIKPCNK\GFRGQRNGYJQGPVGTVJGRTGVTKCN

detention centres from the general population.

In Eastern Europe, drug-resistant TB has been associated with

detention and in many countries prisons have had to deal with

UWDUVCPVKCNECUGNQCFUQH/&46$RCVKGPVUf–h The provision of

GHHGEVKXG/&46$ECTGHQTRTKUQPKPOCVGUKUVJGTGHQTGKORQTVCPV

The possibility of close monitoring of imprisoned patients may

also be conducive to achievement of good treatment outcomes.

(QTGZCORNGFCVCHTQOVJGRGPKVGPVKCT[UGEVQTKP#\GTDCKLCPUJQY

VTGCVOGPVUWEEGUUTCVGUKPVJGTCPIG¿KPVJG¿

patient cohorts treated in accordance with WHO-recommended

standards.i

a Tuberculosis surXeillance and monitorinI in Europe 2012. Stockholm, European

%GPVTGHQT&KUGCUG2TGXGPVKQPCPF%QPVTQN9*14GIKQPCN1HßEGHQT'WTQRG

b See Guidelines for the control of tuberculosis in prisons. Geneva, World Health

1TICPK\CVKQP9*16$

c Dara M, Chadha SS, Melchers NV, van den Hombergh J, Gurbanova E, Al-Darraji H,

van der Meer JBW. Time to act to prevent and control tuberculosis among inmates.

International ,ournal of Tuberculosis and LunI &isease,CP¿

d Systematic screeninI for actiXe tuberculosis principles and recommendations.

)GPGXC9QTNF*GCNVJ1TICPK\CVKQP9*1*6/6$

e Tuberculosis in the 4ussian (ederation 2011 an analytical reXiew of statistical

indicators used in the 4ussian (ederation and in the worldKP4WUUKCP/QUEQY

/KPKUVT[QH*GCNVJQHVJG4WUUKCP(GFGTCVKQPGVCN

f 5MTCJKPC#*WTGXKEJ*<CNWVUMC[C#GVCN/WNVKFTWITGUKUVCPVVWDGTEWNQUKUKP

$GNCTWUVJGUK\GQHVJGRTQDNGOCPFCUUQEKCVGFTKUMHCEVQTUBulletin of the World

*ealth OrIanization¿

g #GTVU#*CDQW\KV//UEJKNCF\G.GVCN2WNOQPCT[VWDGTEWNQUKUKPRTKUQPUQH

VJGGZ7554UVCVGQH)GQTIKCTGUWNVUQHCPCVKQPYKFGRTGXCNGPEGUWTXG[COQPI

sentenced inmates. International ,ournal of Tuberculosis and LunI &isease, 2000

&GE¿

h 5JKP552CUGEJPKMQX#&)GNOCPQXC+;2GTGOKVKP))5VTGNKU#-/KUJWUVKP5

GVCN6TGCVOGPVQWVEQOGUKPCPKPVGITCVGFEKXKNKCPCPFRTKUQP/&46$VTGCVOGPV

RTQITCOKP4WUUKCInternational ,ournal of Tuberculosis and LunI &isease, 2006

#RT¿

i 4eXiew of tuberculosis preXention control and care ina#zerbaiLan. Copenhagen,

9QTNF*GCNVJ1TICPK\CVKQP

TB notification rate per 100 000

detainees per year

1999 2001 2003 2005 2007 2009 2011

1000

2000

3000

4000

5000

Combined prison facilities

Correctional facilities

Pre-trial detention centres

FIGURE B3.3.1

6$PQVKßECVKQPTCVGKPVJGRTKUQPHCEKNKVKGUQHVJG

4WUUKCP(GFGTCVKQP¿QXGTCNNCPF

disaggregated by pre-trial detention centres and

correctional facilities

34 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 3.3

Contribution of public-private and public-public mix (PPM) to notißcations of TB cases in 29 countries, 2012

%17064; 6;2'51(%#4'2418+&'45'0)#)'&

07/$'41(6$%#5'5

016+(+'&$;27$.+%010062

%#4'2418+&'45a

07/$'41(6$%#5'5

016+(+'&$;24+8#6'%#4'

2418+&'45b

%1064+$76+1061616#.

NOTIFICATIONS OF TB CASES

IN 2012 (%)

#(4+%#04')+10a

Ethiopia Diverse private providers – 17 133 12

Ghana Diverse non-NTP public and private providers 1 107  13

Kenya Private clinics and hospitals, and prisons  10 364 12

Lesotho Diverse private providers – 1 044 10

Nigeria Public non-NTP and NGO hospitals and private

clinics 14 096  24

5YC\KNCPF Diverse non-NTP public and private providers   33

7PKVGF4GRWDNKEQH6CP\CPKC 2TKXCVGHCEKNKVKGUCPFHCKVJDCUGFQTICPK\CVKQPU – 13 734 22

REGION OF THE AMERICASa

El Salvador Diverse non-NTP public and private providers 761 50 40

Peru 5QEKCNUGEWTKV[QTICPK\CVKQPUCPFQVJGTPQP062

public providers 6 576 – 22

EASTERN MEDITERRANEAN REGIONa

Afghanistan 2TKXCVGENKPKEUJQURKVCNUNCDQTCVQTKGUaCPF

pharmacies 1 362  12

Egypt *GCNVJKPUWTCPEGQTICPK\CVKQPU0)1UCPFQVJGT

public non-NTP providers 1 993 213 26

+TCP+UNCOKE4GRWDNKEQH *GCNVJKPUWTCPEGQTICPK\CVKQPURTKUQPUOKNKVCT[CPF

private care providers 1 205  40

Iraq Diverse non-NTP public and private providers 2 693  65

Pakistan Private clinics and hospitals 925 56 363 21

Sudan Diverse private and non-NTP public providers 450 1 475 10

5[TKCP#TCD4GRWDNKE Diverse private and non-NTP public providers 175 2 400 

;GOGP Public hospitals including university, military and

police hospitals, prisons and private hospitals  –35

EUROPEAN REGIONa

Georgia Diverse non-NTP public and private providers, and

prisons 673  

Tajikistan Diverse non-NTP public providers and prisons 1 549 – 24

SOUTH-EAST ASIA REGION

Bangladesh Diverse private, non-NTP public and NGO providers 2 429 14 934 10

IndiacDiverse private, non-NTP public and NGO providers 13 572 3 533 –

Indonesia Public and private hospitals 77 376 5 432 25

Myanmar Diverse private, non-NTP public and NGO providers   23

Nepal Diverse private providers – 5 366 15

Sri Lanka Diverse non-NTP public and private providers 5 004 445 60

Thailand Diverse non-NTP public and private providers 1 532 1 267 4.6

WESTERN PACIFIC REGION

China General public hospitals  –44

Philippines Private clinics and hospitals  36 744 24

Viet Nam Diverse non-NTP public and private providers 3 404 4 724 

a Includes all contributions from non-NTP providers, including public hospitals, public medical colleges, prisons/detention centres, military facilities, railways and public health

KPUWTCPEGQTICPK\CVKQPU

b 2TKXCVGUGEVQTRTQXKFGTUKPENWFGRTKXCVGKPFKXKFWCNCPFKPUVKVWVKQPCNRTQXKFGTUEQTRQTCVGDWUKPGUUUGEVQTRTQXKFGTUOKUUKQPJQURKVCNUPQPIQXGTPOGPVCNQTICPK\CVKQPUCPF

HCKVJDCUGFQTICPK\CVKQPU

c Data for India are for smear-positive cases of pulmonary TB in 14 cities where PPM surveillance is in place.

35GLOBAL TUBERCULOSIS REPORT 2013

BOX 3.4

Engaging hospitals to improve TB care and prevention

In 2009, WHO initiated a project to help intensify TB case

FGVGEVKQPKPßXGEQWPVTKGUKP#HTKECCPF#UKC+PVGPUKßGF

hospital engagement, mainly targeting large hospitals in urban

CTGCUYCUVJGOCKPKPVGTXGPVKQPKPCNNßXGEQWPVTKGU6JTQWIJ

a consultative process involving NTPs, departments responsible

for hospitals within the ministries of health, directors of

RCTVKEKRCVKPIJQURKVCNUCPF9*1CVQVCNQHJQURKVCNU

covering a total population of 10 million were involved. This

KPENWFGFJQURKVCNUKP-KPUJCUCKPVJG&GOQETCVKE4GRWDNKEQH

the Congo; 10 in Accra, Ghana; 17 in Manila, The Philippines;

KP5YC\KNCPFCPFVJGNCTIGUVPCVKQPCNIGPGTCNJQURKVCNU

KPVJTGGEKVKGUKP8KGVa0CO*CPQK*Q%JK/KPJ%KV[CPF*WG

The initiative was funded by the Department of Foreign Affairs,

Trade and Development of Canada.

Prior to the project, hospitals provided TB diagnosis

and treatment for many patients without following national

IWKFGNKPGUQTJCXKPIHQTOCNTGHGTTCNCPFPQVKßECVKQPTQWVKPGU

6JGURGEKßEQDLGEVKXGUQHVJGRTQLGEVYGTGVQKORTQXG6$

diagnosis and management of patients presenting to hospitals

through setting up mechanisms for internal coordination,

and to improve external networking to help intensify TB case

FGVGEVKQPCPFPQVKßECVKQP6JGOCKPCEVKXKVKGUYGTGKORTQXKPI

KFGPVKßECVKQPQHRGQRNGYKVJUWURGEVGF6$UVCPFCTFK\CVKQP

of diagnostic routines and introduction of external quality

assurance in hospital laboratories; establishing a ‘hospital

DOTS unit’; a systematic approach to internal referrals so that

cases diagnosed in hospitals would be referred to the hospital

&165WPKVHQTOCNK\CVKQPQHTQWVKPGUHQTGZVGTPCNTGHGTTCNQH

cases to health centres and feedback about referrals from

health centres; ensuring proper treatment and follow up of

patients started on treatment in hospitals; and introduction of

UVCPFCTFK\GFTGEQTFKPICPFTGRQTVKPI

After successful implementation of project activities, total

JQURKVCNPQVKßECVKQPUKPETGCUGFHTQOCDQWVRGT[GCT

CETQUUVJGßXGUKVGUDGHQTGVJGRTQLGEVVQCDQWVRGT[GCT

in 2012. The documented number of people tested for TB with

a bacteriological test increased in all sites, and the average

increase was roughly fourfold (Figure B3.4.1).

Documentation of referrals for treatment and feedback to

EQPßTOVTGCVOGPVKPKVKCVKQPFGOQPUVTCVGFVJCVVJGNQUUGUCHVGT

referral were very large at baseline in the two Asian countries

VJG2JKNKRRKPGUCPF8KGVa0CO6JGUGNQUUGUYGTGUWDUVCPVKCNN[

reduced by the end of the third project year through improved

communication between hospitals and the primary health care

facilities to which they were making referrals. Treatment success

rates among those started on treatment in hospitals were

similar to those reported by the NTP.

This project helped to describe a baseline situation in

which hospitals were not engaged. It then demonstrated that

it is possible to proactively engage hospitals and align their

services to national guidelines and in turn to improve detection

QH6$ECUGUCPFPQVKßECVKQPVQ062U#NNEQWPVTKGUJCXGGKVJGT

developed new national policies for hospital engagement or are

in the process of doing so, based on the project results. Similar

efforts are anticipated and needed in other countries.

FIGURE B3.4.1

Trends in bacteriological testing for TB and TB case

PQVKßECVKQPUKPRTQLGEVUKVGU¿

Number

20 000

40 000

60 000

80 000

100 000

2010 2011 2012

Number of bacteriological tests done

Total number of TB cases diagnosed and notified

Number of bacteriologically-positive cases diagnosed

 %QOOWPKV[EQPVTKDWVKQPUVQ6$PQVKßECVKQPU

and treatment support

Community-based TB activities can be dened as activ-

ities that are conducted outside the premises of formal

health facilities, within community-based structures (for

example, schools and places of worship) and homesteads.

Such activities can be implemented by community health

workers1 and community volunteers,2 regardless of wheth-

er they are employed and supervised by a government

department or by a nongovernmental organization, and

make an important contribution to health services includ-

ing prevention, diagnosis, improved treatment adherence,

care and support. In the specic context of TB, commu-

nity activities can help to increase case notications and

improve treatment outcomes, especially in settings where

people with TB have poor access to formal health services.

As shown in section 3.3, approximately one third of people

with TB are diagnosed but not reported to national surveil-

lance systems, or not diagnosed at all.

Accurate documentation of the contributions of commu-

nities to TB notications and treatment support has been

challenging. One reason has been the lack of standardiza-

tion of indicators that can be used for routine recording and

1 Community health workers can be dened as people with some

formal education who have been given training to contribute to

community-based health services, including TB prevention and

patient care and support. eir prole, roles and responsibilities

vary greatly among countries, and their time is often compensated

by incentives in kind or in cash.

2 Community volunteers can be dened as community members who

have been systematically sensitized about TB prevention and care,

either through a short, specic training scheme or through repeat-

ed, regular contact sessions with professional health workers.

36 GLOBAL TUBERCULOSIS REPORT 2013

BOX 3.5

The ENGAGE-TB approach

The ENGAGE-TB approacha describes the need for

PQPIQXGTPOGPVCNQTICPK\CVKQPUCPFQVJGTEKXKNUQEKGV[

QTICPK\CVKQPUVQKPVGITCVGEQOOWPKV[DCUGF6$CEVKXKVKGU

KPVQVJGKTGZKUVKPIYQTM2KNQVRTQLGEVUKPßXG#HTKECP

EQWPVTKGUVJG&GOQETCVKE4GRWDNKEQHVJG%QPIQ'VJKQRKC

-GP[C5QWVJ#HTKECCPFVJG7PKVGF4GRWDNKEQH6CP\CPKC

are showing promising results. Selected nongovernmental

QTICPK\CVKQPUKPVJGUGEQWPVTKGUJCXGUVCTVGFKPVGITCVKPI

TB services into community-based programmes for HIV,

maternal, newborn and child health (MNCH), and cancer

UETGGPKPIYKVJßPCPEKCNUWRRQTVHTQOVJG$TKUVQN/[GTU

Squibb Foundation.

NGO %17064; 241,'%6(1%75

Femmeplus Democratic

4GRWDNKEQH

the Congo

Integration of TB services into

community-based HIV activities

in two major cities (Kinshasa and

Kikwit)

AMREF Ethiopia Integration of TB/HIV services

into community-based MNCH

activities in a pastoralist region

CUAMM Ethiopia Integrated community-based TB,

HIV and cancer screening project

Save the

Children

Ethiopia Integration of community-based

TB/HIV services into MNCH

programmes in pastoralist

communities

Centre for

Positive Care

South Africa Strengthening integration of

TB into community-based HIV

activities

2CVJßPFGT 746CP\CPKC Integration of TB services into

community-based HIV services

0)1PQPIQXGTPOGPVCNQTICPK\CVKQP

The challenge is to scale up these experiences and

UKIPKßECPVN[KPETGCUGVJGPWODGTQHEQOOWPKV[DCUGF

workers and volunteers who are providing screening for TB,

referring those who might have TB for diagnosis and then

providing follow-up care and support to those diagnosed

YKVJVJGFKUGCUG9*1KUßPCNK\KPICPKORNGOGPVCVKQP

manual that will help to inform nongovernmental

QTICPK\CVKQPUCPF062UCDQWVJQYVJG[ECPYQTMVQIGVJGTVQ

implement integrated community-based TB activities, with a

RCTVKEWNCTHQEWUQPPQPIQXGTPOGPVCNQTICPK\CVKQPUYQTMKPI

on MNCH, HIV, primary health care, agriculture, livelihood

development and education services.

a ENG#GE-TB – InteIratinI community-based tuberculosis actiXities into

the work of nonIoXernmental orIanizations. Geneva, World Health

1TICPK\CVKQP

reporting. To address this challenge, WHO recently devel-

oped a minimum set of standardized indicators as part of

its ENGAGE-TB approach (Box 3.5). In 2013, these indi-

cators were used to collect standardized, comparable data

from a set of 13 countries in which data were known to be

routinely recorded and reported in at least some geograph-

ical areas.1 Data collection was undertaken separately from

the main round of global TB data collection, since most

countries are not routinely recording and reporting such

data and they are not relevant in all settings.

Among the 13 countries (Table 3.4), notied TB patients

referred from the community as a share of total notica-

tions in the areas covered by reporting ranged from 2% in

Myanmar (in 92/330 districts) to 33% in Ethiopia (in 98

out of 821 districts). It is possible that these gures are

an underestimate, pending optimization of recording and

reporting systems. Nonetheless, the nding that the con-

tribution of communities in referring people with TB was

under 10% in several countries suggests that there may

be opportunities to use untapped community resources in

TB prevention, diagnosis and treatment. In settings where

access to formal health services is limited, more emphasis

in policy and practice on the role of community referrals

of people with presumptive TB as early as possible is war-

ranted.

e share of patients receiving treatment support in the

community was generally high: for example, 50% country-

wide in India and 88% countrywide in Kenya.

Kenya also provides an interesting example of the

untapped potential of communities. While 88% of all TB

patients were reported as having received support for treat-

ment adherence, demonstrating the spread and reach of

community workers and volunteers in the country, only 5%

of TB case notications had been referred by community

members. is suggests that more could be done to increase

community engagement in and contribution to TB screen-

ing and referral.

It is evident that data on community contributions to

referrals and treatment adherence are not collected uni-

formly or systematically, even in the 13 countries shown

in Table 3.4. Only three of the 13 countries reported data

for both indicators that covered all districts in the country

(Burkina Faso, Kenya and Rwanda). e remaining coun-

tries reported data that covered only parts of the country

(sometimes very limited areas) or data were not available

for both indicators. Better understanding of the contri-

bution of communities to TB services will require more

routine collection of data; this is of greatest relevance in

settings where community contributions are considered a

necessary and integral part of TB services.

1 ere was no attempt to compile data about the contribution of

communities to programme design and implementation (including

advocacy activities at local levels). Such data are not routinely avail-

able.

37GLOBAL TUBERCULOSIS REPORT 2013

1 www.who.int/tb/data

2 e CDR is actually a ratio rather than a rate, but the term ‘rate’ has

become standard terminology in the context of this indicator.

3 It is approximate because of uncertainty in the underlying inci-

dence of TB and because notied cases are not necessarily a subset

of incident cases that occurred in the same year; see Chapter 2 for

further discussion.

TABLE 3.4

Community contributions to TB case notißcations and treatment adherence support, 2011–2012

%17064;

NOTIFIED PATIENTS

(41/%1//70+6;4'('44#.5

2#6+'0659*14'%'+8'&64'#6/'065722146+06*'%1//70+6;

%1*14670.'5552'%+(+'&

5*#4'1(616#.016+(+%#6+105+0#4'#5

(149*+%*&#6#9'4'4'2146'& )'1)4#2*+%%18'4#)'1(&#6# 5*#4'1(%1*146+0#4'#5(149*+%*

&#6#9'4'4'2146'& )'1)4#2*+%%18'4#)'1(&#6#

Burkina Faso 9% All districts 33% All districts

Côte d’Ivoire 16% FKUVTKEVU Not available

&4%QPIQ 10% 45/515 districts 3% FKUVTKEVU

Ethiopia 33% FKUVTKEVU 40%aFKUVTKEVU

India 3% 374/662 districts 50% All districts

Kenya 5% All districts  All districts

Malawi 20% FKUVTKEVU 91% FKUVTKEVU

Myanmar 2% 92/330 districts 2% 92/330 districts

Nigeria Not available 5% 36/774 districts

4YCPFC  All districts 46% All districts

Senegal 6% All districts Not available

Uganda Not available 35% All districts

746CP\CPKC 14% 63/162 districts  All districts

a Data are for the 2012 cohort.

FIGURE 3.1

Global trends in case notißcation (black) and

estimated TB incidence (green) rates, 1990–2012.

%CUGPQVKßECVKQPUKPENWFGPGYCPFTGNCRUGECUGUCNNHQTOU

1990 1995 2000 2005 2012

100

150

200

Rate per 100 000 population per year

3.3 Trends in case notißcations since 1990

and estimates of the case detection rate

Globally, the number of TB cases diagnosed and notied per

100000 population was relatively stable between 1990 and

2000, rose sharply between 2000 and 2008 and has subse-

quently started to fall slowly (Figure 3.1). Globally and in

all WHO regions, a clear gap exists between the numbers of

notied cases and the estimated numbers of incident cases,

although this has narrowed in the past decade globally and

in all six WHO regions (Figure 3.2). Trends in the 22 HBCs

are shown in Figure 3.3, and for other countries are illus-

trated in country proles that are available online.1

e case detection rate (CDR)2 for TB is an indicator

that is included within the MDGs (Chapter 1). For a giv-

en country and year, the CDR is calculated as the number

of new and relapse TB cases (see Box 3.1 for denitions)

that were notied by NTPs (Table 3.1), divided by the esti-

mated number of incident cases of TB that year. e CDR is

expressed as a percentage; it gives an approximate3 indica-

tion of the proportion of all incident TB cases that are actu-

ally diagnosed, reported to NTPs and started on treatment.

e best estimate of the CDR for all forms of TB globally

in 2012 was 66% (range, 64–69%), up from 53–59% in 2005

and 38–43% in 1995 – the year in which the DOTS strategy

began to be introduced and expanded (Table 3.5). e high-

est CDRs in 2012 were estimated to be in the Region of the

Americas (best estimate 79%; range, 74–85%), the Western

 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 3.2

Case notißcation and estimated TB incidence rates by WHO region, 1990–2012. 4GIKQPCNVTGPFUKPECUG

PQVKßECVKQPTCVGUPGYCPFTGNCRUGECUGUCNNHQTOUblack) and estimated TB incidence rates (green). Shaded areas

represent uncertainty bands.

Rate per 100 000 population per year

100

200

300

400

100

200

300

120

160

100

150

200

1990 1995 2000 2005 2012 1990 1995 2000 2005 20121990 1995 2000 2005 2012

Africa The Americas Eastern Mediterranean

Europe South-East Asia Western Pacific

Pacic Region (best estimate 81%; range, 75–89%) and the

European Region (best estimate 74%; range, 70–79%). e

other regions had estimated CDRs in the range of 55–71%,

with best estimates of around 60%. All regions have

improved their estimated CDRs since the mid-1990s, with

improvements particularly evident since 2000. Among the

22 HBCs, the highest rates of case detection in 2012 were

estimated to be in Brazil, China, Kenya, the Philippines and

the Russian Federation. e lowest rates, with best esti-

mates of around 50%, were in Afghanistan, Bangladesh,

the Democratic Republic of the Congo, Mozambique, Nige-

ria and Zimbabwe.

e gap between notications to national surveillance

systems and the true number of incident cases can be

explained by two factors. e rst is underreporting of

diagnosed TB cases, for example because private sector pro-

viders fail to notify cases. e second is under-diagnosis of

people with TB for reasons such as poor access to health

care and failure to recognize TB signs and symptoms and

test for TB when people do present to health care facilities.

Achieving the goal of universal health coverage, imple-

menting PPM initiatives such as those described in sec-

tion 3.2, and ensuring that there is an eective regulatory

framework that includes mandatory notication of cases

are essential to reduce underreporting and under-diagnosis.

A point-of-care diagnostics test would also help.

3.4 Treatment outcomes

Denitions of the categories used to report treatment out-

comes in this report are provided in Box 3.6. e updated

denitions that will be used from 2014 are explained in

Box 3.7.

3.4.1 New cases of smear-positive pulmonary TB

Data on treatment outcomes for new sputum smear-

positive cases of pulmonary TB are shown in Table 3.6 and

Figure 3.4. Globally, the rate of treatment success for the

2.6 million new cases of sputum smear-positive pulmonary

TB who were treated in the 2011 cohort was 87%. is was

the fth successive year that the target of 85% (rst set by

the World Health Assembly in 1991) was met or exceeded

globally. It is also impressive that as the size of the global

treatment cohort grew from 1.0 million in 1995 to 2.7 mil-

lion in 2009 and 2010 and 2.6 million in 2011, the treat-

ment success rate progressively improved.

Among the six WHO regions, three met or exceeded the

85% target: the Eastern Mediterranean Region, the South-

East Asia Region and the Western Pacic Region. e treat-

ment success rate was 82% in the African Region (where

there has been steady improvement since 1999), 78% in the

Region of the Americas (similar to the previous seven years)

and 65% in the European Region (where major eorts to

increase treatment success rates are needed).

Of the 22 HBCs, 16 reached or exceeded the 85% target

in 2011, including Ethiopia and Nigeria for the rst time.

Five HBCs reported lower rates of treatment success: Brazil

(76%), the Russian Federation (52%), South Africa (79%),

Uganda (77%) and Zimbabwe (81%). Nonetheless, among

these ve countries all except the Russian Federation sus-

tained their level or made progress compared with 2010.

39GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 3.3

Case notißcation and estimated TB incidence rates, 22 high-burden countries, 1990–2012. Trends in case

PQVKßECVKQPTCVGUPGYCPFTGNCRUGECUGUCNNHQTOUblack) and estimated TB incidence rates (green). Shaded areas

represent uncertainty bands.

Afghanistan Bangladesh Brazil Cambodia China

DR Congo Ethiopia India Indonesia Kenya

Mozambique Myanmar Nigeria Pakistan Philippines

Russian Federation South Africa Thailand Uganda UR Tanzania

Viet Nam Zimbabwe

Rate per 100 000 population per year

100

200

300

100

200

300

400

500

250

500

750

1000

1250

100

150

200

100

200

300

400

250

500

750

1000

1250

250

500

750

1000

1250

100

150

200

250

500

750

1000

1250

100

200

300

100

200

300

400

500

600

200

400

600

100

200

300

400

200

400

600

200

400

600

800

100

200

300

100

200

300

100

200

300

400

100

200

300

400

100

150

250

500

750

1000

100

150

200

1990 1995 2000 2005 2012 1990 1995 2000 2005 2012

1990 1995 2000 2005 2012 1990 1995 2000 2005 2012 1990 1995 2000 2005 2012

FIGURE 3.4

Treatment outcomes by WHO region, 2011 cohorts

Global

WPR

SEAR

EUR

EMR

AMR

AFR

0% 20% 40% 60% 80% 100%

Global

WPR

SEAR

EUR

EMR

AMR

AFR

0% 20% 40% 60% 80% 100%

a. New smear-positive cases b. All new cases

Successfully treated Died Treatment failed Defaulted Not evaluated

40 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 3.5

Estimates of the case detection rate for new and relapse cases (%), 1995–2012a

1995 2000 2005 2010 2012

BESTbLOW HIGH BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH BEST LOW HIGH

Afghanistan ––– 15 22 46 39 57 52 44 63 52 44 63

Bangladesh 21 17 26 25 21 31  32 47 45  55 49 41 59

$TC\KN 79 66 97 74 62 91  72 100  69 99  69 99

Cambodia 23 19 30 27 22 34 52 44 63 64 56 75 66 57 77

China 32 27 39 33   74 65   76   79 100

&4%QPIQ 31 26  40 34  55 47 64 56 49 65 51 44 59

Ethiopia 11 7.2  33 22 55  32  66 49 93 64 49 

India 595267494555494455605466595466

Indonesia  7.1 12 20 16 25 57 47 71 66 56  72 61 

Kenya 61 56 66 72 67 77  76     79 76 

/Q\CODKSWG 23 11 73 23 13 51 30 20 53 33 25  34 25 50

Myanmar 10  13 15 13 19 53 45 63 66 57 77 71 62 

Nigeria  2.7 170 12 3.9 170 26 9.6 200 40 23  51 29 110

Pakistan 4.5 3.7 5.5 3.3  4.1 39 32  66 55  65 54 

Philippines  40  47 39 57 53 44 65 65 54 79  71 100

4WUUKCP(GFGTCVKQP 60 51 70 75 65  66 56   71   70 96

South Africa 56 47 69 59 49 72 61 50 74 70 59  62 52 75

Thailand 59 50 72 32 27 39 57  69 79 66 95 76 64 92

Uganda 23 14 41 29 20  47 36 65 60 50 75 69 57 

746CP\CPKC 59 51 69  60 77 74 69  77 72  79 74 

Viet Nam 33 25 47 56 43  63 49  70 54 95 76 59 100

<KODCDYG 55 40 79 56 45 71 50 40 63 53 43 69 46 37 60

High-burden countries 38 36 42 39 37 42 55 51 58 66 63 69 66 63 70

#(4 32 27 39 39 33  52 44 61 60 56 65 59 55 64

#/4 67 63 72 70 65 75 75 71  76 71  79 74 

'/4 23 21 26 25 22   43 54 64 57 72 63 56 71

'74 51 49 54 59 55 62 65 61 70 77 72  74 70 79

5'#4 44 40 49 41  44 50 46 53 61 56 65 62  66

924 37 32 42 39 35 44 70 63 77  73   75 

Global 40 38 43 41 39 44 56 53 59 66 63 68 66 64 69

– indicates values that cannot be calculated.

a 'UVKOCVGUHQTCNN[GCTUCTGTGECNEWNCVGFCUPGYKPHQTOCVKQPDGEQOGUCXCKNCDNGCPFVGEJPKSWGUCTGTGßPGFUQVJG[OC[FKHHGTHTQOVJQUGRWDNKUJGFRTGXKQWUN[

b $GUVNQYCPFJKIJKPFKECVGDGUVGUVKOCVGUHQNNQYGFD[NQYGTCPFWRRGTDQWPFU6JGNQYGTCPFWRRGTDQWPFUCTGFGßPGFCUVJGVJCPFVJEGPVKNGUQHQWVEQOG

distributions produced in simulations.

Data for Mozambique were not reported to WHO, but the

level in 2010 was 85%. In the Russian Federation, improve-

ment of treatment outcomes has been identied as a high

priority by the Ministry of Health and actions to improve

it have been dened. ese include ensuring earlier detec-

tion of MDR-TB and enrolment of patients on second-line

treatment, and strengthening patient support to improve

adherence to treatment (especially among the most social-

ly and economically disadvantaged patients). It is expected

that the introduction of a patient-based monitoring system

for those with MDR/XDR-TB and patients coinfected with

HIV in the near future will also help to improve the quality

of care and treatment outcomes.

3.4.2 All new cases

Data on treatment outcomes for all new cases of TB are

shown in Table 3.7 and Figure 3.4. Globally, the rate of

treatment success was 87% in 2011. Among the six WHO

regions, the highest rates were in the Eastern Mediterra-

nean Region (88%), the South-East Asia Region (89%) and

Western Pacic Region (93%). e treatment success rate

was 79% in the African Region, a big improvement from

73% in 2010. In the Region of the Americas and the Euro-

pean Region it was 75% and 72%, respectively.

Of the 22 HBCs, 15 reached or exceeded a treatment

success rate of 85% among all new cases in 2011, includ-

ing Ethiopia (following a major improvement from 77% in

41GLOBAL TUBERCULOSIS REPORT 2013

BOX 3.6

Deßnitions of treatment outcomes for drug-

susceptible TB until the end of 2012 and in this

global TB reporta

Cured A patient who was initially sputum smear-positive and

who was sputum smear-negative in the last month of treatment

and on at least one previous occasion.

Completed treatment A patient who completed treatment

DWVFKFPQVOGGVVJGETKVGTKCHQTEWTGQTHCKNWTG6JKUFGßPKVKQP

applies to sputum smear-positive and sputum smear-

negative patients with pulmonary TB and to patients with

extrapulmonary disease.

Died A patient who died from any cause during treatment.

Failed A patient who was initially sputum smear-positive

and who remained sputum smear-positive at month 5 or later

FWTKPIVTGCVOGPV#NUQKPENWFGFKPVJKUFGßPKVKQPCTGRCVKGPVU

found to have a multidrug-resistant strain at any point in time

during treatment, whether they are smear-negative or smear–

positive.

Defaulted A patient whose treatment was interrupted for two

consecutive months or more.

Not evaluated A patient whose treatment outcome is not

known.

Successfully treated A patient who was cured or who

completed treatment.

Cohort A group of patients in whom TB has been diagnosed,

CPFYJQYGTGTGIKUVGTGFHQTVTGCVOGPVFWTKPICURGEKßGFVKOG

period (e.g. the cohort of new sputum smear-positive cases

registered in the calendar year 2010). This group forms the

denominator for calculating treatment outcomes. The sum of

the above treatment outcomes, plus any cases for whom no

outcome is recorded (including those ‘still on treatment’ in the

'WTQRGCP4GIKQPCPFÁVTCPUHGTTGFQWVÂECUGUUJQWNFGSWCNVJG

number of cases registered. Some countries monitor outcomes

COQPIEQJQTVUFGßPGFD[URWVWOUOGCTCPFQTEWNVWTG

CPFFGßPGEWTGCPFHCKNWTGCEEQTFKPIVQVJGDGUVNCDQTCVQT[

evidence available for each patient.

a See Treatment of tuberculosis Iuidelines th ed. Geneva, World Health

1TICPK\CVKQP9*1*6/56$#XCKNCDNGCV

JVVRYJSNKDFQEYJQKPVRWDNKECVKQPUAGPIRFH

BOX 3.7

WHO deßnitions of treatment outcomes for

drug-susceptible TB recommended for use

starting in 2013 and that will be used in the

2014 global TB reporta

Cured A pulmonary TB patient with bacteriologically-

EQPßTOGF6$CVVJGDGIKPPKPIQHVTGCVOGPVYJQYCU

smear- or culture-negative in the last month of treatment

and on at least one previous occasion.

Completed treatment A TB patient who completed

treatment without evidence of failure but with no record

to show that sputum smear or culture results in the

last month of treatment and on at least one previous

occasion were negative, either because tests were not

done or because results are unavailable.

Died A patient who died from any cause during

treatment.

Failed A TB patient whose sputum smear or culture is

positive at month 5 or later during treatment.

Lost to follow-up A TB patient who did not start

treatment or whose treatment was interrupted for two

consecutive months or more.

Not evaluated A TB patient for whom no treatment

outcome is assigned. This includes cases ‘transferred out’

to another treatment unit as well as cases for whom the

treatment outcome is unknown to the reporting unit.

Successfully treated A patient who was cured or who

completed treatment.

Cohort #UFGßPGFKPBox 3.6. In addition, it should

be highlighted that any patient found to haXe druI-

resistant TB and placed on second-line treatment is

remoXed from the druI-susceptible TB outcome cohort.

This means that management of the standard TB register

and of the second-line TB treatment register needs to be

coordinated to ensure proper accounting of the outcomes

of treatment. (See also Box 4.4)

a &eßnitions and reportinI framework for tuberculosis – 201 reXision

9*1*6/6$)GPGXC9QTNF*GCNVJ1TICPK\CVKQP

Available at www.who.int/iris/bitstream/10665/79199/

AGPIRFH

BOX 3.8

Achievements in global TB care and control, 1995–2012

WHO began systematic monitoring of TB control progress in 1995. Data compiled on an annual basis since then allow achievements

in TB care and control to be assessed.

Between 1995 and 2012, 56 million people were successfully treated for TB in countries that had adopted the DOTS/Stop TB

StrateIy. This saved approximately 22 million lives.a

The number of lives saved is based on the estimate that in the absence of treatment, approximately one third of people with TB

would die of the disease. This estimate allows for differences in the mortality rates for smear-positive compared with other types of

TB disease (see Chapter 1), and for differences in mortality rates between HIV-negative and HIV-positive people.

a For estimates of the incremental number of lives saved by improvements in TB care associated with implementation of the DOTS and Stop TB Strategy compared

YKVJRTGUVCPFCTFUQHECTGUGG)NC\KQW2GVCN.KXGUUCXGFD[VWDGTEWNQUKUEQPVTQNCPFRTQURGEVUHQTCEJKGXKPIVJGINQDCNVCTIGVHQTTGFWEKPIVWDGTEWNQUKU

mortality. Bulletin of the World *ealth OrIanization¿

42 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 3.6

Treatment success for new smear-positive cases (%) and cohort size (thousands), 1995–2011

a. Treatment success (%)

1995 1996 1997  1999 2000 2001 2002 2003 2004 2005 2006 2007  2009 2010 2011

Afghanistan – – 45 33       90     90 91

Bangladesh 71 63 73 77 79     90 91 92 92 91 92 92 92

$TC\KN 17 20 27 40  71 55  77 76 76 73 72 71 72 74 76

Cambodia 91 94 91 95 93 91 92 92 93 91 93 93 94 95 95 94 93

China 9394959595939592939494949494959695

&4%QPIQ 74  64 70 69  77         90 

Ethiopia 61 71 72 74 74  76 76 70 79       90

India 25 21  27 21 34 54 60 76        

Indonesia 91  54  50     90 91 91 91 91 91 90 90

Kenya 75 77 65 77 79   79         

/Q\CODKSWG 39 55 65 – 71 75   76 77 79  79    –

Myanmar 67 79               

Nigeria 4932737375797979 73 75 76     

Pakistan 70 – 67 23 70 74 77  79    91 90 91 91 92

Philippines 60 35  71            91 90

4WUUKCP(GFGTCVKQP 65 57 67  65  67 67 61 60    57 55 53 54

South Africa  61  72 57 63 61  67 69 71 74 74 76 73 79 79

Thailand 64    77 69 75 74 73 74 75 77     

Uganda 44 33 40 62 61 63 56 60  70 73 70 75 70 67 71 77

746CP\CPKC 73 76 77 76            90 

Viet Nam    92 92 92 93 92 92 93 92 93 92 92 92 92 93

<KODCDYG 53 32 69 70 73 69 71 67 66 54  60  74   

High-burden countries 53 50 56 62 60 67 72 75 81 84 86 87 87 87 88 88 88

#(4 60 56 64 70  71 70 73 73 74 76 75     

#/4 50 51  67 79 76 69   79 79 76 79 77 76 75 

'/4 79 66 73 57 79            

'74 67  72 63 75 75 74 74 75 71 72 70 71 70 69 67 65

5'#4 33 31 29 40 34 50 63  79        

924  72 91 92 91 90 91 90 91 91 92 92 92 92 93 93 94

Global 57 54 60 64 64 69 73 76 80 83 85 84 86 86 86 87 87

D%QJQTVUK\GVJQWUCPFU

1995 1996 1997  1999 2000 2001 2002 2003 2004 2005 2006 2007  2009 2010 2011

Afghanistan 2.0 2.9 2.0 3.1 6.3   10 10 12 13 13 12 13 14

Bangladesh 11 30 34    41 47 54 63  102 104 106 109 106 99

$TC\KN 46 45 43 30 27 34 41 29  43 42   41 41 42 43

Cambodia 4.4 9.1 12 13 16 15 14 17 19 19 21 19 19 20  17 16

China 131 175  210  214 190 194 267  473 470 466 464 449 430 377

&4%QPIQ 16 25 26 33 35 36 41 45 54 62 65 63 66 66 72 73 71

Ethiopia 5.1 11 12 15 21 30 32 37 40 41 39 37  41 45 47 41

India 265 291 293  345 349  396 420  507 553 592 616 625 630 642

Indonesia 3.0 12 21 40 46 52 54 76 93 129 159 175 161 166 169  

Kenya 6.5 13 19 22 27  31 31 34 41 40 39  37 37 36 37

/Q\CODKSWG 11 13 11 12 13 14 15 16 17    19 20 20

Myanmar 7.9 9.7 9.2 10 12 17 21 24 27 31 37 40 43 41 42 42 42

Nigeria 9.5 24 11 13 15 16 17 21  34 35 40 44 46 45 45 47

Pakistan   29 3.0 4.1 6.3 15 20 32  66  100 102 104 106

Philippines 90 126 27 21 37 50 55 59         94

4WUUKCP(GFGTCVKQP 0.05 43 0.7 0.7 1.5 3.6 4.1 5.2 6.3 26 26 31 32 32 32 30 37

South Africa  45 55 37   101 99 114 127 135 140 143 144 139 134 133

Thailand 20 0.1 3.7  14 23 20 27   30 29 30 33  30 31

Uganda 15 15  13 14 14 17 19 20 21 21 20 21 23 23 23 26

746CP\CPKC 20 21 22 24 24 24 24 24 25 26 25 25 25 24 25 24 24

Viet Nam   54 55 53 53 54 57 56  55 56 54 53 51 52 51

<KODCDYG 9.712121313141716141513161110101213

High-burden countries 739 967 879 912 1 044 1 119 1 186 1 260 1 450 1 776 1 965 2 087 2 132 2 181 2 184 2 185 2 140

#(4  233  235 323 365 409 452 491 552 564 566 577 591 606 599 579

#/4 129 134 125 111 110 111 102 105 110 121 119 132 116 109 123 126 127

'/4 46 51 60  66 64 52 76   114 132 156 167 167 170 171

'74 34 94 24  22 41 50 54 60     114 105 99 97

5'#4  360 376 399 473 512 550 604 661    974 1 011 1 022 1 045 1 065

924 296 372 294 313 353 360 346 357 439 575 663 663 661 657 641 622 560

Global 1 001 1 245 1 147 1 195 1 347 1 453 1 510 1 649 1 842 2 206 2 396 2 529 2 591 2 649 2 665 2 662 2 599

Blank cells indicate data not reported.

– indicates values that cannot be calculated.

43GLOBAL TUBERCULOSIS REPORT 2013

TABLE 3.7

Treatment success for all new cases (%) and cohort size (thousands), 1995–2011

a. Treatment success (%)

1995 1996 1997  1999 2000 2001 2002 2003 2004 2005 2006 2007  2009 2010 2011

Afghanistan – – 45 33       90      

Bangladesh 71 63 73 77 79     90 90 91 90 91 91 91 91

$TC\KN 17 20 27 40  71 55  77 72 72 69 72 69 70 72 73

Cambodia 91 94 91 95 93 91 92 92 93 91 91 92 93 94 94  94

China 9394959595939592939292929393949595

&4%QPIQ 74  64 70 69  77     60     

Ethiopia 61 71 72 74 74  76 76 70 79      77 

India 25 21  27 21 34 54 60 76        

Indonesia 91  54  50       90 90 90   

Kenya 75 77 65 77 79   79  77       

/Q\CODKSWG 39 55 65 – 71 75   76 77 79  79    –

Myanmar 67 79               

Nigeria 49 32 73 73 75 79 79 79  73 75 76     

Pakistan 70 – 67 23 70 74 77  79    90  91 90 92

Philippines 60 35  71            90 

4WUUKCP(GFGTCVKQP 65 57 67  65  67 67 61 65 67 69 69 69  66 65

South Africa  61  72 57 63 61  67 65 69 70 71 73  53 77

Thailand 64    77 69 75 74 73 71 71 75     

Uganda 44 33 40 62 61 63 56 60  70 73  72 67 64  73

746CP\CPKC 73 76 77 76             

Viet Nam    92 92 92 93 92 92 92 92 92 91 92 92 92 93

<KODCDYG 53 32 69 70 73 69 71 67 66  66 67  70 75 76 

High-burden countries 53 50 56 62 60 67 72 75 81 82 85 85 87 87 86 86 88

#(4 60 56 64 70  71 70 73 73 70 74 72 77 77 76 73 79

#/4 50 51  67 79 76 69   76 75 73  73 73 73 75

'/4 79 66 73 57 79            

'74 67  72 63 75 75 74 74 75 76 77 75 76 76 75 74 72

5'#4 33 31 29 40 34 50 63  79        

924  72 91 92 91 90 91 90 91  90 90 91 91 91 92 93

Global 57 54 60 64 64 69 73 76 80 81 84 84 85 85 85 84 87

D%QJQTVUK\GVJQWUCPFU

1995 1996 1997  1999 2000 2001 2002 2003 2004 2005 2006 2007  2009 2010 2011

Afghanistan 2.0 2.9 2.0 3.1 6.3   10 10 12 13 13 12 26 26

Bangladesh 11 30 34    41 47 54 63 119 141 144 106 156 150 

$TC\KN 46 45 43 30 27 34 41 29     47 73 75  71

Cambodia 4.4 9.1 12 13 16 15 14 17 19 30 34 34 35  39 40 37

China 131 175  210  214 190 194 267 644    932 923  

&4%QPIQ 16 25 26 33 35 36 41 45 54 62 65 92  93 106 109 92

Ethiopia 5.11112152130323740413937 139 139 152 91

India 265 291 293  345 349  396 420 1 066 1 071 1 137 1 199 1 226 1 244 1 229 1 209

Indonesia 3.0 12 21 40 46 52 54 76 93 206 244 266 263 293  296 314

Kenya 6.5 13 19 22 27  31 31 34 97  101 99 99 99 90 

/Q\CODKSWG 11 13 11 12 13 14 15 16 17    19 20 20

Myanmar 7.9 9.7 9.2 10 12 17 21 24 27 66 73   90 91 127 135

Nigeria 9.5 24 11 13 15 16 17 21  34 35 40 44 46   

Pakistan   29 3.0 4.1 6.3 15 20  117 149 191 206 212 256 255

Philippines 90 126 27 21 37 50 55 59  126  123 136 140 141 162 190

4WUUKCP(GFGTCVKQP 0.05 43 0.7 0.7 1.5 3.6 4.1 5.2 6.3 39 74 97 99 103 101 94 

South Africa  45 55 37   101 99 114 243 259 271 247 236 367  292

Thailand 20 0.1 3.7  14 23 20 27  47 49 47 47 54 43  49

Uganda 15 15  13 14 14 17 19 20 21 21 31 37 39  40 43

746CP\CPKC 20 21 22 24 24 24 24 24 25 61 59  25 59 60 59 59

Viet Nam   54 55 53 53 54 57 56 92 55 91 91 91   

<KODCDYG 9.7 12 12 13 13 14 17 16 14 54 43 43 39 40 45 46 40

High-burden countries 739 967 879 912 1 044 1 119 1 186 1 260 1 450 3 183 3 430 3 799 3 872 4 134 4 374 4 403 4 252

#(4  233  235 323 365 409 452 491   940 930  1 297 1 215 1 094

#/4 129 134 125 111 110 111 102 105 110 191  197 157  191 200 

'/4 46 51 60  66 64 52 76   226 259 307 320 331 391 

'74 34 94 24  22 42 50 55 60  221 274 276 279  250 217

5'#4  360 376 399 473 512 550 604 661 1 530 1 639    1 940  

924 296 372 294 313 353 360 346 357 439 963 1 030 1 163 1 216 1 261 1 259 1 240 1 213

Global 1 001 1 245 1 147 1 195 1 347 1 453 1 511 1 649 1 843 3 892 4 188 4 592 4 720 4 995 5 267 5 275 5 096

Blank cells indicate data not reported.

– indicates values that cannot be calculated.

44 GLOBAL TUBERCULOSIS REPORT 2013

BOX 3.9

Outcomes of TB treatment by HIV status

HIV+

(109 137)

HIV-

(925 024)

HIV+

(148 798)

HIV-

(811 586)

HIV+

(73 354)

HIV-

(370 385)

HIV+

(117 094)

HIV-

(959 174)

HIV+

(163 300)

HIV-

(845 907)

HIV+

(79 817)

HIV-

(385 748)

New smear-positive

patients (data from

88 countries)

New smear-negative

and extrapulmonary

patients (data from

72 countries)

Retreatment

patients (data from

59 countries)

100

Percentage of cohort (%)

a. Treatment success, 2011

b. Death rate among evaluated cases, 2011

Percentage (%)

New smear-positive

patients (data from

88 countries)

New smear-negative

and extrapulmonary

patients (data from

72 countries)

Retreatment

patients (data from

59 countries)

FIGURE B3.9.1

6TGCVOGPVUWEEGUUCCPFFGCVJTCVGUDCOQPI*+8

positive and HIV-negative TB patients, 2011

+PEQWPVTKGUYKVJa*+8RQUKVKXG6$

patients reported treatment outcomes for 2011 that were

disaggregated by HIV status. These countries accounted for

QHCNN*+8RQUKVKXG6$RCVKGPVUTGIKUVGTGFKPVJCV[GCT

This was a considerable increase from 2010, when countries

that reported outcomes disaggregated by HIV status

accounted for 25% of TB patients with a documented HIV-

positive test result. Much of the improvement is due to the

TGRQTVKPIQHFCVCFKUCIITGICVGFD[*+8UVCVWUHQTVJGßTUV

time by high TB/HIV burden countries such as South Africa

and Uganda. Of the 41 TB/HIV priority countries (listed in

Table 6.1 of Chapter 6), 19 reported treatment outcomes

FKUCIITGICVGFD[*+8UVCVWU$WTWPFK$WTMKPC(CUQ$TC\KN

Botswana, China, Ghana, Haiti, India, Kenya, Lesotho,

/CNK/[CPOCT0COKDKC0KIGTKC5QWVJ#HTKEC5YC\KNCPF

6JCKNCPFVJG7PKVGF4GRWDNKEQH6CP\CPKCCPF8KGV0CO

Data for 2011 show that treatment outcomes for HIV-

positive TB patients continue to be worse than those of

HIV-negative TB patients. The treatment success rate for all

PGY*+8RQUKVKXG6$RCVKGPVUYCUEQORCTGFYKVJ

among HIV-negative TB patients (Figure B3.9.1). If it is

assumed that HIV-positive TB patients who defaulted from

treatment would have died from TB, the death rate was 19%

among HIV-positive TB patients compared with 3% among

*+8PGICVKXG6$RCVKGPVU5WEJßPFKPIUCTGEQPUKUVGPVYKVJ

two autopsy studies in South Africa, which showed that

undiagnosed TB remains the main cause of death among

HIV-positive people.a,b

a /WVGXGF\K2GVCNEarly mortality followinI initiation of #4T in

rural South #frica the contribution of eZistinI co-morbidities. 20th

%QPHGTGPEGQP4GVTQXKTWUGUCPF1RRQTVWPKUVKE+PHGEVKQPU#VNCPVC

)GQTIKC75#¿/CTEJ2CRGTwww.retroconference.

org/2013b/Abstracts/46910.htm, accessed 3 June 2013).

b Martinson N et al. 7ndiaInosed infectious TB in adult home deaths

South #frica 201VJ%QPHGTGPEGQP4GVTQXKTWUGUCPF1RRQTVWPKUVKE

+PHGEVKQPU#VNCPVC)GQTIKC75#¿/CTEJ2CRGTwww.

TGVTQEQPHGTGPEGQTID#DUVTCEVUJVOCEEGUUGF,WPG).

2010 to 89% in 2011) and Nigeria for the rst time. e

six countries that reported lower rates of treatment suc-

cess were Brazil (73%), the Russian Federation (65%),

South Africa (77%), ailand (82%), Uganda (73%) and

Zimbabwe (80%). Data were not reported for Mozambique.

Treatment outcomes are worse among HIV-positive TB

patients compared with HIV-negative TB patients (Box 3.9).

Further eorts are needed to narrow the gap.

45GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

Drug-resistant TB

KEY FACTS AND MESSAGES

■ By the end of 2012, data on anti-TB drug resistance were available for 136 countries (70% of 194 WHO Member States), either

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■ 5WTXG[UWPFGTYC[KPKPVJGITQWRQHJKIJ6$CPFQT/&46$DWTFGPEQWPVTKGUCPFHTQOYJKEJTGUWNVUCTGGZRGEVGFKP

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JCXG/&46$6JGJKIJGUVNGXGNUCTGKPGCUVGTP'WTQRGCPFEGPVTCN#UKCYJGTGKPUGXGTCNEQWPVTKGUOQTGVJCPQHPGYECUGUCPF

OQTGVJCPQHRTGXKQWUN[VTGCVGFECUGUJCXG/&46$

■ 6JGTGYGTGCPGUVKOCVGFTCPIG¿PGYECUGUQH/&46$YQTNFYKFGKP#OQPIRCVKGPVUYKVJ

RWNOQPCT[6$PQVKßGFKPKGVJGITQWRQHRCVKGPVUMPQYPVQ062UCPFVJCVECPDGVGUVGFHQTFTWITGUKUVCPEGWUKPI9*1

TGEQOOGPFGFFKCIPQUVKEVGUVUVJGTGYGTGCPGUVKOCVGFaTCPIGa¿a/&46$ECUGUKP/QTGVJCPJCNH

QHVJGUGECUGUYGTGKP+PFKC%JKPCCPFVJG4WUUKCP(GFGTCVKQP

■ 'ZVGPUKXGN[FTWITGUKUVCPV6$:&46$JCUDGGPTGRQTVGFD[EQWPVTKGU1PCXGTCIGCPGUVKOCVGF%+¿

QH/&46$ECUGUJCXG:&46$

■ #VQVCNQH6$ECUGUGNKIKDNGHQT/&46$VTGCVOGPVYKVJ/&46$CPFYKVJTKHCORKEKPTGUKUVCPEGFGVGEVGF

WUKPI:RGTV/6$4+(YGTGPQVKßGFINQDCNN[KPOQUVN[D['WTQRGCPEQWPVTKGU+PFKCCPF5QWVJ#HTKEC6JKUTGRTGUGPVGF

RTQITGUUEQORCTGFYKVJYJGP/&46$ECUGUCPFTKHCORKEKPTGUKUVCPV6$ECUGUYGTGFGVGEVGFVJGNCTIGUV

increases between 2011 and 2012 were in India, South Africa and Ukraine. However, worldwide and in most countries with a high

DWTFGPQH/&46$NGUUVJCPQPGVJKTFQHVJG6$RCVKGPVUGUVKOCVGFVQJCXG/&46$YGTGCEVWCNN[FGVGEVGFKP

■ %QWPVTKGUFGVGEVKPIENQUGVQQHVJGPQVKßGF6$RCVKGPVUGUVKOCVGFVQJCXG/&46$KPKPENWFGF'UVQPKC-C\CMJUVCP

.CVXKC.KVJWCPKC5QWVJ#HTKECCPF7MTCKPG6JGNQYGUVßIWTGUYGTGKPVJG5QWVJ'CUV#UKC4GIKQPCPFVJG9GUVGTP2CEKßE

4GIKQPYJKEJEQODKPGFJCXGQHVJGYQTNFÂUECUGUQH/&46$

■ ,WUVQXGTRGQRNGYKVJ/&46$YGTGUVCTVGFQPUGEQPFNKPGVTGCVOGPVKPGSWKXCNGPVVQQHVJGPGYN[

FGVGEVGFECUGUVJCVYGTGGNKIKDNGHQTUWEJVTGCVOGPVINQDCNN[&KCIPQUVKEVTGCVOGPVICRUYGTGOWEJNCTIGTKPUQOGEQWPVTKGU

GURGEKCNN[KPVJG#HTKECP4GIKQPQHFGVGEVGFECUGUGPTQNNGFQPVTGCVOGPVCPFYKFGPGFDGVYGGPCPFKP%JKPC

Pakistan and South Africa.

■ 6JGVTGCVOGPVUWEEGUUVCTIGVQHÜUGVKPVJGGlobal Plan to Stop TB 2011–2015HQT/&46$YCUTGCEJGFD[QH

EQWPVTKGUVJCVTGRQTVGFQWVEQOGFCVCHQTVJGRCVKGPVEQJQTV*QYGXGTQXGTCNNQPN[QHRCVKGPVUYGTGUWEEGUUHWNN[VTGCVGF

■ +PVGPUKßGFINQDCNCPFPCVKQPCNGHHQTVUVQFGVGEVECUGUQH/&46$VQGPTQNVJGOQPVTGCVOGPVCPFVQKORTQXGVTGCVOGPV

outcomes are urgently required.

Drug-resistant TB (DR-TB) threatens global TB control and

is a major public health concern in several countries. is

chapter summarizes the progress made in global surveil-

lance of anti-TB drug resistance, using the most recent data

on MDR-TB and XDR-TB gathered from special surveys and

continuous surveillance systems, and summarizes global

estimates of disease burden associated with MDR-TB based

on these data (section 4.1). It also includes an assessment

of national progress in diagnosing and treating MDR-TB,

using data on diagnostic testing for DR-TB, enrolment on

treatment with second-line drugs for those found to have

MDR-TB, and treatment outcomes (section 4.2).

4.1 Surveillance of drug-resistant TB

4.1.1 Progress in the coverage of drug resistance

surveillance

Since the launch of the Global Project on Anti-tuberculosis

Drug Resistance Surveillance in 1994, data on drug resis-

tance have been systematically collected and analysed from

136 countries worldwide (70% of WHO Member States).

is includes 70 countries that have continuous surveil-

lance systems based on routine diagnostic drug suscepti-

bility testing (DST) of all TB patients and 66 countries that

rely on special epidemiological surveys of representative

samples of patients. e progress towards achieving global

coverage of drug resistance data is shown in Figure 4.1.

46 GLOBAL TUBERCULOSIS REPORT 2013

Continuous surveillance for MDR-TB, based on routine

DST of TB patients and systematic collection, collation and

analysis of data, is the most eective approach to monitor

trends in drug resistance over time. Additionally, such sys-

tems can detect outbreaks that might otherwise be unde-

tected, even during the course of a survey if the outbreak

site was not among those sites selected for patient enrol-

ment.

e number of countries that can rely on data generat-

ed by continuous surveillance systems is increasing, due to

eorts invested in scaling up the availability of culture and

DST services. Several high MDR-TB burden countries in the

European Region, including Belarus, Georgia, Kazakhstan,

Republic of Moldova, Ukraine and the Baltic States, have

put in place high quality surveillance systems to monitor

drug resistance both in new and previously treated TB cas-

es. A group of countries – Bolivia, Chile, Colombia, Costa

Rica, Ecuador, Egypt, El Salvador, Kyrgyzstan, Lebanon,

Mongolia, Nicaragua, Rwanda, Sri Lanka, Syrian Arab

Republic and Tajikistan – that previously relied on special

surveys to monitor drug resistance, have now established

routine surveillance systems for all previously treated cas-

es. is is the rst step towards achieving routine DST for

all TB patients.

Special surveys still represent the most common

approach to investigating the burden of drug resistance in

resource-limited settings where routine DST is not acces-

sible to all TB patients due to lack of laboratory capacity

or resources. Between 2010 and 2012, drug resistance

surveys were completed for the rst time in 16 countries:

Afghanistan (Central region), Albania, Bangladesh, Belar-

us, Benin, Bulgaria, Kyrgyzstan, Malawi, Nigeria, Saudi

Arabia, Somalia, Tajikistan, Tunisia, Uganda, Uzbekistan

and Yemen. In addition, Egypt, Brazil, Nepal and Zambia

completed a repeat survey.

In mid-2013, drug resistance surveys were ongoing in

12 high TB and MDR-TB burden countries. ese include

the rst nationwide surveys in Azerbaijan, India, Pakistan,

Turkmenistan, Ukraine, and repeat surveys in China, Ethi-

opia, Kenya, the Philippines, South Africa, ailand and

VietNam.

Molecular technologies are increasingly being used in

drug resistance surveys to simplify logistics and reduce

laboratory workload. GenoType® MTBDRplus (Hain Life-

science, Germany) was used in the national survey com-

pleted in 2012 in Nigeria and Xpert® MTB/RIF (Cepheid,

USA) is being used in the surveys underway in Pakistan and

Papua New Guinea. Several more countries are planning to

use Xpert MTB/RIF as a screening tool in drug resistance

surveys. ough not a complete surrogate for MDR-TB,

particularly in settings where levels of drug resistance are

low, rifampicin resistance is the most important indicator

of MDR-TB, with serious clinical implications for aected

patients. In countries where there is not yet the capacity

for culture and DST using conventional methods or where

laboratories cannot cope with the large workload generat-

ed by a drug resistance survey, Xpert MTB/RIF can play

an important role. It can be used to screen specimens for

rifampicin resistance and identify those requiring further

testing to be performed at national or supranational TB ref-

erence laboratories, also reducing the cost of initial screen-

ing by conventional commercial DST systems.

FIGURE 4.1

Progress in global coverage of data on drug resistance, 1994–2013

Year of most

recent data

1995–1999

2000–2004

2005–2009

2010–2012

Ongoing in 2013

No data

Subnational data only

Not applicable

47GLOBAL TUBERCULOSIS REPORT 2013

Five high TB and MDR-TB burden countries (Afghani-

stan, Brazil, Democratic Republic of the Congo, Indonesia

and the Russian Federation) still rely on drug resistance

surveillance data gathered from sub-national areas only.

ese countries should consider conducting nationwide

drug resistance surveys in the short term to better under-

stand the burden of MDR-TB and to guide the planning of

diagnostic and treatment services. A further six countries

(Dominican Republic, Guinea, Iran, Lesotho, Sierra Leone

and Zimbabwe) rely on drug resistance data gathered from

studies conducted in the late 1990s and should consider

implementing repeat surveys. Central and Francophone

Africa remain the parts of the world where drug resistance

surveillance data are most lacking, largely as a result of the

current weak laboratory infrastructure. Eorts should be

made to increase diagnostic and surveillance capacity in

these settings so that a drug resistance survey can be con-

ducted.

Of the 136 countries with surveillance data on drug

resistance, 35% (48 countries) have only one data point and

should consider repeating surveys to assess time trends.

Data on time trends in drug resistance were available

from 88 countries and 10 territories worldwide for a total

of 870 country-year data points. Among the 36 high TB and

high MDR-TB burden countries, 11 countries (Cambodia,

Estonia, Georgia, Latvia, Lithuania, Mozambique, Myan-

mar, Republic of Moldova, the Russian Federation (7 Fed-

eral Subjects), ailand and Viet Nam) have completed at

least two surveys at least ve years apart, allowing trends

over time to be evaluated. However, for ve of these coun-

tries (Cambodia, Mozambique, Myanmar, ailand and

Viet Nam) the most recent data are more than ve years

old. Among the six countries with recent data, in Estonia

and Latvia, surveillance data show that the rates of both

TB and MDR-TB have been declining. ese data suggest

that MDR-TB can indeed be controlled once eective policy

decisions are put into practice, and the necessary preven-

tion and control measures are implemented. In Lithuania,

Georgia, Republic of Moldova and most Federal Subjects of

the Russian Federation, MDR-TB rates appear to be stable

whereas in Ivanovo Oblast and Mary-El Republic MDR-TB

rates are increasing. Extending trend analyses to other

countries requires more data from repeat surveys or contin-

uous surveillance systems. NTPs should plan to repeat drug

resistance surveys regularly, approximately every ve years,

until capacity for continuous surveillance is established.

4.1.2 Percentage of new and previously treated

TB cases that have MDR-TB

Globally, 3.6% (95% CI: 2.1–5.1%) of new TB cases and

20.2% (95%CI: 13.3–27.2%) of previously treated cases are

estimated to have MDR-TB (Table 4.1). ese estimates are

essentially unchanged from 2011.

e proportions of new and previously treated TB cases

with MDR-TB at the country level are shown in Figure 4.2

and Figure 4.3, and for the 27 high MDR-TB burden coun-

tries in Table 4.1. Eastern European and especially central

Asian countries continue to have the highest levels of MDR-

TB. Among new cases, examples include Azerbaijan (22.3%

in 2007), Belarus (34.8% in 2012), Estonia (19.7% in 2012),

FIGURE 4.2

Percentage of new TB cases with MDR-TBa

Percentage

of cases

0–2.9

3–5.9

6–11.9

12–17.9

≥18

No data

Subnational data only

Not applicable

a Figures are based on the most recent year for which data have been reported, which varies among countries.

 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 4.1

Estimated proportion of TB cases that have

MDR-TB, globally and for 27 high MDR-TB burden

countries and WHO regions

ESTIMATED

% OF NEW TB

CASES WITH

/&46$a

CONFIDENCE

+06'48#.

ESTIMATED

% OF

4'64'#6/'06

TB CASES WITH

/&46$a

CONFIDENCE

+06'48#.

Armenia 9.4 7.0–12 43 ¿

#\GTDCKLCP 22 19–27 56 50–62

Bangladesh 1.4 0.7–2.5 29 24–34

Belarus 35 33–37 69 66–71

Bulgaria 2.3 ¿ 23 17–31

China 5.7 4.5–7.0 26 22–30

&4%QPIQ 2.5 0.1–5.0 10 .5–1

Estonia 20 14–26 50 35–65

Ethiopia 1.6 ¿ 12 5.6–21

Georgia 9.2 7.9–11 31 27–35

India 2.2 1.9–2.6 15 11–19

Indonesia 1.9 1.4–2.5 12 ¿

-C\CMJUVCP 23 22–24 55 54–56

-[TI[\UVCP 26 23–31  65–72

Latvia 11 ¿ 32 23–42

Lithuania 11 9.5–14 44 39–49

Myanmar 4.2 3.1–5.6 10 6.9–14

Nigeria 2.9 2.1–4.0 14 10–19

Pakistan .5 0.1–12 2.5–5

Philippines 4.0 2.9–5.5 21 14–29

4GRWDNKEQH/QNFQXC 24 21–26 62 59–65

4WUUKCP(GFGTCVKQP 23 21–25 49 45–53

South Africa  1.4–2.3 6.7 ¿

Tajikistan 13 ¿ 56 52–61

Ukraine 14 14–15 32 31–33

7\DGMKUVCP 23 ¿ 62 53–71

Viet Nam 2.7 2.0–3.7 19 14–25

High MDR-TB

burden countries 4.2 2.1–6.2 21 12–30

#(4 2.3 0.2–4.4 11 4.4–17

#/4 2.2 1.4–3.0 14 4.7–22

'/4 3.5 0.1–11 33 12–54

'74 16 10–22 45 39–52

5'#4 2.2 ¿ 16 11–21

924 4.7 3.3–6.1 22 ¿

Global 3.6 2.1–5.1 20 13–27

a Best estimates are for the latest available year. Estimates in italics are based on

regional data.

Kazakhstan (22.9% in 2012), Kyrgyzstan (26.4% in 2011),

the Republic of Moldova (23.7% in 2012), the Russian Fed-

eration (average: 23.1%, with Yamalo-Nenets Autonomous

Area being the highest: 41.9% in 2011) and Uzbekistan

(23.2% in 2011). Among previously treated cases, exam-

ples include Azerbaijan (Baku City: 55.8% in 2007), Belar-

us (68.6% in 2012), Estonia (50.0% in 2012), Kazakhstan

(55.0% in 2012), Kyrgyzstan (68.4% in 2012), the Republic

of Moldova (62.3% in 2012), Tajikistan (56.0% in 2012) and

Uzbekistan (62.0% in 2011). In the Russian Federation,

even though the average proportion of cases with MDR-

TB does not exceed 50%, the proportion is well above 50%

in several Federal Subjects (with Ulyanovsk Oblast at the

highest level: 74.0% in 2011).1

1 Tuberculosis in the Russian Federation 2011: an analytical review of

statistical indicators used in the Russian Federation and in the world (in

Russian). Moscow: Ministry of Health of the Russian Federation et

al., 2013.

BOX 4.1

MDR-TB in children

TB in children poses a diagnostic challenge, as

paucibacillary disease is more likely. Specimens suitable

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from the youngest children who cannot expectorate sputum.

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children.

6JGTGNCVKQPUJKRDGVYGGP/&46$CPFCIGITQWR

(children aged less than 15 years versus adults aged 15

years or older) was recently assessed using representative

drug resistance surveillance data reported to WHO between

1994 and 2012. Data were analysed for 376 293 TB cases

for whom age and DST data were available. Odds ratios

were derived by logistic regression with robust standard

errors, as described in detail elsewhere.a1HVJGEQWPVTKGU

reporting data from nationwide surveys or surveillance

U[UVGOUTGRQTVGFCVNGCUVQPGRCGFKCVTKE/&46$ECUG

A child with TB was shown to be as likely as an adult

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KFGPVKßECVKQPQH/&46$KPEJKNFTGPDGUVTGPIVJGPGF

Efforts should be made to systematically conduct household

EQPVCEVKPXGUVKICVKQPQHCNNRCVKGPVUYKVJ/&46$KPENWFKPI

children. Additionally, children must be routinely included

in all drug resistance surveillance activities, including drug

resistance surveys.

a <KIPQNGVCN/WNVKFTWITGUKUVCPVVWDGTEWNQUKUKPEJKNFTGPGXKFGPEGHTQO

global surveillance. European 4espiratory ,ournal¿

More positively, levels of drug resistance among new cas-

es remain low (<3%) in many parts of the world, including

almost all countries in the Region of the Americas, most

African countries where drug resistance surveys have been

conducted, most of the South-East Asia Region, most of

western Europe, and several countries in the Western Pacif-

ic Region (examples include Australia, Cambodia, Japan,

New Zealand and VietNam).

49GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 4.3

Percentage of previously treated TB cases with MDR-TBa

Percentage

of cases

0–5.9

6–11.9

12–29.9

30–49.9

≥50

No data

Subnational data only

Not applicable

a (KIWTGUCTGDCUGFQPVJGOQUVTGEGPV[GCTHQTYJKEJFCVCJCXGDGGPTGRQTVGFYJKEJXCTKGUCOQPIEQWPVTKGU6JGJKIJRGTEGPVCIGUQHRTGXKQWUN[VTGCVGF6$ECUGUYKVJ/&46$

KP$CJTCKP$QPCKTG¿5CKPV'WUVCVKWUCPF5CDC%QQM+UNCPFU+EGNCPF5CQ6QOGCPF2TKPEKRGCPF.GDCPQPTGHGTVQQPN[CUOCNNPWODGTQHPQVKßGFECUGU

4.1.3 Estimated global incidence of MDR-TB and

estimated number of MDR-TB cases among

 PQVKßGF6$RCVKGPVUKP

e data compiled from surveillance of drug resistance

among TB patients allow estimation of the total number of

incident cases of MDR-TB worldwide in 2012. e number

of incident cases includes not only cases among notied

TB patients, but also cases among people diagnosed with

TB that were not notied to NTPs (and in whom MDR-TB

may not have been detected) and cases among people not

yet diagnosed with TB. Globally in 2012, there were an

estimated 450 000 (range: 300 000‒600 000) new cases

of MDR-TB. Methods used to produce this estimate are

explained in Annex 1.

Data compiled from surveillance of drug resistance

among TB patients also allow production of global as well as

country-specic estimates of the number of MDR-TB cases

among notied TB patients with pulmonary TB. ese are

the MDR-TB cases that could be found by NTPs if all noti-

ed patients were tested for drug resistance to rifampicin

and isoniazid using WHO-recommended diagnostic tests,

and is a useful indicator for assessing country performance

in detecting cases of MDR-TB and enrolling them on treat-

ment. Globally in 2012, there were an estimated 300000

(range: 220000–380 000) MDR-TB cases among notied

TB patients. Country-specic estimates are discussed in

section 4.2.

4.1.4 Resistance to second-line drugs

Extensively drug-resistant TB (XDR-TB) had been reported

by 92 countries globally by the end of 2012 (Figure 4.4). A

total of 75 countries and 4 territories reported represen-

tative data from continuous surveillance or special sur-

veys regarding the proportion of MDR-TB cases that had

XDR-TB. Combining their data, the average proportion of

MDR-TB cases with XDR-TB was 9.6% (95% CI: 8.1%–11%),

similar to the estimate from 2011 (9.0%). irteen of these

countries reported more than 10 XDR-TB cases in the most

recent year for which data were available. Among those

countries, the proportion of MDR-TB cases with XDR-

TB was highest in Azerbaijan (Baku city: 12.8%), Belarus

(11.9%), Latvia (16.0%), Lithuania (24.8%) and Tajikistan

(Dushanbe city and Rudaki district: 21.0%).

e proportion of MDR-TB cases with resistance to u-

oroquinolones and second-line injectable agents was 16.5%

(95% CI: 12.3–20.7) and 22.7% (15.4%–30.0%), respective-

ly. A total of 32.0% (21.9%–42.1%) of patients with MDR-

TB have resistance to a uoroquinolone, a second-line

injectable agent, or both. ese patients would likely be

eligible to receive bedaquiline, the new bactericidal drug

recently approved for use in patients with MDR-TB when

options to treat using existing drugs have been exhausted

(see Box 8.2 in Chapter 8).

50 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 4.4

Countries that had notißed at least one case of XDR-TB by the end of 2012

At least one case reported

No cases reported

Not applicable

4.2 Management of drug-resistant TB

 %QXGTCIGQHFTWIUWUEGRVKDKNKV[VGUVKPI&56

e diagnosis of DR-TB requires TB patients to be tested

for susceptibility to drugs. Notication data combined with

data from drug resistance surveillance suggest that if all

notied TB patients with pulmonary TB had been tested in

2012, around 300000 cases of MDR-TB would have been

found (section 4.1.3).

Targets included in the Global Plan to Stop TB 2011–2015

are that by 2015 all new cases of TB considered at high risk

of MDR-TB (estimated to be about 20% of all new bacterio-

logically-positive TB cases globally), as well as all previously

treated cases, should undergo DST for at least the rst-line

drugs rifampicin and isoniazid. Similarly, all patients with

MDR-TB should be tested for XDR-TB.

First-line DST results were reported by just over 50%

of countries in 2012 and overall for a small proportion of

cases (Table 4.2). Globally, only 5% of new bacteriological-

ly-conrmed TB cases and 9% of those previously treated

for TB were tested for MDR-TB in 2012. e proportion of

new cases with DST results has increased slightly in recent

years but remains below the target envisaged for 2012

by the Global Plan (Figure 4.5). Coverage was highest in

the European Region, where 72% of new cases and 41% of

previously treated cases were tested for MDR-TB in 2012,

reecting the relatively better access to TB laboratory ser-

vices than elsewhere. Levels of testing were particularly

low in the African and South-East Asia Regions (0.3% and

0.1% of new bacteriologically cases and 3.1% and 0.7% of

previously treated cases, respectively).

Among the 27 high MDR-TB burden countries – which

account for >85% of estimated MDR-TB cases in the world

– the proportion of TB patients who were tested ranged

from 56 to 100% among new cases in 13 of the 14 Euro-

pean countries reporting data (17% in Tajikistan; no data

reported by Azerbaijan), and exceeded 60% among pre-

viously treated cases in nine of these countries. Among

non-European high MDR-TB burden countries, testing for

MDR-TB among new cases was highest in China (3.6%). In

previously treated cases, the coverage of testing was higher

and reached 10% in Indonesia and 12% in China and the

Philippines. In South Africa, 16% of TB cases overall were

tested for MDR-TB although DST data were not available

separately for new and previously treated cases. Five other

countries did not report data, including India, the country

estimated to have the highest number of MDR-TB cases

among notied TB patients (Table 4.2).

Among TB patients who were notied and conrmed to

have MDR-TB in 2012, 23% were reported to have DST per-

formed for both uoroquinolones and second-line injectable

drugs. Second-line DST coverage exceeded 90% in Armenia,

Bulgaria, the Democratic Republic of the Congo, Georgia

and Latvia. South Africa accounted for most of the global

cases for which second-line DST data were reported, as well

as the highest proportion observed in the African Region

(the regional gure drops from 62% to 1% when South Afri-

ca is excluded). Second-line DST reports were available for

53% of MDR-TB cases in the Western Pacic Region, 47% in

the Region of the Americas and 3–8% in the other regions.

Improving the coverage of diagnostic DST is urgently

needed to improve the detection of MDR-TB and XDR-TB.

51GLOBAL TUBERCULOSIS REPORT 2013

TABLE 4.2

DST coverage among TB and MDR-TB cases, globally and for 27 high MDR-TB burden countries and WHO

regions, 2012

0'9$#%6'4+1.1)+%#..;215+6+8'%#5'5 4'64'#6/'06%#5'5 %10(+4/'&/&46$%#5'5

07/$'49+6*

DSTa4'57.65

% OF CASES WITH

&564'57.65

07/$'49+6*

DSTa4'57.65

% OF CASES WITH

&564'57.65

07/$'49+6*

DSTb4'57.65

% OF CASES WITH

&564'57.65

Armenia  64  27 92 100

#\GTDCKLCP –––

Bangladesh 41  557 7.0 142 

Belarus 2 164 90   –

Bulgaria  71 142 45 49 100

China 11 472 3.6  12 2 042 

&4%QPIQ 12  95 1.3 65 100

Estonia 193 100 46  55 

Ethiopia 469 1.0  4.4 –

Georgia 1 931  541 45 341 99

India – – 597 3.6

Indonesia 2   10  43

-C\CMJUVCPc >100 10 443 93 –

-[TI[\UVCP  57 662 61 511 53

Latvia 666 97 100  106 96

Lithuania 1 017 100 350 100 210 77

Myanmar – –  11

Nigeria 11  94 1.2 –

Pakistan 461 0.4 154 1.3 –

Philippines 35    –

4GRWDNKEQH/QNFQXC 1 264 67 933 63 –

4WUUKCP(GFGTCVKQP 32 647 79 12 324 24 –

South Africa – – 11 046 72

Tajikistan 919 17 496 66 345 50

Ukraine  77 5 925 72 –

7\DGMKUVCP 2 703 56  30 356 21

Viet Nam – – –

High MDR-TB burden countries 77 277 3.9 42 851 7.7 16 225 21

#(4 2 216 0.3 3 969 3.1 11 303 62

#/4  22  23  47

'/4 1 990 1.1 1 617 7.6 51 3.2

'74  72 37 774 41 2 523 6.7

5'#4 1 352 0.1 2 292 0.7 1 619 

924  3.3  10 2 365 53

Global 136 630 5.1 59 267 8.7 19 245 23

Blank cells indicate data not reported.

– indicates values that cannot be calculated.

a &56KUHQTKUQPKC\KFCPFTKHCORKEKP

b &56KUHQTCàWQTQSWKPQNQPGCPFCUGEQPFNKPGKPLGEVCDNGFTWI

c #RQUUKDNGGZRNCPCVKQPHQTYJ[VJGRGTEGPVCIGHQTPGYECUGUKP-C\CMJUVCPGZEGGFUKUKPCFGSWCVGNKPMCIGUDGVYGGPENKPKECNCPFNCDQTCVQT[TGIKUVGTU

52 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 4.5

DST coverage among new cases and enrolment on MDR-TB treatment, compared with the targets in the Global

Plan to Stop TB, 2011–2015. Lines indicate the planned targets, blue squares show the situation in 2009–2012 and

orange circles the projected enrolments 2013–2015. Data on projected enrolments in 2015 were incomplete.

Number of patients

b. Enrolment on MDR-TB treatment

2009 2010 2011 2012 2013 2014 2015

50 000

100 000

150 000

200 000

250 000

300 000

Percentage of cases

2009 2010 2011 2012 2013 2014 2015

a. DST coverage among new bacteriologically-positive cases

is requires the strengthening of laboratory capacity, the

introduction of new rapid diagnostics and improved report-

ing from diagnostic centres (see Chapter 5). e identi-

cation of XDR-TB cases in countries worldwide (Box 4.2,

Figure 4.4) reects the risk of acquisition of additional sec-

ond-line drug resistance and the transmission of resistant

strains when TB care and prevention (including infection

control) are inadequate.

 0QVKßECVKQPQH/&46$ECUGUCPFGPTQNOGPV

on treatment

e low coverage of DST in many countries is one of the

main constraints limiting the detection of MDR-TB among

people diagnosed with TB. Globally, 83 715 cases of MDR-

TB were notied to WHO in 2012, with India, the Russian

Federation and South Africa reporting more than a half of

these cases (Table 4.3). In addition, just over 10 000 rifam-

picin-resistant TB (RR-TB) cases were reported to have

been detected using rapid molecular techniques.1 India,

Kyrgyzstan, the Philippines and Uzbekistan each reported

>500 of such cases.

e 83 715 reported cases of MDR-TB cases represent-

ed 28% of the 300 000 (range, 220 000–380 000) pulmo-

nary TB patients estimated to have MDR-TB in 2012 (Table

4.3), up from 20% in 2011, and 19% of the 450 000 (range:

300 000‒600 000) estimated incident MDR-TB cases in

the world in 2012. Much of the increase between 2011 and

2012 was accounted for by India (4237 to 16 588), South

Africa (10 085 to 15 419)2 and Ukraine (4305 to 6934),

although increases were reported by a total of 17 high

MDR-TB burden countries and all WHO regions with the

exception of the Region of the Americas. In the Democratic

BOX 4.2

XDR-TB in Africa

+PCENWUVGTQH:&46$RCVKGPVUKPTWTCN5QWVJ#HTKEC

made international headlines.a All of the patients from this

cluster who were tested for HIV were found to be infected.

Most of these patients died very quickly. South Africa

TGOCKPUVJGEQWPVT[VJCVTGRQTVUVJGOQUV:&46$ECUGU

KPVJGYQTNFCPFCPPWCNPQVKßECVKQPUJCXGKPETGCUGFHTQO

KPVQKP#DQWVQH/&46$ECUGU

TGRQTVGFKPVJKUEQWPVT[JCXG:&46$

FIGURE B4.2.1

Treatment outcomes for 623 TB patients with XDR-

TB in South Africa, 2010

Completed 6%

Cured 12%

Not evaluated 17%

Lost to follow-up 9%

Treatment failed 8%

Died 49%

By the end of 2012, 15 countries in the African region had

KFGPVKßGFCPFTGRQTVGFCVNGCUVQPGECUGQH:&46$Figure

4.4+PVYQJKIJ/&46$DWTFGPEQWPVTKGUKPVJG

#HTKECP4GIKQP¿VJG&GOQETCVKE4GRWDNKEQHVJG%QPIQ

CPF0KIGTKC¿GCEJTGRQTVGFVJGKTßTUV:&46$ECUG5GXGP

#HTKECPEQWPVTKGUTGRQTVGFUVCTVKPI:&46$RCVKGPVUQP

treatment in 2011 or 2012, most of them in South Africa.

Treatment outcomes reported by South Africa reveal the very

low likelihood of a favourable outcome in such patients and

the high proportion of patients lost to or not evaluated by

the health services (see Figure B4.2.1).

a )CPFJK04/QNN#5VWTO#92CYKPUMK4)QXGPFGT6.CNNQQ7GVCN

Extensively drug-resistant tuberculosis as a cause of death in patients

co-infected with tuberculosis and HIV in a rural area of South Africa. The

Lancet¿

1 ese are in addition to other rifampicin-resistant cases detected

by Xpert MTB/RIF, which were included under MDR-TB notica-

tions following subsequent testing for isoniazid resistance.

2 In South Africa, the number of cases detected was above the esti-

mated number of cases among pulmonary TB patients; this could

reect either that the estimates of the number of MDR-TB cases

among TB patients are too conservative and/or the absence of link-

ages between the clinical and laboratory registers.

53GLOBAL TUBERCULOSIS REPORT 2013

TABLE 4.3

Estimated MDR-TB cases in 2012, notißed cases of MDR-TB and enrolments on MDR-TB treatment

2009–2012, and treatment outcome reporting for 2010 cohort, globally and for 27 high MDR-TB burden

countries and WHO regions

'56+/#6'&/&46$#/10)016+(+'&

27./10#4;6$%#5'5 NOTIFIED CASES %#5'5'041..'&10/&46$64'#6/'06

/&46$%#5'5

4'2146'&9+6*

64'#6/'06176%1/'

&#6#%1*146

BEST LOW HIGH 2009 2010 2011 2012

2012

NOTIFIED /

ESTIMATED

(%)a

2009 2010 2011 2012 N %b

Armenia 250 220  156 177 79 92 37 134 154  101 132 75

#\GTDCKLCP  2 600 3 000 552  596 21  592 406 263 

Bangladesh 4 200 3 100 5 200 339 509 513 12 352 339 390 513 329 97

Belarus 2 200 2 100 2 200 1 342 1 576 1 594 1 604 73 200 1 446  1 442 91

Bulgaria 100  130 43 56 55 49 49 43 56 42 36 56 100

China 59 000 52 000 66 000 474 2 792 1 601 3 007 5.1  1 222 1 155 1 906 1 222 44

&4%QPIQ 2 900 670 5 100 91  121 65 2.2 176 191  179 105 121

Estonia 70 56   63  62   63 75 54 64 102

Ethiopia 2 100 1 200 3 000 233 140 212  14  120 199  114 

Georgia 630 570 690 369 359 475 346 55 266  737 665 504 140

India 64 000 49 000 79 000 1 660 2 967 4 237  26 1 136 2 967  14 143  74

Indonesia 6 900 5 200     6.2 20 142 260 426 140 77

-C\CMJUVCP   9 000 3 644     3 209 5 705 5 261 7 213 5 777 

-[TI[\UVCP  1 600 1 900  566   53 545 566 492 790 441 

Latvia 120 100 140 131  105 110 92 124  103 110  101

Lithuania 300 270 330 322 310 296 271 90 322 310 296 271 310 100

Myanmar 6 000 4 600 7 500  192 690  13 64 192 163 442  

Nigeria 3 600 2 700 4 500  21 95 107 3.0 0 23  125 23 110

Pakistan 11 000 0 29 000 49 444 344 1 602 15  424 344 1 045 195 44

Philippines 13 000 10 000 16 000 1 073 522  679 5.2 501  2 397   150

4GRWDNKEQH/QNFQXC 1 700 1 600  1 069  1 001  53 334 791 765  –

4WUUKCP(GFGTCVKQP 46 000 43 000 49 000  13 692  13 612 30  13 692    34

South Africa  6 900 9 400 9 070   15 419 >100 4 143 5 402 5 643 6 494  66

Tajikistan 910  1 000 319 333 604 694 76 52 245  535 245 74

Ukraine  6 500 7 000  5 336 4 305 6 934 >100   4 950 7 672 3 902 73

7\DGMKUVCP 4 000 3 700 4 300 654 1 023   43 464   1 491  61

Viet Nam  3 000 4 600 217 101 601 273 7.2 307 101  713 97 96

High MDR-TB

burden countries 270 000 180 000 350 000 40 798 47 772 52 813 75 301 28 24 521 38 942 49 663 69 320 28 793 60

#(4  14 000 62 000 10 741 9 340    5 994 7 209 7 467 9 303 6 166 66

#/4 7 100 4 500 9 600  2 661 3 474 2 967 42 3 153 3 249  3 102 2 374 

'/4  0 42 000 496   2 236 12 707 967 756 1 602 676 77

'74 74 000 60 000   33 776 34 199  50 17 169  36 313 42 399 19 496 

5'#4 90 000 71 000 110 000 2 560 3 942 6 615 19 202 21 2 040 3 901 4 597  3 113 79

924 74 000 57 000 91 000 2 059 4 295 4 394 4 473 6.0 1 429 2 210 4 946 5 070 2 456 57

Global 300 000 220 000 380 000 46 897 54 887 61 907 83 715 28 30 492 45 872 57 166 77 321 34 281 62

Blank cells indicate data not reported.

– indicates values that cannot be calculated.

a 0QVKßGFECUGUQH/&46$KPCUCRGTEGPVCIGQHVJGDGUVGUVKOCVGQH/&46$ECUGUCOQPICNNECUGUQHRWNOQPCT[6$KPVJGUCOG[GCT6JGRGTEGPVCIGOC[GZEGGF

KHGUVKOCVGUQHVJGPWODGTQH/&46$CTGVQQEQPUGTXCVKXGCPFKHNKPMCIGDGVYGGPVJGENKPKECNCPFNCDQTCVQT[TGIKUVGTUKUKPCFGSWCVG

b 6JGRGTEGPVCIGQH/&46$ECUGUQTKIKPCNN[PQVKßGFKPYKVJQWVEQOGUTGRQTVGF6JGRGTEGPVCIGOC[GZEGGFCUCTGUWNVQHWRFCVGFKPHQTOCVKQPCDQWV/&46$

ECUGUKPKPCFGSWCVGNKPMCIGUDGVYGGPPQVKßECVKQPU[UVGOUHQT6$CPF/&46$CPFVJGKPENWUKQPKPVJGVTGCVOGPVEQJQTVQHECUGUQH/&46$ECUGUHTQOC[GCTRTKQTVQ

2010.

54 GLOBAL TUBERCULOSIS REPORT 2013

Republic of the Congo, the Philippines and Viet Nam, which

detected less than 30% of their estimated burden in 2012,

MDR-TB notications decreased between 2011 and 2012.

Of the MDR-TB cases reported globally in 2012, most (82%)

were detected in either the European Region (36 708), India

(16 588) or South Africa (15 419).

Countries detecting close to 100% of the TB patients esti-

mated to have MDR-TB in 2012 included Estonia, Kazakh-

stan, Latvia, Lithuania, South Africa and Ukraine (Table

4.3). In the African and European Regions and the Region

of the Americas, about 50% of the TB patients estimated

to have MDR-TB were detected in 2012. e lowest gures

were in the two regions with the largest number of cases:

the South-East Asia region (21%) and the Western Pacic

Region (6%). India and China, the two countries estimat-

ed to have the largest numbers of TB patients with MDR-

TB (both over 50000, Figure 4.6), strongly inuence the

overall gures for the South-East Asia and Western Pacic

Regions. China and India, together with the Russian Federa-

tion – which ranks third globally in total cases of MDR-TB –

detected and reported less than one third of the TB patients

estimated to have MDR-TB (5%, 26% and 30% respectively).

e absolute numbers of TB cases started on second-line

treatment for MDR-TB increased from 30492 in 2009 to

77321 in 2012 (+154%). ere was a 40% increase in enrol-

ments between 2011 and 2012 in the 27 high MDR-TB

burden countries, which reected progress in 20 of these

countries and especially in India, Kazakhstan and Ukraine

(Table 4.3). e ratio of the numbers of patients starting

treatment with second-line drug regimens for MDR-TB,

to those notied with MDR-TB in 2012, was 92% globally

FIGURE 4.6

Number of MDR-TB cases estimated to occur among notißed pulmonary TB cases, 2012

MDR-TB cases

0–199

200–1999

2000–19 999

20 000–49 999

≥ 50 000

No data

Not applicable

(82% when RR-TB cases are included), but was lower in the

African (51%) and South-East Asia (83%) Regions (Table

4.3). Waiting lists of people requiring treatment for MDR-

TB are persisting or growing in several countries, particu-

larly when additional RR-TB cases diagnosed using Xpert

MTB/RIF are taken into account. Diagnosis:treatment

gaps of 5% or more were evident in 14 of the high MDR-

TB burden countries in 2012 (Figure 4.7), and the ratio of

MDR-TB cases diagnosed to enrolments on MDR-TB treat-

ment increased by more than 10% between 2011 and 2012

in China, Pakistan and South Africa. e number of XDR-

TB cases reported worldwide increased from 1464 to 2230

between 2011 and 2012. All the WHO regions reported

more XDR-TB cases enrolled on treatment in 2012 than in

2011, reaching 1557 globally in 2012.

Common constraints to treatment scale up include a

critical shortage of trained sta, insucient availability

of second-line medications, inadequate numbers of facili-

ties for treatment and monitoring, incomplete diagnosis

of patients and other weaknesses in the coordination of

activities required for eective programmatic management

of DR-TB. ere is a global shortfall in capacity to place peo-

ple diagnosed with MDR-TB on treatment, and increased

resources for the programmatic management of MDR-TB

are urgently required.

In a few countries, such as Georgia, the Russian Feder-

ation and Ukraine, enrolments have outstripped notica-

tions of MDR-TB in recent years. Possible explanations for

this include frequent empirical treatment of TB patients

considered at risk of having MDR-TB but for whom a labo-

ratory-conrmed diagnosis is missing, incomplete report-

55GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 4.7

MDR-TB cases (orange) and additional rifampicin-resistant TB cases (blue) detected compared with

TB cases enrolled on MDR-TB treatment (green) 2009–2012, globally and in 27 high MDR-TB burden

countries, 2009–2012

Number of cases

100

150

200

400

600

800

200

400

600

1000

2000

3000

100

150

200

100

Armenia Azerbaijan Bangladesh Belarus

Bulgaria China DR Congo Estonia

100

200

300

200

400

600

800

5000

10000

15000

100

200

300

400

500

Ethiopia Georgia India Indonesia

2000

4000

6000

8000

250

500

750

1000

100

150

250

270

290

310

330

350

Kazakhstan Kyrgyzstan Latvia Lithuania

200

400

600

800

100

200

300

500

1000

1500

2000

Myanmar Nigeria Pakistan Philippines

500

1000

1500

2000

2500

300

500

700

900

1100

5000

10000

15000

20000

5000

10000

15000

200

400

600

800

Republic of Moldova Russian Federation South Africa Tajikistan

2000

4000

6000

8000

500

1000

1500

2000

200

400

600

800

2009 2010 2011 2012 2009 2010 2011 2012 2009 2010 2011 2012 2009 2010 2011 2012

Ukraine Uzbekistan Viet Nam Global

500

1000

1500

2000

2500

20 000

40 000

60 000

80 000

100 000

56 GLOBAL TUBERCULOSIS REPORT 2013

ing of laboratory data, or enrolment of ‘backlogs’ or waiting

lists of MDR-TB patients who were detected before 2012.

Among 119 countries reporting sex-disaggregated data

for enrolments, the median male:female ratio was 2. Most

countries that reported data on MDR-TB patient enrol-

ments did not report the inclusion of any children. In the

44 countries that did, the proportion of children ranged

from <1% to 33% of total enrolments.

Many countries envisage increases in the number of

patients enrolled on treatment for MDR-TB between 2013

and 2015. However, global projections remain well below

Global Plan targets, partly as a result of slow rates of

increase as well as incomplete information regarding fore-

casts, notably for China (2015) and the Russian Federation

BOX 4.3

Pharmacovigilance for TB care

2JCTOCEQXKIKNCPEGKUFGßPGFD[

9*1CUÄThe science and actiXities

relatinI to the detection assessment

understandinI and preXention of

adXerse effects or any other druI-

related problem.”

#FXGTUGFTWITGCEVKQPU#&4UECP

lead to a TB patient interrupting

treatment before completion, thus contributing to avoidable

morbidity, drug resistance, treatment failure, reduced

quality of life, or death. It is important to routinely monitor

VJGQEEWTTGPEGQH#&4UKP6$RCVKGPVUQPVTGCVOGPVKP062U

This is particularly relevant in the care of patients with

&46$CPFRCVKGPVUYJQCTG*+8RQUKVKXG

6JTGGCRRTQCEJGUVQRJCTOCEQXKIKNCPEGCTGKPWUG

Spontaneous reporting. This involves the reporting of

#&4U¿GIQVQVQZKEKV[CUUQEKCVGFYKVJCOKPQIN[EQUKFGU

– to the national pharmacovigilance centre.

Targeted spontaneous reporting. This is an extension

of spontaneous reporting that can be focused on the

UWTXGKNNCPEGQHUGTKQWUCFXGTUGGXGPVUKPURGEKßERCVKGPV

ITQWRUUWEJCURCVKGPVUYKVJ/&46$

Cohort event monitoring (CEM). This is an active form of

surveillance, similar in design and management to an

epidemiological cohort study. CEM is particularly well

suited to the post-marketing surveillance of new drugs.

In 2012, WHO produced a handbook on pharmacovigilance

for TB.a WHO offers technical assistance to countries for

the introduction and strengthening of pharmacovigilance

in their programmes. The handbook explains how

pharmacovigilance can be effectively implemented in a TB

programme through key stakeholders, including regulators

and manufacturers, and provides a step-by-step approach

to identifying signals, assessing the relationship between

an event and a drug, determination of causality, acting on

QDUGTXCVKQPUCPFEQOOWPKECVKQPQHßPFKPIU

a # practical handbook on the pharmacoXiIilance of medicines used in

the treatment of tuberculosis enhancinI the safety of the TB patient.

)GPGXC9QTNF*GCNVJ1TICPK\CVKQPwww.who.int/medicines/

RWDNKECVKQPURJCTOCEQXKIKNCPEGAVD).

(2013) (Figure 4.5b). To reach the targets set out in the

Global Plan and advance towards universal access to treat-

ment, a bold and concerted drive is still needed on many

fronts of TB care, particularly in the countries where the

burden is highest. e capacity to address this challenge has

increased in recent years as a result of the intensied tech-

nical assistance provided by international organizations.

With the reform of the Green Light Committee (GLC) struc-

ture in 2011, and the creation of regional level committees

(rGLCs) in all six WHO regions, international support to

national eorts to strengthen programmatic management

of DR-TB is now focused on devolving available resources

and technical assistance closer to countries.

4.2.3 Treatment outcomes for MDR-TB and XDR-TB

Standardized monitoring methods and indicators have

allowed countries to report MDR-TB treatment outcomes

in a comparable manner for several years. In 2013, the de-

nitions for treatment outcomes were simplied and the

reporting requirements changed to allow for the inclusion

of RR-TB cases in the MDR-TB cohort (Box 4.4).

e number of cases reported in annual MDR-TB treat-

ment outcome cohorts has tripled between 2007 and 2010,

reecting increases in all regions (Figure 4.8). All high

MDR-TB burden countries have now reported treatment

outcomes for at least one annual cohort since 2007.

A total of 107 countries reported outcomes for more

than 34000 MDR-TB cases started on treatment in 2010

(Table 4.3). is is equivalent to 62% of the number of

MDR-TB cases notied by countries in the same year. e

low proportion reects weaknesses in reporting systems to

reconcile outcome data with notications. e Global Plan

envisages that by 2015, all countries will report outcomes

for all notied MDR-TB cases. In 2010, only 71 countries

– including 13 high MDR-TB burden countries – reported

outcomes for a cohort whose size exceeded 80% of the orig-

inal number of MDR-TB notications in 2010.

Overall, the proportion of MDR-TB patients in the 2010

cohort who successfully completed treatment was 48%,

while 28% of cases were reported as lost to follow-up or had

no outcome information. Treatment success was highest in

the Eastern Mediterranean Region (56%), as well as in the

Region of the Americas (54%) where this proportion has

increased steadily since 2007 alongside a reduction in the

proportion of patients whose treatment outcome was not

evaluated. In the 2010 cohort, deaths were highest in the

African Region (17%) and the proportion of patients whose

treatment failed was highest in the European Region (11%).

e Global Plan’s target of achieving at least 75% treatment

success in MDR-TB patients by 2015 was only reached by

34/107 countries reporting outcomes for the 2010 cohort,

but included three high MDR-TB burden countries: Bangla-

desh, Ethiopia and VietNam.

Among a subset of 795 XDR-TB patients in 26 countries,

treatment success was 20% overall and 44% of patients

died; excluding South Africa, the gures were 27% and 28%

respectively (Box 4.2).

A PRACTICAL HANDBOOK

ON THE PHARMACOVIGILANCE

OF MEDICINES USED

IN THE TREATMENT OF

TUBERCULOSIS

ENHANCING THE SAFETY OF THE TB PATIENT

57GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 4.8

Treatment outcomes for patients diagnosed with MDR-TB by WHO region, 2007–2010 cohorts.

The total numbers of cases with outcome data are shown beside each bar.

Africa The Americas

Eastern Mediterranean Europe

South-East Asia Western Pacific

Global

2010

2009

2008

2007

2010

2009

2008

2007

2010

2009

2008

2007

2010

2009

2008

2007

2010

2009

2008

2007

2010

2009

2008

2007

2010

2009

2008

2007

0% 20% 40% 60% 80% 100%

6 166

6 143

5 496

4 570

676

511

262

128

34 281

23 250

15 565

10 959

3 113

1 140

413

253

2 374

2 298

1 732

1 458

19 496

12 131

6 904

4 097

2 456

1 027

758

453

Cured Completed Died

Treatment failed Lost to follow-up Not evaluated

Progressing towards the target for treatment success

requires the scale up of treatment programmes globally,

enhancing the eectiveness of drug regimens, support to

patients to avoid treatment interruption and improved

data collection. In particular, countries need to analyse the

poor treatment outcomes observed in MDR-TB cases and

intensify measures to improve adherence and monitoring.

TB programmes need to apply a package of services for

MDR-TB patients that include free TB and ancillary med-

ications, free laboratory testing, enablers and social sup-

port, and the use of short treatment regimens following

current WHO policy in selected patients. e treatment of

XDR-TB patients in particular remains very unsatisfactory

and more eective regimens for this condition are urgently

required.

4.2.4 Other aspects of MDR-TB programme

management

During their illness, patients with MDR-TB may be cared

for as either outpatients or within hospitals, usually sec-

ondary or tertiary facilities. WHO recommends that, where

possible, patients with MDR-TB should be treated using

ambulatory or community-based care rather than models

of care based principally on hospitalization.

National policies and practices dier in the predominant

model of care that is employed. Among the high MDR-TB

burden countries, the lowest level of hospitalization was

reported by the Philippines (5% of MDR-TB patients),

while levels in Eastern European countries ranged between

75 and 100% but were lower in Central Asia (30–50% in

Kazakhstan, Tajikistan and Uzbekistan). In the African

Region, there is wide variation in the extent to which

 GLOBAL TUBERCULOSIS REPORT 2013

patients with MDR-TB are hospitalized, ranging from 10%

of patients (Democratic Republic of the Congo) to 100%

(Ethiopia and Nigeria). Globally, the average duration of

hospital stay ranged from 7 to 240 days (median: 84 days).

e number of visits to a health facility after diagnosis of

BOX 4.4

WHO deßnitions of treatment outcomes for

RR-TB, MDR-TB and XDR-TB

Cured Treatment completed as recommended by the

national policy without evidence of failure AND three or

more consecutive cultures taken at least 30 days apart are

negative after the intensive phase.

Treatment completed Treatment completed as

recommended by the national policy without evidence

of failure BUT no record that three or more consecutive

cultures taken at least 30 days apart are negative after the

intensive phase.

Treatment failed Treatment terminated or need for

permanent regimen change of at least two anti-TB drugs

DGECWUGQH

lack of conversion by the end of the intensive phase; or

bacteriological reversion in the continuation phase after

conversion to negative; or

evidence of additional acquired resistance to

àWQTQSWKPQNQPGUQTUGEQPFNKPGKPLGEVCDNGFTWIUQT

adverse drug reactions.

Died A patient who died for any reason during the course

of treatment.

Lost to follow-up A patient whose treatment was

interrupted for two consecutive months or more.

Not evaluated A patient for whom no treatment outcome

is assigned (this includes cases ‘transferred out’ to another

treatment unit and whose treatment outcome is unknown).

Successfully treated The sum of cured and treatment

completed.

Cohort #ITQWRQHRCVKGPVUYJGTG446$JCUDGGP

FKCIPQUGFKPENWFKPI/&46$CPF:&46$CPFYJQYGTG

UVCTVGFQPCHWNNEQWTUGQHCUGEQPFNKPG/&46$FTWI

TGIKOGPFWTKPICURGEKßGFVKOGRGTKQFGIVJGEQJQTVQH

/&46$ECUGUTGIKUVGTGFKPVJGECNGPFCT[GCT6JKU

group forms the denominator for calculating treatment

QWVEQOGU9KVJVJGTGXKUGFFGßPKVKQPUany patient found to

haXe druI-resistant TB and placed on second-line treatment

is remoXed from the druI-susceptible TB outcome cohort.

This means that management of the basic management unit

TB register and of the second-line TB treatment register

needs to be coordinated to ensure proper accounting of the

outcomes of treatment.

/QTGFGVCKNUQPVJGFGßPKVKQPQHEQPXGTUKQPTGXGTUKQPCPF

the end of the intensive phase are provided in the WHO

guidance.a

a &eßnitions and reportinI framework for tuberculosis – 201 reXision

9*1*6/6$)GPGXC9QTNF*GCNVJ1TICPK\CVKQPwww.

YJQKPVKTKUDKVUVTGCOAGPIRFH).

MDR-TB also varies markedly among countries, from 30

or less (Bangladesh, the Democratic Republic of the Con-

go, Estonia, Pakistan, and VietNam) to over 600 (Bulgaria,

Indonesia, Latvia, Tajikistan and Uzbekistan).

Palliative and end-of-life care delivered through home-

based or institutional services is fundamental to allevi-

ate the suering associated with MDR-TB, particularly in

patients with advanced disease that is not responding to

treatment. Only eleven high MDR-TB burden countries –10

in the European region plus South Africa – reported that

they provided such care within the scope of their NTPs.

When considered in the context of the poor outcomes

reported in patients with MDR-TB and especially XDR-TB,

this nding attests to the persistent, huge unmet need for

palliative care services in countries with the largest bur-

dens of drug-resistant TB.

Among 18 high MDR-TB burden countries providing

information on the quality of second-line drugs in the pub-

lic sector in 2012, two countries reported that all of the

drugs that they used conformed only to national regulatory

norms. In the other 16 countries, most reported conformi-

ty to international standards for all supplies of kanamycin

(11), capreomycin (9, with 2 other countries not using it),

levooxacin (10, with 1 other not using it), ethionamide/

prothionamide (12), cycloserine/terizidone (11) and p-ami-

nosalicylic acid (10, with 2 others not using it).

More information is required to adequately monitor TB

patients on MDR-TB treatment than is needed for drug-

susceptible TB. e denitions for monitoring of RR-TB

and MDR-TB and their outcomes were revised in 2013

(see Chapter 3 and Box 4.4). e employment of electron-

ic systems to manage patient data is therefore strongly

encouraged. One of the Global Plan’s targets is that all 27

high MDR-TB countries manage their data on treatment

of MDR-TB patients electronically by 2015. By 2012, 19

reported that national databases were in place for MDR-

TB patients (see Figure 2.16 in Chapter 2). ese systems

dier markedly from one country to another, varying

from individual patient medical records accessible online

to the periodic collation of records from registers across

the country. Before introducing electronic systems to han-

dle patient data, WHO recommends that NTPs undertake

a detailed assessment of their needs and expectations

and then try to match these with the best suited infor-

matics solution. A fragmentary approach with parallel

systems dealing with dierent programme components

(for example, management of data for patients with drug-

susceptible and drug-resistant TB in separate systems)

should be avoided. Guidance on the design and implementa-

tion of electronic systems for recording and reporting data

was produced by WHO and technical partners in 2012.1

4 Electronic recording and reporting for TB care and control. Geneva,

World Health Organization, 2013 (WHO/HTM/TB/2011.22).

59GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

Diagnostics and laboratory

strengthening

KEY FACTS AND MESSAGES

■ The conventional laboratory tests for the diagnosis of

TB, which have been used for decades, are sputum smear

microscopy and bacterial culture. Diagnosis based on

cultured specimens is the reference standard but results

take weeks to obtain. Drug susceptibility testing (DST) on

EWNVWTGUKUWUGFVQFGVGEVTGUKUVCPEGVQßTUVCPFUGEQPFNKPG

TB drugs.

■ There have been important breakthroughs in TB

FKCIPQUVKEUKPTGEGPV[GCTU+P9*1GPFQTUGFVJGßTUV

rapid molecular test that can be used to simultaneously test

HQTRWNOQPCT[6$CPFTKHCORKEKPTGUKUVCPEG:RGTV® MTB/

4+(6JGUGPUKVKXKV[QHVJGVGUVKUOWEJDGVVGTVJCPUOGCT

microscopy and is comparable to solid culture. In 2013,

a review of the 2010 policy was initiated, to examine the

substantial body of new evidence on the use and positioning

QH:RGTV/6$4+(HQTVJGFKCIPQUKUQHRWNOQPCT[

extrapulmonary and paediatric TB. Updated guidance is

expected in 2014.

■ :RGTV/6$4+(KUDGKPITCRKFN[CFQRVGFD[EQWPVTKGU

$[VJGGPFQH,WPG)GPG:RGTVOCEJKPGUCPF

OKNNKQP:RGTV/6$4+(ECTVTKFIGUJCFDGGPRTQEWTGF

D[QHVJGEQWPVTKGUGNKIKDNGHQTEQPEGUUKQPCNRTKEGU

Almost half (49%) of reporting low- and middle-income

countries and territories indicated that WHO policy

IWKFCPEGQP:RGTV/6$4+(JCFDGGPKPEQTRQTCVGFKPVQ

VJGKTPCVKQPCNIWKFGNKPGU5QWVJ#HTKECKUVJGßTUVEQWPVT[VQ

CFQRV:RGTV/6$4+(CUVJGRTKOCT[FKCIPQUVKEVGUVHQT6$

replacing smear microscopy.

■ Laboratory capacity to conduct high-quality sputum

UOGCTOKETQUEQR[TGSWKTGUUKIPKßECPVUVTGPIVJGPKPI1PN[

14 of the 22 HBCs met the target of having 1 microscopy

EGPVTGRGTaRQRWNCVKQPKPCPFQPN[GKIJV

reported a programme for external quality assessment that

covered at least 95% of all centres in the country.

■ Globally, laboratory capacity to perform DST continues

to be low and is not growing quickly enough to ensure that

6$RCVKGPVUYKVJ/&46$CTGRTQORVN[FKCIPQUGF(TQO

2009 to 2012, the percentage of new and previously treated

TB patients receiving DST increased from 4% to 5% and

HTQOVQTGURGEVKXGN[6JG':2#0&6$RTQLGEV

which started in 2009 and has entered a phase of routine

testing in 25 countries, shows how it is possible to introduce

routine testing for drug resistance and achieve considerable

KPETGCUGUKPVJGPWODGTQH/&46$ECUGUFGVGEVGF

■ The national reference laboratory of Uganda has become

the newest member of the WHO/Global Laboratory Initiative

).+5WRTCPCVKQPCN4GHGTGPEG.CDQTCVQT[54.0GVYQTM

ßNNKPICETKVKECNIGQITCRJKECNICRKP'CUV#HTKEC

e early, rapid and accurate detection of TB and drug resis-

tance relies on a well-managed and equipped laboratory

network. Laboratory conrmation of TB and drug resis-

tance is critical to ensure that people with TB signs and

symptoms are correctly diagnosed and have access to the

correct treatment as soon as possible.

e conventional laboratory tests for the diagnosis of

TB, which have been used for decades, are sputum smear

microscopy and culture. Diagnosis based on culture is the

reference standard but results take weeks to obtain. Drug

susceptibility testing (DST) on cultured specimens is the

conventional method used to detect resistance to rst- and

second-line TB drugs. Following increased investments in

TB research and development in the past decade (Chapter

8), there have been important breakthroughs in TB diag-

nostics. In 2008, rapid molecular tests (line probe assays,

or LPAs) for detection of RR-TB and MDR-TB using posi-

tive sputum specimens or cultures were recommended by

WHO. In 2010, the rst rapid molecular test that can be

used to simultaneously test for TB and rifampicin resis-

tance, Xpert® MTB/RIF (Cepheid, Sunnyvale, CA, USA),

was recommended for diagnosis of pulmonary TB and

rifampicin resistance in adults. e sensitivity of the test

is much better than smear microscopy and similar to solid

culture.1

Although laboratories play a fundamental role in TB care

and control, only 57% of the 4.6 million new pulmonary

TB patients notied globally in 2012 were bacteriologically

conrmed using a WHO-recommended diagnostic meth-

od. Low coverage of laboratory conrmation may result in

people without TB needlessly being enrolled on TB treat-

ment, while true TB cases are being missed. Furthermore,

the 5.7 million incident (new and relapse) TB patients diag-

nosed and notied to NTPs in 2012 represent only 66% of

the estimated 8.6 million incident TB cases globally. e

gap reects both underreporting of diagnosed TB cases and

failure to diagnose cases at all; the latter can be attributed

in part to weak laboratory capacity in many countries.

Detection of TB without investigating for drug resis-

tance can lead to poor treatment outcomes, additional and

unnecessary suering and costs for patients and further

spread of drug-resistant strains. While there was a small

increase between 2011 and 2012, only 5.1% of new cases

and 8.7% of previously treated cases received DST in 2012.

1 Steingart KR et al. Xpert® MTB/RIF assay for pulmonary tubercu-

losis and rifampicin resistance in adults (Review). Cochrane Data-

base of Systematic Reviews 2013, Issue 1. Art. No.: CD009593. 2013.

60 GLOBAL TUBERCULOSIS REPORT 2013

Of the 300 000 cases of MDR-TB estimated to exist among

notied TB patients with pulmonary TB in 2012 (i.e. the

group of patients known to NTPs and that could be tested

for drug resistance using WHO-recommended diagnostic

tests), only 83715 received a laboratory-conrmed diagno-

sis of MDR-TB and were notied in 2012. In addition, just

over 10 000 RR-TB cases were detected using rapid molec-

ular methods, though without results for isoniazid DST at

the time of reporting. Given the large burden of undiag-

nosed DR-TB, strengthening DST capacity is a high priority

for NTPs (see also Chapter 4).

is chapter has three parts. Section 5.1 summarizes

the key developments in WHO guidance on TB diagnostics

and laboratory strengthening during 2012–2013. Section

5.2 provides the status of laboratory capacity globally,

regionally and nationally based on data reported to WHO

by countries in 2013. e focus is on the 36 countries in

the combined list of 22 HBCs and 27 high MDR-TB burden

countries. Innovative public–private mix (PPM) laboratory

initiatives are highlighted as well. Section 5.3 describes

recent achievements in strengthening TB laboratories, cov-

ering incorporation of WHO guidance into policy and prac-

tice at country level and the latest status of progress of two

multinational projects (EXPAND-TB and TBXpert) that are

helping to introduce new diagnostics.

5.1 Developments in WHO policy guidance

on TB diagnostics and laboratory

strengthening, 2012–2013

WHO follows a systematic process for policy development

on TB diagnostics, involving synthesis of the available evi-

dence through systematic reviews and meta-analyses where

possible, assessment of the evidence by an external Expert

Group using the GRADE approach,1 and development of

policy guidance2 for dissemination to Member States and

other stakeholders.3 Policy documents are reviewed every

3–5 years, and revised as necessary when new evidence

becomes available.

e rst WHO policy guidance on the use of Xpert®

MTB/RIF was issued in December 2010. e recommen-

dations were that Xpert MTB/RIF should be used as the

initial diagnostic test in individuals at risk of having MDR-

TB or HIV-associated TB (strong recommendation), and

that Xpert MTB/RIF could be used as a follow-on test to

microscopy in settings where MDR and/or HIV is of lesser

concern, especially in smear-negative specimens (this was

a conditional recommendation, recognizing major resource

implications). e 2010 recommendations applied to the

use of Xpert MTB/RIF in sputum specimens only, as data

on its performance (sensitivity and specicity) for testing

of extrapulmonary specimens at that time were limited.

e recommendations applied to children, but only based

on generalization of data from adults.

Following rapid uptake of Xpert MTB/RIF (see section

5.2), a substantial body of new evidence had been generat-

ed by 2013.4 is included much more data about the test’s

performance characteristics (sensitivity and specicity) in

a wide range of laboratory and epidemiological settings,

additional data on test accuracy in detection of extrapul-

monary and paediatric TB, and more evidence about aord-

ability and cost-eectiveness from early implementers in

a limited number of settings. WHO therefore embarked

on a review of policy guidance in 2013. ree systematic

reviews were commissioned on the sensitivity and specic-

ity of Xpert MTB/RIF for the diagnosis of pulmonary and

extrapulmonary TB and RR-TB, in adults and children. A

review of published studies on the aordability and cost-ef-

fectiveness of Xpert MTB/RIF was also conducted.

An Expert Group convened by WHO met in May 2013

to review the expanded body of evidence, according to

GRADE procedures. Based on the outcomes of the review

and the recommendations of the Expert Group, which were

also supported by WHO’s Strategy and Technical Advisory

Group for TB (STAG-TB) in June 2013, updated WHO pol-

icy guidance was under development at the time that the

current report went to press. Upon nalization, the recom-

mendations are expected to have a major impact on further

country adoption of Xpert MTB/RIF into diagnostic and

clinical algorithms.

Several other new TB diagnostic tests are on the hori-

zon, in various stages of research and development (see

Chapter 8). Once data on their performance are available in

varying epidemiological settings, WHO will be in a position

to evaluate their performance and develop corresponding

policy guidance. A comprehensive list of existing WHO pol-

icy documents, including those on the use of microscopy,

culture, DST and non-commercial and molecular methods,

can be found at: http://www.who.int/tb/laboratory/policy_

statements

In addition to diagnostics, WHO

also develops guidance in other areas

of laboratory strengthening. In 2013,

the WHO Tuberculosis laboratory bio-

safety manual was issued, featuring a

risk-based approach that guides the

essential biosafety measures required

for performing dierent technical

procedures. e manual describes the

combination of good laboratory practices together with

administrative controls, containment principles, safety

equipment and laboratory facilities that are required to

minimize the generation of infectious aerosols and thus

prevent laboratory-acquired infections. e risk-based

approach to laboratory biosafety is framed around a three-

tiered system of ‘low’, ‘moderate’ and ‘high’ TB risk precau-

tions:

1 www.gradeworkinggroup.org

2 WHO handbook for guideline development. Geneva, World Health

Organization, 2012.

3 WHO policies on TB diagnostics are available at: www.who.int/tb/

laboratory/policy_statements

4 Weyer K et al. R apid molecular T B diagnosis: ev idence, polic y-making

and global implementation of Xpert® MTB/RIF. European Respirato-

ry Journal. November 22, 2012, doi: 10.1183/09031936.00157212

61GLOBAL TUBERCULOSIS REPORT 2013

Low TB risk precautions. ese apply to direct acid-fast

bacilli (AFB) microscopy and to Xpert MTB/RIF.

Moderate TB risk precautions. ese apply to the pro-

cessing of sputum specimens for primary culture inoc-

ulation, direct testing (i.e. on sputum smear-positive

samples) using direct non-commercial drug susceptibil-

ity assays and LPAs.

High TB risk precautions in TB containment laborato-

ries. ese apply to procedures used to manipulate cul-

tures (solid and liquid) for identication and DST, and

for indirect testing (i.e. on culture isolates) using LPA

and non-commercial DST.

5.2 Status of laboratory capacity globally,

regionally and nationally

Diagnosis of TB in most low- and middle-income countries

still relies on low-cost sputum smear microscopy, despite its

relatively low sensitivity and inability to detect drug resis-

tance. e Global Plan to Stop TB 2011–2015 includes the tar-

get that countries maintain at least one smear microscopy

centre per 100 000 population. Globally the target has been

met (1.1 centres per 100 000 population in 2012), but con-

siderable disparities remain at regional and country levels

(Table 5.1). Eight of the 22 HBCs did not meet the target in

2012: Bangladesh, China, Myanmar, Nigeria, Pakistan, the

Russian Federation, South Africa and Viet Nam. Overall,

the Western Pacic and Eastern Mediterranean Regions

had less than one centre per 100000 population.

Given the continued critical role of microscopy in

TB detection and monitoring of treatment, ensuring

high-quality performance of smear microscopy is essential.

Of the 153 countries and territories that reported data on

the number of smear microscopy centres in 2012, only 39%

indicated the existence of an external quality assessment

programme that covered all centres in the country. Among

the 22 HBCs, only three reported such a programme that

encompassed all centres in 2012 (Bangladesh, India and

Viet Nam), ve reported a programme that included at least

95% of centres (Cambodia, China, Myanmar, the Russian

Federation and South Africa), and 14 reported a programme

that included at least 80% of centres.

In 2009, WHO recommended the use of the more sensi-

tive uorescent light-emitting diode (LED) microscopy as

a replacement for traditional Ziehl–Neelsen (ZN) micros-

copy. Globally the switch to LED microscopes has been

gradual, and they were reported to be present in only 2%

of microscopy centres in 2012. Overall in 2012, the African

Region was the most advanced in rolling out LED micro-

scopes (6% of microscopy centres), led by South Africa

where 97% of microscopy centres were reported to have

them. Other HBCs in the African Region have shown sig-

nicant increases in uptake from 2011 to 2012, including

the United Republic of Tanzania (3% to 17% of microscopy

centres) and Mozambique (<1% to 9%).

e current target in the Global Plan to Stop TB 2011–

2015 for both culture and DST (to at least rifampicin and

isoniazid) capacity is one laboratory per 5 million popu-

lation. In 2012, 14 of the 27 high MDR-TB burden coun-

tries did not reach the target (Table 5.1; there were two

additional countries that did not report data). Of these 27

countries, 9 reported more than one laboratory per 5 mil-

lion population using LPAs – a high-throughput molecular

tool that can be used at central and regional levels to rapid-

ly detect resistance to rifampicin and, in some cases, isoni-

azid. e nine countries comprise eight European countries

and South Africa.

Of the 147 countries and territories that reported

numbers of laboratories with capacity to perform DST, 22

indicated that such capacity did not exist in 2012. While

countries and territories with small TB patient populations

may nd it more practical to send specimens to neighbour-

ing countries for DST than to establish national capacity,

countries with larger patient populations should aim as

a priority to build sustainable DST capacity in-country

to allow timely diagnosis of drug-resistant strains. Eight

countries reported more than 1000 notied TB cases in

2012 yet reported having no capacity to perform DST:

Afghanistan, Chad, Eritrea, Guinea-Bissau, Liberia, Papua

New Guinea, Sierra Leone and Somalia.

Quality-assured DST is critical to ensure accurate detec-

tion of drug resistance for subsequent treatment decisions

and to avoid false diagnoses. Of the high TB and MDR-TB

burden countries that reported on external quality assess-

ment coverage of DST laboratories (34 of 36), 27 (79%)

reported having a scheme that encompassed all DST lab-

oratories. Of the 117 countries globally that reported on

external quality assessment coverage of DST laboratories,

70% (82 countries) reported such a scheme.

Given its high sensitivity to detect TB and rifampicin

resistance together with its ability to be placed at relative-

ly low levels of laboratory networks, Xpert MTB/RIF has

been rapidly adopted by countries. By the end of June 2013,

3.2 million test cartridges and 1402 GeneXpert machines

(comprising 7553 machine modules) had been procured in

88 of the 145 countries eligible to purchase machines and

cartridges at concessional prices (Figure 5.1).1 e current

price per cartridge is US$9.98, following a novel nancing

agreement reached in August 2012 between the manufac-

turer and the United States Agency for International Devel-

opment (USAID), the United States President’s Emergency

Plan for AIDS Relief (PEPFAR), UNITAID and the Bill &

Melinda Gates Foundation. South Africa alone accounts

for 43% of the modules and 60% of the cartridges procured

globally, and is aiming to position Xpert MTB/RIF as a

replacement for microscopy for the diagnosis of TB. After

South Africa, leading procurers include India, Pakistan,

Zimbabwe and Nigeria.

e complete or partial replacement of microscopy

by Xpert MTB/RIF as the initial diagnostic test and the

increasing number of rifampicin-resistant cases being

detected by Xpert MTB/RIF will require adjustment of

countries’ smear, culture and DST capacities going forward.

1 http://www.who.int/tb/laboratory/mtbrifrollout/

62 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 5.1

Laboratory capacity, 2012a

HIGH

$74&'0

HIGH

/&46$

$74&'0

5/'#4/+%415%12; %7.674' &47)575%'26+$+.+6;

TESTING .+0'241$'#55#; :2'46

/6$4+(

07/$'4

1(.#$14#-

614+'5

.#$14#614+'5

2'4

POPULATION

2'4%'06#)'1(

.#$14#614+'5

USING LED

/+%415%12'5

07/$'41(

.#$14#61-

4+'5

.#$14#-

614+'52'4

5 MILLION

POPULATION

07/$'4

.#$14#-

614+'5

.#$14#614+'5

2'4/+..+10

POPULATION

07/$'4

OF LABO-

4#614+'5

.#$14#614+'5

2'4/+..+10

POPULATION

07/$'4

OF SITES

Afghanistan 603 2.0 2 2 0.3 0 0 0 0 1

Armenia 30 1.0 0 1 1.7 1 1.7 1 1.7 0

#\GTDCKLCP 72  47 31.6 1 0.5 7

Bangladesh 

1 070 0.7 2 3  3 1 12

Belarus 196 2.1 2 29 15 4.3 4.3 

$TC\KN 4 000 2.0 – 220 5.5 35 0.9 0.2 13

Bulgaria 34 0.5 0 31 21 14 9.6 4 2.7 0

Cambodia 214 1.4 10 3 1.0 1 0.3 0 0 6

China 

 0.2 2 1 014 3.7 190 0.7 21  16

&4%QPIQ 

1 522 2.3  40.3 20.2 1 26

Estonia 5 0.4 10 0 2 7.7 2 7.7 2 7.7 2

Ethiopia 

2 531  050.31 50.3 7

Georgia 11 0.3 9 2 2.3 1 1.1 2 2.3 1

India 

 1.1 2 70 0.3  0.2 33 0.1 32

Indonesia 

5 566 2.3 0 46 0.9 5 0.1 2  9

-C\CMJUVCP 466 2.9 0 22  22  11 3.4 4

Kenya  4.2 2 0.2 2 0.2 2 0.2 15

-[TI[\UVCP 122 2.2 0 11 10 3 2.7 2  7

Latvia 16  0 4 9.7 1 2.4 1 2.4 2

Lithuania –– – – –

/Q\CODKSWG 300 1.2 9 3 0.6 2 0.4 0 0 12

Myanmar   0.9 14 2 0.2 2 0.2 2 0.2 3

Nigeria 

1 314  250.13 40.132

Pakistan 

   70.2 40.1 2 15

Philippines 

2 565 2.7  13 0.7 3 0.2 1  17

4GRWDNKEQH/QNFQXC –– – – –

4WUUKCP(GFGTCVKQP 

1 031 0.7 – 117 4.1 110  –

South Africa   0.4 97 15 1.4 15 1.4 15 1.4 100

Tajikistan  1.1 4 3 1.9 1 0.6 1 0.6 3

Thailand  1.6 6 65 4.9  1.3 12 0.9 14

Uganda 1 152 3.2 4 0.6 4 0.6 4 0.6 25

Ukraine   5 9.4 41 4.5 0 0 15

746CP\CPKC 945 2.0 17 4 0.4 1 0.1 3 0.3 13

7\DGMKUVCP 291 1.0 1 7 1.2 3 0.5 3 0.5 7

Viet Nam   0.9  25 1.4 2 0.1 2 0.1 22

<KODCDYG  1.3 1 2 0.7 2 0.7 0 0 17

High-burden countries – 1.0 2 – 1.8 – 0.5 – 0.1 –

High MDR-TB burden countries – 0.9 2 – 1.9 – 0.6 – 0.2 –

#(4 – 1.5 6 – 0.6 – 0.4 – 0.3 –

#/4 –2.2 –16 –  –0.2–

'/4 –  – 1.4 – 0.4 – 0.1 –

'74 –0.7 2 – –4.6– –

5'#4 – 1.2 2 – 0.5 – 0.2 – 0.1 –

924 – 0.5 2 – 3.4 – 0.6 – 0.1 –

Global – 1.1 2 – 3.8 – 0.9 – 0.3 –

Blank cells indicate data not reported.

– indicates values that cannot be calculated.

a 6JGTGIKQPCNCPFINQDCNßIWTGUCTGCIITGICVGUQHFCVCTGRQTVGFD[NQYCPFOKFFNGKPEQOGEQWPVTKGUCPFVGTTKVQTKGU&CVCHQTVJGXCTKCDNGUUJQYPKPVJGVCDNGCTGPQV

requested from high-income countries in the WHO data collection form.

;'5  NO 

63GLOBAL TUBERCULOSIS REPORT 2013

e introduction of Xpert MTB/RIF reduces the need for

culture as a diagnostic test, yet the growing number of

RR-TB cases will require culture for monitoring of treat-

ment and DST of other anti-TB drugs to guide the design of

treatment regimens. e increasing capacity of countries to

diagnose RR-TB must also be matched by increased capaci-

ty to provide appropriate treatment to the diagnosed cases

(see also Chapter 4).

One of the main reasons for low case detection rates in

many parts of the world (Chapter 3) is the existence of a

signicant private sector, in which care providers frequent-

ly diagnose people with TB but fail to notify these cases to

national authorities. e quality of diagnostic services in

the private sector is highly variable, and some private prac-

titioners continue to use tests that are not recommended by

WHO, including antibody-based serodiagnostics and inter-

feron-gamma release assays (IGRAs) for detection of active

TB. Furthermore in some settings, laboratories in the pub-

lic sector that are not under the auspices of the NTP also

diagnose TB without necessarily following recommended

guidelines and quality assurance procedures. Collaboration

between NTPs and all laboratories oering TB diagnosis is

therefore critical to ensure that national guidelines are fol-

lowed, that appropriate diagnostic tests are used, and that

patients diagnosed with TB are notied to the NTP and

receive proper care. In 2012, 20 of 36 high TB and MDR-

TB burden countries reported some level of collaboration

with laboratories in the private sector, and 25 reported

collaboration with non-NTP laboratories in the public sec-

tor. Additionally, the availability of WHO-recommended

diagnostic tests at concessional prices from manufacturers

under specied conditions has been used as leverage by new

initiatives to form innovative PPM partnerships, increas-

ing access to WHO-recommended diagnostics for people

seeking care in the private sector. Examples are provided

in Box 5.1.

5.3 Strengthening TB laboratories globally,

regionally and nationally

Advances in TB diagnostics in recent years provide an

opportunity to improve laboratory capacity to rapidly and

accurately detect TB and drug resistance. One of the main

prerequisites for eective uptake of new diagnostics is

dynamic policy reform, properly incorporating new tests

and testing methods into diagnostic algorithms. Table

5.2 presents the uptake of selected WHO policy guidance

on TB diagnostics into NTP guidelines at global, region-

al and country levels, focusing on the 36 countries in the

combined list of 22 HBCs and 27 high MDR-TB burden

countries. Overall, high burden countries have been faster

in adopting WHO TB diagnostic guidelines than the glob-

al average. All reporting high MDR-TB burden countries,

95% of HBCs and 84% of reporting countries globally had

reported incorporation of the WHO policy guidance on con-

ventional phenotypic DST into their national guidelines by

2012. ree quarters (74%) of all countries globally had

incorporated guidance on liquid culture and rapid specia-

tion. Countries in the European Region have been particu-

larly fast in adopting these policies, with 97% of countries

reporting having taken up these technologies.

Uptake of WHO policy on use of LPAs for detection of

resistance to rifampicin remains relatively modest, with

FIGURE 5.1

Progress in the roll-out of Xpert MTB/RIF, by July 2013

1–1999

2000–9999

10 000–39 999

40 000–99 999

≥ 100 000

Not eligible for preferential pricing

Not applicable

Xpert MTB/RIF

cartridges ordered

64 GLOBAL TUBERCULOSIS REPORT 2013

only 58% of countries globally adopting the policy to date.

Uptake is, however, growing. In the Region of the Ameri-

cas, for example, 61% of countries reported incorporation

of the policy in their national guidelines in 2012 compared

to only 17% in 2011.

Approximately half of low- and middle-income coun-

tries and territories globally (49%) indicated that they had

incorporated WHO guidance on Xpert MTB/RIF into their

diagnostic algorithms for people at risk of HIV-associated

and DR-TB by the end of 2012, highlighting fast uptake

of recommendations rst issued in December 2010. High

MDR-TB burden countries have been particularly quick

to adopt WHO guidance, with 84% of countries reporting

incorporation of the test into their diagnostic algorithms

for people at risk of drug-resistant TB. Funding from sourc-

es including the Global Fund, PEPFAR, USAID, TB REACH

and Médecins Sans Frontières has supported ministries of

health to rapidly establish capacity to use Xpert MTB/RIF.

ese initiatives, together with the TBXpert and EXPAND-

TB projects, will enable further roll out and scale up of the

test in targeted low- and middle-income countries, with

BOX 5.1

Innovative PPM initiatives to increase access to WHO-recommended diagnostics

Some manufacturers of rapid

diagnostics, including Becton, Dickenson

and Company (producer of the BD

MGIT™ 960 automated liquid culture

system), Hain LifeScience (Genotype®

/6$&4RNWUNKPGRTQDGCUUC[CPF

%GRJGKF:RGTV®/6$4+(QHHGTVJGKT

RTQFWEVUVQ062UCPFVJGKTPQVHQTRTQßV

partners in low- and middle-income

countries at concessional prices. Private

HQTRTQßVUGEVQTNCDQTCVQTKGUJCXG

traditionally not been included in such

arrangements, resulting in prices that

are prohibitively high for poor people

seeking care in the private sector and

encouraging use of other diagnostics

that are not recommended by WHO.

4GEGPVN[VYQRWDNKE¿RTKXCVGOKZ22/

initiatives that aim to increase access

to rapid and accurate diagnostics for

vulnerable populations in Asian settings

with vast private sector markets have

been established.

In June 2012, the government of

India took the unprecedented step

of banning the import, manufacture,

distribution and sale of antibody-based

TB serodiagnostic tests, in line with

the WHO recommendation that such

tests should not be used to diagnose

TB. Unfortunately, this ban created a

gap in the private market that allowed

other suboptimal tests to gain market

share, especially since TB diagnostics

recommended by WHO were considered

too expensive and well beyond the

reach of the typical TB patient. To

overcome this market shortcoming, the

Initiative for Promoting Affordable,

Quality TB Tests (IPAQT)a in India was

launched in March 2013. IPAQT is a

consortium of 42 private diagnostic

NCDQTCVQTKGUUWRRQTVGFD[PQVHQTRTQßV

stakeholders (examples include the

Clinton Health Access Initiative and the

McGill International TB Centre). It has

established agreements with Cepheid

Inc, Hain LifeScience, and Becton,

Dickenson and Company that allow

CEEGUUVQEQPEGUUKQPCNRTKEGUHQT:RGTV

/6$4+(ßTUVNKPGNKPGRTQDGCUUC[UCPF

liquid culture in the private sector, which

is normally excluded from negotiated

pricing agreements. Participating

laboratories must abide by several

EQPFKVKQPUVJG[PGGFVQDGCEETGFKVGF

to assure quality; they must report

EQPßTOGFECUGUVQVJG4GXKUGF0CVKQPCN

6$%QPVTQN2TQITCOOG406%2VJG[

must adhere to a ceiling price when

charging patients; and they must

refrain from using any tests that are not

TGEQOOGPFGFD[9*1QTVJG406%2

Together, the laboratories participating

in IPAQT have approximately 3000

franchisee laboratories and over 10 000

specimen collection centres across India,

thus increasing access to rapid, accurate

and affordable diagnostics for patients

seeking care in the country’s extensive

private sector.

As part of the recently launched

70+6#+&HWPFGF6$:RGTVRTQLGEVBox

5.2) and with support from the Stop TB

2CTVPGTUJKR6$4'#%*KPKVKCVKXGHWPFGF

by the Department of Foreign Affairs,

Trade and Development of Canada,

innovative social business models have

been formed in Bangladesh, Indonesia

CPF2CMKUVCPD[+PVGTCEVKXG4GUGCTEJ

and Development in cooperation with

local partners and NTPs. Based in

the megacities of Dhaka, Jakarta and

Karachi and equipped with up to 25

)GPG:RGTVKPUVTWOGPVUGCEJVJGUG

social business models will provide

:RGTV/6$4+(VGUVUTGEGKXGFHTQO

VJG6$:RGTVRTQLGEVHTGGQHEJCTIGVQ

people at high risk of TB who seek care

at private screening centres and other

partnering locations. Free treatment will

be provided to everyone diagnosed with

6$KPEQQRGTCVKQPYKVJ062U4GXGPWG

will be generated from adjunct tests and

services provided to patients, allowing

for sustainability of the businesses

beyond the duration of the three-year

6$:RGTVRTQLGEV

a www.ipaqt.org/

expected increased detection of DR-TB and HIV-associated

TB (Box 5.2).

e WHO/Global Laboratory Initiative (GLI) TB Supra-

national Reference Laboratory (SRL) Network is a driving

force in strengthening national and central level labora-

tories globally, providing long-term technical assistance

to countries under the framework of collaborative agree-

ments. e network comprises 29 laboratories covering all

six WHO regions. e newest addition to the network is the

national TB reference laboratory of Uganda; this lls a criti-

cal geographical gap that had existed in the network in East

Africa. e laboratory has already established collaborative

agreements with Somalia, South Sudan and Zambia for

provision of technical assistance. Additionally, four can-

didate SRLs are under mentorship, including the national

TB reference laboratories of Benin, Denmark and South

Africa, and the Aga Khan University of Pakistan. Pending

completion of successful mentorship and the establishment

of country partners, the new laboratories will help to widen

the geographical reach of the network, in particular in the

African and Eastern Mediterranean Regions.

65GLOBAL TUBERCULOSIS REPORT 2013

TABLE 5.2

Incorporation of WHO guidance for diagnosis of TB into national policy, 2012a

*+)*6$$74&'0

*+)*/&46$

$74&'0

CONVENTIONAL

&47)

575%'26+$+.+6;

TESTING (DST)

.+37+&%7.674'

#0&4#2+&

SPECIATION TEST

.+0'241$'#55#;

(14&'6'%6+0)

4'5+56#0%'61

4+(#/2+%+0

#.)14+6*/(14

THE DIAGNOSIS

OF TB IN PEOPLE

LIVING WITH HIV

:2'46/6$4+((14

DIAGNOSIS OF TB IN

2'45105#64+5-1(

HIV-ASSOCIATED TB

:2'46/6$4+(

(14&+#)015+51(

&47)4'5+56#06

6$+02'45105

#64+5-

Afghanistan 

Armenia 

#\GTDCKLCP  

Bangladesh 

Belarus 

$TC\KN 

Bulgaria 

Cambodia 

China 

&4%QPIQ 

Estonia 

Ethiopia 

Georgia 

India 

Indonesia 

-C\CMJUVCP 

Kenya 

-[TI[\UVCP 

Latvia 

Lithuania 

/Q\CODKSWG 

Myanmar 

Nigeria 

Pakistan 

Philippines 

4GRWDNKEQH/QNFQXC 

4WUUKCP(GFGTCVKQP 

South Africa 

Tajikistan 

Thailand 

Uganda 

Ukraine 

746CP\CPKC 

7\DGMKUVCP 

Viet Nam 

<KODCDYG 

High-burden countries 95% 77% 77% 95% 73% 77%

High MDR-TB burden countries 100% 88% 92% 96% 84% 84%

#(4  67% 54% 74% 60% 62%

#/4 91%  61%  35% 35%

'/4 77%   75% 32% 36%

'74 100% 97%   60% 56%

5'#4  73% 64%  64% 64%

924 61% 56% 39%  33% 33%

Global 84% 74% 58% 78% 49% 49%

Blank cells indicate data not reported.

requested from high-income countries in the WHO data collection form.

;'5  NO 

66 GLOBAL TUBERCULOSIS REPORT 2013

BOX 5.2

The EXPAND-TB and TBXpert projects: progress to date

.CWPEJGFKPCPFEQPVKPWKPIWPVKNVJGGPFQHVJG':2#0&6$RTQLGEVCKOUVQCEEGNGTCVGCPFGZRCPFCEEGUUVQFKCIPQUVKEUHQT

RCVKGPVUCVTKUMQH/&46$KPEQWPVTKGU':2#0&6$JCUHWNNQYPGTUJKRD[VJGOKPKUVTKGUQHJGCNVJQHVJGTGEKRKGPVEQWPVTKGUCPFYQTMU

QPCOQFGNQHDGUVRTCEVKEGUNGCTPKPID[FQKPICPFQRVKOK\KPITGUQWTEGUHQTNCDQTCVQT[UVTGPIVJGPKPICVEQWPVT[NGXGN6JGRTQLGEV

is a collaboration between WHO, the Global Laboratory Initiative (GLI), the Foundation for Innovative New Diagnostics (FIND) and the

5VQR6$2CTVPGTUJKR)NQDCN&TWI(CEKNKV[)&(CPFKUHWPFGFD[70+6#+&CPFQVJGTRCTVPGTU':2#0&6$DWKNFUQP75OKNNKQPQH

70+6#+&UWRRQTVVQOCZKOK\GTGUQWTEGUCPFVGEJPKECNCUUKUVCPEGHTQOOWNVKRNGRCTVPGTUHQTNCDQTCVQT[UVTGPIVJGPKPIKPENWFKPIVJG)NQDCN

(WPFVJG9QTNF$CPM2'2(#475#+&VJG#OGTKECP5QEKGV[HQT/KETQDKQNQI[VJG75%GPVGTUHQT&KUGCUG%QPVTQNCPF2TGXGPVKQP,QJPU

Hopkins University, the KfW Development Bank, the KNCV Tuberculosis

Foundation, Partners in Health, Project Hope, PATH, the International

%QOOKVVGGQHVJG4GF%TQUUCPF6JG7PKQP

Overcoming the challenges to establish the necessary infrastructure

for central level laboratories capable of using liquid culture and LPAs, the

':2#0&6$RTQLGEVKUUJQYKPIOCLQTRTQITGUUKPTQWVKPGFGVGEVKQPCPF

TGRQTVKPIQHFTWITGUKUVCPV6$(QTGZCORNG/&46$ECUGUYGTG

diagnosed in supported laboratories in 24 reporting countries in 2012.

6JGEWOWNCVKXGPWODGTQHFKCIPQUGFECUGUQH/&46$TGCEJGFD[

the end of 2012, equivalent to 32% of the overall project target. Several

of the countries participating in the project have reported striking

KPETGCUGUKPVJGPWODGTUQHNCDQTCVQT[EQPßTOGFECUGUQHFTWITGUKUVCPV

TB, especially in 2012 (Figure B5.2.1). The project has recently been

COGPFGFVQCFF:RGTV/6$4+(VQVJGNKUVQHRTQEWTGFFKCIPQUVKEUCNQPI

with liquid culture and LPAs. In October 2012, project partners began

to pilot a strategy for a transition from project-funded to country-

DCUGFßPCPEKPI6JGGZRGTKGPEGHTQOVJGRKNQVYKNNDGWUGFCUCOQFGN

HQTKORNGOGPVCVKQPCETQUUCNN':2#0&6$TGEKRKGPVEQWPVTKGUHQTVJG

remainder of the project, ensuring a smooth transition and sustainability

QHCEJKGXGOGPVUYJGP':2#0&6$GPFU

2TQEWTGOGPVCPFKPUVCNNCVKQPQH)GPG:RGTVKPUVTWOGPVUUVCTVGFKP

OKFHQTVJGPGY6$:RGTVRTQLGEVYJKEJYKNNRTQXKFGCRRTQZKOCVGN[

OKNNKQP:RGTV/6$4+(VGUVECTVTKFIGUCPF)GPG:RGTVOCEJKPGU

to 21 recipient low- and middle-income countries over three years. The

75OKNNKQPRTQLGEVKUHWPFGFD[70+6#+&CPFOCPCIGFD[VJG9*1

Global TB Programme and the Stop TB Partnership. To ensure country

CDUQTRVKXGECRCEKV[CPFGHHGEVKXGWUGQHVJGVGEJPQNQI[VJG6$:RGTV

project links a broad network of partners and existing initiatives for TB

laboratory strengthening and innovative approaches to expand access to

vulnerable populations in both the public and private sector (Box 5.1),

resulting in increased and rapid case detection of TB, HIV-associated TB

CPF446$6$:RGTVRTQLGEVRCTVPGTUKPENWFGVJG).+6$4'#%*VJG)&(

VJG':2#0&6$RTQLGEV+PVGTCEVKXG4GUGCTEJCPF&GXGNQROGPVCPFVJG

African Society for Laboratory Medicine.

MDR-TB cases detected

5000

10 000

15 000

20 000

2008 2009 2010 2011 2012

308 1660 2967 4237

16 588

India

MDR-TB cases detected

Belarus

500

1000

1500

2000

923

1342

1576 1594 1604

2008 2009 2010 2011 2012

MDR-TB cases detected

2008 2009 2010 2011 2012

24 43 50 30

221

100

200

300

Côte d’Ivoire

MDR-TB cases detected

Tajikistan

200

400

600

800

319 333

604

694

2008 2009 2010 2011 2012

FIGURE B5.2.1

Increase in cases of MDR-TB reported by selected

EQWPVTKGURCTVKEKRCVKPIKPVJG':2#0&6$RTQLGEV

2009–2012, compared with 2008 baseline

FIGURE B5.2.2

%QWPVTKGUKPbrownRCTVKEKRCVKPIKPVJG6$:RGTVRTQLGEV

67GLOBAL TUBERCULOSIS REPORT 2013

e SRL Network is expanding its membership to

include Centres of Excellence (SRL-CE), a new category that

recognizes laboratories that are performing well in large

low- and middle-income countries and that work primar-

ily to build in-country laboratory capacity. Countries with

laboratories currently eligible to apply for designation as

an SRL-CE include Brazil, China, India, the Russian Fed-

eration and South Africa. To be eligible for this designa-

tion, laboratories need to be nominated by their NTP to the

WHO country oce, establish a collaborative agreement

with an existing SRL, undergo a laboratory assessment

by WHO, and actively implement a quality management

system towards accreditation.

 GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

Addressing the co-epidemics

of TB and HIV

KEY FACTS AND MESSAGES

■ +POKNNKQPQHOKNNKQPRGQRNGYJQ

developed TB worldwide were HIV-positive. The African

4GIKQPCEEQWPVGFHQTQHVJGGUVKOCVGFPWODGTQH*+8

positive incident TB cases.

■ The number of people dying from HIV-associated TB has

been falling since 2003. However, there were still 320 000

deaths from HIV-associated TB in 2012 and further efforts

are needed to reduce this burden.

■ The prevalence of HIV co-infection among TB patients is

JKIJGUVKPVJG#HTKECP4GIKQP1H6$RCVKGPVUYKVJCP*+8

test result, 43% tested positive in 2012, ranging from 9.6%

KP#PIQNCCPF'VJKQRKCVQKP5YC\KNCPF

■ )NQDCNN[VJGRGTEGPVCIGQHPQVKßGF6$RCVKGPVUYKVJC

documented HIV test result was 46% in 2012, up from 40%

in 2011 and 15 times higher than the 2004 level. In the

#HTKECP4GIKQPQHPQVKßGF6$RCVKGPVUJCFCP*+8VGUV

result in 2012, a further improvement compared with 69%

in 2011. Among the 41 countries with the highest TB/HIV

DWTFGPCEJKGXGF*+8VGUVKPINGXGNUQHÜKPENWFKPI

UGXGP-GP[C/CNCYK/Q\CODKSWG4YCPFC5YC\KNCPF

6QIQCPF<CODKCCDQXG

■ 6JGTGYCUCPGPEQWTCIKPIKPETGCUGKP#46EQXGTCIG

among HIV-positive TB patients between 2011 and 2012,

from 49% worldwide in 2011 to 57% in 2012. Nonetheless,

given the WHO recommendation that all HIV-positive TB

RCVKGPVUCTGGNKIKDNGHQT#46VJGEQXGTCIGQH#46HQT*+8

positive TB patients still needs to be greatly improved.

■ +PQH*+8RQUKVKXG6$RCVKGPVUYGTGRTQXKFGF

YKVJEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26CNGXGNUKOKNCT

to recent years.

■ In 2012, 4.1 million people enrolled in HIV care were

reported to have been screened for TB, up from 3.5 million

in 2011. Of the reported 1.6 million people newly enrolled

KP*+8ECTGKPCNOQUVaYGTGRTQXKFGFYKVJ

KUQPKC\KFRTGXGPVKXGVJGTCR[+26%QXGTCIGPGGFUVQDG

increased, since about 50% of those newly enrolled in HIV

care and screened for TB are likely to be eligible for IPT.

People living with HIV who are also infected with TB are

much more likely to develop TB disease than those who are

HIV-negative.1 Starting in the 1980s, the HIV epidemic led

to a major upsurge in TB cases and TB mortality in many

countries, especially in southern and eastern Africa (Chap-

ter 2, Chapter 3).

In 2012, 1.1 million (13%) of the 8.6 million people who

developed TB worldwide were HIV-positive (Chapter 2,

Table 2.1); 75% of these HIV-positive TB cases were in

the African Region. Although the number of people dying

from HIV-associated TB has continued to fall globally and

in most regions including the African Region, there were

still 320 000 deaths from HIV-associated TB in 2012, with

approximately equal numbers among men and women (see

Chapter 2). UNAIDS and the Stop TB Partnership have set

a target of halving TB mortality rates among people who

are HIV-positive by 2015 compared with 2004.2

WHO recommendations on the interventions needed to

prevent, diagnose and treat TB in people living with HIV

have been available since 2004,3,4 and are collectively known

as collaborative TB/HIV activities. ey include establishing

and strengthening coordination mechanisms for delivering

integrated TB and HIV services, testing TB patients for HIV,

providing ART and CPT to TB patients living with HIV, pro-

viding HIV prevention services for TB patients, intensifying

TB case-nding among people living with HIV, oering IPT

to people living with HIV who do not have active TB, and

controlling the spread of TB infection in health care and

congregate settings (the latter three activities are referred

to as the ree ‘Is’ for HIV/TB). Since December 2010, the

rapid molecular test Xpert MTB/RIF has been recommend-

ed as the primary diagnostic test for TB among people living

with HIV who have TB signs and symptoms.

WHO began monitoring the implementation and expan-

sion of collaborative TB/HIV activities in 2004. is chap-

1 e probability of developing TB among people living with HIV

divided by the probability of developing TB among HIV-negative

people is the incidence rate ratio (IRR). e estimated global IRR

(all ages) in 2012 was 29.6 (uncertainty interval 27.1–32.1). Fur-

ther details are provided in Annex 1.

2 Getting to zero: 2011–2015 strategy. Geneva, Joint United Nations

Programme on HIV/AIDS, 2010.

3 Interim policy on collaborative TB/HIV activities. Geneva, World

Health Organization, 2004 (WHO/HTM/TB/2004.330; WHO/

HTM/HIV/2004.1). Available at http://whqlibdoc.who.int/hq/

2004/who_htm_tb_2004.330_eng.pdf

4 WHO policy on collaborative TB/HIV activities: guidelines for national

programmes and other stakeholders. Geneva, World Health Organi-

zation, 2012 (WHO/ HTM/TB/2012.1). Available at http://whqlibdoc.

who.int/publications/2012/9789241503006_eng_Annexes.pdf

69GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 6.1

Number of TB patients with known HIV status,

2004Ų2012

FIGURE 6.2

Percentage of TB patients with known HIV status,

2004Ų2012

HIV status

Negative

Positive

TB patients (thousands)

1000

2000

3000

2004 2005 2006 2007 2008 2009 2010 2011 2012

Percentage of TB patients

2004 2005 2006 2007 2008 2009 2010 2011 2012

African region

Global

Regions outside Africa

ter presents the latest status of progress, using data for

2004 up to 2012.

6.1 HIV testing for TB patients

In 2012, the number of notied TB patients who had a doc-

umented HIV test result reached 2.8 million (Figure 6.1),

equivalent to 46% of notied TB cases (Table 6.1, Figure

6.2). is was an increase from 2.5 million and 40% respec-

tively in 2011, and 15 times the level of 3.1% reported in

2004 (Figure 6.2).

e coverage of HIV testing for TB patients was particu-

larly high in the African Region, where 74% of TB patients

had a documented HIV test result in 2012, up from 69%

in 2011 (Figure 6.2). Impressively, in 29 of 46 African

countries, ≥75% of TB patients had a documented HIV test

result in 2012 (Figure 6.3).

Overall, among the 41 countries identied as priorities

for the global TB/HIV response, (listed in Table 6.1), 53%

of TB patients notied had a documented HIV test. Of these

countries, 15 achieved testing levels of ≥85% including

seven (Kenya, Malawi, Mozambique, Rwanda, Swaziland,

Togo and Zambia) that achieved levels above 90%. In addi-

tion, although national data for China show that 34% of

TB patients were tested for HIV in 2012, coverage was 88%

in the 294 high TB/HIV burden counties in which testing

of all notied TB patients is recommended. Globally, there

were 87 countries in which ≥75% of TB patients had a docu-

mented HIV test result.

FIGURE 6.3

Percentage of patients with known HIV status by country, 2012a

Percentage of

notiﬁed TB patients

0–14

15–49

50–74

≥75

No data

Not applicable

a +PVJGEQWPVKGUKP%JKPCKFGPVKßGFHQT*+8VGUVKPICOQPIPQVKßGF6$RCVKGPVUQHPQVKßGFECUGUYGTGVGUVGFHQT*+8&CVCHQTVJG4WUUKCP

Federation are for new TB patients only excluding cases in prisons.

70 GLOBAL TUBERCULOSIS REPORT 2013

TABLE 6.1

HIV testing, treatment for HIV-positive TB patients and prevention of TB among people living with HIV,

globally and for 41 high TB/HIV burden countries and WHO regions, 2012. Numbers in thousands except

where indicated.

ESTIMATED HIV-POSITIVE INCIDENT TB CASES

07/$'41(

TB PATIENTS

WITH KNOWN

HIV STATUS

% OF

NOTIFIED

TB PATIENTS

6'56'&(14

HIV

% OF

TESTED

TB PATIENTS

HIV-POSITIVE

% OF

IDENTIFIED

HIV-POSITIVE

TB PATIENTS

56#46'&10

CPT

% OF

IDENTIFIED

HIV-POSITIVE

TB PATIENTS

56#46'&10

#46

07/$'41(

HIV-

POSITIVE

PEOPLE

5%4''0'&

(146$

07/$'4

HIV-POSITIVE

PEOPLE

2418+&'&

WITH IPT

BEST LOW HIGH

Angola 5.5 4.7 6.5 12 23 9.6 100 100 12 1.1

Botswana 5.1 4.5 5.6 6.0  63 91 66

$TC\KN 16 13 19 46 55 20 0 100

Burkina Faso 1.6 1.3  4.6  15 96 75 7.4

Burundi 2.5 2.2  5.7  19 94 55 0.2

Cambodia 2.7 2.3 3.1 32  4.4   1.1

Cameroon 19 16 23 21  37  55 12

%GPVTCN#HTKECP4GRWDNKE 5.3 4.4 6.4  46 39  20

Chad 4.1 3.4   44 20 65 1.0

China 7.3 6.4  309 34a1.9 59 295

Congo 3.6 2.9 4.3 2.0 17 33 20 23

Côte d’Ivoire  6.9 9.2 21  27 75 44

Djibouti 0.54 0.45 0.64 1.3 36 10 64 0

&4%QPIQ 16 14 19 35 31 16 61 40

Ethiopia 23 17 30 96 65 10 37  272 30

Ghana  2.4 3.1 12  24 72 37

Haiti 4.3 3.5 5.1 14  20 59 46 2.1 15

India 130 120 140  56 5.4 92 59 1 324

Indonesia 7.5 5.6 9.7 2.7    29 23

Kenya 45 44 47 93 94 39  74

Lesotho 9.9  11 10  75 97 53 21 16

Malawi 16 15 17 19 93 59   393 21

Mali 1.2 1.2 1.3 1.5   42 100

/Q\CODKSWG   110  94   55 17

Myanmar 19 16 21 19 13 27 

Namibia 7.3   9.9  47 99 72 12 12

Nigeria 46 21    23  56 140 2.3

4WUUKCP(GFGTCVKQP 9.3 7.9 11 76b

4YCPFC 2.9 2.6 3.2 6.1 99 26 99 122

Sierra Leone 3.9 3.2  12  12 26 69  1.1

South Africa 330 270 390 294  65 74 54 950 370

Sudan 4.3 3.5 5.1 3.1 15 7.5 0 17 1.3

5YC\KNCPF 13 11 15 7.4 95 77  66 69 1.9

Thailand 12 10 14 44 72 13 77 62

Togo 1.2  1.4 2.7 91 24  76

Uganda 35  42 41  50 94 49

Ukraine  3.9 5.7 34  14 94 14

746CP\CPKC 32 30 34 52  39 96 54 357

Viet Nam 9.3 6.9 12  66 7.0 73 47 5.7

<CODKC 35 32 39 45 100 54 93 60

<KODCDYG 55 42 69 34  70 26 

High TB/HIV burden countries 1 000 960 1 100 2 454 53 21 80 57 4 024 509

#(4  760 910 1 040 74 43 79 55 2 392 473

#/4 31  34 129 56 16 61 76 4.5 19

'/4 11 10 12  14 3.5 69  15 0.2

'74 19 17 21 204 60 6.3 67 74 24 

5'#4 170 160  904 39 6.2  61 1 352 

924 24 21 27 451 34 3.1 79 56  

Global 1 100 1 000 1 200 2 787 46 20 80 57 4 095 519

Blank cells indicate data not reported.

a +PVJGEQWPVKGUKP%JKPCKFGPVKßGFHQT*+8VGUVKPICOQPIPQVKßGF6$RCVKGPVUQHPQVKßGFECUGUYGTGVGUVGFHQT*+8#OQPIVJGUGYGTG

HIV-positive (1.6%).

b &CVCHQTVJG4WUUKCP(GFGTCVKQPGZENWFGTGVTGCVOGPVECUGUCPFECUGUHTQORTKUQPU

71GLOBAL TUBERCULOSIS REPORT 2013

Outside the African Region, in 2012 the percentage of

TB patients who had a documented HIV test result reached

60% in the European Region. It should be noted, how ever,

that the coverage of testing in the Russian Federation is

underestimated since the national data on HIV testing

reported to WHO are for new TB cases in the civilian sector

only (i.e. excluding prisons) while the denominator used

in calculations of coverage is all notied TB cases. e per-

centage of TB patients with a documented HIV test result

in the Region of the Americas was 56% in 2012. Brazil

(where 55% of new TB cases had a documented HIV test

result, very similar to the regional average) accounted for

more than a third of all cases tested in the region, followed

by Mexico (12%) and Haiti (10%). In other regions, where

testing rates have remained consistently low, the percent-

age ranged from 14% in the Eastern Mediterranean Region

to 39% in the South-East Asia Region.

e highest rates of HIV co-infection were reported for

TB patients in the African Region (Table 6.1), where 43%

of those with an HIV test result were positive (compared

with 46% in 2011). e percentage of TB patients found

to be HIV-positive in the 28 African countries in the list

of 41 priority countries ranged from 10% in Ethiopia and

Angola to 77% in Swaziland. In the Region of the Americas,

the percentage of TB patients with a documented HIV test

result who were HIV-positive was 16%. In the Eastern Med-

iterranean, European, South-East Asia and Western Pacic

Regions, less than 10% of TB patients with a documented

HIV test result were HIV-positive. e global average across

all regions was 20%, and 21% among the 41 high TB/HIV

burden countries.

6.2 Antiretroviral therapy and co-trimoxazole

preventive therapy for TB patients living

with HIV

ART is a critical intervention for reducing the risk of TB

morbidity and mortality among people living with HIV. It

reduces the individual risk of TB disease by 65%, irrespec-

tive of CD4 cell count,1 and when combined with IPT it can

have a signicant impact on TB prevention.2 In the latest

WHO guidelines released in July 2013,3 the threshold CD4

count at which starting ART is recommended has been

raised from a CD4 count of ≤350 to ≤500 CD4/mm3. Imple-

mentation of these guidelines on a large scale should sub-

stantially reduce morbidity and mortality resulting from

HIV-associated TB. As in previous guidelines, ART is rec-

ommended for all TB patients living with HIV, irrespective

of their CD4 cell count. CPT also helps to reduce mortality

among HIV-positive TB patients.4

e number of HIV-positive TB patients on ART has

grown from a very low level in 2004 (Figure 6.4) to reach

0.3 million in 2012. Among TB patients notied in 20125

and who had a documented HIV-positive test result, 57%

were on ART globally (Table 6.1, Figure 6.5); this is a

considerable improvement from 49% in 2011. In the Afri-

can Region, 55% of TB patients notied in 2012 who had

a documented HIV-positive test result were on ART (up

from 48% in 2011). Among the 41 high TB/HIV burden

countries, 28 reported enrolling more than 50% of notied

TB patients known to be living with HIV on ART in 2012

(Table 6.1, Figure 6.6). is important progress notwith-

standing, the WHO recommendation that all HIV-positive

TB patients are eligible for ART irrespective of their CD4

cell count also means that the coverage of ART for HIV-pos-

itive TB patients still needs to be greatly improved with the

goal of reaching the 2015 target of 100% set in the Global

Plan to Stop TB 2011–2015.

Early initiation of ART, as soon as possible within eight

weeks after initiation of TB treatment or within two weeks

for profoundly immunosuppressed patients (CD4 count

<50), is recommended. WHO also strongly recommends

the integration of ART and TB treatment services for TB

patients living with HIV either through TB or HIV treat-

ment facilities in settings with a high burden of TB and HIV.

In many settings, facilities providing TB services are more

decentralized than ART services and oer an opportunity

to scale up the delivery of integrated TB and HIV services

through task shifting and task sharing.6 A recent example

of the integration of TB services with those for HIV and

1 Suthar AB et al. Antiretroviral therapy for prevention of tuberculosis

in adults with HIV: a systematic review and meta-analysis. PLoS Med-

icine, 2012, 9(7): e1001270. (doi:10.1371/journal.pmed.1001270).

2 Samandari T et al. 6-month versus 36-month isoniazid preven-

tive treatment for tuberculosis in adults with HIV infection in

Botswana: a randomised, double-blind, placebo-controlled trial.

e Lancet. 2011 May 7;377(9777):1588-98. doi: 10.1016/S0140-

6736(11)60204-3.

3 Consolidated guidelines on the use of antiretroviral drugs for treat-

ing and preventing HIV infection. Geneva, World Health Organi-

zation, 2013. Available at http://apps.who.int/iris/bitstream/

10665/85321/1/9789241505727_eng.pdf

4 Nunn AJ et al. Role of co-trimoxazole prophylaxis in reducing mor-

tality in HIV infected adults being treated for tuberculosis: ran-

domized clinical trial. British Medical Journal. 2008, 337:a257.

5 In the annual WHO TB data collection form, countries are asked to

report the number of TB patients notied in the most recent calen-

dar year who were living with HIV and who “started or continued

on ART”.

6 Global Tuberculosis Report 2012. Geneva, World Health Organiza-

tion, 2012.

FIGURE 6.4

Number of HIV-positive TB patients enrolled

on co-trimoxazole preventive therapy (CPT) and

antiretroviral therapy (ART), 2004–2012

TB patients (thousands)

HIV-positive

CPT

ART

100

200

300

400

500

600

2004 2005 2006 2007 2008 2009 2010 2011 2012

72 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 6.5

Percentage of TB patients with known HIV status who were HIV positive, and percentage of HIV-positive TB

patients enrolled on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART), 2007–2012a

a The solid lines show values for countries that reported data. The shaded areas show upper and lower limits when countries that did not report data are considered.

Percentage of TB patients

2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012

100

% of TB patients with known

HIV status who were HIV-positive

% of HIV-positive patients on CPT % of HIV-positive patients on ART

FIGURE 6.6

Percentage of HIV-positive TB patients enrolled on antiretroviral therapy (ART), 2012

Percentage of

HIV-positive

TB patients

0–24

25–49

50–74

75–100

No data

Not applicable

maternal, new-born and child health (MNCH) services is

provided in Box 6.1.

Globally, 0.4 million TB patients living with HIV were

enrolled on CPT in 2012, up from a negligible number in

2004. e absolute number fell between 2011 and 2012,

which is at least partly explained by the decrease in the

number of HIV-positive TB cases reported between 2011

and 2012 (Figure 6.4). e coverage of CPT among TB

patients with a documented HIV-positive test result was

80% in 2012, similar to the level of 2010 and 2011 (Table

6.1, Figure 6.5). e African, South-East Asia and Western

Pacic Regions achieved particularly high levels of enrol-

ment on CPT: 79%, 89% and 79%, respectively (Table 6.1).

Of the 41 high TB/HIV burden countries, the percentage of

HIV-positive TB patients enrolled on CPT in 2012 exceeded

90% in Angola, Botswana, Burkina Faso, Burundi, Cambo-

dia, India, Kenya, Lesotho, Mozambique, Namibia, Rwan-

da, Swaziland, Uganda, the United Republic of Tanzania

and Zambia.

6.3 Intensifying TB screening and

isoniazid preventive therapy among

people living with HIV

Recording and reporting of TB screening among people liv-

ing with HIV and provision of IPT to those without active

TB is a particular challenge in many countries, and further

eorts are needed to facilitate and improve the tracking of

progress nationally and globally (Box 6.2).

73GLOBAL TUBERCULOSIS REPORT 2013

BOX 6.1

Linkages between TB, HIV and maternal, newborn and child health (MNCH) services in Cambodia

Cambodia has achieved great progress in responding to its HIV epidemic and in reducing TB prevalence and mortality. It has also

made progress in improving services for maternal, newborn and child health (MNCH). Attendance at antenatal services and the

RGTEGPVCIGQHFGNKXGTKGUCVJGCNVJHCEKNKVKGUJCXGKPETGCUGFCPFOCVGTPCNCPFWPFGTßXGOQTVCNKV[JCXGDQVJDGGPTGFWEGF/CLQT

efforts to establish and strengthen service linkages between the TB, HIV and MNCH programmes have also been made.

Linkages between TB and

HIV services

+PQHPQVKßGF6$RCVKGPVU

MPGYVJGKT*+8UVCVWUCPFQH

*+8RQUKVKXG6$RCVKGPVUYGTGQP#46

The number of people living with HIV

given IPT increased by a factor of 22

between 2006 and 2012, following

the introduction of the WHO screening

algorithm to rule out active TB (and

associated removal of the previous

requirement for a positive tuberculin

skin test before initiation of IPT).

Linkages between MNCH and

HIV services

The percentage of pregnant women

tested for HIV increased from 16% in

VQKP6JGEQXGTCIG

QH#46COQPI*+8KPHGEVGFRTGIPCPV

women increased from 11% in 2007 to

65% in 2012. The percentage of infants

born to HIV-positive women who were

RTQXKFGFYKVJ#46VQRTGXGPVOQVJGT

to-child transmission rose from 50% in

2010 to 73% in 2012.

Linkages between MNCH and

TB services

A new MNCH-TB collaborative framework

offering cross-programme referrals

between TB services and clinics

providing antenatal, growth monitoring

CPFKOOWPK\CVKQPUGTXKEGURTQOKUGUVQ

further reduce the burden of TB among

women and children.

Scaling up collaboration among

the three programmes

Collaboration among the three

programmes aims to strengthen

linkages and synergies to achieve better

outcomes. The government, with support

from WHO, has piloted efforts to set

up a collaborative project involving

the three programmes in two districts.

Lessons learned from these and other

pilot sites are helping the country to

OCZKOK\GRQVGPVKCNHQTETQUURTQITCOOG

EQNNCDQTCVKQPCPFVQQRVKOK\GVJGWUGQH

resources.

The three-programme collaborative

CEVKXKVKGUDGKPIRKNQVGFKPENWFG

 *CTOQPK\KPIVTCPURQTVCVKQPQHDNQQF

samples required for testing HIV

that are collected at sites providing

services for pregnant women, TB

patients and populations at high risk

of HIV.

 *CTOQPK\KPIKPHQTOCVKQPGFWECVKQP

and communication related to MNCH,

HIV and TB at the sites providing

MNCH, HIV and TB services.

3. Expanding cross-programme

laboratory services.

4. Strengthening the system

for referrals between the

three programmes including

UVCPFCTFK\CVKQPQHEQOOWPKECVKQP

and referral procedures.

 *CTOQPK\CVKQPQHEQOOWPKV[U[UVGO

strengthening by sharing the costs

and time spent during monthly

meetings of village health support

groups at health centres.

BOX 6.2

Improving the quality of TB/HIV data: challenges and solutions

Major efforts have been made in recent years to improve the quality of TB/HIV data. Indicators used by TB and HIV programmes have

DGGPUVCPFCTFK\GFCPFEQNNCDQTCVKQPDGVYGGP6$CPF*+8RTQITCOOGUJCUDGGPKORTQXGFYKVJENGCTFGßPKVKQPQHTGURQPUKDKNKVKGU

for data collection related to TB/HIV interventions. WHO and UNAIDS have worked intensively with countries to try to ensure

complete and consistent reporting and to reconcile any apparent discrepancies between data reported by TB and HIV programmes.

6JGUGGHHQTVUPQVYKVJUVCPFKPIEJCNNGPIGUTGOCKP

Missing or inaccurate denominators required to calculate the coverage of TB screening and IPT among people

living with HIV. There has been an increase in the number of countries capturing and reporting data on the number of people

living with HIV who are screened for TB and the number without active TB who are provided with IPT. However, many of these

countries are not reporting the corresponding denominators needed to calculate coverage (i.e. people registered in HIV care

CPFRGQRNGPGYN[TGIKUVGTGFKP*+8ECTGHQTUETGGPKPICPF+26TGURGEVKXGN[6JGTGCTGCNUQGZCORNGUQHVJGUCOGßIWTGUDGKPI

reported for both denominators.

Discrepant reporting by NTPs and National AIDS Programmes (NAPs). In some countries, the NTP and NAP report

FKHHGTGPVßIWTGUHQTVJGPWODGTQH*+8RQUKVKXG6$RCVKGPVUYJQCTGQP#46+PEQWPVTKGUVJGPWODGTUTGRQTVGFD[VJG

062CPF0#2YGTGFKHHGTGPVKPDQVJCPF#NVJQWIJUWDUGSWGPVFCVCXGTKßECVKQPCPFJCTOQPK\CVKQPGHHQTVUNGFVQ

consensus on one number in most countries, the different numbers could not be reconciled for either year in Angola, Myanmar

CPFVJG7PKVGF4GRWDNKEQH6CP\CPKC5QNWVKQPUVQCFFTGUUVJKURTQDNGOKPENWFGKORTQXKPIU[UVGOUHQTTGEQTFKPICPFTGRQTVKPI

data and further strengthening of collaboration and communication between the NAP and NTP as well as their partners.

74 GLOBAL TUBERCULOSIS REPORT 2013

In 2012, a total of 4.1 million people who were enrolled in

HIV care were screened for TB in 61 countries, an increase

from 3.5 million in 58 countries in 2011 (Figure 6.7). In

the 49 countries that reported both the number screened

for TB and the number in HIV care, the coverage of screen-

ing was 66% (3.9/5.9 million).

Among 42 countries that reported data, IPT was ini-

tiated among almost 520 000 people newly registered

in HIV care in 2012. is was an increase from less than

450000 people in 2011 (Figure 6.8). One country – South

Africa – accounted for 71% of the global total with 370000

people reported to have been provided with IPT in 2012,

followed by Ethiopia (30 000), Malawi (21000), Mozam-

1 Getahun H, et al. Development of a standardized screening rule for

tuberculosis in people living with HIV in resource-constrained set-

tings: Individual participant data meta-analysis of observational

studies. PLoS Medicine, 2011, 8(1): e1000391. doi:10.1371/journal.

pmed.1000391.

FIGURE 6.7

Intensißed TB case-ßnding among people living

with HIV, 2005–2012

Number of people screened (millions)

2005 2006 2007 2008 2009 2010 2011 2012

FIGURE 6.8

Provision of isoniazid preventive therapy (IPT)

to people living with HIV without active TB,

2005–2012

Number of HIV-positive people without

active TB (thousands)

100

200

300

400

500

600

2005 2006 2007 2008 2009 2010 2011 2012

bique (17000), Lesotho (16000), Haiti (15000), Ukraine

(14000), and Namibia (12000).

irty countries reported both the total number of peo-

ple newly enrolled in HIV care (1.6 million) and the num-

ber of people living with HIV who were started on IPT

(0.47 million) in 2012 i.e. 30% of those newly enrolled in

HIV care were initiated on IPT. If the WHO-recommend-

ed four-symptom screening algorithm is used to rule out

active TB in people living with HIV, approximately 50% of

people living with HIV would be expected to be eligible for

IPT.1 Further eorts are needed to reach the Global Plan’s

2015 target of providing IPT to all those eligible.

75GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

Financing

KEY FACTS AND MESSAGES

■ Funding required for a full response to the global TB

epidemic in low- and middle-income countries is estimated

CV75aDKNNKQPRGT[GCTD[GZENWFKPITGUGCTEJCPF

development for new TB diagnostics, drugs and vaccines).

Of this total, about two thirds is needed for the detection

and treatment of drug-susceptible TB, 20% for treatment

QH/&46$HQTTCRKFFKCIPQUVKEVGUVUCPFCUUQEKCVGF

laboratory strengthening, and 5% for collaborative TB/HIV

activities.

■ A recent long-term study using data reported to WHO

shows that TB funding in low- and middle-income countries

grew substantially between 2002 and 2011, especially in

$TC\KNVJG4WUUKCP(GFGTCVKQP+PFKC%JKPCCPF5QWVJ#HTKEC

$4+%56JGKPETGCUKPIUGNHUWHßEKGPE[QHVJGUGCPFUQOG

other countries is a success story for these countries and the

global TB community.

■ Despite growth in funding for TB, funding gaps persist

CPFCFFKVKQPCNHWPFKPIPGGFUVQDGOQDKNK\GFHTQODQVJ

domestic and international donor sources. There is capacity

to increase funding from domestic sources beyond the

75aDKNNKQPCXCKNCDNGKPGURGEKCNN[KP$4+%5

Funding required from international donor sources is

GUVKOCVGFCV75a¿DKNNKQPRGT[GCT

■ Funding from international donor sources is expected

VQTGCEJ75aDKNNKQPKPOQUVQHVJKUHWPFKPIKU

from the Global Fund and USAID. Donor funding accounts

HQTCNCTIGUJCTGÜQHVQVCNHWPFKPIKPUQOGEQWPVT[

ITQWRUPQVCDN[VJG*$%UGZENWFKPI$4+%5CPFCNNNQY

income countries, and an even higher proportion in some

individual countries. International donors have a crucial

role in sustaining and ensuring further progress in TB

prevention, diagnosis and treatment worldwide.

■ 6JGEQUVRGTRGTUQPUWEEGUUHWNN[VTGCVGFHQT6$YKVJßTUV

NKPGFTWIUKUKPVJGTCPIG75aVQ75aKPCNOQUVCNN

countries with a high burden of TB.

Progress in TB prevention, diagnosis and treatment

requires adequate funding sustained over many years.

WHO began annual monitoring of funding for TB in 2002,

and ndings have subsequently been published in global

TB reports. Particular attention has always been given to

the 22 HBCs that account for about 80% of estimated cases

(Chapter 2). Recent reports have included aggregated anal-

yses of trends since 2006 for approximately 100 countries.

In 2012, WHO conducted a comprehensive analysis of

long-term trends in TB funding in low- and middle-income

countries for the decade 2002–2011, using data reported

by countries between 2002 and 2012. e analysis was able

to include 104 out of a total of 154 countries classied by

the World Bank as low- or middle-income in 2011 (gross

national income (GNI) per capita < US$12,476). ese 104

countries had 94% of the world’s estimated cases of TB and

88% of the world’s estimated cases of MDR-TB in 2011. Lev-

els of funding in 2011 were then analysed in combination

with the most recent estimates of resource requirements

for TB prevention, diagnosis and treatment to assess the

funding that could be mobilized from domestic sources and

the balance required from international donors up to 2015.

Results from these analyses were published in an article in

the August 2013 issue of e Lancet Global Health.1

Given this very recent publication, the scope of this

nancing chapter has been adjusted compared with pre-

vious years to avoid unnecessary duplication. Section 7.1

presents the most up-to-date estimates of nancial resourc-

es required until the end of 2015 in all of the 154 countries

that were classied as low- or middle-income countries in

2011, alongside projections of the funding that could be

mobilized domestically. Section 7.2 provides a summary

of the main ndings from the analysis of trends in fund-

ing between 2002 and 2011 in 104 low- and middle-income

countries. With this background and context, the rest of

the chapter (section 7.3) contains detailed analyses of TB

funding in 2013, using data compiled in the 2013 round of

global TB data collection. Funding levels in 2013 are pre-

sented by WHO region and for other country groupings

based on income level, burden and geography, with break-

downs by source of funding (section 7.3.1) and category

of expenditure (section 7.3.2). Funding gaps reported by

countries are also illustrated and discussed (section 7.3.3).

1 Floyd K, Fitzpatrick C, Pantoja A and Raviglione M. Domestic and

donor nancing for tuberculosis care and control in low-income

and middle-income countries: an analysis of trends, 2002–11, and

requirements to meet 2015 targets. e Lancet Global Health; 1:

e105–15.

76 GLOBAL TUBERCULOSIS REPORT 2013

Further country-specic data can be found in nance pro-

les that are available online.1

7.1 Estimates of funding required up to

2015 for a full response to the global

TB epidemic

e Global Plan to Stop TB 2011–20152 sets out the actions

and funding needed for a full response to the TB epidem-

ic, based on the Stop TB Strategy.3 e overall goal of the

plan is to achieve the 2015 global targets for reductions in

cases of and deaths from TB (i.e. that incidence should be

falling and that prevalence and mortality rates should be

halved compared with their levels in 1990) (Chapter 1). Key

components of the plan include increasing the number of

patients detected and treated according to WHO’s recom-

mended strategy from 5.8 million in 2011 to 6.9 million

by 2015 (which would be equivalent to more than 80% of

projected incident cases in that year); ensuring that all pre-

viously treated patients and all new patients with known

risk factors for MDR-TB are tested for drug resistance by

2015 (including with recently endorsed rapid tests such as

Xpert MTB/RIF that are discussed in Chapter 5); enrol-

ment of all TB patients with conrmed MDR-TB (projected

to be around 300000 in 2015) on second-line treatment;

HIV testing of all patients with TB; and prompt initiation

of ART in all HIV-positive TB patients.

In 2013, the Global Plan datasets were used in combi-

nation with new country-specic planning and budgeting

work with nine high TB or high MDR-TB burden countries

to produce updated estimates of funding needs for TB

prevention, diagnosis and treatment in low- and middle-

income countries.4 e nine countries were Ethiopia, India,

Indonesia, Kazakhstan, Kenya, Nigeria, Pakistan, South

Africa and Ukraine. Analyses were conducted in the context

of estimates of funding needs and funding gaps required

for the Global Fund’s replenishment eorts in 2013.5 WHO

subsequently extended these analyses to cover all low- and

middle-income countries and not only the countries eligi-

ble to apply to the fund.6 Notable countries (in terms of TB

burden and funding requirements) that are not eligible to

apply to the Global Fund are Brazil, China and the Russian

Federation.

During the course of the work done for the rst pre-

replenishment meeting held in April 2013, it should be

highlighted that the Global Fund, WHO, UNAIDS, and

other partners agreed that funding needs for ART for HIV-

positive TB patients should be included in estimates of HIV

resource needs to avoid double-counting. For this reason,

the estimates of resource requirements for TB/HIV inter-

ventions included in the updated estimates of resource

needs for TB are lower than those published in the Global

Plan.

Funding needs were compared with the domestic fund-

ing that could be mobilized in two alternative scenarios.

e rst scenario was that TB funding could increase (from

a 2011 baseline) in line with International Monetary Fund

forecasts for growth in total government expenditures.7

e second scenario had the same assumptions as the rst,

but also assumed that countries that currently under-

perform in domestic nancing relative to their income level

(i.e. their ability to pay) and disease burden reach the lev-

el of the median performer by 2020. ese scenarios were

chosen to be fully consistent with the methods previously

used to assess the potential to mobilize domestic funding

for prevention, treatment and care of HIV.8

e main results from these analyses are summarized

in Figure 7.1. e total funding required in all low- and

middle-income countries reaches about US$ 8 billion in

2015, compared with US$6 billion in 2012 (Figure 7.2).9

Of the total funding required, about two thirds is needed

for the detection and treatment of drug-susceptible TB,

20% for treatment of MDR-TB, 10% for rapid diagnostic

tests and associated laboratory strengthening, and 5% for

collaborative TB/HIV activities (excluding ART). Funding

needed for each of these four categories increases over time.

e largest relative increases are for treatment of MDR-TB

and diagnostics/laboratory strengthening.

ere is potential to mobilize a large share of these fund-

ing needs from domestic resources in some country groups,

notably BRICS and upper middle-income countries (Figure

7.1). Elsewhere, there are relatively large gaps between

the estimated amounts of domestic funding that could be

mobilized and the total funding needed, especially in three

country groups: the 17 HBCs excluding BRICS; low-income

countries; and the African Region excluding South Africa.

In the rst scenario in which domestic funding grows from

2011 levels in line with projected growth in total govern-

ment expenditures, the total gap amounts to US$2.3 bil-

lion per year by 2015. In the second and more optimistic

scenario, the gap would be US$1.6 billion per year by 2015.

1 www.who.int/tb/data

2 e Global Plan to Stop TB, 2011–2015. Geneva, World Health Orga-

nization, 2010 (WHO/HTM/STB/2010.2).

3 Raviglione M, Uplekar M. WHO’s new Stop TB strategy. Lancet

2006; 367: 952–5.

4 Funding required for research and development for new TB diag-

nostics, drugs and vaccines was not considered. In the Global

Plan, it is estimated that about US$2 billion per year is needed for

research and development.

5 e Global Fund to Fight AIDS, Tuberculosis and Malaria fourth replen-

ishment (2014–2016): needs assessment. Geneva, Global Fund to

Fight AIDS, Tuberculosis and Malaria, 2013.

6 Floyd K, Fitzpatrick C, Pantoja A and Raviglione M. Domestic and

donor nancing for tuberculosis care and control in low-income

and middle-income countries: an analysis of trends, 2002–11, and

requirements to meet 2015 targets. e Lancet Global Health; 1:

e105–15.

7 World economic outlook database. Washington, International Mon-

etary Fund, 2012 (www.imf.org/external/pubs/ft/weo/2012/02/

weodata/index.aspx).

8 Schwartlander B, Stover J, Hallett T, et al. Towards an improved

investment approach for an eective response to HIV/AIDS. e

Lancet 2011; 377: 2031–41.

9 In Figure 7.1, country groups are not all mutually exclusive. e

global total can be calculated by adding together the totals in the

panels for BRICS, low-income countries, lower middle-income

countries (excluding China and India) and upper middle-income

countries (excluding Brazil, the Russian Federation and South

Africa).

77GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 7.1

Forecast of funding that could be mobilized from domestic sources compared with total funding needed for

a full response to the global TB epidemic in nine country groups, 2012–2015. The black line shows the total

funding required. The blueDCPFTGRTGUGPVUUEGPCTKQYJKEJUJQYUFQOGUVKEHWPFKPIVJCVEQWNFDGOQDKNK\GFKHFQOGUVKE

funding increases from a 2011 baseline at the same rate of growth as International Monetary Fund forecasts of growth in total

government expenditures. The greenDCPFUJQYUCFFKVKQPCNTGUQWTEGUVJCVEQWNFDGOQDKNK\GFEQORCTGFYKVJUEGPCTKQKH

current underperformers (relative to income level and TB disease burden) improve at a consistent rate to reach the level of the

median performer by 2020. $4+%5$TC\KNVJG4WUUKCP(GFGTCVKQP+PFKC%JKPC5QWVJ#HTKEC

US$ billions

Africa excluding S

US$ billions

BRICS

Low-income countries

17 HBCs excluding BRICS

Lower-middle income countries

excluding I and C

Asia excluding I and C Rest of world excluding B and R

Upper-middle income countries

excluding B, R, S

Low-income countries excluding HBCs

US$ billions

1.0

2.0

3.0

4.0

5.0

2012 2013 2014 2015

0.5

1.0

1.5

2012 2013 2014 2015

0.10

0.20

0.30

2012 2013 2014 2015

0.2

0.4

0.6

0.8

1.0

1.2

2012 2013 2014 2015

0.2

0.4

0.6

1.2

1.4

1.6

1.8

0.8

2012 2013 2014 2015

1.0

0.2

0.4

0.6

0.8

2012 2013 2014 2015

0.2

0.4

0.6

1.0

1.2

1.4

1.6

1.8

0.8

2012 2013 2014 2015

0.2

0.4

0.6

0.8

1.0

1.2

2012 2013 2014 20152012 2013 2014 2015

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

 GLOBAL TUBERCULOSIS REPORT 2013

It should be highlighted that in the second and more

optimistic scenario, it is assumed that countries that cur-

rently underperform in terms of their levels of domestic

nancing relative to their TB burden and income level will

steadily progress to reach the level of the current median

peformer (in terms of domestic funding relative to burden

and income level) by 2020. Two countries in particular –

India and Indonesia – would need to substantially increase

their levels of domestic funding for this scenario to mate-

rialize in practice, since they account for about two-thirds

of the additional funding in Scenario 2 compared with

Scenario 1. Current trends are not in line with Scenario

2. In India, domestic funding reported for 2013 is lower

than the amount available in 2012, while in Indonesia an

increase in domestic funding between 2012 and 2013 was

reported but by a relatively small amount (see Annex 2 for

further details).

7.2 Trends in TB funding, 2002–2011:

a summary

Data reported to WHO between 2002 and 2012 allowed

analysis of trends 2002–2011 in 104 countries. ese 104

countries are shown in Table 7.1 (an additional 21 coun-

tries that could be included in analyses of funding in 2013,

described in section 7.3, are shown in bold). Among the 104

countries, there were ≥6 observations for 83 countries. For

most countries, there were between 7 and 10 observations,

including 14/22 HBCs that had 10 observations each and

5/22 HBCs for which there were 9/10 observations. Values

for country-year combinations for which data were missing

in the 104 countries were imputed using country-specic

linear regression models. Details on the criteria used to

include or exclude countries and the imputation methods

are available in an online technical appendix.1

In the 104 low- and middle-income countries with 94%

of the world’s TB cases and 88% of the world’s MDR-TB cas-

es, total funding for TB (domestic plus international donor

sources) grew in real terms (2011 US$ prices) from US$1.7

billion in 2002 to US$ 4.4 billion in 2011. e increases var-

ied among country groups, from 100% in low-income coun-

tries to 177% in upper middle-income countries. Increases

in funding were accompanied by large increases in the num-

ber of people successfully treated for TB, from 2.8 million

in 2002 to 5.0 million in 2011. A cumulative total of 43 mil-

lion people were treated between 2002 and 2011. e cost

per patient treated was in the range US$100–500 in most

of the countries with the highest burdens of TB. e size

of the patient caseload and gross domestic product (GDP)

per capita explained more than 70% of the variation among

countries in the cost per patient treated.

Domestic funding (national and local budgets, and loans)

in the 104 countries included in trend analyses rose from

US$1.5 billion in 2002 to US$3.9 billion in 2011. Loans

accounted for a small proportion (≤5%) of total domestic

funding each year. Most of the increase in total domestic

funding (US$1.7 out of US$2.4 billion [71%]) was account-

ed for by BRICS (which account for almost half of the world’s

TB cases) and other middle-income countries in Asia, Latin

America and Europe. e magnitude of domestic funding

in these country groups (69–98% of total funding per year)

and BRICS in particular (>95% of total funding per year)

meant that domestic funding dominated total funding for

TB globally (88–92% per year).

International donor funding in the 104 countries includ-

ed in trend analyses grew from US$0.2 billion in 2002 to

US$0.5 billion in 2011. ere was striking variation among

country groups in terms of the share of total funding pro-

vided from international donor sources. By 2011, donor

funding represented 39% of total funding in the 17 HBCs

excluding BRICS, which account for about one third of

the world’s TB cases; 42% of funding in African countries

excluding South Africa; and 67% of total funding in low-

income countries (25 of which are in Africa). e Global

Fund accounted for 64% of all donor funding reported by

countries during the decade 2002–2011.

Most funding was used for the diagnosis and treat-

ment of drug-susceptible TB (over 85% each year). Small

amounts were used for diagnosis and treatment of MDR-

TB, although funding started to increase in BRICS, upper

middle-income countries, and countries in Europe and

Latin America around 2006.

Despite growth in funding from domestic and interna-

tional donor sources, NTPs were not able to mobilize all the

funding that they estimated to be needed. Funding gaps

(i.e. the dierence between assessments by NTPs of funding

needs for TB prevention, diagnosis and treatment and the

actual amount of funds mobilized) persisted, and increased

from US$257 million in 2002 to US$563 million in 2011. It

should be noted that the funding gaps reported by NTPs are

sometimes based on relatively conservative assessments of

funding needs. When national strategic plans with more

FIGURE 7.2

Total funding required for a full response

to the global TB epidemic, by intervention area,

2013–2015

TB/HIV

Laboratory

strengthening/

diagnostics

MDR-TB

Drug-susceptible

US$ billions

2012 2013 2014 2015

1 Floyd K, Fitzpatrick C, Pantoja A and Raviglione M. Domestic and

donor nancing for tuberculosis care and control in low-income

and middle-income countries: an analysis of trends, 2002–11, and

requirements to meet 2015 targets. e Lancet Global Health; 1:

e105–15.

79GLOBAL TUBERCULOSIS REPORT 2013

TABLE 7.1

125 countries included in analyses of TB ßnancing in 2013a,b

LOW-INCOME

QHPQVKßGFECUGUINQDCNN[

.19'4/+&&.'+0%1/'

QHQHPQVKßGFECUGU

globally)

722'4/+&&.'+0%1/'

QHPQVKßGFECUGUINQDCNN[

$4+%5

QHPQVKßGFECUGU

globally)

*+)*$74&'0%17064+'5

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Lesotho, Mauritania,

Nigeria, Sao Tome

and Principe,

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 GLOBAL TUBERCULOSIS REPORT 2013

1 World malaria report 2012. Geneva, World Health Organization,

2012.

2 World AIDS day report 2012. Geneva, Joint United Nations Pro-

gramme on HIV/AIDS, 2012 (

www.unaids.org/en/resources/

presscentre/pressreleaseandstatementarchive/2012/november/

20121120prresults).

FIGURE 7.3

Available funding for TB care and control in

125 countries reporting 96% of global cases by

source of funding and WHO region, 2013

Global Fund

Grants (excluding

Global Fund)

Government,

general health-

care services

(inpatient and

outpatient care)

Government,

NTP budget

(including loans)

US$ billions (current 2013 US$)

0.5

1.0

1.5

2.0

2.5

3.0

EUR AFR WPR SEAR AMR EMR

FIGURE 7.4

Available funding for TB care and control in

125 countries reporting 96% of global cases by

source of funding and income group, 2013

Global Fund

Grants (excluding

Global Fund)

Government,

general health-

care services

(inpatient and

outpatient care)

Government,

NTP budget

(including loans)

US$ billions (current 2013 US$)

Upper-

middle-income

High-

income

Lower-

middle-income

Low-

income

0.5

1.0

1.5

2.0

2.5

3.0

FIGURE 7.5

Available funding for TB care and control in BRICS,

17 other HBCs and Africa excluding South Africa,

by source of funding, 2013

Global Fund

Grants (excluding

Global Fund)

Government,

general health-

care services

(inpatient and

outpatient care)

Government,

NTP budget

(including loans)

US$ billions (current 2013 US$)

0.5

1.0

1.5

2.0

2.5

3.0

3.5

BRICS Africa without

South Africa

Other HBCs

ambitious targets are developed, as was done for the nine

countries described in section 7.1, funding needs and gaps

invariably increase. e gap between the US$8 billion esti-

mated to be needed for a full response to the TB epidemic in

2015 (section 7.1) and the US$6.1 billion available in 2013

(see section 7.3 below) is US$1.9 billion.

Overall, these ndings show that TB funding increased

substantially between 2002 and 2011, resulting in impres-

sive and cost-eective gains. e increasing self-suciency

of many countries, including BRICS, which account for

almost half of the world’s TB cases, is a success story for

these countries and the global TB community. At the same

time, it is clear that international donor funding remains

crucial in many countries and needs to be continued to sus-

tain and consolidate recent gains.

7.3 TB funding in 2013

Data reported by countries to WHO in the 2013 round of

global TB data collection allowed inclusion of 122 low-

and middle-income countries (GNI per capita less than

US$12616 in 2012) in analyses of TB funding by source

of funding and category of expenditure in 2013 (Table 7.1;

the additional countries compared with those included in

analyses of trends 2002–2011 are shown in bold). An addi-

tional three high-income countries (Estonia, Latvia and

the Russian Federation) were also included in analyses

because they are in the list of 22 HBCs or 27 high MDR-

TB HBCs. Collectively, the 125 countries account for 96%

of the world’s TB cases. Methods used to compile, validate

and analyse these data are summarized in Box 7.1.

e total funding available in the 125 countries in 2013

amounts to US$6.1 billion, and US$3.1 billion excluding

the European Region (Figure 7.3). Approximately US$1.3

billion is available in the African Region, much of which

is accounted for by South Africa. In the other four WHO

regions, funding is in the range US$0.2 to US$0.7 billion.

7.3.1 Funding in 2013 by source of funding

Of the total of US$ 6.1 billion reported for 2013, 87%

(US$ 5.3 billion) is from domestic sources and 13% (US$0.8

billion) is from international donor sources (Figure 7.3,

Figure 7.4). Both fall short of amounts needed for a full

response to the TB epidemic up to 2015 (section 7.1). e

US$5.3 billion from domestic sources represents at most

67% of the total needed by 2015. e US$0.8 billion from

international donor sources is at most 50% of the US$1.6–

2.3 billion per year estimated to be required by 2015, and

remains much less than international donor funding for

malaria (US$ 1.8 billion in 2011)1 and HIV (US$8.2 bil-

lion in 2011).2 Of the international donor funding for

TB in 2013, approximately three-quarters was from the

GLOBAL TUBERCULOSIS REPORT 2013

Global Fund; the remainder was largely from USAID. Tech-

nical assistance to support countries to eectively mobilize

funding from the Global Fund and to implement grants

once approved is provided by the TB Technical Assistance

Mechanism (Box 7.2).

Breakdowns of total funding by source for dierent coun-

try groups are shown in Figure 7.4 and Figure 7.5. Find-

ings strongly reinforce those previously reported for the

decade 2002–2011 (Section 7.2). BRICS are relatively self-

sucient overall (95% of funding from domestic sources),

although India is an exception where only 64% of funding

in 2013 is from domestic sources (and as shown in Annex 1,

BOX 7.1

Methods used to compile, validate and analyse ßnancial data reported by countries to WHO

WHO began monitoring government

CPFKPVGTPCVKQPCNFQPQTßPCPEKPI

for TB in 2002. All data are stored

in the WHO global TB database. The

standard methods used to compile,

review, validate and analyse these

ßPCPEKCNFCVCJCXGDGGPFGUETKDGFKP

detail elsewhere.a,b This box provides a

summary.

Each year, WHO requests data from

low- and middle-income countries

about funding for NTPs by category

of expenditure and source of funding,

and funding gaps by category of

expenditure, in US dollars. Categories

QHGZRGPFKVWTGHQT6$EQORTKUGßTUV

line drugs; NTP staff; programme

management and supervision

activities; laboratory supplies and

equipment; advocacy, communication,

CPFUQEKCNOQDKNK\CVKQPCEVKXKVKGU

community-based care; public–private

mix approaches; collaborative TB/

HIV activities; the Practical Approach

to Lung Health; operational research

including surveys; outpatient visits;

and hospital admissions. Categories of

GZRGPFKVWTGHQT/&46$CTGUGEQPF

NKPGFTWIUQVJGTKVGOUURGEKßECNN[HQT

programmatic management of patients

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outpatient visits. Funding sources are

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NQCPUDQVJENCUUKßGFCUFQOGUVKE

funding), grants from the Global

Fund, and grants from other donors

DQVJENCUUKßGFCUKPVGTPCVKQPCNFQPQT

HWPFKPI%QWPVTKGUVJCVCTGENCUUKßGF

as high-income are asked to report data

on total funding and total expenditures

(without breakdowns by source of

funding and category of expenditure).

WHO uses methods to review and

validate data that have remained

consistent since 2002. These methods

include routine checks for plausibility

and consistency, including validation

checks that are built into the online

reporting system. Examples of validation

checks are checks for implausibly large

year-to-year changes (for example

in total reported funding by source

and by category of expenditure), or

implausibly high or low values relative

to the number of TB patients (for

GZCORNGßTUVNKPGQTUGEQPFNKPGFTWI

budgets or expenditures per patient

that greatly exceed prices quoted by

the Global TB Drug Facility). Methods

to review and validate data also include

discussions with country respondents to

resolve queries, and triangulation with

other data sources such as the detailed

budgets prepared using the WHO TB

planning and budgeting tool,c economic

evaluations that include detailed

cost data, the Global Fund and the

1TICPK\CVKQPHQT'EQPQOKE%QQRGTCVKQP

and Development (OECD) Creditor

4GRQTVKPI5[UVGO2CTVKEWNCTCVVGPVKQP

has always been given to the 22 HBCs.

In a few countries (China and the

4WUUKCP(GFGTCVKQPCTGRTQOKPGPV

examples), funding for TB reported

by NTPs includes funding for all

staff, infrastructure, and other inputs

necessary for hospital admissions and

outpatient visits during TB treatment,

DGECWUGECTGKURTQXKFGFKP6$URGEKßE

hospitals and clinics that have dedicated

budgets. In most countries, however,

the funding used for inpatient and

outpatient care for TB patients is

not captured in funding reported by

NTPs. Since detailed costing studies

of TB diagnosis and treatment in a

wide range of countries show that

JQURKVCNK\CVKQPCPFQWVRCVKGPVECTGCTG

the most important costs not captured

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VJGGUVKOCVKQPQHßPCPEKCNTGUQWTEGU

used for inpatient and outpatient care

of TB patients has always been given

considerable attention in WHO’s work

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For all countries with the exception of

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Federation, the funding used for

inpatient and outpatient care of TB

patients is estimated by multiplying

the number of outpatient visits and

days of inpatient care per patient

(reported by NTPs to WHO each year) by

EQWPVT[URGEKßEGUVKOCVGUQHVJGKTWPKV

cost available from the WHO-CHOICE

database,d and then by the reported

number of TB patients. This is done

UGRCTCVGN[HQTCRCVKGPVUYKVJFTWI

susceptible TB; and b) patients with

/&46$DCUGFQPVJGWVKNK\CVKQPFCVC

that are reported separately for these

two groups of patients on the annual

WHO TB data collection form.

a Floyd K, Pantoja A, Dye C. Financing tuberculosis

EQPVTQNVJGTQNGQHCINQDCNßPCPEKCN

monitoring system. Bulletin of the World *ealth

OrIanization¿

b (NQ[F-(KV\RCVTKEM%2CPVQLC#CPF4CXKINKQPG

/&QOGUVKECPFFQPQTßPCPEKPIHQT

tuberculosis care and control in low-income and

OKFFNGKPEQOGEQWPVTKGUCPCPCN[UKUQHVTGPFU

2002–11, and requirements to meet 2015

targets. The Lancet Global *ealthG¿

c PlanninI and budIetinI for TB control actiXities.

)GPGXC9QTNF*GCNVJ1TICPK\CVKQP

(YYYYJQKPVVDFQVURNCPPKPIADWFIGVKPIAVQQN).

d ChoosinI interXentions that are cost effectiXe

W*O-C*OICE. Geneva, World Health

1TICPK\CVKQPwww.who.int/choice/

EQWPVT[EQWPVT[AURGEKßE).

for the NTP budget specically, 37% is funded from domes-

tic sources in 2013). High-income countries are fully self-

sucient and the group of upper middle-income countries

rely on international donor funding for only a small share

(4%) of their total funding (and most is accounted for by

China). Low- and lower middle-income countries account

for most of the international donor funding (US$0.7 bil-

lion, 88%). In the group of low-income countries, it accounts

for about half of total funding. International donor fund-

ing also has a crucial role in the 17 HBCs excluding BRICS,

and in African countries excluding South Africa (Figure

7.5), where it accounts for 35% and 54% respectively of

 GLOBAL TUBERCULOSIS REPORT 2013

BOX 7.2

Technical Assistance for national TB programmes; the role of TB-TEAM

The TB Technical Assistance Mechanism (TB-TEAM) was

established to coordinate and monitor the provision of technical

assistance to NTPs. The secretariat and a dedicated websitea are

hosted by WHO’s Global TB Programme and funded by USAID.

In mid-2013, there were 34 technical partners actively engaged

in TB-TEAM. Each partner shares information about country

missions, including reports that are uploaded to the country-

URGEKßERCIGUQHVJG6$6'#/YGDUKVG

In 2012, TB-TEAM partners reported 706 missions. By

topic area, laboratory strengthening and the programmatic

OCPCIGOGPVCPFUECNGWRQH/&4CPF:&46$CEEQWPVGFHQT

one quarter of all missions. A further 30% of missions were

related to monitoring and evaluation/impact measurement,

national TB programme reviews and management of drugs and

commodities. Most missions were conducted by WHO (40%)

and KNCV Tuberculosis Foundation (20%). A further 24% were

conducted by the US Centers for Disease Control and Prevention

(CDC); the Union, and the Global TB Drug Facility (GDF).

The main focus of TB-TEAM to date has been provision of

technical assistance to support the implementation of grants

from the Global Fund. Within the context of the fund’s new

funding model (NFM) established in 2013, this is now being

extended to support the development of robust national

strategic plans and associated concept notes that are required

HQTVJGOQDKNK\CVKQPQHPGYßPCPEKCNTGUQWTEGUCUQRRQUGF

to implementation of grants that have already been secured)

from the Global Fund. The focus on support to countries that

CTGEWTTGPVQTRQVGPVKCN)NQDCN(WPFTGEKRKGPVUTGàGEVUVJGHCEV

that the fund is the main source of international donor funding

in many countries, especially in low-income countries and

several high-burden, lower-middle income countries (section

7.2). TB-TEAM partners are taking a proactive approach to

providing technical support to countries, giving particular

attention to grants that are not performing well. The TB-TEAM

UGETGVCTKCVOQPKVQTURTQITGUUKPOQDKNK\CVKQPQHHWPFKPICPF

implementation of grants using indicators such as proposal

success rates, funding for TB as a share of total grant approvals,

disbursement rates and grant performance ratings.

5VCVKUVKEUHQTVJGUGKPFKECVQTUKPECPDGUWOOCTK\GFCU

HQNNQYU

Proposal success rates. TB-TEAM helped 21 countries

VQOQDKNK\GTGUQWTEGUXKCVJG)NQDCN(WPFÂUVTCPUKVKQPCN

funding mechanism (TFM). This was put in place during

the transition to the NFM to prevent countries from

experiencing critical funding shortages that would affect

essential services. Among the three diseases supported

by the fund, TB proposals had the best recommendation

TCVGVJG6GEJPKECN4GXKGY2CPGNQHVJG)NQDCN(WPF

TGEQOOGPFGFVJCVQH6$RTQRQUCNUUJQWNFDGCRRTQXGF

compared with 79% for malaria and 62% for HIV).

TB as a share of total funding.+PVJG6(/75a

million was awarded to TB grants, equivalent to 25% of all

approved funding.

Disbursement rates. In total and across all grants in 101

EQWPVTKGU75aOKNNKQPYCUFKUDWTUGFHQT6$KP

GSWKXCNGPVVQQHVQVCNFKUDWTUGOGPVU75aDKNNKQP

D[VJG)NQDCN(WPF1HVJGTGOCKPKPIHWPFKPI75

DKNNKQPYCUFKUDWTUGFVQ*+8ITCPVU75aDKNNKQP

VQOCNCTKCITCPVUCPF75aOKNNKQPVQETQUU

cutting investments.

Grant performance ratings. At the end of 2012, TB

grants were performing relatively well (Figure B7.1.1),

YKVJKPVJGVQRVJTGGECVGIQTKGUQH#GZEGNNGPV#

(meets expectations) and B1 (adequate), compared with

53% for malaria grants and 79% for HIV grants. The other

categories are B2 (adequate but potential demonstrated)

and C (inadequate).

FIGURE B.7.1.1

Latest Global Fund performance rating by disease

HQTCNNCEVKXGITCPVU)NQDCN(WPF&CVCDCUG

CEEGUUGF,CPWCT[

Percentage (%)

100

Malaria

(110 grants)

HIV/AIDS

(183 grants)

(130 grants)

Grand Total

(423 grants)

In 2013 and 2014, Global Fund projections suggest that an

GUVKOCVGF75aDKNNKQPYKNNDGFKUDWTUGFVQ6$ITCPVU6JKU

equates to an amount per year that is approximately double the

level of 2012. TB-TEAM aims to support countries as effectively

as possible to help to ensure that these funds are disbursed and

used well.

a www.stoptb.org/countries/tbteam/

GLOBAL TUBERCULOSIS REPORT 2013

TABLE 7.2

Reported NTP budget, available funding for NTP budget by intervention area and estimated cost

of inpatient and outpatient care for drug-susceptible (DS-TB) and MDR-TB, 36 high TB or high MDR-TB

burden countries, 2013 (current US$ millions)

4'2146'&

NTP BUDGET

AVAILABLE FUNDING

INPATIENT AND

1762#6+'06%#4'

DS-TBb

INPATIENT AND

1762#6+'06%#4'

/&46$b

DS-TB /&46$ TB/HIV

PPM/PAL/ACSM/

%$%145748';5 16*'4

22 HIGH-BURDEN COUNTRIES

Afghanistan 13 6.0  00.71.32.90

Bangladesh 43 4.6 1.6 0 1.9 0.2 5.0 1.4

$TC\KN  60 6.3 2.3  020 1.4

Cambodia 24 5.3 0.6 0.2 2.2 0.7 6.7 0.2

China 359 267 25 0.2 12 0.5 0 0

&GOQETCVKE4GRWDNKEQHVJG%QPIQ 61  1.7 0.3 1.0 4.5 0.2 0

Ethiopia 145 47 6.0 3.1 12 3.6 11 0.6

India   67 0  2.1  32

Indonesia 119 39  1.3  0.6 39 2.0

Kenya 55 19 0.5 0.5 0.5  90.3

/Q\CODKSWG 11 5.6 1.1 0  05.70.1

Myanmar 36 9.1 3.5 1.6 0.4 0 5.6 1.6

Nigeria 154 17 4.6 1.6 3.6 22 6.2 1.3

Pakistan 73 26 34 0.1 1.5 5.0 11 

Philippines 149 27  0.4 6.9 2.7 109 3.4

4WUUKCP(GFGTCVKQPc1 592 1 332 129 27 0.4 104 0 0

South Africa 475 217 41 124 19 67 109 232

Thailanda44 31 3.9 0.1  03.30

Uganda 31 6.0 2.2 0.2 3.9 9.3 0.6 0

7PKVGF4GRWDNKEQH6CP\CPKC  14 0.5 2.1 0.9 1.3 1.5 0.1

Viet Nam 66 4.4 4.6 1.2 3.4  49 0.6

<KODCDYG  11 0.1 3.4 0.5 1.4 15 0.1

22 high-burden countries total 3 814 2 241 350 170 111 232 494 279

REMAINING HIGH MDR-TB BURDEN COUNTRIES

Armenia 5.4 4.5 0.6 0 0.1 0.2 7.5 1.2

#\GTDCKLCP ––

Belarusa––

Bulgaria 16 14 0.3 0 0.6 0.3 22 1.5

Estonia  0.1 0.5 0 0 0.2 0.1 0.1

Georgia 10 2.6  00 3.6 3.2

-C\CMJUVCP 242 149 70 1.0 1.7 21 192 57

-[TI[\UVCP 35 11 5.6 0.3 13 4.0 13 3.1

Latvia  3.7 1.1 0 0 0.1 20 7.3

Lithuania ––

4GRWDNKEQH/QNFQXCa35 2.6  00.615113.2

Tajikistan 46 5.0 1.1 0.6 1.1  6.6 1.1

Ukraine  21 15 0.6 0 7.9 66 40

7\DGMKUVCP 76 15 14 0 1.5 46  5.7

27 high MDR-TB burden

countries 4 011 2 312 448 164 108 325 854 400

36 high TB or high MDR-TB

burden countries 4 371 2 471 464 172 130 340 919 402

Blank cells indicate data not reported.

– indicates values that cannot be calculated.

a Based on data reported for 2013 in the 2012 round of data collection. In 2013, Thailand was not able to report funding for the sub-national level.

b 0QCOQWPVKUUJQYPHQT%JKPCCPFVJG4WUUKCP(GFGTCVKQPDGECWUG062DWFIGVKPENWFGUCNNEQUVUHQTKPRCVKGPVCPFQWVRCVKGPVECTG

c 6JGUVCHHCPFKPHTCUVTWEVWTGTGSWKTGFHQT6$ECTGCPFEQPVTQNEQWNFPQVDGFKUCIITGCVGFHQT/&46$CPF&56$UGRCTCVGN[CPFCTGUJQYPWPFGT&56$6JGHWNNCOQWPVHQTUVCHH

and other recurrent costs for TB hospitals is included in the column for DS-TB.

 GLOBAL TUBERCULOSIS REPORT 2013

FIGURE 7.6

Available funding for TB care and control in

125 countries reporting 96% of global cases by

intervention area and WHO region, 2013

Other

TB/HIV

Inpatient and

outpatient care:

MDR-TB

Inpatient and

outpatient care:

DS-TB

DS-TBb

US$ billions (current 2013 US$)

0.5

1.0

1.5

2.0

2.5

3.0

EURaAFR WPR SEAR AMR EMR

a (QT'74&56$KPENWFGUCNNQHVJGUVCHHCPFKPHTCUVTWEVWTGTGSWKTGFHQT6$ECTG

CPFEQPVTQNKPVJG4WUUKCP(GFGTCVKQPVJCVEQWNFPQVDGFKUCIITGICVGFHQT/&46$

CPF&56$UGRCTCVGN[6JGCOQWPVQHHWPFKPIUJQYPHQT/&46$KPVJG'WTQRGCP

4GIKQPKUVJWUCPWPFGTGUVKOCVG

b &TWIUWUEGRVKDNG6$&56$KPENWFGUHWPFKPICXCKNCDNGHQTßTUVNKPGFTWIU062

staff, programme management and supervision, and laboratory equipment and

supplies.

FIGURE 7.7

Available funding for TB care and control in BRICS,

17 other HBCs and Africa excluding South Africa,

by intervention area, 2013

Other

TB/HIV

Inpatient and

outpatient care:

MDR-TB

Inpatient and

outpatient care:

DS-TB

DS-TBa

US$ billions (current 2013 US$)

0.5

1.0

1.5

2.0

2.5

3.0

3.5

BRICS Africa without

South Africa

Other HBCs

a (QT$4+%5FTWIUWUEGRVKDNG6$&56$KPENWFGUCNNQHVJGUVCHHCPFKPHTCUVTWEVWTG

TGSWKTGFHQT6$ECTGCPFEQPVTQNKPVJG4WUUKCP(GFGTCVKQPVJCVEQWNFPQVDG

FKUCIITGICVGFHQT/&46$CPF&56$UGRCTCVGN[6JGCOQWPVQHHWPFKPIUJQYPHQT

/&46$KP$4+%5KUVJWUCPWPFGTGUVKOCVG   

total funding in 2013. e share is even higher in specic

countries and above 80% in four HBCs: Afghanistan, the

Democratic Republic of the Congo, Pakistan and Uganda

(Annex 2).

7.3.2 Funding in 2013 by budget category

Funding in 2013 by budget category is shown by WHO

region in Figure 7.6, for other country groups in Figure 7.7

and for HBCs and high-MDR-TB burden countries in Table

7.2. It should be highlighted that the amount of funding

shown for MDR-TB in the European Region is an underesti-

mate due to the fact that the budget category ‘Drug-suscep-

tible-TB’ (DS-TB) includes all of the sta and infrastructure

required for TB prevention, diagnosis and treatment in the

Russian Federation that could not be disaggregated for

MDR-TB and DS-TB separately. Among the 122 low- and

middle-income countries for which a breakdown could be

calculated, most of the funding available in 2013 is for

diagnosis and treatment of DS-TB.

e WHO regions in which the shares of funding

for MDR-TB are highest are the African Region (mostly

explained by South Africa), the European Region and the

South-East Asia Region. is is consistent with the distri-

bution of the burden of MDR-TB cases, which are mostly in

BRICS and the European Region, and with the latest data

on numbers of MDR-TB patients detected and enrolled on

treatment (Chapter 4). ese data show that European

countries and South Africa are enrolling the highest pro-

portion of estimated cases of MDR-TB on treatment and

that progress in scaling up treatment in India (in the South-

East Asia Region) is accelerating. e low share of funding

for MDR-TB in the Western Pacic Region, within which

most of the estimated cases of MDR-TB are in China, is

consistent with the small number of cases reported to have

been detected and started on treatment in China in 2012

(just over 3000, equivalent to 5% of the estimated number

of TB patients with MDR-TB). Among the 22 HBCs, 85% of

the available funding for MDR-TB treatment is accounted

for by BRICS (Table 7.2).

Most of the reported funding for collaborative TB/HIV

activities is accounted for by the African Region (77%),

followed by Europe (16%). is is consistent with the dis-

tribution of the burden of TB/HIV: the latest estimates are

that 75% of HIV-positive TB patients are in the African

Region (Chapter 6).

7.3.3 Reported funding gaps in 2013

In 2013, funding gaps reported by NTPs (i.e. the dierence

between assessments by NTPs of funding needs for TB pre-

vention, diagnosis and treatment and the actual amount of

funds mobilized) amount to US$1 billion. is is a consid-

erable increase from gaps in the range US$0.3–0.6 billion

that were reported during the decade 2002–2011 (section

7.2). A possible explanation may be that NTPs are devel-

oping more ambitious plans for implementation and scale

up of interventions with resulting increases in funding

gaps. African countries account for almost half of the total

(Figure 7.8a), followed by Asian countries (37% of the

total). Funding gaps were reported by countries in all

income groups with the exception of high-income countries

(Figure 7.8b), and for multiple elements of TB prevention,

diagnosis and treatment (Figure 7.8c).

GLOBAL TUBERCULOSIS REPORT 2013

Africa 48%

Asia: Low-income,

high-burden 7%

Asia: Other 30%

Rest of World 15%

FIGURE 7.8

Funding gaps reported by national TB programmes

in 125 countries with 96% of global cases, 2013

a. By region and income group

b. By income group

c. By intervention area

Low-income 36%

Lower-middle-income 44%

Upper-middle-income 20%

DS-TB, first-line

drugs 3%

DS-TB, excluding

first-line drugs 33%

ACSM/CBC/PPM/PAL/OR surveys 25%

MDR-TB 13%

TB/HIV 9%

Other 17%

 GLOBAL TUBERCULOSIS REPORT 2013

%*#26'4

Research and development

KEY FACTS AND MESSAGES

■ Efforts to develop new TB diagnostics, drugs and

XCEEKPGUJCXGKPVGPUKßGFFWTKPIVJGRCUVFGECFGCPF

considerable progress has been made.

■ More than 50 companies are involved in the development

of TB diagnostics. Although many new diagnostic

VGEJPQNQIKGUCTGCXCKNCDNGQPVJGOCTMGVCEEGNGTCVGFßGNF

evaluation of diagnostic accuracy and robustness of these

assays is needed.

■ Increased and sustained investment in new TB

diagnostics remains essential for the development of an

accurate, easy-to-use, affordable point-of-care assay for the

rapid and early diagnosis of TB.

■ There are 10 new or repurposed anti-TB drugs currently

in late phases of clinical development. In December 2012,

one of the new compounds, bedaquiline, was approved for

WUGKPVTGCVOGPVQHRCVKGPVUYKVJ/&46$D[VJG75(QQF

and Drug Administration (FDA). Interim guidance about the

WUGQHDGFCSWKNKPGKPVJGVTGCVOGPVQH/&46$YCUKUUWGF

D[9*1KP,WPG$GFCSWKNKPGKUVJGßTUVPGYFTWI

approved for TB treatment in many years.

■ 4GUWNVUHTQOVYQ2JCUG+++VTKCNUQHHQWTOQPVJTGIKOGPU

for the treatment of drug-susceptible TB are expected in late

2013. New combination regimens are also being tested in

a series of early bactericidal activity (EBA) or two-month

sputum-culture conversion Phase II studies.

■ There are 10 vaccine candidates for TB prevention

in Phase I, Phase II or Phase IIb trials and two

immunotherapeutic vaccines in Phase II or Phase III trials.

■ 4GUWNVUHTQOC2JCUG++DRTQQHQHEQPEGRVUVWF[QHVJG

XCEEKPGECPFKFCVG/8##YGTGRWDNKUJGFKP(GDTWCT[

2013. Among infants who received the vaccine as a boost

to the Bacille-Calmette-Guérin (BCG) vaccine, no additional

protection was conferred compared with BCG alone. This

study demonstrated, however, that the vaccine had an

CEEGRVCDNGUCHGV[RTQßNGKPVJKURQRWNCVKQPCPFVJCVCJKIJ

quality trial of a novel TB vaccine can be conducted and

produce robust results in a high TB burden setting.

■ 4GUGCTEJCPFFGXGNQROGPVKUQPGQHVJGVJTGGRKNNCTUQH

the WHO post-2015 global TB strategy, in recognition of its

crucial role in accelerating reductions in TB incidence and

mortality to reach post-2015 global TB targets.

e proposed goal of the post-2015 global TB strategy is

to end the global TB epidemic (Chapter 1). Despite major

progress in TB care and control since the mid-1990s (Chap-

ters 2–7), reaching this goal will require major technolog-

ical breakthroughs from the research and development

pipeline. Short, eective and well-tolerated treatments for

latent TB infection, a point-of-care diagnostic test able to

distinguish latent TB infection from active TB disease, and

an eective post-exposure vaccine are of key importance to

end the global TB epidemic.

is is the third successive year in which a chapter on

research and development has been included in the Global

tuberculosis report. e status of progress in the develop-

ment of new TB diagnostics, drugs and vaccines as of July

2013 is summarized, drawing on information provided by

the secretariats of the relevant Working Groups of the Stop

TB Partnership and recent publications. Particular atten-

tion is given to developments between August 2012 and

July 2013. e nal section of the chapter highlights key

elements of the research and development agenda post-

2015.

8.1 New diagnostics for TB

Sputum smear microscopy remains the most widely used

diagnostic test for TB, despite its relatively low sensitivity

(especially for those with paucibacillary TB such as people

living with HIV and children). e current reference stan-

dard for the bacteriological conrmation of TB is culture

in liquid media. However, culture-based diagnosis is not

widely available in most high TB burden settings because it

requires sophisticated laboratory and biosafety infrastruc-

ture, and test results take up to several weeks to obtain.

Recent breakthroughs include the development of rapid

molecular tests that can be used to diagnose TB and rifam-

picin-resistant TB at decentralized levels of health systems.

ese tests are now being rolled out worldwide (see also

Chapter 5). However, TB remains unique among the major

infectious diseases in lacking accurate and rapid point-of-

care tests, largely due to insucient progress in biomark-

er discovery despite active ongoing research. Indeed, the

most pressing priority in TB diagnostics research today

is the development of a simple, low-cost, instrument-free

rapid test using one or more reliable biomarkers that can

be implemented at the rst point of patient contact with

peripheral health services, or used as a triage test at com-

munity level to rapidly identify people who should be

referred for conrmatory testing.

e status of development and evaluation of new TB

GLOBAL TUBERCULOSIS REPORT 2013

diagnostics in July 2013 is summarized in Figure 8.1,

based on recent documentation produced by UNITAID1

and the Treatment Action Group (TAG).2 In Figure 8.1,

diagnostic tests and methods on the market are grouped

according to whether they have been evaluated by WHO

and, if so, whether they have been endorsed. Given the

rapidly evolving TB diagnostic landscape, WHO has estab-

lished a systematic process for the timely evaluation of

evidence and formulation of policy on new TB diagnostics.

is is described in Box 8.1 and further details are avail-

able elsewhere. It should also be highlighted that the list of

technologies in ‘early development’ is not necessarily com-

plete or exhaustive.3 ose listed are the ones documented

in the UNITAID and TAG reports.

Development of molecular technologies such as nucle-

ic acid amplication tests (NAATs) is most advanced i.e.

either already commercially available or in late-stage devel-

opment. e majority of tests are, however, intended for

use at reference laboratory level only, requiring dedicated

infrastructure and experienced sta. Most NAATs require

manual preparation of samples, which is technically chal-

lenging and prevents their use at more decentralized labo-

ratory levels. Testing in reference laboratories oers higher

throughput of tests and/or improved screening of samples

for drug resistance markers, but is typically relatively

expensive. e next-generation molecular tests that have

emerged since Xpert® MTB/RIF have not yet undergone rig-

orous eld trials in the settings where their use is intend-

ed, and substantial challenges with sample processing and

DNA extraction in peripheral laboratories has been report-

ed for all of them.

Technologies in the early stages of development (rst

part of Figure 8.1) include tests to detect TB, drug resis-

tance, or TB and drug resistance combined. ese include

microarray-based multiplexing diagnostic platforms for

the simultaneous detection of a large number of resistance-

conferring mutations; assays that use novel approaches to

combine nucleic acid testing with phage-based technology

to identify drug resistance in clinical isolates; a rapid colo-

rimetric culture-based method for detection of resistance

to rifampicin, isoniazid and uoroquinolones for use at

the intermediate laboratory level; second-generation Xpert

assays for the detection of resistance to drugs other than

rifampicin; and a cartridge-based point-of-care isothermal

amplication platform. In addition to technologies aimed

a This is not an exhaustive list of technologies in early development. Those listed are

the ones documented in recent (2013) publications by UNITAID and TAG.

b 7RFCVGFRQNKE[IWKFCPEGQP:RGTV/6$4+(KUWPFGTFGXGNQROGPV5GG%JCRVGT

for further details.

FIGURE 8.1

An overview of progress in the development and

evaluation of TB diagnostics, July 2013

Technologies in early developmenta

Volatile organic compounds

 $TGCVJ.KPM/GPUUCPC4GUGCTEJ75#

 2TQVQV[RGDTGCVJCPCN[\GTFGXKEG0GZV&KOGPUKQPU

Technology, USA

Molecular technologies

 Alere Q, Alere, USA

 $5/#46.CD%QTR75#

 )GPFTKXG/6$4+(+&'RKUVGO7-

 .#6'2%4$TCPFGKU7PKXGTUKV[75#

 )GPG:RGTV:&4ECTVTKFIG%GRJGKF75#

 6TW#TTC[/&46$#MMQPK75#

 INFINITIMTB Assay, AutoGenomics, USA

Culture-based technologies

 BNP Middlebrook, NanoLogix, USA

 /&4:&46$%QNQT6GUV(+0&5YKV\GTNCPF+ORGTKCN

College, UK

 64'-5GPUKVKVTG/;%16$/+%RNCVG6TGM&KCIPQUVKE

5[UVGOU6JGTOQ(KUJGT5EKGPVKßE75#

Other technologies

 6$4CRKF5ETGGP)NQDCN$KQ&KCIPQUVKEU75#

 TBDx, Signature Mapping Medical Sciences, USA

Evaluated by WHO but not yet endorsed

due to insufßcient evidence

Molecular technologies

 TB LAMP, Eiken, Japan

 )GPQV[RG/6$&4UN*CKP.KHGUEKGPEG)GTOCP[

On the market but evidence for use not yet

submitted to WHO for evaluation

Molecular technologies

 iCubate System, iCubate, USA

 TB drug resistance array, Capital Bio, China

 EasyNAT TB Diagnostic kit, Ustar Biotechnologies, China

 Truelab/Truenat MTB, Molbio/bigtec Diagnostics, India

Non-molecular technologies

 Alere Determine TB-LAM, Alere, USA

Evaluated by WHO and not recommended

 Commercial serodiagnostics (all manufacturers)

 Interferon-gamma release assays for the detection of

active TB (all settings)

Technologies endorsed by WHO

Molecular technologies

 :RGTV/6$4+(b

 Line probe assays (acid-fast bacilli smear-positive

sputum specimens or culture-positive specimens)

Microscopy

 <KGJN0GGNUGPCPFàWQTGUEGPEGOKETQUEQR[OGVJQFU

Culture-based technologies

 Commercial liquid culture systems and rapid speciation

 Non-commercial culture and drug susceptibility testing

methods

1 Tuberculosis: Diagnostics Technology and Market Landscape 2013.

Geneva, UNITAID/World Health Organization, 2013. Available

at: http://www.unitaid.eu/images/marketdynamics/publications/

TB-Dx-Landscape_1-Jul-2013.pdf

2 Clayden P. et al (on behalf of e HIV i-Base/Treatment Action

Group) 2013 Pipeline Report: HIV, Hepatitis C Virus (HCV), and

Tuberculosis (TB) Drugs, Diagnostics, Vaccines, Preventive Technolo-

gies, Research Toward a Cure, and Immune-Based and Gene erapies in

Development. New York, Treatment Action Group, 2013. Available

at: http://www.treatmentactiongroup.org/pipeline-report

3 Weyer K et al. Rapid molecular TB diagnosis: evidence, policy-mak-

ing and global implementation of Xpert® MTB/RIF European

Respiratory Journal erj01572-2012; published ahead of print 2012,

doi:10.1183/09031936.00157212.

 GLOBAL TUBERCULOSIS REPORT 2013

at diagnosis of TB and drug-resistant TB, assays for use

in monitoring patients’ response to treatment are needed

as alternatives to culture. Ribosomal RNA (rRNA)-based

amplication assays have potential to be used in this way,

given that rRNA levels per TB bacilli are much higher than

genomic DNA targets and that they are present only in

viable organisms.

Several new diagnostic technologies are on the market,

but evidence to support their use has not been provided

to WHO and thus their performance characteristics have

not been assessed and WHO cannot recommend their use.

As an alternative to real-time polymerase chain reaction

(PCR) assays (e.g. Xpert MTB/RIF) or line-probe assays for

the detection of TB and drug resistance, these technolo-

gies include PCR assays combined with DNA microarrays

(arrays), which allow the detection of a greater number

of resistance conferring alleles and may potentially oer

superior performance for the rapid detection of drug resis-

tance. e technologies include:

iCubate system (iCubate, USA). is is a multiplexed

PCR assay that detects TB, non-tuberculous mycobac-

teria and drug resistance-conferring mutations in a

single reaction. e assay allows multiple targets to be

amplied with array detection technology that simulta-

neously analyses multiple targets. e assay is currently

available for research purposes only.

Capital Bio Corporation (China) has developed a TB drug

resistance detection array kit that can detect 14 of the

most frequently found mutations in three genes asso-

ciated with resistance to rifampicin and isoniazid. e

assay is currently only appropriate for testing at refer-

ence laboratory level given the complexity of performing

the assay.

EasyNAT TB Diagnostic kit, Ustar Biotechnologies,

(China) has developed three isothermal based NAATs

for the detection of TB as well as rifampicin and isoni-

azid resistance-conferring mutations. A clinical trial

conducted in four provinces across central and northern

China showed promising preliminary results for a rapid

and easy-to-use screening tool for the diagnosis of pul-

monary TB.

A micro-PCR system developed by Truelab™ (Molbio,

India) was launched in 2013 in India. e system uses

microchips with TB-specic genetic sequences for the

quantitative detection of TB DNA in sputum samples

in a one hour reaction from sample preparation to nal

reporting of results. Battery powered equipment is used

for the steps of DNA extraction, amplication and detec-

tion. Although promising, only limited evaluation data

are currently available.

Alere Determine LAM, (Alere, USA). is is an assay for

the detection of M. tuberculosis lipoarabinomannan in

urine. e assay seems to be most useful for the diagno-

sis of TB in people living with HIV who have a low CD4

count.

BOX 8.1

Evidence required for WHO review of

new diagnostics

Phase 1: Research and Development

7RUVTGCOTGUGCTEJCPFFGXGNQROGPVVQFGßPGCPF

validate a prototype;

Laboratory validation under international standards that

culminates in a design-locked product;

WHO interacts with developers if requested to discuss

end-user requirements such as biosafety, assay

robustness and intended settings of use.

Phase 2: Evaluation and Demonstration

The performance of the new diagnostic product should

be evaluated in controlled trials at 3–5 trial sites in

high-burden TB and HIV countries;

Product registration with global and/or national

regulatory authorities;

2TQFWEVURGEKßECVKQPUCPFRGTHQTOCPEGUJQWNF

subsequently be validated in uncontrolled trials under

ßGNFEQPFKVKQPUKP¿VTKCNUKVGUKPJKIJDWTFGP6$CPF

HIV countries, and include cost-effectiveness studies.

Phase 3: Evidence Assessment

NEW TECHNOLOGIES

Submission of a dossier with Phase I and Phase II data to

WHO.

FAST-FOLLOWER

/CPWHCEVWTGFWPFGT+51UVCPFCTFU

Equivalent performance demonstrated – Supranational

4GHGTGPEG.CDQTCVQT[EQORCTKUQP

Structured evidence assessment using the Grading

QH4GEQOOGPFCVKQPU#UUGUUOGPV&GXGNQROGPVCPF

'XCNWCVKQP)4#&'CRRTQCEJ

WHO does not recommend technologies for individual

country use.

Phase 4: Phased uptake and collection of evidence

for scale-up

New diagnostic successfully implemented in routine

diagnostic services by early implementers in high-burden

countries;

Systematic assessment of proposed algorithms,

laboratory workload, operational constraints and cost-

effectiveness;

Lessons learnt by early implementers used for country

adaptation.

Phase 5: Scale-up and Policy reßnement

Scale-up of the new diagnostic, with subsequent data

WUGFVQKPHQTOCPFTGßPG9*1RQNKE[IWKFCPEGKPC

dynamic and on-going process.

GLOBAL TUBERCULOSIS REPORT 2013

Two tests are commercially available but have not been

endorsed by WHO after evaluation. e rst is a manual

molecular assay to detect TB DNA in sputum specimens

(TB-LAMP®, Eiken Chemical Co. Ltd., Japan). e evi-

dence-based process followed by WHO concluded that the

data available for the TB-LAMP assay were insucient to

proceed with the development of policy guidance. Addition-

al independent evaluation studies to investigate TB-LAMP

as a replacement test for culture are now underway in 16

countries (17 sites). e second assay evaluated by WHO

but not endorsed is a line probe assay for detecting resis-

tance to second-line anti-TB agents (GenoType® MTBDRsl,

Hain Lifescience, Germany). is cannot be recommended

as a replacement test for conventional phenotypic testing

for drug susceptibility because of suboptimal sensitivity in

detecting resistance to uoroquinolones and second-line

injectable agents. e latter group of drugs also share muta-

tions, which means that even if they are detected by the

line probe assay it is not possible to identify exactly which

drug(s) is linked to the detected mutation(s), and therefore

the test cannot be used to guide the choice of individual

injectable drugs to be used in treatment regimens for MDR-

TB. Conventional phenotypic testing for drug susceptibil-

ity to second-line drugs therefore remains necessary for

all detected strains of MDR-TB and to conrm or exclude

XDR-TB.

Two rapid molecular tests have been evaluated and

endorsed by WHO in recent years (bottom of Figure 8.1).

Line-probe assays that allow the rapid diagnosis of TB

and drug resistance within a day were endorsed in 2008.1

eir use is currently limited to acid-fast bacilli sputum

smear-positive samples or positive cultures. Xpert MTB/

RIF (Cepheid, Sunnyvale, CA, USA) was endorsed by WHO

in 2010 for the rapid diagnosis (i.e. within 2 hours) of pul-

monary TB and rifampicin-resistance in adults.2 In July

2013, the Xpert MTB/RIF assay remained the only fully

automated real-time DNA-based cartridge test that can

detect both TB and resistance to rifampicin, and the only

mature technology representing a new generation of auto-

mated molecular diagnostic platforms.

Since 2010, almost 100 articles on Xpert MTB/RIF have

been published and others are underway.3 In 2013, given

the amount of additional data, WHO commissioned three

systematic reviews of the evidence on sensitivity and

specicity of Xpert MTB/RIF as a test for pulmonary and

extrapulmonary TB, in both adults and children. Findings

were reviewed by an expert group and updated recommen-

dations are anticipated in 2014 (see Chapter 5).

e UNITAID 2013 Report: Tuberculosis: Diagnostic tech-

nology and market landscape4 describes the following four

innovations to the Xpert MTB/RIF technology, which were

made or under development in 2012 and 2013.

Assay improvements. A new prototype assay for MDR-

TB is in development. is uses new dyes and quenchers

that increase the spectral range for detection of targets

using 10 uorophores rather than the six currently used.

Remote calibration. is was made available in late

2012 and is already being used in more than 40 coun-

tries. It allows users to recalibrate the optical system,

verify the functioning of the thermal system and con-

duct a series of system-level tests to ensure full system

functionality within specications. It is anticipated that

over 90% of modules can be successfully calibrated over

the internet.

Enhancements to data management. Real-time

aggregation of geo-positioned test data (from which per-

sonal identiers have been removed) is being evaluated

in South Africa. is oers the potential to substantially

improve monitoring of the TB epidemic and the associ-

ated programmatic response.

HIV cartridges for use with the GeneXpert plat-

form. ese are planned for release in 2014. A separate

cartridge for the qualitative and quantitative detection

of HIV viral load is in development.

With over 50 companies working on TB diagnostics, there

is now considerable industry interest in TB diagnostics.

Nonetheless, a recent survey of more than 25 test devel-

opers identied several critical frequently-asked questions

for which answers are required by industry to invest in TB

diagnostic test development (www.tbfaqs.org). Test devel-

opers are particularly interested in identifying the most

important attributes on which to focus test development

eorts (examples include cost, sensitivity, specicity,

infrastructure requirements, time to result, throughput,

sputum versus other samples, manual versus automated,

point-of-care versus centralized laboratory testing, inte-

grated or reex drug resistance test and which drugs are

critical for DST). In addition, updated market analyses

are urgently needed, given that the TB diagnostics market

landscape has changed signicantly since the last global

assessment of the TB diagnostics market in 2006.5 Updat-

ed market analyses and development of target product

1 Molecular Line Probe Assay for rapid screening of patients at risk

of MDR-TB. Policy Statement. Geneva, World Health Organization,

2008. Available at http://www.who.int/tb/features_archive/policy_

statement.pdf

2 Policy Statement: Automated real-time Nucleic Acid Amplication

Technology for Rapid and Simultaneous Detection of Tuberculosis and

Rifampicin Resistance: Xpert MTB/RIF System. Geneva: World Health

Organization, 2011 (WHO/HTM/TB/2011.4). Available at http://

whqlibdoc.who.int/publications/2011/9789241501545_eng.pdf

3 Weyer K et al. Rapid molecular TB diagnosis: evidence, policy-mak-

ing and global implementation of Xpert® MTB/RIF European

Respiratory Journal erj01572-2012; published ahead of print 2012,

doi:10.1183/09031936.00157212.

4 Tuberculosis: Diagnostics Technology and Market Landscape 2013.

Geneva, UNITAID/World Health Organization, 2013. Available

at: http://www.unitaid.eu/images/marketdynamics/publications/

TB-Dx-Landscape_1-Jul-2013.pdf

5 Diagnostics for tuberculosis. Global Demand and market potential.

Geneva, Special Programme for Research and Training in Tropical

Diseases (TDR) and Foundation for Innovative New Diagnostics

(FIND), 2006. Available at: http://www.who.int/tdr/publications/

documents/tbdi.pdf

90 GLOBAL TUBERCULOSIS REPORT 2013

proles could facilitate greater engagement of test develop-

ers in TB diagnostics.

Despite good progress with the pipeline for new diagnos-

tics, much more eort and investment are needed by both

donors and manufacturers to expedite evaluations of new

technologies in dierent epidemiological settings in order

to determine their diagnostic accuracy and robustness in

the settings of intended use. Substantial additional fund-

ing and innovation for new TB diagnostic development

remain essential to ensure the availability of tests that are

reliable, easy to use, aordable, and accessible to all those

with TB. More than ever, the TB diagnostic pipeline needs

increased and sustained investment.

8.2 New drugs to treat and prevent TB

e anti-TB drugs currently used in rst-line treatments

are around 50 years old. e regimen that is currently rec-

ommended by WHO for new cases of drug-susceptible TB is

h i g h ly e c a c io us , w it h c u re ra te s o f a r ou n d 9 0 % i n H I V- ne g -

ative patients. Nonetheless, it requires six months of treat-

ment with rst-line drugs (a combination of rifampicin,

isoniazid, ethambutol and pyrazinamide for two months,

followed by a four-month continuation phase of rifampicin

and isoniazid). Regimens for treatment of MDR-TB cur-

rently recommended by WHO entail at least 20 months of

treatment with second-line drugs for most patients, and

are associated with multiple (and sometimes serious) side-

eects and lower cure rates (see Chapter 4). ere are also

interactions between anti-TB treatments and antiretro-

viral therapy (ART) for people living with HIV. New drugs

are required to shorten and simplify treatment, to improve

the ecacy and tolerability of treatment for MDR-TB and

to improve the treatment of TB among people living with

HIV.

e status of the pipeline for new anti-TB drugs in July

2013 is shown in Figure 8.2. ere are seven drugs in Phase

II (early bactericidal activity, EBA, and eight-week culture

conversion) trials and four drugs in Phase III (ecacy) tri-

als. In total, there are 10 new or repurposed drugs in Phase

II or Phase III trials; one drug (rifapentine, a rifamycin that

has a longer half-life than rifampicin) is in both Phase II

and Phase III trials, for dierent indications.

8.2.1 Phase III trials

Results from a Phase III trial (the ‘Rifaquin trial’) that eval-

uated the safety and ecacy of two regimens for patients

with drug-susceptible TB, in which moxioxacin was sub-

stituted for isoniazid in the intensive phase of treatment

and rifapentine was used in the continuation phase of

treatment, were presented in March 2013.1 A total of 827

patients with drug-susceptible TB were enrolled in Botswa-

na, South Africa, Zambia and Zimbabwe. Both new reg-

imens were well tolerated. e six-month regimen with a

weekly dose of rifapentine (1200 mg) and moxioxacin in

the continuation phase was not inferior to the currently

recommended regimen. However, the four-month regimen

with twice-weekly doses of rifapentine (900 mg) and moxi-

oxacin in the continuation phase was clearly inferior to

the currently recommended regimen.

Two Phase III trials are evaluating four-month combina-

tion regimens in which a uoroquinolone (gatioxacin in the

case of the OFLOTUB trial and moxioxacin in the case of

the ReMOX trial) is substituted for either ethambutol (in the

FIGURE 8.2

The development pipeline for new TB drugs, July 2013a

Discovery Preclinical development Clinical development

Lead

optimization Preclinical

development

Good

Laboratory

Practice

toxicity

Phase I Phase II Phase III

Cyclopeptides

Diarylquinoline

DprE Inhibitors

InhA Inhibitor

LeuRS Inhibitor

Macrolides

Mycobacterial Gyrase

Inhibitors

Pyrazinamide Analogs

Riminophenazines

Ruthenium (II)

complexes

Spectinamides

Translocase-1

Inhibitors

CPZEN-45

DC-159a

Q203

SQ609

SQ641

TBI-166

#<&

Bedaquiline

(TMC-207)

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2#

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SQ-109

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Delamanid

12%

Gatifloxacin

Moxifloxacin

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Chemical classes: àuoroSuinolone, rifamycin, oxazolidinone, nitroimidazole, diarylSuinoline, benzothiazinone

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www.newtbdrugs.org/pipeline-discovery.

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1 Jindani A et al. 2013. A Multicentre Randomized Clinical Trial to Eval-

uate High-dose Rifapentine with a Quinolone for Treatment of Pulmo-

nary TB: e RIFAQUIN Trial. Oral abstract and paper 147LB. 20th

Conference on Retroviruses and Opportunistic Infections (CROI),

March 3–6 2013, Atlanta.

91GLOBAL TUBERCULOSIS REPORT 2013

OFLOTUB trial) or ethambutol or isoniazid (in the ReMOX

trial). e results from both trials are expected in late 2013.

A new compound, delamanid (OPC-67683), is currently

being tested in a Phase III trial as an adjunct to existing

optimized regimens for treatment of MDR-TB.

8.2.2 Phase II trials – individual compounds

e safety, tolerability and antimicrobial activity of an

increased daily dose of rifapentine (at 10, 15 and 20 mg/

kg) in combination with isoniazid, pyrazinamide and

ethambutol during the rst two months of treatment are

being investigated in a Phase IIb trial (TBTC trial 29X).

Early results were reported in May 2013.1 ese showed

that rifapentine-based regimens were well-tolerated, with

no toxicity events specically related to increasing doses

of the drug. Compared with the currently recommended

six-month regimen, a higher proportion of patients who

received the regimens including rifapentine had convert-

ed to culture-negative status (both in solid and liquid

BOX 8.2

WHO interim guidance on the use of bedaquiline to treat MDR-TB

1 Moro et al. Tolerability and safety of escalating Rifapentine (RPT) dos-

es during the rst two months of tuberculosis (TB) treatment. Abstract

A6051. American oracic Society International Conference, Phila-

delphia, May 17–22, 2013

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worldwide each year (Chapter 2). Current drug regimens

TGEQOOGPFGFD[9*1HQTVTGCVOGPVQH/&46$RTGUGPVOCP[

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daily dosages of drugs that are more toxic, less effective, and

far more expensive than those used to treat drug-susceptible

TB.a)NQDCNN[QPN[CDQWVQHRCVKGPVUYJQUVCTV/&46$

therapy are treated successfully (Chapter 4).

(QTVJGßTUVVKOGKPQXGT[GCTUCPGY6$FTWIYKVJCPQXGN

mechanism of action – bedaquiline – has become available

for use. It was approved by the US FDA in December 2012,

following an accelerated approval process. There is considerable

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information remains limited, since it has only been evaluated

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WHO has issued “interim policy guidance”.b

This interim guidance provides advice on the inclusion of

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with the existing WHO guidelines for the programmatic

management of drug-resistant TB.a The interim guidance lists

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1. Effective treatment and monitoring. Treatment must be

closely monitored for effectiveness and safety, using sound

treatment and management protocols approved by relevant

national authorities.

2. Proper patient inclusion. Special caution is required

when bedaquiline is used in people aged 65 and over, and

in adults living with HIV. Its use among pregnant women

and children is not advised.

3. Informed consent. Patients must be fully aware of the

RQVGPVKCNDGPGßVUCPFTKUMUQHVJGPGYFTWICPFIKXG

documented informed consent before embarking on

treatment.

4. Adherence to WHO recommendations. All principles on

YJKEJ9*1TGEQOOGPFGF/&46$VTGCVOGPVTGIKOGPUCTG

based must be followed. In particular, four effective second-

line drugs must be part of the regimen. In line with the

general principles of TB treatment, bedaquiline should not

be introduced into a regimen in which the companion drugs

are failing to show effectiveness.

5. Active pharmacovigilance and management of

adverse events. Active pharmacovigilance measures

must be in place to ensure early detection and proper

management of adverse drug reactions and potential

interactions with other drugs.

WHO strongly recommends the acceleration of Phase III trials

to generate more comprehensive evidence that can inform

HWVWTGRQNKE[IWKFCPEGQPDGFCSWKNKPG6JGQTICPK\CVKQPYKNN

review, revise or update the interim guidance as additional

KPHQTOCVKQPQPGHßECE[CPFUCHGV[DGEQOGUCXCKNCDNG9*1

is also developing a document that will provide operational

guidance on the implementation of bedaquiline and is working

with partners to help ensure rational introduction of the drug.

a Guidelines for the proIrammatic manaIement of druI-resistant tuberculosis

– 2011 update)GPGXC9QTNF*GCNVJ1TICPK\CVKQP9*1*6/6$

2011.6).

b The use of bedaSuiline in the treatment of multidruI-resistant tuberculosis

interim policy Iuidance9QTNF*GCNVJ1TICPK\CVKQP)GPGXC5YKV\GTNCPF

2013 (WHO/HTM/TB/2013.6).

medium) after eight weeks. Among patients receiving the

regimen with the highest dose of rifapentine, 100% were

culture-negative after eight weeks of treatment (compared

with 16 weeks for those receiving the current standard of

care). e trial investigators concluded that the robust anti-

microbial activity alongside the good tolerability and safety

of the compound at increasing doses justied the assess-

ment of daily high-dose rifapentine in regimens of shorter

than six months duration in a Phase III trial.

Among other drugs tested in Phase II trials, the high-

est-prole in the past year is bedaquiline (TMC-207). e

US Food and Drug Administration (FDA) approved the use

of bedaquiline as an adjunct to existing regimens for the

treatment of MDR-TB in December 2012, under an accel-

erated procedure. Bedaquiline became the rst new TB

drug to be approved for use in 40 years. A Phase III trial,

which will investigate the safety and ecacy of bedaquiline

when used in combination with a short MDR-TB regimen,

is scheduled to start before the end of 2013. Following the

release of trial results and the FDA decision, WHO issued

interim guidance about the use of bedaquiline in the treat-

ment of MDR-TB in June 2013 (Box 8.2).

Five other individual compounds are in the Phase II

92 GLOBAL TUBERCULOSIS REPORT 2013

development phase. ese are linezolid, sutezolid, PA-824,

SQ-109 and AZD-5847.

Linezolid (a member of the oxazolidinone antibiotic

class of drugs) was approved in 2000 for the treatment of

drug-resistant, gram-positive bacterial infections. It has

good anti-mycobacterial activity in vitro and is increasingly

used ‘o-label’ for patients who have highly drug-resistant

TB. However, serious adverse events (such as peripheral

and optic neuropathies, anaemia and thrombocytopenia)

have been reported. Results from a prospective, random-

ized trial in which linezolid was used to treat patients with

XDR-TB who had not responded to other available chemo-

therapeutic options were published in late 2012.1 A total

of 41 patients were randomly assigned to linezolid therapy

(600 mg per day), which was either started immediately or

after two months without any change to the background

regimen. After conrmed sputum-smear conversion or

after four months of treatment (whichever came rst),

patients underwent a second randomization to continue

linezolid therapy at a dose of either 600 mg or 300 mg per

day for at least an additional 18 months, with close moni-

toring of toxicity.

e results showed that at four months, 15 of the 19

patients (79%) in the immediate-start group and 7 of the

20 (35%) in the delayed-start group had converted to cul-

ture-negative status (p = 0.001). Most patients (34 of 39

[87%]) had a negative sputum culture within six months

after linezolid had been added to their drug regimen. Of the

38 patients treated with linezolid, 31 (82%) had clinically

signicant adverse events that were possibly or probably

related to linezolid, including three patients who discontin-

ued therapy. Patients who received 300 mg per day after the

second randomization had fewer adverse events than those

who continued taking 600 mg per day. irteen patients

completed therapy and had not relapsed at the end of fol-

low up. Four cases of acquired resistance to linezolid were

observed. Trial investigators concluded that linezolid was

eective at achieving culture conversion among patients

with chronic XDR pulmonary TB, but warned that patients

must be monitored carefully for adverse events. Study lim-

itations include the small number of patients evaluated,

and that 10% of patients acquired resistance to linezolid.

Further data are needed to balance the long-term risks and

benets of linezolid when used as part of a combination

regimen with other eective anti-TB drugs.

Sutezolid (PNU-100480) is an oxazolidinone and an

analogue of linezolid. It has been tested in an EBA study at

doses of either 600 mg twice a day or 1200 mg once a day.

Results were presented in 2012 and showed that sutezolid

led to a signicant reduction in log colony forming units

(CFU) counts compared with the baseline level following 14

days of treatment, using both dosage options.2 e results

suggested a superior response with the 600 mg twice-daily

dose.

PA-824 is a nitroimidazole compound that is being test-

ed as part of several potential combination regimens (see

below).

SQ-109, originally synthesized as a derivative of etham-

butol, is also being tested as part of a combination regimen

(see below).

AZD-5847 is being tested in a Phase II trial.

8.2.3 Phase II trials – new regimens

Besides individual compounds, new combinations of drugs

are or will soon be tested in various Phase II trials. In the

Global tuberculosis report 2012, the results of the EBA study

of a new combination regimen (NC-001) that included moxi-

oxacin, pyrazinamide and the novel drug PA-824 were

summarized.3 ree trials of various combination regimens

are currently underway. e rst of these is NC-002, which

is building on the NC-001 study to test the same regimen in

a two-month trial. e trial is being implemented in South

Africa and the United Republic of Tanzania. e regimen

is being tested in patients with drug-susceptible TB and in

patients who have drug-resistant TB but not resistance to

the drugs included in the new regimen. e NC-002 trial

is a landmark trial, since it is the rst to simultaneously

investigate treatment of both drug-sensitive and drug-

resistant TB with the same regimen. Results are expected

at the end of 2013.4

e second trial, NC-003, is testing the EBA of various

combinations of clofazimine, bedaquiline, PA-824 and pyr-

azinamide in patients with drug-susceptible TB.5

e MAMS-TB-01 trial, conducted by the PanACEA

consortium, is evaluating new three-month combina-

tion regimens using a new adaptive study design.6 e

drugs included in the combination regimens are isoniazid,

rifampicin, pyrazinamide, ethambutol, moxioxacin and

SQ-109. e end-point of the trial is time to culture conver-

sion in liquid media. e trial started in May 2013.7

8.2.4 New developments in the treatment of latent

TB infection

New drugs are being tested for the treatment of latent TB

infection (LTBI) in people without active TB disease.

Rifapentine has been investigated as part of a combined

regimen (TBTC 26, also called PREVENT-TB), and the rst

results were published in December 2011.8 Enrolment and

1 Lee M et al. Linezolid for Treatment of Chronic Extensively

Drug-Resistant Tuberculosis. New England Journal of Medicine

2012;367:1508-18. DOI: 10.1056/NEJMoa1201964

2 Wallis R et al. Safety, tolerability and early bactericidal activity in spu-

tum of PNU-100480 (sutezolid) in patients with pulmonary tuberculo-

sis (Abstract THLBB02). 19th International AIDS Conference 2012,

July 22–27, Washington DC.

3 Diacon A H et a l. 14-day bactericida l activity of PA- 824, bedaquil ine,

pyrazinamide and moxioxacin combinations: a randomised trial.

e Lancet, 2012

4 See: http://clinicaltrials.gov/show/NCT01498419

5 See: http://clinicaltrials.gov/show/NCT01691534

6 Phillips P et al. Innovative trial designs are practical solutions for

improving the treatment of tuberculosis. Journal of Infectious Dis-

eases. 2012;205 Suppl 2:S250–7.

7 See: http://clinicaltrials.gov/show/NCT01785186

8 Sterling T et al. ree Months of Rifapentine and Isoniazid for

Latent Tuberculosis Infection. New England Journal of Medicine

2011; 365;23: 2155–66.

93GLOBAL TUBERCULOSIS REPORT 2013

follow-up for two groups of particular interest (young chil-

dren 2–11 years of age, and people living with HIV) were

extended and are scheduled to end in September 2013.Pre-

liminary results showed that the once-weekly, three month

regimen of rifapentine and isoniazid (3HP) was generally

well-tolerated and oered ‘substantial advantages’ com-

pared with the current standard of nine months of isoniazid

for treatment of LTBI in children.1Study 33, also called iAd-

here, is a follow-up Phase IV study of TBTC 26, investigating

the eectiveness of the 3HP combination (tested in PRE-

VENT-TB), either given by: (1) DOT, (2) self-administered,

or (3) self-administered with text message reminders by cell

phone.is study is expected to be completed in March 2014.

A second study is an AIDS Clinical Trials Group (ACTG)

trial of daily rifapentine and isoniazid for one month to

treat LTBI in people living with HIV. A third study to eval-

uate the eect of single and repeated administration of

rifapentine (given as a daily or weekly regimen) on steady-

state pharmacokinetic parameters of efavirenz, emtric-

itabine and tenofovir given as a xed dose combination

BOX 8.3

Raising the proßle of treatment for latent TB infection

One third of the world’s population is

estimated to be latently infected with

M. tuberculosis. People with latent TB

infection (LTBI) do not have symptoms

of TB and are not infectious, but they

are at risk of developing active disease

and becoming infectious. Studies show

that 5–20% of those infected will

develop active TB at some point in their

lifetime, with the majority developing

TB disease within 2–5 years of the initial

infection. Several factors increase the

risk of progressing from infection to

CEVKXG6$FKUGCUGKOOWPQUWRRTGUUKQP

(for example, related to HIV infection

or immunosuppressive treatment),

malnutrition, diabetes and alcohol

abuse. Preventing active TB by

addressing these risk factors as well as

proper diagnosis and treatment of LTBI

in selected risk groups is thus important

for the individual and public health.

Modelling has shown that diagnosis

and treatment of LTBI could play a

key role in TB elimination. WHO has

recently published guidelines on TB

contact investigation and on systematic

screening of active TB,a,b both of which

QHHGTCPGPVT[RQKPVVQKFGPVKßECVKQP

of risk groups for LTBI diagnosis and

treatment.

+UQPKC\KFRTGXGPVKXGVJGTCR[

(IPT) is the mainstay of current WHO

recommendations on treatment of

LTBI. Treatment is recommended for

VYQURGEKßERQRWNCVKQPITQWRURGQRNG

living with HIV, and children less than

ßXG[GCTUQNFYJQCTGJQWUGJQNFQT

close contacts of TB patients. A recent

Cochrane review showed that rifampicin-

and rifapentine-containing regimens

among HIV negative people have higher

completion rate and fewer adverse events

compared with those based on IPT only.c

Before initiating LTBI treatment, it

is essential that active TB is effectively

ruled out and the diagnosis of LBTI

reliably established. The tuberculin

skin test (TST) and interferon-gamma

TGNGCUGCUUC[U+)4#CTGFGUKIPGFVQ

detect a cellular immune response to

M. tuberculosis, but do not differentiate

between latent infection and active

disease and, if negative, do not allow

TB infection to be ruled out. Most

importantly, they cannot accurately

predict the risk of infected individuals

developing active TB disease, and their

use in routine practice poses operational

and resource challenges.

There are several unanswered

questions related to the detection

and management of LTBI that require

WTIGPVUEKGPVKßECVVGPVKQPCPF

increased research investments. There

is still limited understanding of the

fundamental biology of latency and

there are no truly adequate animal

models to study it. There is also no

diagnosis and treatment for people

who are latently infected with drug-

resistant strains of M. tuberculosis.

Expediting the discovery of robust

tools to effectively diagnose and treat

LTBI is crucially important for global

TB control. Particular emphasis needs

to be given to development of a better

understanding of the basic pathogenesis

of M. tuberculosisCPFVJGKFGPVKßECVKQP

of biomarkers that will enable reliable

diagnosis and shorter and less toxic

treatment for LTBI.

Following recent developments in the

treatment of LTBI, WHO plans to update

its guidelines on the management of

LTBI. This will entail a review of the

existing evidence with a particular focus

on risk groups that have the highest

likelihood of progression to active TB

disease following infection, and due

EQPUKFGTCVKQPVQTKUMDGPGßVCPCN[UKU

and concomitant risk factors.

a 4GEQOOGPFCVKQPUHQTKPXGUVKICVKPIEQPVCEVU

of persons with infectious tuberculosis

in low- and middle-income countries.

Available at JVVRCRRUYJQKPVKTKU

DKVUVTGCOA

eng.pdf

b Systematic screening for active tuberculosis

– Principles and recommendations. Available

at JVVRCRRUYJQKPVKTKUDKVUVTGCO

AGPIRFH

c 5JCTOC5-GVCN4KHCO[EKPUTKHCORKEKP

TKHCDWVKPCPFTKHCRGPVKPGEQORCTGFVQKUQPKC\KF

for preventing tuberculosis in HIV-negative

people at risk of active TB. Cochrane &atabase

of Systematic 4eXiews+UUWG#TV0Q

%&&1+%&

pub2.

(ATRIPLA™) started patient enrolment in September 2012

and recruitment was completed in August 2013. A fourth

study to compare the safety and eectiveness of a four-week

daily regimen of rifapentine and isoniazid with a standard

nine-month regimen of daily isoniazid among people liv-

ing with HIV started patient enrolment in May 2012 and

is expected to complete enrolment in March 2018. A fth

study to determine the safety and tolerability of a four-

month, once daily rifampicin regimen in children is being

conducted by the Canadian Institutes of Health Research

and McGill University and results are expected in 2016.2

1 Villarino et al. Tolerability among children of three months of

once-weekly rifapentine + INH (3HP) vs. 9 months of daily INH (9H)

for treatment of latent tuberculosis infection: e PREVENT TB Study

(TBTC Study 26/ACTG 5259). IDSA Conference 2012.

2 Clayden P et al, on behalf of the HIV i-Base/Treatment Action

Group. 2013 Pipeline Report: HIV, Hepatitis C Virus (HCV), and Tuber-

culosis (TB) Drugs, Diagnostics, Vaccines, Preventive Technologies,

Research Toward a Cure, and Immune-Based and Gene erapies in

Development. Available at: http://www.treatmentactiongroup.org/

pipeline-report

94 GLOBAL TUBERCULOSIS REPORT 2013

8.3 New vaccines to prevent TB

e slow decline in TB incidence globally and the growing

problem of MDR-TB highlight the critical need for new

eective TB vaccines. e BCG vaccine for the prevention

of TB is almost 100 years old, and while the vaccine pro-

tects against severe forms of TB in children (TB meningitis

and miliary TB), its ecacy in preventing pulmonary TB

in adults is highly variable. BCG is also not recommended

for use in infants known to be infected with HIV, due to

the risk of disseminated BCG disease. e development of

techniques for genetic manipulation of mycobacteria, com-

pletion of the genome sequence of M. tuberculosis in the

1990s, and recent advances in immunology provide historic

opportunities for developing a new generation of TB vac-

cines that can achieve dramatically higher levels of impact.

For the past decade, two major strategies have been used

to develop new vaccines for prevention of TB.1 One strategy

has been to develop vaccines that would have a higher e-

cacy than BCG and replace it – such as an improved version

of BCG or a new attenuated live M. tuberculosis vaccine. e

second strategy has been a ‘prime-boost’ strategy in which

BCG continues to be given to neonates (as is done current-

ly, since it prevents TB in infants and children), and a new

vaccine is given as a ‘booster’ dose to increase the ecacy

and extend the duration of protection. Modelling of the

potential public health impact of new TB vaccines in the

WHO South-East Asia Region suggested that a TB vaccine

for infants with 60% ecacy would contribute to a signif-

icant decline in TB incidence by 2050.2 Furthermore, this

modelling also indicated that if a preventive TB vaccine of

similar ecacy among adolescents and adults was deliv-

ered as part of a mass vaccination strategy, the impact on

the TB epidemic would be much larger. More recent mod-

elling of the public health impact of a new vaccine at global

level3 has reinforced this nding, indicating that an adoles-

cent and adult vaccine with 60% ecacy could potentially

avert 30‒50 million new TB cases over a 25 year period.

e much greater potential impact of an adult/adolescent

vaccine has shifted the focus of TB vaccine development

towards a new paradigm that emphasizes the development

of a diverse pipeline of new TB vaccine candidates that tar-

get the prevention of TB in this older population. Scientic

advances have also enabled the pursuit of more sophisticat-

ed approaches to vaccine design, and the global pipeline of

TB vaccine candidates in clinical trials is more robust than

at any previous period in history, now including recombi-

nant BCGs, attenuated M. tuberculosis strains, recombinant

viral-vectored platforms, protein/adjuvants combinations,

and mycobacterial extracts.

e status of the pipeline for new vaccines in July 2013

is shown in Figure 8.3. ere are 12 vaccine candidates in

clinical trials. Most are designed for prevention of TB, either

to prevent infection (pre-exposure) or to prevent primary

progression to disease or reactivation of latent TB (post-

exposure). Two are BCG replacement vaccines and two are

proposed as immunotherapeutic agents, to improve respon-

siveness to chemotherapy or prevent relapse or re-infection.

Two vaccines are in Phase IIb studies.

MVA85A is an attenuated vaccinia-vectored vaccine

candidate expressing Ag85A of M. tuberculosis. It was

designed as a booster vaccine for BCG vaccinated infants

and the rst Phase IIb trial of this vaccine was conducted

in South Africa from 2009 to 2012 with results published

in early 2013 (Box 8.4).4 An additional Phase IIb trial of

MVA85A is currently being conducted in adults living with

HIV in Senegal and South Africa; the trial has been recently

re-designed as a safety trial in which up to 650 participants

will be enrolled.

M72+AS01E is a protein subunit vaccine, formulated

in a novel adjuvant to enhance immunogenicity. It con-

tains a fusion protein of the M. tuberculosis antigens 32A

and 39A in the adjuvant AS01E. Safety and immunogenic-

ity are being tested in three dierent populations: infants

in e Gambia, people living with HIV in India and adults

with TB disease in China (Province of Taiwan) and Esto-

nia. e Phase IIb study will be the largest trial of a novel

TB vaccine in adults, aiming to enrol 4500 HIV-negative

adults in TB-endemic countries in Africa. e primary end-

point will be the protective ecacy of two doses of M72+

AS01E against pulmonary TB disease. Secondary endpoints

include safety and immunogenicity.

ere are six additional vaccines in Phase II trials.

AERAS-402/Crucell Ad35 is an adenovirus-vectored

vaccine candidate expressing three M. tuberculosis antigens:

Ag85A, Ag85B and TB10.4. It is designed as a booster vac-

cine for infants, adolescents and adults. Although started

as a Phase IIb proof-of-concept trial, based on preliminary

data the trial is now being revised to be a smaller Phase

II trial with safety and immunogenicity as primary end-

points. Of note, AERAS-402/Crucell Ad35 and MVA85A

are also being tested in combination, to try to drive a bal-

anced CD4+/CD8+ immune response. One or two doses of

AERAS-402/Crucell Ad35 followed by a dose of MVA85A

are being evaluated in a combined Phase I/Phase II trial

in adults in the United Kingdom for safety and immuno-

genicity.

ree vaccines are protein subunit adjuvanted vac-

cines, initially developed by the Statens Serum Institute in

Copenhagen, Denmark. Hybrid 1 + IC31 contains Ag85B

and ESAT-6 in an adjuvant, IC31. Hybrid 56 + IC31 con-

tains antigens 85B and ESAT6 as well as AgRv2660, which

is expressed during latency. Hybrid 4 + IC31, now being

developed with Sano Pasteur, is a fusion protein candi-

1 Evans TG, Brennan MJ, Barker L and ole J. Preventive vaccines

for tuberculosis. Vaccine. 31S (2013) B223– B226.

2 Abu-Raddad LJ, et al. Epidemiological benets of more-eective

tuberculosis vaccines, drugs, and diagnostics. Proceedings of the

National Academy of Science. 2009. 106:33; 13980–13985.

3 A model of the global public health impact of new TB vaccines was

commissioned by Aeras and developed by Applied Strategies. For-

mal publication of the model and associated results is pending.

4 Tameris MD, et al. Safety and ecacy of MVA85A, a new tuber-

culosis vaccine, in infants previously vaccinated with BCG: a

randomised, placebo-controlled phase 2b trial. e Lancet. 2013.

381:9871; 1021–1028.

95GLOBAL TUBERCULOSIS REPORT 2013

date that expresses Ag85B and TB10.4; the latter antigen is

from the same gene family as ESAT-6. All three vaccines are

being studied in Phase IIa clinical trials in Africa.

VPM 1002 is a live recombinant vaccine, derived from

the Prague strain of BCG into which the listerolysin gene

from Listeria monocytogenes has been cloned and the urease

gene deleted to improve immunogenicity. A Phase IIa trial

of this vaccine has recently been completed in South Africa.

A second Phase II trial will assess the safety and immunoge-

nicity of the vaccine in HIV exposed/unexposed newborns.

RUTI is a non-live vaccine based on fragmented M. tuber-

culosis bacteria. It is in a Phase IIa trial in Spain and is being

developed as an immunotherapeutic vaccine.

In addition to the vaccine candidates described above,

AnHui Longcom, a Chinese pharmaceutical company, is

studying Mycobacterium vaccae, a non-living preparation

from the non-pathogenic bacterium, as an adjunct to stan-

dard antimicrobial therapy. Phase III ecacy studies are

reportedly underway.

ere are three vaccine candidates in Phase I clinical

trials. ese include the rst live attenuated M. tuberculosis

vaccine, MTBVAC, as well as a new fusion protein vaccine,

ID93, formulated with a novel adjuvant GLA-SE.

MTBVAC is being developed by the University of Zara-

gosa, Institut Pasteur, BIOFABRI and the Tuberculosis

Vaccine Initiative (TBVI). It is a live M. tuberculosis strain

attenuated via deletions of the phoP and fadD26 genes. It

is the rst live attenuated M. tuberculosis vaccine to enter a

Phase I clinical trial.

ID93+GLA-SE is a recombinant fusion protein formu-

lated in the novel adjuvant, GLA-SE. It is being developed

by the Infectious Disease Research Institute (IDRI) in col-

laboration with Aeras. It expresses three M. tuberculosis

virulence antigens (Rv2608, Rv3619 and Rv3620) and one

M. tuberculosis latency antigen (Rv1813). It is beginning a

Phase 1b trial in adults in South Africa to assess safety and

immunogenicity in this population.

Ad5 Ag85A is an adenovirus serotype 5 vector express-

ing Ag85A. It has been developed by McMaster University

with support from CanSino, a Chinese biotechnology com-

pany based in Tianjin. e vaccine was recently evaluated in

a Phase I trial that demonstrated no vaccine-related serious

adverse events and showed greater immunogenicity in the

study group primed with BCG.

Research on new TB vaccines is now at a crucial juncture.

Despite the diversity that already exists in the global portfo-

lio of TB vaccine candidates in clinical trials, there is grow-

ing recognition among scientists and researchers in the eld

that there is still too much similarity in the immunological

strategies being pursued.1 In the absence of known immune

correlates for either protective immunity against TB or con-

trol of infection, the portfolio must be further diversied so

that candidates explore a dierent and novel immunological

‘space’. ere is already a robust pipeline of candidates being

evaluated pre-clinically – including nucleic acid-based (DNA

and RNA) vaccines – and these pursuits may help to broaden

the diversity of the clinical portfolio and ll the scientic

gaps that currently exist. To rationalize and streamline the

advancement of TB vaccine candidates, consensus has been

Phase I Phase II Phase III

Phase IIb

VPM 1002

Max Planck, VPM, TBVI,

Serum Institute

P B

H1+IC31

SSI, TBVI, EDCTP,

Intercell

P B PI

476+

Archivel Farma, S.L.

B PI it

*#'4#5+%

SSI, Aeras, Intercell

P B PI

*#'4#5+%

SSI, Sanofi Pasteur,

Aeras, Intercell

%TWEGNN#F#'4#5

Crucell, Aeras

P Prime B Boost PI Post-infection it Immunotherapy

#F#I#

McMaster, CanSino

P B PI

MTBVAC

TBVI, Zaragoza, Biofabri

ID93+GLA-SE

Infectious Disease

Research Institute (IDRI),

Aeras

%TWEGNN#F/8##

Crucell, Oxford, Aeras

P B

/8###'4#5

Oxford, Aeras, EDCTP

B PI it

M72+AS01

GSK, Aeras

B PI

M. Vaccae

Anhui Longcom

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-KNNGF9%QT'ZVTCEV/Y476+

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FIGURE 8.3

The development pipeline for new TB vaccines, July 2013

1 Evans TG et al. Preventive vaccines for tuberculosis. Vaccine 31S

(2013) B223– B226.

96 GLOBAL TUBERCULOSIS REPORT 2013

developed among key stakeholders on ‘stage-gating’ crite-

ria for new TB vaccines, and increased emphasis is being

placed on global coordination among key stakeholders to

advance a common research agenda.

To supplement these existing eorts, a re-prioritized

focus on early stage research is also underway. In accor-

dance with this shift in emphasis, more energy and resourc-

es will be directed towards the pursuit of novel designs, to

studies focused on immunological mechanisms and bio-

markers, and to a diversication of scientic approaches

and strategies to ensure that a more diverse pipeline of new

TB vaccine candidates moves forward into clinical trials.1

8.4 The post-2015 global TB strategy: the

critical role of research and development

Fundamental science is necessary to drive innovations in

new tools for improved TB care and control. Fundamental

research is required to better characterize M. tuberculosis

and to improve understanding of the interaction between

the bacillus and the human host, as a basis for maintain-

ing the ow of new technologies into the product pipeline.

Researchers are making great strides in redening the

1 Brennan MJ and ole J (editors). Tuberculosis vaccines: A stra-

tegic blueprint for the next decade. Tuberculosis. 2012. 92: Supple-

ment 1; S6–S13.

BOX 8.4

The MVA85A trial in South Africa

/8##KUCRQZXKTWUÄ/QFKßGF

Vaccinia Ankara”, MVA)-vectored vaccine

that expresses the immune-dominant

M. tuberculosisCPVKIGP#+VYCU

originally developed at the University

of Oxford. An infant Phase IIb proof-

of-concept trial was recently completed

in South Africa.a The study population

consisted of 2794 BCG-vaccinated,

HIV-negative infants aged 4–6 months,

with both study arms almost equally

UK\GFKPHCPVUTGEGKXGFQPGFQUG

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control arm received a placebo (Candin,

a C. albicans-derived skin test antigen).

Follow up lasted 37 months. The primary

objective of the study was to assess the

UCHGV[QH/8##KPVJGUGKPHCPVU6JG

secondary objectives were to evaluate

VJGGHßECE[QHVJGXCEEKPGCICKPUV

(a) the disease and (b) M. tuberculosis

infection, as measured by Quantiferon

conversion (this distinction is important

as infection only leads to active TB

disease in a small minority of immune-

competent individuals). Additional

objectives included the evaluation of

immunogenicity.

Conclusions drawn from the

results of the Phase IIb trial

6JKUYCUVJGßTUVENKPKECNVTKCNVQGXCNWCVG

VJGGHßECE[QHCPGY6$XCEEKPG

candidate for prevention of clinical

TB or M. tuberculosis infection, and

results were therefore of considerable

interest to the vaccine research and

public health communities. In this trial,

/8##CRRGCTGFVQDGUCHGCPFYGNN

VQNGTCVGFEQPßTOKPIUKOKNCTßPFKPIU

from previous Phase I and Phase IIa

clinical trials using this vaccine. None

of the observed serious adverse events

(or deaths) observed in the study arm

were assessed by the investigators to

be related to the vaccine, and only one

serious adverse event involving a brief

JQURKVCNK\CVKQPQEEWTTGFKPVJGRNCEGDQ

ITQWR6JGRTKOCT[GHßECE[CPCN[UKUYCU

based on the number of TB cases among

the vaccinated versus control subjects.

In the vaccine arm, there were 32 cases,

while in the placebo arm there were

39 cases. Based on this, the calculated

XCEEKPGGHßECE[YCU%+

VQHQTVJGRTKOCT[

6$ECUGFGßPKVKQPYJKEJYCUPQV

UVCVKUVKECNN[UKIPKßECPV/QTGQXGTVJGTG

was no evidence of protection against

M. tuberculosisKPHGEVKQPWUKPIVJG

Quantiferon-TB Gold assay as the read-

out. A total of 349 out of 2792 infants

DGECOGKPHGEVGFKPVJGXCEEKPGCTO

and 171 in the placebo arm), giving a

ECNEWNCVGFXCEEKPGGHßECE[QH¿

%+VQYJKEJYCU

CNUQPQVUVCVKUVKECNN[UKIPKßECPV

Implications for future studies

of this and other TB vaccine

candidates

Phase IIb proof–of-concept trials are

designed to allow ‘triage’ of vaccine

candidates and target populations, to

decrease risks before embarking on

hugely complex and resource consuming

Phase III trials. Current regulations

require a Phase IIb proof–of-concept

trial to be corroborated in larger

Phase III trials before a vaccine can be

licensed.

This study demonstrated that the

XCEEKPGJCFCPCEEGRVCDNGUCHGV[RTQßNG

in infants, and that a high quality trial

of a novel TB vaccine can be conducted

and produce robust results in a high

TB burden setting. The vaccine was

given months after all the infants had

received BCG vaccine, and it is possible

that BCG may have provided a plateau

level of protection, with very little, if any

CFFKVKQPCNRTQVGEVKQPCFFGFD[/8##

4CVGUQH6$KP5QWVJ#HTKECCPFVJG

Western Cape province in particular)

are exceptionally high in all age groups,

including young children, and this high

HQTEGQHKPHGEVKQPOC[DGFKHßEWNVVQ

address with any vaccine. It cannot be

assumed that similar results would have

been obtained in other populations. It

is also possible that adults, adolescents

and older children could be a better

VCTIGVRQRWNCVKQPHQTVJKUXCEEKPG

there is some evidence that it induces

a stronger immune response in older

age groups than in infants. Adults and

adolescents are the primary source

of transmission as they more likely to

develop the most infectious forms of the

disease and account for the largest share

of the burden of TB disease worldwide.

The vaccine is currently being evaluated

in HIV-infected adults in Senegal and

South Africa, using a two-dose regimen.

For all these reasons, the results of

the trial should not be considered as

RTQXKFKPICP[FGßPKVKXGCPUYGTVQVJG

question of whether a new TB vaccine

can provide better protection than BCG

alone. Further studies of this and other

vaccines are urgently needed. Several

of the other TB vaccine candidates in

VJGENKPKECNRKRGNKPGFKHHGTHTQO/8##

both in their antigenic composition and

in the way these antigens are delivered.

a 6COGTKU/&GVCN5CHGV[CPFGHßECE[QH

/8##CPGYVWDGTEWNQUKUXCEEKPGKPKPHCPVU

RTGXKQWUN[XCEEKPCVGFYKVJ$%)CTCPFQOK\GF

placebo-controlled phase 2b trial. The Lancet.

¿

97GLOBAL TUBERCULOSIS REPORT 2013

spectrum of TB disease and the transition from latent to

active TB, and developing a better understanding of the

behaviour of M. tuberculosis within the host. is progress

is expected to deliver better knowledge about pathogenesis

and identication of biomarkers and bio-signatures rele-

vant to new TB diagnostics. It is also expected to point to

new targets for anti-TB drugs as well as early indicators of

protective immunity, vaccine ecacy and early response to

treatment. Such developments will facilitate the selection

and testing of new interventions.

To highlight the crucial role of research in ending the

global TB epidemic, the WHO post-2015 global TB strategy

that is currently under development includes “Intensied

Research and Innovation” as one of three strategic pillars

(Chapter 1). e strategy is being developed as a successor

to the Stop TB Strategy, which covers the period 2006–2015.

In wide consultations held during 2012 and 2013, there has

been strong support for this pillar and its two main sub-

components, which are:

1. Discovery, development and rapid uptake of new tools,

interventions and strategies;

2. Research to optimize implementation and impact.

e research pillar will be essential to the success of the two

other pillars of the post-2015 global TB strategy and the

achievement of post-2015 global TB targets.

Biomedical research will need to be integrated as a crit-

ical component of the new post-2015 research strategy.

Creating connections among scientic disciplines that have

historically been inadequate or lacking (for example, bio-

medical research, epidemiology and operational research)

will depend upon close collaboration, consultation and

input from many research and public health stakeholders.

e need for more and expanded operational research

to optimize implementation and adopt innovations will

require extensive work at the country level, for example to

generate essential data on the epidemiology of TB (‘Know

your epidemic’) and universal health coverage, and to allow

adaptation of global recommendations and policies at the

national level.

#00':

Methods used to

estimate the global

burden of disease

caused by TB

101GLOBAL TUBERCULOSIS REPORT 2013

is annex explains the methods that were used to pro-

duce estimates of the global burden of disease caused by TB

(measured in terms of incidence, prevalence and mortality).

It has nine major sections:

General approach. is section provides some back-

ground information about the methods used to produce

estimates of disease burden.

Denitions. is section denes TB incidence, prev-

alence and mortality, the case fatality rate (CFR) and

the case notication rate. It also explains the regions

for which estimates of disease burden are produced and

sources of information on population estimates.

Estimates of TB mortality, 1990–2012. is section

explains the three methods used to estimate TB mor-

tality, and the countries for which they were applied.

Methods for estimating the number of HIV-associated

TB deaths and for disaggregation of TB mortality by age

and sex are also described.

Estimates of TB incidence, 1990–2012. is section

explains the main methods used to estimate TB inci-

dence, and the countries for which they were applied.

Methods to estimate the prevalence of HIV among inci-

dent TB cases are described.

Estimates of TB prevalence, 1990–2012. is sec-

tion explains the two methods used to estimate TB prev-

alence, and the countries for which they were applied.

Estimates of multidrug-resistant TB (MDR-TB)

incidence and mortality. is section explains the

main methods used to estimate MDR-TB mortality and

incidence based on drug resistance surveillance data and

parameters obtained from a recent literature review.

Projections of TB incidence, prevalence and mor-

tality. is section explains how projections from 2013

to 2015 were produced.

Uncertainty framework. is section explains the

general approach to including uncertainty in all esti-

mates.

1. General approach

Estimates of the burden of disease caused by TB (mea-

sured in terms of incidence, prevalence and mortality) are

produced annually by WHO using information gathered

through surveillance systems (case notications and death

registrations), special studies (including surveys of the

prevalence of disease, mortality surveys and in-depth anal-

yses of surveillance data), expert opinion and consultations

with countries. Two recent publications provide up-to-date

guidance about how TB incidence, prevalence and mortality

should be measured,1 based on the work of the WHO Global

Task Force on TB Impact Measurement.2 e methods used

to estimate the burden of disease were updated in 2009 fol-

lowing 18 months of work by an expert group convened by

the Task Force. ese updates were endorsed at a meeting of

the full Task Force in March 2010. Improvements to meth-

ods included systematic documentation of expert opinion

and how this has been used to produce estimates of disease

burden, simplication of models,3 updates to parameter

values based on the results of systematic reviews, much

greater use of mortality data from vital registration (VR)

systems and systematic documentation of uncertainty

(hence the uncertainty intervals shown on all of the esti-

mates of disease burden in this report).

2. Deßnitions

2.1 Incidence, prevalence, mortality, case fatality

 TCVGECUGPQVKßECVKQPTCVG

Incidence is dened as the number of new and recurrent

(relapse) episodes of TB (all forms) occurring in a given

year. Recurrent episodes are dened as a new episode of TB

in people who have had TB in the past and for whom there

was bacteriological conrmation of cure and/or documen-

tation that treatment was completed (Box 3.1, Chapter 3).

In the remainder of this Annex, relapse cases are referred

to as recurrent cases because the term is more useful when

explaining the estimation of TB incidence. Recurrent cas-

es may be true relapses or a new episode of TB caused by

reinfection. In current case denitions, both relapse cases

and patients who require a change in treatment are called

‘retreatment cases’. However, people with a continuing epi-

sode of TB that requires a treatment change are prevalent

cases, not incident cases.

Prevalence is dened as the number of TB cases (all forms)

at a given point in time.

Mortality from TB is dened as the number of deaths

caused by TB in HIV-negative people, according to the

latest revision of the International classication of diseases

(ICD-10). TB deaths among HIV-positive people are classi-

ed as HIV deaths in ICD-10. For this reason, estimates of

deaths from TB in HIV-positive people are presented sepa-

rately from those in HIV-negative people.

e case fatality rate is the risk of death from TB among

people with active TB disease.4

e case notication rate refers to new and recurrent

episodes of TB notied to WHO for a given year, expressed

per 100000 population. e case notication rate for new

and recurrent TB is important in the estimation of TB inci-

dence. In some countries, however, information on treat-

ment history may be missing for some cases. When data

on treatment history are not available, recurrent cases

cannot be distinguished from cases whose treatment was

1 TB impact measurement: policy and recommendations for how to assess

the epidemiological burden of TB and the impact of TB control. Gene-

va, World Health Organization, 2009 (Stop TB policy paper, no.

2; WHO/HTM/TB/2009.416). e policy paper is available on the

Task Force web site: www.who.int/tb/advisory_bodies/impact_

measurement_taskforce

2 For further details, see the Task Force web site at: www.who.int/tb/

advisory_bodies/impact_measurement_taskforce

3 For example, some parameter values are now estimated only at glob-

al level or for regions, rather than for each country individually.

4 Straetemans M et al. Assessing tuberculosis case fatality ratio: a

meta-analysis. PLoS One. 2011, 6(6):e20755.

102 GLOBAL TUBERCULOSIS REPORT 2013

changed, since both are registered and reported in the cat-

egory ‘retreatment’. Patients reported in the ‘unknown his-

tory’ category are considered incident TB episodes (new or

relapse). is is a change from previous years in view of past

diculties to estimate with NTPs the proportion of true

new or relapse TB episodes in this category of patients (pre-

viously, patients with unknown treatment history were not

considered new or relapse cases). is change aects rela-

tively few countries, mostly in Western Europe.

2.2 Regions

Regional analyses are generally undertaken for the six

WHO regions (that is, the African Region, the Region of the

Americas, the Eastern Mediterranean Region, the Euro-

pean Region, the South-East Asia Region and the Western

Pacic Region). For analyses related to MDR-TB and for an

ecological model used to estimate TB mortality in some

countries, nine epidemiological regions were dened. ese

were African countries with high HIV prevalence, African

countries with low HIV prevalence, Central Europe, East-

ern Europe, high-income countries,1 Latin America, the

Eastern Mediterranean Region (excluding high-income

countries), the South-East Asia Region (excluding high-

income countries) and the Western Pacic Region (exclud-

ing high-income countries). e countries in these nine

regions are listed in Appendix 1.

2.3 Population estimates

e source of population estimates needed to calculate var-

ious TB indicators was the 2012 revision of the World Pop-

ulation Prospects, which is produced by the United Nations

Population Division (UNPD).2 e UNPD estimates some-

times dier from those made by countries.

3. Estimates of TB mortality, 1990–2012

e best sources of data about deaths from TB (excluding

TB deaths among HIV-positive people) are VR systems

in which causes of death are coded according to ICD-10

(although the older ICD-9 and ICD-8 classication are still

in use in several countries). Deaths from TB in HIV-positive

people are coded under HIV-associated codes.

ree methods were used to estimate TB mortality

among HIV-negative people:

direct measurements of mortality from VR systems or

mortality surveys;

indirect estimates based on an ecological model that

uses data from VR systems;

indirect estimates derived from multiplying estimates

of TB incidence by estimates of the CFR.

Each method is described in more detail below. Details

on the method used for each country are available online

at www.who.int/tb/publications/global_report/gtbr13_

mortality_source.csv.

3.1 Estimating TB mortality among HIV-negative

people from vital registration data and

mortality surveys

Data from VR systems are reported to WHO by Member

States and territories every year. In countries with func-

tioning VR systems in which causes of death are coded

according to the two latest revisions of the International

classication of diseases (underlying cause of death: ICD-10

A15-A19, equivalent to ICD-9: 010-018), VR data are the

best source of information about deaths from TB among

people not infected with HIV. When people with AIDS

die from TB, HIV is registered as the underlying cause of

death and TB is recorded as a contributory cause. Since one

third of countries with VR systems report to WHO only the

underlying causes of death and not contributory causes, VR

data usually cannot be used to estimate the number of TB

deaths in HIV-positive people.

TB mortality data obtained from VR systems are essen-

tial to understanding trends in TB disease burden where

case notications have incomplete coverage or their cov-

erage is not documented through an inventory study. An

updated description of the global coverage and quality of

VR data is available in World Health Statistics 2013.3

As of May 2013, 125 countries had reported mortality

data to WHO (including data from sample VR systems and

mortality surveys), among 217 countries and territories

from which TB data were requested. ese 125 countries

included 9 of the 22 high TB burden countries (HBCs): Bra-

zil, China, India, the Philippines, the Russian Federation,

South Africa, ailand, Viet Nam and Zimbabwe. However,

the VR data on TB deaths from South Africa and Zimbabwe

were not used for this report because large numbers of HIV

deaths were miscoded as TB deaths. Improved empirical

adjustment procedures have recently been published,4 and

options for specic post-hoc adjustments for misclassi-

cation errors in the measurement of TB mortality will be

reviewed extensively by the WHO Global Task Force on TB

Impact Measurement in 2014.

Among the countries for which VR data could be used

(see Figure 2.11 in Chapter 2), there were 2087 coun-

try-year data points 1990–2012. Of these data points, 24

outliers and points obtained from systems with very low

coverage were excluded for analytical purposes. Outliers

were detected visually by plotting country-specic time

series of reported TB mortality rates. As of June 2013, 62

data points were available for 2010, 35 for 2011 and none

for 2012. On average, 16 data points were retained for anal-

ysis per country (standard deviation (SD) of 6.7) from a

total of 2063 usable data points.

1 High-income countries are dened by the World Bank as countries

with a per capita gross national income (GNI) of ≥US$12 616 in

2012.

2 http://esa.un.org/unpd/wpp/ (accessed June 2013).

3 www.who.int/gho/publications/world_health_statistics/2013/en/

(accessed July 2013) (see particularly pages 15–16).

4 Birnbaum JK, Murray CJL, Lozano R. Exposing misclassied HIV/

AIDS deaths in South Africa. Bulletin of the World Health Organiza-

tion, 2011, 89:278–285.

103GLOBAL TUBERCULOSIS REPORT 2013

Reports of TB mortality were adjusted upwards to

account for incomplete coverage (estimated deaths with no

cause documented) and ill-dened causes of death (ICD-9

code B46, ICD-10 codes R00–R99).1

It was assumed that the proportion of TB deaths among

deaths not recorded by the VR system was the same as the

proportion of TB deaths in VR-recorded deaths. For VR-

recorded deaths with ill-dened causes, it was assumed

that the proportion of deaths attributable to TB was the

same as the observed proportion in recorded deaths.

e adjusted number of TB deaths da was obtained from

the VR report d as follows:

da =

c(1 – g)

where c denotes coverage (i.e. the number of deaths with

a documented cause divided by the total number of esti-

mated deaths) and g denotes the proportion of ill-dened

causes.

e uncertainty related to the adjustment was estimated

with standard deviation SD = d/4[1/c(1 – g) – 1]. e uncer-

tainty calculation does not account for miscoding, such as

HIV deaths miscoded as deaths due to TB.

Missing data between existing adjusted data points were

interpolated. Trailing missing values were predicted using

exponential smoothing models for time series.2 A penal-

ized likelihood method based on the in-sample t was used

for country-specic model selection. Leading missing val-

ues were similarly predicted backwards to 1990. A total of

799 country-year data points were thus imputed.

Results from mortality surveys were used to estimate

TB mortality in India and VietNam.

In 2012, 45% of global TB mortality (excluding HIV) was

directly measured from VR or survey data (or imputed from

survey or VR data from previous years). e remaining 55%

was estimated using the indirect methods described in

section 3.2 and section 3.3.

3.2 Estimating TB mortality among HIV-negative

people from an ecological model

An out-of-sample, goodness-of-t, stepwise selection

approach was used in 2012 using the series 1990–2011 to

select an ecological model that could predict TB mortality

in countries without VR data. e model was based on the

time series of VR data reported to WHO as described above,

expressed as counts of TB deaths and corrected for ill-

dened causes of deaths and VR coverage.

A population-averaged negative binomial model, with

total population as the oset converting model outputs to

rates, was used to account for the longitudinal structure of

the data as well as the observed over-dispersion of counts

of TB deaths.

Ten variables were investigated for inclusion in the

model. ese were: the infant mortality rate per 1000 live

births; gross domestic product per capita; HIV prevalence

among the general population; the percentage of the total

population aged <15 and ≥65 years; the TB treatment suc-

cess rate; the total number of newly notied TB cases per

year; whether or not a country had a high or low burden

of MDR-TB; whether a country was among the 22 HBCs or

not; and a categorical variable classifying countries in nine

groups with similar TB epidemiology (see Appendix 1).

At the univariate level, all risk factors were associated

with the outcome of TB mortality. e nal multivariate

model included the infant mortality rate per 1000 live

births, HIV prevalence among the general population, gross

domestic product per capita, the percentage of the total

population aged <15 and ≥65 years, whether a country was

in the list of 22 HBCs or not; and the categorical variable

that dened country groups with similar TB epidemiology.

Out of a total 4686 country-year observations in the

time series for 1990–2011, 802 could not be predicted

due to data not being available for any of the ten variables

included in the model.

Estimates of TB mortality predicted by the model were

used for 26 countries3 in which VR or mortality survey data

of sucient quality and coverage were not available and for

which estimates of TB incidence were judged too uncertain.

3.3 Estimating TB mortality among HIV-negative

people from estimates of case-fatality rates and

TB incidence

In 68 countries lacking VR data of the necessary coverage

and quality (in total, 94 countries lacked VR data of su-

cient coverage and quality but among 26 of them, the eco-

logical model described above was used), TB mortality was

estimated as the product of TB incidence (see section 4)

and the CFR using a model developed in 2012.

CFRs were estimated separately for TB cases notied to

NTPs and non-notied cases and, within these two groups,

separate estimates were made for HIV-negative TB cases in

high-income and other countries (Table A1.1).

TABLE A1.1

Estimates of TB case-fatality rates (HIV-negative) by

case type and country

%#5'6;2'#0&%17064;)4172 /'#056#0&#4&&'8+#6+10

0QPPQVKßGFJKIJKPEQOG

countries

0.12 (0.042)

0QPPQVKßGFQVJGTEQWPVTKGU 0.32 (0.13)

0QVKßGFJKIJKPEQOGEQWPVTKGU 0.039 (0.042)

0QVKßGFQVJGTEQWPVTKGU 0.074 (0.03)

For consistency with VR- or survey-based mortality esti-

mates, CFRs were estimated such that they gave the best t

to the directly measured TB death rates (within their uncer-

tainty ranges) in the 123 countries with VR or mortality

1 Mathers CD et al. Counting the dead and what they died from: an

assessment of the global status of cause of death data. Bulletin of the

World Health Organization, 2005, 83:171–177.

2 Hyndman R et al. Forecasting with exponential smoothing: the state

space approach. Springer Series in Statistics, 2008.

3 For the list of the 26 countries, see www.who.int/tb/publications/

global_report/gtbr13_ mortality_source.csv.

104 GLOBAL TUBERCULOSIS REPORT 2013

survey data that were retained for analysis, in conjunction

with WHO estimates of distributions of TB incidence in

those countries. is statistical tting used Bayesian linear

models and was done separately for two groups of countries

(high-income and all other countries), to account for dier-

ences in the ratio of reported TB mortality to TB notica-

tion rates among these two groups (data not shown).

e models used normal errors and Gibbs sampling:

y = (I – N)β1 + Nβ2 + ¡, ¡ ~ N(0,σ2)

where y is TB mortality from VR, I denotes TB incidence

excluding people living with HIV, N denotes TB notica-

tions excluding people living with HIV, and parameters β1

and β2 denote the CFR in non-notied and notied cases

respectively. Semi-conjugate priors were set with an unin-

formative inverse Gamma prior on the conditional error

variance:

b ~ N(bi,Bi-2), σ2 ~ IG(5.10-4,5.10-4)

For low- and middle-income countries, priors b and their

precision B were dened based on literature reviews1 and

the country-year CFR parameters used by WHO for the

years 1999–2008. For high-income countries, non-infor-

mative priors were used. Convergence of Markov Chains

was assessed graphically and using convergence diagnos-

tic tests. Within each case category 1990–2011, mortality

estimates were computed by taking the product of posteri-

or distributions of the CFR, assumed to be time-indepen-

dent (Table A1.1), and country-year specic distributions

of estimated incidence.

3.4 Estimating TB mortality among

HIV-positive people

No nationally representative measurements of HIV-associ-

ated TB mortality were available from VR systems for use

in this report. In the absence of direct measurements, TB

mortality among HIV-positive people was estimated indi-

rectly according to the following methods (also see section

4.5) implemented in the Spectrum software.2

TB mortality is calculated as the product of HIV-positive

TB incidence (see section 4.5) and case fatality ratios:

M = (I-N)Fu + NFn

where I represents incident TB cases among people living

with HIV, N represents HIV-positive cases that are notied,

(I-N) represents HIV-positive TB cases that are not notied

and M represents TB mortality among HIV-positive peo-

ple. Fn and Fu are the case fatality ratios for notied and

non-notied incident cases, respectively.

e case fatality ratios were obtained in collabora-

tion with the TB Modeling and Analysis Consortium

(TB-MAC),3,4,5 and are shown in Table A1.2.

e disaggregation of incident TB into notied and not

notied cases is based on the ratio of the point estimates

for incident and notied cases. A single CFR was used for all

bootstrapped mortality estimates.

Direct measurements of HIV-associated TB mortality

are urgently needed. is is especially the case for coun-

tries such as South Africa and Zimbabwe, where national

VR systems are already in place. In other countries, more

eorts are needed to initiate the implementation of sample

VR systems as an interim measure.

3.5 TB mortality disaggregated by age and sex

For countries with VR data, it was possible to estimate TB

deaths (excluding TB deaths among HIV-positive people)

among children (aged <15 years) and adults (aged ≥ 15 years)

separately. It was also possible to disaggregate TB deaths by

sex. For these countries, male:female and child:adult ratios

of TB deaths (expressed as rates per 100000 population)

were calculated (after correction for ill-dened causes of

deaths and VR coverage). e ecological model described in

section 3.2 was used to predict ratios for countries with no

VR data. Directly measured (i.e. based on VR data for the

latest available year) or predicted country-level ratios were

then used to estimate ratios for WHO regions. ese were

then used to estimate the global ratio which was in turn

applied to the global number of estimated TB deaths among

HIV-negative TB cases to produce age and sex-disaggregat-

ed estimates.

TB deaths among HIV-positive people were disaggregat-

ed by sex using the assumption that the male:female sex

ratio is the same as the sex ratio of AIDS deaths estimated

by UNAIDS. Further details are provided in Box 2.2, Chap-

ter 2. Disaggregation of TB deaths by age and sex will be

one of the future developments of the TB component of the

Spectrum software (also see section 3.4).

TABLE A1.2

Estimates of the case fatality ratio among

HIV-positive TB cases

NON-NOTIFIED NOTIFIED

HIV-

Mode of triangular distribution 0.43 0.03

*+8PQVTGEGKXKPI#46

Mode of triangular distribution  0.09

4GEGKXKPI#46HQTNGUUVJCPQPG[GCT

Mode of triangular distribution 0.62 0.06

4GEGKXKPI#46HQTOQTGVJCPQPG[GCT

Mode of triangular distribution 0.49 0.04

1 Straetemans M et al. Assessing tuberculosis case fatality ratio: a

meta-analysis. PLoS One. 2011, 6(6):e20755.

2 http://www.futuresinstitute.org/spectrum.aspx

3 Tiemersma EW, van der Werf MJ, Borgdor MW, Williams BG,

Nagelkerke NJ (2011) Natural history of tuberculosis: duration

and fatality of untreated pulmonary tuberculosis in HIV negative

patients: a systematic review. PLoS One 6: e17601.

4 Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, et al. (2003)

e growing burden of tuberculosis: global trends and interactions

with the HIV epidemic. Archives of Internal Medicine; 163: 1009–

1021.

5 Mukadi YD, Maher D, Harries A (2001) Tuberculosis case fatality

rates in high HIV prevalence populations in sub-Saharan Africa.

AIDS; 15: 143–152.

105GLOBAL TUBERCULOSIS REPORT 2013

4. Estimates of TB incidence, 1990–2012

No country has ever undertaken a nationwide survey of

TB incidence because of the large sample sizes required

and associated major logistic and nancial challenges. As

a result, there are no direct measurements of the incidence

of TB. eoretically, data from TB surveillance systems

that are linked to health systems of high coverage and per-

formance may capture all (or almost all) incident cases of

TB. e WHO Global Task Force on TB Impact Measure-

ment has developed a set of TB surveillance standards and

benchmarks that, if met, would allow direct measurement

of TB cases and deaths from surveillance data (Chapter 2).

In the absence of direct measurements, estimates of TB

incidence for almost all countries rely on methods described

in sections 4.1–4.3.

It should be emphasized that incidence estimates are

no longer derived from surveys of the prevalence of TB

infection as measured in tuberculin surveys. e WHO

Global Task Force on TB Impact Measurement has agreed

that methods for deriving incidence from the prevalence

of infection are unreliable. e Task Force has also stated

that, with a few exceptions, repeat tuberculin surveys do

not provide a reliable estimate of the trend in TB incidence.1

4.1 Estimating TB incidence from estimates of

the proportion of cases detected

Notication data for new and recurrent cases have been

analysed in combination with evidence about the cover-

age of the TB surveillance system and expert opinion in

six regional workshops and country missions held during

the period 2009–2013, according to methods developed by

the WHO Global Task Force on TB Impact Measurement.

By May 2013, these workshops and country missions had

covered 96 countries (Figure 2.1, Chapter 2), with several

countries re-assessed multiple times.

For the 96 countries covered by these regional work-

shops and country missions, incidence was estimated

according to the following equation:

case notications

incidence =

1 – underreporting

Expert opinion about the proportion of TB cases2 that were

not reported was elicited for three reference years (1997,

2003 and, depending on when the workshop was held,

2008–2012). is was done following in-depth analysis of

notication data (including data from sub-national admin-

istrative levels), programmatic data reecting eorts in TB

care and control (for example, data on infrastructure, sta-

ing, the performance of services and funding) and (where

available) data from inventory studies.3 In addition, data

on access to health care from Demographic and Health Sur-

veys and the overall performance of health systems (using

indicators such as the infant mortality rate) were used to

substantiate opinion on the proportion of cases with no

or very limited access to health care (Table A1.3). Results

from inventory studies combined with capture–recapture

modelling were used to estimate the gap between notied

cases and TB incidence in three countries that participated

in regional workshops: Egypt, Iraq and Yemen.

A full description of the methods used in these work-

shops is available in a report of the workshop held for

countries in the African Region (in Harare, Zimbabwe,

December 2010).4

TABLE A1.3

Sources of information and data on TB incidence

used in regional workshops and country missions

2155+$.'%#6')14+'51(+0%+&'06%#5'5 5174%'51(&#6#

Do not have physical or

ßPCPEKCNCEEGUUVQJGCNVJECTG

Demographic and health

surveys, KABPa surveys Capture–

recapture

modelling

Seek care, but TB not

diagnosed Survey

TB diagnosed, but not

reported ‘Inventory’ survey

4GRQTVGFECUGU TB surveillance

a KABP = knowledge, attitudes, behaviour and practices.

Distributions of the proportion of cases that were not

reported in the three reference years were assumed to fol-

low a Beta distribution (Table A1.4). Reasons for using

Beta distributions include the following:

ey are continuous and dened on the interval (0, 1).

Since the variance of the proportions of cases that were

not reported tend to be large as a result of high uncer-

tainty, random draws of numbers from a normal distri-

bution would yield numbers outside the interval (0, 1).

e use of truncated normal distributions may result in

excess density towards one of the bounds.

ey are not necessarily symmetrical.

ey are dened with two parameters that can be

estimated from available data using the method of

moments.5

e shape and scale parameters necessary to dene the Beta

distribution were computed using the method of moments,

as follows:

First, the variance for the distribution was taken as:

V = ((u – l)/4)2

where l and u are the lower and upper bounds of the plau-

sible range for the proportion of incident cases that were

1 TB impact measurement: policy and recommendations for how to assess

the epidemiological burden of TB and the impact of TB control. Gene-

va, World Health Organization, 2009 (Stop TB policy paper, no. 2;

WHO/HTM/TB/2009.416).

2 Dened as cases of all forms of TB, including sputum smear-pos-

itive pulmonary cases, sputum smear-negative pulmonary cases

and extrapulmonary cases.

3 Measurements from ‘inventory’ studies can be used to quantify the

number of cases that are diagnosed but not reported to national

surveillance systems.

4 See www.who.int/tb/advisory_bodies/impact_measurement_

taskforce

5 Rényi A. Probability theory. New York, Dover Publications Inc.,

2007.

106 GLOBAL TUBERCULOSIS REPORT 2013

reported (also referred to as the case detection rate in

Chapter 3).

Shape 1 (noted α) and 2 (noted β) follow from:

α = sE

β = s(l – E)

where E is the expected value of the distribution.

Time series for the period 1990–2012 were built accord-

ing to the characteristics of the levels of underreporting

and under-diagnosis that were estimated for the three ref-

erence years. A cubic spline extrapolation of V and E, with

knots set at the reference years, was used for countries

with low-level or concentrated HIV epidemics. In countries

with a generalized HIV epidemic, the trajectory of inci-

dence from 1990 to the rst reference year (usually 1997)

was based on the annual rate of change in HIV prevalence.

Incidence trajectories were derived from the series of noti-

ed TB cases using Monte Carlo simulations from which

expected values, 2.5th and 97.5th centiles were extracted.

All computations were conducted in the R statistical envi-

ronment.1

In two countries, incidence rates were estimated to be

similar to those in a neighbouring country because infor-

mation from surveillance systems was insucient: esti-

mates for West Bank and Gaza Strip were extrapolated

from estimates for Jordan and estimates for South Sudan

were extrapolated from estimates for Sudan. e estimates

for West Bank and Gaza Strip and South Sudan should

therefore be considered as preliminary.

Trends in incidence were derived from repeat tuberculin

survey results in Bhutan, India and Yemen and for 40 coun-

tries (including countries in Eastern Europe) from trends

in mortality.

If there were insucient data to determine the factors

leading to time-changes in case notications, incidence was

assumed to follow a horizontal trend going through the

most recent estimate of incidence.

4.2 Estimating TB incidence from data on

case notißcations and expert opinion for

high-income countries

For high-income countries, the level of TB incidence was

assumed to be distributed between the notication rate

for new and recurrent cases combined, including reported

cases with undocumented treatment history as explained

in section 2.1 (lower uncertainty bound, noted l) and 1.3

times the notication rate (upper uncertainty bound, not-

ed u), as informed by expert opinion. e distribution of

incidence was assumed to follow a Beta distribution with

shape and scale parameters computed using the method of

moments, as described above.

In the absence of country-specic data on the quality

and coverage of TB surveillance systems, it was assumed

that TB surveillance systems from countries in the high-in-

come group performed similarly well, although the mod-

el does allow for stochastic uctuations. e exceptions

were the United Kingdom and the Netherlands, where the

underreporting of TB cases has been measured using inven-

tory studies and capture–recapture modelling.2,3 For these

two countries, the results from these studies were used to

measure TB incidence directly.

4.3 Estimating TB incidence from empirical

measurements of disease prevalence

Incidence can be estimated using measurements from

national surveys of the prevalence of TB disease combined

with estimates of the duration of disease. Incidence is esti-

mated as the prevalence of TB divided by the average dura-

tion of disease.

In practice, the duration of disease cannot be directly

measured. For example, measurements of the duration of

symptoms in prevalent TB cases that are detected during a

prevalence survey are systematically biased towards lower

values, since active case-nding truncates the natural his-

tory of undiagnosed disease. Measurements of the duration

of disease in notied cases ignore the duration of disease

among non-notied and untreated cases.

Literature reviews commissioned by the WHO Global

Task Force on TB Impact Measurement have provided esti-

mates of the duration of disease in untreated TB cases from

the pre-chemotherapy era (before the 1950s). e best esti-

mate of the mean duration of disease (for smear-positive

cases and smear-negative cases combined) in HIV-negative

individuals is about three years. However, the proportion

of incident cases that remain untreated is unknown. ere

are few data on the duration of disease in HIV-positive indi-

viduals.

When measurements from two prevalence surveys were

available, trends in TB prevalence were derived by tting a

log-linear model to available measurements. When three or

more prevalence measurements were available, the preva-

lence trajectory was built using cubic spline interpolation.

If only one prevalence survey measurement was available,

time-trends were assessed using in-depth analysis of sur-

veillance data, as described above.

In this report, the prevalence to incidence method was

used for two countries: Ethiopia and the Lao People’s Dem-

ocratic Republic.

4.4 Disaggregation of TB incidence

In this report, TB incidence is disaggregated by HIV-infec-

tion status (see section 4.5) at country level. e estima-

tion of smear-positive TB incidence was discontinued in

E(l – E)

s = – l

1 R Development Core Team. R: a language and environment for sta-

tistical computing. Vienna, R Foundation for Statistical Computing,

2009 (www.R-project.org).

2 Tuberculosis in the UK: annual report on tuberculosis surveillance in the UK

2010. London, Health Protection Agency Centre for Infections, 2010

(also available at: www.hpa.org.uk/web/HPAweb&HPAwebStandard/

HPAweb_C/1287143581697; accessed July 2011).

3 van Hest NA et al. Completeness of notication of tuberculosis in

e Netherlands: how reliable is record-linkage and capture–recap-

ture analysis? Epidemiology and Infection, 2007, 135(6):1021–1029.

107GLOBAL TUBERCULOSIS REPORT 2013

2010, for reasons explained in detail in the global report

published in 2010.

Global and WHO regional estimates of sex-disaggregat-

ed incidence were also calculated, based on country-level

female:male ratios of total new (all case types) TB case

notications, under the assumption that they are a proxy

of female:male ratios of incidence. Model-based estimated

WHO regional ratios were applied to global incidence for

the nal sex disaggregation (Chapter 2).

TB incidence was also disaggregated by age, to produce

global estimates among children (aged <15 years) and

adults (aged ≥ 15 years). Details of methods are provided in

Chapter 2, Box 2.2.

4.5 Estimates of HIV prevalence among

incident TB cases, 1990–2012

TB incidence was disaggregated by HIV and CD4 status

using the Spectrum software.1 WHO estimates of TB inci-

dence were used as inputs to the Spectrum HIV model. e

model was tted to WHO estimates of TB incidence, and

then used to produce estimates of TB incidence among

people living with HIV disaggregated by CD4 category.2 A

regression method was used to estimate the relative risk

(RR) for TB incidence according to the CD4 categories used

by Spectrum for national HIV projections. Spectrum data

were based on the national projections prepared for the

UNAIDS Report on the global AIDS epidemic 2012. e model

can also be used to estimate TB mortality among HIV-pos-

itive people, the resource requirements associated with

recently updated guidance on ART3 and the impact of ART

expansion.

A exible and relatively simple way of modelling TB inci-

dence (or any time-dependent function) is to represent it as

k time-dependent m’th order cubic-spline functions:

I(x) = Σi=1 to k βi Bmi(x)

where βi is the i’th spline coecient and Bmi(x) represents

the evaluation of the i-th basis function at time(year) x. e

TABLE A1.4

Parameter estimates used to produce estimates of TB incidence, prevalence and mortality

/1&'.2#4#/'6'4 &+564+$76+10 &+564+$76+102#4#/'6'45b

Incidence, high-income countries Betaa

where ě was set at 1. times the notißcation rate noted N and V is

deßned by

HIV prevalence among incident TB Betaa

Where –

Z is the eZpected Xalue and V is IiXen by

&WTCVKQPQHFKUGCUGPQPPQVKßGF 7PKHQTO NW[GCTU

HIV-negative cases of TB

&WTCVKQPQHFKUGCUGPQPPQVKßGF 7PKHQTO NW[GCTU

HIV-positive cases of TB

&WTCVKQPQHFKUGCUGPQVKßGF 7PKHQTO NW[GCTU

HIV-negative cases of TB

&WTCVKQPQHFKUGCUGPQVKßGF 7PKHQTO NW[GCTU

HIV-positive cases of TB

a 6JGRTQDCDKNKV[FGPUKV[HWPEVKQPQHVJG$GVCFKUVTKDWVKQPKU

b u and l denote upper and lower bounds.

α = –

Z .–

Z (1– –

Z )

V– 1

α = ě .ě (1– ě )

V– 1

β = (1– ě )

.ě (1– ě )

V– 1

β = (1– –

Z ) .–

Z (1– –

Z )

V– 1

4 (Z; _, β) = Z _ –1 (1– x) ` –1

0t _ –1 (1– t) ` –1 dt

V = 0.3

4N2

V = u – l

1 http://www.futuresinstitute.org/spectrum.aspx

2 Stover J, McKinnon R, Winfrey B. Spectrum: a model platform for

linking maternal and child survival interventions with AIDS, fam-

ily planning and demographic projections. International Journal of

Epidemiology 2010; 39 Suppl 1:i7–10.

3 http://www.who.int/hiv/pub/guidelines/arv2013/en/index.html

 GLOBAL TUBERCULOSIS REPORT 2013

order of each basis function is m and cubic splines are used,

i.e. m=3. e equation simply states that any time-depen-

dent function, such as incidence, can be represented as a

linear combination of cubic-spline basis functions. e val-

ues of the cubic-spline coecients β were determined by

an optimization routine that minimizes the least squares

error between incidence data (Iobs) and the estimated inci-

dence curve I(x):

Σx=1990:2012 |I(x) - Iobs(x)|2 + λ β T S β

Here |I - Iobs|2 is the sum of squared errors in estimat-

ed incidence and S is a dierence penalty matrix applied

directly to the parameters β to control the level of varia-

tion between adjacent coecients of the cubic-spline, and

thus control (through a choice of λ) the smoothness of the

time-dependent case incidence curve. Another important

purpose of the use of the smoothness penalty matrix S is to

regularize (by creating smoothness dependencies between

adjacent parameters) the ill-conditioned inverse problem

(more unknown parameters than the data can resolve) that

would tend to over t the data when left ill-conditioned.

Cubic5plines and conßdence intervals

e cubic-spline method was then used to t indicators

(incidence, case notications, etc.) to a set of bootstrapped

data, obtained by sampling from the normal error distribu-

tion resulting from tting the ‘point estimate’. is boot-

strap method produces a sample of projected cubic-spline

curves that are practically equivalent to a set that would

be obtained from tting the model to the same number of

repeated measurements (or assessments) of the given indi-

cator. Condence intervals based on the bootstrapped data

are typically narrow in the years where the model has data

to utilize, and ‘spread out’ after that, according to a Gauss-

ian process with an increasing variance.

Projecting TB incidence among people living with HIV

by CD4 category

e disaggregation of TB incidence by CD4 category among

people living with HIV was based on the idea that an

increase in the relative risk for TB incidence is a function of

CD4 decline. Williams et al captured this idea in a model for

the relationship between the RR for TB and CD4 decline.1

ey suggested a 42% (+/- 17%) increase in RR for TB for

each unit of 100μL CD4 decline.

e Spectrum-TB model’s disaggregation method is

based on the Williams et al. model. e model rst esti-

mates incidence among people living with HIV, and then

calculates the ‘risk of TB’ F=I- / P-, where I- is TB incidence

among people living with HIV and P- is the number of peo-

ple living with HIV who are susceptible to TB.

An assumption is made that the risk of TB infection

among people living with HIV with CD4 count > 500 μL is

proportional to F (it was assumed that it was higher by a

factor of 2.52). For each 100 μL CD4 decline in the remain-

ing categories (350–499, 250–349, 200–249, 100–199,

50–99 CD4 cells/μL, and CD4 count less than 50 cells μL),

the risk of infection is represented as:

F(c<500) = F(c>500)∙p(1)∙p(2)dc,

where p(1) is a parameter that is used to recognize that

people living with HIV who have high CD4 counts could

be at higher risk of TB infection relative to those who are

HIV-negative, and p(2) controls the exponential increase in

RR that occurs with CD4 decline. dc is the number of 100μL

CD4 decline associated with the midpoint of each CD4 cate-

gory relative to 500: dc= (3.0, 4.4, 8.6, 12.9, 19.2, 28.6, 37.3)

for the six CD4 categories.

A reduction in RR is applied for those who have been on

ART for more than one year.

Parameter assumptions

To match total TB incidence and estimates of the num-

ber of HIV-positive TB cases from HIV testing data where

available, it was assumed that p(1)=2.5 and p(2) was tted

accordingly.

In the RR-approach, the ‘biological meaning’ that should

be attached to the parameters and a more straightforward

interpretation of these parameters as regression coe-

cients need to be balanced. Both parameters can be tted

or both can be xed. Varying at least p(2) captures the vari-

ation among countries that is expected due to variation

in the baseline (HIV-negative) CD4 count, and it strikes a

balance between the biological and regression mechanisms.

e RR model approach to estimation of TB incidence

was used for people on ART. Although an estimate of TB

incidence among people on ART could be obtained from

surveillance data reported to WHO (such that it is arguably

not necessary to use the RR model), limitations of the ART

data (in particular that some countries appear to report

cumulative totals of people on ART) meant that the RR

approach needed to be used.

Hazard ratios (HR) of 0.35 were assumed for all CD4 at

ART initiation categories. Suthar et al have reported HRs

of 0.16, 0.35 and 0.43 for those on ART with CD4 count

< 200, 200–350 and > 350,3 and these values could in prin-

ciple be used. However, Spectrum tracks only CD4 at initi-

ation, thus limiting the use of CD4-specic HRs for people

on ART.

It was further assumed that the HR of 0.35 applies only

to patients on ART for more than six months. Spectrum’s

ART-mortality estimates, derived mostly from ART cohorts

in Sub-Saharan Africa, suggest that mortality remains very

1 Williams B. e impact of ART for HIV on TB. http://www.who.int/

hiv/topics/artforprevention/williams.pdf (accessed July 2013).

2 Sonnenberg P, et al. How Soon after Infection with HIV Does the

Risk of Tuberculosis Start to Increase? A Retrospective Cohort

Study in South African Gold Miners. Journal of Infectious Diseas-

es.2005 Jan 15;191(2):150–8.

3 Suthar AB, Lawn SD, del Amo J, Getahun H, Dye C, et al. (2012)

Antiretroviral erapy for Prevention of Tuberculosis in Adults

with HIV: A Systematic Review and Meta-Analysis. PLoS Med 9(7):

e1001270. doi:10.1371/journal.pmed.1001270

109GLOBAL TUBERCULOSIS REPORT 2013

high in the rst six months of ART. Since TB is a leading

contributor to mortality among HIV-positive people, it was

judged that the HR for patients on ART for 0‒6 months is

likely to remain high; therefore, a reduction factor due to

ART was not applied for this subset of patients.

Likelihood function

A simple least squares approach was used to t the model to

total TB incidence, and to all available estimates of TB inci-

dence among people living with HIV. ese estimates of TB

incidence among people living with HIV were obtained by

three sampling methods: population surveys of the preva-

lence of HIV among TB cases (least biased, but scarce due

to logistical constraints), sentinel HIV data (biases include

more testing of people with advanced HIV-related disease)

and routine HIV testing of reported TB patients (variable

coverage). To increase the inuence of survey data, replicas

of the survey data were included in the likelihood function.

In other words, for years for which data from HIV testing

were available, identical copies of the HIV-test data were

added to the likelihood function. e estimate of total TB

incidence was based on much more data, evenly spread out

in the estimation period 1990–2015.

Model testing showed that using two replicates of the

HIV survey data (i.e. duplicating the survey data) and

two replicates of the routine testing data with coverage

greater than 90% was the best approach to disaggregating

TB incidence: the t passed close to the survey or high-

coverage routine testing data points that were available.

For each of a) HIV sentinel and b) routine testing with cov-

erage between 50–90%, data were not used.

A prototype Bayesian importance sampling (IMIS)

algorithm was developed to handle complex data weigh-

ing possibilities, but it was based on subjective priors and

likelihood functions and is more time-consuming to run

than simple least squares. For the purposes of producing

estimates for all countries automatically, the least squares

method was used. In future, least squares and IMIS tting

could be made available to the end user.

For countries with no data, a range for p(2) was esti-

mated from countries with survey or testing data, which

suggest that p(2) = 1.96 [1.8–2.1]. e RR-model was then

tted to total TB incidence only. ere is no satisfactory

way to verify results for TB incidence among people living

with HIV when no HIV-testing data are available. However,

comparison of the global estimate for TB incidence among

people living with HIV produced by Spectrum and esti-

mates previously published by WHO (based on a dierent

method using HIV prevalence instead of CD4 distributions

and using HIV-test data in a dierent way) suggests that

the RR-model works reasonably well.

Provider-initiated testing and counselling with at least

50% HIV testing coverage is the most widely available

source of information on the prevalence of HIV in TB

patients. However, this source of data is aected by biases,

particularly when coverage is closer to 50% than to 100%.

In all countries with repeat data from testing, the relation-

ship between the prevalence of HIV in TB patients and the

coverage of HIV testing was examined graphically. In some

countries, the prevalence of HIV in TB patients was found

to decrease with increasing HIV testing coverage while in

others it increased with increasing HIV testing coverage;

in most countries, the prevalence of HIV followed highly

inconsistent patterns (with repeat changes in direction) as

HIV testing coverage increased. erefore, it was not pos-

sible to adjust for the eect of incomplete coverage of HIV

testing on estimates of the prevalence of HIV among TB

patients. e assumption was thus made that TB patients

with an HIV test result were statistically representative

of all TB cases. As coverage of HIV testing continues to

increase globally, biases will decrease.

For the 1003 country-year data points corresponding to

countries for which no surveillance data were available, the

prevalence of HIV was estimated indirectly according to

the following equation:

In this equation, t is HIV prevalence among incident TB

cases, h is HIV prevalence among the general population

(from the latest time-series provided by UNAIDS) and ρ is

the incidence rate ratio (IRR) (dened as the incidence rate

of TB in HIV-positive people divided by the incidence rate

of TB in HIV-negative people). We then let logit(t) be log(t/

(1-t)) and logit(h) be log(h/(1-h)). Using data from countries

where HIV prevalence has been estimated by UNAIDS as an

independent variable, a linear model of logit-transformed

t was tted using logit-transformed h according to the fol-

lowing equation, written in matrix notation:

TXβ

where ˆ

T is a vector of predicted logit(t), X is an n x 2 matrix

in which the rst column holds 1s, and the second column

holds logit(h). e vector β holds estimated model parame-

ters. Models were tested with lags set for logit(h) ranging

from no lag to a lag of eight years. e best t was obtained

with a lag of one year.

Models were run using Monte Carlo simulations in

which h was drawn randomly from a Beta distribution with

shape parameters computed as described in Section 4.1,

(low and high uncertainty bounds are provided by UNAIDS

– also see Table A1.5). e model was run 50000 times

TABLE A1.5

Sources of data on HIV prevalence among

incident TB cases

&+4'%6/'#574'/'061(6*'24'8#.'0%'1(*+8+06$2#6+'065 07/$'41(%17064;;'#45

National surveysa124

HIV sentinel surveillance 24

Provider-initiated testing and counselling with at

least 50% coverage of testing 1297

Total, at least one data source available 1322

a the reported survey number is over-stated as a number of country reports confused

survey and routine testing with near 100% coverage

l + h(l – l)

t =

110 GLOBAL TUBERCULOSIS REPORT 2013

using country-specic distributions for H and T (noted in

capital letters to denote vectors or matrices) based on their

uncertainty intervals. e uncertainty bounds for β were

chosen as the 2.5th and 97.5th centiles.

5. Estimates of TB prevalence, 1990–2012

e best way to measure the prevalence of TB is through

national population-based surveys of TB disease.1,2 Data

from such surveys are available for an increasing number

of countries (Chapter 2). It should be noted, however, that

measurements of prevalence are typically conned to the

adult population. Furthermore, prevalence surveys exclude

extrapulmonary cases and do not allow the diagnosis of

cases of culture-negative pulmonary TB.

When there is no direct measurement from a national

survey of the prevalence of TB disease, prevalence is the

most uncertain of the three TB indicators used to measure

disease burden. is is because prevalence is the product of

two uncertain quantities: (i)incidence and (ii) disease dura-

tion. e duration of disease is very dicult to quantify

because it cannot be measured during surveys of the prev-

alence of TB disease (surveys truncate the natural history

of disease). Duration can be assessed in self-presenting

patients, but there is no practical way to measure the dura-

tion of disease in patients who are not notied to NTPs.

Indirect estimates of prevalence were calculated accord-

ing to the following equation:

P = -Ii,jdi,j, iD{1,2}, jD{1,2}

where the index variable i denotes HIV+ and HIV–, the

index variable j denotes notied and non-notied cases, d

denotes the duration of disease in notied cases and I is

total incidence. In the absence of measurements, we did not

allow duration in notied cases to vary among countries.

Given their underlying uncertainty, prevalence estimates

should be used with great caution in the absence of direct

measurements from a prevalence survey. Unless measure-

ments were available from national programmes (for exam-

ple, Turkey), assumptions of the duration of disease were

used as shown in the last four rows of Table A1.3.

6. Estimates of the number of cases

of and deaths from MDR-TB

 2TQRQTVKQPQHPQVKßGFECUGUQH6$VJCVJCXG

MDR-TB, 2012

Global and regional estimates of the proportion of new and

retreatment cases of TB that had MDR-TB in 2012 were cal-

culated using country-level information. If countries had

reported data on the proportion of new and retreatment

cases of TB that have MDR-TB from routine surveillance

or a survey of drug resistance the latest available informa-

tion was used. For countries that have not reported such

data, estimates of the proportion of new and retreatment

cases of TB that have MDR-TB were produced using mod-

elling (including multiple imputation) that was based on

data from countries for which data do exist. Estimates for

countries without data were based on countries that were

considered to be similar in terms of TB epidemiology (for

country groups see Appendix 1). e observed and imputed

estimates of the proportion of new and retreatment cases

of TB that have MDR-TB were then pooled to give a global

estimate, with countries weighted according to their share

of global notications of new and retreatment cases.

6.2 MDR-TB mortality, 2012

e VR mortality data reported to WHO by Member States

does not dierentiate between MDR-TB and non-MDR-TB

as a cause of death (there is no specic ICD-9 or ICD-10

codes for MDR-TB, although countries such as South Africa

have allocated two specic codes U51 and U52 to classify

deaths from MDR-TB and XDR-TB respectively).3 ere-

fore, a systematic review and meta-analysis of the pub-

lished literature was undertaken to estimate the relative

risk of dying from MDR-TB compared with non MDR-TB.

e global estimate of MDR-TB deaths (Box 2.3) was then

based on the following formula:

m = M.p.r

Where:

m = global MDR-TB mortality,

M = global TB mortality,

p = overall proportion of MDR-TB among prevalent TB

cases, approximated by the weighted average of the

proportion of new and retreated cases that have MDR-

TB,

r = the relative risk of dying from MDR-TB versus non-

MDR-TB.

6.3 Numbers of incident cases of MDR-TB, 2012

e global estimate of MDR-TB incidence was calculated as

the addition of three groups of MDR-TB incident cases:

1. incident MDR-TB among new pulmonary and extra-pul-

monary incident TB cases, using the proportion of

MDR-TB among new cases from drug resistance surveil-

lance (DRS);

2. incident MDR-TB among relapses, using the proportion

of MDR-TB among new cases from DRS and the esti-

mated relative risk of MDR among relapse versus new

cases; and

3. incident MDR-TB among retreated cases that are not

relapses, which was assumed to follow a uniform distri-

bution with min=0, max=upper limit of the global pro-

portion of MDR-TB among retreated cases estimated

from DRS.

A second method to estimate global MDR-TB incidence was

also explored, in which the global estimate of mortality due

1 Glaziou P et al. Tuberculosis prevalence surveys: rationale and

cost. International Journal of Tuberculosis and Lung Disease, 2008,

12(9):1003–1008.

2 TB prevalence surveys: a handbook. Geneva, World Health Organiza-

tion, 2011 (WHO/HTM/TB/2010.17).

3 Mortality and causes of death in South Africa, 2010: Findings from

death notification. http://www.statssa.gov.za/publications/

p03093/p030932010.pdf

111GLOBAL TUBERCULOSIS REPORT 2013

to MDR-TB was divided by the estimated case fatality ratio

(CFR) among cases of MDR-TB. e CFR was calculated as

a weighted average of the case fatality ratio among patients

that are treated and those that are not, according to the fol-

lowing formula:

4 = pt * 4t + (1-pt)*4un

Where:

pt = proportion treated, approximated by the proportion

of enrolled MDR-TB patients on treatment out of

those estimated to exist among notied TB patients

with pulmonary TB;

4t = case fatality rate among patients treated for MDR-TB,

using treatment outcome data for MDR-TB patient

cohorts;

4un = case fatality rate among people with MDR-TB who are

not treated, which was assumed to follow a uniform

distribution with min=0.4, max=0.6.

Outputs from both methods gave similar best estimates

of MDR-TB incidence with largely overlapping condence

intervals.

6.4 Resistance to second-line drugs among

patients with MDR-TB

Data from 75 countries were used to produce global esti-

mates of the following proportions: (i) patients with MDR-

TB who had XDR-TB; (ii) patients with MDR-TB who had

uoroquinolone resistance; (iii) patients with MDR-TB who

had resistance to second-line injectable drugs and uoro-

quinolones but not XDR-TB. e latest available national

and subnational data from each country were analysed

using logistic regression models with robust standard

errors to account for the clustering eect at the level of the

country or territory. e analysis was limited to countries

in which more than 66% of MDR-TB cases received sec-

ond-line DST.

7. Projections of incidence, prevalence

and mortality up to 2015

Projections of TB incidence, prevalence and mortality

ratesup to 2015enable assessment of whether global tar-

gets set for 2015 are likely to be achieved at global, region-

al and country levels. Projections for the years 2013–2015

weremade using exponential smoothingmodels tted to

data from 2006–2012.

8. Estimation of uncertainty

ere are many potential sources of uncertainty associated

with estimates of TB incidence, prevalence and mortality,

as well as estimates of the burden of HIV-associated TB

and MDR-TB. ese include uncertainties in input data, in

parameter values, in extrapolations used to impute missing

data, and in the models used.

We used xed population values from the UNPD. We did

not account for any uncertainty in these values.

Notication data are of uneven quality. Cases may be

underreported (for example, missing quarterly reports

from remote administrative areas are not uncommon), mis-

classied (in particular, misclassication of recurrent cases

in the category of new cases is common), or overreported

as a result of duplicated entries in TB information systems.

e latter two issues can only be addressed eciently in

countries with case-based nationwide TB databases that

include patient identiers. Sudden changes in notications

over time are often the result of errors or inconsistencies in

reporting, but may sometimes reect abrupt changes in TB

epidemiology (for example, resulting from a rapid inux of

migrants from countries with a high burden of TB, or from

rapid improvement in case-nding eorts).

Missing national aggregates of new and recurrent cas-

es were imputed by interpolation. Notication trajectories

were smoothed using a penalized cubic splines function

with parameters based on the data. Attempts to obtain cor-

rections for historical data are made every year, but only

rarely do countries provide appropriate data corrections.

Mortality estimates incorporated the following sourc-

es of uncertainty: sampling uncertainty in the underlying

measurements of TB mortality rates from data sources,

uncertainty in estimates of incidence rates and rates of HIV

prevalence among both incident and notied TB cases, and

parameter uncertainty in the Bayesian model. Time series

of TB mortality were generated for each country through

Monte Carlo simulations.

Unless otherwise specied, uncertainty bounds and

ranges were dened as the 2.5th and 97.5th centiles of out-

come distributions. roughout this report, ranges with

upper and lower bounds dened by these centiles are pro-

vided for all estimates established with the use of simula-

tions. When uncertainty was established with the use of

observed or other empirical data, 95% condence intervals

are reported.

e model used the following sequence: (1) Overall TB

incidence estimation after review and cleaning of case

notication data; (2) cleaning and adjustment of raw mor-

tality data from VR systems and mortality surveys, fol-

lowed by imputation of missing values in countries with

VR or survey data – in some countries, step 1 was updat-

ed to account for mortality data; (3) cleaning of measure-

ments of HIV prevalence among TB patients followed by

estimating HIV-positive TB incidence using the Spectrum

programme and HIV-positive TB mortality; (4) estimation

of HIV prevalence among incident cases of TB through

modelling in countries with no measurements; (5) estima-

tion of HIV-negative TB mortality in countries with no VR

data followed with an update of step 1 in some countries;

(6) review of prevalence measurements, adjustments for

childhood TB and bacteriologically unconrmed TB, and

estimation of prevalence followed with an update of step 1

in some countries; (7) estimation of incidence and mortali-

ty disaggregated by age and sex and disaggregated by drug

resistance status.

e general approach to uncertainty analyses was to

draw values from specied distributions for every param-

112 GLOBAL TUBERCULOSIS REPORT 2013

eter (except for notications and population values) in

Monte Carlo simulations, with the number of simulation

runs set so that they were sucient to ensure stability

in the outcome distributions. For each country, the same

random generator seed was used for every year, and errors

were assumed to be time-dependent within countries

(thus generating autocorrelation in time series). Regional

parameters were used in some instances (for example, for

CFRs). Summaries of quantities of interest were obtained

by extracting the mean, 2.5th and 97.5th centiles of pos-

terior distributions. Wherever possible, uncertainty was

propagated analytically by approximating the moments of

functions of random variables using Taylor expansions –

such as when taking the product or the ratio of two random

variables – rather than through Monte Carlo simulations,

in order to shorten computing time.

Appendix 1. Epidemiological regions used

for analyses

Africa – countries with high HIV prevalence: Botswa-

na, Burundi, Cameroon, the Central African Republic, the

Congo, Côte d’Ivoire, the Democratic Republic of the Con-

go, Ethiopia, Gabon, Kenya, Lesotho, Malawi, Mozambique,

Namibia, Nigeria, Rwanda, South Africa, South Sudan,

Swaziland, Uganda, the United Republic of Tanzania, Zam-

bia, Zimbabwe.

Africa – countries with low HIV prevalence: Alge-

ria, Angola, Benin, Burkina Faso, Cape Verde, Chad, the

Comoros, Djibouti, Eritrea, the Gambia, Ghana, Guinea,

Guinea-Bissau, Liberia, Madagascar, Mali, Mauritania,

Mauritius, the Niger, Sao Tome and Principe, Senegal, Sey-

chelles, Sierra Leone, Somalia, Sudan, Togo.

Central Europe: Albania, Bosnia and Herzegovina, Mon-

tenegro, Serbia, the former Yugoslav Republic of Macedo-

nia, Turkey.

Eastern Europe: Armenia, Azerbaijan, Belarus, Bulgaria,

Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the

Republic of Moldova, Romania, the Russian Federation,

Tajikistan, Turkmenistan, Ukraine, Uzbekistan.

High-income countries: Andorra, Aruba, Australia,

Austria, the Bahamas, Bahrain, Barbados, Belgium, Bermu-

da, Brunei Darussalam, Canada, the Cayman Islands, Chi-

na, Hong Kong SAR, China Macao SAR, Croatia, Cyprus,

the Czech Republic, Denmark, Equatorial Guinea, Esto-

nia, Finland, France, French Polynesia, Germany, Greece,

Greenland, Guam, Hungary, Iceland, Ireland, Israel, Italy,

Japan, Kuwait, Luxembourg, Malta, Monaco, the Nether-

lands, the Netherlands Antilles, New Caledonia, New Zea-

land, Northern Mariana Islands, Norway, Oman, Poland,

Portugal, Puerto Rico, Qatar, the Republic of Korea, Saint

Kitts and Nevis, San Marino, Saudi Arabia, Singapore, Slo-

vakia, Slovenia, Spain, Sweden, Switzerland, Trinidad and

Tobago, the Turks and Caicos Islands, US Virgin Islands,

United Arab Emirates, the United Kingdom, the United

States.

Eastern Mediterranean: Afghanistan, Egypt, Iran (Islamic

Republic of), Iraq, Jordan, Lebanon, Libya, Morocco, Paki-

stan, Syrian Arab Republic, Tunisia, West Bank and the

Gaza Strip, Yemen.

Latin America: Anguilla, Antigua and Barbuda, Argen-

tina, Belize, Bolivia (Plurinational State of), Bonaire,

Saint Eustatius and Saba, Brazil, British Virgin Islands,

Chile, Colombia, Costa Rica, Cuba, Curaçao, Dominica, the

Dominican Republic, Ecuador, El Salvador, Grenada, Gua-

temala, Guyana, Haiti, Honduras, Jamaica, Mexico, Mont-

serrat, Nicaragua, Panama, Paraguay, Peru, Saint Kitts

and Nevis, Saint Lucia, Saint Vincent and the Grenadines,

Sint Maarten (Dutch part), Suriname, Uruguay, Venezuela

(Bolivarian Republic of).

South East Asia: Bangladesh, Bhutan, Democratic Peo-

ple’s Republic of Korea, India, Indonesia, Maldives, Myan-

mar, Nepal, Sri Lanka, ailand, Timor-Leste.

West Pacic: American Samoa, Cambodia, China, Cook

Islands, Fiji, Kiribati, Lao People’s Democratic Republic,

Malaysia, Marshall Islands, Micronesia (Federated State

of), Mongolia, Nauru, Niue, Palau, Papua New Guinea,

the Philippines, Samoa, Solomon Islands, Tokelau, Tonga,

Tuvalu, Vanuatu, Viet Nam, Wallis and Futuna Islands.

#00':

Country proßles

115 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

HIGH TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6' (per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿ 

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 0.31 (0.19–0.46) 1 (0.63–1.5)

Case detection, all forms (%) 52 (44–63)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 4 740 (17) Treatment after failure 160 (13)

Smear-unknown / not done 2 665 (9) Treatment after default 37 (3)

Extrapulmonary 6 906 (24) Other

Other 702 (2)

Total new 28 332 Total retreatment 1 246

Other (history unknown)

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 2.0

Culture (per 5 million population) 0.3

Drug susceptibility testing (per 5 million population) 0

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 91

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

Is rifampicin used throughout treatment for new patients? No

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 7 275 (25)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

HIV-positive people provided with IPT 25

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 750 (21–2 600) 400 (93–700)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 3%

% Funded internationally 65%

% Unfunded 32%

AFGHANISTAN Population 2012 30 million

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

120

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

250

500

750

1000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

Treatment success rate (%)

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

Number of patients

HIV-positive TB patients on CPT on ART

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

116 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU'UVKOCVGUQH6$FKUGCUGDWTFGPJCXGPQVDGGPCRRTQXGFD[

the national TB programme in Bangladesh and a joint reassessment will be undertaken following the

completion of the prevalence survey planned for 2014.

b Comprehensive data on domestic and international funding in 2013 could not be reported. Funding from

75#+&HQT1EVQDGT¿5GRVGODGTYCU75OKNNKQP

BANGLADESH Population 2012 155 million

HIGH TB BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

 07/$'46*175#0&5 4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 0.24 (0.2–0.29) 0.16 (0.13–0.19)

Case detection, all forms (%) 49 (41–59)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

Smear-unknown / not done 0 (0) Treatment after default 257 (3)

'ZVTCRWNOQPCT[   1VJGT  

Other 0 (0)

Total new 161 790 Total retreatment 8 001

1VJGTJKUVQT[WPMPQYP     

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 0.7

%WNVWTGRGTOKNNKQPRQRWNCVKQP 

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQP 

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 92

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 63 (3)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB 429

HIV-positive people provided with IPT 0

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 1 900 (920–3 300) 2 300 (1 900–2 700)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB controlb 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

250

500

750

1000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

100

1995 1997 1999 2001 2003 2005 2007 2009 2011

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012

117 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

BRAZIL Population 2012 199 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6' (per 100 000 population)

Mortality (excludes HIV+TB) 4.9 (4.6–5.2) 2.5 (2.3–2.6)

Mortality (HIV+TB only) 2.5 (2.2–3) 1.3 (1.1–1.5)

Prevalence (includes HIV+TB) 120 (51–210) 59 (25–107)

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV 

Extrapulmonary 10 297 (14) Other 4 133 (36)

1VJGT     

Total new 71 230 Total retreatment 11 500

Other (history unknown) 25

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 2.0

Culture (per 5 million population) 5.5

Drug susceptibility testing (per 5 million population) 0.9

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 76

New smear-negative/extrapulmonary 70

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 45 733 (55)

HIV-positive TB patients 9 049 (20)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

(WPFGFFQOGUVKECNN[ 

% Funded internationally 2%

% Unfunded 14%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

200

300

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

150

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

8000

10 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

CAMBODIA Population 2012 15 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 9.3 (4.3–16) 63 (29–110)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

Incidence (includes HIV+TB) 61 (52–70) 411 (353–474)

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 66 (57–77)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

Smear-unknown / not done 0 (0) Treatment after default 22 (4)

Extrapulmonary 15 290 (40) Other

Other 0 (0)

Total new 38 637 Total retreatment 519

Other (history unknown) 1 102

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 1.4

Culture (per 5 million population) 1.0

Drug susceptibility testing (per 5 million population) 0.3

Is second-line drug susceptibility testing available? No

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 93

New smear-negative/extrapulmonary 94

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 1 433 (4)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT 1 145

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 330 (160–590) 56 (21–110)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 5%

% Funded internationally 34%

% Unfunded 62%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

200

300

400

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

2000

2500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

250

500

750

1000

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

119 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

CHINA Population 2012 1 377 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6' (per 100 000 population)

Mortality (excludes HIV+TB) 44 (43–46) 3.2 (3.1–3.3)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV 

'ZVTCRWNOQPCT[   1VJGT  

Other 0 (0)

Total new 858 861 Total retreatment 41 817

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 0.2

Culture (per 5 million population) 3.7

Drug susceptibility testing (per 5 million population) 0.7

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 95

New smear-negative/extrapulmonary 95

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV statusb  

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB 294 795

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 74%

% Funded internationally 11%

% Unfunded 15%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

200

300

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

150

200

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

200

300

400

120 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

DEMOCRATIC REPUBLIC OF THE CONGO Population 2012 66 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 36 (16–64) 54 (24–97)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 16 (14–19) 25 (22–29)

Case detection, all forms (%) 51 (44–59)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

Extrapulmonary 20 669 (20) Other 2 321 (31)

Other

Total new 105 007 Total retreatment 7 492

Other (history unknown)

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 2.3

Culture (per 5 million population) 0.3

Drug susceptibility testing (per 5 million population) 0.2

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPCPFQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 35 097 (31)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 1%

% Funded internationally 25%

% Unfunded 74%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

8000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

121 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

ETHIOPIA Population 2012 92 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6' (per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 23 (17–30) 25 (19–33)

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

'ZVTCRWNOQPCT[   1VJGT  

Other 0 (0)

Total new 143 503 Total retreatment 4 089

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

5OGCTRGTRQRWNCVKQP 

Culture (per 5 million population) 0.3

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQP 

Is second-line drug susceptibility testing available? No

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 90

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 96 245 (65)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

HIV-positive people provided with IPT 30 395

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 17%

% Funded internationally 32%

% Unfunded 51%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

200

400

600

800

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

250

500

750

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

4000

8000

12 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

120

180

122 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU'UVKOCVGUHQT+PFKCJCXGPQV[GVDGGPQHßEKCNN[CRRTQXGFD[VJG

/KPKUVT[QH*GCNVJ(COKN[9GNHCTG)QXGTPOGPVQH+PFKCCPFUJQWNFVJGTGHQTGDGEQPUKFGTGFRTQXKUKQPCN

INDIA Population 2012 1 237 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 270 (170–390) 22 (14–32)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

Incidence (includes HIV+TB) 2 200 (2 000–2 400) 176 (159–193)

Incidence (HIV+TB only) 130 (120–140) 10 (9.4–12)

Case detection, all forms (%) 59 (54–66)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 317 616 (27) Treatment after failure 16 400 (6)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

Extrapulmonary 234 029 (20) Other 96 567 (34)

1VJGT     

Total new 1 183 373 Total retreatment 284 212

Other (history unknown)

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 1.1

Culture (per 5 million population) 0.3

Drug susceptibility testing (per 5 million population) 0.2

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

New smear-negative/extrapulmonary 90

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 44 063 (5)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 37%

% Funded internationally 57%

% Unfunded 6%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

200

400

600

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

10 000

20 000

30 000

40 000

50 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

150

200

250

123 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

INDONESIA Population 2012 247 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 730 (350–1 200) 297 (144–506)

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 7.5 (5.6–9.7) 3.1 (2.3–3.9)

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

Smear-unknown / not done Treatment after default 954 (11)

Extrapulmonary 15 697 (5) Other 1 179 (14)

Other

Total new 322 882 Total retreatment 8 542

Other (history unknown)

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 2.3

Culture (per 5 million population) 0.9

Drug susceptibility testing (per 5 million population) 0.1

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 90

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB 22 677

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 14%

% Funded internationally 35%

% Unfunded 51%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

250

500

750

1000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

1000

2000

3000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

125

124 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

KENYA Population 2012 43 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 9.5 (5.4–15) 22 (13–34)

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 130 (71–210) 299 (163–475)

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 45 (44–47) 105 (101–109)

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

'ZVTCRWNOQPCT[   1VJGT  

Other 0 (0)

Total new 89 568 Total retreatment 9 581

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 4.2

Culture (per 5 million population) 0.2

Drug susceptibility testing (per 5 million population) 0.2

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPCPFQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 24%

% Funded internationally 15%

% Unfunded 61%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

200

400

600

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

20 000

40 000

60 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

125 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

MOZAMBIQUE Population 2012 25 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 34 (25–50)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 19 797 (43) Treatment after failure 243 (5)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

Extrapulmonary 5 542 (12) Other 2 595 (57)

Other 0 (0)

Total new 46 290 Total retreatment 4 537

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 1.2

Culture (per 5 million population) 0.6

Drug susceptibility testing (per 5 million population) 0.4

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive

New smear-negative/extrapulmonary

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 47 960 (94)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

HIV-positive people screened for TB

HIV-positive people provided with IPT 17 317

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 1 400 (900–2 000) 540 (0–1 100)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 19%

% Funded internationally 51%

% Unfunded 30%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

200

300

400

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

1000

2000

3000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

250

500

750

1000

1250

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

10 000

20 000

30 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

126 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

MYANMAR Population 2012 53 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

Incidence (includes HIV+TB) 200 (170–230) 377 (322–435)

Incidence (HIV+TB only) 19 (16–21) 35 (30–41)

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 73 042 (53) Treatment after failure 1 671 (14)

Smear-unknown / not done 0 (0) Treatment after default 521 (5)

'ZVTCRWNOQPCT[   1VJGT  

Other 0 (0)

Total new 136 612 Total retreatment 11 537

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 0.9

Culture (per 5 million population) 0.2

Drug susceptibility testing (per 5 million population) 0.2

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPCPFQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

New smear-negative/extrapulmonary 90

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 19 219 (13)

HIV-positive TB patients 5 161 (27)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 4 900 (3 600–6 500) 1 200 (790–1 600)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 2%

% Funded internationally 39%

% Unfunded 60%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

200

300

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

2000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

200

400

600

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

127 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

NIGERIA Population 2012 169 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

Mortality (HIV+TB only) 19 (11–25) 11 (6.7–15)

Prevalence (includes HIV+TB) 270 (43–710) 161 (25–420)

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 51 (29–110)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

Smear-unknown / not done Treatment after default 1 174 (16)

Extrapulmonary 4 432 (5) Other 3 249 (43)

Other

Total new 90 305 Total retreatment 7 548

Other (history unknown)

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

5OGCTRGTRQRWNCVKQP 

Culture (per 5 million population) 0.1

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQP 

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUQWVUKFGEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 19 342 (23)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

HIV-positive people screened for TB 140 460

HIV-positive people provided with IPT 2 257

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

(WPFGFFQOGUVKECNN[ 

% Funded internationally 24%

7PHWPFGF 

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

200

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

500

600

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

5000

10 000

15 000

20 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

120

180

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

PAKISTAN Population 2012 179 million

HIGH TB BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 62 (27–110) 34 (15–61)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

Incidence (includes HIV+TB) 410 (340–490) 231 (190–276)

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

Smear-unknown / not done 0 (0) Treatment after default 1 241 (11)

Extrapulmonary 41 410 (16) Other 3 534 (30)

Other 0 (0)

Total new 261 380 Total retreatment 11 717

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

5OGCTRGTRQRWNCVKQP 

Culture (per 5 million population) 0.2

Drug susceptibility testing (per 5 million population) 0.1

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 92

New smear-negative/extrapulmonary 93

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 10 419 (4)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 5%

(WPFGFKPVGTPCVKQPCNN[ 

% Unfunded 9%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

200

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

129 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

PHILIPPINES Population 2012 97 million

HIGH TB BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 23 (22–25) 24 (22–26)

Mortality (HIV+TB only) 0.11 (0.09–0.13) 0.11 (0.09–0.14)

Prevalence (includes HIV+TB) 450 (390–500) 461 (405–520)

Incidence (includes HIV+TB) 260 (210–310) 265 (219–316)

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 115 263 (54) Treatment after failure 591 (3)

Smear-unknown / not done 0 (0) Treatment after default 1 243 (5)

Extrapulmonary 3 270 (2) Other 17 575 (75)

Other 0 (0)

Total new 212 119 Total retreatment 23 489

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 2.7

Culture (per 5 million population) 0.7

Drug susceptibility testing (per 5 million population) 0.2

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 90

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 16%

% Funded internationally 15%

% Unfunded 69%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

200

400

600

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

120

160

130 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b The reported number of TB patients with known HIV status is for new TB patients in the civilian sector only.

It was not possible to calculate the percentage of all TB patients with known HIV status.

RUSSIAN FEDERATION Population 2012 143 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 170 (73–320) 121 (51–221)

Incidence (includes HIV+TB) 130 (110–150) 91 (77–106)

Incidence (HIV+TB only) 9.3 (7.9–11) 6.5 (5.5–7.5)

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 59 019 (61) Treatment after failure 9 109 (17)

Smear-unknown / not done 1 039 (1) Treatment after default 2 593 (5)

Extrapulmonary 10 017 (10) Other 32 466 (62)

Other 0 (0)

Total new 97 542 Total retreatment 52 379

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 0.7

Culture (per 5 million population) 4.1

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQP 

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 54

New smear-negative/extrapulmonary 73

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV statusb 75 995

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 100%

(WPFGFKPVGTPCVKQPCNN[ 

% Unfunded 0%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

200

300

400

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

150

200

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

8000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

600

1200

1800

131 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

SOUTH AFRICA Population 2012 52 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 330 (270–390) 631 (521–752)

Case detection, all forms (%) 62 (52–75)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 63 210 (21) Treatment after failure 3 123 (6)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

Extrapulmonary 42 467 (14) Other 15 007 (29)

Other 0 (0)

Total new 296 996 Total retreatment 52 586

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 0.4

Culture (per 5 million population) 1.4

Drug susceptibility testing (per 5 million population) 1.4

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 79

New smear-negative/extrapulmonary 76

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 190 093 (65)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

HIV-positive people provided with IPT 369 747

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 97%

% Funded internationally 3%

% Unfunded 0%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

200

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

2000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

250

500

750

1000

1250

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

50 000

100 000

150 000

200 000

250 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

200

300

400

500

132 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Based on data reported for 2013 in the 2012 round of data collection. In 2013, Thailand was not able to

report funding for the sub-national level.

THAILAND Population 2012 67 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 76 (64–92)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 17 537 (31) Treatment after failure 327 (12)

Smear-unknown / not done Treatment after default 577 (21)

'ZVTCRWNOQPCT[   1VJGT  

Other

Total new 57 387 Total retreatment 2 791

Other (history unknown) 1 030

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 1.6

Culture (per 5 million population) 4.9

Drug susceptibility testing (per 5 million population) 1.3

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

TB patients with known HIV status 44 035 (72)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU b

% Funded domestically 92%

% Funded internationally 2%

% Unfunded 6%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

200

300

400

500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

150

200

250

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

8000

10 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

133 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

UGANDA Population 2012 36 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 64 (24–120) 175 (67–334)

Incidence (includes HIV+TB) 65 (53–79) 179 (145–216)

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

Extrapulmonary 5 143 (12) Other 1 114 (29)

Other 0 (0)

Total new 43 329 Total retreatment 3 882

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 3.2

Culture (per 5 million population) 0.6

Drug susceptibility testing (per 5 million population) 0.6

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 77

New smear-negative/extrapulmonary 66

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 20 376 (50)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 7%

% Funded internationally 62%

% Unfunded 31%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

200

300

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

2000

2500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

250

500

750

1000

1250

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

5000

10 000

15 000

20 000

25 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

134 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

UNITED REPUBLIC OF TANZANIA Population 2012 48 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 21 393 (35) Treatment after failure 154 (6)

Smear-unknown / not done 0 (0) Treatment after default 201 (7)

Extrapulmonary 14 595 (24) Other 1 359 (49)

Other 0 (0)

Total new 61 126 Total retreatment 2 766

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 2.0

Culture (per 5 million population) 0.4

Drug susceptibility testing (per 5 million population) 0.1

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 20 269 (39)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

HIV-positive people screened for TB 357 400

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 500 (140–1 300) 0 (0–160)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 14%

% Funded internationally 19%

% Unfunded 67%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

200

400

600

800

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

100

1995 1997 1999 2001 2003 2005 2007 2009 2011

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

5000

10 000

15 000

20 000

25 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

135 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

VIET NAM Population 2012 91 million

HIGH TB BURDEN | HIGH HIV BURDEN | HIGH MDR-TB BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

Incidence (includes HIV+TB) 130 (99–170) 147 (109–192)

Incidence (HIV+TB only) 9.3 (6.9–12) 10 (7.6–13)

Case detection, all forms (%) 76 (59–100)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 21 706 (23) Treatment after failure 567 (6)

Smear-unknown / not done Treatment after default 494 (5)

'ZVTCRWNOQPCT[   1VJGT  

Other 3 210 (3)

Total new 94 853 Total retreatment 9 053

Other (history unknown)

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 0.9

Culture (per 5 million population) 1.4

Drug susceptibility testing (per 5 million population) 0.1

+UUGEQPFNKPGFTWIUWUEGRVKDKNKV[VGUVKPICXCKNCDNG! ;GUKPEQWPVT[

6TGCVOGPVUWEEGUUTCVG    

New smear-positive and/or culture-positive 93

New smear-negative/extrapulmonary 93

4GVTGCVOGPV 

Is rifampicin used throughout treatment for new patients? No

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 4 775 (7)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT 5 663

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

(WPFGFFQOGUVKECNN[ 

% Funded internationally 20%

% Unfunded 72%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

250

500

750

1000

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

100

1995 1997 1999 2001 2003 2005 2007 2009 2011

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

2000

4000

6000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

136 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Data are as reported to WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with

countries.

a Ranges represent uncertainty intervals.

ZIMBABWE Population 2012 14 million

HIGH TB BURDEN | HIGH HIV BURDEN

Estimates of TB burdena 2012

07/$'4(thousands)4#6'(per 100 000 population)

Mortality (excludes HIV+TB) 4.6 (0.16–16) 33 (1.2–117)

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 59 (13–140) 433 (92–1 034)

Incidence (includes HIV+TB) 77 (60–97) 562 (434–706)

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 46 (37–60)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 14 354 (42) Treatment after failure 200 (5)

Smear-unknown / not done 2 962 (9) Treatment after default 176 (4)

'ZVTCRWNOQPCT[   1VJGT  

Other 0 (0)

Total new 34 391 Total retreatment 4 329

Other (history unknown) 0

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012

Smear (per 100 000 population) 1.3

Culture (per 5 million population) 0.7

Drug susceptibility testing (per 5 million population) 0.7

Is second-line drug susceptibility testing available? No

6TGCVOGPVUWEEGUUTCVG    

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

+UTKHCORKEKPWUGFVJTQWIJQWVVTGCVOGPVHQTPGYRCVKGPVU! ;GU

TB/HIV 2012 07/$'4 (%)

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 23 957 (70)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB

HIV-positive people provided with IPT

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 570 (300–960) 360 (76–970)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

Financing TB control 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 4%

% Funded internationally 39%

% Unfunded 56%

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

100

150

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

500

1000

1500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

250

500

750

1000

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

HIV-positive TB patients on CPT on ART

10 000

20 000

30 000

40 000

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

#00':

Regional proßles

139 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WHO AFRICAN REGION Population 2012 893 million

WHO MEMBER STATES 46

Estimates of TB burdena 2012

 07/$'4thousands 4#6'per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 2 700 (2 100–3 300) 303 (239–373)

Incidence (includes HIV+TB) 2 300 (2 100–2 500) 255 (235–275)

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 59 (55–64)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 345 947 (27) Treatment after failure 9 174 (7.2)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

'ZVTCRWNOQPCT[   1VJGT  

1VJGT     

Total new 1 282 355 Total retreatment 128 267

Other (history unknown) 2 017

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012 07/$'41(/'/$'456#6'5b

5OGCTRGTRQRWNCVKQPÜ QWVQH

%WNVWTGRGTOKNNKQPRQRWNCVKQPÜ QWVQH

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQPÜ QWVQH

6TGCVOGPVUWEEGUUTCVG 

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

New smear-negative/extrapulmonary 76

4GVTGCVOGPV 

/&46$EQJQTV 

TB/HIV 2012 07/$'4 (%)c

TB patients with known HIV status 1 040 292 (74)

*+8RQUKVKXG6$RCVKGPVU  

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB 2 391 601

HIV-positive people provided with IPT 473 214

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 24 000 (2 100–46 000) 14 000 (5 600–22 000)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

(KPCPEKPI6$EQPVTQNNQYCPFOKFFNGKPEQOGEQWPVTKGUd 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 44

% Funded internationally 21

% Unfunded 36

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Data are not collected from all Member States.

c Calculations exclude countries with missing numerators or denominators.

d Financing indicators exclude funding for general healthcare services provided outside NTPs.

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

250

500

750

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

400

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

HIV-positive TB patients on CPT on ART

2004 2005 2006 2007 2008 2009 2010 2011 2012

100

200

300

400

500

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

500

1000

1500

140 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

WHO REGION OF THE AMERICAS Population 2012 961 million

WHO MEMBER STATES 35

OTHER COUNTRIES AND TERRITORIES 11

Estimates of TB burdena 2012

 07/$'4thousands 4#6'per 100 000 population)

Mortality (excludes HIV+TB) 19 (16–21) 1.9 (1.7–2.2)

/QTVCNKV[*+86$QPN[ ¿ ¿

Prevalence (includes HIV+TB) 390 (300–490) 40 (31–51)

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 35 606 (17) Treatment after failure 1 195 (5.0)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

'ZVTCRWNOQPCT[   1VJGT  

1VJGT     

Total new 208 845 Total retreatment 23 811

Other (history unknown) 39

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012 07/$'41(/'/$'456#6'5b

5OGCTRGTRQRWNCVKQPÜ QWVQH

%WNVWTGRGTOKNNKQPRQRWNCVKQPÜ QWVQH

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQPÜ QWVQH

6TGCVOGPVUWEEGUUTCVG 

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

New smear-negative/extrapulmonary 71

4GVTGCVOGPV 

/&46$EQJQTV 

TB/HIV 2012 07/$'4 (%)c

TB patients with known HIV status 129 174 (56)

HIV-positive TB patients 20 355 (16)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

*+8RQUKVKXGRGQRNGRTQXKFGFYKVJ+26  

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

(KPCPEKPI6$EQPVTQNNQYCPFOKFFNGKPEQOGEQWPVTKGUd 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 69

% Funded internationally 12

% Unfunded 19

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

150

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

HIV-positive TB patients on CPT on ART

2004 2005 2006 2007 2008 2009 2010 2011 2012

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

150

200

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Data are not collected from all Member States.

c Calculations exclude countries with missing numerators or denominators.

d Financing indicators exclude funding for general healthcare services provided outside NTPs.

141 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WHO EASTERN MEDITERRANEAN REGION Population 2012 617 million

WHO MEMBER STATES 22

OTHER COUNTRIES AND TERRITORIES 1

Estimates of TB burdena 2012

 07/$'4thousands 4#6'per 100 000 population)

Mortality (excludes HIV+TB) 100 (63–150) 16 (10–24)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

Incidence (includes HIV+TB) 670 (590–750) 109 (96–122)

+PEKFGPEG*+86$QPN[ ¿ ¿

Case detection, all forms (%) 63 (56–71)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 135 346 (33) Treatment after failure 2 007 (9.5)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV  

Extrapulmonary 90 943 (22) Other 5 200 (24)

1VJGT     

Total new 409 477 Total retreatment 21 228

1VJGTJKUVQT[WPMPQYP     

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012 07/$'41(/'/$'456#6'5b

5OGCTRGTRQRWNCVKQPÜ QWVQH

%WNVWTGRGTOKNNKQPRQRWNCVKQPÜ QWVQH

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQPÜ QWVQH

6TGCVOGPVUWEEGUUTCVG 

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

/&46$EQJQTV 

TB/HIV 2012 07/$'4 (%)c

6$RCVKGPVUYKVJMPQYP*+8UVCVWU  

HIV-positive TB patients 2 020 (3.5)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB 15 012

HIV-positive people provided with IPT 243

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 11 000 (320–36 000) 6 900 (2 400–11 000)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

(KPCPEKPI6$EQPVTQNNQYCPFOKFFNGKPEQOGEQWPVTKGUd 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 32

% Funded internationally 53

% Unfunded 16

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

200

300

400

500

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

150

200

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

HIV-positive TB patients on CPT on ART

2004 2005 2006 2007 2008 2009 2010 2011 2012

0.5

1.0

1.5

2.0

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

100

150

200

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Data are not collected from all Member States.

c Calculations exclude countries with missing numerators or denominators.

d Financing indicators exclude funding for general healthcare services provided outside NTPs.

142 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

WHO EUROPEAN REGION Population 2012 905 million

WHO MEMBER STATES 53

OTHER COUNTRIES AND TERRITORIES 1

Estimates of TB burdena 2012

 07/$'4thousands 4#6'per 100 000 population)

Mortality (excludes HIV+TB) 36 (35–36) 3.9 (3.9–4)

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 19 (17–21) 2.1 (1.9–2.3)

Case detection, all forms (%) 74 (70–79)

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG  

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV 

Extrapulmonary 39 029 (16) Other 51 237 (55)

1VJGT     

Total new 242 266 Total retreatment 92 847

Other (history unknown) 2 054

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012 07/$'41(/'/$'456#6'5b

5OGCTRGTRQRWNCVKQPÜ QWVQH

%WNVWTGRGTOKNNKQPRQRWNCVKQPÜ QWVQH

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQPÜ QWVQH

6TGCVOGPVUWEEGUUTCVG 

New smear-positive and/or culture-positive 65

New smear-negative/extrapulmonary 79

4GVTGCVOGPV 

/&46$EQJQTV 

TB/HIV 2012 07/$'4 (%)c

TB patients with known HIV status 203 705 (60)

HIV-positive TB patients 12 900 (6.3)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

HIV-positive people screened for TB 23 567

*+8RQUKVKXGRGQRNGRTQXKFGFYKVJ+26  

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

(KPCPEKPI6$EQPVTQNNQYCPFOKFFNGKPEQOGEQWPVTKGUd 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 92

% Funded internationally 3.7

% Unfunded 4.3

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

150

200

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

HIV-positive TB patients on CPT on ART

2004 2005 2006 2007 2008 2009 2010 2011 2012

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

500

1000

1500

2000

2500

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Data are not collected from all Member States.

c Calculations exclude countries with missing numerators or denominators.

d Financing indicators exclude funding for general healthcare services provided outside NTPs.

143 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WHO SOUTH-EAST ASIA REGION Population 2012 1 833 million

WHO MEMBER STATES 11

Estimates of TB burdena 2012

 07/$'4thousands 4#6'per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

/QTVCNKV[*+86$QPN[ ¿ ¿

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEG*+86$QPN[ ¿ ¿

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

5OGCTPGICVKXG   6TGCVOGPVCHVGTHCKNWTG 

Smear-unknown / not done 0 (0) Treatment after default 69 100 (21)

'ZVTCRWNOQPCT[   1VJGT  

1VJGT     

Total new 1 993 614 Total retreatment 332 580

Other (history unknown) 5 261

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012 07/$'41(/'/$'456#6'5b

5OGCTRGTRQRWNCVKQPÜ QWVQH

%WNVWTGRGTOKNNKQPRQRWNCVKQPÜ QWVQH

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQPÜ QWVQH

6TGCVOGPVUWEEGUUTCVG 

0GYUOGCTRQUKVKXGCPFQTEWNVWTGRQUKVKXG 

0GYUOGCTPGICVKXGGZVTCRWNOQPCT[ 

4GVTGCVOGPV 

/&46$EQJQTV 

TB/HIV 2012 07/$'4 (%)c

TB patients with known HIV status 904 223 (39)

HIV-positive TB patients 56 093 (6.2)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46 

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

*+8RQUKVKXGRGQRNGRTQXKFGFYKVJ+26  

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

pulmonary TB cases 36 000 (26 000–46 000) 54 000 (37 000–70 000)

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

(KPCPEKPI6$EQPVTQNNQYCPFOKFFNGKPEQOGEQWPVTKGUd 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 30

% Funded internationally 41

% Unfunded 29

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

200

400

600

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

200

300

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

HIV-positive TB patients on CPT on ART

2004 2005 2006 2007 2008 2009 2010 2011 2012

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

200

400

600

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Data are not collected from all Member States.

c Calculations exclude countries with missing numerators or denominators.

d Financing indicators exclude funding for general healthcare services provided outside NTPs.

144 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

WHO WESTERN PACIFIC REGION Population 2012 1 846 million

WHO MEMBER STATES 27

OTHER COUNTRIES AND TERRITORIES 9

Estimates of TB burdena 2012

 07/$'4thousands 4#6'per 100 000 population)

/QTVCNKV[GZENWFGU*+86$ ¿ ¿

Mortality (HIV+TB only) 5 (4–5) 0.26 (0.23–0.29)

2TGXCNGPEGKPENWFGU*+86$ ¿ ¿

+PEKFGPEGKPENWFGU*+86$ ¿ ¿

Incidence (HIV+TB only) 24 (21–27) 1.3 (1.1–1.5)

%CUGFGVGEVKQPCNNHQTOU ¿ 

6$ECUGPQVKßECVKQPU    

0'9%#5'5   4'64'#6/'06%#5'5  

5OGCTRQUKVKXG   4GNCRUG  

Smear-negative 691 714 (55) Treatment after failure 3 714 (4.6)

5OGCTWPMPQYPPQVFQPG   6TGCVOGPVCHVGTFGHCWNV 

'ZVTCRWNOQPCT[   1VJGT  

1VJGT     

Total new 1 264 217 Total retreatment 80 017

Other (history unknown) 1 232

6QVCNPGYCPFTGNCRUG   6QVCNECUGUPQVKßGF 

New cases

  5/'#40')#6+8'70-0190

 5/'#4215+6+8' 016&10' ':64#27./10#4;

/(TCVKQ   

#IG   

Laboratories 2012 07/$'41(/'/$'456#6'5b

5OGCTRGTRQRWNCVKQPÜ QWVQH

%WNVWTGRGTOKNNKQPRQRWNCVKQPÜ QWVQH

&TWIUWUEGRVKDKNKV[VGUVKPIRGTOKNNKQPRQRWNCVKQPÜ QWVQH

6TGCVOGPVUWEEGUUTCVG 

New smear-positive and/or culture-positive 94

New smear-negative/extrapulmonary 93

4GVTGCVOGPV 

/&46$EQJQTV 

TB/HIV 2012 07/$'4 (%)c

TB patients with known HIV status 451 302 (34)

HIV-positive TB patients 14 119 (3.1)

*+8RQUKVKXG6$RCVKGPVUQPEQVTKOQZC\QNGRTGXGPVKXGVJGTCR[%26  

*+8RQUKVKXG6$RCVKGPVUQPCPVKTGVTQXKTCNVJGTCR[#46  

*+8RQUKVKXGRGQRNGUETGGPGFHQT6$  

*+8RQUKVKXGRGQRNGRTQXKFGFYKVJ+26  

Estimates of MDR-TB burden 2012a 0'9 4'64'#6/'06

QH6$ECUGUYKVJ/&46$ ¿ ¿

/&46$ECUGUCOQPIPQVKßGF

RWNOQPCT[6$ECUGU ¿ ¿

Reported cases of MDR-TB 20120'9 4'64'#6/'06 616#.

%CUGUVGUVGFHQT/&46$   

.CDQTCVQT[EQPßTOGF/&46$ECUGU   

2CVKGPVUUVCTVGFQP/&46$VTGCVOGPV   

(KPCPEKPI6$EQPVTQNNQYCPFOKFFNGKPEQOGEQWPVTKGUd 2013

0CVKQPCN6$RTQITCOOGDWFIGV75OKNNKQPU 

% Funded domestically 50

% Funded internationally 15

% Unfunded 36

Mortality (excludes HIV+TB) (rate

per 100 000 population per year)

1990 1995 2000 2005 2010

Prevalence

(rate per 100 000 population)

1990 1995 2000 2005 2010

100

200

300

400

Incidence (rate per 100 000

population per year)

1990 1995 2000 2005 2010

Incidence Incidence (HIV+TB) Notifications

100

150

200

Treatment success rate (%)

New smear-positive (and/or culture-positive) Retreatment

New smear-negative/extrapulmonary

1995 1997 1999 2001 2003 2005 2007 2009 2011

100

Number of patients

HIV-positive TB patients on CPT on ART

2004 2005 2006 2007 2008 2009 2010 2011 2012

Total budget (US$ millions)

Funded domestically Funded internationally Unfunded

2009 2010 2011 2012 2013

200

400

600

800

&CVCCTGCUTGRQTVGFVQ9*1'UVKOCVGUQH6$CPF/&46$DWTFGPCTGRTQFWEGFD[9*1KPEQPUWNVCVKQPYKVJ

countries.

a 4CPIGUTGRTGUGPVWPEGTVCKPV[KPVGTXCNU

b Data are not collected from all Member States.

c Calculations exclude countries with missing numerators or denominators.

d Financing indicators exclude funding for general healthcare services provided outside NTPs.

#00':

Key indicators for the

world, WHO regions

and individual countries

Summary by WHO region 147

#HTKECP4GIKQP 

4GIKQPQHVJG#OGTKECU 

'CUVGTP/GFKVGTTCPGCP4GIKQP 

'WTQRGCP4GIKQP 

5QWVJ'CUV#UKC4GIKQP 

9GUVGTP2CEKßE4GIKQP 

57//#4;$;9*14')+10

Table A4.1 Estimates of the burden of disease caused by TB, 1990–2012 149

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

Table A4.4 Treatment outcomes, new smear-positive cases, 1995–2011 152

Table A4.5 Treatment outcomes, retreatment cases, 1995–2011 152

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

149 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SUMMARY BY WHO REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEa

Global 1990 5 298 1 300 (1 100–1 500) 25 (21–29) 15 000 (13 000–16 000) 274 (249–302) 7 800 (7 200–8 500) 147 (136–160)

1995 5 718 1 400 (1 100–1 600) 24 (20–28) 16 000 (14 000–17 000) 275 (251–301) 8 400 (7 900–9 000) 148 (139–157)

2000 6 102 1 400 (1 100–1 600) 22 (18–27) 16 000 (14 000–18 000) 263 (237–290) 9 000 (8 500–9 500) 148 (139–156)

2005 6 489 1 200 (1 000–1 400) 19 (16–22) 15 000 (13 000–16 000) 225 (200–250) 9 200 (8 700–9 700) 142 (134–150)

2010 6 890 1 000 (850–1 200) 15 (12–17) 13 000 (11 000–14 000) 182 (160–205) 8 800 (8 400–9 100) 128 (123–133)

2011 6 972 980 (820–1 100) 14 (12–16) 12 000 (11 000–14 000) 176 (155–198) 8 700 (8 400–9 100) 125 (120–130)

2012 7 054 940 (790–1 100) 13 (11–16) 12 000 (11 000–13 000) 169 (149–190) 8 600 (8 300–9 000) 122 (117–127)

Africa 1990 503 210 (120–340) 43 (24–67) 2 000 (1 300–3 000) 404 (254–590) 1 200 (950–1 600) 245 (189–309)

1995 577 230 (140–350) 41 (24–61) 2 300 (1 600–3 200) 405 (276–558) 1 600 (1 300–1 900) 275 (226–329)

2000 655 250 (130–400) 38 (20–61) 2 600 (1 700–3 700) 397 (257–567) 2 000 (1 700–2 400) 310 (255–370)

2005 744 240 (130–390) 32 (17–53) 2 700 (1 800–3 800) 364 (239–515) 2 300 (2 000–2 700) 310 (263–361)

2010 847 230 (160–310) 27 (19–36) 2 700 (2 100–3 300) 318 (249–395) 2 300 (2 100–2 500) 271 (249–293)

2011 870 230 (160–310) 26 (18–35) 2 700 (2 100–3 300) 310 (244–383) 2 300 (2 100–2 500) 262 (242–284)

2012 893 230 (160–310) 26 (18–35) 2 700 (2 100–3 300) 303 (239–373) 2 300 (2 100–2 500) 255 (235–275)

The Americas 1990 727 43 (35–52) 5.9 (4.8–7.1) 750 (540–990) 103 (74–136) 430 (370–490) 59 (51–68)

1995 783 37 (32–42) 4.7 (4.1–5.4) 600 (470–750) 76 (59–95) 380 (360–410) 49 (46–52)

2000 841 29 (25–33) 3.5 (3.0–4.0) 510 (390–640) 60 (47–76) 340 (320–370) 41 (38–43)

2005 892 24 (21–27) 2.7 (2.3–3.1) 440 (340–550) 49 (38–61) 310 (290–330) 34 (32–36)

2010 942 21 (18–24) 2.2 (1.9–2.5) 390 (300–490) 41 (32–52) 280 (260–300) 30 (28–32)

2011 951 19 (17–22) 2 (1.8–2.3) 400 (300–500) 42 (32–53) 280 (260–300) 30 (28–32)

2012 961 19 (16–21) 1.9 (1.7–2.2) 390 (300–490) 40 (31–51) 280 (260–300) 29 (27–31)

Eastern 1990 378 120 (57–200) 32 (15–54) 1 100 (600–1 600) 279 (159–433) 460 (360–580) 122 (94–153)

Mediterranean 1995 429 130 (67–210) 30 (16–50) 1 200 (720–1 700) 272 (168–401) 530 (470–590) 123 (109–137)

2000 480 140 (70–230) 29 (15–48) 1 200 (740–1 800) 256 (155–383) 560 (500–630) 118 (104–132)

2005 533 120 (65–190) 23 (12–36) 1 200 (740–1 700) 216 (138–312) 600 (530–670) 112 (99–126)

2010 593 100 (61–150) 17 (10–25) 1 100 (710–1 500) 184 (120–260) 650 (570–720) 109 (96–122)

2011 605 100 (62–150) 17 (10–25) 1 100 (720–1 600) 182 (119–258) 660 (580–740) 109 (97–122)

2012 617 100 (63–150) 16 (10–24) 1 100 (730–1 600) 180 (118–256) 670 (590–750) 109 (96–122)

Europe 1990 849 39 (36–43) 4.6 (4.2–5.1) 610 (500–720) 71 (59–85) 370 (350–380) 43 (41–45)

1995 863 60 (58–62) 6.9 (6.7–7.2) 1 000 (840–1 200) 120 (97–144) 560 (530–590) 65 (62–69)

2000 870 71 (69–73) 8.1 (7.9–8.4) 1 100 (890–1 400) 129 (103–159) 640 (600–680) 73 (69–78)

2005 882 66 (64–67) 7.4 (7.3–7.6) 910 (700–1 100) 103 (79–130) 570 (530–600) 64 (60–68)

2010 899 44 (43–46) 4.9 (4.8–5.1) 620 (470–790) 68 (52–87) 420 (400–450) 47 (44–50)

2011 902 40 (39–41) 4.5 (4.4–4.6) 580 (440–740) 64 (49–82) 400 (380–430) 44 (42–47)

2012 905 36 (35–36) 3.9 (3.9–4.0) 510 (380–650) 56 (42–72) 360 (340–390) 40 (38–43)

South-East 1990 1 310 570 (410–750) 43 (31–57) 6 100 (5 200–7 000) 465 (400–535) 2 900 (2 500–3 200) 218 (192–246)

Asia 1995 1 435 640 (460–840) 44 (32–58) 6 700 (5 800–7 700) 469 (404–538) 3 100 (2 800–3 400) 218 (198–239)

2000 1 560 680 (500–890) 43 (32–57) 7 000 (6 000–8 100) 449 (387–516) 3 400 (3 200–3 700) 220 (203–237)

2005 1 682 620 (480–780) 37 (29–47) 6 300 (5 300–7 400) 375 (314–442) 3 600 (3 300–3 900) 213 (197–229)

2010 1 790 500 (370–660) 28 (21–37) 5 200 (4 000–6 600) 293 (224–371) 3 500 (3 200–3 700) 194 (181–208)

2011 1 812 480 (350–620) 26 (19–34) 5 000 (3 900–6 400) 278 (213–352) 3 500 (3 200–3 700) 191 (177–204)

2012 1 833 450 (330–590) 25 (18–32) 4 800 (3 700–6 100) 264 (203–333) 3 400 (3 200–3 700) 187 (174–200)

Western 1990 1 532 320 (280–350) 21 (18–23) 4 000 (3 600–4 400) 261 (238–286) 2 500 (2 100–2 900) 161 (135–189)

Pacific 1995 1 630 260 (230–300) 16 (14–18) 3 900 (3 500–4 300) 238 (216–262) 2 300 (2 000–2 600) 138 (120–158)

2000 1 697 200 (160–230) 12 (9.6–14) 3 600 (3 200–4 000) 210 (187–234) 2 000 (1 800–2 300) 119 (106–133)

2005 1 756 150 (140–170) 8.6 (7.9–9.5) 3 100 (2 700–3 400) 174 (156–193) 1 800 (1 700–2 000) 105 (95–115)

2010 1 820 120 (110–130) 6.4 (5.9–7.1) 2 500 (2 300–2 800) 139 (124–153) 1 700 (1 500–1 800) 92 (84–100)

2011 1 833 110 (100–120) 6.1 (5.5–6.7) 2 500 (2 200–2 700) 134 (120–148) 1 600 (1 500–1 800) 90 (82–98)

2012 1 846 110 (96–120) 5.8 (5.2–6.4) 2 400 (2 100–2 600) 128 (115–142) 1 600 (1 500–1 800) 87 (80–95)

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

a Rates are per 100 000 population.

150 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEaNUMBER RATEaPERCENT

Global 1990 5 298 7 800 (7 200–8 500) 147 (136–160) 280 (230–320) 5.2 (4.4–6.1) 3 740 222 71 48 (44–52)

1995 5 718 8 400 (7 900–9 000) 148 (139–157) 620 (560–680) 11 (9.8–12) 3 400 278 59 40 (38–43)

2000 6 102 9 000 (8 500–9 500) 148 (139–156) 1 100 (960–1 200) 17 (16–19) 3 748 455 61 42 (39–44)

2005 6 489 9 200 (8 700–9 700) 142 (134–150) 1 300 (1 200–1 400) 20 (18–21) 5 148 342 79 56 (53–59)

2010 6 890 8 800 (8 400–9 100) 128 (123–133) 1 100 (1 100–1 200) 17 (15–18) 5 792 075 84 66 (63–69)

2011 6 972 8 700 (8 400–9 100) 125 (120–130) 1 100 (1 000–1 200) 16 (15–17) 5 833 253 84 67 (64–70)

2012 7 054 8 600 (8 300–9 000) 122 (117–127) 1 100 (1 000–1 200) 15 (14–16) 5 776 838 82 67 (64–70)

Africa 1990 503 1 200 (950–1 600) 245 (189–309) 230 (190–280) 46 (38–56) 418 520 83 34 (27–44)

1995 577 1 600 (1 300–1 900) 275 (226–329) 460 (410–520) 80 (71–91) 504 377 87 32 (27–39)

2000 655 2 000 (1 700–2 400) 310 (255–370) 780 (690–880) 119 (105–134) 794 464 121 39 (33–48)

2005 744 2 300 (2 000–2 700) 310 (263–361) 960 (850–1 100) 130 (115–145) 1 188 876 160 52 (44–61)

2010 847 2 300 (2 100–2 500) 271 (249–293) 880 (800–950) 103 (94–113) 1 380 530 163 60 (56–65)

2011 870 2 300 (2 100–2 500) 262 (242–284) 850 (780–930) 98 (89–107) 1 386 327 159 61 (56–66)

2012 893 2 300 (2 100–2 500) 255 (235–275) 830 (760–910) 93 (85–102) 1 344 122 151 59 (55–64)

The Americas 1990 727 430 (370–490) 59 (51–68) 17 (14–20) 2.3 (2.0–2.7) 231 215 32 54 (47–63)

1995 783 380 (360–410) 49 (46–52) 31 (28–33) 3.9 (3.6–4.3) 258 232 33 67 (63–72)

2000 841 340 (320–370) 41 (38–43) 32 (30–35) 3.8 (3.5–4.2) 238 636 28 70 (65–75)

2005 892 310 (290–330) 34 (32–36) 34 (31–37) 3.8 (3.5–4.1) 230 124 26 75 (71–81)

2010 942 280 (260–300) 30 (28–32) 33 (30–36) 3.5 (3.1–3.8) 214 930 23 76 (71–82)

2011 951 280 (260–300) 30 (28–32) 33 (30–36) 3.5 (3.1–3.8) 221 625 23 78 (73–84)

2012 961 280 (260–300) 29 (27–31) 31 (28–34) 3.3 (3.0–3.6) 219 349 23 79 (74–85)

Eastern 1990 378 460 (360–580) 122 (94–153) 0.91 (0.77–1.1) 0.2 (0.20–0.28) 234 620 62 51 (40–66)

Mediterranean 1995 429 530 (470–590) 123 (109–137) 2.8 (2.5–3.2) 0.7 (0.59–0.74) 121 745 28 23 (21–26)

2000 480 560 (500–630) 118 (104–132) 5.9 (5.3–6.6) 1.2 (1.1–1.4) 141 748 30 25 (22–28)

2005 533 600 (530–670) 112 (99–126) 8.6 (7.6–9.6) 1.6 (1.4–1.8) 287 178 54 48 (43–54)

2010 593 650 (570–720) 109 (96–122) 11 (9.9–12) 1.9 (1.7–2.1) 412 913 70 64 (57–72)

2011 605 660 (580–740) 109 (97–122) 11 (9.7–12) 1.8 (1.6–1.9) 415 719 69 63 (56–71)

2012 617 670 (590–750) 109 (96–122) 11 (10–12) 1.8 (1.6–2.0) 420 769 68 63 (56–71)

Europe 1990 849 370 (350–380) 43 (41–45) 1.8 (1.8–1.9) 0.2 (0.21–0.23) 242 429 29 66 (63–69)

1995 863 560 (530–590) 65 (62–69) 3.4 (3.3–3.6) 0.4 (0.38–0.42) 289 874 34 51 (49–54)

2000 870 640 (600–680) 73 (69–78) 6.7 (6.2–7.1) 0.8 (0.71–0.82) 373 094 43 59 (55–62)

2005 882 570 (530–600) 64 (60–68) 17 (15–18) 1.9 (1.7–2.0) 368 624 42 65 (61–70)

2010 899 420 (400–450) 47 (44–50) 20 (18–21) 2.2 (2.0–2.4) 328 254 37 77 (73–83)

2011 902 400 (380–430) 44 (42–47) 19 (18–21) 2.1 (2.0–2.3) 312 588 35 78 (73–83)

2012 905 360 (340–390) 40 (38–43) 19 (17–21) 2.1 (1.9–2.3) 286 765 32 79 (74–84)

South-East 1990 1 310 2 900 (2 500–3 200) 218 (192–246) 22 (19–26) 1.7 (1.5–2.0) 1 719 365 131 60 (53–68)

Asia 1995 1 435 3 100 (2 800–3 400) 218 (198–239) 110 (96–120) 7.5 (6.7–8.4) 1 401 096 98 45 (41–49)

2000 1 560 3 400 (3 200–3 700) 220 (203–237) 210 (190–230) 13 (12–15) 1 414 228 91 41 (38–45)

2005 1 682 3 600 (3 300–3 900) 213 (197–229) 220 (200–240) 13 (12–14) 1 789 388 106 50 (46–54)

2010 1 790 3 500 (3 200–3 700) 194 (181–208) 180 (160–190) 9.9 (9.1–11) 2 124 237 119 61 (57–66)

2011 1 812 3 500 (3 200–3 700) 191 (177–204) 170 (160–180) 9.4 (8.7–10) 2 142 573 118 62 (58–67)

2012 1 833 3 400 (3 200–3 700) 187 (174–200) 170 (160–180) 9.2 (8.5–10) 2 130 120 116 62 (58–67)

Western 1990 1 532 2 500 (2 100–2 900) 161 (135–189) 1.8 (1.5–2.1) 0.1 (0.10–0.14) 894 073 58 36 (31–43)

Pacific 1995 1 630 2 300 (2 000–2 600) 138 (120–158) 8.6 (7.4–9.9) 0.5 (0.45–0.61) 824 954 51 37 (32–42)

2000 1 697 2 000 (1 800–2 300) 119 (106–133) 17 (15–19) 1 (0.90–1.1) 786 285 46 39 (35–44)

2005 1 756 1 800 (1 700–2 000) 105 (95–115) 24 (21–27) 1.4 (1.2–1.5) 1 284 152 73 70 (63–77)

2010 1 820 1 700 (1 500–1 800) 92 (84–100) 24 (22–27) 1.3 (1.2–1.5) 1 331 211 73 80 (73–87)

2011 1 833 1 600 (1 500–1 800) 90 (82–98) 24 (22–27) 1.3 (1.2–1.5) 1 354 421 74 83 (76–90)

2012 1 846 1 600 (1 500–1 800) 87 (80–95) 24 (21–27) 1.3 (1.1–1.5) 1 375 713 75 85 (78–93)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

151 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SUMMARY BY WHO REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

Global 1990 3 740 222 30 046 22 393 4 237 0 734 49 783 29 57

1995 3 400 278 1 175 290 1 811 850 262 728 5 59 240 0 59 240 44 39

2000 3 748 455 1 541 607 1 615 263 399 677 37 115 334 236 107 351 441 229 49

2005 5 148 342 2 413 708 1 722 281 686 525 8 111 259 937 406 355 666 292 18 172 58

2010 5 792 075 2 655 557 2 002 463 806 373 12 870 285 966 418 071 704 037 28 846 57

2011 5 833 253 2 630 564 2 037 926 817 668 12 164 284 815 413 363 698 178 50 116 56

• 71 82 • 2012 5 776 838 2 563 744 2 084 246 813 960 9 689 288 119 393 437 681 556 17 080 55

Africa 1990 418 520 24 064 6 137 2 067 0 554 49 603 0 80

1995 504 377 212 910 191 477 72 689 0 15 133 0 15 133 0 53

2000 794 464 368 750 222 230 141 255 0 19 173 68 118 87 291 0 62

2005 1 188 876 550 004 364 785 208 979 2 941 60 092 66 449 126 541 2 075 60

2010 1 380 530 601 149 477 516 247 020 561 53 967 94 506 148 473 317 56

2011 1 386 327 606 085 467 022 240 839 1 073 52 357 74 545 126 902 18 951 56

• 83 151 • 2012 1 344 122 600 355 446 213 234 707 977 60 085 67 960 128 045 1 785 57

The Americas 1990 231 215 1 542 516 723 0 180 0 180 29 75

1995 258 232 138 932 72 312 32 991 5 1 723 0 1 723 44 66

2000 238 636 131 294 60 392 32 037 37 10 834 14 344 25 178 56 68

2005 230 124 124 840 56 056 33 285 3 685 10 152 12 481 22 633 2 106 69

2010 214 930 116 994 52 265 32 240 2 133 10 413 12 133 22 546 885 69

2011 221 625 122 010 51 165 34 048 1 502 10 087 11 856 21 943 2 813 70

• 32 23 • 2012 219 349 122 730 50 338 34 496 1 636 10 100 13 879 23 979 49 71

Eastern 1990 234 620 1 587 12 394 754 0 0 0 0 0 11

Mediterranean 1995 121 745 46 851 51 823 33 382 0 2 407 0 2 407 0 47

2000 141 748 60 959 34 289 40 754 0 5 568 0 5 568 0 64

2005 287 178 113 765 102 274 64 612 12 6 495 5 334 11 829 20 53

2010 412 913 168 627 137 301 92 070 633 11 203 8 713 19 916 3 079 55

2011 415 719 170 748 135 388 93 605 623 11 223 10 102 21 325 4 132 56

• 62 68 • 2012 420 769 173 963 143 869 90 943 702 11 208 10 020 21 228 84 55

Europe 1990 242 429 0 0 0 0 0 0 0 0

1995 289 874 104 444 146 592 29 866 0 7 927 0 7 927 0 42

2000 373 094 94 442 208 147 35 081 0 21 607 19 127 40 734 173 31

2005 368 624 96 121 157 237 49 747 0 22 248 64 831 87 079 3 663 38

2010 328 254 91 324 145 140 40 951 8 008 24 304 60 736 85 040 18 527 39

2011 312 588 85 551 136 456 46 012 3 381 24 628 67 986 92 614 16 560 39

• 29 32 • 2012 286 765 80 453 129 293 43 134 83 25 133 65 121 90 254 8 669 38

South-East 1990 1 719 365 2 769 3 241 656 0 0 0 0 0 46

Asia 1995 1 401 096 357 882 939 945 76 865 0 5 546 0 5 546 0 28

2000 1 414 228 510 053 741 471 120 708 0 27 095 80 444 107 539 0 41

2005 1 789 388 857 371 594 185 242 332 1 439 93 859 158 215 252 074 202 59

2010 2 124 237 1 047 013 615 463 328 421 1 508 130 714 208 542 339 256 1 118 63

2011 2 142 573 1 067 367 598 800 333 993 2 878 135 650 215 554 351 204 3 885 64

• 131 116 • 2012 2 130 120 1 065 852 586 455 338 303 3 004 131 245 201 335 332 580 5 261 65

Western 1990 894 073 84 105 37 0 0 0 0 0 44

Pacific 1995 824 954 314 271 409 701 16 935 0 26 504 0 26 504 0 43

2000 786 285 376 109 348 734 29 842 0 31 057 54 074 85 131 0 52

2005 1 284 152 671 607 447 744 87 570 34 67 091 99 045 166 136 10 106 60

2010 1 331 211 630 450 574 778 65 671 27 55 365 33 441 88 806 4 920 52

2011 1 354 421 578 803 649 095 69 171 2 707 50 870 33 320 84 190 3 775 47

• 58 75 • 2012 1 375 713 520 391 728 078 72 377 3 287 50 348 35 122 85 470 1 232 42

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

152 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Global 1995 1 175 290 1 000 581 85 40 17 3 1 5 34

2000 1 541 607 1 452 991 94 60 941719

2005 2 413 708 2 396 387 99 7774254

2009 2 662 588 2 664 704 100 8074244

2010 2 655 557 2 661 653 100 80 7 4 2 4 3

• 57 87 • 2011 2 630 564 2 610 821 99 80 7 4244

Africa 1995 212 910 177 567 83 46 14 6 2 12 20

2000 368 750 364 804 99 59 12 7 1 11 10

2005 550 004 563 750 102 62 13 7 1 9 7

2009 607 254 605 932 100 70 10 5 1 6 7

2010 601 149 598 985 100 72 9 5 1 6 6

• 60 82 • 2011 606 085 578 920 96 72 10 5166

The Americas 1995 138 932 128 531 93 37 14 3 1 6 39

2000 131 294 110 642 84 60 17 5 1 8 11

2005 124 840 118 840 95 55 24 5 1 7 9

2009 110 614 122 534 111 53 23 5 1 8 11

2010 116 994 126 450 108 53 22 5 1 8 11

• 50 78 • 2011 122 010 126 859 104 54 23 5279

Eastern 1995 46 851 46 318 99 60 19 2 3 13 4

Mediterranean 2000 60 959 63 749 105 69 12 4 2 8 6

2005 113 765 113 742 100 72 11 3 1 8 5

2009 168 013 167 317 100 74 14 3153

2010 168 627 169 872 101 74 14 2 1 5 3

• 79 88 • 2011 170 748 170 903 100 74 14 2 1 5 4

Europe 1995 104 444 33 823 32 58 10 6 6 4 16

2000 94 442 41 480 44 47 28 5 6 6 7

2005 96 121 81 410 85 59 13 8775

2009 100 493 105 441 105 56 13 8 12 6 5

2010 91 324 98 689 108 54 13 8 12 6 7

• 67 66 • 2011 85 551 106 626 125 51 15 8 8 6 12

South-East 1995 357 882 318 410 89 9 23 1 0 2 64

Asia 2000 510 053 512 286 100 44 6 2 1 7 40

2005 857 371 855 962 100 83 4 4261

2009 1 028 656 1 022 380 99 8534251

2010 1 047 013 1 045 179 100 8544251

• 33 89 • 2011 1 067 367 1 064 879 100 8544251

Western 1995 314 271 295 932 94 67 13 2 1 4 13

Pacific 2000 376 109 360 030 96 85 5 2124

2005 671 607 662 683 99 89 32113

2009 647 558 641 100 99 9032113

2010 630 450 622 478 99 9032113

• 80 94 • 2011 578 803 562 634 97 91 3 2 1 1 2

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Global 1995 59 240 71 395 121 8243334

2000 351 441 188 509 54 60 10 6 4 11 10

2005 666 292 546 182 82 51 19 7 4 12 6

2009 673 854 594 019 88 49 23 7 6 10 5

2010 704 037 613 895 87 47 22 7 5 10 10

• 86 72 • 2011 698 178 601 904 86 48 24 7 5 10 7

Africa 1995 15 133 5 756 38 57 12 9 3 12 6

2000 87 291 44 147 51 47 11 9 3 16 14

2005 126 541 114 838 91 35 27 11 3 13 12

2009 144 320 94 342 65 50 20 9 3 9 10

2010 148 473 113 405 76 41 13 6 3 7 31

• 69 68 • 2011 126 902 85 278 67 53 15 7 3 9 12

The Americas 1995 1 723 1 104 64 61 11 6 4 11 8

2000 25 178 15 302 61 478531225

2005 22 633 18 603 82 38 16 6 2 15 21

2009 21 492 19 158 89 29 22 8 3 19 21

2010 22 546 17 499 78 26 23 7 2 20 21

• 72 51 • 2011 21 943 20 228 92 27 24 8 3 20 18

Eastern 1995 2 407 1 860 77 61 14 3 4 12 5

Mediterranean 2000 5 568 4 217 76 51 11 6 7 15 11

2005 11 829 12 860 109 60 15 5 4 10 6

2009 17 964 16 332 91 56 21 4 3 10 6

2010 19 916 18 326 92 54 21 4 3 10 8

• 75 74 • 2011 21 325 22 191 104 52 22 4 3 10 8

Europe 1995 7 927 480 6 20 20 11 8 32 8

2000 40 734 10 739 26 39 19 9 14 11 8

2005 87 079 39 497 45 32 18 11 13 14 10

2009 67 190 58 966 88 27 22 11 22 11 7

2010 85 040 58 698 69 25 25 11 16 10 13

• 40 47 • 2011 92 614 58 831 64 24 23 10 15 10 18

South-East 1995 5 546 3 271 59 62645158

Asia 2000 107 539 59 337 55 57 14 6 5 15 3

2005 252 074 254 378 101 49 22 7 5 15 2

2009 331 424 332 286 100 48 27 7 4 12 2

2010 339 256 338 748 100 47 28 7 4 12 2

• 68 75 • 2011 351 204 350 251 100 45 30 7 4 11 3

Western 1995 26 504 58 924 222 88 2 3 3 1 3

Pacific 2000 85 131 54 767 64 83 3 2 2 1 9

2005 166 136 106 006 64 8163326

2009 91 464 72 935 80 7973227

2010 88 806 67 219 76 7973227

• 90 86 • 2011 84 190 65 125 77 80 6 3 3 2 6

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

153 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Global 2005 8.3 463 027 5 554 697 103 683 22 76 35 25 938

2010 34 2 080 846 6 210 146 493 186 24 81 46 204 802

2011 40 2 526 072 6 246 616 569 074 23 82 49 446 598

• 8 46 • 2012 46 2 808 221 6 170 275 549 769 20 79 57 518 670

Africa 2005 11 140 713 1 255 325 73 332 52 78 29 22 211

2010 60 888 765 1 475 036 394 332 44 81 44 182 524

2011 69 1 013 342 1 460 872 465 647 46 82 47 438 121

• 11 74 • 2012 74 1 040 262 1 412 082 443 558 43 79 55 473 214

The Americas 2005 35 84 032 242 605 14 232 17 10 81 3 727

2010 53 121 421 227 063 19 615 16 50 63 12 906

2011 56 129 613 233 481 20 497 16 41 69 1 705

• 35 57 • 2012 57 132 943 233 228 20 798 16 63 77 18 710

Eastern 2005 0.88 2 582 292 512 330 13 18 16 0

Mediterranean 2010 11 44 596 421 626 1 360 3 50 44 253

2011 11 48 271 425 821 1 738 3.6 60 31 52

• 1 14 • 2012 14 58 498 430 789 2 036 3.5 69 49 243

Europe 2005 40 171 248 433 455 6 543 2.8 25 16 0

2010 55 212 727 388 990 12 858 5.9 58 61 6 575

2011 57 215 256 380 574 11 790 5.3 63 58 4 565

• 40 60 • 2012 60 212 880 351 886 13 103 6.2 71 62 17 938

South-East 2005 1.6 31 847 1 947 603 7 025 22 50 31 0

Asia 2010 23 546 350 2 332 779 52 519 9.6 86 56 581

2011 33 767 813 2 358 127 55 608 7.2 88 58 368

• 2 39 • 2012 39 909 026 2 331 455 56 093 6.2 89 61 8

Western 2005 2.4 32 605 1 383 197 2 221 6.8 31 33 0

Pacific 2010 20 266 987 1 364 652 12 502 4.6 55 41 1 963

2011 25 351 777 1 387 741 13 794 3.9 71 48 1 787

• 2 32 • 2012 32 454 612 1 410 835 14 181 3.1 79 56 8 557

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

Global 2005 11988 72870 2.9 24002 3.6

2010 54887 118835 4 47315 6.7

2011 61907 133064 4.6 48124 6.9

2012 85085 310 000 (230 000–380 000) 170 000 (98 000–240 000) 153626 5.7 140 000 (91 000–190 000) 60589 8.9

Africa 2005 2445 1826 0.32 3922 3.1

2010 9340 2732 0.36 4294 2.9

2011 12384 1311 0.19 3707 2.9

2012 18146 38 000 (14 000–62 000) 24 000 (2 100–46 000) 2565 0.39 14 000 (5 600–22 000) 4118 3.2

The Americas 2005 4427 14568 11 11003 49

2010 2661 11309 8.6 4234 19

2011 3474 13334 10 4234 19

2012 2967 7 100 (4 600–9 600) 3 800 (2 400–5 200) 29869 23 3 200 (1 100–5 300) 5565 23

Eastern 2005 350 1442 1.3 94 0.79

Mediterranean 2010 873 2397 1.4 1257 6.3

2011 841 2264 1.2 1466 6.9

2012 2249 18 000 (0–42 000) 11 000 (320–36 000) 1990 1.1 6 900 (2 400–11 000) 1617 7.6

Europe 2005 4347 34527 27 7024 8.1

2010 33776 89005 68 34212 40

2011 34199 89438 67 31646 34

2012 36772 74 000 (60 000–88 000) 33 000 (20 000–46 000) 92580 76 41 000 (35 000–46 000) 38268 42

South-East 2005 68 661 <0.1 420 0.17

Asia 2010 3942 1073 0.1 1264 0.37

2011 6615 1204 0.1 1935 0.55

2012 19202 90 000 (71 000–110 000) 36 000 (26 000–46 000) 1352 0.13 54 000 (37 000–70 000) 2292 0.69

Western 2005 351 19846 2.9 1539 0.93

Pacific 2010 4295 12319 1.7 2054 2.3

2011 4394 25513 4.2 5136 6.1

2012 5749 78 000 (60 000–95 000) 59 000 (41 000–76 000) 25270 4.6 19 000 (15 000–23 000) 8729 10

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

a TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED

CASES).

b BACT+VE = bacteriologically positive cases.

SUMMARY BY WHO REGION

154 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Global 1995 7 491 48 816 76 799 65 678 49 514 41 756 34 776 0 7 730 41 378 50 102 32 741 22 688 17 816 16 686 0 1.7

2000 12 387 115 250 172 896 156 274 121 277 82 844 75 156 0 14 749 94 641 110 306 74 705 49 823 33 696 33 829 0 1.8

2005 18 415 242 356 329 720 312 526 261 233 184 836 166 858 42 26 178 199 700 220 530 153 503 106 029 72 022 65 717 15 1.8

2010 20 239 268 884 345 937 336 981 298 715 227 530 186 815 7 502 28 825 210 729 225 986 163 260 118 565 86 264 75 368 2 601 1.9

2011 19 701 265 503 349 803 333 792 300 666 229 756 183 782 579 28 133 209 821 224 552 162 884 119 644 87 668 74 004 313 1.9

2012 17 046 246 030 330 650 321 408 290 214 225 684 177 736 268 24 834 197 407 210 454 153 967 115 659 86 968 74 189 172 1.9

Africa 1995 2 910 16 754 28 172 20 240 12 017 7 008 4 104 0 3 167 15 873 19 005 11 339 6 643 3 655 1 734 0 1.5

2000 3 625 29 522 47 654 34 435 17 923 8 970 5 751 0 4 315 29 530 35 386 20 037 9 402 4 581 2 578 0 1.4

2005 7 635 54 066 94 388 71 072 40 974 18 931 12 143 0 10 023 57 115 75 056 43 213 22 855 11 047 7 163 0 1.3

2010 8 393 57 146 98 636 78 660 48 543 24 094 14 478 17 10 287 55 537 76 051 47 070 26 299 13 522 8 685 9 1.4

2011 8 551 59 072 105 549 81 247 49 967 24 393 14 732 516 10 632 57 027 76 968 47 873 26 401 13 543 8 843 301 1.4

2012 6 032 51 158 96 915 79 312 46 870 23 665 14 186 31 8 003 48 828 67 255 43 481 23 378 12 683 8 642 37 1.5

The Americas 1995 437 2 888 3 443 3 157 2 448 1 866 2 251 0 431 2 293 2 434 1 654 1 109 912 1 311 0 1.6

2000 3 464 18 564 21 869 19 787 15 138 9 899 9 717 0 3 535 15 305 14 961 10 323 7 294 5 038 5 894 0 1.6

2005 1 520 16 410 16 671 14 369 12 340 7 801 7 951 0 1 718 12 405 11 563 7 891 5 933 3 788 4 751 0 1.6

2010 1 050 11 461 14 267 11 332 10 627 7 433 7 084 59 1 137 8 405 8 496 5 818 4 880 3 467 4 068 22 1.7

2011 1 103 12 436 15 023 11 704 11 234 7 709 7 198 56 1 241 8 517 8 766 5 875 4 973 3 690 4 243 9 1.8

2012 935 12 125 14 784 11 278 10 716 7 596 6 989 67 1 044 8 615 8 561 5 710 5 023 3 760 4 157 30 1.7

Eastern 1995 2 010 6 796 8 673 5 475 3 731 3 732 2 604 0 1 881 5 035 5 797 3 679 3 047 2 742 1 902 0 1.4

Mediterranean 2000 1 339 8 135 9 002 6 525 4 409 2 990 3 036 0 1 711 6 710 5 780 3 922 2 851 2 039 1 893 0 1.4

2005 1 546 13 558 14 609 10 798 8 729 6 581 5 595 0 2 766 13 529 12 098 8 386 6 245 4 383 3 399 0 1.2

2010 2 316 19 526 19 993 14 908 13 086 10 596 9 521 0 4 377 21 108 17 151 12 183 9 776 7 532 7 032 0 1.1

2011 1 924 19 630 20 303 14 984 13 857 11 049 9 871 0 3 839 21 322 17 214 12 380 10 060 7 770 6 432 0 1.2

2012 1 999 20 119 20 411 15 178 14 006 11 333 10 059 160 3 642 22 258 17 341 12 564 10 187 8 082 6 784 20 1.2

Euro

e 1995 553 3 588 7 046 10 157 7 625 5 716 4 842 0 548 2 906 3 636 2 594 1 549 1 560 3 289 0 2.5

2000 201 4 636 8 322 9 862 8 065 4 313 3 321 0 290 3 506 4 405 2 945 1 798 1 243 2 490 0 2.3

2005 299 6 170 9 151 9 150 8 704 4 443 4 089 42 422 4 667 5 101 3 161 2 242 1 336 3 176 15 2.1

2010 156 7 319 13 259 12 447 12 270 6 916 4 125 7 423 301 4 958 6 559 4 218 3 051 2 033 3 398 2 567 2.4

2011 164 6 536 13 704 13 498 12 966 7 569 4 329 7 257 4 734 6 767 4 507 3 195 2 292 3 693 3 2.3

2012 138 5 997 13 038 13 394 12 301 7 624 4 113 5 224 4 258 6 336 4 387 2 986 2 125 3 528 3 2.4

South-East 1995 165 3 179 6 467 6 508 5 241 4 682 3 523 0 250 2 187 2 834 2 404 2 003 1 866 1 480 0 2.3

Asia 2000 2 453 30 093 45 720 47 107 38 058 25 080 16 208 0 3 222 21 518 25 653 19 241 13 019 8 142 5 468 0 2.1

2005 5 064 94 638 120 560 122 256 107 228 74 084 45 533 0 8 591 71 923 76 779 54 000 37 709 24 289 12 975 0 2.0

2010 6 737 114 806 136 683 142 080 132 411 101 728 67 131 0 10 923 84 006 84 704 63 272 48 470 34 052 20 004 0 2.0

2011 6 490 114 254 136 142 141 636 135 592 106 420 72 264 0 10 654 85 376 84 383 64 868 50 920 36 755 21 593 0 2.0

2012 6 581 111 501 133 040 140 542 136 569 108 866 72 554 0 10 535 85 726 82 947 64 170 52 118 38 516 22 187 0 2.0

Western 1995 1 416 15 611 22 998 20 141 18 452 18 752 17 452 0 1 453 13 084 16 396 11 071 8 337 7 081 6 970 0 1.8

Pacific 2000 1 305 24 300 40 329 38 558 37 684 31 592 37 123 0 1 676 18 072 24 121 18 237 15 459 12 653 15 506 0 2.0

2005 2 351 57 514 74 341 84 881 83 258 72 996 91 547 0 2 658 40 061 39 933 36 852 31 045 27 179 34 253 0 2.2

2010 1 587 58 626 63 099 77 554 81 778 76 763 84 476 3 1 800 36 715 33 025 30 699 26 089 25 658 32 181 3 2.4

2011 1 469 53 575 59 082 70 723 77 050 72 616 75 388 0 1 510 32 845 30 454 27 381 24 095 23 618 29 200 0 2.4

2012 1 361 45 130 52 462 61 704 69 752 66 600 69 835 5 1 386 27 722 28 014 23 655 21 967 21 802 28 891 82 2.4

#(4+%#04')+10

Table A4.1 Estimates of the burden of disease caused by TB, 1990–2012 157

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

Table A4.4 Treatment outcomes, new smear-positive cases, 1995–2011 166

Table A4.5 Treatment outcomes, retreatment cases, 1995–2011 169

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

Table A4.9 Laboratories, NTP services, drug management and infection control, 2012 179

6CDNG# /GCUWTGFRGTEGPVCIGQH6$ECUGUYKVJ/&46$OQUVTGEGPV[GCTCXCKNCDNG 

156 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

157 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

Algeria 1990 26 2.8 (0.970–5.5) 11 (3.7–21) 29 (13–53) 112 (49–202) 17 (13–22) 66 (48–86)

1995 29 2.9 (0.980–5.9) 9.9 (3.4–20) 32 (13–59) 110 (46–203) 20 (15–26) 68 (50–89)

2000 32 4.4 (1.5–8.8) 14 (4.9–28) 47 (20–85) 148 (64–267) 28 (20–36) 87 (64–114)

2005 34 5 (1.7–9.9) 15 (5.1–29) 53 (23–95) 156 (67–281) 31 (23–41) 93 (68–121)

2010 37 5.3 (1.8–11) 14 (5.0–28) 56 (24–100) 151 (65–273) 33 (24–44) 90 (66–118)

2011 38 5.4 (1.9–11) 14 (5.0–29) 57 (25–100) 152 (65–274) 34 (25–44) 90 (66–117)

2012 38 5.6 (1.9–11) 15 (5.1–29) 59 (25–110) 152 (66–274) 34 (25–45) 89 (65–117)

Angola 1990 10 4 (1.0–8.9) 39 (9.9–87) 39 (14–76) 378 (137–738) 21 (13–31) 205 (127–303)

1995 12 6.1 (2.3–12) 50 (19–96) 55 (27–93) 458 (225–772) 27 (22–33) 226 (185–272)

2000 14 5.8 (2.4–11) 42 (17–77) 59 (29–99) 421 (207–709) 35 (28–42) 250 (204–300)

2005 17 4.4 (1.7–8.1) 26 (11–49) 57 (22–110) 347 (132–663) 46 (37–54) 276 (227–329)

2010 20 6.6 (3.0–12) 34 (16–60) 80 (35–140) 411 (181–731) 59 (50–69) 304 (256–355)

2011 20 7.6 (3.5–13) 38 (17–66) 90 (42–160) 447 (209–772) 62 (53–73) 310 (261–362)

2012 21 8.7 (3.9–15) 42 (19–73) 99 (48–170) 474 (230–804) 66 (55–77) 316 (266–369)

Benin 1990 5 0.97 (0.390–1.8) 19 (7.9–36) 9.7 (4.7–17) 195 (93–333) 6.4 (5.3–7.6) 128 (106–152)

1995 6 0.95 (0.390–1.7) 16 (6.6–29) 8.9 (4.3–15) 149 (72–253) 6 (4.9–7.1) 100 (82–118)

2000 7 0.95 (0.400–1.7) 14 (5.8–25) 9.3 (4.6–16) 134 (66–225) 6 (4.9–7.1) 86 (71–102)

2005 8 0.87 (0.380–1.6) 11 (4.7–19) 9.2 (4.6–15) 113 (56–189) 6 (5.0–7.2) 74 (61–88)

2010 10 0.88 (0.390–1.6) 9.3 (4.1–16) 10 (5.0–17) 107 (53–179) 6.5 (5.4–7.8) 69 (57–82)

2011 10 0.91 (0.400–1.6) 9.3 (4.1–17) 11 (5.3–18) 109 (54–182) 6.8 (5.6–8.1) 70 (58–83)

2012 10 0.94 (0.420–1.7) 9.4 (4.2–17) 11 (5.6–18) 110 (55–184) 7 (5.8–8.3) 70 (58–83)

Botswana 1990 1 1.3 (0.095–4.2) 97 (6.9–302) 13 (1.9–33) 915 (135–2 410) 7.4 (2.9–14) 533 (212–997)

1995 2 1.3 (0.076–4.4) 85 (4.8–276) 15 (2.6–37) 925 (166–2 310) 14 (8.8–19) 855 (553–1 220)

2000 2 0.88 (0.046–2.9) 50 (2.6–165) 13 (3.4–28) 720 (194–1 580) 16 (13–20) 918 (736–1 120)

2005 2 0.66 (0.190–1.4) 35 (10–76) 11 (5.2–19) 579 (276–991) 14 (13–15) 733 (667–802)

2010 2 0.48 (0.120–1.1) 24 (6.0–56) 8.1 (3.6–14) 411 (185–727) 9.9 (8.8–11) 503 (449–560)

2011 2 0.45 (0.120–1.0) 23 (5.9–51) 7.5 (3.4–13) 380 (172–668) 9 (8.1–10) 455 (406–507)

2012 2 0.42 (0.110–0.920) 21 (5.5–46) 6.9 (3.1–12) 343 (157–600) 8.2 (7.3–9.1) 408 (364–454)

Burkina Faso 1990 9 1.2 (0.470–2.3) 14 (5.3–26) 12 (5.4–20) 132 (61–230) 7.6 (6.5–8.9) 87 (73–101)

1995 10 1.4 (0.540–2.6) 14 (5.3–26) 12 (5.7–21) 121 (57–209) 8.3 (7.0–9.6) 82 (70–95)

2000 12 1.5 (0.580–2.8) 13 (5.0–24) 13 (6.0–22) 108 (52–186) 8.2 (7.0–9.6) 71 (60–83)

2005 13 1.5 (0.610–2.7) 11 (4.5–20) 13 (6.6–22) 97 (49–161) 8.4 (7.1–9.8) 62 (53–73)

2010 16 1.4 (0.630–2.5) 9.2 (4.0–16) 14 (7.1–23) 89 (46–147) 9 (7.6–10) 58 (49–67)

2011 16 1.4 (0.620–2.5) 8.8 (3.9–16) 14 (7.2–23) 88 (45–145) 9.1 (7.7–11) 57 (48–66)

2012 16 1.4 (0.600–2.5) 8.5 (3.7–15) 14 (6.9–22) 82 (42–136) 9 (7.6–10) 54 (46–63)

Burundi 1990 6 1.3 (0.570–2.3) 23 (10–40) 15 (7.8–24) 263 (140–425) 9.1 (8.0–10) 162 (143–183)

1995 6 3 (1.2–5.6) 48 (19–90) 32 (16–53) 510 (251–858) 20 (18–23) 321 (283–362)

2000 7 2.6 (1.1–4.9) 40 (16–73) 27 (14–45) 408 (207–675) 19 (17–22) 288 (254–325)

2005 8 2.2 (0.960–4.0) 28 (12–51) 22 (12–37) 289 (151–471) 15 (14–17) 198 (174–223)

2010 9 1.8 (0.840–3.2) 20 (9.1–35) 20 (11–33) 219 (116–354) 13 (12–15) 144 (127–163)

2011 10 1.8 (0.840–3.2) 19 (8.8–33) 20 (11–33) 214 (114–345) 13 (12–15) 139 (122–157)

2012 10 1.8 (0.790–3.2) 18 (8.0–32) 20 (10–32) 199 (106–322) 13 (11–14) 130 (114–147)

Cameroon 1990 12 2.3 (0.980–4.1) 19 (8.1–34) 24 (12–39) 195 (98–325) 14 (11–16) 112 (92–133)

1995 14 5.8 (2.2–11) 42 (16–80) 56 (26–98) 404 (186–704) 29 (24–34) 206 (170–246)

2000 16 8.1 (3.1–16) 51 (19–98) 80 (36–140) 504 (227–889) 49 (41–59) 310 (255–369)

2005 18 7.3 (3.0–14) 40 (16–75) 78 (36–140) 432 (201–750) 57 (47–68) 312 (258–372)

2010 21 6.6 (2.8–12) 32 (14–58) 76 (36–130) 366 (174–629) 56 (47–67) 274 (226–327)

2011 21 6.3 (2.7–11) 30 (13–54) 68 (32–120) 320 (152–549) 51 (42–61) 243 (200–290)

2012 22 6.4 (2.7–12) 29 (12–54) 69 (33–120) 319 (153–544) 52 (43–61) 238 (197–283)

Cape Verde 1990 < 1 0.13 (0.034–0.290) 37 (9.8–81) 1.2 (0.440–2.3) 340 (125–660) 0.62 (0.380–0.910) 175 (108–259)

1995 < 1 0.14 (0.055–0.270) 36 (14–68) 1.3 (0.640–2.2) 326 (161–549) 0.67 (0.550–0.800) 168 (137–201)

2000 < 1 0.15 (0.057–0.290) 34 (13–65) 1.4 (0.670–2.3) 311 (152–526) 0.71 (0.580–0.850) 160 (131–193)

2005 < 1 0.15 (0.057–0.280) 31 (12–59) 1.4 (0.680–2.3) 288 (142–485) 0.73 (0.600–0.880) 153 (125–184)

2010 < 1 0.13 (0.051–0.240) 26 (11–49) 1.3 (0.630–2.1) 257 (129–427) 0.71 (0.590–0.850) 147 (121–175)

2011 < 1 0.12 (0.049–0.220) 25 (10–46) 1.2 (0.610–2.0) 248 (124–414) 0.71 (0.590–0.850) 145 (120–173)

2012 < 1 0.11 (0.047–0.210) 23 (9.5–42) 1.2 (0.590–2.0) 237 (119–395) 0.71 (0.590–0.850) 144 (119–172)

Central African 1990 3 3.6 (1.3–6.9) 122 (45–236) 40 (17–72) 1 360 (583–2 460) 25 (21–30) 861 (710–1 030)

Republic 1995 3 5.1 (1.9–9.9) 156 (57–303) 55 (23–100) 1 680 (704–3 070) 39 (32–47) 1 200 (988–1 430)

2000 4 5.2 (1.9–10) 143 (53–277) 54 (23–99) 1 500 (631–2 720) 39 (32–46) 1 070 (884–1 280)

2005 4 3.9 (1.5–7.5) 99 (37–190) 40 (17–71) 1 000 (438–1 790) 27 (23–33) 690 (569–822)

2010 4 2.6 (1.0–4.8) 59 (24–110) 28 (13–47) 637 (304–1 090) 19 (16–22) 433 (357–515)

2011 4 2.4 (0.980–4.4) 54 (22–99) 26 (12–44) 579 (279–987) 18 (15–21) 400 (330–477)

2012 5 2.2 (0.840–4.3) 50 (19–95) 24 (11–40) 520 (251–884) 17 (14–20) 367 (302–438)

Chad 1990 6 0.86 (0.370–1.5) 14 (6.2–26) 9.4 (4.7–16) 157 (78–264) 5.6 (4.7–6.7) 95 (78–112)

1995 7 1.5 (0.610–2.9) 22 (8.8–41) 16 (7.7–27) 228 (111–388) 9 (7.4–11) 128 (106–153)

2000 8 2 (0.800–3.7) 24 (9.7–45) 21 (10–36) 252 (122–429) 13 (10–15) 151 (125–180)

2005 10 2.3 (0.940–4.2) 23 (9.4–42) 24 (12–41) 243 (119–412) 15 (12–18) 150 (124–178)

2010 12 2.3 (1.0–4.1) 20 (8.5–35) 28 (14–47) 237 (118–397) 18 (15–21) 151 (125–179)

2011 12 2.2 (0.960–3.9) 18 (8.0–33) 28 (14–46) 229 (114–383) 18 (15–22) 151 (125–179)

2012 12 2.3 (0.980–4.1) 18 (7.9–33) 28 (14–46) 221 (109–372) 19 (16–22) 151 (125–180)

Comoros 1990 < 1 0.043 (0.018–0.077) 10 (4.4–19) 0.38 (0.180–0.660) 93 (45–159) 0.22 (0.180–0.270) 54 (44–64)

1995 < 1 0.038 (0.017–0.069) 8.3 (3.6–15) 0.35 (0.170–0.600) 75 (36–129) 0.21 (0.180–0.250) 46 (38–55)

2000 < 1 0.037 (0.016–0.065) 6.9 (3.0–12) 0.34 (0.160–0.580) 64 (30–111) 0.21 (0.170–0.250) 39 (32–46)

2005 < 1 0.045 (0.019–0.083) 7.6 (3.2–14) 0.4 (0.200–0.680) 67 (33–114) 0.22 (0.180–0.260) 36 (30–43)

2010 < 1 0.045 (0.019–0.082) 6.6 (2.8–12) 0.42 (0.210–0.710) 62 (31–103) 0.23 (0.190–0.270) 33 (28–40)

2011 < 1 0.046 (0.019–0.083) 6.5 (2.8–12) 0.45 (0.230–0.740) 64 (32–105) 0.24 (0.200–0.290) 34 (28–41)

2012 < 1 0.045 (0.019–0.084) 6.3 (2.6–12) 0.44 (0.220–0.740) 62 (31–103) 0.25 (0.200–0.290) 34 (28–41)

Congo 1990 2 0.7 (0.220–1.4) 29 (9.4–61) 7.7 (2.6–16) 323 (108–654) 4 (2.5–5.9) 169 (104–250)

1995 3 0.83 (0.340–1.5) 31 (13–56) 9.6 (4.6–16) 352 (168–601) 6.7 (5.4–8.0) 245 (200–294)

2000 3 1.1 (0.500–2.0) 36 (16–63) 14 (6.9–24) 455 (222–770) 11 (9.3–13) 353 (298–412)

2005 4 1.7 (0.730–3.0) 47 (21–85) 21 (9.8–35) 580 (276–994) 15 (12–18) 425 (347–510)

2010 4 1.8 (0.790–3.3) 44 (19–80) 23 (11–39) 557 (265–955) 16 (13–19) 391 (320–470)

2011 4 1.8 (0.800–3.3) 44 (19–78) 23 (11–40) 548 (262–938) 16 (13–20) 387 (317–465)

2012 4 1.8 (0.780–3.4) 42 (18–77) 23 (11–40) 530 (250–913) 17 (14–20) 381 (311–458)

Côte d'Ivoire 1990 12 4.8 (1.9–9.0) 40 (16–74) 48 (23–80) 394 (193–664) 29 (25–33) 238 (206–272)

1995 14 8.2 (3.2–16) 58 (23–109) 78 (38–130) 551 (265–940) 54 (47–62) 379 (329–433)

2000 16 9 (3.6–17) 56 (22–105) 83 (40–140) 513 (249–870) 60 (52–68) 369 (320–422)

2005 17 6.6 (2.8–12) 38 (16–69) 64 (33–100) 366 (187–604) 46 (40–53) 267 (232–306)

2010 19 4.7 (2.1–8.2) 25 (11–43) 49 (25–80) 258 (133–424) 36 (31–41) 190 (165–217)

2011 19 4.7 (2.2–8.3) 24 (11–43) 51 (26–83) 262 (135–430) 37 (32–42) 191 (165–218)

2012 20 4.4 (1.8–8.0) 22 (9.1–41) 45 (23–75) 228 (115–380) 34 (30–39) 172 (149–198)

Democratic 1990 35 26 (9.9–49) 74 (28–140) 240 (110–420) 695 (327–1 200) 110 (92–140) 327 (262–398)

Republic 1995 42 28 (11–53) 67 (27–126) 270 (130–470) 654 (318–1 110) 140 (110–160) 327 (268–392)

of the Congo 2000 47 29 (12–53) 61 (25–112) 290 (140–480) 611 (308–1 020) 150 (130–180) 327 (273–385)

2005 54 29 (13–52) 54 (24–97) 300 (150–500) 558 (285–920) 180 (150–200) 327 (279–379)

2010 62 33 (15–59) 54 (24–96) 350 (180–560) 555 (288–908) 200 (180–230) 327 (282–375)

2011 64 35 (15–62) 54 (24–97) 360 (190–590) 568 (297–923) 210 (180–240) 327 (282–375)

2012 66 36 (16–64) 54 (24–97) 380 (200–620) 576 (301–938) 210 (190–250) 327 (282–375)

Equatorial 1990 < 1 0 (0–0.063) 0 (0–17) 0.38 (0.150–0.720) 101 (39–193) 0.3 (0.260–0.340) 80 (70–91)

Guinea 1995 < 1 0 (0–0.087) 0 (0–20) 0.42 (0.160–0.820) 96 (35–187) 0.35 (0.310–0.400) 80 (70–90)

2000 < 1 0 (0–0.086) 0 (0–17) 0.67 (0.300–1.2) 130 (58–231) 0.52 (0.460–0.590) 101 (88–114)

2005 < 1 0 (0–0.058) 0 (0–9.7) 0.81 (0.350–1.5) 135 (58–243) 0.66 (0.580–0.750) 110 (96–124)

2010 < 1 0 (0–0.058) 0 (0–8.3) 1.2 (0.520–2.0) 166 (75–294) 0.94 (0.830–1.1) 135 (119–153)

2011 < 1 0 (0–0.053) 0 (0–7.4) 1.2 (0.560–2.2) 174 (79–305) 1 (0.890–1.1) 142 (124–161)

2012 < 1 0 (0–0.054) 0 (0–7.4) 1.2 (0.510–2.2) 164 (69–299) 1 (0.900–1.2) 139 (122–158)

Eritrea 1990 3 0.39 (0.260–0.540) 12 (7.9–17) 16 (6.5–29) 484 (198–894) 8 (5.3–11) 243 (162–341)

1995 3 0.33 (0.220–0.460) 9.7 (6.4–14) 12 (4.1–25) 362 (121–731) 6.7 (4.5–9.5) 198 (132–278)

2000 4 0.3 (0.200–0.420) 7.7 (5.1–11) 7.6 (1.9–17) 194 (49–436) 6.2 (4.1–8.7) 157 (104–220)

2005 5 0.29 (0.190–0.400) 5.9 (3.9–8.3) 9.1 (3.2–18) 187 (67–368) 5.9 (3.9–8.2) 121 (80–169)

2010 6 0.28 (0.190–0.390) 4.9 (3.2–6.9) 9.6 (3.6–18) 167 (63–319) 5.8 (3.8–8.1) 100 (67–140)

2011 6 0.28 (0.190–0.390) 4.7 (3.1–6.6) 9.5 (3.6–18) 160 (60–307) 5.7 (3.8–8.1) 97 (64–136)

2012 6 0.28 (0.190–0.400) 4.6 (3.0–6.5) 9.3 (3.5–18) 152 (56–294) 5.7 (3.8–8.0) 93 (62–131)

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Rates are per 100 000 population.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Ethiopia 1990 48 23 (14–35) 49 (29–73) 200 (140–290) 426 (285–594) 180 (100–270) 367 (218–553)

1995 57 27 (16–41) 48 (28–72) 270 (200–370) 480 (342–642) 240 (140–360) 419 (249–633)

2000 66 27 (16–41) 41 (25–63) 280 (210–370) 429 (318–556) 280 (170–420) 421 (251–636)

2005 76 22 (13–33) 29 (17–44) 250 (190–320) 331 (250–422) 260 (150–390) 342 (203–516)

2010 87 17 (12–23) 20 (14–26) 220 (170–270) 250 (199–307) 230 (170–310) 269 (191–359)

2011 89 16 (12–21) 18 (14–24) 210 (170–260) 237 (191–288) 230 (170–300) 258 (191–335)

2012 92 16 (12–21) 18 (13–23) 210 (170–250) 224 (180–272) 230 (170–290) 247 (183–321)

Gabon 1990 < 1 0.39 (0.160–0.710) 41 (17–74) 4 (2.0–6.6) 419 (210–699) 2.1 (1.7–2.5) 221 (182–263)

1995 1 0.62 (0.250–1.2) 57 (23–107) 6.4 (3.1–11) 592 (289–1 000) 3.4 (2.8–4.1) 315 (260–375)

2000 1 0.99 (0.390–1.9) 81 (32–152) 11 (5.2–19) 898 (426–1 540) 6.5 (5.3–7.7) 527 (435–627)

2005 1 1.1 (0.430–2.0) 78 (32–145) 13 (6.0–21) 908 (434–1 550) 8.1 (6.7–9.6) 586 (484–698)

2010 2 0.8 (0.340–1.4) 51 (22–93) 10 (5.0–17) 663 (323–1 120) 7.4 (6.1–8.8) 475 (392–566)

2011 2 0.73 (0.320–1.3) 46 (20–83) 9.8 (4.7–17) 612 (295–1 040) 7.2 (5.9–8.6) 450 (372–536)

2012 2 0.72 (0.300–1.3) 44 (18–81) 9.2 (4.3–16) 563 (265–971) 7 (5.8–8.3) 428 (354–510)

Gambia 1990 < 1 0.33 (0.087–0.730) 36 (9.4–80) 3.2 (1.2–6.2) 350 (129–679) 1.7 (1.0–2.5) 185 (114–273)

1995 1 0.4 (0.160–0.740) 38 (15–70) 4 (2.0–6.6) 372 (186–622) 2.2 (1.8–2.6) 204 (167–245)

2000 1 0.44 (0.180–0.810) 36 (15–66) 4.6 (2.3–7.7) 373 (184–628) 2.8 (2.3–3.3) 225 (184–271)

2005 1 0.57 (0.230–1.1) 39 (16–74) 5.8 (2.9–9.7) 404 (200–677) 3.6 (2.9–4.3) 248 (203–298)

2010 2 0.78 (0.300–1.5) 46 (18–87) 7.7 (3.8–13) 455 (227–762) 4.6 (3.8–5.5) 273 (226–325)

2011 2 0.84 (0.330–1.6) 49 (19–92) 8.2 (4.1–14) 472 (236–788) 4.8 (4.0–5.7) 279 (230–331)

2012 2 0.91 (0.360–1.7) 51 (20–96) 8.8 (4.4–15) 490 (245–819) 5.1 (4.2–6.0) 284 (234–337)

Ghana 1990 15 5.3 (0.880–14) 36 (6.0–93) 47 (12–110) 320 (81–722) 23 (10–40) 155 (69–275)

1995 17 5.4 (1.1–13) 32 (6.3–79) 50 (15–110) 301 (91–634) 28 (16–44) 167 (93–263)

2000 19 5.1 (1.2–12) 27 (6.3–62) 48 (17–96) 257 (89–510) 29 (18–41) 152 (97–220)

2005 21 4 (1.3–8.3) 19 (5.9–39) 40 (17–72) 188 (81–338) 25 (19–33) 119 (88–154)

2010 24 2.5 (1.2–4.4) 10 (5.0–18) 29 (15–48) 121 (62–199) 21 (18–24) 86 (75–97)

2011 25 2.1 (1.0–3.6) 8.6 (4.2–15) 26 (13–44) 106 (52–179) 20 (17–22) 79 (69–89)

2012 25 1.7 (0.880–2.9) 6.9 (3.5–11) 23 (11–41) 92 (41–162) 18 (16–21) 72 (63–82)

Guinea 1990 6 3.7 (1.4–7.2) 62 (23–119) 33 (15–58) 556 (257–968) 15 (12–18) 248 (204–295)

1995 8 4.2 (1.6–8.1) 54 (21–103) 40 (19–68) 505 (237–873) 20 (16–23) 249 (205–297)

2000 9 3.9 (1.5–7.3) 44 (17–83) 38 (18–64) 429 (205–734) 20 (17–24) 234 (193–279)

2005 10 3.3 (1.4–6.1) 34 (14–63) 33 (16–57) 350 (171–590) 20 (17–24) 211 (173–251)

2010 11 2.8 (1.2–5.0) 25 (11–46) 33 (16–54) 299 (149–500) 20 (17–24) 188 (155–224)

2011 11 2.6 (1.2–4.7) 24 (10–42) 32 (16–54) 287 (143–481) 20 (17–24) 183 (151–219)

2012 11 2.6 (1.1–4.8) 23 (9.8–42) 31 (16–53) 274 (136–459) 20 (17–24) 178 (146–213)

Guinea-Bissau 1990 1 0.21 (0.051–0.480) 21 (5.0–47) 2.4 (0.860–4.8) 237 (84–469) 1.6 (1.1–2.2) 158 (108–217)

1995 1 0.26 (0.100–0.470) 22 (9.2–41) 2.9 (1.4–5.0) 256 (120–442) 2 (1.6–2.4) 174 (142–209)

2000 1 0.36 (0.130–0.690) 28 (11–54) 3.7 (1.8–6.2) 290 (142–490) 2.4 (2.0–2.9) 192 (157–230)

2005 1 0.32 (0.110–0.660) 23 (7.5–46) 3.8 (1.7–6.6) 264 (121–462) 3 (2.5–3.6) 211 (173–254)

2010 2 0.43 (0.150–0.860) 27 (9.4–54) 4.8 (2.3–8.1) 300 (144–513) 3.7 (3.0–4.4) 233 (192–278)

2011 2 0.46 (0.150–0.920) 28 (9.5–57) 5 (2.4–8.5) 306 (145–525) 3.9 (3.2–4.6) 238 (196–283)

2012 2 0.49 (0.160–0.990) 29 (9.8–59) 5.2 (2.5–8.9) 312 (148–537) 4 (3.3–4.8) 242 (200–289)

Kenya 1990 23 7.1 (2.8–13) 30 (12–57) 64 (32–110) 272 (138–452) 33 (28–37) 139 (121–159)

1995 27 4.5 (2.0–7.9) 16 (7.4–29) 54 (29–85) 196 (108–311) 46 (43–50) 169 (155–184)

2000 31 5.9 (2.8–10) 19 (9.0–32) 85 (46–140) 273 (147–437) 89 (84–95) 286 (267–305)

2005 36 8.1 (4.3–13) 23 (12–36) 120 (65–200) 345 (183–559) 130 (120–140) 359 (339–380)

2010 41 8.2 (5.1–12) 20 (12–30) 130 (65–200) 306 (159–500) 120 (120–130) 298 (286–311)

2011 42 8.9 (5.3–14) 21 (13–32) 130 (68–210) 305 (163–491) 120 (120–130) 288 (276–300)

2012 43 9.5 (5.4–15) 22 (13–34) 130 (71–210) 299 (164–475) 120 (110–120) 272 (261–283)

Lesotho 1990 2 0.35 (0.100–0.730) 22 (6.5–46) 4.3 (1.6–8.2) 267 (99–515) 2.9 (2.2–3.8) 184 (135–240)

1995 2 0.34 (0.110–0.680) 19 (6.5–39) 5.7 (2.4–10) 323 (134–593) 5.7 (5.0–6.4) 323 (283–367)

2000 2 0.29 (<0.01–1.1) 16 (0.38–58) 7.2 (2.4–15) 387 (129–784) 10 (9.0–12) 553 (484–626)

2005 2 0.2 (0–1.6) 10 (0–82) 7.9 (1.3–20) 409 (65–1 060) 12 (10–14) 639 (535–752)

2010 2 0.27 (<0.01–1.3) 14 (<0.1–66) 8.5 (2.5–18) 425 (126–903) 13 (11–14) 633 (553–719)

2011 2 0.34 (<0.01–1.4) 17 (0.20–67) 8.9 (2.8–18) 439 (139–905) 13 (11–15) 632 (551–717)

2012 2 0.34 (<0.01–1.4) 17 (0.18–68) 8.7 (2.7–18) 424 (130–888) 13 (11–15) 630 (550–716)

Liberia 1990 2 0.62 (0.130–1.5) 29 (6.0–71) 6.7 (2.2–14) 321 (102–661) 4.2 (2.6–6.2) 199 (123–293)

1995 2 1.1 (0.400–2.0) 51 (19–97) 9.4 (4.6–16) 453 (220–769) 4.6 (3.7–5.5) 219 (179–263)

2000 3 1.6 (0.580–3.0) 54 (20–104) 14 (6.7–24) 482 (231–822) 7 (5.7–8.4) 242 (197–290)

2005 3 1.6 (0.630–3.1) 50 (19–94) 16 (7.7–26) 475 (234–798) 8.7 (7.1–10) 266 (218–320)

2010 4 1.9 (0.790–3.5) 48 (20–88) 20 (9.8–33) 493 (247–822) 12 (9.6–14) 293 (242–349)

2011 4 1.9 (0.810–3.5) 47 (20–86) 20 (10–34) 494 (245–827) 12 (10–15) 299 (247–356)

2012 4 1.9 (0.830–3.5) 46 (20–84) 21 (10–35) 495 (244–832) 13 (11–15) 304 (251–362)

Madagascar 1990 12 13 (4.9–25) 114 (43–220) 110 (50–190) 946 (434–1 650) 45 (37–54) 391 (322–466)

1995 13 11 (4.4–21) 82 (33–154) 98 (48–170) 729 (356–1 230) 45 (37–54) 335 (276–400)

2000 16 11 (4.4–20) 69 (28–127) 96 (47–160) 609 (300–1 020) 46 (38–55) 293 (241–349)

2005 18 10 (4.3–19) 56 (24–103) 95 (48–160) 522 (261–870) 48 (39–57) 262 (216–313)

2010 21 10 (4.3–18) 48 (21–88) 97 (49–160) 461 (233–767) 51 (42–61) 242 (199–288)

2011 22 10 (4.4–18) 47 (20–85) 98 (50–160) 452 (228–749) 52 (43–62) 238 (196–284)

2012 22 10 (4.3–19) 46 (19–84) 99 (50–160) 442 (222–735) 52 (43–62) 234 (193–280)

Malawi 1990 9 3.8 (0.700–9.5) 40 (7.4–101) 39 (12–80) 412 (131–849) 31 (22–41) 326 (230–438)

1995 10 3.7 (0.760–8.9) 37 (7.6–90) 43 (16–81) 427 (165–810) 46 (38–55) 462 (383–548)

2000 11 3.2 (0.360–9.0) 28 (3.2–80) 41 (13–85) 365 (118–749) 53 (44–63) 467 (387–554)

2005 13 2.3 (0.130–7.4) 18 (1.0–57) 34 (10–72) 262 (77–556) 46 (38–54) 354 (292–421)

2010 15 1.8 (0.680–3.5) 12 (4.5–23) 27 (14–45) 182 (95–298) 33 (31–35) 219 (203–236)

2011 15 1.5 (0.560–3.0) 9.9 (3.6–19) 24 (12–40) 156 (80–256) 30 (27–32) 191 (177–206)

2012 16 1.4 (0.570–2.7) 9 (3.6–17) 22 (11–36) 140 (72–229) 26 (24–28) 163 (151–176)

Mali 1990 8 1.2 (0.510–2.1) 15 (6.4–26) 11 (6.0–18) 138 (75–221) 6 (5.8–6.3) 76 (72–80)

1995 9 1.2 (0.540–2.2) 13 (6.0–24) 12 (6.5–18) 131 (73–206) 7.2 (6.9–7.6) 80 (76–84)

2000 10 1.2 (0.560–2.2) 12 (5.5–21) 12 (6.7–19) 117 (65–184) 7.9 (7.6–8.3) 77 (74–81)

2005 12 1.3 (0.600–2.2) 11 (5.0–19) 12 (7.0–20) 105 (58–164) 8.3 (7.9–8.7) 69 (66–73)

2010 14 1.3 (0.620–2.2) 9.3 (4.4–16) 13 (7.3–21) 94 (52–149) 8.8 (8.4–9.2) 63 (60–66)

2011 14 1.3 (0.630–2.2) 9.1 (4.4–16) 13 (7.4–21) 94 (52–148) 8.9 (8.5–9.3) 62 (59–65)

2012 15 1.3 (0.630–2.3) 9 (4.3–15) 14 (7.6–22) 92 (51–146) 9 (8.5–9.4) 60 (57–63)

Mauritania 1990 2 0.38 (0.015–1.3) 19 (0.76–65) 5.7 (1.1–14) 283 (53–703) 4.6 (2.8–6.8) 228 (140–336)

1995 2 0.92 (0.390–1.7) 39 (17–71) 9.7 (4.7–17) 417 (202–707) 5.9 (4.8–7.0) 251 (205–302)

2000 3 1.5 (0.610–2.9) 57 (23–106) 15 (7.3–24) 536 (268–895) 7.5 (6.1–9.0) 277 (226–333)

2005 3 2.3 (0.880–4.4) 73 (28–140) 20 (9.9–35) 651 (315–1 110) 9.6 (7.9–12) 305 (250–367)

2010 4 3.2 (1.2–6.1) 88 (33–170) 27 (13–47) 756 (357–1 300) 12 (10–15) 337 (277–402)

2011 4 3.4 (1.2–6.5) 91 (34–175) 29 (13–50) 775 (364–1 340) 13 (10–15) 344 (283–410)

2012 4 3.5 (1.3–6.9) 93 (34–181) 30 (14–52) 794 (373–1 370) 13 (11–16) 350 (288–418)

Mauritius 1990 1 0.027 (0.026–0.028) 2.5 (2.4–2.6) 0.58 (0.220–1.1) 55 (21–105) 0.29 (0.180–0.430) 28 (17–41)

1995 1 0.013 (0.012–0.013) 1.1 (1.1–1.2) 0.57 (0.290–0.950) 51 (25–85) 0.29 (0.240–0.350) 26 (21–31)

2000 1 <0.01 (<0.01–<0.01) 0.68 (0.67–0.70) 0.54 (0.270–0.910) 46 (23–76) 0.29 (0.240–0.350) 24 (20–29)

2005 1 0.013 (0.013–0.014) 1.1 (1.1–1.1) 0.52 (0.260–0.870) 43 (22–72) 0.28 (0.230–0.330) 23 (19–28)

2010 1 0.012 (0.011–0.012) 0.94 (0.93–0.95) 0.5 (0.250–0.830) 41 (20–68) 0.27 (0.220–0.320) 22 (18–26)

2011 1 0.019 (0.019–0.019) 1.5 (1.5–1.6) 0.49 (0.250–0.820) 40 (20–66) 0.26 (0.220–0.310) 21 (18–25)

2012 1 0.012 (0.012–0.012) 0.97 (0.96–0.98) 0.48 (0.240–0.810) 39 (20–65) 0.26 (0.210–0.310) 21 (17–25)

Mozambique 1990 14 13 (0.360–48) 98 (2.6–357) 120 (7.5–370) 863 (56–2 730) 54 (8.5–140) 401 (62–1 050)

1995 16 16 (1.0–52) 101 (6.4–323) 140 (17–400) 897 (104–2 520) 76 (24–160) 478 (153–985)

2000 18 14 (0.430–49) 75 (2.3–270) 130 (10–390) 701 (56–2 130) 94 (41–170) 513 (227–914)

2005 21 12 (0.360–44) 58 (1.7–208) 120 (12–350) 576 (59–1 660) 110 (63–170) 524 (298–811)

2010 24 12 (0.890–38) 51 (3.7–160) 130 (25–320) 541 (105–1 320) 130 (90–180) 544 (377–741)

2011 25 13 (0.890–40) 51 (3.6–161) 130 (26–330) 544 (106–1 330) 130 (93–180) 548 (380–747)

2012 25 13 (0.980–41) 53 (3.9–163) 140 (28–340) 553 (111–1 340) 140 (96–190) 552 (383–753)

Namibia 1990 1 0.074 (0.058–0.091) 5.2 (4.1–6.4) 11 (5.1–18) 751 (358–1 280) 5.4 (4.3–6.6) 379 (300–468)

1995 2 0.15 (0.110–0.180) 8.8 (6.9–11) 13 (5.7–23) 770 (344–1 360) 9.5 (7.5–12) 575 (456–709)

2000 2 0.46 (0.360–0.580) 24 (19–31) 27 (9.8–53) 1 430 (517–2 790) 27 (21–33) 1 410 (1 110–1 730)

2005 2 0.46 (0.350–0.580) 23 (17–28) 23 (6.5–51) 1 160 (321–2 510) 28 (22–35) 1 390 (1 100–1 720)

2010 2 0.34 (0.270–0.410) 15 (12–19) 18 (6.3–36) 834 (291–1 660) 19 (15–23) 867 (686–1 070)

2011 2 0.32 (0.250–0.390) 14 (11–18) 15 (5.3–31) 699 (241–1 390) 16 (13–20) 723 (573–891)

2012 2 0.32 (0.260–0.400) 14 (11–18) 16 (6.1–29) 688 (271–1 300) 15 (12–18) 655 (524–800)

Rates are per 100 000 population.

159 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Niger 1990 8 7.7 (2.9–15) 99 (37–191) 65 (30–110) 839 (388–1 460) 28 (23–33) 358 (295–426)

1995 9 6.8 (2.5–13) 74 (28–143) 57 (26–99) 620 (283–1 080) 25 (20–29) 270 (223–321)

2000 11 5 (2.0–9.5) 46 (18–86) 44 (21–75) 396 (189–678) 21 (17–25) 191 (157–227)

2005 13 3.7 (1.5–6.8) 28 (12–51) 34 (17–57) 261 (130–436) 19 (15–22) 142 (118–170)

2010 16 2.9 (1.3–5.2) 18 (8.0–33) 30 (15–50) 187 (94–312) 18 (15–21) 113 (94–135)

2011 17 2.8 (1.2–5.0) 17 (7.4–30) 29 (14–49) 176 (88–294) 18 (15–21) 108 (90–129)

2012 17 2.8 (1.2–5.1) 16 (6.8–30) 28 (14–48) 166 (83–277) 18 (15–21) 104 (86–124)

Nigeria 1990 96 34 (0.019–180) 35 (<0.1–183) 290 (0.550–1 400) 302 (0.58–1 440) 120 (1.3–500) 128 (1.3–526)

1995 108 40 (0.250–170) 37 (0.23–161) 340 (4.9–1 300) 311 (4.5–1 230) 150 (8.0–490) 139 (7.4–456)

2000 123 47 (0.077–230) 38 (<0.1–185) 400 (2.6–1 700) 326 (2.1–1 400) 210 (15–660) 172 (12–536)

2005 140 46 (0.084–220) 33 (<0.1–159) 420 (4.2–1 700) 298 (3.0–1 220) 240 (33–660) 175 (23–476)

2010 160 34 (3.1–100) 22 (2.0–64) 330 (62–830) 210 (39–521) 210 (100–360) 133 (64–225)

2011 164 30 (2.0–93) 18 (1.2–57) 300 (49–760) 181 (30–464) 190 (91–340) 118 (55–204)

2012 169 27 (1.6–86) 16 (0.92–51) 270 (43–710) 161 (25–420) 180 (85–310) 108 (50–186)

Rwanda 1990 7 2.7 (1.1–5.1) 37 (15–70) 26 (13–44) 356 (173–603) 21 (19–23) 290 (259–323)

1995 6 4.4 (1.7–8.4) 78 (30–149) 37 (17–64) 655 (305–1 130) 29 (26–32) 513 (458–571)

2000 8 4.1 (1.6–7.7) 49 (19–91) 35 (17–59) 417 (205–701) 27 (24–30) 325 (290–362)

2005 9 2 (0.880–3.7) 22 (9.3–39) 21 (11–35) 228 (120–370) 17 (15–19) 181 (162–202)

2010 11 1.3 (0.610–2.3) 12 (5.7–21) 15 (7.9–24) 136 (73–219) 11 (10–13) 106 (94–118)

2011 11 1.2 (0.580–2.1) 11 (5.2–19) 14 (7.2–22) 121 (65–196) 11 (9.4–12) 94 (84–105)

2012 11 1.2 (0.530–2.1) 10 (4.6–18) 13 (7.0–21) 114 (61–183) 9.8 (8.8–11) 86 (77–96)

Sao Tome and 1990 < 1 0.031 (<0.01–0.070) 27 (7.1–59) 0.3 (0.110–0.590) 258 (96–499) 0.16 (0.098–0.230) 135 (83–199)

Principe 1995 < 1 0.034 (0.013–0.064) 26 (10–49) 0.32 (0.160–0.530) 244 (122–408) 0.16 (0.130–0.190) 124 (102–149)

2000 < 1 0.018 (<0.01–0.032) 13 (5.3–23) 0.22 (0.093–0.410) 159 (67–291) 0.16 (0.130–0.190) 114 (93–137)

2005 < 1 0.012 (<0.01–0.023) 7.6 (2.8–15) 0.2 (0.070–0.390) 128 (46–253) 0.16 (0.140–0.190) 105 (88–123)

2010 < 1 0.024 (0.010–0.045) 14 (5.7–25) 0.26 (0.130–0.450) 149 (72–252) 0.17 (0.140–0.200) 96 (79–115)

2011 < 1 0.027 (0.011–0.050) 15 (6.1–27) 0.28 (0.140–0.470) 154 (76–258) 0.17 (0.140–0.210) 94 (78–113)

2012 < 1 0.03 (0.012–0.055) 16 (6.4–29) 0.3 (0.150–0.500) 159 (80–264) 0.17 (0.140–0.210) 93 (76–111)

Senegal 1990 8 1.8 (0.800–3.3) 24 (11–44) 19 (9.4–31) 249 (125–414) 10 (8.5–12) 138 (114–164)

1995 9 2.2 (0.980–4.0) 26 (11–46) 23 (12–39) 269 (135–448) 13 (11–16) 153 (126–183)

2000 10 2.6 (1.1–4.7) 26 (12–48) 27 (14–45) 273 (137–453) 15 (13–18) 155 (128–184)

2005 11 2.5 (1.1–4.4) 22 (9.6–39) 26 (13–44) 234 (116–393) 16 (13–19) 142 (117–169)

2010 13 2.5 (1.1–4.5) 20 (8.7–35) 28 (14–47) 217 (106–366) 18 (15–21) 137 (113–163)

2011 13 2.6 (1.2–4.7) 20 (8.7–35) 29 (14–49) 217 (106–366) 18 (15–22) 136 (112–162)

2012 14 2.7 (1.2–4.8) 20 (8.8–35) 30 (15–50) 219 (108–368) 19 (16–22) 137 (113–163)

Seychelles 1990 < 1 <0.01 (<0.01–<0.01) 2 (1.9–2.0) 0.035 (<0.01–0.091) 50 (7.7–131) 0.03 (0.019–0.044) 43 (27–64)

1995 < 1 <0.01 (<0.01–<0.01) 2 (1.9–2.0) 0.059 (0.028–0.100) 79 (37–135) 0.03 (0.025–0.036) 40 (33–48)

2000 < 1 <0.01 (<0.01–<0.01) 2 (1.9–2.0) 0.045 (0.021–0.080) 57 (26–100) 0.029 (0.024–0.035) 37 (30–44)

2005 < 1 <0.01 (<0.01–<0.01) 2.5 (2.4–2.7) 0.053 (0.026–0.091) 61 (29–104) 0.029 (0.024–0.035) 33 (27–40)

2010 < 1 <0.01 (<0.01–<0.01) 1.8 (1.8–1.9) 0.048 (0.023–0.082) 52 (25–90) 0.028 (0.023–0.033) 31 (25–37)

2011 < 1 <0.01 (<0.01–<0.01) 1.8 (1.8–1.9) 0.039 (0.016–0.071) 42 (17–78) 0.028 (0.023–0.033) 30 (25–36)

2012 < 1 <0.01 (<0.01–<0.01) 1.8 (1.8–1.9) 0.036 (0.013–0.072) 39 (14–78) 0.027 (0.023–0.033) 30 (24–35)

Sierra Leone 1990 4 2.4 (0.730–5.2) 61 (18–128) 21 (7.8–39) 507 (194–968) 8.4 (5.2–12) 207 (128–305)

1995 4 2 (0.730–3.9) 51 (18–99) 18 (8.3–31) 454 (211–788) 8.3 (6.4–11) 212 (162–269)

2000 4 2.4 (0.860–4.8) 59 (21–116) 22 (10–39) 537 (245–940) 11 (8.1–14) 264 (196–341)

2005 5 5.9 (2.2–11) 116 (43–223) 53 (25–90) 1 030 (491–1 750) 26 (21–31) 503 (410–605)

2010 6 8.2 (3.1–16) 142 (54–273) 74 (36–130) 1 290 (624–2 180) 38 (31–45) 660 (540–791)

2011 6 8.3 (3.1–16) 142 (53–274) 76 (37–130) 1 290 (625–2 200) 39 (32–47) 668 (542–807)

2012 6 8.5 (3.2–16) 143 (53–275) 78 (37–130) 1 300 (626–2 220) 40 (32–49) 674 (540–821)

South Africa 1990 37 16 (4.2–34) 42 (11–93) 170 (64–340) 475 (173–925) 110 (76–150) 301 (206–413)

1995 41 15 (5.6–28) 35 (14–68) 180 (81–310) 427 (195–747) 130 (110–160) 317 (259–381)

2000 45 20 (4.0–48) 44 (8.9–107) 250 (100–480) 568 (225–1 070) 260 (210–310) 576 (471–691)

2005 48 25 (2.0–75) 51 (4.1–156) 360 (110–750) 748 (234–1 560) 450 (360–540) 925 (756–1 110)

2010 51 26 (2.2–80) 51 (4.3–155) 410 (140–840) 803 (266–1 630) 500 (420–600) 981 (809–1 170)

2011 52 28 (2.9–83) 55 (5.6–159) 430 (150–860) 831 (289–1 650) 520 (430–610) 993 (819–1 180)

2012 52 31 (3.7–86) 59 (7.0–164) 450 (160–880) 857 (305–1 680) 530 (430–630) 1 000 (827–1 190)

Swaziland 1990 < 1 0.31 (0.051–0.800) 36 (5.9–93) 3.4 (1.0–7.3) 397 (116–847) 2.3 (1.4–3.4) 267 (165–394)

1995 < 1 0.27 (0.065–0.620) 28 (6.8–64) 3.4 (1.4–6.3) 357 (149–653) 3.2 (2.7–3.9) 337 (275–405)

2000 1 0.37 (<0.01–1.4) 34 (0.74–129) 6.1 (1.5–14) 573 (145–1 290) 8.5 (7.0–10) 803 (657–964)

2005 1 0.32 (<0.01–2.0) 29 (0–177) 7.4 (1.1–19) 666 (104–1 730) 13 (10–15) 1 150 (938–1 380)

2010 1 0.46 (<0.01–2.3) 39 (<0.1–196) 9 (1.5–23) 751 (130–1 900) 15 (13–18) 1 290 (1 060–1 530)

2011 1 0.67 (0.015–2.5) 56 (1.3–208) 11 (2.6–24) 870 (213–1 970) 16 (13–19) 1 320 (1 090–1 570)

2012 1 0.78 (0.031–2.7) 63 (2.5–219) 11 (2.9–25) 907 (232–2 030) 17 (14–20) 1 350 (1 110–1 610)

Togo 1990 4 0.23 (0.100–0.410) 6.1 (2.7–11) 2.7 (1.3–4.6) 71 (34–122) 1.8 (1.5–2.1) 47 (39–56)

1995 4 0.37 (0.160–0.670) 8.7 (3.8–16) 4 (2.0–6.6) 92 (46–155) 2.5 (2.0–3.0) 58 (48–69)

2000 5 0.59 (0.250–1.1) 12 (5.0–22) 5.6 (2.7–9.4) 114 (56–193) 3.5 (2.9–4.2) 72 (59–86)

2005 6 0.58 (0.250–1.0) 10 (4.5–19) 5.9 (2.9–10) 107 (52–181) 4.2 (3.5–5.1) 77 (63–91)

2010 6 0.54 (0.230–0.970) 8.5 (3.7–15) 6.2 (3.0–11) 99 (47–169) 4.6 (3.8–5.5) 73 (60–87)

2011 6 0.56 (0.240–1.0) 8.6 (3.8–15) 6.6 (3.2–11) 102 (49–174) 4.7 (3.9–5.6) 73 (60–87)

2012 7 0.58 (0.250–1.0) 8.7 (3.8–15) 6.9 (3.4–12) 104 (51–176) 4.9 (4.0–5.8) 73 (60–87)

Uganda 1990 18 8.7 (<0.01–48) 50 (<0.1–273) 86 (0.490–370) 492 (2.8–2 140) 110 (57–180) 624 (328–1 010)

1995 21 8.3 (<0.01–46) 40 (<0.1–223) 89 (0.760–370) 429 (3.6–1 800) 110 (62–180) 542 (297–860)

2000 24 8.5 (0.055–37) 35 (0.23–151) 92 (6.1–290) 380 (25–1 200) 100 (63–150) 427 (259–636)

2005 29 7.6 (0.660–23) 26 (2.3–79) 88 (22–200) 305 (76–689) 87 (63–120) 304 (220–402)

2010 34 5.5 (1.0–14) 16 (3.0–40) 70 (27–130) 207 (80–392) 71 (57–86) 209 (169–253)

2011 35 5.1 (0.960–13) 15 (2.7–36) 68 (26–130) 192 (74–366) 68 (55–82) 193 (156–234)

2012 36 4.7 (0.820–12) 13 (2.3–33) 64 (24–120) 175 (67–334) 65 (53–79) 179 (145–216)

United Republic 1990 25 9.9 (3.8–19) 39 (15–74) 94 (47–160) 368 (185–611) 58 (49–67) 226 (193–261)

of Tanzania 1995 30 6.4 (2.2–13) 21 (7.3–43) 76 (37–130) 254 (123–430) 68 (58–78) 226 (193–261)

2000 34 5.8 (1.9–12) 17 (5.6–35) 80 (38–140) 234 (113–399) 80 (70–91) 236 (207–268)

2005 39 5.7 (2.7–9.8) 15 (6.9–25) 82 (43–130) 211 (111–341) 83 (76–89) 213 (197–229)

2010 45 6.2 (3.3–10) 14 (7.4–22) 86 (46–140) 190 (102–306) 80 (75–85) 177 (166–189)

2011 46 6.1 (3.3–9.8) 13 (7.1–21) 85 (45–140) 183 (97–295) 78 (74–83) 169 (159–180)

2012 48 6.1 (3.2–9.9) 13 (6.8–21) 84 (45–140) 176 (95–283) 79 (74–84) 165 (154–175)

Zambia 1990 8 4.9 (1.5–10) 63 (19–132) 52 (24–91) 665 (308–1 160) 56 (49–63) 710 (624–801)

1995 9 3.9 (1.1–8.3) 44 (13–93) 53 (26–90) 605 (299–1 020) 70 (64–76) 788 (719–861)

2000 10 3.1 (0.940–6.5) 31 (9.4–64) 53 (26–89) 524 (256–885) 72 (67–77) 713 (661–767)

2005 11 2.2 (0.450–5.4) 19 (3.9–47) 47 (20–83) 406 (177–727) 65 (59–71) 566 (519–615)

2010 13 3.2 (0.970–6.8) 24 (7.4–51) 51 (25–87) 387 (186–659) 61 (55–67) 462 (418–509)

2011 14 3.4 (1.1–7.0) 25 (8.0–52) 52 (25–87) 379 (185–640) 61 (55–67) 444 (401–489)

2012 14 3.9 (1.4–7.7) 28 (9.8–55) 55 (28–90) 388 (197–642) 60 (54–66) 427 (385–470)

Zimbabwe 1990 10 3.5 (0.068–13) 33 (0.65–128) 34 (2.4–110) 323 (23–1 000) 31 (17–50) 296 (159–476)

1995 12 1.9 (0–15) 16 (0–125) 34 (0.860–130) 295 (7.4–1 090) 56 (39–77) 483 (335–658)

2000 13 2.1 (0–16) 17 (0–129) 49 (3.9–150) 389 (31–1 180) 91 (72–110) 726 (573–897)

2005 13 3.6 (<0.01–18) 28 (<0.1–146) 60 (7.0–170) 473 (55–1 320) 100 (81–130) 799 (634–984)

2010 13 4 (0.037–17) 31 (0.28–129) 57 (9.1–150) 438 (70–1 140) 83 (64–100) 633 (489–795)

2011 13 4.6 (0.140–17) 35 (1.1–125) 61 (12–150) 458 (93–1 110) 81 (62–100) 603 (466–757)

2012 14 4.6 (0.160–16) 33 (1.2–117) 59 (13–140) 433 (92–1 030) 77 (60–97) 562 (434–706)

Rates are per 100 000 population.

160 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Algeria 1990 26 17 (13–22) 66 (48–86) <0.01 (<0.01–<0.01) <0.1 (0–<0.1) 11 607 44 67 (52–92)

1995 29 20 (15–26) 68 (50–89) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 13 507 46 68 (52–92)

2000 32 28 (20–36) 87 (64–114) 0.025 (0.018–0.032) <0.1 (<0.1–0.10) 18 572 59 67 (52–92)

2005 34 31 (23–41) 93 (68–121) 0.057 (0.042–0.074) 0.2 (0.12–0.22) 21 336 63 68 (52–92)

2010 37 33 (24–44) 90 (66–118) 0.08 (0.059–0.10) 0.2 (0.16–0.28) 22 336 60 67 (51–91)

2011 38 34 (25–44) 90 (66–117) 0.085 (0.062–0.11) 0.2 (0.16–0.29) 21 429 57 63 (48–87)

2012 38 34 (25–45) 89 (65–117) 0.086 (0.063–0.11) 0.2 (0.16–0.29) 21 880 57 64 (49–87)

Angola 1990 10 21 (13–31) 205 (127–303) 0.51 (0.31–0.75) 4.9 (3.0–7.2) 10 271 99 48 (33–78)

1995 12 27 (22–33) 226 (185–272) 1.3 (1.1–1.5) 11 (8.7–13) 5 143 42 19 (16–23)

2000 14 35 (28–42) 250 (204–300) 2.5 (2.0–3.0) 18 (14–21) 16 062 115 46 (38–56)

2005 17 46 (37–54) 276 (227–329) 4 (3.3–4.8) 24 (20–29) 37 175 225 82 (68–99)

2010 20 59 (50–69) 304 (256–355) 5.3 (4.5–6.2) 27 (23–32) 44 655 228 75 (64–89)

2011 20 62 (53–73) 310 (261–362) 5.3 (4.5–6.2) 26 (22–31) 47 240 234 76 (65–90)

2012 21 66 (55–77) 316 (266–369) 5.5 (4.7–6.5) 27 (22–31) 51 819 249 79 (67–94)

Benin 1990 5 6.4 (5.3–7.6) 128 (106–152) 2.1 (1.7–2.4) 41 (34–49) 2 074 41 32 (27–39)

1995 6 6 (4.9–7.1) 100 (82–118) 1.9 (1.5–2.2) 31 (26–37) 2 400 40 40 (34–49)

2000 7 6 (4.9–7.1) 86 (71–102) 1.5 (1.3–1.8) 22 (18–26) 2 697 39 45 (38–55)

2005 8 6 (5.0–7.2) 74 (61–88) 1.2 (1.0–1.5) 15 (12–18) 3 270 40 54 (46–66)

2010 10 6.5 (5.4–7.8) 69 (57–82) 0.99 (0.82–1.2) 10 (8.6–12) 3 756 39 57 (48–69)

2011 10 6.8 (5.6–8.1) 70 (58–83) 1 (0.84–1.2) 10 (8.6–12) 4 212 43 62 (52–75)

2012 10 7 (5.8–8.3) 70 (58–83) 1 (0.84–1.2) 10 (8.3–12) 3 966 39 57 (48–68)

Botswana 1990 1 7.4 (2.9–14) 533 (212–997) 1.5 (0.58–2.7) 105 (42–196) 2 938 212 40 (21–100)

1995 2 14 (8.8–19) 855 (553–1 220) 7.2 (4.7–10) 456 (295–651) 5 665 358 42 (29–65)

2000 2 16 (13–20) 918 (736–1 120) 11 (9.0–14) 638 (511–777) 9 292 529 58 (47–72)

2005 2 14 (13–15) 733 (667–802) 9.3 (8.4–10) 494 (449–541) 10 058 536 73 (67–80)

2010 2 9.9 (8.8–11) 503 (449–560) 6.3 (5.6–7.0) 321 (286–357) 7 013 356 71 (64–79)

2011 2 9 (8.1–10) 455 (406–507) 5.7 (5.1–6.3) 285 (254–317) 6 603 332 73 (66–82)

2012 2 8.2 (7.3–9.1) 408 (364–454) 5.1 (4.5–5.6) 253 (226–281) 6 161 307 75 (68–84)

Burkina Faso 1990 9 7.6 (6.5–8.9) 87 (73–101) 2.9 (2.5–3.4) 33 (28–38) 1 497 17 20 (17–23)

1995 10 8.3 (7.0–9.6) 82 (70–95) 3.3 (2.8–3.8) 32 (27–37) 2 572 25 31 (27–37)

2000 12 8.2 (7.0–9.6) 71 (60–83) 2.8 (2.4–3.3) 25 (21–29) 2 331 20 28 (24–33)

2005 13 8.4 (7.1–9.8) 62 (53–73) 2.3 (2.0–2.7) 17 (15–20) 3 478 26 41 (36–49)

2010 16 9 (7.6–10) 58 (49–67) 1.8 (1.5–2.1) 11 (9.7–13) 4 800 31 54 (46–63)

2011 16 9.1 (7.7–11) 57 (48–66) 1.7 (1.4–1.9) 10 (8.9–12) 5 286 33 58 (50–68)

2012 16 9 (7.6–10) 54 (46–63) 1.6 (1.3–1.8) 9.5 (8.0–11) 5 210 32 58 (50–69)

Burundi 1990 6 9.1 (8.0–10) 162 (143–183) 1.6 (1.4–1.8) 28 (25–31) 4 575 82 50 (45–57)

1995 6 20 (18–23) 321 (283–362) 6.7 (5.9–7.5) 107 (94–121) 3 326 54 17 (15–19)

2000 7 19 (17–22) 288 (254–325) 7.4 (6.5–8.3) 110 (97–124) 6 421 96 33 (30–38)

2005 8 15 (14–17) 198 (174–223) 4.8 (4.3–5.5) 62 (55–70) 6 585 85 43 (38–49)

2010 9 13 (12–15) 144 (127–163) 3 (2.7–3.4) 33 (29–37) 7 611 82 57 (51–65)

2011 10 13 (12–15) 139 (122–157) 2.8 (2.4–3.1) 29 (26–33) 6 742 71 51 (45–58)

2012 10 13 (11–14) 130 (114–147) 2.5 (2.2–2.8) 25 (22–28) 6 921 70 54 (48–62)

Cameroon 1990 12 14 (11–16) 112 (92–133) 0.71 (0.58–0.84) 5.8 (4.8–7.0) 5 892 49 44 (37–53)

1995 14 29 (24–34) 206 (170–246) 5.5 (4.6–6.6) 40 (33–47) 3 292 24 11 (9.6–14)

2000 16 49 (41–59) 310 (255–369) 17 (14–20) 105 (87–126) 5 251 33 11 (8.9–13)

2005 18 57 (47–68) 312 (258–372) 22 (18–26) 121 (100–145) 21 499 119 38 (32–46)

2010 21 56 (47–67) 274 (226–327) 21 (18–25) 103 (85–123) 24 073 117 43 (36–52)

2011 21 51 (42–61) 243 (200–290) 19 (16–23) 91 (75–109) 24 533 116 48 (40–58)

2012 22 52 (43–61) 238 (197–283) 19 (16–23) 88 (73–104) 24 802 114 48 (40–58)

Cape Verde 1990 < 1 0.62 (0.380–0.910) 175 (108–259) 0.039 (0.024–0.058) 11 (6.8–16) 221 63 36 (24–58)

1995 < 1 0.67 (0.550–0.800) 168 (137–201) 0.057 (0.046–0.069) 14 (12–17) 303 76 45 (38–55)

2000 < 1 0.71 (0.580–0.850) 160 (131–193) 0.071 (0.057–0.085) 16 (13–19)

2005 < 1 0.73 (0.600–0.880) 153 (125–184) 0.074 (0.060–0.089) 15 (12–19) 292 61 40 (33–49)

2010 < 1 0.71 (0.590–0.850) 147 (121–175) 0.067 (0.055–0.081) 14 (11–17) 356 73 50 (42–60)

2011 < 1 0.71 (0.590–0.850) 145 (120–173) 0.068 (0.055–0.081) 14 (11–17) 380 77 53 (45–65)

2012 < 1 0.71 (0.590–0.850) 144 (119–172) 0.071 (0.058–0.086) 14 (12–17) 420 85 59 (49–72)

Central African 1990 3 25 (21–30) 861 (710–1 030) 9.8 (8.1–12) 336 (277–400) 2 124 73 8.5 (7.1–10)

Republic 1995 3 39 (32–47) 1 200 (988–1 430) 18 (15–21) 549 (453–654) 3 339 102 8.5 (7.1–10)

2000 4 39 (32–46) 1 070 (884–1 280) 18 (15–21) 492 (406–587)

2005 4 27 (23–33) 690 (569–822) 11 (9.4–14) 287 (237–342) 3 210 81 12 (9.9–14)

2010 4 19 (16–22) 433 (357–515) 6.3 (5.2–7.5) 145 (119–172) 6 643 153 35 (30–43)

2011 4 18 (15–21) 400 (330–477) 5.8 (4.8–6.9) 131 (108–156) 5 611 126 32 (27–38)

2012 5 17 (14–20) 367 (302–438) 5.3 (4.4–6.4) 118 (97–141) 8 084 179 49 (41–59)

Chad 1990 6 5.6 (4.7–6.7) 95 (78–112) 0.69 (0.57–0.83) 12 (9.7–14) 2 591 44 46 (39–56)

1995 7 9 (7.4–11) 128 (106–153) 1.8 (1.5–2.2) 26 (22–31) 3 186 46 36 (30–43)

2000 8 13 (10–15) 151 (125–180) 3.1 (2.5–3.6) 37 (31–44)

2005 10 15 (12–18) 150 (124–178) 3.7 (3.1–4.4) 37 (31–44) 6 311 63 42 (35–51)

2010 12 18 (15–21) 151 (125–179) 3.6 (2.9–4.2) 30 (25–36) 9 452 81 53 (45–65)

2011 12 18 (15–22) 151 (125–179) 3.8 (3.2–4.6) 32 (26–38) 10 505 87 58 (48–70)

2012 12 19 (16–22) 151 (125–180) 4.1 (3.4–4.8) 33 (27–39) 10 585 85 56 (47–68)

Comoros 1990 < 1 0.22 (0.180–0.270) 54 (44–64) 140 34 63 (53–76)

1995 < 1 0.21 (0.180–0.250) 46 (38–55) 123 26 58 (48–70)

2000 < 1 0.21 (0.170–0.250) 39 (32–46) 120 23 58 (49–71)

2005 < 1 0.22 (0.180–0.260) 36 (30–43) 111 18 51 (43–62)

2010 < 1 0.23 (0.190–0.270) 33 (28–40) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.13)

2011 < 1 0.24 (0.200–0.290) 34 (28–41) <0.01 (<0.01–<0.01) 0.5 (0.45–0.65) 117 17 49 (41–59)

2012 < 1 0.25 (0.200–0.290) 34 (28–41) 0.01 (<0.01–0.012) 1.4 (1.2–1.7) 120 17 49 (41–59)

Congo 1990 2 4 (2.5–5.9) 169 (104–250) 0.94 (0.58–1.4) 40 (24–58) 591 25 15 (9.9–24)

1995 3 6.7 (5.4–8.0) 245 (200–294) 2.1 (1.7–2.5) 76 (62–91) 3 615 133 54 (45–66)

2000 3 11 (9.3–13) 353 (298–412) 3.2 (2.7–3.7) 102 (86–119) 9 239 296 84 (72–99)

2005 4 15 (12–18) 425 (347–510) 3.8 (3.1–4.6) 108 (88–130) 9 853 278 66 (55–80)

2010 4 16 (13–19) 391 (320–470) 3.4 (2.8–4.1) 83 (68–100) 10 150 247 63 (53–77)

2011 4 16 (13–20) 387 (317–465) 3.5 (2.8–4.2) 82 (67–98) 10 975 260 67 (56–82)

2012 4 17 (14–20) 381 (311–458) 3.6 (2.9–4.3) 83 (68–100) 11 303 261 68 (57–84)

Côte d'Ivoire 1990 12 29 (25–33) 238 (206–272) 8.3 (7.2–9.5) 68 (59–78) 7 841 65 27 (24–31)

1995 14 54 (47–62) 379 (329–433) 21 (19–24) 151 (131–172) 11 988 84 22 (19–26)

2000 16 60 (52–68) 369 (320–422) 25 (22–28) 154 (134–177) 15 094 94 25 (22–29)

2005 17 46 (40–53) 267 (232–306) 17 (15–19) 98 (85–112) 19 681 113 42 (37–49)

2010 19 36 (31–41) 190 (165–217) 9.4 (8.2–11) 50 (43–57) 22 708 120 63 (55–73)

2011 19 37 (32–42) 191 (165–218) 9.5 (8.3–11) 49 (43–56) 22 476 116 61 (53–70)

2012 20 34 (30–39) 172 (149–198) 8.8 (7.6–10) 44 (38–51) 23 762 120 69 (61–81)

Democratic 1990 35 110 (92–140) 327 (262–398) 8.1 (6.5–9.9) 23 (19–28) 21 131 61 19 (15–23)

Republic 1995 42 140 (110–160) 327 (268–392) 12 (9.7–14) 28 (23–34) 42 819 102 31 (26–38)

of the Congo 2000 47 150 (130–180) 327 (273–385) 14 (12–17) 30 (25–35) 61 024 130 40 (34–48)

2005 54 180 (150–200) 327 (279–379) 16 (14–19) 30 (25–34) 97 075 180 55 (47–64)

2010 62 200 (180–230) 327 (282–375) 16 (14–19) 26 (23–30) 114 170 184 56 (49–65)

2011 64 210 (180–240) 327 (282–375) 17 (14–19) 26 (22–30) 110 132 172 53 (46–61)

2012 66 210 (190–250) 327 (282–375) 16 (14–19) 25 (22–29) 108 984 166 51 (44–59)

Equatorial 1990 < 1 0.3 (0.260–0.340) 80 (70–91) 0.014 (0.012–0.016) 3.7 (3.2–4.2) 260 70 87 (77–99)

Guinea 1995 < 1 0.35 (0.310–0.400) 80 (70–90) 0.028 (0.024–0.032) 6.3 (5.5–7.1) 306 69 87 (77–99)

2000 < 1 0.52 (0.460–0.590) 101 (88–114) 0.062 (0.054–0.071) 12 (11–14)

2005 < 1 0.66 (0.580–0.750) 110 (96–124) 0.11 (0.095–0.12) 18 (16–20)

2010 < 1 0.94 (0.830–1.1) 135 (119–153) 0.18 (0.16–0.21) 26 (23–30) 820 118 87 (77–99)

2011 < 1 1 (0.890–1.1) 142 (124–161) 0.2 (0.18–0.23) 29 (25–32) 883 123 87 (77–99)

2012 < 1 1 (0.900–1.2) 139 (122–158) 0.2 (0.17–0.23) 27 (24–31)

Eritrea 1990 3 8 (5.3–11) 243 (162–341) 0.15 (0.098–0.21) 4.5 (3.0–6.3) 3 699 113 46 (33–70)

1995 3 6.7 (4.5–9.5) 198 (132–278) 0.4 (0.27–0.56) 12 (7.8–16) 21 453 630 320 (230–480)

2000 4 6.2 (4.1–8.7) 157 (104–220) 0.97 (0.64–1.4) 25 (16–34) 6 652 169 110 (77–160)

2005 5 5.9 (3.9–8.2) 121 (80–169) 1.1 (0.72–1.5) 22 (15–31) 3 585 74 61 (44–92)

2010 6 5.8 (3.8–8.1) 100 (67–140) 0.8 (0.53–1.1) 14 (9.3–20) 2 870 50 50 (36–75)

2011 6 5.7 (3.8–8.1) 97 (64–136) 0.79 (0.53–1.1) 13 (8.9–19) 3 049 51 53 (38–80)

2012 6 5.7 (3.8–8.0) 93 (62–131) 0.73 (0.49–1.0) 12 (7.9–17) 3 143 51 55 (39–83)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

161 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

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INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Ethiopia 1990 48 180 (100–270) 367 (218–553) 11 (6.3–16) 22 (13–33) 88 634 184 50 (33–85)

1995 57 240 (140–360) 419 (249–633) 36 (22–55) 64 (38–97) 26 034 46 11 (7.2–18)

2000 66 280 (170–420) 421 (251–636) 61 (36–92) 93 (55–140) 91 101 138 33 (22–55)

2005 76 260 (150–390) 342 (203–516) 54 (32–81) 71 (42–107) 124 262 163 48 (32–80)

2010 87 230 (170–310) 269 (191–359) 30 (21–40) 35 (25–46) 154 694 178 66 (49–93)

2011 89 230 (170–300) 258 (191–335) 27 (20–35) 30 (22–39) 156 539 175 68 (52–91)

2012 92 230 (170–290) 247 (183–321) 23 (17–30) 25 (19–33) 145 323 158 64 (49–87)

Gabon 1990 < 1 2.1 (1.7–2.5) 221 (182–263) 0.12 (0.096–0.14) 12 (10–15) 917 97 44 (37–53)

1995 1 3.4 (2.8–4.1) 315 (260–375) 0.47 (0.39–0.56) 44 (36–52) 1 115 103 33 (28–40)

2000 1 6.5 (5.3–7.7) 527 (435–627) 1.6 (1.3–1.9) 132 (108–157)

2005 1 8.1 (6.7–9.6) 586 (484–698) 2.5 (2.0–2.9) 178 (146–212) 2 512 182 31 (26–38)

2010 2 7.4 (6.1–8.8) 475 (392–566) 2.1 (1.7–2.5) 136 (112–162) 3 790 244 51 (43–62)

2011 2 7.2 (5.9–8.6) 450 (372–536) 2 (1.6–2.4) 125 (103–149) 4 404 276 61 (52–74)

2012 2 7 (5.8–8.3) 428 (354–510) 1.9 (1.5–2.2) 115 (95–137) 4 929 302 71 (59–85)

Gambia 1990 < 1 1.7 (1.0–2.5) 185 (114–273) 0.023 (0.014–0.033) 2.5 (1.5–3.6)

1995 1 2.2 (1.8–2.6) 204 (167–245) 0.071 (0.058–0.085) 6.7 (5.5–8.0) 1 023 96 47 (39–57)

2000 1 2.8 (2.3–3.3) 225 (184–271) 0.2 (0.16–0.24) 16 (13–19) 1 553 126 56 (47–69)

2005 1 3.6 (2.9–4.3) 248 (203–298) 0.47 (0.38–0.56) 33 (27–39) 2 031 141 57 (47–70)

2010 2 4.6 (3.8–5.5) 273 (226–325) 0.78 (0.65–0.93) 47 (39–56) 1 989 118 43 (36–52)

2011 2 4.8 (4.0–5.7) 279 (230–331) 0.77 (0.64–0.91) 44 (37–53) 2 302 133 48 (40–58)

2012 2 5.1 (4.2–6.0) 284 (234–337) 0.76 (0.63–0.90) 42 (35–50) 2 333 130 46 (39–56)

Ghana 1990 15 23 (10–40) 155 (69–275) 1.7 (0.74–2.9) 11 (5.0–20) 6 407 44 28 (16–63)

1995 17 28 (16–44) 167 (93–263) 4.2 (2.3–6.6) 25 (14–39) 8 636 52 31 (20–55)

2000 19 29 (18–41) 152 (97–220) 5.9 (3.8–8.6) 31 (20–46) 10 933 58 38 (26–60)

2005 21 25 (19–33) 119 (88–154) 5.4 (4.0–7.0) 25 (19–33) 12 124 57 48 (37–64)

2010 24 21 (18–24) 86 (75–97) 3.7 (3.2–4.2) 15 (13–17) 14 607 60 70 (62–80)

2011 25 20 (17–22) 79 (69–89) 3.3 (2.9–3.7) 13 (12–15) 15 389 62 79 (70–90)

2012 25 18 (16–21) 72 (63–82) 2.8 (2.4–3.1) 11 (9.6–12) 14 753 58 81 (71–92)

Guinea 1990 6 15 (12–18) 248 (204–295) 1.1 (0.90–1.3) 18 (15–22) 1 988 33 13 (11–16)

1995 8 20 (16–23) 249 (205–297) 2.8 (2.3–3.3) 35 (29–42) 3 523 45 18 (15–22)

2000 9 20 (17–24) 234 (193–279) 4.1 (3.3–4.8) 46 (38–55) 5 440 62 27 (22–32)

2005 10 20 (17–24) 211 (173–251) 4.5 (3.7–5.4) 47 (39–56) 6 863 72 34 (29–41)

2010 11 20 (17–24) 188 (155–224) 3.8 (3.2–4.6) 35 (29–42) 11 038 101 54 (45–66)

2011 11 20 (17–24) 183 (151–219) 3.7 (3.1–4.5) 33 (28–40) 11 359 102 55 (47–67)

2012 11 20 (17–24) 178 (146–213) 3.7 (3.0–4.4) 32 (27–39) 11 407 100 56 (47–68)

Guinea-Bissau 1990 1 1.6 (1.1–2.2) 158 (108–217) 0.08 (0.054–0.11) 7.8 (5.3–11) 1 163 114 73 (53–110)

1995 1 2 (1.6–2.4) 174 (142–209) 0.23 (0.19–0.27) 20 (16–24) 1 613 142 81 (68–100)

2000 1 2.4 (2.0–2.9) 192 (157–230) 0.55 (0.45–0.66) 43 (35–52) 1 273 100 52 (43–64)

2005 1 3 (2.5–3.6) 211 (173–254) 1 (0.84–1.2) 73 (59–87) 1 774 125 59 (49–72)

2010 2 3.7 (3.0–4.4) 233 (192–278) 1.3 (1.1–1.5) 81 (67–97) 2 183 138 59 (50–72)

2011 2 3.9 (3.2–4.6) 238 (196–283) 1.4 (1.2–1.7) 88 (73–105) 2 063 127 53 (45–65)

2012 2 4 (3.3–4.8) 242 (200–289) 1.6 (1.3–1.9) 94 (77–112) 1 939 117 48 (40–58)

Kenya 1990 23 33 (28–37) 139 (121–159) 3.6 (3.1–4.1) 15 (13–17) 11 788 50 36 (32–41)

1995 27 46 (43–50) 169 (155–184) 19 (18–21) 70 (64–76) 28 142 103 61 (56–66)

2000 31 89 (84–95) 286 (267–305) 47 (44–50) 151 (141–161) 64 159 205 72 (67–77)

2005 36 130 (120–140) 359 (339–380) 64 (60–67) 177 (168–188) 102 680 287 80 (76–85)

2010 41 120 (120–130) 298 (286–311) 51 (49–53) 124 (119–129) 99 272 243 81 (78–85)

2011 42 120 (120–130) 288 (276–300) 49 (47–51) 116 (111–121) 97 320 232 80 (77–84)

2012 43 120 (110–120) 272 (261–283) 45 (44–47) 105 (101–109) 92 987 215 79 (76–83)

Lesotho 1990 2 2.9 (2.2–3.8) 184 (135–240) 0.083 (0.061–0.11) 5.2 (3.8–6.8) 2 525 158 86 (66–120)

1995 2 5.7 (5.0–6.4) 323 (283–367) 2.2 (1.9–2.5) 125 (109–142) 5 181 295 91 (81–100)

2000 2 10 (9.0–12) 553 (484–626) 7.6 (6.6–8.6) 408 (357–462) 9 746 525 95 (84–110)

2005 2 12 (10–14) 639 (535–752) 10 (8.3–12) 517 (433–608) 10 802 561 88 (75–100)

2010 2 13 (11–14) 633 (553–719) 9.7 (8.5–11) 483 (422–549) 11 674 581 92 (81–110)

2011 2 13 (11–15) 632 (551–717) 9.5 (8.3–11) 467 (408–531) 11 561 570 90 (79–100)

2012 2 13 (11–15) 630 (550–716) 9.9 (8.7–11) 485 (423–550) 10 776 525 83 (73–95)

Liberia 1990 2 4.2 (2.6–6.2) 199 (123–293) 0.095 (0.058–0.14) 4.5 (2.8–6.7)

1995 2 4.6 (3.7–5.5) 219 (179–263) 0.31 (0.25–0.38) 15 (12–18) 1 393 67 31 (25–37)

2000 3 7 (5.7–8.4) 242 (197–290) 0.8 (0.65–0.98) 28 (22–34) 1 500 52 21 (18–26)

2005 3 8.7 (7.1–10) 266 (218–320) 1 (0.83–1.3) 32 (25–38) 3 432 105 39 (33–48)

2010 4 12 (9.6–14) 293 (242–349) 0.91 (0.73–1.1) 23 (18–28) 6 597 167 57 (48–69)

2011 4 12 (10–15) 299 (247–356) 0.83 (0.67–1.0) 20 (16–25) 7 906 194 65 (54–79)

2012 4 13 (11–15) 304 (251–362) 0.76 (0.61–0.93) 18 (15–22) 8 093 193 64 (53–77)

Madagascar 1990 12 45 (37–54) 391 (322–466) 0.34 (0.28–0.40) 2.9 (2.4–3.5) 6 261 54 14 (12–17)

1995 13 45 (37–54) 335 (276–400) 0.55 (0.46–0.66) 4.1 (3.4–4.9) 21 616 161 48 (40–58)

2000 16 46 (38–55) 293 (241–349) 0.73 (0.60–0.87) 4.6 (3.8–5.5)

2005 18 48 (39–57) 262 (216–313) 0.77 (0.64–0.92) 4.2 (3.5–5.0) 18 993 104 40 (33–48)

2010 21 51 (42–61) 242 (199–288) 0.7 (0.57–0.83) 3.3 (2.7–3.9) 24 432 116 48 (40–58)

2011 22 52 (43–62) 238 (196–284) 0.67 (0.55–0.80) 3.1 (2.6–3.7) 26 019 120 50 (42–61)

2012 22 52 (43–62) 234 (193–280) 0.64 (0.53–0.77) 2.9 (2.4–3.4) 25 782 116 49 (41–60)

Malawi 1990 9 31 (22–41) 326 (230–438) 13 (9.5–18) 143 (101–192) 12 395 131 40 (30–57)

1995 10 46 (38–55) 462 (383–548) 29 (24–34) 291 (241–345) 19 155 192 42 (35–50)

2000 11 53 (44–63) 467 (387–554) 37 (31–44) 329 (273–391) 23 604 208 45 (38–54)

2005 13 46 (38–54) 354 (292–421) 33 (27–39) 256 (211–305) 25 491 197 56 (47–68)

2010 15 33 (31–35) 219 (203–236) 21 (20–23) 142 (132–153) 21 092 140 64 (59–69)

2011 15 30 (27–32) 191 (177–206) 19 (18–21) 125 (116–135) 19 361 125 66 (61–71)

2012 16 26 (24–28) 163 (151–176) 16 (15–17) 100 (93–108) 20 335 128 78 (73–85)

Mali 1990 8 6 (5.8–6.3) 76 (72–80) 0.59 (0.56–0.62) 7.4 (7.0–7.8) 2 933 37 49 (46–51)

1995 9 7.2 (6.9–7.6) 80 (76–84) 1.2 (1.2–1.3) 14 (13–14) 3 087 34 43 (41–45)

2000 10 7.9 (7.6–8.3) 77 (74–81) 1.6 (1.6–1.7) 16 (15–17) 4 216 41 53 (51–56)

2005 12 8.3 (7.9–8.7) 69 (66–73) 1.6 (1.5–1.7) 13 (13–14) 4 704 39 57 (54–60)

2010 14 8.8 (8.4–9.2) 63 (60–66) 1.3 (1.3–1.4) 9.4 (9.0–9.9) 5 291 38 60 (57–63)

2011 14 8.9 (8.5–9.3) 62 (59–65) 1.3 (1.2–1.4) 8.9 (8.5–9.4) 5 428 38 61 (58–64)

2012 15 9 (8.5–9.4) 60 (57–63) 1.2 (1.2–1.3) 8.2 (7.8–8.6) 5 446 37 61 (58–64)

Mauritania 1990 2 4.6 (2.8–6.8) 228 (140–336) 0.05 (0.031–0.074) 2.5 (1.5–3.7) 5 284 261 110 (78–190)

1995 2 5.9 (4.8–7.0) 251 (205–302) 0.1 (0.083–0.12) 4.4 (3.6–5.2) 3 849 165 66 (55–80)

2000 3 7.5 (6.1–9.0) 277 (226–333) 0.17 (0.14–0.20) 6.3 (5.1–7.5) 3 067 113 41 (34–50)

2005 3 9.6 (7.9–12) 305 (250–367) 0.27 (0.22–0.32) 8.4 (6.9–10) 2 162 69 22 (19–28)

2010 4 12 (10–15) 337 (277–402) 0.44 (0.36–0.53) 12 (10–15) 2 461 68 20 (17–25)

2011 4 13 (10–15) 344 (283–410) 0.5 (0.41–0.60) 14 (11–16) 1 804 49 14 (12–17)

2012 4 13 (11–16) 350 (288–418) 0.57 (0.47–0.68) 15 (12–18) 2 616 69 20 (16–24)

Mauritius 1990 1 0.29 (0.180–0.430) 28 (17–41) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 119 11 41 (28–66)

1995 1 0.29 (0.240–0.350) 26 (21–31) <0.01 (<0.01–<0.01) 0.3 (0.24–0.35) 131 12 45 (37–55)

2000 1 0.29 (0.240–0.350) 24 (20–29) 0.011 (<0.01–0.013) 0.9 (0.74–1.1) 160 14 55 (46–68)

2005 1 0.28 (0.230–0.330) 23 (19–28) 0.017 (0.014–0.021) 1.4 (1.2–1.7) 125 10 45 (37–55)

2010 1 0.27 (0.220–0.320) 22 (18–26) 0.016 (0.013–0.020) 1.3 (1.1–1.6) 122 9.9 46 (39–56)

2011 1 0.26 (0.220–0.310) 21 (18–25) 0.015 (0.013–0.018) 1.2 (1.0–1.5) 114 9.2 43 (36–53)

2012 1 0.26 (0.210–0.310) 21 (17–25) 0.014 (0.011–0.017) 1.1 (0.92–1.3) 128 10 49 (41–60)

Mozambique 1990 14 54 (8.5–140) 401 (62–1 050) 0.84 (0.13–2.2) 6.2 (0.97–16) 15 899 117 29 (11–190)

1995 16 76 (24–160) 478 (153–985) 15 (4.8–31) 94 (30–194) 17 882 112 23 (11–73)

2000 18 94 (41–170) 513 (227–914) 41 (18–74) 227 (100–404) 21 158 116 23 (13–51)

2005 21 110 (63–170) 524 (298–811) 61 (35–94) 290 (165–449) 33 231 158 30 (20–53)

2010 24 130 (90–180) 544 (377–741) 78 (54–110) 327 (227–446) 43 558 182 33 (25–48)

2011 25 130 (93–180) 548 (380–747) 81 (56–110) 331 (229–451) 44 627 182 33 (24–48)

2012 25 140 (96–190) 552 (383–753) 83 (58–110) 330 (228–450) 47 741 189 34 (25–50)

Namibia 1990 1 5.4 (4.3–6.6) 379 (300–468) 0.48 (0.38–0.59) 34 (27–41) 2 671 189 50 (40–63)

1995 2 9.5 (7.5–12) 575 (456–709) 2.8 (2.2–3.4) 168 (133–207) 1 540 93 16 (13–20)

2000 2 27 (21–33) 1 410 (1 110–1 730) 15 (12–19) 798 (631–983) 10 799 569 40 (33–51)

2005 2 28 (22–35) 1 390 (1 100–1 720) 19 (15–23) 932 (738–1 150

)

14 920 736 53 (43–67)

2010 2 19 (15–23) 867 (686–1 070) 11 (8.3–13) 483 (383–596) 11 281 518 60 (48–75)

2011 2 16 (13–20) 723 (573–891) 8.7 (6.9–11) 391 (310–482) 10 806 487 67 (55–85)

2012 2 15 (12–18) 655 (524–800) 7.3 (5.8–8.9) 323 (258–394) 10 003 443 68 (55–84)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

162 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Niger 1990 8 28 (23–33) 358 (295–426) 1.1 (0.91–1.3) 14 (12–17) 5 200 67 19 (16–23)

1995 9 25 (20–29) 270 (223–321) 1.7 (1.4–2.1) 19 (16–22) 1 980 22 8 (6.7–9.7)

2000 11 21 (17–25) 191 (157–227) 2.1 (1.7–2.5) 19 (16–23) 4 701 43 22 (19–27)

2005 13 19 (15–22) 142 (118–170) 2.2 (1.8–2.6) 16 (14–20) 7 873 60 42 (35–51)

2010 16 18 (15–21) 113 (94–135) 1.9 (1.6–2.3) 12 (9.8–14) 10 130 64 56 (47–68)

2011 17 18 (15–21) 108 (90–129) 1.9 (1.6–2.3) 11 (9.5–14) 10 510 64 59 (49–71)

2012 17 18 (15–21) 104 (86–124) 1.9 (1.5–2.2) 11 (8.9–13) 10 989 64 62 (52–75)

Nigeria 1990 96 120 (1.3–500) 128 (1.3–526) 2.2 (0.023–9.1) 2.3 (<0.1–9.5) 20 122 21 16 (4.0–1 600)

1995 108 150 (8.0–490) 139 (7.4–456) 16 (0.84–52) 15 (0.78–48) 13 423 12 8.9 (2.7–170)

2000 123 210 (15–660) 172 (12–536) 46 (3.3–140) 38 (2.7–118) 25 821 21 12 (3.9–170)

2005 140 240 (33–660) 175 (23–476) 64 (8.6–170) 46 (6.2–125) 63 990 46 26 (9.6–200)

2010 160 210 (100–360) 133 (64–225) 53 (26–91) 33 (16–57) 84 121 53 40 (23–82)

2011 164 190 (91–340) 118 (55–204) 49 (23–85) 30 (14–52) 86 778 53 45 (26–95)

2012 169 180 (85–310) 108 (50–186) 46 (21–80) 27 (13–47) 92 818 55 51 (29–110)

Rwanda 1990 7 21 (19–23) 290 (259–323) 11 (9.5–12) 148 (132–165) 6 387 89 30 (27–34)

1995 6 29 (26–32) 513 (458–571) 15 (13–16) 260 (232–290) 3 054 54 11 (9.4–12)

2000 8 27 (24–30) 325 (290–362) 13 (12–15) 157 (140–175) 6 093 73 22 (20–25)

2005 9 17 (15–19) 181 (162–202) 7.5 (6.7–8.3) 79 (71–88) 7 220 77 42 (38–47)

2010 11 11 (10–13) 106 (94–118) 3.7 (3.3–4.1) 34 (31–38) 6 703 62 59 (53–66)

2011 11 11 (9.4–12) 94 (84–105) 3.3 (3.0–3.7) 30 (26–33) 6 623 59 63 (57–71)

2012 11 9.8 (8.8–11) 86 (77–96) 2.9 (2.6–3.2) 25 (22–28) 6 091 53 62 (56–69)

Sao Tome and 1990 < 1 0.16 (0.098–0.230) 135 (83–199) <0.01 (<0.01–<0.01) 2 (1.2–2.9) 17 14 11 (7.3–17)

Principe 1995 < 1 0.16 (0.130–0.190) 124 (102–149) <0.01 (<0.01–<0.01) 3.8 (3.1–4.6)

2000 < 1 0.16 (0.130–0.190) 114 (93–137) <0.01 (<0.01–0.010) 6.2 (5.0–7.4) 97 70 61 (51–75)

2005 < 1 0.16 (0.140–0.190) 105 (88–123) 0.015 (0.012–0.017) 9.6 (8.0–11) 136 88 84 (72–100)

2010 < 1 0.17 (0.140–0.200) 96 (79–115) 0.018 (0.015–0.021) 9.9 (8.1–12) 121 68 71 (59–86)

2011 < 1 0.17 (0.140–0.210) 94 (78–113) 0.018 (0.014–0.021) 9.6 (7.9–11) 136 74 79 (66–96)

2012 < 1 0.17 (0.140–0.210) 93 (76–111) 0.017 (0.014–0.021) 9.2 (7.5–11) 115 61 66 (55–80)

Senegal 1990 8 10 (8.5–12) 138 (114–164) 0.17 (0.14–0.20) 2.2 (1.8–2.6) 4 977 66 48 (40–58)

1995 9 13 (11–16) 153 (126–183) 0.4 (0.33–0.48) 4.6 (3.8–5.5) 7 561 87 57 (47–69)

2000 10 15 (13–18) 155 (128–184) 0.8 (0.66–0.96) 8.1 (6.7–9.7) 8 508 86 56 (47–68)

2005 11 16 (13–19) 142 (117–169) 1.2 (1.0–1.4) 11 (8.9–13) 9 765 87 61 (51–74)

2010 13 18 (15–21) 137 (113–163) 1.5 (1.3–1.8) 12 (9.7–14) 11 061 85 63 (52–76)

2011 13 18 (15–22) 136 (112–162) 1.6 (1.3–1.9) 12 (9.6–14) 11 022 83 61 (51–74)

2012 14 19 (16–22) 137 (113–163) 1.7 (1.4–2.0) 12 (9.9–14) 12 265 89 65 (55–79)

Seychelles 1990 < 1 0.03 (0.019–0.044) 43 (27–64) 41 59 140 (92–220)

1995 < 1 0.03 (0.025–0.036) 40 (33–48) 8 11 27 (22–33)

2000 < 1 0.029 (0.024–0.035) 37 (30–44) 20 25 69 (57–84)

2005 < 1 0.029 (0.024–0.035) 33 (27–40) 14 16 48 (40–59)

2010 < 1 0.028 (0.023–0.033) 31 (25–37) <0.01 (<0.01–<0.01) 1.8 (<0.1–8.0) 17 19 61 (51–74)

2011 < 1 0.028 (0.023–0.033) 30 (25–36) <0.01 (<0.01–0.011) 5.8 (1.6–12) 21 23 76 (64–92)

2012 < 1 0.027 (0.023–0.033) 30 (24–35) <0.01 (<0.01–<0.01) 2.7 (<0.1–10) 20 22 73 (61–88)

Sierra Leone 1990 4 8.4 (5.2–12) 207 (128–305) 0.011 (<0.01–0.016) 0.3 (0.17–0.40) 632 16 7.5 (5.1–12)

1995 4 8.3 (6.4–11) 212 (162–269) 0.087 (0.067–0.11) 2.2 (1.7–2.8) 1 955 50 23 (19–31)

2000 4 11 (8.1–14) 264 (196–341) 0.45 (0.33–0.58) 11 (8.0–14) 3 760 91 34 (27–46)

2005 5 26 (21–31) 503 (410–605) 2.3 (1.9–2.7) 44 (36–53) 6 737 132 26 (22–32)

2010 6 38 (31–45) 660 (540–791) 4.2 (3.4–5.0) 73 (60–87) 12 859 224 34 (28–41)

2011 6 39 (32–47) 668 (542–807) 4.3 (3.5–5.2) 73 (59–88) 12 734 217 32 (27–40)

2012 6 40 (32–49) 674 (540–821) 3.9 (3.2–4.8) 66 (53–81) 13 074 219 32 (27–40)

South Africa 1990 37 110 (76–150) 301 (206–413) 2.5 (1.7–3.4) 6.7 (4.6–9.2) 80 400 219 73 (53–110)

1995 41 130 (110–160) 317 (259–381) 25 (21–30) 61 (50–73) 73 917 178 56 (47–69)

2000 45 260 (210–310) 576 (471–691) 140 (110–170) 311 (254–374) 151 239 337 59 (49–72)

2005 48 450 (360–540) 925 (756–1 110) 300 (250–360) 622 (508–746) 270 178 560 61 (50–74)

2010 51 500 (420–600) 981 (809–1 170) 330 (270–390) 640 (528–763) 354 786 690 70 (59–85)

2011 52 520 (430–610) 993 (819–1 180) 330 (270–390) 635 (524–756) 362 453 698 70 (59–85)

2012 52 530 (430–630) 1 000 (827–1 190) 330 (270–390) 631 (521–752) 323 664 618 62 (52–75)

Swaziland 1990 < 1 2.3 (1.4–3.4) 267 (165–394) 0.38 (0.23–0.56) 44 (27–64)

1995 < 1 3.2 (2.7–3.9) 337 (275–405) 1.6 (1.3–1.9) 161 (132–194) 2 050 213 63 (53–77)

2000 1 8.5 (7.0–10) 803 (657–964) 6.3 (5.2–7.6) 595 (486–714) 5 877 552 69 (57–84)

2005 1 13 (10–15) 1 150 (938–1 380) 11 (8.7–13) 962 (787–1 150

)

8 705 788 69 (57–84)

2010 1 15 (13–18) 1 290 (1 060–1 530) 13 (11–15)

070 (882–1 270

)

10 101 847 66 (55–80)

2011 1 16 (13–19) 1 320 (1 090–1 570) 12 (10–15)

020 (844–1 220

)

8 337 688 52 (44–63)

2012 1 17 (14–20) 1 350 (1 110–1 610) 13 (11–15)

040 (856–1 240

)

7 165 582 43 (36–52)

Togo 1990 4 1.8 (1.5–2.1) 47 (39–56) 0.18 (0.15–0.21) 4.7 (3.8–5.6) 1 324 35 74 (62–90)

1995 4 2.5 (2.0–3.0) 58 (48–69) 0.44 (0.37–0.53) 10 (8.5–12) 1 520 35 61 (51–74)

2000 5 3.5 (2.9–4.2) 72 (59–86) 0.89 (0.73–1.1) 18 (15–22) 1 409 29 40 (34–49)

2005 6 4.2 (3.5–5.1) 77 (63–91) 1.2 (1.0–1.5) 22 (18–26) 2 541 46 60 (50–73)

2010 6 4.6 (3.8–5.5) 73 (60–87) 1.2 (0.99–1.4) 19 (16–23) 2 791 44 61 (51–74)

2011 6 4.7 (3.9–5.6) 73 (60–87) 1.2 (0.97–1.4) 18 (15–22) 2 888 45 61 (51–74)

2012 7 4.9 (4.0–5.8) 73 (60–87) 1.2 (0.98–1.4) 18 (15–21) 2 843 43 59 (49–71)

Uganda 1990 18 110 (57–180) 624 (328–1 010) 79 (41–130) 449 (236–729) 14 740 84 13 (8.3–26)

1995 21 110 (62–180) 542 (297–860) 81 (44–130) 390 (214–619) 25 316 122 23 (14–41)

2000 24 100 (63–150) 427 (259–636) 68 (41–100) 280 (170–417) 30 372 125 29 (20–48)

2005 29 87 (63–120) 304 (220–402) 50 (36–66) 173 (125–228) 41 040 143 47 (36–65)

2010 34 71 (57–86) 209 (169–253) 38 (31–46) 113 (91–137) 42 885 126 60 (50–75)

2011 35 68 (55–82) 193 (156–234) 36 (29–44) 102 (83–124) 46 306 132 68 (56–84)

2012 36 65 (53–79) 179 (145–216) 35 (28–42) 95 (77–115) 44 663 123 69 (57–85)

United Republic 1990 25 58 (49–67) 226 (193–261) 14 (12–16) 56 (47–64) 22 249 87 39 (33–45)

of Tanzania 1995 30 68 (58–78) 226 (193–261) 31 (26–36) 103 (88–119) 39 847 133 59 (51–69)

2000 34 80 (70–91) 236 (207–268) 41 (36–46) 121 (106–137) 54 442 160 68 (60–77)

2005 39 83 (76–89) 213 (197–229) 40 (37–43) 104 (96–112) 61 022 157 74 (69–80)

2010 45 80 (75–85) 177 (166–189) 33 (31–35) 72 (68–77) 61 098 136 77 (72–82)

2011 46 78 (74–83) 169 (159–180) 31 (29–33) 68 (63–72) 59 357 128 76 (71–81)

2012 48 79 (74–84) 165 (154–175) 32 (30–34) 68 (64–72) 62 178 130 79 (74–84)

Zambia 1990 8 56 (49–63) 710 (624–801) 35 (31–40) 449 (395–507) 16 863 215 30 (27–34)

1995 9 70 (64–76) 788 (719–861) 49 (45–54) 559 (510–611) 35 958 407 52 (47–57)

2000 10 72 (67–77) 713 (661–767) 52 (48–56) 513 (475–551) 49 806 493 69 (64–75)

2005 11 65 (59–71) 566 (519–615) 47 (43–51) 409 (375–445) 49 576 432 76 (70–83)

2010 13 61 (55–67) 462 (418–509) 39 (35–43) 292 (264–322) 44 154 334 72 (66–80)

2011 14 61 (55–67) 444 (401–489) 38 (34–42) 277 (250–305) 43 583 320 72 (65–80)

2012 14 60 (54–66) 427 (385–470) 35 (32–39) 251 (226–276) 40 726 289 68 (62–75)

Zimbabwe 1990 10 31 (17–50) 296 (159–476) 18 (9.5–29) 170 (91–273) 9 132 87 29 (18–55)

1995 12 56 (39–77) 483 (335–658) 46 (32–62) 392 (272–535) 30 831 265 55 (40–79)

2000 13 91 (72–110) 726 (573–897) 79 (62–97) 629 (496–777) 50 855 407 56 (45–71)

2005 13 100 (81–130) 799 (634–984) 83 (66–100) 657 (521–809) 50 454 397 50 (40–63)

2010 13 83 (64–100) 633 (489–795) 63 (48–79) 480 (371–603) 44 209 338 53 (43–69)

2011 13 81 (62–100) 603 (466–757) 58 (45–73) 433 (335–543) 38 404 287 48 (38–62)

2012 14 77 (60–97) 562 (434–706) 55 (42–69) 399 (308–501) 35 760 261 46 (37–60)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

163 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

eria 1990 11 607

–

1995 13 507 5 735 2 256 5 065 451 451 72

2000 18 572 8 328 2 019 7 758 467 80 547 80

2005 21 336 8 654 1 651 10 216 267 548 165 713 84

2010 22 336 8 299 1 770 11 770 0 497 194 691 0 82

2011 21 429 7 790 1 753 11 444 0 442 168 610 0 82

• 44 57 • 2012 21 880 7 510 1 702 12 294 0 374 202 576 0 82

ola 1990 10 271

–

1995 5 143 3 804 1 631 266 134 134 70

2000 16 062 9 053 5 367 1 102 540 540 63

2005 37 175 20 410 12 467 2 569 1 729 1 142 2 871 62

2010 44 655 21 146 17 285 3 780 2 444 5 332 7 776 55

2011 47 240 21 703 18 380 4 399 0 2 758 1 686 4 444 0 54

• 99 249 • 2012 51 819 21 124 23 056 4 776 0 2 863 1 607 4 470 48

Benin 1990 2 074 1 410 310 182 172 49 221 82

1995 2 400 1 839 281 212 68 68 87

2000 2 697 2 277 130 199 91 189 280 95

2005 3 270 2 739 96 285 150 187 337 97

2010 3 756 2 973 296 367 0 120 85 205 0 91

2011 4 212 3 331 329 398 0 154 108 262 0 91

• 41 39 • 2012 3 966 3 171 305 316 0 174 109 283 0 91

Botswana 1990 2 938

–

1995 5 665 1 903 2 885 720 147 147 40

2000 9 292 3 091 4 789 1 231 181 1 058 1 239 39

2005 10 058 3 170 5 166 1 220 502 46 548 38

2010 7 013 3 295 2 055 1 210 0 453 619 1 072 0 62

2011 6 603 2 669 1 983 1 213 0 738 130 868 0 57

• 212 307 • 2012 6 161 2 426 2 208 1 151 0 376 62 438 0 52

Burkina Faso 1990 1 497

–

1995 2 572 1 028 195 195 45 45 84

2000 2 331 1 545 196 502 88 90 178 0 89

2005 3 478 2 290 367 571 90 160 167 327 0 86

2010 4 800 3 041 736 729 77 217 335 552 0 81

2011 5 286 3 450 692 742 175 227 257 484 0 83

• 17 32 • 2012 5 210 3 583 662 617 154 194 195 389 0 84

Burundi 1990 4 575

–

1995 3 326 1 121 908 1 116 181 181 55

2000 6 421 3 159 1 489 1 568 0 205 20 225 0 68

2005 6 585 3 262 1 160 2 089 0 74 42 116 0 74

2010 7 611 4 590 963 1 826 8 224 108 332 0 83

2011 6 742 4 060 799 1 649 5 229 86 315 0 84

• 82 70 • 2012 6 921 4 075 746 1 887 3 210 95 305 0 85

Cameroon 1990 5 892

–

1995 3 292 2 896 142 18 236 236 95

2000 5 251 3 960 625 415 251 251 86

2005 21 499 13 001 5 021 2 461 0 1 016 574 1 590 0 72

2010 24 073 14 464 5 437 3 157 0 1 015 479 1 494 0 73

2011 24 533 14 927 4 941 3 597 0 1 068 593 1 661 0 75

• 49 114 • 2012 24 802 15 016 5 204 3 524 0 1 058 558 1 616 0 74

e Verde 1990 221

–

1995 303 111 150 12 30 30 43

2000

–

2005 292 135 93 43 0 21 13 34 0 59

2010 356 186 98 54 18 9 27 65

2011 380 182 127 54 0 17 10 27 0 59

• 63 85 • 2012 420 189 151 66 0 14 5 19 0 56

Central African 1990 2 124

–

ublic 1995 3 339 1 794 964 393 188 188 65

2000

–

2005 3 210 2 153 608 286 0 163 128 291 0 78

2010 6 643 3 638 1 598 1 079 24 304 117 421 0 69

2011 5 611 3 479 964 876 60 232 113 345 0 78

• 73 179 • 2012 8 084 4 641 1 752 1 356 335 199 534 73

Chad 1990 2 591

–

1995 3 186 2 002 518 463 203 203 79

2000

–

2005 6 311 2 516 2 419 1 055 321 194 515 51

2010 9 452 3 833 3 746 1 217 193 463 245 708 0 51

2011 10 505 4 434 4 211 1 033 249 578 269 847 0 51

• 44 85 • 2012 10 585 3 849 4 809 1 113 180 634 215 849 0 44

Comoros 1990 140

–

1995 123 103 10 7 7 7 91

2000 120 87 14 15 4 1 5 86

2005 111 79 14 16 0 2 1 3 0 85

2010

–

2011 117 62 13 28 5 9 2 11 0 83

• 34 17 • 2012 120 71 24 23 2 2 4 75

Con

o 1990 591

–

1995 3 615 2 013 849 675 78 78 70

2000 9 239 4 218 2 016 2 810 169 650 819 68

2005 9 853 3 640 3 249 2 665 299 108 407 53

2010 10 150 3 568 3 545 2 692 345 171 516 50

2011 10 975 3 716 3 930 2 990 0 339 168 507 0 49

• 25 261 • 2012 11 303 3 984 3 937 3 110 0 272 209 481 0 50

Côte d'Ivoire 1990 7 841

–

1995 11 988 8 254 1 508 1 577 649 649 85

2000 15 094 10 276 1 616 2 756 0 446 447 893 0 86

2005 19 681 12 496 2 315 4 235 0 635 345 980 0 84

2010 22 708 14 131 2 381 5 179 0 1 017 502 1 519 0 86

2011 22 476 14 416 2 316 4 729 0 1 015 444 1 459 0 86

• 65 120 • 2012 23 762 14 660 2 818 5 344 0 940 460 1 400 0 84

Democratic 1990 21 131

–

ublic 1995 42 819 20 914 7 953 9 112 2 891 2 891 72

of the Con

o 2000 61 024 36 513 8 089 13 785 2 637 2 637 82

2005 97 075 65 040 9 959 18 494 3 582 2 483 6 065 87

2010 114 170 73 653 14 039 22 340 0 4 138 4 466 8 604 0 84

2011 110 132 71 321 13 471 21 579 3 761 4 158 7 919 84

• 61 166 • 2012 108 984 71 124 13 214 20 669 3 977 3 515 7 492 84

uatorial 1990 260

–

Guinea 1995 306 219 45 41 1 1 83

2000

–

2005

–

2010 820 579 98 109 0 34 33 67 0 86

2011 883 611 118 131 0 23 30 53 0 84

• 70 0 • 2012

–

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Rates are per 100 000 population.

NEW AND RELAPSE includes cases for which the treatment history is unknown.

164 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Eritrea 1990 3 699

–

1995 21 453 18 205 3 248

–

2000 6 652 590 5 332 683 47 20 67 10

2005 3 585 687 1 764 1 001 97 27 124 36 28

2010 2 870 832 1 115 836 0 87 121 208 0 43

2011 3 049 835 1 163 888 60 103 44 147 0 42

• 113 51 • 2012 3 143 779 1 154 1 093 0 117 111 228 0 40

Ethio

ia 1990 88 634

–

1995 26 034 9 040 8 888 7 763 343 343 50

2000 91 101 30 510 30 565 28 907 1 119 1 658 2 777 50

2005 124 262 38 525 39 816 43 675 2 246 873 3 119 49

2010 154 694 46 634 54 979 50 417 0 2 664 2 234 4 898 46

2011 156 539 49 594 55 497 49 305 0 2 143 2 478 4 621 0 47

• 184 158 • 2012 145 323 47 236 49 413 46 854 0 1 820 2 269 4 089 0 49

Gabon 1990 917

–

1995 1 115 486 517 68 44 44 48

2000

–

2005 2 512 1 042 1 071 241 158 99 257 49

2010 3 790 1 560 1 366 379 0 168 390 558 317 53

2011 4 404 1 740 1 959 384 0 321 512 833 0 47

• 97 302 • 2012 4 929 1 745 2 353 414 0 175 486 661 242 43

Gambia 1990

–

1995 1 023 778 171 68 6 6 82

2000 1 553 919 515 99 20 33 53 64

2005 2 031 1 127 749 78 0 77 89 166 0 60

2010 1 989 1 344 462 143 0 40 41 81 0 74

2011 2 302 1 375 673 199 4 51 31 82 0 67

• 0 130 • 2012 2 333 1 429 643 169 0 92 54 146 69

Ghana 1990 6 407

–

1995 8 636 2 638 1 225 109 159 159 68

2000 10 933 7 316 2 500 615 502 502 75

2005 12 124 7 505 3 068 1 019 532 532 71

2010 14 607 7 656 5 068 1 400 0 483 538 1 021 0 60

2011 15 389 7 616 5 875 1 471 427 451 878 56

• 44 58 • 2012 14 753 7 097 5 979 1 301 376 454 830 54

Guinea 1990 1 988

–

1995 3 523 2 263 527 620 55 55 81

2000 5 440 3 920 430 938 152 294 446 90

2005 6 863 5 479 524 629 231 227 458 91

2010 11 038 7 041 1 472 2 077 86 362 286 648 0 83

2011 11 359 6 934 1 446 2 284 273 422 247 669 83

• 33 100 • 2012 11 407 6 653 1 510 2 434 321 489 234 723 0 82

Guinea-Bissau 1990 1 163

–

1995 1 613 956 714 19 59 59 57

2000 1 273 526 600 57 90 90 47

2005 1 774 1 132 522 24 0 96 42 138 0 68

2010 2 183 1 409 636 22 0 116 76 192 0 69

2011 2 063 1 230 644 63 0 126 7 133 0 66

• 114 117 • 2012 1 939 1 324 521 43 0 51 11 62 0 72

Ken

a 1990 11 788 6 800 100

1995 28 142 13 934 9 676 3 468 1 064 1 064 59

2000 64 159 28 773 24 143 9 118 1 773 704 2 477 54

2005 102 680 40 389 43 772 15 265 3 254 5 721 8 975 48

2010 99 272 36 260 41 962 17 382 0 3 668 6 811 10 479 0 46

2011 97 320 37 085 39 810 17 069 0 3 356 6 661 10 017 0 48

• 50 215 • 2012 92 987 36 937 36 697 15 934 0 3 419 6 162 9 581 0 50

Lesotho 1990 2 525

–

1995 5 181 1 361 2 685 653 147 147 34

2000 9 746 3 041 2 838 2 520 385 1 096 1 481 52

2005 10 802 4 280 4 063 2 020 439 602 1 041 51

2010 11 674 3 600 5 331 2 222 521 1 464 1 985 40

2011 11 561 3 666 5 296 2 095 504 1 224 1 728 41

• 158 525 • 2012 10 776 3 298 5 142 1 877 459 1 195 1 654 39

Liberia 1990

–

1995 1 393 1 154 119 120 91

2000 1 500 1 021 285 187 7 25 32 78

2005 3 432 2 167 575 657 33 24 57 79

2010 6 597 3 750 1 385 1 363 0 99 71 170 0 73

2011 7 906 4 261 1 967 1 612 0 66 59 125 0 68

• 0 193 • 2012 8 093 4 342 1 946 1 749 0 56 39 95 0 69

Mada

ascar 1990 6 261

–

1995 21 616 8 026 987 2 219 596 596 89

2000

–

2005 18 993 13 056 1 287 3 634 0 1 016 482 1 498 0 91

2010 24 432 16 795 1 657 4 545 0 1 435 674 2 109 0 91

2011 26 019 17 927 1 726 4 851 1 515 703 2 218 91

• 54 116 • 2012 25 782 17 206 1 804 4 964 0 1 519 427 1 946 289 91

Malawi 1990 12 395 4 301 5 827 1 885 382 382 42

1995 19 155 6 285 7 054 5 257 551 551 47

2000 23 604 8 260 8 846 5 734 764 0 764 48

2005 25 491 8 443 10 132 5 823 1 093 2 119 3 212 45

2010 21 092 7 240 8 245 4 857 0 750 1 444 2 194 47

2011 19 361 7 003 6 612 5 076 670 1 493 2 163 51

• 131 128 • 2012 20 335 6 951 6 550 4 886 0 694 128 822 1 254 51

Mali 1990 2 933

–

1995 3 087 1 866 609 459 153 153 75

2000 4 216 2 527 797 653 239 239 76

2005 4 704 3 530 482 492 200 180 380 0 88

2010 5 291 3 686 481 926 0 198 157 355 0 88

2011 5 428 3 777 491 984 176 145 321 88

• 37 37 • 2012 5 446 3 724 487 1 081 0 154 156 310 0 88

Mauritania 1990 5 284

–

1995 3 849 2 074 800 455 520 520 72

2000 3 067 1 583 687 580 580 358 938 70

2005 2 162 1 155 454 403 0 150 56 206 0 72

2010 2 461 1 422 390 524 0 125 28 153 78

2011 1 804 1 009 222 458 0 87 16 103 28 82

• 261 69 • 2012 2 616 1 522 354 628 0 112 20 132 0 81

Mauritius 1990 119

–

1995 131 113 8 12 2 2 93

2000 160 115 14 23 8 4 12 89

2005 125 110 4 8 3 2 5 96

2010 122 105 5 6 0 6 1 7 0 95

2011 114 100 3 8 0 3 2 5 0 97

• 11 10 • 2012 128 118 3 5 0 2 2 4 0 98

Rates are per 100 000 population.

NEW AND RELAPSE includes cases for which the treatment history is unknown.

165 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Mozambi

ue 1990 15 899

–

1995 17 882 10 566 5 054 1 363 899 899 68

2000 21 158 13 257 4 037 2 262 917 546 1 463 77

2005 33 231 17 877 9 184 4 771 1 399 487 1 886 66

2010 43 558 20 097 16 408 5 621 0 1 432 2 616 4 048 0 55

2011 44 627 19 537 18 159 5 504 0 1 427 2 825 4 252 0 52

• 117 189 • 2012 47 741 20 951 19 797 5 542 0 1 451 3 086 4 537 0 51

Namibia 1990 2 671

–

1995 1 540 697 507 248 88 88 58

2000 10 799 4 012 4 724 1 459 604 930 1 534 46

2005 14 920 5 222 4 455 1 907 2 487 849 974 1 823 54

2010 11 281 4 464 3 309 2 330 1 178 1 344 2 522 57

2011 10 806 4 503 3 034 2 039 0 1 230 1 132 2 362 0 60

• 189 443 • 2012 10 003 4 333 2 473 2 063 1 134 1 142 2 276 64

er 1990 5 200

–

1995 1 980 1 492 116 372 93

2000 4 701 3 045 699 702 255 255 81

2005 7 873 5 050 1 193 1 227 403 351 754 0 81

2010 10 130 6 283 1 730 1 492 173 452 215 667 0 78

2011 10 510 6 604 1 856 1 489 376 204 580 185 78

• 67 64 • 2012 10 989 6 848 1 989 1 689 116 347 218 565 0 77

eria 1990 20 122

–

1995 13 423 9 476 3 364 280 303 303 74

2000 25 821 17 423 6 613 1 069 716 1 640 2 356 72

2005 63 990 35 048 22 705 2 836 0 2 009 2 858 4 867 1 392 61

2010 84 121 45 416 32 616 3 422 0 2 667 6 326 8 993 0 58

2011 86 778 47 436 33 034 3 793 0 2 515 6 272 8 787 0 59

• 21 55 • 2012 92 818 52 901 32 972 4 432 2 513 5 035 7 548 62

Rwanda 1990 6 387

–

1995 3 054 1 840 676 338 200 200 73

2000 6 093 3 681 845 1 289 278 96 374 81

2005 7 220 4 166 859 1 727 97 371 460 831 83

2010 6 703 3 785 1 072 1 577 269 362 631 78

2011 6 623 3 811 1 017 1 300 242 253 161 414 0 79

• 89 53 • 2012 6 091 3 571 858 1 247 203 212 117 329 0 81

Sao Tome and 1990 17

–

Princi

e 1995

–

2000 97 30 56 7 4 4 35

2005 136 49 75 1 0 11 16 27 40

2010 121 47 63 10 0 1 1 2 0 43

2011 136 53 49 28 0 6 10 16 0 52

• 14 61 • 2012 115 59 37 16 0 3 12 15 0 61

Sene

al 1990 4 977

–

1995 7 561 5 421 1 073 504 563 563 83

2000 8 508 5 823 1 370 800 0 515 541 1 056 81

2005 9 765 6 722 1 557 921 565 355 920 81

2010 11 061 7 688 1 470 1 404 0 499 530 1 029 0 84

2011 11 022 7 765 1 389 1 315 0 553 566 1 119 0 85

• 66 89 • 2012 12 265 8 448 1 755 1 524 0 538 554 1 092 0 83

chelles 1990 41

–

1995 8 6 2 1 0 0 75

2000 20 11 7 2 0 0 61

2005 14 8 3 1 0 2 0 2 73

2010 17 9 8 0 0 0 0 0 0 53

2011 21 2 13 6 0 0 0 0 0 13

• 59 22 • 2012 20 9 8 2 0 1 1 2 0 53

Sierra Leone 1990 632

–

1995 1 955 1 454 339 121 41 41 81

2000 3 760 2 472 821 400 67 374 441 75

2005 6 737 4 370 1 679 551 137 193 330 72

2010 12 859 6 898 4 919 831 211 336 547 58

2011 12 734 7 435 4 358 775 166 209 375 63

• 16 219 • 2012 13 074 8 031 4 241 570 232 280 512 65

South Africa 1990 80 400

–

1995 73 917 23 112 74 399 10 636 179 179 24

2000 151 239 75 967 16 392 17 486 56 202 56 202 82

2005 270 178 125 460 76 680 39 739 0 28 299 32 289 60 588 0 62

2010 354 786 132 107 151 772 52 095 0 18 812 41 768 60 580 0 47

2011 362 453 129 770 148 266 47 285 0 18 394 27 521 45 915 18 738 47

• 219 618 • 2012 323 664 119 898 134 631 42 467 0 26 668 25 918 52 586 0 47

Swaziland 1990

–

1995 2 050 660 687 219 489 489 49

2000 5 877 1 823 3 198 583 273 976 1 249 36

2005 8 705 2 187 4 106 1 458 311 159 470 643 35

2010 10 101 3 011 5 064 1 631 395 1 045 1 440 37

2011 8 337 2 408 4 228 1 395 0 306 843 1 149 0 36

• 0 582 • 2012 7 165 2 548 3 111 1 209 0 297 574 871 0 45

o 1990 1 324

–

1995 1 520 887 304 236 93 93 74

2000 1 409 984 91 287 47 86 133 92

2005 2 541 1 798 170 484 85 94 179 4 91

2010 2 791 2 096 164 397 0 134 106 240 0 93

2011 2 888 2 087 205 475 0 121 92 213 0 91

• 35 43 • 2012 2 843 2 112 168 444 0 119 69 188 0 93

anda 1990 14 740

–

1995 25 316 13 631 5 912 2 070 955 955 70

2000 30 372 17 246 9 003 2 618 1 505 0 1 505 66

2005 41 040 20 559 15 040 3 780 0 1 661 769 2 430 58

2010 42 885 23 456 13 567 4 571 0 1 291 2 661 3 952 0 63

2011 46 306 25 614 14 389 5 001 1 302 2 712 4 014 64

• 84 123 • 2012 44 663 24 916 13 270 5 143 0 1 334 2 548 3 882 0 65

United Re

ublic 1990 22 249 11 553 100

of Tanzania 1995 39 847 19 955 12 362 6 195 1 335 1 335 62

2000 54 442 24 049 17 624 10 997 1 772 1 772 58

2005 61 022 25 264 20 810 13 094 1 854 3 178 5 032 55

2010 61 098 24 769 21 184 13 715 1 430 2 355 3 785 54

2011 59 357 24 115 20 438 13 725 0 1 079 1 791 2 870 0 54

• 87 130 • 2012 62 178 25 138 21 393 14 595 0 1 052 1 714 2 766 0 54

Zambia 1990 16 863

–

1995 35 958 10 038 3 268 656 243 243 75

2000 49 806 12 927 25 222 10 202 1 455 1 455 34

2005 49 576 14 857 24 327 8 587 1 805 3 691 5 496 38

2010 44 154 12 639 20 412 9 255 0 1 848 4 462 6 310 0 38

2011 43 583 12 046 20 004 9 908 1 625 5 011 6 636 38

• 215 289 • 2012 40 726 12 645 17 050 9 174 1 857 4 551 6 408 43

Zimbabwe 1990 9 132

–

1995 30 831 8 965 10 934 5 040 737 737 45

2000 50 855 14 392 27 626 8 837 34

2005 50 454 13 155 29 074 6 721 0 1 504 4 437 5 941 31

2010 44 209 11 654 25 157 6 061 0 1 337 3 348 4 685 0 32

2011 38 404 12 596 19 172 5 192 0 1 444 2 901 4 345 0 40

• 87 261 • 2012 35 760 12 163 17 316 4 912 0 1 369 2 960 4 329 0 41

Rates are per 100 000 population.

NEW AND RELAPSE includes cases for which the treatment history is unknown.

166 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Algeria 1995 5 735 –

2000 8 328 8 328 100 80 7 1 2 5 5

2005 8 654 8 379 97 74 13 2 0 3 8

2009 8 402 8 438 100 81 10 2 1 3 3

2010 8 299 7 894 95 79 10 2 1 4 4

• 0 92 • 2011 7 790 7 364 95 81 11 2 0 4 2

Angola 1995 3 804 –

2000 9 053 6 392 71 68 3 2 26 2

2005 20 410 20 113 99 45 28 3 3 19 3

2009 22 488 21 627 96 47 25 4 2 18 5

2010 21 146 21 145 100 30 18 8 1 8 35

• 0 55 • 2011 21 703 21 703 100 36 19 7 2 13 23

Benin 1995 1 839 1 839 100 50 21 6 1 17 5

2000 2 277 2 277 100 57 20 6 2 11 3

2005 2 739 2 766 101 74 13 7 2 3 1

2009 2 960 2 963 100 8295210

2010 2 973 2 987 100 8475211

• 71 90 • 2011 3 331 3 324 100 8466310

Botswana 1995 1 903 2 060 108 13 54 5 1 12 15

2000 3 091 3 991 129 22 55 6 0 7 10

2005 3 170 3 335 105 37 33 7 1 8 15

2009 3 144 3 492 111 57 22 5349

2010 3 295 3 314 101 50 32 5238

• 67 81 • 2011 2 669 3 107 116 36 46 6239

Burkina Faso 1995 1 028 1 200 117 22 2 5 1 3 67

2000 1 545 1 574 102 53 7 13 2 16 9

2005 2 290 2 290 100 66 5 14 7 6 1

2009 3 061 3 061 100 72 4 10 9 4 2

2010 3 041 3 057 101 74 3 9 7 6 1

• 25 78 • 2011 3 450 3 442 100 74 4 9 6 6 1

Burundi 1995 1 121 1 798 160 25 20 3 0 14 38

2000 3 159 3 465 110 42 39 4 0 13 1

2005 3 262 3 424 105 52 27 4 0 17 1

2009 3 974 3 974 100 8373150

2010 4 590 4 590 100 8744130

• 45 92 • 2011 4 060 4 060 100 8844130

Cameroon 1995 2 896 2 740 95 45 8 7 1 35 4

2000 3 960 3 164 80 67 10 7 2 13 1

2005 13 001 13 169 101 66761145

2009 14 635 14 428 99 65 13 6 1 10 5

2010 14 464 14 464 100 64 14 6 1 10 5

• 53 80 • 2011 14 927 14 927 100 67 13 6 1 9 4

Cape Verde 1995 111 –

2000 14 – 64070029

2005 135 135 100 56 8 3 2 19 12

2009 172 –

2010 186 –

• 0 77 • 2011 182 182 100 55 23 4 0 9 10

Central African 1995 1 794 692 39 16 21 7 0 53 3

Republic 2000 1 366 – 36 21 0 3 34 5

2005 2 153 3 217 149 38 28 6 2 8 19

2009 5 132 5 132 100 33 20 3 1 13 30

2010 3 638 3 569 98 45 23 6 1 19 7

• 37 68 • 2011 3 479 3 205 92 44 23 4 1 18 10

Chad 1995 2 002 529 26 17 30 6 1 43 3

2000 –

2005 2 516 –

2009 3 820 3 820 100 55 22 4 2 15 3

2010 3 833 3 780 99 39 28 4 2 21 5

• 47 68 • 2011 4 434 4 430 100 45 23 4 1 19 8

Comoros 1995 103 113 110 9004060

2000 87 85 98 9124400

2005 79 70 89 9103401

2009 76 –

2010 87 – 9103212

• 90 25 • 2011 62 4 6 25 75 0

Congo 1995 2 013 –

2000 4 218 3 114 74 57 12 4 0 22 5

2005 3 640 4 121 113 244011358

2009 3 433 3 634 106 66 12 1 0 13 7

2010 3 568 3 447 97 63 13 2 1 12 8

• 0 71 • 2011 3 716 3 716 100 59 12 2 2 11 14

Côte d'Ivoire 1995 8 254 7 221 87 63641179

2000 10 276 10 631 103 47 10 5 2 16 20

2005 12 496 12 496 100 62 11 8 2 10 6

2009 14 300 14 300 100 69 10 8 3 7 4

2010 14 131 14 131 100 66 12 7 2 8 5

• 68 78 • 2011 14 416 14 416 100 6997293

Democratic 1995 20 914 16 247 78 55 20 5 1 10 9

Republic 2000 36 513 36 123 99 6986187

of the Congo 2005 65 040 65 066 100 8056144

2009 73 078 72 367 99 8534134

2010 73 653 73 448 100 8644133

• 74 87 • 2011 71 321 71 321 100 8254145

Equatorial 1995 219 219 100 8903080

Guinea 2000 –

2005 –

2009 490 490 100 47 19 3 1 16 14

2010 579 590 102 50 20 5 1 17 7

• 89 0 • 2011 611 –

Eritrea 1995 –

2000 590 765 130 64 12 8196

2005 687 688 100 8357121

2009 802 804 100 8325325

2010 832 804 97 8147315

• 0 87 • 2011 835 835 100 8344415

Ethiopia 1995 9 040 5 087 56 565521319

2000 30 510 29 662 97 63 17 6194

2005 38 525 39 430 102 64 14 5 1 4 12

2009 44 396 44 807 101 65 19 3 1 3 10

2010 46 634 46 634 100 66 17 3 1 3 10

• 61 90 • 2011 49 594 41 351 83 70 19 3 1 2 4

Gabon 1995 486 249 51 63 22 1 2 9 2

2000 –

2005 1 042 1 165 112 35 12 10 1 42 1

2009 1 244 1 163 93 37 18 1 1 25 18

2010 1 560 1 671 107 34 29 2 3 26 6

• 86 51 • 2011 1 740 1 654 95 26 25 2 1 36 11

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

167 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Gambia 1995 778 686 88 69751135

2000 919 –

2005 1 127 1 127 100 81 6 7132

2009 1 313 1 296 99 88 1 6121

2010 1 344 1 344 100 86 2 5133

• 76 88 • 2011 1 375 1 375 100 86 2 6222

Ghana 1995 2 638 361 14 41 13 11 2 11 22

2000 7 316 7 316 100 455631427

2005 7 505 7 584 101 68 5 9 2 11 5

2009 8 255 8 255 100 79 8 7133

2010 7 656 7 656 100 76 10 7133

• 54 86 • 2011 7 616 7 623 100 75 11 8132

Guinea 1995 2 263 2 263 100 62 17 6 2 9 5

2000 3 920 3 920 100 59971159

2005 5 479 5 811 106 657621010

2009 5 377 5 597 104 7265278

2010 7 041 7 250 103 7644269

• 78 82 • 2011 6 934 5 152 74 7664275

Guinea-Bissau 1995 956 959 100 42 23 6 0 23 6

2000 526 –

2005 1 132 1 167 103 51 18 12 1 11 7

2009 1 310 1 498 114 51 17 6 1 21 5

2010 1 409 1 271 90 54 18 6 0 14 7

• 65 73 • 2011 1 230 1 308 106 60 14 6 0 13 7

Kenya 1995 13 934 6 470 46 60 14 9 1 9 7

2000 28 773 28 376 99 66 14 5 0 9 6

2005 40 389 40 436 100 71 11 5 0 8 5

2009 37 402 37 402 100 7884164

2010 36 260 36 260 100 8163154

• 75 88 • 2011 37 085 36 717 99 8353143

Lesotho 1995 1 361 1 788 131 32 14 7 0 9 36

2000 3 041 –

2005 4 280 5 542 129 73 8 1 4 14

2009 3 976 4 070 102 59 11 11 2 5 12

2010 3 600 3 852 107 58 10 10 2 8 12

• 47 74 • 2011 3 666 3 666 100 63 11 11 2 6 7

Liberia 1995 1 154 1 595 138 79 5 5 12 0

2000 1 021 924 90 71926103

2005 2 167 2 167 100 60 16 3 0 12 8

2009 3 796 3 796 100 57 26 5193

2010 3 750 –

• 79 86 • 2011 4 261 3 853 90 64 22 4164

Madagascar 1995 8 026 9 101 113 478621620

2000 10 506 – 61971175

2005 13 056 15 298 117 67 7 6 1 13 5

2009 15 729 15 709 100 7834195

2010 16 795 16 789 100 7844194

• 55 83 • 2011 17 927 17 602 98 7944184

Malawi 1995 6 285 6 293 100 65 6 19 1 0 10

2000 8 260 8 296 100 70 3 19 1 4 3

2005 8 443 8 443 100 72 2 15 1 3 7

2009 7 623 7 624 100 8727121

2010 7 240 7 240 100 8627122

• 71 85 • 2011 7 003 7 012 100 8147224

Mali 1995 1 866 1 290 69 41 18 5 0 22 14

2000 2 527 –

2005 3 530 3 530 100 69 6 11 4 7 3

2009 5 163 4 454 86 66 12 10 4 7 2

2010 3 686 3 778 102 7608394

• 59 68 • 2011 3 777 3 777 100 55 13 7 3 7 15

Mauritania 1995 2 074 –

2000 1 583 –

2005 1 155 1 761 152 44 11 2 1 19 24

2009 1 555 1 563 101 51 12 3 1 10 23

2010 1 422 1 422 100 55 14 2 1 13 15

• 0 73 • 2011 1 009 1 450 144 57 16 2 0 16 9

Mauritius 1995 113 –

2000 115 160 139 0 92 2230

2005 110 110 100 86 3 6 5

2009 98 98 100 8804044

2010 105 105 100 9004150

• 0 90 • 2011 100 100 100 9005050

Mozambique 1995 10 566 10 566 100 34 5 3 1 9 48

2000 13 257 13 296 100 73 2 10 1 11 3

2005 17 877 17 877 100 78 1 12 1 5 2

2009 19 579 19 579 100 84 1 9 1 3 2

2010 20 097 20 097 100 8328141

• 39 0 • 2011 19 537 –

Namibia 1995 697 –

2000 4 012 4 012 100 41 15 6 2 15 21

2005 5 222 5 222 100 59 16 7 2 10 7

2009 4 608 4 702 102 74 11 5 4 4 2

2010 4 464 4 538 102 74 11 5 4 3 2

• 0 84 • 2011 4 503 4 502 100 74 10 5 5 5 0

Niger 1995 1 492 –

2000 3 045 3 193 105 42 22 8 4 12 11

2005 5 050 5 050 100 49 25 5 2 14 5

2009 6 347 6 313 99 66 13 7 2 7 5

2010 6 283 6 266 100 69 13 7 2 6 3

• 0 80 • 2011 6 604 6 604 100 66 15 5 3 9 3

Nigeria 1995 9 476 9 476 100 34 15 5 2 9 35

2000 17 423 16 372 94 65 14 6 2 11 2

2005 35 048 35 080 100 50 25 9 4 11 1

2009 44 863 44 863 100 73 10 5 1 8 4

2010 45 416 45 416 100 73 10 5 1 8 2

• 49 85 • 2011 47 436 47 436 100 77 9 5 1 7 2

Rwanda 1995 1 840 –

2000 3 681 3 776 103 52961428

2005 4 166 4 175 100 73 10 6236

2009 4 184 4 165 100 7785433

2010 3 785 3 806 101 8085421

• 0 89 • 2011 3 811 3 811 100 8455421

Sao Tome and 1995 –

Principe 2000 30 97 323 52 27 9570

2005 49 49 100 9802000

2009 52 50 96 9800200

2010 47 45 96 20 58 9 0 13 0

• 0 72 • 2011 53 53 100 45 26 4 19 6 0

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Senegal 1995 5 421 5 421 100 359461631

2000 5 823 5 823 100 439312122

2005 6 722 6 722 100 70 6 4 2 11 8

2009 7 883 7 883 100 81 3 4 2 5 5

2010 7 688 7 855 102 81 4 4 2 6 4

• 44 85 • 2011 7 765 7 898 102 82 3 3 2 7 3

Seychelles 1995 6 9 150 89 0 11 0 0 0

2000 11 11 100 82 0 0 0 9 9

2005 8 –

2009 11 11 100 55 9 18 0 0 18

2010 9 7 78 100 0 0 0 0 0

• 89 67 • 2011 2 9 450 56 11 0 0 11 22

Sierra Leone 1995 1 454 1 315 90 55 15 5 7 16 2

2000 2 472 2 296 93 70 7 6 2 13 2

2005 4 370 4 370 100 77 8 6 1 6 2

2009 6 092 6 083 100 68 10 6 1 11 4

2010 6 898 6 897 100 77 9 4 1 6 3

• 69 88 • 2011 7 435 7 351 99 79 9 3 1 6 2

South Africa 1995 23 112 28 209 122 40 18 4 4 15 19

2000 75 967 86 276 114 54 9 6 1 13 17

2005 125 460 134 782 107 58 13 7 2 10 10

2009 139 468 139 458 100 67 6 7 2 7 12

2010 132 107 134 250 102 7366276

• 58 79 • 2011 129 770 132 867 102 7456267

Swaziland 1995 660 –

2000 1 823 –

2005 2 187 2 187 100 22 20 6 2 5 45

2009 3 498 3 498 100 51 19 10 7 7 7

2010 3 011 3 011 100 51 22 11 9 6 2

• 0 73 • 2011 2 408 2 499 104 48 25 8855

Togo 1995 887 856 97 42 18 9 3 17 11

2000 984 –

2005 1 798 1 796 100 66 5 12 4 11 2

2009 2 267 2 267 100 77 4 10 4 3 2

2010 2 096 2 096 100 8138341

• 60 85 • 2011 2 087 2 075 99 8137251

Uganda 1995 13 631 15 301 112 26 18 7 1 13 36

2000 17 246 13 874 80 33 30 7 0 17 12

2005 20 559 20 559 100 32 41 6 0 16 5

2009 23 113 23 113 100 30 38 5 1 12 16

2010 23 456 23 456 100 35 36 5 1 11 13

• 44 77 • 2011 25 614 25 614 100 39 38 5 1 12 5

United Republic 1995 19 955 19 955 100 69 5 9 1 6 11

of Tanzania 2000 24 049 23 923 99 72 6 10 0 6 5

2005 25 264 25 324 100 7949044

2009 24 895 24 895 100 8265025

2010 24 769 24 373 98 8465023

• 73 88 • 2011 24 115 24 218 100 8074026

Zambia 1995 10 038 5 957 59 47 23 7 2 14 8

2000 12 927 7 014 54 48 19 7 6 6 14

2005 14 857 14 857 100 7688125

2009 12 995 12 995 100 85 66130

2010 12 639 12 639 100 83 6 6131

• 70 88 • 2011 12 046 12 711 106 82 5 4134

Zimbabwe 1995 8 965 9 702 108 32 21 10 0 10 26

2000 14 392 14 392 100 61 8 12 0 7 13

2005 13 155 12 860 98 59 9 12 2 7 12

2009 10 195 10 195 100 70 9 8176

2010 11 654 11 654 100 72 10 8 1 5 5

• 53 81 • 2011 12 596 12 596 100 73 8 8 1 4 6

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

169 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Algeria 1995 451 –

2000 547 512 94 61 16 5 4 5 10

2005 713 713 100 48 24 2 1 6 19

2009 612 553 90 72 12 4 2 5 5

2010 691 598 87 69 14 4 2 5 6

• 0 80 • 2011 610 588 96 65 15 3 4 11 3

Angola 1995 134 –

2000 540 –

2005 2 871 1 613 56 23 24 5 17 26 4

2009 3 863 3 044 79 45 21 5 4 21 3

2010 7 776 2 272 29 42 23 8 4 16 7

• 0 0 • 2011 4 444 4 444 100 0 0 0 0 100

Benin 1995 68 139 204 48 19 9 4 19 1

2000 280 282 101 61 21 5 1 11 0

2005 337 341 101 60 21 10 3 6 1

2009 271 270 100 70 11 11 6 1 1

2010 205 203 99 76 9 6 6 1 1

• 67 84 • 2011 262 262 100 80 4 8 5 1 1

Botswana 1995 147 –

2000 1 239 395 32 21 54 8 1 11 6

2005 548 219 40 33 28 11 5 12 11

2009 1 122 1 126 100 22 43 13 4 8 10

2010 1 072 1 027 96 20 46 14 3 7 10

• 0 70 • 2011 868 998 115 15 55 11 3 6 10

Burkina Faso 1995 45 26 58 65 12 8 12 0 4

2000 178 166 93 57 4 13 5 15 7

2005 327 272 83 71 4 6 10 6 4

2009 608 509 84 70 5 9 8 5 3

2010 552 475 86 72 4 9 8 6 1

• 77 75 • 2011 484 481 99 70 4 10 8 6 1

Burundi 1995 181 265 146 25 21 6 2 28 18

2000 225 92 41 50 13 15 3 17 1

2005 116 –

2009 238 238 100 81 3 6 3 4 2

2010 332 332 100 78 4 7 5 6 0

• 46 85 • 2011 315 315 100 80 4 6 5 4 0

Cameroon 1995 236 –

2000 251 347 138 50 10 9 5 26 2

2005 1 590 1 611 101 49 7 6 3 16 19

2009 1 569 1 516 97 51 18 9 2 13 7

2010 1 494 1 489 100 55 16 9 3 12 6

• 0 70 • 2011 1 661 1 661 100 54 16 9 3 12 6

Cape Verde 1995 30 –

2000 –

2005 34 34 100 41 15 0 0 24 21

2009 33 –

2010 27 –

• 0 37 • 2011 27 27 100 22 15 4 4 11 44

Central African 1995 188 –

Republic 2000 353 – 33 16 1 4 39 8

2005 291 291 100 53 30 9 0 8 1

2009 629 629 100 19 12 5 2 8 53

2010 421 284 67 35 24 7 4 25 6

• 0 55 • 2011 345 275 80 33 21 11 4 20 11

Chad 1995 203 92 45 29 18 5 2 40 4

2000 –

2005 515 –

2009 676 676 100 49 21 4 3 15 8

2010 708 704 99 38 35 4 2 18 3

• 48 60 • 2011 847 847 100 29 31 4 1 27 7

Comoros 1995 7 7 100 43 0 29 0 29 0

2000 5 5 100 100 0 0 0 0 0

2005 3 5 167 100 0 0 0 0 0

2009 6 –

2010 5 – 80 0 0 20 0 0

• 43 0 • 2011 11 –

Congo 1995 78 –

2000 819 187 23 49 13 3 3 28 4

2005 407 477 117 12 2 0 0 3 83

2009 451 418 93 59 22 2 1 14 2

2010 516 235 46 40 17 3 2 21 18

• 0 51 • 2011 507 528 104 51 0 5 4 10 31

Côte d'Ivoire 1995 649 –

2000 893 507 57 45 10 8 9 21 7

2005 980 980 100 43 14 8 7 13 15

2009 1 436 1 436 100 50 14 13 11 9 3

2010 1 519 1 519 100 51 14 12 8 11 3

• 0 67 • 2011 1 459 1 459 100 56 11 10 8 12 3

Democratic 1995 2 891 1 202 42 56 16 8 2 12 6

Republic 2000 2 637 –

of the Congo 2005 6 065 5 448 90 71 4 10 4 6 5

2009 8 666 7 193 83 54 23 8 2 4 8

2010 8 604 5 583 65 72 5 7 3 6 8

• 72 74 • 2011 7 919 4 572 58 68 5 8 2 5 12

Equatorial 1995 1 6 600 83 0 0 17 0 0

Guinea 2000 –

2005 –

2009 44 44 100 36 14 14 2 16 18

2010 67 41 61 32 15 22 0 27 5

• 83 0 • 2011 53 –

Eritrea 1995 –

2000 67 –

2005 124 –

2009 207 157 76 70 12 7 6 2 3

2010 208 120 58 81 8 9 2 1 0

• 0 69 • 2011 147 147 100 67 3 7 10 1 13

Ethiopia 1995 343 193 56 71 8 3 5 8 5

2000 2 777 1 556 56 60 11 10 4 8 7

2005 3 119 3 116 100 41 15 9 2 5 28

2009 3 544 2 942 83 47 21 5 2 3 23

2010 4 898 3 934 80 56 27 4 3 5 6

• 79 78 • 2011 4 621 1 796 39 57 21 4 0 3 15

Gabon 1995 44 –

2000 –

2005 257 150 58 18 12 5 3 60 3

2009 655 611 93 12 67 2 1 17 1

2010 558 147 26 32 33 3 3 26 2

• 0 40 • 2011 833 200 24 18 21 2 2 30 26

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

170 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Gambia 1995 6 45 750 69 0 11 2 11 7

2000 53 –

2005 166 –

2009 99 100 101 67 5 17 2 7 2

2010 81 81 100 30 6 6 1 0 57

• 69 78 • 2011 82 86 105 74 3 13 3 3 2

Ghana 1995 159 47 30 68 6 6 9 9 2

2000 502 –

2005 532 540 102 40 8 6 3 11 32

2009 860 717 83 50 26 10 2 3 10

2010 1 021 1 021 100 38 39 12 2 2 7

• 74 77 • 2011 878 878 100 40 38 12 3 4 5

Guinea 1995 55 112 204 44 23 3 9 13 8

2000 446 299 67 63 8 5 3 8 13

2005 458 458 100 45 16 10 7 13 11

2009 589 –

2010 648 111 17 55 14 8 5 13 6

• 67 64 • 2011 669 121 18 56 7 8 3 16 9

Guinea-Bissau 1995 59 –

2000 90 –

2005 138 146 106 44 34 8 0 8 7

2009 76 89 117 30 34 2 0 29 4

2010 192 140 73 23 31 10 0 27 9

• 0 68 • 2011 133 47 35 47 21 13 2 9 9

Kenya 1995 1 064 879 83 61 11 9 1 10 8

2000 2 477 1 964 79 65 11 2 8 10 4

2005 8 975 3 794 42 68 9 10 1 7 5

2009 10 711 4 859 45 70 8 8 4 7 4

2010 10 479 4 333 41 73 6 6 3 8 4

• 72 82 • 2011 10 017 7 235 72 77 5 4 4 7 3

Lesotho 1995 147 –

2000 1 481 –

2005 1 041 597 57 71 11 2 2 14

2009 1 970 1 931 98 20 42 17 2 4 15

2010 1 985 2 091 105 16 42 16 2 8 16

• 0 58 • 2011 1 728 1 728 100 17 41 18 2 10 12

Liberia 1995 –

2000 32 41 128 39 22 12 7 20 0

2005 57 57 100 75 9 2 9 5

2009 123 123 100 70 15 8 4 2 0

2010 170 –

• 0 82 • 2011 125 125 100 72 10 4 12 2 0

Madagascar 1995 596 –

2000 –

2005 1 498 1 825 122 65 7 7 2 12 6

2009 2 089 2 073 99 62 11 7 2 8 10

2010 2 109 1 800 85 71 3 8 2 9 8

• 0 80 • 2011 2 218 1 843 83 75 4 7 1 8 4

Malawi 1995 551 492 89 65 4 22 2 1 6

2000 764 797 104 61 5 23 1 6 3

2005 3 212 1 093 34 74 1 19 1 3 3

2009 2 470 788 32 83 2 9 2 2 1

2010 2 194 750 34 77 1 10 3 1 9

• 69 82 • 2011 2 163 670 31 79 3 10 1 3 5

Mali 1995 153 –

2000 239 –

2005 380 379 100 67 6 10 5 10 3

2009 425 390 92 67 8 9 6 7 3

2010 355 345 97 87 12 1 0 0 0

• 0 69 • 2011 321 321 100 64 5 7 4 4 15

Mauritania 1995 520 –

2000 938 –

2005 206 –

2009 182 182 100 48 13 3 1 20 14

2010 153 153 100 46 13 5 2 15 20

• 0 53 • 2011 103 133 129 43 10 10 2 17 19

Mauritius 1995 2 –

2000 12 2 17 0 0 50 50 0 0

2005 5 5 100 60 20 20 0

2009 5 5 100 60 0 20 0 20 0

2010 7 7 100 86 0 0 0 14 0

• 0 80 • 2011 5 5 100 80 0 0 0 20 0

Mozambique 1995 899 –

2000 1 463 1 594 109 69 3 11 4 11 2

2005 1 886 1 855 98 69 1 15 2 10 3

2009 3 630 –

2010 4 048 –

• 0 0 • 2011 4 252 –

Namibia 1995 88 –

2000 1 534 604 39 41 14 8 6 13 17

2005 1 823 2 009 110 24 29 11 3 13 22

2009 2 558 1 546 60 58 15 9 9 6 3

2010 2 522 2 548 101 63 15 6 10 5 2

• 0 80 • 2011 2 362 2 361 100 67 13 5 9 5 0

Niger 1995 –

2000 255 –

2005 754 –

2009 690 667 97 64 12 9 4 5 6

2010 667 661 99 64 11 10 3 5 7

• 0 76 • 2011 580 580 100 62 14 6 5 10 4

Nigeria 1995 303 –

2000 2 356 1 848 78 58 13 7 7 11 4

2005 4 867 3 662 75 48 18 2 11 20 1

2009 8 151 8 151 100 48 33 6 2 7 4

2010 8 993 8 993 100 43 39 4 4 7 3

• 0 82 • 2011 8 787 8 787 100 42 40 4 4 6 4

Rwanda 1995 200 –

2000 374 296 79 49 5 14 1 5 25

2005 831 506 61 56 9 15 3 4 13

2009 475 448 94 62 10 11 7 4 6

2010 631 446 71 65 9 9 6 4 6

• 0 80 • 2011 414 415 100 72 8 10 7 2 1

Sao Tome and 1995 –

Principe 2000 4 –

2005 27 0 0

2009 3 3 100 33 33 0 33 0 0

2010 2 12 600 0 50 8 17 8 17

• 0 31 • 2011 16 16 100 0 31 6 38 25 0

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

171 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Senegal 1995 563 634 113 45 11 5 10 25 4

2000 1 056 931 88 40 8 4 3 23 23

2005 920 920 100 58 5 8 5 13 11

2009 1 112 889 80 67475108

2010 1 029 1 029 100 56463724

• 56 68 • 2011 1 119 914 82 64453149

Seychelles 1995 0 –

2000 0 –

2005 2 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Sierra Leone 1995 41 69 168 72 14 3441

2000 441 –

2005 330 328 99 68 7 6 3 15 1

2009 467 466 100 56 13 10 3 15 4

2010 547 543 99 65 11 5 2 15 2

• 87 70 • 2011 375 362 97 63 7 6 3 15 5

South Africa 1995 179 –

2000 56 202 24 847 44 438831919

2005 60 588 64 923 107 29 29 11 2 16 13

2009 65 916 34 122 52 53 8 10 3 12 15

2010 60 580 60 580 100 31 4 5 2 7 52

• 0 66 • 2011 45 915 31 168 68 59 7 9 3 12 10

Swaziland 1995 489 –

2000 1 249 –

2005 470 1 113 237 7 21 11 3 5 54

2009 1 474 1 474 100 14 41 17 9 10 8

2010 1 440 446 31 32 18 17 21 7 6

• 0 59 • 2011 1 149 1 151 100 12 46 15 8 5 13

Togo 1995 93 93 100 16 17 5 4 19 38

2000 133 –

2005 179 128 72 73 2 14 4 7 0

2009 214 237 111 68 3 18 3 4 5

2010 240 240 100 78 4 6 4 8 1

• 33 78 • 2011 213 210 99 75 3 8 4 8 1

Uganda 1995 955 –

2000 1 505 1 209 80 34 30 13 0 13 10

2005 2 430 –

2009 4 014 2 856 71 31 39 7 1 15 7

2010 3 952 2 764 70 31 34 8 1 12 13

• 0 71 • 2011 4 014 2 814 70 38 33 8 2 14 5

United Republic 1995 1 335 1 455 109 66 10 11 1 8 4

of Tanzania 2000 1 772 3 356 189 49 24 14 1 6 6

2005 5 032 5 067 101 37 39 13 1 4 6

2009 4 217 4 217 100 34 49 8 1 3 5

2010 3 785 3 714 98 37 47 9 1 3 4

• 76 82 • 2011 2 870 2 936 102 38 43 7 1 3 7

Zambia 1995 243 –

2000 1 455 894 61 52 15 11 4 5 12

2005 5 496 5 496 100 24 60 9134

2009 2 485 5 444 219 33 53 9140

2010 6 310 –

• 0 0 • 2011 6 636 –

Zimbabwe 1995 737 –

2000 1 063 – 51 14 17 1 8 9

2005 5 941 4 667 79 13 46 16 0 13 11

2009 4 685 1 203 26 72 8 11 0 5 4

2010 4 685 1 629 35 63 11 13 3 5 5

• 0 78 • 2011 4 345 1 772 41 63 15 11 4 4 3

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

172 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Algeria 2005 21 501

2010 22 530

2011 21 597

– – 2012 22 082

Angola 2005 38 317

2010 4.9 2 434 49 987 1 620 67 43 43

2011 10 5 107 48 926 789 15 100 100

– 23 • 2012 23 12 022 53 426 1 149 9.6 100 100 1 100

Benin 2005 15 503 3 457 57 11

2010 98 3 774 3 841 592 16 97 57

2011 99 4 259 4 320 727 17 98 74 339

• 15 98 • 2012 98 4 006 4 075 637 16

Botswana 2005 23 2 291 10 104 1 829 80 18 762

2010 81 6 147 7 632 4 018 65 79 43 738

2011 97 6 545 6 733 4 129 63 62 53

• 23 95 • 2012 95 5 940 6 223 3 759 63 90 65

Burkina Faso 2005 33 1 213 3 645 559 46 68 32

2010 93 4 761 5 135 839 18 98 60

2011 89 4 944 5 543 829 17 97 70

• 33 84 • 2012 84 4 567 5 405 671 15 96 75

Burundi 2005 6 627 0

2010 71 5 511 7 719 1 260 23 95 40

2011 71 4 817 6 828 1 036 22 95 48 0

– 82 • 2012 82 5 734 7 016 1 076 19 94 55

Cameroon 2005 0 0 22 073 0 0

2010 78 19 117 24 552 8 314 43 81 51

2011 81 20 280 25 126 7 731 38 87 62 1 373

• 0 82 • 2012 82 20 810 25 360 7 747 37 83 55

Cape Verde 2005 98 298 305 14 4.7 100

2010 365

2011 90 352 390 47 13

• 98 89 • 2012 89 378 425 45 12 44 98 123

Central African 2005 3 338

Republic 2010 39 2 638 6 760 862 33 0 62

2011 33 1 890 5 724 733 39 12 9.3

– 46 • 2012 46 3 839 8 283 1 483 39 28 20

Chad 2005 6 505

2010 39 3 801 9 697 663 17 53 45

2011 38 4 124 10 774 959 23 39 43

– 44 • 2012 44 4 766 10 800 960 20 65

Comoros 2005 100 112 112 2 1.8 100 100

2010 119 0 0 0

2011 3.4 4 119 4 100 100 100

• 100 3 • 2012 3.3 4 122 4 100 100 100 2

Congo 2005 9 961

2010 40 4 106 10 321 757 18 2.9 2.9

2011 20 2 247 11 143 687 31 24 26

– 17 • 2012 17 1 979 11 512 653 33 20 23

Côte d'Ivoire 2005 20 4 079 20 026 1 551 38 38 14

2010 73 16 991 23 210 4 112 24 80 27

2011 80 18 297 22 920 4 820 26 80 36

• 20 85 • 2012 85 20 663 24 222 5 482 27 75 44

Democratic 2005 1.9 1 885 99 558 386 20 74 0.78

Republic 2010 24 28 997 118 636 5 273 18 24 9.3

of the Congo 2011 27 30 636 114 290 4 942 16 54 23

• 2 31 • 2012 31 35 097 112 499 5 748 16 61 40

Equatorial 2005

Guinea 2010 92 786 853 225 29 85 31

2011 100 911 913 234 26 21

– – 2012

Eritrea 2005 3 612

2010 2 991

2011 3 093 0

– 59 • 2012 59 1 913 3 254 164 8.6

Ethiopia 2005 2.6 3 211 125 135 1 321 41 88 29 1 983

2010 43 66 955 156 928 9 809 15 69 39 6 636

2011 41 65 140 159 017 5 442 8.4 62 39 30 816

• 3 65 • 2012 65 96 245 147 592 9 819 10 37 82 30 395

Gabon 2005 7.1 185 2 611 185 100 100 0

2010 27 1 130 4 180 667 59 52 52

2011 46 2 252 4 916 578 26

• 7 100 • 2012 100 5 415 5 415 852 16 66

Gambia 2005 2 120

2010 97 1 962 2 030 224 11 93 46

2011 74 1 726 2 333

– 78 • 2012 78 1 859 2 387 302 16 97 48

Ghana 2005 7 844 12 124 340 40 100 37

2010 67 10 147 15 145 2 676 26 77 18

2011 79 12 587 15 840 2 907 23 72 28

• 7 78 • 2012 78 11 825 15 207 2 812 24 72 37

Guinea 2005 7 090

2010 51 5 776 11 324 1 483 26 87 41

2011 56 6 548 11 606 1 670 26 72 49

– 65 • 2012 65 7 575 11 641 1 859 25 83 49

Guinea-Bissau 2005 11 200 1 816 110 55 100 30 0

2010 46 1 046 2 259 396 38

2011 50 1 037 2 070 431 42 0 0

• 11 68 • 2012 68 1 322 1 950 517 39 0 0 0

Kenya 2005 14 15 658 108 401 8 954 57 44 17

2010 91 96 930 106 083 40 069 41 100 48

2011 93 97 136 103 981 38 175 39 97 64

• 14 94 • 2012 94 92 890 99 149 35 837 39 98 74

Lesotho 2005 1.4 156 11 404 127 81 79

2010 84 11 005 13 138 8 459 77 96 27

2011 89 11 413 12 785 8 519 75 95 68

• 1 88 • 2012 88 10 476 11 971 7 878 75 97 53 16 403

Liberia 2005 3.3 114 3 456 14 12 0

2010 53 3 533 6 668 283 8 8.5 0

2011 55 4 355 7 965 454 10 26 9.3

• 3 70 • 2012 70 5 661 8 132 772 14 90 15

Madagascar 2005 9 1 759 19 475 16 0.91

2010 65 16 439 25 106 39 0.24 36

2011 58 15 532 26 722 40 0.26

• 9 54 • 2012 54 14 146 26 209 19 0.13 95

173 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Malawi 2005 44 12 243 27 610 8 447 69 92 49

2010 88 19 855 22 536 12 476 63 94 46

2011 83 17 334 20 854 10 341 60 89 60

• 44 93 • 2012 93 19 009 20 463 11 296 59 88 81 20 542

Mali 2005 4 884

2010 42 2 303 5 448 416 18 75 52 0

2011 35 1 963 5 573 404 21 72 69

– 28 • 2012 28 1 544 5 602 425 28 42 100

Mauritania 2005 0.45 10 2 218 0 0

2010 24 608 2 489 90 15 61 0

2011 0.66 12 1 820 12 100 100

• 0 – 2012 2 636

Mauritius 2005 91 115 127 2 1.7 100 50

2010 95 117 123 8 6.8 100 75

2011 93 108 116 8 7.4 100 62

• 91 96 • 2012 96 125 130 10 8 100 90

Mozambique 2005 33 718

2010 88 40 554 46 174 24 574 61 97 25 13 164

2011 91 43 096 47 452 26 538 62 91 29 17 064

– 94 • 2012 94 47 960 50 827 27 979 58 98 55 17 317

Namibia 2005 16 2 547 15 894 1 465 58

2010 76 9 534 12 625 5 227 55 93 44 13 989

2011 84 10 042 11 938 4 990 50 98 54 14 428

• 16 89 • 2012 89 9 927 11 145 4 688 47 99 72 11 906

Niger 2005 8 224 152 43 34

2010 48 4 925 10 345 405 8.2 37 0

2011 44 4 710 10 714 334 7.1 6.6 4.8

– 46 • 2012 46 5 166 11 207 431 8.3 31 16

Nigeria 2005 10 6 897 66 848 1 241 18

2010 79 71 844 90 447 17 736 25 59 33 1 750

2011 81 75 772 93 050 19 553 26 68 43 1 107

• 10 84 • 2012 84 82 641 97 853 19 342 23 80 56 2 257

Rwanda 2005 65 5 003 7 680 2 276 45 15 13

2010 98 6 914 7 065 2 199 32 97 72

2011 97 6 560 6 784 1 855 28 97 75

• 65 99 • 2012 99 6 131 6 208 1 601 26 99

Sao Tome and 2005 100 152 152 5 3.3 0 0

Principe 2010 92 112 122 13 12 92 54 0

2011 100 146 146 15 10 100 100 0

• 100 99 • 2012 99 126 127 18 14 100 100 0

Senegal 2005 10 120

2010 69 8 018 11 591 776 9.7 85 37

2011 76 8 757 11 588 877 10 85 48

– 78 • 2012 78 10 048 12 819 882 8.8 90 64 426

Seychelles 2005 14 2 100 100

2010 100 17 17 1 5.9 100 100 0

2011 100 21 21 4 19 75 100

– 100 • 2012 100 21 21 3 14 67 100 0

Sierra Leone 2005 6 930

2010 74 9 718 13 195 976 10 6.4 19

2011 78 10 159 12 943 902 8.9 25 28

– 87 • 2012 87 11 655 13 354 1 343 12 26 69 1 062

South Africa 2005 22 67 988 302 467 35 299 52 100 33 1 466

2010 54 213 006 396 554 128 457 60 74 54 146 247

2011 83 322 732 389 974 211 128 65 77 46 372 994

• 22 84 • 2012 84 294 196 349 582 190 093 65 74 54 369 747

Swaziland 2005 8 864

2010 86 9 536 11 146 7 788 82 93 35

2011 92 8 419 9 180 6 480 77 95 51

– 95 • 2012 95 7 363 7 739 5 666 77 98 66 1 934

Togo 2005 0 0 2 635 0 0

2010 77 2 242 2 897 632 28 72 49

2011 84 2 513 2 980 667 27 77 67

• 0 91 • 2012 91 2 657 2 912 625 24 87 76

Uganda 2005 25 10 555 41 809 7 523 71 25 10

2010 81 36 742 45 546 19 836 54 90 24

2011 80 39 394 49 018 20 725 53 93 32

• 25 86 • 2012 86 40 581 47 211 20 376 50 94 49

United Republic 2005 2.5 1 613 64 200 841 52 61 22

of Tanzania 2010 90 56 849 63 453 21 662 38 92 35

2011 88 53 842 61 148 20 632 38 95 38

• 3 82 • 2012 82 52 499 63 892 20 269 39 96 54

Zambia 2005 2 1 082 53 267 614 57 68

2010 84 40 704 48 616 26 571 65 75 48

2011 100 48 594 48 594 26 737 55 87 53

• 2 100 • 2012 100 45 269 45 277 24 309 54 93 60

Zimbabwe 2005 0 0 54 891 0

2010 86 41 062 47 557 31 849 78 88 45

2011 90 37 029 41 305 27 562 74 94 60 0

• 0 88 • 2012 88 34 212 38 720 23 957 70 26 18

174 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

Algeria 2005 74 809 9.1 164 23

2010 56 ––

2011 ––

2012 180 (69–290) 130 (56–250) – 52 (6.5–170) –

Angola 2005 ––

2010 3 ––

2011 40 29 0.13 –

2012 45 1 700 (780–2 500) 800 (44–1 500) – 860 (330–1 400) 45 1.0

Benin 2005 28 31 1.1 107 32

2010 15 103 3.5 6 2.9

2011 20 0 0 152 58

2012 25 54 (26–83) 17 (2.1–70) 26 0.78 37 (23–55) 110 39

Botswana 2005 ––

2010 106 488 11 286 27

2011 46 151 4.5 90 10

2012 53 140 (94–190) 120 (70–160) 349 14 29 (11–47) 149 34

Burkina Faso 2005 3 – 126 39

2010 31 1 <0.1 117 21

2011 42 1 <0.1 68 14

2012 38 150 (71–240) 79 (4.4–150) 7 0.20 75 (29–120) 72 19

Burundi 2005 ––

2010 24 22 0.48 2 0.60

2011 6 0 0 6 1.9

2012 24 150 (27–280) 120 (0.48–240) 1 <0.1 31 (11–52) 23 7.5

Cameroon 2005 ––

2010 35 0 0 35 2.3

2011 63 ––

2012 153 670 (140–1 200) 510 (2.0–1 000) 0 0 160 (57–270) 80 5.0

Cape Verde 2005 ––

2010 0 ––

2011 0 0 0 0 0

2012 0 9.8 (4.0–16) 6.1 (0.34–12) 0 0 3.6 (1.4–5.9) 0 0

Central African 2005 ––

Republic 2010 9 9 0.25 0 0

2011 15 0 0 56 16

2012 28 130 (36–220) 28 (0.72–160) – 97 (37–190) –

Chad 2005 ––

2010 3 0 0 0 0

2011 0 0 0 0 0

2012 0 320 (150–490) 160 (8.8–300) 0 0 160 (63–260) 0 0

Comoros 2005 ––

2010 ––

2011 0 ––

2012 0 2.5 (0.92–4.0) 1.7 (0.10–3.2) – 0.77 (0.30–1.2) –

Congo 2005 ––

2010 ––

2011 ––

2012 250 (43–450) 200 (0.79–400) – 49 (17–81) –

Côte d'Ivoire 2005 47 0 0 0 0

2010 50 0 0 72 4.7

2011 30 1 <0.1 29 2.0

2012 221 580 (270–890) 440 (190–850) 0 0 140 (49–240) 365 26

Democratic 2005 ––

Republic 2010 87 – 100 1.2

of the Congo 2011 121 22 <0.1 160 2.0

2012 81 2 900 (670–5 100) 2 100 (8.4–4 200) 12 <0.1 760 (260–1 300) 95 1.3

Equatorial 2005 ––

Guinea 2010 0 0 0 0 0

2011 3 ––

2012 – – – – –

Eritrea 2005 ––

2010 ––

2011 11 ––

2012 0 79 (38–120) 35 (1.9–66) – 44 (17–71) –

Ethiopia 2005 ––

2010 140 42 <0.1 510 10

2011 212 73 0.15 139 3.0

2012 284 2 000 (1 200–2 900) 1 600 (830–2 700) 469 0.99 480 (230–870) 180 4.4

Gabon 2005 ––

2010 0 ––

2011 ––

2012 0 170 (57–280) 100 (0.41–200) – 67 (23–110) –

Gambia 2005 ––

2010 0 ––

2011 0 ––

2012 0 9.9 (0–29) 9.9 (0.25–54) 0 0 0 (0–26) 0 0

Ghana 2005 1 50 0.62 2 0.38

2010 4 –212.1

2011 7 0 0 61 6.9

2012 20 390 (170–620) 240 (13–440) 0 0 160 (61–260) 44 5.3

Guinea 2005 20 215 3.9 34 7.4

2010 31 5 <0.1 26 4.0

2011 78 8 0.12 26 3.9

2012 69 250 (130–380) 47 (9.8–140) – 200 (100–340) –

Guinea-Bissau 2005 ––

2010 ––

2011 2 ––

2012 6 45 (15–75) 33 (1.8–63) – 12 (4.6–19) –

Kenya 2005 44 0 0 1829 20

2010 112 – 706 6.7

2011 166 92 0.25 1195 12

2012 225 2 800 (840–4 800) 1 800 (7.4–3 700) 78 0.21 980 (340–1 600) 1183 12

Lesotho 2005 ––

2010 117 ––

2011 64 ––

2012 46 170 (36–300) 77 (16–220) 5 0.15 94 (20–260) 28 1.7

Liberia 2005 ––

2010 0 0 0 0 0

2011 ––

2012 6 130 (32–230) 110 (6.3–210) – 18 (7.0–29) –

Madagascar 2005 ––

2010 3 60 0.36 24 1.1

2011 9 9 <0.1 64 2.9

2012 10 170 (32–310) 94 (26–240) 7 <0.1 76 (9.3–260) 63 3.2

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED CASES).

BACT+VE = bacteriologically positive cases.

175 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Malawi 2005 9 – 917 29

2010 40 871 10 449 20

2011 26 102 1.5 552 26

2012 27 96 (45–150) 56 (18–130) 0 0 40 (27–57) 27 3.3

Mali 2005 2 0 0 0 0

2010 12 0 0 12 3.4

2011 10 ––

2012 12 140 (60–210) 76 (4.2–140) 23 0.62 60 (23–96) 39 13

Mauritania 2005 11 161 12 30 15

2010 35 ––

2011 8 3 0.30 4 3.9

2012 1 59 (26–92) 34 (1.9–64) 1 <0.1 25 (9.8–41) –

Mauritius 2005 0 114 100 3 60

2010 2 105 100 7 100

2011 1 100 100 5 100

2012 0 0 (0–0) 0 (0–3.6) 121 100 0 (0–2.4) 4 100

Mozambique 2005 115 113 0.63 305 16

2010 165 80 0.39 251 6.2

2011 283 206 1.1 443 10

2012 266 2 000 (1 300–2 700) 1 400 (900–2 000) 205 0.98 540 (0–1 100) 243 5.4

Namibia 2005 ––

2010 214 ––

2011 192 ––

2012 210 630 (510–750) 260 (190–350) – 370 (290–470) –

Niger 2005 ––

2010 39 0 0 47 7.0

2011 18 1 <0.1 21 3.6

2012 35 270 (110–420) 160 (9.0–300) 0 0 110 (42–180) 35 6.2

Nigeria 2005 ––

2010 21 27 <0.1 19 0.21

2011 95 12 <0.1 76 0.86

2012 107 3 600 (2 700–4 500) 2 500 (1 800–3 400) 11 <0.1 1 100 (770–1 500) 94 1.2

Rwanda 2005 35 57 1.4 0 0

2010 90 171 4.0 431 68

2011 76 ––

2012 58 240 (170–310) 180 (120–270) – 63 (51–76) –

Sao Tome and 2005 ––

Principe 2010 0 ––

2011 4 2 1.9 2 12

2012 8 15 (11–19) 1.7 (0.10–3.3) 16 27 13 (7.1–15) 8 53

Senegal 2005 ––

2010 38 41 0.53 66 6.4

2011 50 14 0.18 97 8.7

2012 27 400 (170–620) 220 (70–500) 25 0.30 180 (76–340) 113 10

Seychelles 2005 ––

2010 0 ––

2011 0 0 0 1 –

2012 0 0 (0–0) 0 (0–3.9) 14 82 0 (0–1.7) 2 100

Sierra Leone 2005 ––

2010 ––

2011 8 ––

2012 220 (0–460) 100 (2.7–570) – 120 (26–280) –

South Africa 2005 2000 ––

2010 7386 ––

2011 10085 ––

2012 15419 8 100 (6 900–9 400) 4 600 (3 700–5 800) – 3 500 (2 800–4 300) –

Swaziland 2005 ––

2010 326 148 2.9 505 35

2011 332 ––

2012 280 730 (560–890) 430 (270–590) – 290 (250–340) –

Togo 2005 ––

2010 2 ––

2011 4 86 4.1 83 39

2012 2 77 (35–120) 41 (2.3–78) 0 0 36 (14–58) 2 1.1

Uganda 2005 46 ––

2010 93 358 1.5 356 9.0

2011 71 316 1.2 360 9.0

2012 89 1 000 (660–1 300) 540 (230–860) 196 0.79 470 (260–750) 748 19

United Republic 2005 10 276 0.60 405 8.0

of Tanzania 2010 34 201 0.44 246 6.5

2011 68 83 0.34 17 0.59

2012 42 500 (13–1 000) 500 (140–1 300) 639 2.5 0 (0–160) 108 3.9

Zambia 2005 ––

2010 ––

2011 ––

2012 80 620 (290–940) 98 (12–350) – 520 (260–900) –

Zimbabwe 2005 ––

2010 17 ––

2011 118 0 0 0 0

2012 149 930 (430–1 400) 570 (300–960) 360 3.0 360 (76–970) 258 6.0

TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED CASES).

BACT+VE = bacteriologically positive cases.

176 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

eria 1995

–

2000 59 927 1 516 610 491 234 299 36 1 005 1 293 746 314 208 312 1.1

2005 53 1 309 1 841 919 473 314 426 102 1 044 820 389 270 229 465 1.6

2010 52 1 203 1 669 825 513 392 397 79 1 086 826 417 251 222 367 1.6

2011 42 1 147 1 513 881 483 345 347 58 1 050 787 383 211 202 341 1.6

2012 29 1 102 1 467 857 464 354 349 0 60 917 773 382 198 229 329 0 1.6

ola 1995 386 724 562 346 224 155 14 371 707 443 264 248 130 18 1.1

2000 186 999 1 003 912 482 312 194 247 1 142 1 091 844 417 200 120 1.0

2005 520 2 549 2 797 1 918 1 255 665 461 704 2 926 2 682 1 797 1 138 581 417 0.99

2010 448 2 900 3 584 2 415 1 424 691 355 558 2 763 2 594 1 688 958 482 286 1.3

2011 501 3 000 3 792 2 386 1 395 680 455 0 708 2 731 2 563 1 683 1 006 457 346 0 1.3

2012 390 2 804 3 627 2 529 1 427 732 424 592 2 501 2 540 1 617 1 028 529 384 1.3

Benin 1995 14 186 352 306 176 101 92 26 148 197 118 69 32 22 2.0

2000 19 277 428 327 213 103 74 36 239 275 149 76 45 25 1.7

2005 21 306 595 396 270 135 87 25 249 331 145 89 51 39 1.9

2010 18 314 631 443 267 164 85 0 29 265 382 200 98 42 35 0 1.8

2011 21 320 650 497 353 210 107 0 41 288 385 246 119 42 52 0 1.8

2012 23 314 595 524 329 179 121 0 39 264 346 221 105 65 46 0 1.9

Botswana 1995

–

2000 25 185 605 488 267 135 96 37 335 469 262 98 57 36 1.4

2005 27 260 563 506 272 135 97 45 321 491 253 97 55 48 1.4

2010 45 256 590 477 239 137 107 0 68 338 509 301 119 56 53 0 1.3

2011 36 220 464 354 206 110 94 0 65 286 421 211 105 48 49 0 1.3

2012 40 207 394 333 190 79 75 0 63 267 402 193 109 43 31 0 1.2

Burkina Faso 1995 4 67 133 124 62 48 29 7 76 53 39 26 11 10 2.1

2000 12 91 274 252 133 68 65 7 59 128 101 45 38 14 2.3

2005 18 181 430 370 273 144 113 15 125 248 174 109 54 40 2.0

2010 20 231 620 493 328 224 173 0 33 158 259 198 124 97 83 0 2.2

2011 22 265 708 582 375 262 196 0 31 163 277 221 146 110 92 0 2.3

2012 25 277 769 631 423 250 198 0 27 160 288 191 156 106 82 0 2.5

Burundi 1995 5 128 238 224 73 32 19 19 109 124 89 33 12 4 1.8

2000

–

2005 34 352 591 525 372 111 55 46 298 399 288 122 36 33 1.7

2010 56 481 773 651 570 270 157 0 78 390 421 332 225 99 87 0 1.8

2011 37 484 743 620 504 235 98 0 56 345 374 263 180 81 40 0 2.0

2012 45 447 801 667 461 233 103 0 74 338 367 283 162 64 30 0 2.1

Cameroon 1995 20 208 569 323 287 204 164 9 185 313 223 153 106 93 1.6

2000 41 518 842 584 284 130 75 63 368 530 293 139 60 33 1.7

2005 134 1 472 2 482 1 766 1 035 463 289 226 1 467 1 788 1 028 503 205 143 1.4

2010 106 1 497 2 750 1 996 1 314 559 329 172 1 474 2 031 1 121 642 290 183 1.4

2011 114 1 580 2 931 2 139 1 283 625 361 178 1 461 2 022 1 177 581 281 194 1.5

2012 108 1 597 2 900 2 182 1 304 658 375 184 1 417 2 053 1 177 579 295 187 1.5

e Verde 1995

–

2000

–

2005 0 22 23 26 9 2 8 2 9 16 4536 2.0

2010

–

2011 0 17 43 35 31 3 3 0 4 14 15 46340 2.6

2012 0 29 36 34 24 8 2 0 0 19 13 98340 2.4

Central African 1995 38 162 356 206 120 40 18 39 233 350 145 57 21 9 1.1

ublic 2000

–

2005 29 40 1 136 160 26 35 15 30 32 420 145 30 40 15 2.0

2010 78 379 633 468 251 135 63 1 88 367 576 319 155 73 44 8 1.2

2011 70 362 576 467 269 119 59 4 96 382 530 289 162 62 26 6 1.2

2012 73 502 799 660 360 158 92 101 511 689 370 191 96 39 1.3

Chad 1995

–

2000

–

2005 25 194 535 409 229 123 82 28 148 298 211 148 59 27 1.7

2010 76 382 850 666 379 173 99 0 59 274 413 263 158 79 44 0 2.0

2011 92 469 951 764 418 184 121 0 84 296 438 298 166 109 44 0 2.1

2012 68 405 842 634 376 210 88 0 51 273 403 227 135 91 46 0 2.1

Comoros 1995 0 18 13 9784 11398652 1.3

2000 0 18 7 14 9 3 4 1 9 6 12 1 2 1 1.7

2005 0 12 96424 21074838 0.88

2010

–

2011 0 10 13 95250 28421010 2.4

2012 9 15 8466 1575113 2.1

Con

o 1995 16 265 409 221 73 44 15 17 296 353 167 61 38 11 1.1

2000

–

2005

–

2010 41 435 672 424 203 77 55 49 409 510 296 152 70 56 1.2

2011 58 453 705 462 222 80 76 0 72 408 463 332 200 88 97 0 1.2

2012 46 563 716 519 276 113 72 63 438 482 349 171 68 108 1.4

Côte d'Ivoire 1995 41 989 2 092 1 344 759 283 130 99 810 813 497 273 105 19 2.2

2000

–

2005 128 1 346 2 449 1 606 888 422 385 193 1 280 1 756 989 528 232 201 1.4

2010 159 1 751 2 858 1 882 1 010 505 375 246 1 431 1 819 1 051 531 304 209 1.5

2011 189 1 743 3 043 1 852 1 072 601 348 0 244 1 358 1 838 1 044 560 301 223 0 1.6

2012 163 1 743 3 087 2 017 1 032 552 430 204 1 306 1 870 1 120 536 337 263 1.6

Democratic 1995 373 1 572 2 382 1 890 1 184 634 289 331 1 223 1 532 1 232 863 427 137 1.4

ublic 2000 485 4 048 5 833 4 151 2 549 1 295 602 718 4 422 5 146 3 309 1 724 855 351 1.1

of the Con

o 2005 1 321 6 675 9 808 7 577 5 022 2 637 1 499 1 695 7 570 8 501 5 832 3 898 2 054 951 1.1

2010 1 707 6 859 10 412 9 134 6 464 3 641 1 907 1 987 7 199 9 120 6 721 4 579 2 612 1 311 1.2

2011 1 579 6 640 9 872 8 932 6 415 3 584 1 911 1 800 6 802 8 742 6 541 4 537 2 671 1 295 1.2

2012 1 439 6 612 10 274 9 361 6 612 3 698 1 941 1 699 6 598 8 406 6 471 4 131 2 625 1 257 1.3

uatorial 1995 8 15 45 37 15 11 7 2 18 28 20 4 7 1 1.7

Guinea 2000

–

2005

–

2010 10 71 80 59 35 16 10 0 13 80 57 45 26 9 6 0 1.2

2011 11 77 90 89 59 22 12 0 15 76 81 46 21 9 3 0 1.4

2012

–

Eritrea 1995

–

2000 9 70 75 57 32 25 20 10 100 87 71 21 12 8 0.93

2005 9 68 73 50 45 51 39 8 67 127 72 39 21 18 0.95

2010 10 93 109 81 51 37 60 0 3 88 111 79 43 31 36 0 1.1

2011 0

–

2012 2 84 105 90 62 39 51 0 4 86 98 74 45 19 20 0 1.3

Ethio

ia 1995 247 1 221 1 017 541 276 142 51 283 908 781 382 152 64 15 1.4

2000 915 5 095 5 187 3 082 1 495 610 397 1 037 4 699 4 424 2 105 976 366 122 1.2

2005 1 109 6 726 6 181 3 454 1 985 1 027 475 1 326 5 885 5 663 2 730 1 296 513 155 1.2

2010 1 582 7 400 7 785 4 451 2 746 1 473 822 1 608 5 708 6 480 3 439 1 950 855 335 1.3

2011 1 847 7 835 9 246 3 881 2 771 1 218 771 1 983 6 570 7 917 3 069 1 564 719 303 1.2

2012

–

Gabon 1995 3 45 74 80 54 30 15 9 47 54 28 25 19 3 1.6

2000

–

2005 13 123 199 140 70 38 25 19 128 123 88 29 29 18 1.4

2010 15 145 223 208 130 89 91 0 13 110 164 122 100 86 64 0 1.4

2011 34 240 269 229 144 86 66 0 25 177 188 125 74 44 39 0 1.6

2012 42 236 286 228 166 101 41 0 29 185 165 109 78 45 34 0 1.7

Gambia 1995 3 68 181 88 72 29 24 4 39 61 44 25 12 8 2.4

2000

–

2005 13 133 292 206 62 53 44 2 84 87 64 38 22 27 2.5

2010 9 194 314 184 141 68 39 0 6 104 121 71 35 40 18 0 2.4

2011 14 183 271 181 136 87 56 0 16 103 112 88 63 32 33 0 2.1

2012 7 210 331 191 107 80 54 0 16 123 106 89 41 32 42 0 2.2

177 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Ghana 1995 42 223 397 398 302 190 112 40 199 272 205 122 88 48 1.7

2000 73 550 1 266 1 115 811 495 426 74 456 791 566 338 179 176 1.8

2005 49 592 1 201 1 311 944 462 414 68 450 693 527 366 207 221 2.0

2010 63 570 1 146 1 301 1 030 540 447 64 446 667 560 369 204 249 2.0

2011 50 550 1 127 1 328 955 491 456 52 470 699 614 390 174 260 1.9

2012 30 559 1 051 1 271 921 512 462 51 418 563 468 332 188 271 2.1

Guinea 1995 18 244 538 357 189 98 61 28 202 255 153 64 37 19 2.0

2000 39 551 860 570 282 203 103 66 314 446 245 114 82 45 2.0

2005 51 749 1 165 778 463 195 130 65 594 583 354 203 94 55 1.8

2010 61 679 877 982 876 565 289 51 549 739 751 405 145 72 1.6

2011 45 1 051 1 537 955 541 293 197 85 709 688 432 219 109 73 2.0

2012 28 761 1 104 791 383 190 120 0 49 505 509 323 134 61 57 0 2.1

Guinea-Bissau 1995

–

2000 2 52 92 80 64 39 19 4 30 46 47 24 15 12 2.0

2005 14 116 167 153 130 72 42 13 78 110 92 82 44 19 1.6

2010 18 164 219 183 141 80 43 0 30 100 161 133 80 38 19 0 1.5

2011 6 140 230 181 104 65 36 0 12 119 122 90 56 44 25 0 1.6

2012 7 145 262 183 115 63 38 10 7 121 157 98 56 33 25 4 1.6

Ken

a 1995 154 2 072 3 073 1 675 920 485 296 187 1 802 1 759 741 411 242 117 1.6

2000 264 3 739 6 653 3 548 1 630 630 414 416 3 916 4 363 1 874 831 347 148 1.4

2005 359 4 790 8 832 5 069 2 521 1 031 590 577 5 144 6 521 2 781 1 266 593 315 1.3

2010 357 4 698 7 945 5 077 2 509 994 658 549 4 044 5 112 2 372 1 056 544 345 1.6

2011 356 4 773 8 376 5 201 2 660 1 045 665 0 629 4 183 4 917 2 434 1 025 477 344 0 1.6

2012 393 4 893 8 149 5 302 2 493 1 099 669 603 4 097 4 975 2 363 993 529 379 1.6

Lesotho 1995 9 108 214 256 189 96 88 14 106 125 71 49 17 19 2.4

2000 8 165 458 517 395 198 76 11 222 336 195 83 36 29 2.0

2005 32 395 695 397 148 82 37 19 226 721 616 494 297 121 0.72

2010 16 222 607 497 364 244 133 27 283 597 329 169 64 48 1.4

2011 19 179 584 493 329 245 121 23 311 572 307 185 84 58 1.3

2012 15 204 580 427 295 196 114 0 30 309 571 296 143 71 47 0 1.2

Liberia 1995

–

2000 12 133 196 127 52 17 26 21 140 149 88 28 16 16 1.2

2005 26 240 352 333 155 74 65 37 232 297 171 108 52 25 1.4

2010 90 338 621 510 295 114 21 0 254 339 488 259 171 151 99 0 1.1

2011 67 382 595 727 440 194 87 0 67 329 433 517 285 88 50 0 1.4

2012 65 382 627 667 406 129 83 0 61 354 535 605 292 79 57 0 1.2

Mada

ascar 1995 79 791 1 289 1 173 630 423 242 100 799 1 108 744 340 230 78 1.4

2000

–

2005 98 1 159 1 867 1 732 1 349 582 333 150 1 012 1 451 1 047 614 248 129 1.5

2010 204 1 721 1 621 2 525 1 782 960 485 0 323 1 621 1 943 1 376 946 397 192 0 1.4

2011 146 1 807 2 764 2 495 1 938 1 044 522 0 252 1 726 2 031 1 503 978 462 188 0 1.5

2012 177 1 725 2 474 2 460 1 927 1 059 490 0 242 1 720 1 848 1 420 914 474 199 0 1.5

Malawi 1995 25 493 1 195 833 519 215 89 65 802 1 028 573 294 108 45 1.2

2000 50 653 1 476 1 113 585 245 114 66 1 038 1 481 831 401 148 64 1.1

2005 58 622 1 653 1 031 549 279 157 84 913 1 598 859 386 180 74 1.1

2010 50 565 1 509 985 485 275 187 0 103 610 1 196 661 314 198 102 0 1.3

2011 70 519 1 486 1 050 440 238 201 79 601 1 119 660 283 161 96 1.3

2012 52 495 1 537 1 051 471 292 204 0 71 538 1 057 609 298 156 120 0 1.4

Mali 1995 27 72 357 294 181 138 102 31 132 184 128 107 61 52 1.7

2000 23 206 430 396 297 235 144 14 174 232 152 106 75 43 2.2

2005 26 350 628 539 365 263 193 33 208 348 245 152 101 72 2.0

2010 94 381 707 526 354 227 207 31 265 337 247 144 96 70 2.1

2011 25 370 772 515 352 267 230 42 255 393 223 147 118 68 2.0

2012 25 405 731 547 377 257 211 0 34 253 344 239 137 89 77 0 2.2

Mauritania 1995

–

2000

–

2005

–

2010 17 192 295 206 137 99 76 14 90 104 82 52 29 29 2.6

2011 36 165 185 131 106 58 55 28 68 72 47 36 19 20 2.5

2012 22 204 302 195 139 114 114 25 112 81 88 73 46 28 2.4

Mauritius 1995 2 17 13 22 27 13 8 2 4 12 10 8 4 4 2.3

2000 2 6 9 18 19 14 8 1588674 1.9

2005 10 15 21 20 10 6 4 5 5 11 2 1 2.9

2010 0 9 9 13 23 15 7 0 07944320 2.6

2011 0 10 13 9 17 10 8 0 0 7 12 2 3 6 3 0 2.0

2012 2 11 14 16 17 11 7 0 0 11 782840 2.0

Mozambi

ue 1995 187 1 136 1 475 1 338 1 022 664 320 226 994 1 314 1 016 551 234 89 1.4

2000

–

2005

–

2010

–

2011

–

2012

–

Namibia 1995 0 68 235 113 55 21 6 5 49 78 50 16 1 0 2.5

2000 18 269 874 665 300 147 81 16 352 654 348 161 76 52 1.4

2005 98 355 1 027 874 365 146 120 105 399 809 525 213 95 91 1.3

2010 36 359 852 680 287 146 126 67 429 685 382 206 122 87 1.3

2011 48 337 844 660 361 152 138 78 427 653 410 185 100 110 1.3

2012 61 358 810 686 292 157 137 81 394 582 396 198 84 97 1.4

er 1995

–

2000 29 270 174 441 252 151 78 31 123 206 168 151 63 9 1.9

2005 35 557 1 204 819 497 350 198 34 214 388 330 223 131 70 2.6

2010 44 669 1 587 988 615 415 342 39 272 418 347 238 174 135 2.9

2011 50 709 1 673 1 025 646 436 347 0 50 285 449 323 278 189 147 0 2.8

2012 40 702 1 752 1 133 747 444 360 0 48 260 485 302 237 214 124 0 3.1

eria 1995 450 845 921 937 557 611 515 404 842 795 770 724 654 451 1.0

2000 157 2 173 3 164 1 836 1 091 566 463 239 2 934 2 434 1 110 676 344 231 1.2

2005 325 3 824 6 758 4 544 2 863 1 464 950 482 3 996 4 884 2 448 1 350 745 415 1.4

2010 521 4 457 9 186 6 218 3 804 1 974 1 363 0 595 4 182 6 117 3 431 1 846 1 040 682 0 1.5

2011 529 4 549 9 520 6 550 4 230 2 248 1 443 0 578 4 198 6 168 3 574 2 014 1 112 724 0 1.6

2012 538 5 026 10 382 7 684 4 589 2 449 1 686 0 649 4 652 6 762 4 084 2 243 1 290 867 0 1.6

Rwanda 1995

–

2000 155 466 974 824 393 129 56 105 396 473 309 109 52 14 2.1

2005 45 494 713 592 408 142 71 73 483 442 262 157 60 29 1.6

2010 48 430 741 526 325 202 126 48 399 448 261 128 65 38 1.7

2011 42 423 795 500 376 210 124 0 50 358 398 235 146 87 67 0 1.8

2012 22 375 768 519 341 214 123 40 327 393 208 116 66 59 2.0

Sao Tome and 1995

–

Princi

e 2000 1 5 11 4 7 3 10 3 7 15 5 7 4 15 0.73

2005 2576452 1453230 1.7

2010 0 10 14 71010 05432000 2.4

2011 05987140 221041000 1.8

2012 1 6 11 88200 061060010 1.6

Sene

al 1995 94 717 1 219 813 408 300 213 84 428 461 283 203 126 72 2.3

2000 60 772 1 297 857 470 279 189 77 521 540 376 217 107 61 2.1

2005 71 1 050 1 561 904 533 274 236 83 709 568 351 185 116 81 2.2

2010 81 1 351 1 793 972 590 329 221 0 81 835 643 332 217 136 105 0 2.3

2011 75 1 264 1 835 981 582 335 214 89 88 807 664 362 208 144 74 43 2.2

2012 84 1 454 2 036 1 121 597 365 224 0 125 836 715 383 263 155 90 0 2.3

chelles 1995 0201121 0010001 3.5

2000 2411 1011 2.7

2005 0212100 0011000 3.0

2010 00060010 02000000 3.5

2011 00100000 01000000 1.0

2012 00122000 00111010 1.2

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Sierra Leone 1995 10 184 305 201 99 47 22 18 165 193 110 65 24 11 1.5

2000 18 287 486 361 190 113 47 27 249 298 225 92 49 30 1.5

2005 45 490 792 651 397 226 124 54 393 518 312 207 114 47 1.7

2010 64 718 1 176 1 076 663 320 254 77 648 742 556 293 180 131 1.6

2011 75 825 1 224 1 099 781 334 287 0 115 678 796 543 343 219 116 0 1.6

2012 70 858 1 324 1 213 841 416 274 80 703 861 667 391 201 132 1.6

South Africa 1995

–

2000 116 723 1 999 2 135 1 146 435 212 122 1 283 1 716 933 423 167 80 1.4

2005 2 035 10 422 20 576 19 465 11 143 4 124 1 705 2 561 13 632 19 343 11 338 5 416 2 352 1 348 1.2

2010 1 496 9 925 20 855 19 842 12 386 5 155 2 211 0 1 933 13 023 20 205 12 910 6 873 3 165 2 128 0 1.2

2011 1 472 9 772 20 487 19 360 12 111 5 220 2 164 0 1 932 12 751 19 250 12 807 6 955 3 266 2 223 0 1.2

2012 1 132 9 074 19 894 18 510 11 331 5 054 2 085 0 1 545 11 547 17 452 11 430 5 939 2 846 2 059 0 1.3

Swaziland 1995 4 59 117 130 98 40 16 5 52 57 39 29 8 6 2.4

2000 11 130 352 249 138 37 17 10 198 298 62 62 24 5 1.4

2005 9 162 406 285 139 57 27 14 318 453 207 73 21 8 0.99

2010 30 207 537 369 192 109 50 0 51 354 662 276 104 54 16 0 0.98

2011 16 161 459 318 158 69 46 35 281 495 220 86 40 24 1.0

2012 18 163 479 332 168 84 38 0 39 284 535 242 88 51 27 0 1.0

o 1995 7 95 151 123 82 64 49 9 80 96 45 38 23 15 1.9

2000 4 101 168 144 109 48 39 13 107 124 50 36 24 15 1.7

2005 11 177 320 283 125 79 69 23 157 236 146 67 41 32 1.5

2010 21 150 350 358 217 116 80 39 163 285 148 78 62 29 1.6

2011 15 169 340 350 234 123 85 0 11 167 277 146 89 50 38 0 1.7

2012 9 171 338 341 237 121 87 17 165 287 154 109 48 28 1.6

anda 1995 370 1 193 2 491 1 797 1 115 602 323 402 1 376 1 845 1 104 635 312 113 1.4

2000 283 1 511 3 497 2 479 1 279 607 395 400 1 649 2 782 1 510 671 316 163 1.3

2005 257 1 598 4 075 3 209 1 576 725 539 371 1 811 3 099 1 800 818 389 257 1.4

2010 268 2 055 4 735 4 133 2 214 905 613 16 401 1 964 2 923 1 691 924 365 248 1 1.8

2011 295 2 075 5 044 4 613 2 466 994 604 423 400 2 092 2 853 1 809 973 409 313 252 1.8

2012 272 2 174 5 029 4 493 2 479 1 015 633 21 364 2 194 2 912 1 733 864 419 281 33 1.8

United Re

ublic 1995 183 2 108 4 091 2 916 1 754 1 007 640 201 1 904 2 532 1 324 735 380 179 1.8

of Tanzania 2000 200 2 357 4 836 3 430 2 022 1 202 834 257 2 106 3 426 1 738 868 494 269 1.6

2005 190 2 062 4 939 4 025 2 310 1 279 1 054 271 1 852 3 521 1 892 968 547 354 1.7

2010 232 1 975 4 493 4 141 2 427 1 309 1 161 0 248 1 689 2 988 2 013 1 044 578 471 0 1.7

2011 190 1 975 4 405 4 073 2 402 1 211 1 127 221 1 660 2 896 2 140 944 490 381 1.8

2012 208 2 086 4 707 4 397 2 435 1 293 1 114 282 1 651 2 906 2 108 1 022 507 422 1.8

Zambia 1995 91 659 1 668 1 124 487 231 130 129 1 125 1 779 717 257 117 63 1.0

2000 349 2 175 2 610 3 045 435 261 174 150 932 1 118 1 305 186 112 75 2.3

2005 135 1 240 3 166 2 160 917 358 321 168 1 507 2 463 1 433 569 235 185 1.3

2010

–

2011 105 1 033 2 897 2 194 810 280 207 151 940 1 683 1 063 422 162 99 1.7

2012 141 1 003 3 088 2 412 846 319 220 180 1 024 1 646 1 077 376 189 124 1.7

Zimbabwe 1995

–

2000

–

2005 210 837 2 264 1 855 762 295 656 269 1 136 2 242 1 255 578 193 603 1.1

2010 150 710 2 208 1 682 761 350 252 0 173 974 2 185 1 283 490 265 171 0 1.1

2011 152 784 2 467 2 071 780 377 278 0 174 1 084 2 161 1 386 448 274 160 0 1.2

2012 120 783 2 421 2 086 796 360 271 0 173 939 2 053 1 286 483 231 161 0 1.3

179 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

AFRICAN REGION

a LED = Light emitting diode microscopes

b DST = Drug susceptibility testing

c LPA = Line probe assay

d NRL = National Reference Laboratory

7$%/($/DERUDWRULHV173VHUYLFHVGUXJPDQDJHPHQWDQGLQIHFWLRQFRQWURO

LABORATORIES FREE THROUGH NTP

SMEAR LABS

PER 100K

POPULATION

% OF SMEAR

LABS USING

LED

CULTURE

LABS PER 5M

POPULATION

DST

LABS

PER 5M

POPULATION

LPA

LABS

PER 5M

POPULATION

NUMBER OF

LABS USING

XPERT MTB/RIF

SECOND-

LINE DST

AVAILABLE

NRL

TB DIAGNOSIS

FIRST-

LINE

DRUGS

Algeria 0.6 0 3.8 0.3 0.1 1 In country Yes Yes (all suspects) Yes Yes

Angola 0.6 – 0.5 0.5 Yes Yes (all suspects) Yes No 1 870

Benin 0.8 9 0.5 0.5 0.5 1 In and out

of countr y Yes Yes

(

if TB is

confirmed) Yes Yes

Botswana 2.6 21 2.5 2.5 2.5 5 Out of

country Yes Yes (all suspects) Yes Yes

Burkina Faso 0.7 0 0.3 0.3 0.9 0 Out of

country Yes Yes (all suspects) Yes Yes

Burundi 1.7 9 0.5 0 0 0 Out of

country Yes Yes (all suspects) Yes Yes

Cameroon 1.1 4 0.9 0.5 0.5 1 In country Yes No Yes Yes

Cape Verde 3.2 0 0 0 0 1 Out of

country Yes Yes (all suspects) Yes Yes

Central African Republic 1.6 0 1.1 1.1 0 1 No Yes Yes (all suspects) Yes Yes

Chad 0.6 0 0 0 0 0 No Yes Yes (all suspects) Yes Yes 815

Comoros – Yes Yes (all suspects) Yes Yes

Congo 0.8 3 No Y es Yes

(

if TB is

confirmed) Yes Yes

Côte d'Ivoire 0.6 0 0.5 0.5 0 0 No Yes Yes (all suspects) Yes Yes

Democratic Republic

of the Congo 2.3 0 0.3 0.2 <0.1 26 In and out

of countr y Yes Yes

(

if TB is

confirmed) Yes Yes

Equatorial Guinea –

Eritrea 1.3 0 0 0 0 0 No Yes Yes (for smear-

positive TB) Yes Yes

Ethiopia 2.8 0 0.3 <0.1 0.3 7 No Yes Yes (all suspects) Yes Yes

Gabon 0.9 0 3.1 3.1 0 0 No Yes No Yes Yes 0

Gambia 1.8 31 2.8 2.8 0 0 No Yes Yes (all suspects) Yes Yes

Ghana 1.1 1 0.6 0.6 0.6 0 No Yes Yes (all suspects) Yes Yes

Guinea 0.5 6 0.4 0.4 0 1 No Yes Yes

(

if TB is

confirmed) Yes Yes

Guinea-Bissau 1.3 0 3.0 0 0 1 Out of

country Yes Yes (all suspects) Yes Yes

Kenya 4.2 8 0.2 0.2 0.2 15 In and out

of countr y Yes Yes (all suspects) Yes Yes 199

Lesotho 0.9 17 2.4 2.4 2.4 5 Out of

country Yes Yes (all suspects) Yes Yes

Liberia 3.9 0 0 0 0 0 Out of

country No Yes

(

if TB is

confirmed) Yes Yes 28

Madagascar 1.0 6 0.2 0.2 0.2 5 No Yes Yes (all suspects) Yes Yes

Malawi 1.4 19 1.3 0.6 0.3 19 No Yes Yes (all suspects) Yes Yes

Mali 0.4 0 1.0 0.3 0.3 0 No Yes Yes (all suspects) Yes Yes

Mauritania 1.4 – 1.3 1.3 No Yes Yes (all suspects) Yes Yes

Mauritius – Out of

country Yes Yes (all suspects) Yes Yes

Mozambique 1.2 9 0.6 0.4 0 12 Out of

country Yes Yes (all suspects) Yes Yes

Namibia 1.4 100 2.2 2.2 2.2 1 Out of

country Yes Yes (all suspects) Yes Yes

Niger 1.1 1 0.3 0.3 0 0 Out of

country Yes Yes (all suspects) Yes Yes

Nigeria 0.8 2 0.1 <0.1 0.1 32 Out of

country Yes Yes (all suspects) Yes Yes

Rwanda 1.7 13 0.9 0.9 0.9 6 Yes Yes (all suspects) Yes Yes

Sao Tome and Principe 4.3 0 0 0 0 0 No Yes Yes (all suspects) Yes Yes 104

Senegal 0.8 0 1.1 0.7 0.7 3 In country Yes Yes

(

if TB is

confirmed) Yes Yes

Seychelles – Out of

country Yes Yes (all suspects) Yes Yes

Sierra Leone 2.7 0 0 0 0 0 No Yes Yes (all suspects) Yes Yes

South Africa 0.4 97 1.4 1.4 1.4 100 In country Yes Yes (all suspects) Yes Yes

Swaziland 1.5 21 4.1 4.1 4.1 19 Yes Yes (all suspects) Yes Yes

Togo 1.7 0 0.8 0.8 0 1 No Yes Yes

(

if TB is

confirmed) Yes Yes

Uganda 3.2 8 0.6 0.6 0.6 25 Yes Yes (all suspects) Yes Yes

United Republic of Tanzania 2.0 17 0.4 0.1 0.3 13 Yes Yes (all suspects) Yes Yes

Zambia 1.5 1 1.1 In country Yes Yes (all suspects) Yes Yes

Zimbabwe 1.3 1 0.7 0.7 0 17 No Yes Yes (all suspects) Yes Yes

TB NOTIF.

RATE PER

100 000

HEALTH-CARE

WORKERS

RIFAMPICIN

USED

THROUGHOUT

TREATMENT

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($0HDVXUHGSHUFHQWDJHRI7%FDVHVZLWK0'57%

PRVWUHFHQW\HDUDYDLODEOH

New TB cases Previously treated TB cases

Year Source Coverage Percentage Year Source Coverage Percentage

Algeria 2002 Survey National 1.4 (0.60–2.7) 2002 Survey National 9.1 (1.1–29)

Angola

Benin 2010 Survey National 0.5 (<0.1–2.0) 2011 Surveillance National 13 (8.2–20)

Botswana 2008 Survey National 2.5 (1.5–3.5) 2008 Survey National 6.6 (2.4–11)

Burkina Faso

Burundi

Cameroon

Cape Verde

Central African Republic 2009 Survey Sub-national 0.44 (<0.1–2.5) 1998 Survey Sub-national 18 (7.0–35)

Chad

Comoros

Congo

Côte d'Ivoire 2006 Survey National 2.5 (1.1–4.9)

Democratic Republic

of the Congo

Equatorial Guinea

Eritrea

Ethiopia 2005 Survey National 1.6 (0.86–2.8) 2005 Survey National 12 (5.6–21)

Gabon

Gambia 2000 Survey National 0.48 (<0.1–2.6) 2000 Survey National 0 (0–18)

Ghana

Guinea 1998 Survey Sub-national 0.56 (0.11–1.6) 1998 Survey Sub-national 28 (14–47)

Guinea-Bissau

Kenya

Lesotho 1995 Survey National 0.91 (0.19–2.6) 1995 Survey National 5.7 (1.2–16)

Liberia

Madagascar 2007 Survey National 0.49 (0.13–1.3) 2007 Survey National 3.9 (0.48–13)

Malawi 2011 Survey National 0.42 (0.14–0.97) 2011 Survey National 4.8 (3.2–6.9)

Mali

Mauritania

Mauritius 2012 Surveillance National 0 (0–3.0) 2012 Surveillance National 0 (0–60)

Mozambique 2007 Survey National 3.5 (2.2–4.8) 2007 Survey National 12 (0–25)

Namibia 2008 Survey National 3.8 (2.7–5.1) 2008 Survey National 16 (13–21)

Niger

Nigeria 2010 Survey National 2.9 (2.1–4.0) 2010 Survey National 14 (10–19)

Rwanda 2005 Survey National 3.9 (2.5–5.8) 2010 Surveillance National 19 (15–23)

Sao Tome and Principe 2012 Surveillance National 88 (47–100)

Senegal 2006 Survey National 2.1 (0.69–4.9) 2006 Survey National 17 (7.0–31)

Seychelles 2012 Surveillance National 0 (0–23) 2012 Surveillance National 0 (0–84)

Sierra Leone 1997 Survey National 0.85 (<0.1–4.7) 1997 Survey National 23 (5.0–54)

South Africa 2002 Survey National 1.8 (1.4–2.3) 2002 Survey National 6.7 (5.4–8.2)

Swaziland 2009 Survey National 7.7 (4.8–11) 2009 Survey National 34 (28–39)

Togo

Uganda 2011 Survey National 1.4 (0.60–2.2) 2011 Survey National 12 (6.8–19)

United Republic of Tanzania 2007 Survey National 1.1 (0.30–2.8) 2007 Survey National 0 (0–5.9)

Zambia 2008 Survey National 0.33 (<0.1–1.2) 2008 Survey National 8.1 (4.1–14)

Zimbabwe 1995 Survey National 1.9 (1.0–3.3) 1995 Survey National 8.3 (1.8–22)

a Empty rows indicate an absence of high-quality survey or surveillance data. In the absence of high-quality national data, high-quality sub-national data are used.

4')+101(6*'#/'4+%#5

6CDNG# 'UVKOCVGUQHVJGDWTFGPQHFKUGCUGECWUGFD[6$¿ 

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

Table A4.4 Treatment outcomes, new smear-positive cases, 1995–2011 192

Table A4.5 Treatment outcomes, retreatment cases, 1995–2011 195

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

Table A4.9 Laboratories, NTP services, drug management and infection control, 2012 205

6CDNG# /GCUWTGFRGTEGPVCIGQH6$ECUGUYKVJ/&46$OQUVTGEGPV[GCTCXCKNCDNG 

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

Country notes

Caribbean Islands

Data collection from Caribbean Islands that are not Member States of WHO was resumed in 2011 after a break of a few

years. is includes Aruba, Curaçao, Puerto Rico and Sint Maarten, which are Associate Members of the Pan American

Health Organization, plus the territories of Anguilla, Bermuda, Bonaire, Saint Eustatius and Saba, British Virgin Islands,

Cayman Islands, Montserrat and Turks and Caicos Islands. Data are not currently independently collected from the US

Virgin Islands

USA

In addition to the 51 reporting areas, the USA includes territories that report separately to WHO. e data for these terri-

tories are not included in the data reported by the USA. Denitions of case types and outcomes do not exactly match those

used by WHO.

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEa

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Anguilla 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 60 (22–118) <0.01 (<0.01–<0.01) 24 (15–35)

1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 47 (23–81) <0.01 (<0.01–<0.01) 23 (20–27)

2000 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.011) 56 (24–102) <0.01 (<0.01–<0.01) 23 (18–27)

2005 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.012) 54 (23–99) <0.01 (<0.01–<0.01) 22 (18–26)

2010 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.012) 50 (22–89) <0.01 (<0.01–<0.01) 21 (18–25)

2011 < 1 0 (0–14) 0 (0–100 000) <0.01 (<0.01–0.012) 50 (22–89) <0.01 (<0.01–<0.01) 21 (17–25)

2012 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.012) 49 (22–88) <0.01 (<0.01–<0.01) 21 (17–25)

Antigua and 1990 < 1 <0.01 (<0.01–<0.01) 3.9 (3.5–4.3) <0.01 (<0.01–<0.01) 2.8 (0.83–6.0) <0.01 (<0.01–<0.01) 1.9 (1.6–2.1)

Barbuda 1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 4.8 (1.4–10) 0 (0–0) 0 (0–0)

2000 < 1 <0.01 (<0.01–<0.01) 1.8 (1.5–2.2) <0.01 (<0.01–0.012) 9.3 (4.6–16) <0.01 (<0.01–<0.01) 5.9 (5.2–6.7)

2005 < 1 <0.01 (<0.01–<0.01) 1.4 (1.3–1.4) <0.01 (<0.01–0.018) 9.4 (2.2–22) <0.01 (<0.01–<0.01) 8.4 (7.3–9.5)

2010 < 1 <0.01 (<0.01–<0.01) 1.4 (1.2–1.5) <0.01 (<0.01–0.016) 5.3 (0.24–18) <0.01 (<0.01–<0.01) 9.2 (8.1–10)

2011 < 1 <0.01 (<0.01–<0.01) 1.4 (1.2–1.5) <0.01 (<0.01–0.015) 6.8 (1.1–18) <0.01 (<0.01–<0.01) 7.8 (6.9–8.9)

2012 < 1 <0.01 (<0.01–<0.01) 1.4 (1.2–1.5) <0.01 (<0.01–<0.01) 4.8 (1.6–9.9) <0.01 (<0.01–<0.01) 3.9 (3.4–4.4)

Argentina 1990 33 1.4 (1.3–1.4) 4.2 (4.1–4.2) 33 (12–64) 102 (38–198) 19 (13–28) 60 (39–85)

1995 35 1.2 (1.1–1.2) 3.3 (3.3–3.4) 26 (12–46) 74 (33–131) 17 (14–21) 49 (40–59)

2000 37 0.84 (0.810–0.870) 2.3 (2.2–2.3) 22 (9.5–39) 59 (26–107) 15 (12–18) 40 (33–49)

2005 39 0.73 (0.700–0.760) 1.9 (1.8–2.0) 18 (7.8–34) 48 (20–87) 13 (11–15) 33 (27–40)

2010 40 0.54 (0.520–0.570) 1.3 (1.3–1.4) 16 (7.1–29) 40 (18–71) 11 (9.1–13) 27 (23–32)

2011 41 0.55 (0.520–0.570) 1.3 (1.3–1.4) 16 (6.8–28) 38 (17–68) 11 (8.9–13) 26 (22–31)

2012 41 0.55 (0.530–0.580) 1.3 (1.3–1.4) 15 (6.5–27) 36 (16–65) 10 (8.6–12) 25 (21–30)

Aruba 1990 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.013 (<0.01–0.024) 20 (7.9–38) <0.01 (<0.01–0.011) 16 (14–18)

1995 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.016 (<0.01–0.031) 20 (7.9–38) 0.013 (0.011–0.014) 16 (14–18)

2000 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.018 (<0.01–0.035) 20 (7.9–38) 0.014 (0.013–0.016) 16 (14–18)

2005 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.02 (<0.01–0.038) 20 (7.9–38) 0.016 (0.014–0.018) 16 (14–18)

2010 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.021 (<0.01–0.039) 20 (7.9–38) 0.016 (0.014–0.018) 16 (14–18)

2011 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.021 (<0.01–0.039) 20 (7.9–38) 0.016 (0.014–0.018) 16 (14–18)

2012 < 1 <0.01 (<0.01–<0.01) 0.78 (<0.1–2.5) 0.021 (<0.01–0.039) 20 (7.9–38) 0.016 (0.014–0.018) 16 (14–18)

Bahamas 1990 < 1 0.043 (0.043–0.043) 17 (17–17) 0.056 (0.024–0.100) 22 (9.5–39) 0.053 (0.046–0.060) 21 (18–23)

1995 < 1 0.012 (0.012–0.012) 4.3 (4.3–4.3) 0.064 (0.027–0.120) 23 (9.7–41) 0.066 (0.057–0.074) 23 (21–26)

2000 < 1 <0.01 (<0.01–<0.01) 2.2 (2.1–2.3) 0.1 (0.050–0.170) 34 (17–57) 0.094 (0.083–0.110) 32 (28–36)

2005 < 1 <0.01 (<0.01–<0.01) 1.1 (1.1–1.1) 0.056 (0.025–0.100) 17 (7.6–30) 0.055 (0.048–0.062) 17 (15–19)

2010 < 1 <0.01 (<0.01–<0.01) 0.51 (0.49–0.53) 0.037 (0.015–0.068) 10 (4.2–19) 0.036 (0.031–0.040) 9.9 (8.7–11)

2011 < 1 <0.01 (<0.01–<0.01) 0.43 (0.42–0.45) 0.058 (0.028–0.098) 16 (7.6–27) 0.047 (0.041–0.053) 13 (11–15)

2012 < 1 <0.01 (<0.01–<0.01) 0.37 (0.36–0.38) 0.04 (0.016–0.076) 11 (4.2–21) 0.037 (0.032–0.042) 9.9 (8.7–11)

Barbados 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.014) 2.6 (0.93–5.2) <0.01 (<0.01–<0.01) 2.2 (1.9–2.5)

1995 < 1 <0.01 (<0.01–<0.01) 0.63 (0.62–0.64) <0.01 (<0.01–<0.01) 1.5 (0.56–3.0) <0.01 (<0.01–<0.01) 1.3 (1.1–1.5)

2000 < 1 <0.01 (<0.01–<0.01) 0.71 (0.70–0.73) <0.01 (<0.01–0.011) 2.1 (0.79–4.2) <0.01 (<0.01–<0.01) 1.3 (1.1–1.5)

2005 < 1 <0.01 (<0.01–<0.01) 0.62 (0.61–0.63) 0.016 (<0.01–0.027) 5.7 (2.7–9.9) 0.014 (0.012–0.016) 5.1 (4.4–5.7)

2010 < 1 <0.01 (<0.01–<0.01) 0.69 (0.67–0.70) <0.01 (<0.01–0.013) 2.8 (1.4–4.7) <0.01 (<0.01–<0.01) 2.5 (2.2–2.8)

2011 < 1 <0.01 (<0.01–<0.01) 0.69 (0.67–0.70) <0.01 (<0.01–<0.01) 0.79 (0.30–1.5) 0 (0–0) 0 (0–0)

2012 < 1 <0.01 (<0.01–<0.01) 0.69 (0.67–0.70) <0.01 (<0.01–<0.01) 1.8 (0.77–3.1) <0.01 (<0.01–<0.01) 1.6 (1.4–1.8)

Belize 1990 < 1 <0.01 (<0.01–<0.01) 2.5 (1.9–3.1) 0.1 (0.033–0.210) 55 (17–113) 0.075 (0.052–0.100) 40 (28–54)

1995 < 1 0.014 (0.013–0.016) 7 (6.3–7.7) 0.1 (0.037–0.200) 49 (18–95) 0.083 (0.068–0.099) 40 (33–48)

2000 < 1 <0.01 (<0.01–<0.01) 3.3 (3.2–3.3) 0.13 (0.047–0.240) 52 (20–101) 0.095 (0.078–0.110) 40 (33–48)

2005 < 1 <0.01 (<0.01–<0.01) 2.2 (2.1–2.2) 0.13 (0.055–0.230) 48 (20–86) 0.11 (0.094–0.120) 40 (34–46)

2010 < 1 0.013 (0.013–0.013) 4.3 (4.3–4.3) 0.16 (0.073–0.290) 53 (24–93) 0.12 (0.100–0.150) 40 (33–48)

2011 < 1 0.014 (0.014–0.014) 4.3 (4.3–4.3) 0.17 (0.073–0.290) 52 (23–93) 0.13 (0.100–0.150) 40 (33–48)

2012 < 1 0.014 (0.014–0.014) 4.3 (4.3–4.3) 0.17 (0.071–0.300) 51 (22–92) 0.13 (0.110–0.160) 40 (33–48)

Bermuda 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 3.9 (1.2–8.3) 0 (0–0) 0 (0–0)

1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.013) 13 (6.6–22) <0.01 (<0.01–<0.01) 7.5 (6.6–8.5)

2000 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 1.2 (0.35–2.5) 0 (0–0) 0 (0–0)

2005 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.014) 13 (6.4–22) <0.01 (<0.01–<0.01) 8.1 (7.1–9.1)

2010 < 1 <0.01 (<0.01–<0.01) 0.18 (0.18–0.18) <0.01 (<0.01–<0.01) 3.8 (0.97–8.6) <0.01 (<0.01–<0.01) 1.8 (1.6–2.0)

2011 < 1 <0.01 (<0.01–<0.01) 0.18 (0.18–0.18) <0.01 (<0.01–<0.01) 3 (0.78–6.7) <0.01 (<0.01–<0.01) 1.8 (1.5–2.0)

2012 < 1 <0.01 (<0.01–<0.01) 0.18 (0.18–0.18) <0.01 (<0.01–0.012) 11 (5.3–19) <0.01 (<0.01–<0.01) 5.3 (4.6–6.0)

Bolivia 1990 7 2.7 (0.710–6.0) 40 (10–89) 28 (11–55) 419 (156–810) 17 (11–24) 251 (166–354)

(Plurinational 1995 8 2.5 (1.2–4.4) 33 (15–58) 27 (14–44) 352 (180–580) 16 (14–19) 215 (185–248)

State of) 2000 8 2.4 (1.0–4.3) 28 (12–51) 25 (12–43) 299 (145–506) 16 (13–19) 184 (151–221)

2005 9 2.3 (0.950–4.1) 24 (10–44) 24 (12–41) 258 (126–436) 15 (12–18) 158 (129–190)

2010 10 2.2 (0.940–4.0) 22 (9.3–39) 23 (11–39) 227 (113–381) 14 (11–16) 135 (111–161)

2011 10 2.2 (0.930–4.0) 21 (9.1–38) 23 (11–38) 221 (110–370) 14 (11–16) 131 (108–156)

2012 10 2.2 (0.930–3.9) 21 (8.8–37) 23 (11–38) 215 (107–360) 13 (11–16) 127 (105–151)

Bonaire, Saint 2010 < 1 0 (0–0) 0 (0–0) 0 (0–0) 0 (0–0)

Eustatius and Sab

2011 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 8.1 (3.2–15) <0.01 (<0.01–<0.01) 6.3 (5.5–7.2)

2012 < 1 0 (0–0) 0 (0–0) 0 (0–0) 0 (0–0)

Brazil 1990 150 10 (7.8–13) 7 (5.2–9.0) 210 (73–420) 140 (49–278) 130 (79–180) 84 (53–121)

1995 162 8.6 (6.8–11) 5.3 (4.2–6.6) 170 (76–290) 103 (47–180) 120 (94–140) 71 (58–85)

2000 175 7.7 (6.3–9.2) 4.4 (3.6–5.3) 150 (65–260) 84 (37–149) 110 (86–130) 60 (49–72)

2005 186 5.8 (5.2–6.5) 3.1 (2.8–3.5) 120 (52–220) 66 (28–119) 95 (80–110) 51 (43–60)

2010 195 5.4 (5.0–5.8) 2.7 (2.5–3.0) 110 (47–210) 58 (24–106) 91 (75–110) 46 (38–55)

2011 197 5.1 (4.8–5.4) 2.6 (2.4–2.8) 120 (54–220) 62 (27–112) 95 (78–110) 48 (40–57)

2012 199 4.9 (4.6–5.2) 2.5 (2.3–2.6) 120 (51–210) 59 (25–107) 92 (76–110) 46 (38–55)

British Virgin 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 23 (9.3–43) <0.01 (<0.01–<0.01) 17 (15–20)

Islands 1995 < 1 <0.01 (<0.01–<0.01) 5.5 (5.5–5.5) <0.01 (<0.01–<0.01) 23 (9.5–43) <0.01 (<0.01–<0.01) 17 (15–20)

2000 < 1 <0.01 (<0.01–<0.01) 5.3 (5.1–5.5) <0.01 (<0.01–<0.01) 8.4 (2.5–18) <0.01 (<0.01–<0.01) 5.6 (4.9–6.3)

2005 < 1 <0.01 (<0.01–<0.01) 4.6 (4.4–4.7) <0.01 (<0.01–<0.01) 2.7 (0.82–5.8) 0 (0–0) 0 (0–0)

2010 < 1 <0.01 (<0.01–<0.01) 4.1 (4.0–4.3) <0.01 (<0.01–<0.01) 9.2 (4.3–16) <0.01 (<0.01–<0.01) 4.2 (3.7–4.8)

2011 < 1 <0.01 (<0.01–<0.01) 4.1 (4.0–4.3) <0.01 (<0.01–<0.01) 0.97 (0.29–2.0) 0 (0–0) 0 (0–0)

2012 < 1 <0.01 (<0.01–<0.01) 4.1 (4.0–4.3) <0.01 (<0.01–<0.01) 1 (0.30–2.1) 0 (0–0) 0 (0–0)

Canada 1990 28 0.12 (0.110–0.120) 0.42 (0.41–0.44) 3 (1.3–5.6) 11 (4.6–20) 2.3 (2.0–2.6) 8.3 (7.3–9.4)

1995 29 0.12 (0.120–0.120) 0.4 (0.40–0.40) 3 (1.3–5.4) 10 (4.3–18) 2.3 (2.0–2.6) 7.7 (6.8–8.7)

2000 31 0.082 (0.081–0.082) 0.27 (0.26–0.27) 2.6 (1.1–4.8) 8.5 (3.5–16) 2 (1.7–2.2) 6.5 (5.7–7.3)

2005 32 0.086 (0.086–0.086) 0.27 (0.27–0.27) 2.4 (1.0–4.3) 7.3 (3.1–13) 1.8 (1.6–2.0) 5.5 (4.8–6.3)

2010 34 0.074 (0.074–0.074) 0.22 (0.22–0.22) 2 (0.770–3.7) 5.7 (2.2–11) 1.6 (1.4–1.8) 4.6 (4.0–5.2)

2011 34 0.071 (0.070–0.071) 0.21 (0.20–0.21) 2.2 (0.950–3.9) 6.3 (2.7–11) 1.6 (1.4–1.9) 4.8 (4.2–5.4)

2012 35 0.067 (0.067–0.068) 0.19 (0.19–0.19) 2.1 (0.900–3.8) 6.1 (2.6–11) 1.6 (1.4–1.8) 4.6 (4.0–5.2)

Cayman Islands 1990 < 1 <0.01 (<0.01–<0.01) 4 (4.0–4.1) <0.01 (<0.01–<0.01) 12 (3.5–25) <0.01 (<0.01–<0.01) 9.2 (8.1–10)

1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 10 (4.4–18) <0.01 (<0.01–<0.01) 7.3 (6.4–8.2)

2000 < 1 0 (0–0) 0 (0–0) 0.012 (<0.01–0.020) 28 (14–48) <0.01 (<0.01–<0.01) 14 (12–16)

2005 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 2.2 (1.1–3.7) <0.01 (<0.01–<0.01) 1.2 (1.1–1.4)

2010 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.016) 15 (5.5–28) <0.01 (<0.01–<0.01) 8.3 (7.3–9.4)

2011 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.010) 8 (2.2–18) <0.01 (<0.01–<0.01) 4.1 (3.6–4.6)

2012 < 1 0 (0–0) 0 (0–0) 0.011 (<0.01–0.019) 18 (8.2–33) <0.01 (<0.01–<0.01) 12 (11–14)

Chile 1990 13 0.76 (0.710–0.820) 5.8 (5.3–6.2) 10 (4.4–18) 76 (34–136) 7.1 (6.2–8.0) 54 (47–61)

1995 14 0.5 (0.460–0.540) 3.5 (3.2–3.7) 6.4 (2.6–12) 44 (18–82) 4.8 (4.2–5.4) 33 (29–37)

2000 15 0.3 (0.290–0.310) 1.9 (1.8–2.0) 4.6 (1.9–8.6) 30 (12–55) 3.5 (3.0–3.9) 22 (20–25)

2005 16 0.24 (0.240–0.240) 1.5 (1.4–1.5) 4 (1.8–7.1) 25 (11–44) 2.9 (2.5–3.3) 18 (15–20)

2010 17 0.23 (0.220–0.230) 1.3 (1.3–1.4) 3.7 (1.5–6.7) 21 (8.9–39) 2.7 (2.4–3.1) 16 (14–18)

2011 17 0.22 (0.220–0.230) 1.3 (1.3–1.3) 3.8 (1.6–6.9) 22 (9.5–40) 2.8 (2.5–3.2) 16 (14–18)

2012 17 0.21 (0.210–0.220) 1.2 (1.2–1.2) 3.6 (1.4–6.7) 21 (8.3–38) 2.8 (2.4–3.1) 16 (14–18)

Colombia 1990 33 1.7 (1.4–2.0) 5 (4.2–5.9) 28 (10–55) 85 (31–165) 18 (12–25) 54 (36–75)

1995 37 2 (1.8–2.2) 5.3 (4.8–5.9) 30 (15–51) 83 (41–140) 18 (14–21) 48 (39–58)

2000 40 1.3 (1.2–1.4) 3.2 (3.0–3.4) 27 (13–46) 68 (33–116) 17 (14–21) 43 (35–52)

2005 43 1 (1.0–1.0) 2.4 (2.3–2.4) 25 (12–43) 58 (28–100) 17 (14–20) 38 (31–46)

2010 46 0.9 (0.890–0.910) 1.9 (1.9–2.0) 24 (11–41) 51 (24–87) 16 (13–19) 34 (28–41)

2011 47 0.84 (0.830–0.850) 1.8 (1.8–1.8) 23 (11–40) 49 (23–85) 16 (13–19) 34 (28–40)

2012 48 0.77 (0.760–0.790) 1.6 (1.6–1.6) 23 (11–39) 48 (22–83) 16 (13–19) 33 (27–39)

a Rates are per 100 000 population.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Costa Rica 1990 3 0.078 (0.072–0.083) 2.5 (2.3–2.7) 3.6 (1.7–6.3) 118 (54–205) 1.5 (1.3–1.7) 48 (42–54)

1995 3 0.11 (0.100–0.110) 3.1 (3.0–3.2) 3 (1.5–5.0) 87 (44–143) 1.5 (1.3–1.7) 43 (37–48)

2000 4 0.07 (0.067–0.072) 1.8 (1.7–1.8) 2.5 (1.3–4.0) 63 (33–101) 1.4 (1.2–1.5) 35 (31–39)

2005 4 0.06 (0.058–0.061) 1.4 (1.3–1.4) 1.7 (0.920–2.8) 40 (21–65) 1 (0.880–1.1) 23 (20–26)

2010 5 0.043 (0.038–0.047) 0.92 (0.82–1.0) 0.93 (0.460–1.6) 20 (9.8–33) 0.65 (0.570–0.740) 14 (12–16)

2011 5 0.04 (0.036–0.045) 0.85 (0.76–0.95) 0.78 (0.360–1.4) 16 (7.6–29) 0.59 (0.510–0.660) 12 (11–14)

2012 5 0.038 (0.034–0.043) 0.8 (0.70–0.89) 0.6 (0.220–1.2) 12 (4.7–24) 0.51 (0.440–0.580) 11 (9.3–12)

Cuba 1990 11 0.062 (0.059–0.065) 0.58 (0.55–0.62) 6.4 (2.4–12) 60 (23–115) 2.6 (1.6–3.9) 25 (15–37)

1995 11 0.096 (0.095–0.098) 0.88 (0.87–0.89) 3.5 (1.7–5.9) 32 (15–54) 2 (1.7–2.5) 19 (15–23)

2000 11 0.046 (0.045–0.047) 0.41 (0.40–0.42) 2.2 (0.940–3.9) 19 (8.4–35) 1.4 (1.1–1.8) 13 (10–16)

2005 11 0.033 (0.033–0.034) 0.3 (0.30–0.30) 1.6 (0.730–2.8) 14 (6.4–25) 1 (0.850–1.3) 9.2 (7.5–11)

2010 11 0.039 (0.039–0.040) 0.35 (0.35–0.35) 1.6 (0.730–2.8) 14 (6.4–25) 1 (0.840–1.3) 9.3 (7.4–11)

2011 11 0.038 (0.038–0.038) 0.33 (0.33–0.34) 1.6 (0.700–2.8) 14 (6.2–25) 1 (0.830–1.3) 9.3 (7.4–11)

2012 11 0.038 (0.038–0.038) 0.33 (0.33–0.34) 1.6 (0.670–2.8) 14 (5.9–25) 1 (0.840–1.3) 9.3 (7.4–11)

Curaçao 2010 < 1 <0.01 (<0.01–<0.01) 0.19 (<0.1–0.63) <0.01 (<0.01–0.014) 5 (2.0–9.4) <0.01 (<0.01–<0.01) 3.9 (3.4–4.4)

2011 < 1 <0.01 (0–<0.01) <0.1 (0–0.19) <0.01 (<0.01–<0.01) 0.97 (0.38–1.8) <0.01 (<0.01–<0.01) 0.76 (0.67–0.86)

2012 < 1 <0.01 (0–<0.01) <0.1 (0–0.18) <0.01 (<0.01–<0.01) 0.95 (0.37–1.8) <0.01 (<0.01–<0.01) 0.74 (0.65–0.84)

Dominica 1990 < 1 <0.01 (<0.01–<0.01) 7.6 (7.3–7.9) 0.012 (<0.01–0.031) 17 (2.7–43) 0.01 (<0.01–0.015) 15 (9.3–21)

1995 < 1 <0.01 (<0.01–<0.01) 2.4 (2.2–2.5) 0.014 (<0.01–0.026) 19 (7.3–36) 0.01 (<0.01–0.012) 14 (12–17)

2000 < 1 <0.01 (<0.01–<0.01) 3.4 (3.1–3.7) 0.02 (<0.01–0.034) 28 (13–49) <0.01 (<0.01–0.012) 14 (11–17)

2005 < 1 <0.01 (<0.01–<0.01) 1.3 (1.3–1.3) 0.012 (<0.01–0.024) 17 (6.3–34) <0.01 (<0.01–0.011) 13 (11–16)

2010 < 1 <0.01 (<0.01–<0.01) 3.2 (3.2–3.3) 0.013 (<0.01–0.024) 19 (7.9–34) <0.01 (<0.01–0.011) 13 (11–16)

2011 < 1 <0.01 (<0.01–<0.01) 2.1 (2.1–2.1) 0.016 (<0.01–0.033) 23 (7.2–46) <0.01 (<0.01–0.011) 13 (11–16)

2012 < 1 <0.01 (<0.01–<0.01) 2 (2.0–2.0) 0.018 (<0.01–0.030) 25 (12–42) <0.01 (<0.01–0.011) 13 (11–15)

Dominican 1990 7 1 (0.550–1.6) 14 (7.6–22) 25 (9.4–47) 339 (130–646) 11 (6.6–16) 148 (91–218)

Republic 1995 8 1 (0.510–1.7) 13 (6.4–21) 17 (8.6–29) 215 (108–360) 9.7 (7.9–12) 121 (99–146)

2000 9 0.76 (0.400–1.2) 8.7 (4.6–14) 14 (6.8–23) 159 (78–268) 8.6 (7.1–10) 100 (82–120)

2005 9 0.59 (0.380–0.850) 6.3 (4.0–9.1) 12 (6.0–21) 131 (65–220) 7.7 (6.3–9.2) 82 (67–98)

2010 10 0.53 (0.390–0.680) 5.3 (3.9–6.8) 11 (5.3–18) 107 (53–181) 6.7 (5.6–8.0) 67 (55–80)

2011 10 0.49 (0.380–0.620) 4.9 (3.8–6.1) 10 (5.1–18) 103 (50–173) 6.6 (5.4–7.8) 65 (53–77)

2012 10 0.46 (0.380–0.550) 4.4 (3.7–5.3) 10 (4.9–17) 98 (48–165) 6.4 (5.3–7.6) 62 (51–74)

Ecuador 1990 10 2 (1.4–2.6) 19 (14–26) 34 (13–66) 340 (127–655) 18 (11–26) 174 (108–257)

1995 11 2 (1.4–2.7) 17 (12–24) 27 (14–46) 242 (121–403) 15 (13–19) 136 (111–164)

2000 13 1.8 (1.3–2.3) 14 (10–19) 23 (12–39) 187 (93–313) 13 (11–16) 107 (87–128)

2005 14 1.1 (0.910–1.2) 7.7 (6.6–9.0) 20 (10–34) 148 (74–248) 11 (9.4–14) 83 (68–100)

2010 15 0.69 (0.610–0.790) 4.6 (4.0–5.2) 17 (8.5–28) 113 (57–187) 9.7 (8.0–12) 65 (54–77)

2011 15 0.53 (0.460–0.610) 3.5 (3.0–4.0) 16 (8.1–27) 106 (53–176) 9.4 (7.8–11) 62 (51–74)

2012 15 0.41 (0.350–0.480) 2.7 (2.3–3.1) 15 (7.6–25) 98 (49–163) 9.1 (7.5–11) 59 (48–70)

El Salvador 1990 5 0.26 (0.150–0.390) 4.8 (2.8–7.4) 5.1 (1.7–10) 95 (32–191) 3.4 (2.3–4.7) 63 (43–88)

1995 6 0.22 (0.150–0.300) 3.8 (2.6–5.2) 3.1 (1.2–6.1) 55 (21–105) 2.6 (2.3–2.9) 45 (39–50)

2000 6 0.17 (0.120–0.210) 2.8 (2.1–3.6) 3.3 (1.6–5.7) 56 (27–96) 2.2 (1.8–2.6) 37 (30–44)

2005 6 0.11 (0.087–0.140) 1.8 (1.4–2.3) 3.7 (1.8–6.2) 60 (29–103) 2.4 (1.9–2.9) 39 (32–47)

2010 6 0.076 (0.056–0.100) 1.2 (0.90–1.6) 2.1 (0.740–4.0) 33 (12–65) 1.8 (1.5–2.0) 28 (24–33)

2011 6 0.071 (0.051–0.094) 1.1 (0.81–1.5) 2.1 (0.760–4.2) 34 (12–67) 1.7 (1.4–1.9) 27 (23–31)

2012 6 0.065 (0.046–0.088) 1 (0.73–1.4) 2.2 (0.770–4.3) 34 (12–68) 1.6 (1.4–1.8) 25 (22–29)

Grenada 1990 < 1 0 (0–0) 0 (0–0) 0.01 (<0.01–0.020) 11 (3.9–21) <0.01 (<0.01–<0.01) 4.6 (2.9–6.8)

1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.014) 8.2 (4.1–14) <0.01 (<0.01–<0.01) 4.5 (3.8–5.2)

2000 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.015) 8.6 (4.1–15) <0.01 (<0.01–<0.01) 4.4 (3.6–5.2)

2005 < 1 <0.01 (<0.01–<0.01) 1.6 (1.6–1.6) <0.01 (<0.01–0.014) 8.1 (3.9–14) <0.01 (<0.01–<0.01) 4.2 (3.5–5.1)

2010 < 1 <0.01 (<0.01–<0.01) 0.76 (0.75–0.76) <0.01 (<0.01–0.013) 5.5 (1.3–13) <0.01 (<0.01–<0.01) 4.1 (3.4–4.9)

2011 < 1 <0.01 (<0.01–<0.01) 0.99 (0.95–1.0) <0.01 (<0.01–0.015) 7.1 (2.2–15) <0.01 (<0.01–<0.01) 4.1 (3.4–4.9)

2012 < 1 <0.01 (<0.01–<0.01) 0.99 (0.95–1.0) <0.01 (<0.01–0.015) 6.8 (2.1–14) <0.01 (<0.01–<0.01) 4.1 (3.4–4.9)

Guatemala 1990 9 0.86 (0.800–0.930) 9.7 (9.0–10) 13 (4.8–24) 142 (53–274) 6.6 (4.1–9.7) 74 (47–109)

1995 10 0.63 (0.570–0.700) 6.3 (5.7–7.1) 14 (6.8–23) 139 (69–233) 7.1 (5.8–8.5) 71 (58–85)

2000 11 0.57 (0.510–0.640) 5.1 (4.6–5.7) 14 (7.1–24) 129 (63–217) 7.6 (6.2–9.1) 68 (55–81)

2005 13 0.41 (0.370–0.460) 3.3 (2.9–3.6) 15 (7.4–25) 119 (59–200) 8.2 (6.7–9.9) 65 (53–78)

2010 14 0.34 (0.310–0.370) 2.3 (2.1–2.6) 16 (7.9–27) 112 (55–189) 8.8 (7.3–11) 62 (51–73)

2011 15 0.32 (0.290–0.350) 2.2 (2.0–2.4) 16 (8.0–28) 111 (55–188) 9 (7.4–11) 61 (50–73)

2012 15 0.31 (0.280–0.340) 2.1 (1.9–2.2) 17 (8.2–28) 110 (54–187) 9.1 (7.5–11) 60 (50–72)

Guyana 1990 < 1 0.054 (0.036–0.075) 7.5 (5.0–10) 1.4 (0.520–2.7) 193 (72–372) 0.65 (0.400–0.960) 89 (55–132)

1995 < 1 0.067 (0.049–0.087) 9.1 (6.7–12) 1.1 (0.550–1.9) 153 (75–258) 0.65 (0.530–0.780) 89 (73–107)

2000 < 1 0.099 (0.061–0.150) 13 (8.2–20) 1 (0.490–1.8) 139 (66–239) 0.78 (0.630–0.930) 104 (85–125)

2005 < 1 0.12 (0.110–0.140) 16 (14–19) 1.1 (0.470–1.9) 139 (62–248) 0.88 (0.720–1.1) 115 (94–138)

2010 < 1 0.12 (0.098–0.130) 15 (12–17) 1 (0.430–1.9) 132 (55–241) 0.87 (0.720–1.0) 111 (91–132)

2011 < 1 0.12 (0.099–0.140) 15 (12–17) 1 (0.430–1.9) 131 (54–241) 0.87 (0.720–1.0) 110 (91–131)

2012 < 1 0.12 (0.099–0.140) 15 (12–17) 1 (0.430–1.9) 131 (54–242) 0.87 (0.710–1.0) 109 (90–130)

Haiti 1990 7 2.5 (0.450–6.4) 36 (6.3–90) 27 (8.2–56) 376 (115–787) 18 (11–26) 247 (153–365)

1995 8 3 (1.1–6.0) 39 (14–77) 30 (14–51) 378 (180–648) 19 (16–23) 247 (202–297)

2000 9 3.4 (1.2–6.7) 40 (14–78) 34 (17–58) 400 (193–681) 23 (19–28) 271 (221–325)

2005 9 3.4 (1.2–6.6) 37 (13–71) 36 (17–61) 388 (187–659) 25 (21–30) 272 (222–326)

2010 10 2.9 (1.1–5.4) 29 (11–55) 32 (15–55) 326 (156–556) 23 (19–27) 230 (190–275)

2011 10 2.7 (1.1–5.1) 27 (11–51) 31 (15–53) 309 (148–528) 22 (18–27) 222 (183–265)

2012 10 2.6 (1.0–4.9) 25 (10–48) 30 (14–52) 296 (140–509) 22 (18–26) 213 (176–254)

Honduras 1990 5 0.31 (0.096–0.650) 6.4 (2.0–13) 8.7 (3.0–18) 178 (60–358) 5.6 (3.6–7.9) 113 (73–162)

1995 6 0.35 (0.110–0.730) 6.2 (1.9–13) 9.5 (3.0–19) 169 (54–348) 6.4 (4.1–9.2) 115 (74–164)

2000 6 0.31 (0.060–0.760) 5 (0.96–12) 11 (3.4–22) 169 (54–347) 7.1 (4.6–10) 114 (74–163)

2005 7 0.26 (0.025–0.780) 3.8 (0.36–11) 7.7 (2.5–16) 112 (36–228) 5 (3.2–7.2) 73 (47–104)

2010 8 0.24 (<0.01–0.840) 3.1 (0.12–11) 6.4 (2.2–13) 84 (29–170) 4.1 (2.7–5.9) 54 (35–77)

2011 8 0.24 (<0.01–0.850) 3 (<0.1–11) 6.5 (2.2–13) 84 (28–169) 4.2 (2.7–6.0) 54 (35–77)

2012 8 0.23 (<0.01–0.850) 2.9 (<0.1–11) 6.5 (2.1–13) 82 (27–168) 4.3 (2.8–6.1) 54 (35–77)

Jamaica 1990 2 0.021 (0.016–0.026) 0.87 (0.68–1.1) 0.23 (0.081–0.440) 9.5 (3.4–19) 0.15 (0.110–0.210) 6.5 (4.7–8.8)

1995 2 0.025 (0.020–0.031) 1 (0.81–1.2) 0.22 (0.100–0.380) 8.9 (4.1–15) 0.16 (0.130–0.190) 6.5 (5.4–7.9)

2000 3 0.016 (0.013–0.020) 0.63 (0.51–0.77) 0.21 (0.095–0.370) 8.1 (3.7–14) 0.17 (0.140–0.200) 6.5 (5.4–7.9)

2005 3 0.011 (<0.01–0.013) 0.4 (0.32–0.48) 0.23 (0.110–0.400) 8.7 (4.1–15) 0.18 (0.140–0.210) 6.5 (5.4–7.9)

2010 3 <0.01 (<0.01–<0.01) 0.26 (0.21–0.31) 0.26 (0.130–0.430) 9.4 (4.6–16) 0.18 (0.150–0.210) 6.6 (5.4–7.8)

2011 3 <0.01 (<0.01–<0.01) 0.24 (0.20–0.28) 0.26 (0.130–0.440) 9.4 (4.6–16) 0.18 (0.150–0.220) 6.6 (5.4–7.8)

2012 3 <0.01 (<0.01–<0.01) 0.22 (0.18–0.26) 0.26 (0.130–0.440) 9.5 (4.7–16) 0.18 (0.150–0.220) 6.6 (5.4–7.8)

Mexico 1990 86 6.7 (6.4–7.0) 7.8 (7.5–8.1) 130 (61–210) 145 (71–246) 57 (49–66) 67 (57–77)

1995 95 5.3 (4.9–5.7) 5.5 (5.2–5.9) 85 (43–140) 89 (46–146) 44 (38–51) 46 (40–53)

2000 104 3.5 (3.3–3.6) 3.3 (3.2–3.5) 53 (27–87) 51 (26–84) 32 (27–37) 31 (26–36)

2005 111 2.7 (2.6–2.9) 2.5 (2.4–2.6) 38 (19–63) 34 (17–57) 25 (21–28) 22 (19–26)

2010 118 2.6 (2.5–2.7) 2.2 (2.1–2.3) 40 (19–67) 34 (16–57) 26 (23–30) 22 (19–26)

2011 119 2.2 (2.1–2.4) 1.9 (1.8–2.0) 41 (20–69) 34 (16–58) 27 (23–31) 23 (19–26)

2012 121 2.2 (2.1–2.3) 1.8 (1.7–1.9) 40 (19–69) 33 (16–57) 27 (23–32) 23 (19–26)

Montserrat 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 20 (10–33) <0.01 (<0.01–<0.01) 11 (9.4–12)

1995 < 1 <0.01 (<0.01–<0.01) 11 (10–11) <0.01 (<0.01–<0.01) 8.2 (2.5–17) <0.01 (<0.01–<0.01) 4.1 (3.6–4.7)

2000 < 1 <0.01 (<0.01–<0.01) 21 (21–22) <0.01 (<0.01–<0.01) 11 (3.3–23) 0 (0–0) 0 (0–0)

2005 < 1 <0.01 (<0.01–<0.01) 22 (21–22) <0.01 (<0.01–<0.01) 42 (21–69) <0.01 (<0.01–<0.01) 24 (21–27)

2010 < 1 <0.01 (<0.01–<0.01) 21 (21–22) <0.01 (<0.01–<0.01) 9.9 (2.9–21) 0 (0–0) 0 (0–0)

2011 < 1 <0.01 (<0.01–<0.01) 24 (24–25) <0.01 (<0.01–<0.01) 4.7 (1.4–10) 0 (0–0) 0 (0–0)

2012 < 1 <0.01 (<0.01–<0.01) 24 (24–25) 0 (0–0) 0 (0–0)

Netherlands 1990 < 1 <0.01 (<0.01–<0.01) 0.59 (0.56–0.62) 0.013 (<0.01–0.024) 6.7 (2.5–13) <0.01 (<0.01–0.011) 5.3 (4.6–6.0)

Antilles 1995 < 1 <0.01 (<0.01–<0.01) 0.57 (0.54–0.60) 0.014 (<0.01–0.025) 7.2 (3.1–13) 0.01 (<0.01–0.012) 5.3 (4.6–6.0)

2000 < 1 <0.01 (<0.01–<0.01) 0.59 (0.58–0.61) <0.01 (<0.01–0.019) 5 (1.5–11) <0.01 (<0.01–<0.01) 3.2 (2.8–3.7)

2005 < 1 <0.01 (<0.01–<0.01) 0.59 (0.57–0.61) 0.01 (<0.01–0.021) 5.6 (1.7–12) <0.01 (<0.01–<0.01) 4.7 (4.1–5.3)

Nicaragua 1990 4 0.45 (0.260–0.680) 11 (6.4–16) 7.6 (2.8–15) 183 (68–354) 4.5 (2.9–6.3) 108 (71–152)

1995 5 0.41 (0.260–0.600) 8.9 (5.6–13) 6.4 (3.0–11) 137 (65–236) 4 (3.2–4.8) 85 (70–102)

2000 5 0.33 (0.230–0.440) 6.4 (4.5–8.7) 5.5 (2.6–9.5) 108 (51–186) 3.4 (2.8–4.1) 68 (55–81)

2005 5 0.3 (0.220–0.380) 5.4 (4.1–6.9) 4.6 (2.2–8.0) 85 (39–146) 2.9 (2.4–3.5) 53 (44–64)

2010 6 0.26 (0.200–0.330) 4.5 (3.5–5.6) 2.9 (1.0–5.9) 50 (17–101) 2.5 (2.1–2.8) 42 (36–49)

2011 6 0.19 (0.150–0.240) 3.3 (2.6–4.1) 3.1 (1.1–6.3) 53 (18–106) 2.4 (2.0–2.7) 40 (35–46)

2012 6 0.19 (0.150–0.230) 3.1 (2.4–3.8) 3.3 (1.1–6.7) 55 (19–112) 2.3 (2.0–2.7) 38 (33–44)

Rates are per 100 000 population.

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEa

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Panama 1990 2 0.2 (0.130–0.290) 8.1 (5.2–12) 1.9 (0.740–3.6) 77 (30–146) 1.2 (0.810–1.6) 47 (33–65)

1995 3 0.2 (0.160–0.250) 7.4 (5.8–9.2) 1.6 (0.600–3.0) 57 (22–110) 1.3 (1.1–1.6) 47 (39–57)

2000 3 0.2 (0.180–0.230) 6.6 (5.9–7.4) 1.6 (0.600–3.0) 52 (20–99) 1.4 (1.2–1.7) 47 (39–56)

2005 3 0.22 (0.210–0.230) 6.6 (6.3–6.9) 1.8 (0.670–3.4) 53 (20–101) 1.6 (1.3–1.9) 47 (39–57)

2010 4 0.19 (0.190–0.200) 5.2 (5.1–5.4) 2.2 (0.920–3.9) 59 (25–107) 1.8 (1.5–2.0) 48 (42–54)

2011 4 0.19 (0.190–0.190) 5.1 (5.0–5.2) 2.3 (1.0–4.0) 61 (28–108) 1.8 (1.6–2.0) 48 (42–54)

2012 4 0.19 (0.180–0.190) 4.9 (4.8–5.0) 2.4 (1.2–4.2) 64 (30–110) 1.8 (1.6–2.0) 48 (42–54)

Paraguay 1990 4 0.2 (0.150–0.250) 4.6 (3.5–5.9) 4.2 (2.0–7.0) 98 (48–165) 2.8 (2.6–3.0) 66 (61–72)

1995 5 0.23 (0.170–0.290) 4.8 (3.6–6.1) 3.7 (1.9–6.2) 78 (39–129) 2.5 (2.3–2.7) 52 (48–56)

2000 5 0.23 (0.160–0.310) 4.3 (3.1–5.8) 3.8 (1.9–6.4) 72 (36–120) 2.6 (2.4–2.8) 49 (45–53)

2005 6 0.28 (0.220–0.350) 4.7 (3.7–5.9) 4.1 (2.1–7.0) 70 (35–118) 2.9 (2.7–3.1) 49 (45–53)

2010 6 0.19 (0.160–0.230) 3 (2.5–3.6) 4.2 (2.0–7.1) 65 (32–110) 3 (2.7–3.2) 46 (42–50)

2011 7 0.2 (0.160–0.230) 3 (2.5–3.6) 4.2 (2.1–7.1) 64 (32–108) 3 (2.8–3.2) 45 (42–49)

2012 7 0.2 (0.160–0.240) 3 (2.5–3.6) 4.2 (2.1–7.1) 63 (31–106) 3 (2.8–3.2) 45 (41–48)

Peru 1990 22 7.5 (2.5–15) 34 (11–70) 120 (42–240) 554 (191–1 100) 69 (43–100) 317 (196–468)

1995 24 6.2 (3.3–9.9) 26 (14–41) 85 (37–150) 355 (156–634) 58 (47–70) 242 (198–290)

2000 26 3.7 (2.3–5.4) 14 (8.9–21) 70 (30–130) 268 (116–481) 48 (39–57) 184 (151–221)

2005 28 2.7 (2.1–3.4) 9.7 (7.4–12) 54 (23–99) 195 (82–357) 39 (33–46) 140 (118–164)

2010 29 1.8 (1.3–2.3) 6.1 (4.6–7.8) 37 (12–77) 127 (40–263) 31 (27–35) 106 (93–120)

2011 30 1.7 (1.2–2.1) 5.6 (4.1–7.2) 37 (12–74) 124 (42–248) 30 (26–34) 101 (88–114)

2012 30 1.5 (1.1–2.0) 5.1 (3.8–6.7) 36 (12–73) 121 (41–243) 29 (25–32) 95 (83–108)

Puerto Rico 1990 4 0.069 (0.069–0.070) 2 (2.0–2.0) 0.22 (0.064–0.460) 6.1 (1.8–13) 0.18 (0.160–0.210) 5.2 (4.6–5.9)

1995 4 0.081 (0.080–0.081) 2.2 (2.2–2.2) 0.4 (0.170–0.740) 11 (4.5–20) 0.3 (0.260–0.340) 8.2 (7.2–9.2)

2000 4 0.017 (0.017–0.017) 0.45 (0.45–0.45) 0.27 (0.110–0.490) 7 (2.9–13) 0.2 (0.180–0.230) 5.3 (4.6–6.0)

2005 4 0.017 (0.017–0.017) 0.45 (0.45–0.46) 0.15 (0.066–0.270) 4 (1.7–7.1) 0.13 (0.110–0.150) 3.5 (3.0–3.9)

2010 4 0.01 (0.010–0.010) 0.28 (0.27–0.28) 0.12 (0.055–0.210) 3.2 (1.5–5.6) 0.092 (0.081–0.100) 2.5 (2.2–2.8)

2011 4 <0.01 (<0.01–<0.01) 0.25 (0.25–0.25) 0.07 (0.026–0.140) 1.9 (0.69–3.7) 0.058 (0.050–0.065) 1.6 (1.4–1.8)

2012 4 <0.01 (<0.01–<0.01) 0.23 (0.23–0.23) 0.11 (0.053–0.200) 3 (1.4–5.3) 0.082 (0.072–0.092) 2.2 (1.9–2.5)

Saint Kitts and 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 0.56 (0.17–1.2) 0 (0–0) 0 (0–0)

Nevis 1995 < 1 <0.01 (<0.01–<0.01) 2.1 (2.1–2.2) <0.01 (<0.01–0.014) 17 (6.2–32) <0.01 (<0.01–<0.01) 13 (12–15)

2000 < 1 <0.01 (<0.01–<0.01) 2.4 (2.3–2.5) <0.01 (<0.01–<0.01) 7.3 (2.2–15) 0 (0–0) 0 (0–0)

2005 < 1 <0.01 (<0.01–<0.01) 2.2 (2.1–2.3) <0.01 (<0.01–<0.01) 3.7 (1.1–7.9) 0 (0–0) 0 (0–0)

2010 < 1 <0.01 (<0.01–<0.01) 2.5 (2.3–2.6) <0.01 (<0.01–<0.01) 5.6 (1.6–12) <0.01 (<0.01–<0.01) 4.4 (3.8–5.0)

2011 < 1 <0.01 (<0.01–<0.01) 2.5 (2.3–2.6) <0.01 (<0.01–<0.01) 5.1 (1.3–12) <0.01 (<0.01–<0.01) 2.2 (1.9–2.5)

2012 < 1 <0.01 (<0.01–<0.01) 2.5 (2.3–2.6) <0.01 (<0.01–<0.01) 5.1 (1.7–10) <0.01 (<0.01–<0.01) 4.3 (3.8–4.9)

Saint Lucia 1990 < 1 <0.01 (<0.01–<0.01) 4 (3.8–4.2) 0.027 (<0.01–0.051) 19 (7.2–37) 0.021 (0.019–0.024) 15 (13–17)

1995 < 1 0.012 (<0.01–0.016) 8.3 (6.3–11) 0.035 (0.014–0.065) 24 (9.6–44) 0.027 (0.023–0.030) 18 (16–21)

2000 < 1 <0.01 (<0.01–<0.01) 0.81 (0.71–0.92) 0.024 (<0.01–0.044) 15 (5.9–28) 0.018 (0.016–0.021) 12 (10–13)

2005 < 1 <0.01 (<0.01–<0.01) 3.5 (3.3–3.6) 0.023 (<0.01–0.044) 14 (5.4–26) 0.018 (0.016–0.020) 11 (9.5–12)

2010 < 1 <0.01 (<0.01–<0.01) 1.4 (1.3–1.5) 0.015 (<0.01–0.033) 8.6 (2.5–18) 0.012 (0.011–0.014) 6.9 (6.1–7.8)

2011 < 1 <0.01 (<0.01–<0.01) 1.3 (1.2–1.4) 0.011 (<0.01–0.022) 6.1 (2.0–13) <0.01 (<0.01–0.010) 5.1 (4.5–5.8)

2012 < 1 <0.01 (<0.01–<0.01) 1.2 (1.1–1.4) <0.01 (<0.01–0.018) 4.8 (1.5–9.9) <0.01 (<0.01–<0.01) 3.3 (2.9–3.7)

Saint Vincent and 1990 < 1 <0.01 (<0.01–<0.01) 1 (0.95–1.1) 0.071 (0.025–0.140) 66 (24–129) 0.029 (0.018–0.043) 27 (17–40)

the Grenadines 1995 < 1 <0.01 (<0.01–<0.01) 3.7 (3.6–3.8) 0.061 (0.028–0.110) 57 (26–99) 0.029 (0.023–0.035) 27 (22–32)

2000 < 1 <0.01 (<0.01–<0.01) 3.3 (3.0–3.6) 0.055 (0.026–0.094) 51 (24–87) 0.028 (0.023–0.033) 26 (21–31)

2005 < 1 <0.01 (<0.01–<0.01) 0.86 (0.86–0.87) 0.049 (0.020–0.092) 45 (18–84) 0.027 (0.022–0.033) 25 (20–30)

2010 < 1 <0.01 (<0.01–<0.01) 4.8 (4.7–4.8) 0.035 (0.011–0.071) 32 (10–65) 0.027 (0.022–0.032) 24 (20–29)

2011 < 1 <0.01 (<0.01–<0.01) 2.6 (2.5–2.6) 0.031 (0.010–0.064) 29 (9.1–59) 0.026 (0.022–0.032) 24 (20–29)

2012 < 1 <0.01 (<0.01–<0.01) 2.6 (2.5–2.6) 0.027 (<0.01–0.061) 24 (5.6–56) 0.026 (0.022–0.031) 24 (20–29)

Sint Maarten 2010 < 1 <0.01 (0–<0.01) 0.4 (0–2.0) <0.01 (<0.01–0.011) 11 (3.0–25) <0.01 (<0.01–<0.01) 8.1 (7.1–9.2)

(Dutch part) 2011 < 1 <0.01 (0–<0.01) 0.26 (0–1.4) <0.01 (<0.01–<0.01) 7.4 (1.6–17) <0.01 (<0.01–<0.01) 5.3 (4.6–6.0)

2012 < 1 <0.01 (0–<0.01) 0.13 (<0.1–0.43) <0.01 (<0.01–<0.01) 3.3 (1.3–6.3) <0.01 (<0.01–<0.01) 2.6 (2.3–2.9)

Suriname 1990 < 1 0.027 (0.019–0.037) 6.7 (4.6–9.2) 0.53 (0.200–1.0) 129 (50–245) 0.26 (0.170–0.360) 63 (41–90)

1995 < 1 0.016 (<0.01–0.027) 3.6 (1.7–6.2) 0.69 (0.230–1.4) 157 (52–320) 0.4 (0.260–0.570) 92 (59–131)

2000 < 1 <0.01 (<0.01–<0.01) 1.2 (0.98–1.5) 0.6 (0.180–1.3) 128 (38–273) 0.4 (0.260–0.580) 86 (56–124)

2005 < 1 <0.01 (<0.01–<0.01) 1.7 (1.5–1.9) 0.47 (0.150–0.980) 94 (30–195) 0.31 (0.200–0.450) 63 (41–90)

2010 < 1 0.014 (0.012–0.015) 2.6 (2.3–2.9) 0.35 (0.120–0.700) 66 (22–133) 0.24 (0.160–0.340) 46 (31–65)

2011 < 1 0.014 (0.012–0.015) 2.6 (2.3–2.9) 0.33 (0.130–0.620) 62 (24–117) 0.23 (0.170–0.310) 44 (32–58)

2012 < 1 0.014 (0.012–0.016) 2.6 (2.3–2.9) 0.31 (0.120–0.590) 58 (22–110) 0.22 (0.160–0.290) 41 (30–55)

Trinidad and 1990 1 0.032 (0.031–0.033) 2.6 (2.5–2.7) 0.21 (0.099–0.350) 17 (8.1–29) 0.14 (0.120–0.160) 11 (9.9–13)

Tobago 1995 1 0.034 (0.033–0.034) 2.7 (2.7–2.7) 0.23 (0.090–0.440) 19 (7.2–35) 0.19 (0.170–0.220) 15 (13–17)

2000 1 0.025 (0.024–0.025) 1.9 (1.9–2.0) 0.29 (0.140–0.490) 23 (11–39) 0.23 (0.200–0.260) 18 (16–20)

2005 1 0.018 (0.018–0.018) 1.4 (1.4–1.4) 0.2 (0.073–0.390) 15 (5.7–30) 0.19 (0.170–0.220) 15 (13–17)

2010 1 0.028 (0.028–0.028) 2.1 (2.1–2.1) 0.26 (0.096–0.500) 20 (7.2–38) 0.25 (0.220–0.290) 19 (17–21)

2011 1 0.028 (0.028–0.028) 2.1 (2.1–2.1) 0.26 (0.096–0.520) 20 (7.2–39) 0.26 (0.230–0.290) 19 (17–22)

2012 1 0.028 (0.028–0.028) 2.1 (2.1–2.1) 0.37 (0.170–0.650) 28 (13–48) 0.32 (0.280–0.360) 24 (21–27)

Turks and Caicos 1990 < 1 0 (0–0) 0 (0–0) 0 (0–0) 0 (0–0)

Islands 1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–0.015) 47 (14–100) <0.01 (<0.01–<0.01) 36 (32–41)

2000 < 1 <0.01 (<0.01–<0.01) 6.1 (5.7–6.6) 0.016 (<0.01–0.029) 86 (37–156) 0.012 (0.010–0.014) 63 (55–72)

2005 < 1 <0.01 (<0.01–<0.01) 3.9 (3.9–4.0) 0.013 (<0.01–0.021) 47 (24–79) <0.01 (<0.01–<0.01) 29 (26–33)

2010 < 1 <0.01 (<0.01–<0.01) 3.5 (3.4–3.7) <0.01 (<0.01–0.015) 24 (7.5–50) <0.01 (<0.01–<0.01) 22 (20–25)

2011 < 1 <0.01 (<0.01–<0.01) 3.5 (3.4–3.7) 0.015 (<0.01–0.026) 47 (21–82) 0.01 (<0.01–0.012) 33 (29–37)

2012 < 1 <0.01 (<0.01–<0.01) 3.5 (3.4–3.7) 0.01 (<0.01–0.022) 32 (9.1–68) <0.01 (<0.01–0.010) 28 (25–32)

United States 1990 255 2.6 (2.5–2.6) 1 (0.99–1.0) 38 (15–71) 15 (5.9–28) 30 (26–33) 12 (10–13)

of America 1995 268 1.4 (1.4–1.4) 0.51 (0.50–0.52) 35 (15–62) 13 (5.7–23) 26 (23–30) 9.8 (8.5–11)

2000 285 0.81 (0.790–0.820) 0.28 (0.28–0.29) 24 (10–45) 8.6 (3.6–16) 19 (16–21) 6.6 (5.8–7.5)

2005 298 0.64 (0.640–0.650) 0.22 (0.21–0.22) 21 (9.3–38) 7.2 (3.1–13) 16 (14–18) 5.4 (4.8–6.1)

2010 312 0.61 (0.590–0.630) 0.2 (0.19–0.20) 17 (7.1–30) 5.3 (2.3–9.6) 13 (11–15) 4.1 (3.6–4.7)

2011 315 0.47 (0.440–0.500) 0.15 (0.14–0.16) 16 (6.7–28) 5 (2.1–9.0) 12 (11–14) 3.8 (3.4–4.3)

2012 318 0.44 (0.390–0.480) 0.14 (0.12–0.15) 15 (6.5–27) 4.7 (2.0–8.4) 11 (10–13) 3.6 (3.2–4.1)

Uruguay 1990 3 0.085 (0.078–0.092) 2.7 (2.5–3.0) 1.5 (0.690–2.6) 48 (22–83) 1 (0.890–1.2) 33 (29–37)

1995 3 0.076 (0.073–0.078) 2.3 (2.3–2.4) 0.91 (0.340–1.8) 28 (11–54) 0.72 (0.630–0.810) 22 (20–25)

2000 3 0.069 (0.066–0.072) 2.1 (2.0–2.2) 0.96 (0.410–1.7) 29 (12–53) 0.74 (0.650–0.840) 22 (20–25)

2005 3 0.067 (0.064–0.070) 2 (1.9–2.1) 0.89 (0.390–1.6) 27 (12–48) 0.72 (0.630–0.810) 22 (19–24)

2010 3 0.054 (0.051–0.057) 1.6 (1.5–1.7) 0.96 (0.400–1.8) 29 (12–53) 0.8 (0.700–0.910) 24 (21–27)

2011 3 0.053 (0.050–0.056) 1.6 (1.5–1.6) 1.2 (0.560–2.1) 36 (17–62) 0.94 (0.820–1.1) 28 (24–31)

2012 3 0.051 (0.048–0.054) 1.5 (1.4–1.6) 1.1 (0.490–2.1) 34 (14–61) 0.93 (0.810–1.1) 27 (24–31)

US Virgin Islands 1990 < 1 <0.01 (<0.01–<0.01) 3 (3.0–3.1) <0.01 (<0.01–0.011) 5.6 (2.1–11) <0.01 (<0.01–<0.01) 4.5 (3.9–5.0)

1995 < 1 <0.01 (<0.01–<0.01) 2.4 (2.4–2.4) <0.01 (<0.01–0.016) 7.3 (2.2–15) <0.01 (<0.01–<0.01) 4.3 (3.8–4.9)

2000 < 1 <0.01 (<0.01–<0.01) 2.8 (2.8–2.8) 0.011 (<0.01–0.020) 9.9 (3.8–19) <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2005 < 1 <0.01 (<0.01–<0.01) 0.94 (0.94–0.95) 0.011 (<0.01–0.020) 9.9 (3.9–19) <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2010 < 1 <0.01 (<0.01–<0.01) 0.96 (0.94–0.97) 0.011 (<0.01–0.020) 9.9 (3.9–19) <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2011 < 1 <0.01 (<0.01–<0.01) 0.96 (0.94–0.97) 0.011 (<0.01–0.020) 9.9 (3.8–19) <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2012 < 1 <0.01 (<0.01–<0.01) 0.96 (0.94–0.97) 0.011 (<0.01–0.020) 9.9 (3.9–19) <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

Venezuela 1990 20 0.85 (0.830–0.870) 4.3 (4.2–4.4) 11 (3.9–20) 53 (20–103) 7 (4.9–9.4) 35 (25–47)

(Bolivarian 1995 22 0.81 (0.790–0.830) 3.7 (3.6–3.8) 12 (5.4–20) 53 (25–92) 7.7 (6.3–9.2) 35 (28–42)

Republic of) 2000 24 0.67 (0.650–0.690) 2.7 (2.7–2.8) 12 (5.5–21) 50 (22–88) 8.4 (6.8–10) 34 (28–41)

2005 27 0.63 (0.630–0.630) 2.4 (2.3–2.4) 13 (6.2–23) 50 (23–87) 9 (7.4–11) 34 (28–41)

2010 29 0.71 (0.410–1.1) 2.4 (1.4–3.8) 15 (7.3–25) 52 (25–87) 9.7 (8.0–12) 33 (27–40)

2011 30 0.72 (0.410–1.1) 2.4 (1.4–3.8) 15 (7.3–25) 50 (25–85) 9.8 (8.1–12) 33 (27–40)

2012 30 0.73 (0.420–1.1) 2.4 (1.4–3.8) 15 (7.6–26) 52 (25–87) 9.9 (8.2–12) 33 (27–39)

a Rates are per 100 000 population.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Anguilla 1990 < 1 <0.01 (<0.01–<0.01) 24 (15–35) 0 0 0

1995 < 1 <0.01 (<0.01–<0.01) 23 (20–27) 2 20 88 (75–100)

2000 < 1 <0.01 (<0.01–<0.01) 23 (18–27)

2005 < 1 <0.01 (<0.01–<0.01) 22 (18–26)

2010 < 1 <0.01 (<0.01–<0.01) 21 (18–25) 1 7.3 34 (29–41)

2011 < 1 <0.01 (<0.01–<0.01) 21 (17–25) 0 0 0

2012 < 1 <0.01 (<0.01–<0.01) 21 (17–25) 0 0 0

Antigua and 1990 < 1 <0.01 (<0.01–<0.01) 1.9 (1.6–2.1) 1 1.6 87 (77–99)

Barbuda 1995 < 1 0 (0–0) 0 (0–0) 0 0

2000 < 1 <0.01 (<0.01–<0.01) 5.9 (5.2–6.7) 4 5.2 87 (77–99)

2005 < 1 <0.01 (<0.01–<0.01) 8.4 (7.3–9.5) <0.01 (<0.01–<0.01) 4.2 (1.6–7.9) 6 7.3 87 (77–99)

2010 < 1 <0.01 (<0.01–<0.01) 9.2 (8.1–10) <0.01 (<0.01–<0.01) 7.7 (4.9–11) 7 8 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 7.8 (6.9–8.9) <0.01 (<0.01–<0.01) 4.9 (2.6–7.9) 6 6.8 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 3.9 (3.4–4.4) <0.01 (<0.01–<0.01) 1.5 (0.50–3.0) 3 3.4 87 (77–99)

Argentina 1990 33 19 (13–28) 60 (39–85) 0.16 (0.11–0.23) 0.5 (0.33–0.71) 12 309 38 63 (44–97)

1995 35 17 (14–21) 49 (40–59) 0.27 (0.22–0.32) 0.8 (0.62–0.91) 13 450 39 79 (65–96)

2000 37 15 (12–18) 40 (33–49) 0.29 (0.24–0.35) 0.8 (0.64–0.95) 11 767 32 79 (66–96)

2005 39 13 (11–15) 33 (27–40) 0.28 (0.23–0.34) 0.7 (0.59–0.87) 10 576 27 82 (68–100)

2010 40 11 (9.1–13) 27 (23–32) 0.27 (0.23–0.32) 0.7 (0.56–0.80) 7 336 18 67 (56–80)

2011 41 11 (8.9–13) 26 (22–31) 0.27 (0.23–0.32) 0.7 (0.55–0.80) 9 733 24 91 (76–110)

2012 41 10 (8.6–12) 25 (21–30) 0.27 (0.22–0.32) 0.7 (0.55–0.78) 8 758 21 84 (71–100)

Aruba 1990 < 1 <0.01 (<0.01–0.011) 16 (14–18)

1995 < 1 0.013 (0.011–0.014) 16 (14–18)

2000 < 1 0.014 (0.013–0.016) 16 (14–18)

2005 < 1 0.016 (0.014–0.018) 16 (14–18)

2010 < 1 0.016 (0.014–0.018) 16 (14–18) 6 5.9 37 (33–43)

2011 < 1 0.016 (0.014–0.018) 16 (14–18) 8 7.8 50 (44–57)

2012 < 1 0.016 (0.014–0.018) 16 (14–18) 28 27 170 (150–200)

Bahamas 1990 < 1 0.053 (0.046–0.060) 21 (18–23) 0.019 (0.017–0.021) 7.4 (6.5–8.3) 46 18 87 (77–99)

1995 < 1 0.066 (0.057–0.074) 23 (21–26) 0.029 (0.026–0.033) 10 (9.1–12) 57 20 87 (77–99)

2000 < 1 0.094 (0.083–0.110) 32 (28–36) 0.041 (0.036–0.047) 14 (12–16) 82 28 87 (77–99)

2005 < 1 0.055 (0.048–0.062) 17 (15–19) 0.022 (0.020–0.025) 6.8 (5.9–7.7) 48 15 87 (77–99)

2010 < 1 0.036 (0.031–0.040) 9.9 (8.7–11) 0.013 (0.012–0.015) 3.7 (3.2–4.2) 31 8.6 87 (77–99)

2011 < 1 0.047 (0.041–0.053) 13 (11–15) 0.012 (0.011–0.014) 3.3 (2.9–3.7) 41 11 87 (77–99)

2012 < 1 0.037 (0.032–0.042) 9.9 (8.7–11) <0.01 (<0.01–<0.01) 2.3 (2.0–2.6) 32 8.6 87 (77–99)

Barbados 1990 < 1 <0.01 (<0.01–<0.01) 2.2 (1.9–2.5) <0.01 (<0.01–<0.01) 0.1 (0.12–0.15) 5 1.9 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 1.3 (1.1–1.5) <0.01 (<0.01–<0.01) 0.2 (0.14–0.18) 3 1.1 87 (77–99)

2000 < 1 <0.01 (<0.01–<0.01) 1.3 (1.1–1.5) <0.01 (<0.01–<0.01) 0.3 (0.24–0.31) 3 1.1 87 (77–99)

2005 < 1 0.014 (0.012–0.016) 5.1 (4.4–5.7) <0.01 (<0.01–<0.01) 1.6 (1.4–1.8)

2010 < 1 <0.01 (<0.01–<0.01) 2.5 (2.2–2.8) <0.01 (<0.01–<0.01) 1 (0.83–1.1) 6 2.1 87 (77–99)

2011 < 1 0 (0–0) 0 (0–0) 0 0

2012 < 1 <0.01 (<0.01–<0.01) 1.6 (1.4–1.8) <0.01 (<0.01–<0.01) 0.5 (0.47–0.60) 4 1.4 87 (77–99)

Belize 1990 < 1 0.075 (0.052–0.100) 40 (28–54) <0.01 (<0.01–<0.01) 2.8 (1.9–3.8) 57 30 76 (56–110)

1995 < 1 0.083 (0.068–0.099) 40 (33–48) 0.011 (<0.01–0.013) 5.3 (4.3–6.4) 95 46 110 (96–140)

2000 < 1 0.095 (0.078–0.110) 40 (33–48) 0.018 (0.015–0.022) 7.5 (6.2–9.1) 106 44 110 (93–140)

2005 < 1 0.11 (0.094–0.120) 40 (34–46) 0.022 (0.019–0.026) 8.2 (7.1–9.4) 102 38 94 (82–110)

2010 < 1 0.12 (0.100–0.150) 40 (33–48) 0.025 (0.021–0.030) 8.2 (6.7–9.8) 145 47 120 (98–140)

2011 < 1 0.13 (0.100–0.150) 40 (33–48) 0.026 (0.021–0.031) 8.1 (6.6–9.7) 74 23 59 (49–72)

2012 < 1 0.13 (0.110–0.160) 40 (33–48) 0.026 (0.021–0.032) 8.1 (6.6–9.7) 84 26 65 (54–79)

Bermuda 1990 < 1 0 (0–0) 0 (0–0) 0 0

1995 < 1 <0.01 (<0.01–<0.01) 7.5 (6.6–8.5) 4 6.5 87 (77–99)

2000 < 1 0 (0–0) 0 (0–0) 0 0

2005 < 1 <0.01 (<0.01–<0.01) 8.1 (7.1–9.1)

2010 < 1 <0.01 (<0.01–<0.01) 1.8 (1.6–2.0) 1 1.5 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 1.8 (1.5–2.0) 1 1.5 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 5.3 (4.6–6.0) 3 4.6 87 (77–99)

Bolivia 1990 7 17 (11–24) 251 (166–354) 0.86 (0.57–1.2) 13 (8.4–18) 11 166 164 65 (46–99)

(Plurinational 1995 8 16 (14–19) 215 (185–248) 0.94 (0.80–1.1) 12 (11–14) 14 422 189 88 (76–100)

State of) 2000 8 16 (13–19) 184 (151–221) 0.86 (0.71–1.0) 10 (8.3–12) 10 127 119 65 (54–79)

2005 9 15 (12–18) 158 (129–190) 0.77 (0.63–0.92) 8.2 (6.7–9.8) 9 748 104 66 (55–81)

2010 10 14 (11–16) 135 (111–161) 0.52 (0.43–0.62) 5.1 (4.2–6.1) 8 363 82 61 (51–74)

2011 10 14 (11–16) 131 (108–156) 0.48 (0.40–0.57) 4.7 (3.8–5.5) 8 521 83 63 (53–76)

2012 10 13 (11–16) 127 (105–151) 0.43 (0.36–0.52) 4.1 (3.4–4.9) 8 257 79 62 (52–75)

Bonaire, Saint 2010 < 1 0 (0–0) 0 (0–0) 0 0

Eustatius and Sab

2011 < 1 <0.01 (<0.01–<0.01) 6.3 (5.5–7.2) 1 5.5 87 (77–99)

2012 < 1 0 (0–0) 0 (0–0) 0 0

Brazil 1990 150 130 (79–180) 84 (53–121) 5.5 (3.5–8.0) 3.7 (2.3–5.3) 74 570 50 60 (41–94)

1995 162 120 (94–140) 71 (58–85) 12 (9.9–15) 7.5 (6.1–9.0) 91 013 56 79 (66–97)

2000 175 110 (86–130) 60 (49–72) 12 (9.8–14) 6.9 (5.6–8.3) 77 899 45 74 (62–91)

2005 186 95 (80–110) 51 (43–60) 15 (12–18) 8 (6.7–9.4) 80 675 43 85 (72–100)

2010 195 91 (75–110) 46 (38–55) 17 (14–20) 8.5 (7.1–10) 74 395 38 82 (69–99)

2011 197 95 (78–110) 48 (40–57) 17 (14–20) 8.6 (7.1–10) 77 647 39 82 (69–99)

2012 199 92 (76–110) 46 (38–55) 16 (13–19) 8 (6.6–9.5) 75 122 38 82 (69–99)

British Virgin 1990 < 1 <0.01 (<0.01–<0.01) 17 (15–20)

Islands 1995 < 1 <0.01 (<0.01–<0.01) 17 (15–20)

2000 < 1 <0.01 (<0.01–<0.01) 5.6 (4.9–6.3) 1 4.8 87 (77–99)

2005 < 1 0 (0–0) 0 (0–0) 0 0

2010 < 1 <0.01 (<0.01–<0.01) 4.2 (3.7–4.8) 1 3.7 87 (77–99)

2011 < 1 0 (0–0) 0 (0–0) 0 0

2012 < 1 0 (0–0) 0 (0–0) 0 0

Canada 1990 28 2.3 (2.0–2.6) 8.3 (7.3–9.4) 0.11 (0.095–0.12) 0.4 (0.34–0.44) 1 997 7.2 87 (77–99)

1995 29 2.3 (2.0–2.6) 7.7 (6.8–8.7) 0.17 (0.15–0.20) 0.6 (0.52–0.67) 1 965 6.7 87 (77–99)

2000 31 2 (1.7–2.2) 6.5 (5.7–7.3) 0.098 (0.086–0.11) 0.3 (0.28–0.36) 1 723 5.6 87 (77–99)

2005 32 1.8 (1.6–2.0) 5.5 (4.8–6.3) 0.11 (0.094–0.12) 0.3 (0.29–0.38) 1 552 4.8 87 (77–99)

2010 34 1.6 (1.4–1.8) 4.6 (4.0–5.2) 0.11 (0.095–0.12) 0.3 (0.28–0.36) 1 361 4 87 (77–99)

2011 34 1.6 (1.4–1.9) 4.8 (4.2–5.4) 0.11 (0.098–0.13) 0.3 (0.28–0.37) 1 430 4.1 87 (77–99)

2012 35 1.6 (1.4–1.8) 4.6 (4.0–5.2) 0.11 (0.096–0.12) 0.3 (0.28–0.36) 1 653 4.7 100 (91–120)

Cayman Islands 1990 < 1 <0.01 (<0.01–<0.01) 9.2 (8.1–10) 2 8 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 7.3 (6.4–8.2) 2 6.3 87 (77–99)

2000 < 1 <0.01 (<0.01–<0.01) 14 (12–16) 5 12 87 (77–99)

2005 < 1 <0.01 (<0.01–<0.01) 1.2 (1.1–1.4)

2010 < 1 <0.01 (<0.01–<0.01) 8.3 (7.3–9.4) 4 7.2 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 4.1 (3.6–4.6) 2 3.5 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 12 (11–14) 6 10 87 (77–99)

Chile 1990 13 7.1 (6.2–8.0) 54 (47–61) 0.021 (0.019–0.024) 0.2 (0.14–0.18) 6 151 47 87 (77–99)

1995 14 4.8 (4.2–5.4) 33 (29–37) 0.043 (0.038–0.049) 0.3 (0.26–0.34) 4 150 29 87 (77–99)

2000 15 3.5 (3.0–3.9) 22 (20–25) 0.072 (0.063–0.081) 0.5 (0.41–0.53) 3 021 20 87 (77–99)

2005 16 2.9 (2.5–3.3) 18 (15–20) 0.084 (0.074–0.095) 0.5 (0.45–0.58) 2 505 15 87 (77–99)

2010 17 2.7 (2.4–3.1) 16 (14–18) 0.086 (0.076–0.098) 0.5 (0.44–0.57) 2 376 14 87 (77–99)

2011 17 2.8 (2.5–3.2) 16 (14–18) 0.088 (0.077–0.099) 0.5 (0.44–0.57) 2 450 14 87 (77–99)

2012 17 2.8 (2.4–3.1) 16 (14–18) 0.084 (0.074–0.095) 0.5 (0.42–0.54) 2 394 14 87 (77–99)

Colombia 1990 33 18 (12–25) 54 (36–75) 0.36 (0.24–0.50) 1.1 (0.73–1.5) 12 447 37 70 (50–100)

1995 37 18 (14–21) 48 (39–58) 1.2 (0.95–1.4) 3.2 (2.6–3.8) 9 912 27 56 (47–69)

2000 40 17 (14–21) 43 (35–52) 1.7 (1.4–2.0) 4.3 (3.5–5.1) 11 630 29 68 (56–83)

2005 43 17 (14–20) 38 (31–46) 1.8 (1.4–2.1) 4.1 (3.3–4.9) 10 360 24 62 (52–76)

2010 46 16 (13–19) 34 (28–41) 1.8 (1.5–2.1) 3.8 (3.1–4.6) 11 420 25 71 (60–86)

2011 47 16 (13–19) 34 (28–40) 1.7 (1.4–2.0) 3.5 (2.9–4.2) 11 884 25 75 (63–91)

2012 48 16 (13–19) 33 (27–39) 1.6 (1.3–1.9) 3.3 (2.7–4.0) 11 424 24 73 (61–88)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Costa Rica 1990 3 1.5 (1.3–1.7) 48 (42–54) 0.031 (0.027–0.035) 1 (0.87–1.1) 230 7.5 16 (14–18)

1995 3 1.5 (1.3–1.7) 43 (37–48) 0.066 (0.058–0.075) 1.9 (1.7–2.2) 586 17 40 (35–45)

2000 4 1.4 (1.2–1.5) 35 (31–39) 0.092 (0.080–0.10) 2.3 (2.0–2.7) 585 15 43 (38–49)

2005 4 1 (0.880–1.1) 23 (20–26) 0.074 (0.065–0.084) 1.7 (1.5–1.9) 534 12 53 (47–61)

2010 5 0.65 (0.570–0.740) 14 (12–16) 0.074 (0.065–0.084) 1.6 (1.4–1.8) 492 11 75 (67–86)

2011 5 0.59 (0.510–0.660) 12 (11–14) 0.071 (0.062–0.080) 1.5 (1.3–1.7) 514 11 88 (78–100)

2012 5 0.51 (0.440–0.580) 11 (9.3–12) 0.064 (0.056–0.072) 1.3 (1.2–1.5) 475 9.9 93 (82–110)

Cuba 1990 11 2.6 (1.6–3.9) 25 (15–37) 0.023 (0.014–0.034) 0.2 (0.13–0.32) 546 5.2 21 (14–34)

1995 11 2 (1.7–2.5) 19 (15–23) 0.028 (0.023–0.034) 0.3 (0.21–0.31) 1 553 14 76 (63–94)

2000 11 1.4 (1.1–1.8) 13 (10–16) 0.033 (0.026–0.040) 0.3 (0.23–0.36) 1 183 11 82 (67–100)

2005 11 1 (0.850–1.3) 9.2 (7.5–11) 0.023 (0.019–0.028) 0.2 (0.16–0.24) 772 6.8 74 (61–91)

2010 11 1 (0.840–1.3) 9.3 (7.4–11) 0.035 (0.028–0.043) 0.3 (0.25–0.38) 827 7.3 79 (65–99)

2011 11 1 (0.830–1.3) 9.3 (7.4–11) 0.037 (0.030–0.045) 0.3 (0.26–0.40) 805 7.1 77 (63–97)

2012 11 1 (0.840–1.3) 9.3 (7.4–11) 0.037 (0.030–0.046) 0.3 (0.26–0.41) 734 6.5 70 (57–88)

Curaçao 2010 < 1 <0.01 (<0.01–<0.01) 3.9 (3.4–4.4) 5 3.4 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 0.76 (0.67–0.86) 1 0.66 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 0.74 (0.65–0.84) 1 0.64 87 (77–99)

Dominica 1990 < 1 0.01 (<0.01–0.015) 15 (9.3–21) 6 8.5 57 (40–91)

1995 < 1 0.01 (<0.01–0.012) 14 (12–17) 8 11 78 (66–95)

2000 < 1 <0.01 (<0.01–0.012) 14 (11–17)

2005 < 1 <0.01 (<0.01–0.011) 13 (11–16)

2010 < 1 <0.01 (<0.01–0.011) 13 (11–16) 8 11 86 (72–100)

2011 < 1 <0.01 (<0.01–0.011) 13 (11–16) 2 2.8 22 (18–26)

2012 < 1 <0.01 (<0.01–0.011) 13 (11–15) 7 9.8 75 (63–92)

Dominican 1990 7 11 (6.6–16) 148 (91–218) 0.25 (0.15–0.37) 3.5 (2.1–5.1) 2 597 36 24 (16–39)

Republic 1995 8 9.7 (7.9–12) 121 (99–146) 0.81 (0.66–0.98) 10 (8.3–12) 4 053 51 42 (35–51)

2000 9 8.6 (7.1–10) 100 (82–120) 1.1 (0.90–1.3) 13 (10–15) 5 291 61 61 (51–75)

2005 9 7.7 (6.3–9.2) 82 (67–98) 0.98 (0.80–1.2) 11 (8.6–13) 5 003 54 65 (54–80)

2010 10 6.7 (5.6–8.0) 67 (55–80) 0.64 (0.53–0.76) 6.4 (5.2–7.6) 3 964 40 59 (49–71)

2011 10 6.6 (5.4–7.8) 65 (53–77) 0.59 (0.49–0.71) 5.8 (4.8–7.0) 4 309 42 66 (55–80)

2012 10 6.4 (5.3–7.6) 62 (51–74) 0.54 (0.44–0.64) 5.2 (4.3–6.3) 4 262 41 67 (56–81)

Ecuador 1990 10 18 (11–26) 174 (108–257) 0.71 (0.44–1.0) 7 (4.3–10) 8 243 81 47 (32–76)

1995 11 15 (13–19) 136 (111–164) 0.96 (0.78–1.2) 8.5 (6.9–10) 7 893 70 51 (43–63)

2000 13 13 (11–16) 107 (87–128) 1.2 (0.96–1.4) 9.4 (7.7–11) 6 908 55 52 (43–63)

2005 14 11 (9.4–14) 83 (68–100) 1.2 (0.99–1.5) 8.8 (7.2–11) 4 416 32 38 (32–47)

2010 15 9.7 (8.0–12) 65 (54–77) 0.97 (0.80–1.2) 6.5 (5.3–7.7) 4 832 32 50 (42–60)

2011 15 9.4 (7.8–11) 62 (51–74) 0.92 (0.76–1.1) 6 (5.0–7.2) 5 106 33 54 (45–66)

2012 15 9.1 (7.5–11) 59 (48–70) 0.84 (0.70–1.0) 5.4 (4.5–6.5) 5 456 35 60 (50–73)

El Salvador 1990 5 3.4 (2.3–4.7) 63 (43–88) 0.082 (0.055–0.11) 1.5 (1.0–2.1) 2 367 44 70 (50–100)

1995 6 2.6 (2.3–2.9) 45 (39–50) 0.16 (0.14–0.18) 2.7 (2.4–3.1) 2 422 42 95 (84–110)

2000 6 2.2 (1.8–2.6) 37 (30–44) 0.23 (0.19–0.28) 3.9 (3.2–4.7) 1 485 25 68 (56–83)

2005 6 2.4 (1.9–2.9) 39 (32–47) 0.27 (0.22–0.32) 4.4 (3.6–5.2) 1 794 30 75 (63–92)

2010 6 1.8 (1.5–2.0) 28 (24–33) 0.19 (0.16–0.21) 3 (2.5–3.4) 1 700 27 96 (83–110)

2011 6 1.7 (1.4–1.9) 27 (23–31) 0.18 (0.15–0.20) 2.8 (2.4–3.2) 1 896 30 110 (98–130)

2012 6 1.6 (1.4–1.8) 25 (22–29) 0.2 (0.17–0.23) 3.2 (2.7–3.7) 2 053 33 130 (110–150)

Grenada 1990 < 1 <0.01 (<0.01–<0.01) 4.6 (2.9–6.8) 0 0 0

1995 < 1 <0.01 (<0.01–<0.01) 4.5 (3.8–5.2) 4 4 89 (77–100)

2000 < 1 <0.01 (<0.01–<0.01) 4.4 (3.6–5.2) 0 0 0

2005 < 1 <0.01 (<0.01–<0.01) 4.2 (3.5–5.1)

2010 < 1 <0.01 (<0.01–<0.01) 4.1 (3.4–4.9) <0.01 (<0.01–<0.01) 1 (<0.1–3.2) 4 3.8 93 (78–110)

2011 < 1 <0.01 (<0.01–<0.01) 4.1 (3.4–4.9) 2 1.9 46 (39–56)

2012 < 1 <0.01 (<0.01–<0.01) 4.1 (3.4–4.9) <0.01 (0–<0.01) 0.5 (0–3.0) 1 0.95 23 (19–28)

Guatemala 1990 9 6.6 (4.1–9.7) 74 (47–109) 0.14 (0.086–0.20) 1.5 (0.97–2.3) 3 813 43 58 (39–92)

1995 10 7.1 (5.8–8.5) 71 (58–85) 0.38 (0.31–0.46) 3.8 (3.1–4.6) 3 119 31 44 (37–54)

2000 11 7.6 (6.2–9.1) 68 (55–81) 0.78 (0.63–0.93) 6.9 (5.7–8.3) 2 913 26 38 (32–47)

2005 13 8.2 (6.7–9.9) 65 (53–78) 0.99 (0.81–1.2) 7.8 (6.4–9.4) 3 803 30 46 (39–57)

2010 14 8.8 (7.3–11) 62 (51–73) 1.3 (1.1–1.5) 9 (7.4–11) 3 322 23 38 (32–46)

2011 15 9 (7.4–11) 61 (50–73) 1.4 (1.1–1.7) 9.5 (7.8–11) 3 040 21 34 (28–41)

2012 15 9.1 (7.5–11) 60 (50–72) 1.5 (1.2–1.8) 10 (8.2–12) 3 442 23 38 (32–46)

Guyana 1990 < 1 0.65 (0.400–0.960) 89 (55–132) 0.05 (0.031–0.074) 6.9 (4.3–10) 168 23 26 (18–42)

1995 < 1 0.65 (0.530–0.780) 89 (73–107) 0.12 (0.098–0.14) 16 (13–20) 296 41 45 (38–56)

2000 < 1 0.78 (0.630–0.930) 104 (85–125) 0.24 (0.20–0.29) 33 (27–39) 422 57 54 (45–67)

2005 < 1 0.88 (0.720–1.1) 115 (94–138) 0.27 (0.22–0.33) 36 (29–43) 639 84 73 (61–89)

2010 < 1 0.87 (0.720–1.0) 111 (91–132) 0.22 (0.18–0.27) 28 (23–34) 712 91 82 (68–99)

2011 < 1 0.87 (0.720–1.0) 110 (91–131) 0.22 (0.18–0.26) 27 (22–33) 710 90 82 (68–99)

2012 < 1 0.87 (0.710–1.0) 109 (90–130) 0.2 (0.16–0.23) 25 (20–29) 748 94 86 (72–100)

Haiti 1990 7 18 (11–26) 247 (153–365) 3.2 (2.0–4.8) 45 (28–67)

1995 8 19 (16–23) 247 (202–297) 5.6 (4.6–6.8) 72 (59–87) 6 212 79 32 (27–39)

2000 9 23 (19–28) 271 (221–325) 6.8 (5.6–8.2) 79 (65–95) 10 420 121 45 (37–55)

2005 9 25 (21–30) 272 (222–326) 6.5 (5.3–7.9) 71 (58–85) 14 311 155 57 (47–70)

2010 10 23 (19–27) 230 (190–275) 4.6 (3.8–5.5) 47 (39–56) 14 222 144 62 (52–76)

2011 10 22 (18–27) 222 (183–265) 4.5 (3.7–5.4) 45 (37–54) 14 315 143 64 (54–78)

2012 10 22 (18–26) 213 (176–254) 4.3 (3.5–5.1) 42 (35–50) 16 568 163 76 (64–93)

Honduras 1990 5 5.6 (3.6–7.9) 113 (73–162) 0.24 (0.16–0.35) 4.9 (3.2–7.1) 3 647 74 66 (46–100)

1995 6 6.4 (4.1–9.2) 115 (74–164) 0.77 (0.49–1.1) 14 (8.7–20) 4 984 89 78 (54–120)

2000 6 7.1 (4.6–10) 114 (74–163) 0.84 (0.52–1.2) 14 (8.4–20) 6 406 103 90 (63–140)

2005 7 5 (3.2–7.2) 73 (47–104) 0.37 (0.23–0.54) 5.4 (3.3–7.9) 3 333 48 66 (46–100)

2010 8 4.1 (2.7–5.9) 54 (35–77) 0.19 (0.12–0.28) 2.5 (1.5–3.7) 2 876 38 70 (49–110)

2011 8 4.2 (2.7–6.0) 54 (35–77) 0.18 (0.11–0.26) 2.3 (1.4–3.4) 3 233 42 77 (54–120)

2012 8 4.3 (2.8–6.1) 54 (35–77) 0.17 (0.10–0.25) 2.1 (1.3–3.2) 3 014 38 70 (49–110)

Jamaica 1990 2 0.15 (0.110–0.210) 6.5 (4.7–8.8) 0.01 (<0.01–0.013) 0.4 (0.30–0.57) 123 5.2 79 (59–110)

1995 2 0.16 (0.130–0.190) 6.5 (5.4–7.9) 0.033 (0.027–0.040) 1.4 (1.1–1.6) 109 4.4 68 (56–83)

2000 3 0.17 (0.140–0.200) 6.5 (5.4–7.9) 0.052 (0.042–0.062) 2 (1.6–2.4) 127 4.9 75 (63–92)

2005 3 0.18 (0.140–0.210) 6.5 (5.4–7.9) 0.053 (0.043–0.064) 2 (1.6–2.4) 90 3.4 51 (43–63)

2010 3 0.18 (0.150–0.210) 6.6 (5.4–7.8) 0.042 (0.034–0.050) 1.5 (1.3–1.8) 130 4.7 72 (61–88)

2011 3 0.18 (0.150–0.220) 6.6 (5.4–7.8) 0.041 (0.034–0.049) 1.5 (1.2–1.8) 105 3.8 58 (49–70)

2012 3 0.18 (0.150–0.220) 6.6 (5.4–7.8) 0.04 (0.033–0.048) 1.5 (1.2–1.7) 91 3.3 50 (42–61)

Mexico 1990 86 57 (49–66) 67 (57–77) 2.6 (2.2–3.0) 3 (2.6–3.5) 14 437 17 25 (22–29)

1995 95 44 (38–51) 46 (40–53) 2.6 (2.2–3.0) 2.7 (2.3–3.1) 11 329 12 26 (22–30)

2000 104 32 (27–37) 31 (26–36) 2 (1.7–2.3) 1.9 (1.6–2.2) 18 434 18 58 (50–67)

2005 111 25 (21–28) 22 (19–26) 1.5 (1.3–1.7) 1.3 (1.1–1.5) 18 524 17 75 (66–87)

2010 118 26 (23–30) 22 (19–26) 1.5 (1.3–1.7) 1.3 (1.1–1.5) 20 155 17 77 (66–89)

2011 119 27 (23–31) 23 (19–26) 1.6 (1.3–1.8) 1.3 (1.1–1.5) 19 857 17 73 (63–86)

2012 121 27 (23–32) 23 (19–26) 1.6 (1.4–1.8) 1.3 (1.1–1.5) 20 470 17 75 (64–87)

Montserrat 1990 < 1 <0.01 (<0.01–<0.01) 11 (9.4–12) 1 9.3 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 4.1 (3.6–4.7)

2000 < 1 0 (0–0) 0 (0–0) 0 0

2005 < 1 <0.01 (<0.01–<0.01) 24 (21–27) 1 21 87 (77–99)

2010 < 1 0 (0–0) 0 (0–0) 0 0

2011 < 1 0 (0–0) 0 (0–0) 0 0

2012 < 1 0 (0–0) 0 (0–0) 0 0

Netherlands 1990 < 1 <0.01 (<0.01–0.011) 5.3 (4.6–6.0)

Antilles 1995 < 1 0.01 (<0.01–0.012) 5.3 (4.6–6.0)

2000 < 1 <0.01 (<0.01–<0.01) 3.2 (2.8–3.7) 5 2.8 87 (77–99)

2005 < 1 <0.01 (<0.01–<0.01) 4.7 (4.1–5.3)

Nicaragua 1990 4 4.5 (2.9–6.3) 108 (71–152) 0.015 (<0.01–0.025) 0.4 (0.18–0.61) 2 944 71 66 (47–100)

1995 5 4 (3.2–4.8) 85 (70–102) 0.02 (0.011–0.031) 0.4 (0.24–0.66) 2 842 61 72 (60–88)

2000 5 3.4 (2.8–4.1) 68 (55–81) 0.027 (0.015–0.041) 0.5 (0.30–0.81) 2 402 47 70 (58–85)

2005 5 2.9 (2.4–3.5) 53 (44–64) 0.034 (0.020–0.053) 0.6 (0.36–0.97) 1 907 35 65 (54–80)

2010 6 2.5 (2.1–2.8) 42 (36–49) 0.042 (0.025–0.062) 0.7 (0.43–1.1) 2 448 42 100 (86–120)

2011 6 2.4 (2.0–2.7) 40 (35–46) 0.044 (0.027–0.066) 0.8 (0.45–1.1) 2 693 46 110 (98–130)

2012 6 2.3 (2.0–2.7) 38 (33–44) 0.047 (0.028–0.070) 0.8 (0.47–1.2) 2 790 47 120 (110–140)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEaNUMBER RATEaPERCENT

Panama 1990 2 1.2 (0.810–1.6) 47 (33–65) 0.072 (0.050–0.099) 2.9 (2.0–4.0) 846 34 72 (52–100)

1995 3 1.3 (1.1–1.6) 47 (39–57) 0.21 (0.17–0.25) 7.5 (6.1–9.0) 1 300 47 99 (83–120)

2000 3 1.4 (1.2–1.7) 47 (39–56) 0.29 (0.24–0.34) 9.5 (7.9–11) 1 169 38 81 (68–97)

2005 3 1.6 (1.3–1.9) 47 (39–57) 0.3 (0.24–0.36) 8.8 (7.2–11) 1 637 49 100 (85–130)

2010 4 1.8 (1.5–2.0) 48 (42–54) 0.25 (0.22–0.28) 6.7 (5.9–7.6) 1 496 41 85 (76–97)

2011 4 1.8 (1.6–2.0) 48 (42–54) 0.24 (0.21–0.27) 6.5 (5.7–7.3) 1 571 42 88 (78–100)

2012 4 1.8 (1.6–2.0) 48 (42–54) 0.23 (0.20–0.26) 6.1 (5.3–6.8) 1 520 40 84 (75–95)

Paragua

1990 4 2.8 (2.6–3.0) 66 (61–72) 0.05 (0.046–0.055) 1.2 (1.1–1.3) 2 167 51 77 (71–84)

1995 5 2.5 (2.3–2.7) 52 (48–56) 0.1 (0.093–0.11) 2.1 (1.9–2.3) 1 745 36 70 (65–75)

2000 5 2.6 (2.4–2.8) 49 (45–53) 0.15 (0.13–0.16) 2.7 (2.5–2.9) 1 950 36 74 (69–81)

2005 6 2.9 (2.7–3.1) 49 (45–53) 0.2 (0.18–0.21) 3.3 (3.1–3.6) 2 075 35 71 (66–77)

2010 6 3 (2.7–3.2) 46 (42–50) 0.2 (0.19–0.22) 3.2 (2.9–3.4) 2 352 36 79 (73–86)

2011 7 3 (2.8–3.2) 45 (42–49) 0.22 (0.20–0.24) 3.4 (3.1–3.6) 2 372 36 79 (73–86)

2012 7 3 (2.8–3.2) 45 (41–48) 0.24 (0.22–0.26) 3.5 (3.3–3.8) 2 416 36 81 (75–88)

Peru 1990 22 69 (43–100) 317 (196–468) 0.58 (0.36–0.86) 2.7 (1.6–3.9) 37 905 174 55 (37–89)

1995 24 58 (47–70) 242 (198–290) 1.2 (0.98–1.4) 5 (4.1–6.0) 45 310 189 78 (65–96)

2000 26 48 (39–57) 184 (151–221) 1.3 (1.0–1.5) 4.9 (4.0–5.8) 38 661 149 81 (67–98)

2005 28 39 (33–46) 140 (118–164) 0.89 (0.75–1.0) 3.2 (2.7–3.8) 33 747 122 87 (74–100)

2010 29 31 (27–35) 106 (93–120) 0.53 (0.46–0.60) 1.8 (1.6–2.0) 31 073 106 100 (88–110)

2011 30 30 (26–34) 101 (88–114) 0.5 (0.44–0.57) 1.7 (1.5–1.9) 31 241 105 100 (93–120)

2012 30 29 (25–32) 95 (83–108) 0.49 (0.43–0.55) 1.6 (1.4–1.8) 29 760 99 100 (92–120)

Puerto Rico 1990 4 0.18 (0.160–0.210) 5.2 (4.6–5.9) 159 4.5 87 (77–99)

1995 4 0.3 (0.260–0.340) 8.2 (7.2–9.2) 262 7.1 87 (77–99)

2000 4 0.2 (0.180–0.230) 5.3 (4.6–6.0) 174 4.6 87 (77–99)

2005 4 0.13 (0.110–0.150) 3.5 (3.0–3.9) 0.039 (0.027–0.054) 1 (0.72–1.4) 113 3 87 (77–99)

2010 4 0.092 (0.081–0.100) 2.5 (2.2–2.8) 0.017 (<0.01–0.027) 0.5 (0.25–0.72) 80 2.2 87 (77–99)

2011 4 0.058 (0.050–0.065) 1.6 (1.4–1.8) 0.012 (<0.01–0.020) 0.3 (0.15–0.53) 50 1.4 87 (77–99)

2012 4 0.082 (0.072–0.092) 2.2 (1.9–2.5) 0.013 (<0.01–0.024) 0.4 (0.14–0.65) 71 1.9 87 (77–99)

Saint Kitts and 1990 < 1 0 (0–0) 0 (0–0) 0 0

Nevis 1995 < 1 <0.01 (<0.01–<0.01) 13 (12–15) 5 12 87 (77–99)

2000 < 1 0 (0–0) 0 (0–0) 0 0

2005 < 1 0 (0–0) 0 (0–0) 0 0

2010 < 1 <0.01 (<0.01–<0.01) 4.4 (3.8–5.0) 2 3.8 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 2.2 (1.9–2.5) 1 1.9 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 4.3 (3.8–4.9) 2 3.7 87 (77–99)

Saint Lucia 1990 < 1 0.021 (0.019–0.024) 15 (13–17) 13 9.4 61 (54–70)

1995 < 1 0.027 (0.023–0.030) 18 (16–21) 11 7.5 41 (36–47)

2000 < 1 0.018 (0.016–0.021) 12 (10–13) 9 5.7 49 (43–56)

2005 < 1 0.018 (0.016–0.020) 11 (9.5–12) 14 8.5 78 (69–89)

2010 < 1 0.012 (0.011–0.014) 6.9 (6.1–7.8) 9 5.1 73 (65–84)

2011 < 1 <0.01 (<0.01–0.010) 5.1 (4.5–5.8) <0.01 (<0.01–<0.01) 0.7 (<0.1–2.7) 7 3.9 76 (67–87)

2012 < 1 <0.01 (<0.01–<0.01) 3.3 (2.9–3.7) <0.01 (<0.01–<0.01) 0.4 (0–1.7) 11 6.1 180 (160–210)

Saint Vincent and 1990 < 1 0.029 (0.018–0.043) 27 (17–40) 2 1.9 6.8 (4.6–11)

the Grenadines 1995 < 1 0.029 (0.023–0.035) 27 (22–32) 13 12 45 (38–55)

2000 < 1 0.028 (0.023–0.033) 26 (21–31) 16 15 57 (48–70)

2005 < 1 0.027 (0.022–0.033) 25 (20–30) <0.01 (<0.01–0.015) 3.6 (<0.1–13) 7 6.4 26 (21–31)

2010 < 1 0.027 (0.022–0.032) 24 (20–29) <0.01 (<0.01–0.017) 7.3 (2.0–16) 15 14 56 (47–68)

2011 < 1 0.026 (0.022–0.032) 24 (20–29) <0.01 (<0.01–0.016) 7.6 (2.9–14) 17 16 64 (54–78)

2012 < 1 0.026 (0.022–0.031) 24 (20–29) <0.01 (<0.01–0.017) 8.7 (3.9–15) 30 27 110 (96–140)

Sint Maarten 2010 < 1 <0.01 (<0.01–<0.01) 8.1 (7.1–9.2) 3 7.1 87 (77–99)

(Dutch part) 2011 < 1 <0.01 (<0.01–<0.01) 5.3 (4.6–6.0) 2 4.6 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 2.6 (2.3–2.9) 1 2.3 87 (77–99)

Suriname 1990 < 1 0.26 (0.170–0.360) 63 (41–90) 0.023 (0.015–0.033) 5.7 (3.7–8.2) 82 20 32 (22–50)

1995 < 1 0.4 (0.260–0.570) 92 (59–131) 0.12 (0.077–0.17) 28 (18–39)

2000 < 1 0.4 (0.260–0.580) 86 (56–124) 0.16 (0.10–0.22) 34 (22–48) 89 19 22 (15–34)

2005 < 1 0.31 (0.200–0.450) 63 (41–90) 0.1 (0.066–0.15) 21 (13–29) 117 23 37 (26–58)

2010 < 1 0.24 (0.160–0.340) 46 (31–65) 0.06 (0.040–0.085) 12 (7.7–16) 194 37 79 (57–120)

2011 < 1 0.23 (0.170–0.310) 44 (32–58) 0.053 (0.038–0.071) 10 (7.2–13) 125 24 54 (41–74)

2012 < 1 0.22 (0.160–0.290) 41 (30–55) 0.047 (0.033–0.062) 8.7 (6.2–12) 128 24 58 (44–80)

Trinidad and 1990 1 0.14 (0.120–0.160) 11 (9.9–13) <0.01 (<0.01–<0.01) 0.2 (0.16–0.21) 120 9.8 87 (77–99)

Tobago 1995 1 0.19 (0.170–0.220) 15 (13–17) 0.018 (0.016–0.021) 1.5 (1.3–1.7) 166 13 87 (77–99)

2000 1 0.23 (0.200–0.260) 18 (16–20) 0.049 (0.043–0.055) 3.9 (3.4–4.4) 198 16 87 (77–99)

2005 1 0.19 (0.170–0.220) 15 (13–17) 0.048 (0.042–0.054) 3.7 (3.2–4.2) 166 13 87 (77–99)

2010 1 0.25 (0.220–0.290) 19 (17–21) 0.07 (0.061–0.079) 5.2 (4.6–5.9) 219 16 87 (77–99)

2011 1 0.26 (0.230–0.290) 19 (17–22) 0.069 (0.060–0.078) 5.1 (4.5–5.8) 224 17 87 (77–99)

2012 1 0.32 (0.280–0.360) 24 (21–27) 0.083 (0.073–0.094) 6.2 (5.5–7.0) 274 20 87 (77–99)

Turks and Caicos 1990 < 1 0 (0–0) 0 (0–0) 0 0

Islands 1995 < 1 <0.01 (<0.01–<0.01) 36 (32–41)

2000 < 1 0.012 (0.010–0.014) 63 (55–72)

2005 < 1 <0.01 (<0.01–<0.01) 29 (26–33)

2010 < 1 <0.01 (<0.01–<0.01) 22 (20–25) <0.01 (<0.01–<0.01) 4.5 (0.21–15) 6 19 87 (77–99)

2011 < 1 0.01 (<0.01–0.012) 33 (29–37) 9 28 87 (77–99)

2012 < 1 <0.01 (<0.01–0.010) 28 (25–32) 8 25 87 (77–99)

United States 1990 255 30 (26–33) 12 (10–13) 1.6 (1.4–1.8) 0.6 (0.54–0.69) 25 701 10 87 (77–99)

of America 1995 268 26 (23–30) 9.8 (8.5–11) 2.2 (1.9–2.5) 0.8 (0.71–0.91) 22 728 8.5 87 (77–99)

2000 285 19 (16–21) 6.6 (5.8–7.5) 1.2 (1.1–1.4) 0.4 (0.38–0.49) 16 310 5.7 87 (77–99)

2005 298 16 (14–18) 5.4 (4.8–6.1) 1.3 (1.2–1.5) 0.5 (0.39–0.50) 14 080 4.7 87 (77–99)

2010 312 13 (11–15) 4.1 (3.6–4.7) 1.2 (1.0–1.4) 0.4 (0.34–0.43) 11 181 3.6 87 (77–99)

2011 315 12 (11–14) 3.8 (3.4–4.3) 1.1 (1.0–1.3) 0.4 (0.32–0.41) 10 521 3.3 87 (77–99)

2012 318 11 (10–13) 3.6 (3.2–4.1) 1.1 (0.96–1.2) 0.4 (0.30–0.39) 9 945 3.1 87 (77–99)

Urugua

1990 3 1 (0.890–1.2) 33 (29–37) 0.013 (0.011–0.014) 0.4 (0.35–0.46) 886 28 87 (77–99)

1995 3 0.72 (0.630–0.810) 22 (20–25) 0.022 (0.019–0.025) 0.7 (0.60–0.78) 625 19 87 (77–99)

2000 3 0.74 (0.650–0.840) 22 (20–25) 0.067 (0.059–0.076) 2 (1.8–2.3) 645 19 87 (77–99)

2005 3 0.72 (0.630–0.810) 22 (19–24) 0.11 (0.093–0.12) 3.2 (2.8–3.6) 622 19 87 (77–99)

2010 3 0.8 (0.700–0.910) 24 (21–27) 0.13 (0.11–0.14) 3.8 (3.3–4.3) 699 21 87 (77–99)

2011 3 0.94 (0.820–1.1) 28 (24–31) 0.15 (0.13–0.17) 4.4 (3.9–5.0) 817 24 87 (77–99)

2012 3 0.93 (0.810–1.1) 27 (24–31) 0.14 (0.12–0.16) 4.2 (3.7–4.8) 808 24 87 (77–99)

US Virgin Islands 1990 < 1 <0.01 (<0.01–<0.01) 4.5 (3.9–5.0) 4 3.9 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 4.3 (3.8–4.9) 4 3.7 87 (77–99)

2000 < 1 <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2005 < 1 <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2010 < 1 <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2011 < 1 <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

2012 < 1 <0.01 (<0.01–<0.01) 7.7 (6.8–8.7)

Venezuela 1990 20 7 (4.9–9.4) 35 (25–47) 0.24 (0.17–0.33) 1.2 (0.88–1.7) 5 457 28 78 (58–110)

(Bolivarian 1995 22 7.7 (6.3–9.2) 35 (28–42) 0.42 (0.30–0.56) 1.9 (1.4–2.5) 5 578 25 73 (60–89)

Republic of) 2000 24 8.4 (6.8–10) 34 (28–41) 0.59 (0.44–0.78) 2.4 (1.8–3.2) 6 466 26 77 (64–95)

2005 27 9 (7.4–11) 34 (28–41) 0.76 (0.56–0.98) 2.8 (2.1–3.7) 6 847 26 76 (63–93)

2010 29 9.7 (8.0–12) 33 (27–40) 0.89 (0.72–1.1) 3.1 (2.5–3.7) 6 451 22 67 (56–81)

2011 30 9.8 (8.1–12) 33 (27–40) 1.3 (1.0–1.5) 4.3 (3.5–5.2) 6 282 21 64 (54–78)

2012 30 9.9 (8.2–12) 33 (27–39) 1.2 (0.94–1.4) 3.9 (3.1–4.7) 6 495 22 65 (55–79)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Anguilla 1990 0 –

1995 2 0 2 0 0 0 0

2000 –

2005 –

2010 1 0 1 0 0 0 0 0 0 0

2011 0 0 0 0 0 0 0 0 0

• 0 0 • 2012 0 0 0 0 0 0 0 0 0

Antigua and 1990 1 –

Barbuda 1995 0 –

2000 4 3 1 0 0 0 75

2005 6 6 0 0 0 0 0 0 0 100

2010 7 6 0 0 0 0 0 0 1 100

2011 6 6 0 0 0 0 2 2 0 100

• 2 3 • 2012 3 1 1 1 0 0 1 1 50

Argentina 1990 12 309 –

1995 13 450 5 698 4 668 3 067 55

2000 11 767 4 749 4 110 1 773 104 1 724 1 828 54

2005 10 576 4 709 3 357 1 561 0 143 666 809 806 58

2010 7 336 3 973 2 011 854 159 290 426 716 49 66

2011 9 733 5 150 2 705 1 426 138 314 758 1 072 66

• 38 21 • 2012 8 758 4 661 2 341 1 291 143 322 848 1 170 67

Aruba 1990 –

1995 –

2000 –

2005 –

2010 6 4 2 67

2011 8 7 0 1 100

• 0 27 • 2012 28 6 20 1 0 1 1 2 0 23

Bahamas 1990 46 –

1995 57 38 11 8 1 1 78

2000 82 56 23 4 0 0 0 71

2005 48 30 8 7 1 2 2 4 0 79

2010 31 19 3 7 1 1 1 2 0 86

2011 41 23 12 5 0 1 1 2 0 66

• 18 9 • 2012 32 21 11 0 0 0 0 0 0 66

Barbados 1990 5 –

1995 3 3 100

2000 3 3 0 0 0 0 0 100

2005 –

2010 6 6 0 0 0 0 0 0 0 100

2011 0 0 0 0 0 0 0 0 0

• 2 1 • 2012 4 4 0 0 0 0 0 0 0 100

Belize 1990 57 –

1995 95 36 34 1 4 4 51

2000 106 44 55 1 6 0 6 44

2005 102 59 29 3 0 11 4 15 0 67

2010 145 97 47 0 0 1 0 1 0 67

2011 74 64 0 0 0 10 2 12 0 100

• 30 26 • 2012 84 36 36 5 0 7 0 7 0 50

Bermuda 1990 0 –

1995 4 2 2 50

2000 0 0 0 0 0 0 0

2005 –

2010 1 1 0 0 0 0 0 0 0 100

2011 1 0 1 0 0 0 0 0 0 0

• 0 5 • 2012 3 1 1 1 0 0 0 0 0 50

Bolivia 1990 11 166 –

(Plurinational 1995 14 422 7 010 1 408 1 133 63 63 83

State of) 2000 10 127 6 458 1 565 1 288 451 1 630 2 081 80

2005 9 748 6 278 1 250 1 673 547 225 772 83

2010 8 363 5 613 630 1 694 0 408 257 665 18 90

2011 8 521 5 746 643 1 721 411 226 637 90

• 164 79 • 2012 8 257 5 568 571 1 672 0 446 227 673 0 91

Bonaire, Saint 2010 0 0 0 0 0

Eustatius and Saba 2011 1 0 0 0 0 1 0 1 0

2012 0 0 0 0 0 0 0 0 0

Brazil 1990 74 570 –

1995 91 013 45 650 29 291 13 814 61

2000 77 899 41 186 23 622 10 457 2 634 8 700 11 334 64

2005 80 675 42 093 23 990 11 037 3 089 6 548 9 637 466 64

2010 74 395 37 932 23 030 10 017 18 3 398 7 551 10 949 0 62

2011 77 647 40 294 20 961 10 067 15 3 555 6 490 10 045 2 755 66

• 50 38 • 2012 75 122 40 152 20 770 10 297 11 3 867 7 633 11 500 25 66

British Virgin 1990 –

Islands 1995 –

2000 1 1 100

2005 0 0 0 0 0 0 0 0 0

2010 1 1 0 0 0 0 0 0 0 100

2011 0 0 0 0 0 0 0 0 0

• 0 0 • 2012 0 0 0 0 0 0 0 0 0

Canada 1990 1 997 549 516 723 0 180 180 29 52

1995 1 965 436 656 634 0 195 195 44 40

2000 1 723 492 528 482 20 145 145 56 48

2005 1 552 433 446 562 4 39 64 103 68 49

2010 1 361 358 472 444 0 48 24 72 39 43

2011 1 430 407 456 469 0 59 22 81 39 47

• 7 5 • 2012 1 653 478 574 519 0 58 33 91 24 45

Cayman Islands 1990 2 –

1995 2 0 2 1 0 0 0

2000 5 5 0 0 0 0 0 100

2005 –

2010 4 2 2 0 0 0 0 0 0 50

2011 2 1 1 0 0 0 0 0 0 50

• 8 10 • 2012 6 5 1 0 0 0 0 0 0 83

Chile 1990 6 151 –

1995 4 150 1 561 1 284 1 017 225 225 55

2000 3 021 1 290 879 694 158 158 59

2005 2 505 1 186 502 631 186 128 314 70

2010 2 376 1 154 502 553 0 167 96 263 0 70

2011 2 450 1 196 473 594 0 187 85 272 0 72

• 47 14 • 2012 2 394 1 173 538 518 0 165 66 231 0 69

Colombia 1990 12 447 –

1995 9 912 7 530 1 380 1 002 85

2000 11 630 8 358 1 446 1 487 339 339 85

2005 10 360 6 870 1 429 1 618 443 443 83

2010 11 420 7 028 1 696 1 985 311 400 469 869 0 81

2011 11 884 6 807 2 355 2 275 0 447 554 1 001 0 74

• 37 24 • 2012 11 424 6 523 2 279 2 264 0 358 405 763 0 74

Rates are per 100 000 population.

NEW AND RELAPSE includes cases for w hich the treatment history is unknown.

190 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Costa Rica 1990 230 –

1995 586 245 71 31 0 0 78

2000 585 349 184 98 35 35 65

2005 534 330 81 104 19 26 45 80

2010 492 267 89 108 1 25 7 32 2 75

2011 514 285 128 85 0 16 10 26 0 69

• 7 10 • 2012 475 257 99 102 0 17 5 22 0 72

Cuba 1990 546 –

1995 1 553 834 520 199 54 54 62

2000 1 183 675 257 201 50 122 172 72

2005 772 467 160 103 40 9 49 2 74

2010 827 462 212 98 10 45 11 56 0 69

2011 805 437 219 86 6 57 16 73 0 67

• 5 7 • 2012 734 374 200 112 2 46 14 60 0 65

Curaçao 2010 5 5 0 0 0 100

2011 1 0 1 0 0 0 0 0 0 0

2012 1 1 0 0 0 0 0 0 0 100

Dominica 1990 6 –

1995 8 5 3 3 100

2000 –

2005 –

2010 8 8 0 0 0 0 0 0 0 100

2011 2 2 0 0 0 0 1 1 0 100

• 8 10 • 2012 7 5 1 0 0 1 1 2 0 83

Dominican 1990 2 597 –

Republic 1995 4 053 2 787 1 418 244 204 204 66

2000 5 291 2 907 1 234 540 610 610 70

2005 5 003 2 949 1 032 602 420 309 729 74

2010 3 964 2 159 803 578 100 324 196 520 0 73

2011 4 309 2 454 809 655 49 342 163 505 0 75

• 36 41 • 2012 4 262 2 483 817 544 44 374 178 552 0 75

Ecuador 1990 8 243 –

1995 7 893 5 890 2 237 420 72

2000 6 908 5 064 1 338 400 106 280 386 79

2005 4 416 3 048 635 330 403 392 795 83

2010 4 832 3 373 404 655 0 400 263 663 0 89

2011 5 106 3 521 380 808 0 397 244 641 0 90

• 81 35 • 2012 5 456 3 856 285 856 111 348 315 663 93

El Salvador 1990 2 367 –

1995 2 422 2 241 181 –

2000 1 485 1 008 278 108 91 180 271 78

2005 1 794 1 059 402 255 78 36 114 0 72

2010 1 700 972 338 328 0 62 30 92 0 74

2011 1 896 1 079 371 384 0 62 21 83 0 74

• 44 33 • 2012 2 053 1 237 313 415 0 88 10 98 0 80

Grenada 1990 0 –

1995 4 2 100

2000 0 0 0 0 0 0 0

2005 –

2010 4 4 0 0 0 0 0 0 0 100

2011 2 1 1 0 0 0 0 0 0 50

• 0 1 • 2012 1 1 0 0 0 0 0 0 0 100

Guatemala 1990 3 813 –

1995 3 119 2 368 546 205 249 249 81

2000 2 913 2 052 518 202 141 141 80

2005 3 803 2 420 588 256 101 58 159 438 80

2010 3 322 2 121 265 348 436 152 29 181 0 89

2011 3 040 1 961 309 243 415 112 48 160 0 86

• 43 23 • 2012 3 442 2 212 382 311 393 144 57 201 85

Guyana 1990 168 –

1995 296 85 187 22 2 2 31

2000 422 119 231 34 38 46 84 34

2005 639 240 352 33 6 8 17 25 0 41

2010 712 325 274 75 0 38 124 162 0 54

2011 710 323 282 78 0 27 206 233 0 53

• 23 94 • 2012 748 309 339 77 0 23 221 244 0 48

Haiti 1990 –

1995 6 212 –

2000 10 420 5 887 2 930 1 367 236 110 346 67

2005 14 311 7 340 5 292 1 484 195 33 228 58

2010 14 222 8 242 4 335 1 307 0 338 43 381 0 66

2011 14 315 8 011 4 553 1 374 0 377 46 423 0 64

• 0 163 • 2012 16 568 9 254 4 956 1 914 0 444 155 599 65

Honduras 1990 3 647 –

1995 4 984 2 306 2 214 232 100 100 51

2000 6 406 3 404 2 396 370 236 236 59

2005 3 333 2 069 721 362 181 181 74

2010 2 876 1 842 482 382 0 170 25 195 0 79

2011 3 233 2 060 616 377 0 180 10 190 77

• 74 38 • 2012 3 014 1 945 509 362 0 198 32 230 0 79

Jamaica 1990 123 –

1995 109 93 14 2 2 2 87

2000 127 90 20 4 13 13 82

2005 90 53 31 6 0 0 5 5 0 63

2010 130 76 46 6 0 2 17 19 0 62

2011 105 35 39 6 24 1 3 4 0 47

• 5 3 • 2012 91 46 33 9 0 3 3 6 0 58

Mexico 1990 14 437 –

1995 11 329 9 220 1 807 302 84

2000 18 434 11 676 1 675 2 081 421 914 1 335 87

2005 18 524 11 997 421 2 657 2 831 618 1 408 2 026 97

2010 20 155 12 572 2 812 3 464 0 722 544 1 266 585 82

2011 19 857 12 960 2 497 3 529 0 871 671 1 542 0 84

• 17 17 • 2012 20 470 13 038 2 681 3 839 139 773 878 1 651 0 83

Montserrat 1990 1 –

1995 –

2000 0 0 0 0 0 0 0

2005 1 1 0 0 0 0 0 0 0 100

2010 0 0 0 0 0 0 0 0

2011 0 0 0 0 0 0 0 0 0

• 9 0 • 2012 0 0 0 0 0 0 0 0 0

Netherlands 1990 –

Antilles 1995 –

2000 5 2 3 0 0 0 0 0 0 40

• 0 0 • 2005 –

Rates are per 100 000 population.

NEW AND RELAPSE includes cases for which the treatment history is unknown.

191 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Nicaragua 1990 2 944 –

1995 2 842 1 568 854 253 167 167 65

2000 2 402 1 471 541 231 159 159 73

2005 1 907 1 253 395 160 99 169 268 0 76

2010 2 448 1 440 575 274 0 159 127 286 0 71

2011 2 693 1 552 653 335 0 153 129 282 0 70

• 71 47 • 2012 2 790 1 484 817 339 0 150 144 294 0 64

Panama 1990 846 –

1995 1 300 1 066 114 28 108 108 90

2000 1 169 460 589 74 5 41 93 134 44

2005 1 637 860 505 216 56 191 247 63

2010 1 496 707 425 287 0 77 134 211 0 62

2011 1 571 830 433 235 0 55 124 179 18 66

• 34 40 • 2012 1 520 778 434 248 0 60 155 215 0 64

Paraguay 1990 2 167 993 100

1995 1 745 748 870 127 28 28 46

2000 1 950 900 791 170 14 516 530 53

2005 2 075 1 260 665 150 273 273 65

2010 2 352 1 318 499 269 86 105 109 214 75 73

2011 2 372 1 371 515 251 108 127 177 304 0 73

• 51 36 • 2012 2 416 1 391 494 221 187 123 207 330 0 74

Peru 1990 37 905 –

1995 45 310 32 096 7 803 5 411 80

2000 38 661 22 580 6 018 5 682 4 381 4 381 79

2005 33 747 18 490 5 592 5 335 809 3 195 1 794 4 989 326 77

2010 31 073 17 264 5 201 5 185 647 2 776 1 404 4 180 77

2011 31 241 17 754 5 164 5 564 712 2 047 1 603 3 650 0 77

• 174 99 • 2012 29 760 17 653 4 556 5 233 583 1 735 1 945 3 680 0 79

Puerto Rico 1990 159 –

1995 262 128 111 23 54

2000 174 81 69 24 54

2005 113 60 37 16 0 0 0 0 0 62

2010 80 37 35 4 0 4 0 4 0 51

2011 50 29 13 8 0 0 0 0 0 69

• 5 2 • 2012 71 41 17 10 0 3 0 3 0 71

Saint Kitts and 1990 0 –

Nevis 1995 5 4 100

2000 0 0 0 0 0 0 0

2005 0 0 0 0 0 0 2 2

2010 2 2 0 0 0 0 0 0 0 100

2011 1 1 0 0 0 0 0 0 0 100

• 0 4 • 2012 2 2 0 0 0 0 0 0 0 100

Saint Lucia 1990 13 –

1995 11 11 100

2000 9 7 1 0 1 2 3 88

2005 14 11 1 0 0 2 0 2 92

2010 9 9 0 0 0 0 0 0 0 100

2011 7 7 0 0 0 0 0 0 0 100

• 9 6 • 2012 11 11 0 0 0 0 0 0 0 100

Saint Vincent and 1990 2 –

the Grenadines 1995 13 5 7 0 4 4 42

2000 16 9 4 0 3 0 3 69

2005 7 6 1 0 0 0 0 0 0 86

2010 15 8 7 0 0 0 2 2 0 53

2011 17 8 9 0 0 0 0 0 0 47

• 2 27 • 2012 30 27 3 0 0 0 4 4 0 90

Sint Maarten 2010 3 3 0 0 0 0 0 0 100

(Dutch part) 2011 2 2 0 0 0 0 0 100

2012 1 0 1 0 0 0 0 0 0 0

Suriname 1990 82 –

1995 –

2000 89 37 40 12 0 1 1 48

2005 117 49 54 6 2 6 2 8 0 48

2010 194 130 42 14 2 6 10 16 0 76

2011 125 64 34 20 1 5 6 11 1 65

• 20 24 • 2012 128 83 28 13 2 2 5 7 0 75

Trinidad and 1990 120 –

Tobago 1995 166 7 68 12 22 22 9

2000 198 115 61 17 5 26 31 65

2005 166 95 50 12 0 9 13 22 66

2010 219 136 58 20 0 5 39 44 0 70

2011 224 121 77 19 0 7 42 49 0 61

• 10 20 • 2012 274 167 81 19 0 7 47 54 0 67

Turks and Caicos 1990 0 –

Islands 1995 –

2000 –

2005 –

2010 6 3 1 1 0 1 1 2 0 75

2011 9 8 1 0 0 0 1 1 0 89

• 0 25 • 2012 8 5 2 1 0 0 0 0 0 71

United States 1990 25 701 –

of America 1995 22 728 8 093 10 795 3 835 5 43

2000 16 310 5 883 7 204 3 211 12 45

2005 14 080 5 111 6 030 2 939 0 46

2010 11 181 3 695 4 990 2 134 362 43

2011 10 521 3 742 4 556 2 189 34 45

• 10 3 • 2012 9 945 3 563 4 261 2 100 21 46

Uruguay 1990 886 –

1995 625 349 178 78 20 20 66

2000 645 348 165 77 39 39 68

2005 622 355 147 73 32 15 4 19 71

2010 699 368 218 72 0 41 0 41 0 63

2011 817 467 249 48 0 53 0 53 0 65

• 28 24 • 2012 808 432 269 59 0 48 7 55 0 62

US Virgin Islands 1990 4 –

1995 4 2 2 0 50

2000 –

2005 –

2010 –

2011 –

• 4 0 • 2012 –

Venezuela 1990 5 457 –

(Bolivarian 1995 5 578 3 056 1 517 709 272 272 67

Republic of) 2000 6 466 3 525 1 616 948 377 377 69

2005 6 847 3 653 1 853 1 094 247 103 350 66

2010 6 451 3 252 1 758 1 077 0 248 194 442 116 65

2011 6 282 3 224 1 649 1 196 0 213 195 408 0 66

• 28 22 • 2012 6 495 3 446 1 617 1 143 0 289 282 571 0 68

Rates are per 100 000 population.

NEW AND RELAPSE includes cases for which the treatment history is unknown.

192 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Anguilla 1995 0 –

2000 –

2005 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Antigua and 1995 –

Barbuda 2000 3 4 133 100 0 0 0 0 0

2005 6 6 100 50 33 17

2009 1 3 300 67 0 33 0 0 0

2010 6 6 100 0 33 33 0 33 0

• 0 17 • 2011 6 6 100 17 33 50 0

Argentina 1995 5 698 5 707 100 5 7 1 0 3 84

2000 4 749 5 177 109 26 20 5 0 6 43

2005 4 709 4 709 100 19 34 5 0 5 37

2009 4 044 5 062 125 19 26 4 0 7 43

2010 3 973 5 088 128 20 27 4 0 8 40

• 12 52 • 2011 5 150 5 600 109 18 33 5 0 8 36

Aruba 1995 –

2000 –

2005 –

2009 6 –

2010 4 –

• 0 92 • 2011 7 13 186 92 8 0

Bahamas 1995 38 –

2000 56 –

2005 30 30 100 17 40 17 7 20 0

2009 26 26 100 12 69 8 0 12 0

2010 19 19 100 16 53 16 5 11 0

• 0 70 • 2011 23 23 100 4 65 26 0 4 0

Barbados 1995 3 –

2000 3 –

2005 11 – 45 45 9 0

2009 2 2 100 100 0 0 0 0 0

2010 6 6 100 100 0 0 0 0 0

• 0 0 • 2011 0 0 –

Belize 1995 36 29 81 52 0 10 3 28 7

2000 44 45 102 78 0 9 0 2 11

2005 59 59 100 56 19 12 2 12 0

2009 82 –

2010 97 142 146

• 52 0 • 2011 64 –

Bermuda 1995 2 –

2000 0 –

2005 –

2009 1 – 0 0 0 0 0 100

2010 1 1 100 0 0 0 0 0 100

• 0 0 • 2011 0 1 – 0 0 0 0 0 100

Bolivia 1995 7 010 7 010 100 53 9 4 1 9 24

(Plurinational 2000 6 458 6 212 96 73 6 4 1 9 7

State of) 2005 6 278 6 278 100 76 2 3 1 5 12

2009 5 937 5 897 99 84 1 4 1 5 4

2010 5 613 5 571 99 86 2 4 1 5 3

• 62 86 • 2011 5 746 5 770 100 84 2 3 1 5 5

Bonaire, Saint 2009 0 –

Eustatius and Saba 2010 0 0 –

2011 0 0 –

Brazil 1995 45 650 45 650 100 17 0 1 1 3 79

2000 41 186 34 007 83 49 22 4 0 9 16

2005 42 093 42 093 100 31 44 5 1 9 9

2009 39 267 40 818 104 31 41 5 1 10 11

2010 37 932 41 840 110 37 37 5 0 11 10

• 17 76 • 2011 40 294 42 764 106 37 38 5 0 10 9

British Virgin 1995 –

Islands 2000 1 1 100 100 0

2005 0 –

2009 1 – 0 100 0 0 0 0

2010 1 0 0

• 0 0 • 2011 0 0 –

Canada 1995 436 –

2000 492 492 100 22 13 5 1 59

2005 433 459 106 8 59 9 0 1 22

2009 462 850 184 10 65 7 0 0 17

2010 358 854 239 12 65 8 0 0 15

• 0 62 • 2011 407 858 211 8 54 9 0 0 29

Cayman Islands 1995 0 –

2000 5 5 100 0 40 0 0 0 60

2005 1 – 0 0 0 0 100 0

2009 1 2 200 50 0 0 0 0 50

2010 2 2 100 50 0 0 0 0 50

• 0 100 • 2011 1 1 100 100 0 0 0 0 0

Chile 1995 1 561 1 111 71 79 7 0 8 5

2000 1 290 1 360 105 82 9 0 6 2

2005 1 186 1 147 97 83 0 9 0 6 2

2009 1 152 1 365 118 61 11 9 0 7 12

2010 1 154 1 437 125 51 20 9 0 6 14

• 79 71 • 2011 1 196 1 462 122 50 22 7 0 6 15

Colombia 1995 7 530 –

2000 8 358 1 634 20 70 10 5 1 8 6

2005 6 870 7 778 113 63 9 6 1 7 14

2009 7 319 6 899 94 68 9 6 2 9 6

2010 7 028 7 364 105 69 10 7 1 9 4

• 0 77 • 2011 6 807 6 805 100 66 11 7 1 10 5

Costa Rica 1995 245 –

2000 349 349 100 43 14 10 1 12 19

2005 330 306 93 85 4 5 2 3 1

2009 271 166 61 49 4 5 1 1 39

2010 267 297 111 75 12 7 2 2 2

• 0 88 • 2011 285 282 99 85 3 7 1 2 2

Cuba 1995 834 834 100 90 0 4 3 2 2

2000 675 673 100 91 2 4 1 1 1

2005 467 466 100 90 2 6 1 1 1

2009 418 415 99 87 3 7 2 1 0

2010 462 458 99 89 1 7 1 2 0

• 90 88 • 2011 437 443 101 83 5 8 2 3 0

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

193 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Curaçao 2009 5 –

2010 5 –

2011 0 1 –

Dominica 1995 5 –

2000 –

2005 –

2009 4 4 100 100 0 0 0 0 0

2010 8 3 38 67 33 0 0 0 0

• 0 100 • 2011 2 2 100 100 0 0 0 0 0

Dominican 1995 2 787 2 007 72 43 21 5 2 13 16

Republic 2000 2 907 2 760 95 37 34 5 2 19 4

2005 2 949 2 697 91 80 5 4 2 7 3

2009 2 441 2 441 100 79 6 4 2 7 2

2010 2 159 2 194 102 73 7 5 1 7 6

• 64 83 • 2011 2 454 2 454 100 76 7 4 2 8 3

Ecuador 1995 5 890 5 236 89 39 2 8 14 37

2000 5 064 –

2005 3 048 2 150 71 81 3 3 3 6 5

2009 3 317 3 330 100 71 4 4 3 8 11

2010 3 373 3 373 100 75 4 3 3 7 8

• 39 78 • 2011 3 521 3 441 98 73 4 3 3 7 10

El Salvador 1995 –

2000 1 008 1 008 100 78 1 7 1 5 8

2005 1 059 1 059 100 91 0 4 1 2 1

2009 930 930 100 88 1 5 4 2 0

2010 972 972 100 91 1 4 2 2 0

• 0 93 • 2011 1 079 1 079 100 93 0 4 1 2 0

Grenada 1995 2 –

2000 0 –

2005 6 – 67 33 0

2009 4 4 100 50 50 0

2010 4 4 100 75 0 25 0 0 0

• 0 100 • 2011 1 1 100 100 0

Guatemala 1995 2 368 2 368 100 56 5 3 1 4 31

2000 2 052 1 908 93 75 11 5 1 7 1

2005 2 420 –

2009 1 609 2 121 132 77 6 6 1 9 1

2010 2 121 2 121 100 77 6 6 1 9 1

• 61 86 • 2011 1 961 2 056 105 81 5 5 1 8 0

Guyana 1995 85 296 348 10 34 11 1 38 6

2000 119 119 100 43 13 12 5 24 3

2005 240 257 107 2 57 7 26 9

2009 328 328 100 13 57 8 1 19 2

2010 325 325 100 30 41 6 1 18 4

• 44 72 • 2011 323 323 100 22 50 7 1 16 4

Haiti 1995 3 081 – 70 4 1 21 3

2000 5 887 5 887 100 57 14 5 1 13 10

2005 7 340 7 340 100 72 8 6 1 7 6

2009 8 435 – 67 12 5 1 8 7

2010 8 242 8 242 100 72 10 5 1 7 5

• 70 84 • 2011 8 011 8 390 105 74 10 4 1 6 5

Honduras 1995 2 306 2 226 97 39 25 7 0 4 25

2000 3 404 2 362 69 81 5 6 1 5 3

2005 2 069 1 905 92 81 7 5 0 4 3

2009 1 881 1 881 100 79 6 6 1 6 2

2010 1 842 1 918 104 79 6 6 1 6 2

• 64 88 • 2011 2 060 2 004 97 82 6 5 0 5 2

Jamaica 1995 93 93 100 2 65 10 1 17 5

2000 90 99 110 5 40 23 0 11 20

2005 53 53 100 4 53 13 0 26 4

2009 77 76 99 55 14 14 0 11 5

2010 76 76 100 13 34 9 0 5 38

• 67 47 • 2011 35 59 169 25 22 7 0 5 41

Mexico 1995 9 220 9 220 100 69 6 4 3 12 6

2000 11 676 11 538 99 64 12 6 1 9 8

2005 11 997 12 172 101 71 6 5 1 6 11

2009 11 862 11 821 100 82 4 6 1 5 2

2010 12 572 12 304 98 82 4 6 1 5 1

• 75 86 • 2011 12 960 12 622 97 72 15 5 1 4 2

Montserrat 1995 –

2000 0 –

2005 1 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 –

Netherlands 1995 –

Antilles 2000 2 5 250 20 80

• 0 2005 –

Nicaragua 1995 1 568 1 536 98 66 14 4 2 10 4

2000 1 471 1 437 98 70 13 5 1 9 2

2005 1 253 1 496 119 73 12 5 2 6 3

2009 1 329 1 552 117 69 16 4 1 7 3

2010 1 440 1 704 118 66 18 5 2 6 3

• 80 86 • 2011 1 552 1 565 101 68 18 3 2 7 3

Panama 1995 1 066 1 388 130 10 60 14 1 13 3

2000 460 460 100 27 33 7 2 22 10

2005 860 873 102 68 12 8 0 10 1

2009 755 768 102 65 16 7 1 12 0

2010 707 717 101 64 16 7 1 12 0

• 69 84 • 2011 830 861 104 68 16 5 1 10 0

Paraguay 1995 748 748 100 8 43 3 0 17 29

2000 900 900 100 21 45 5 0 22 7

2005 1 260 1 452 115 46 33 5 8 7

2009 1 498 1 467 98 75 5 7 0 5 7

2010 1 318 1 317 100 69 9 8 0 5 8

• 51 78 • 2011 1 371 1 367 100 70 8 7 1 5 9

Peru 1995 32 096 28 185 88 75 9 3 2 6 6

2000 22 580 22 230 98 90 0 2 2 3 4

2005 18 490 14 793 80 91 2 2 4 1

2009 17 391 14 212 82 70 11 3 1 6 9

2010 17 264 17 264 100 57 12 2 5 5 20

• 83 74 • 2011 17 754 16 694 94 68 6 3 7 5 11

Puerto Rico 1995 128 128 100 68 23 8 2

2000 81 81 100 64 31 5 0

2005 60 60 100 75 0 22 0 3 0

2009 30 37 123 81 0 16 0 0 3

2010 37 37 100 78 0 14 3 5 0

• 68 73 • 2011 29 40 138 0 72 25 2 0 0

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

194 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Saint Kitts and 1995 4 5 125 20 40 20 0 20 0

Nevis 2000 0 –

2005 0 –

2009 4 5 125 80 0 0 0 0 20

2010 2 2 100 100 0 0000

• 60 100 • 2011 1 1 100 100 0 0000

Saint Lucia 1995 11 –

2000 7 8 114 88 12 0000

2005 11 13 118 15 54 31 0 0 0

2009 7 7 100 57 29 0 14 0

2010 9 9 100 22 67 0 0 0 11

• 0 57 • 2011 7 7 100 43 14 14 29 0 0

Saint Vincent and 1995 5 –

the Grenadines 2000 9 13 144 100 0 0 0 0 0

2005 6 –

2009 3 1 33 0 0 0 0 0 100

2010 8 8 100 0 0 0 0 0 100

• 0 56 • 2011 8 9 112 44 11 11 0 33 0

Sint Maarten 2009 –

(Dutch part) 2010 3 3 100 100 0000

2011 2 2 100 100 0 0000

Suriname 1995 51 – 10 4 12 8 67

2000 37 37 100 49 19 16 0 14 3

2005 49 –

2009 149 143 96 64 3 11 1 16 5

2010 130 73 56 60 0 12 0 4 23

• 14 76 • 2011 64 75 117 71 5 13 0 4 7

Trinidad and 1995 7 78 1 114 49 21 19 1 10 0

Tobago 2000 115 194 169 22 46 11 2 6 13

2005 95 106 112 68 4 12 16 0

2009 154 154 100 61 8 14 1 14 1

2010 136 136 100 72 4 9 3 11 1

• 69 72 • 2011 121 123 102 69 3 11 1 15 1

Turks and Caicos 1995 –

Islands 2000 2 – 0 0 0 0 100 0

2005 3 – 33 33 0 0 0 33

2009 –

2010 3 4 133 75 25

• 0 22 • 2011 8 9 112 22 67 11

United States 1995 8 093 8 116 100 76 15 4 6

of America 2000 5 883 5 901 100 83 11 3 3

2005 5 111 5 136 100 84 8 2 6

2009 4 014 7 460 186 60 6 1 32

2010 3 695 7 034 190 64 6 1 29

• 76 78 • 2011 3 742 5 955 159 78 6 1 15

Uruguay 1995 349 370 106 41 27 10 1 4 17

2000 348 344 99 85 0 13 1 1 0

2005 355 345 97 80 4 11 0 4 1

2009 409 406 99 73 7 12 0 6 2

2010 368 368 100 80 5 10 0 5 0

• 68 85 • 2011 467 467 100 8148070

US Virgin Islands 1995 2 2 100 50 0 0 0 50

2000 –

2005 –

2009 –

2010 –

• 50 0 • 2011 –

Venezuela 1995 3 056 3 056 100 68641813

(Bolivarian 2000 3 525 3 390 96 76040136

Republic of) 2005 3 653 3 581 98 83 5 0 10 2

2009 3 436 3 433 100 84040111

2010 3 252 3 157 97 83050110

• 74 80 • 2011 3 224 3 224 100 80050123

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

195 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Anguilla 1995 0 –

2000 –

2005 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Antigua and 1995 –

Barbuda 2000 0 –

2005 0 –

2009 2 1 50 100 0 0 0 0 0

2010 0 0 –

• 0 50 • 2011 2 2 100 50 0 50 0 0 0

Argentina 1995 –

2000 1 828 –

2005 809 1 615 200 7 26 5 0 9 53

2009 827 893 108 10 20 4 1 13 52

2010 716 1 114 156 9 23 4 1 15 49

• 0 41 • 2011 1 072 1 492 139 9 33 5 0 16 38

Aruba 1995 –

2000 –

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Bahamas 1995 1 –

2000 0 –

2005 4 4 100 25 50 0 0 25 0

2009 5 5 100 20 60 20 0 0 0

2010 2 2 100 0 100 0 0 0 0

• 0 100 • 2011 2 2 100 0 100 0 0 0 0

Barbados 1995 –

2000 0 –

2005 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Belize 1995 4 13 325 23 0 23 8 38 8

2000 6 –

2005 15 14 93 57 29 14 0 0 0

2009 12 –

2010 1 1 100

• 23 0 • 2011 12 –

Bermuda 1995 –

2000 0 –

2005 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Bolivia 1995 63 462 733 57 9 7 5 15 7

(Plurinational 2000 2 081 804 39 49 11 12 2 8 16

State of) 2005 772 772 100 63 3 5 3 7 19

2009 732 598 82 73 5 7 2 7 7

2010 665 589 89 72 5 5 3 10 5

• 66 73 • 2011 637 560 88 71 2 6 3 10 7

Bonaire, Saint 2009 0 –

Eustatius and Saba 2010 0 –

2011 1 1 100

Brazil 1995 –

2000 11 334 7 859 69 30 10 4 0 14 41

2005 9 637 9 479 98 26 22 7 2 19 25

2009 9 818 10 664 109 15 28 8 2 23 24

2010 10 949 10 721 98 18 28 8 2 25 19

• 0 49 • 2011 10 045 12 083 120 19 30 9 2 23 17

British Virgin 1995 –

Islands 2000 –

2005 0 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Canada 1995 195 –

2000 145 145 100 16 16 6 1 2 60

2005 103 106 103 8 59 7 0 3 23

2009 94 95 101 4 60 7 0 1 27

2010 72 94 131 15 56 9 0 0 20

• 0 56 • 2011 81 101 125 8 49 9 0 0 35

Cayman Islands 1995 0 –

2000 0 –

2005 0 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Chile 1995 225 –

2000 158 150 95 32 26 8 1 18 15

2005 314 140 45 69 3 14 1 9 3

2009 306 219 72 15 9 7 2 7 60

2010 263 336 128 14 12 6 2 9 58

• 0 43 • 2011 272 281 103 24 19 7 1 15 33

Colombia 1995 –

2000 339 –

2005 443 0 0

2009 616 –

2010 869 920 106 11 5 3 1 7 73

• 0 45 • 2011 1 001 1 001 100 32 13 7 4 23 22

Costa Rica 1995 0 –

2000 35 69 197 23 9 10 3 25 30

2005 45 49 109 55 12 4 2 24 2

2009 31 2 6 0 0 50 0 0 50

2010 32 35 109 37 43 11 0 9 0

• 0 81 • 2011 26 26 100 54 27 12 4 4 0

Cuba 1995 54 55 102 82 0 7 5 5 0

2000 172 58 34 78 7 10 3 2 0

2005 49 48 98 67 6 4 2 21

2009 51 61 120 69 5 15 5 7 0

2010 56 55 98 67 15 4 4 11 0

• 82 68 • 2011 73 72 99 53 15 19 3 10 0

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

196 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Curaçao 2009 –

2010 –

2011 0 0 –

Dominica 1995 3 –

2000 –

2005 –

2009 1 0 0

2010 0 1 – 0 100 0 0 0 0

• 0 0 • 2011 1 1 100 0 0 0 100 0 0

Dominican 1995 204 –

Republic 2000 610 498 82 29 26 3 4 27 11

2005 729 530 73 56 5 7 8 19 6

2009 452 434 96 47 6 13 5 29 0

2010 520 384 74 51 13 9 5 18 4

• 0 61 • 2011 505 415 82 46 15 7 5 20 6

Ecuador 1995 –

2000 386 –

2005 795 554 70 56 8 5 10 12 9

2009 756 756 100 46 9 6 8 16 16

2010 663 –

• 0 35 • 2011 641 641 100 29 6 3 5 10 46

El Salvador 1995 –

2000 271 181 67 63 3 9 3 18 3

2005 114 114 100 68 0 6 4 13 8

2009 113 113 100 85 3 3 1 8 1

2010 92 92 100 88 2 2 3 1 3

• 0 90 • 2011 83 83 100 90 0 2 0 5 2

Grenada 1995 –

2000 0 –

2005 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Guatemala 1995 249 254 102 59 15 4 2 4 17

2000 141 164 116 63 16 4 4 10 2

2005 159 –

2009 128 181 141 55 8 5 7 20 4

2010 181 181 100 55 8 5 7 20 4

• 73 64 • 2011 160 182 114 51 14 11 4 20 1

Guyana 1995 2 –

2000 84 38 45 24 29 13 5 26 3

2005 25 23 92 22 35 9 9 13 13

2009 205 205 100 0 51 14 0 18 17

2010 162 162 100 0 52 14 1 28 5

• 0 49 • 2011 233 233 100 6 43 9 1 33 8

Haiti 1995 –

2000 346 55 16 42 15 5 7 22 9

2005 228 228 100 63 7 3 0 13 14

2009 381 – 49 20 7 3 10 11

2010 381 381 100 60 14 5 2 10 8

• 0 72 • 2011 423 453 107 61 11 4 6 10 9

Honduras 1995 100 –

2000 236 180 76 44 10 8 2 6 29

2005 181 169 93 59 9 6 2 17 7

2009 225 192 85 50 7 10 1 10 22

2010 195 164 84 66 9 7 2 15 1

• 0 68 • 2011 190 165 87 64 5 9 2 16 4

Jamaica 1995 2 6 300 0 67 17 0 17 0

2000 13 –

2005 5 5 100 20 80 0

2009 20 19 95 16 58 5 0 21 0

2010 19 19 100 5 26 26 0 21 21

• 67 25 • 2011 4 4 100 0 25 0 0 25 50

Mexico 1995 –

2000 1 335 138 10 33 4 8 7 12 36

2005 2 026 1 456 72 48 7 7 4 14 20

2009 1 535 1 229 80 56 5 9 6 10 14

2010 1 266 1 272 100 55 7 9 6 11 10

• 0 61 • 2011 1 542 1 352 88 47 14 10 5 10 14

Montserrat 1995 –

2000 0 –

2005 0 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 –

Netherlands 1995 –

Antilles 2000 0 –

• 0 2005 –

Nicaragua 1995 167 289 173 69 10 4 3 11 3

2000 159 230 145 65 10 6 2 15 2

2005 268 181 68 71 12 7 2 7 2

2009 282 178 63 70 6 3 6 11 3

2010 286 204 71 60 16 8 4 9 2

• 78 69 • 2011 282 134 48 58 10 10 2 14 4

Panama 1995 108 –

2000 134 42 31 19 24 2 0 48 7

2005 247 237 96 23 35 9 4 22 7

2009 235 203 86 18 30 10 0 37 4

2010 211 208 99 23 34 11 3 30 0

• 0 59 • 2011 179 203 113 24 34 11 2 28 0

Paraguay 1995 28 –

2000 530 144 27 19 40 6 1 25 9

2005 273 164 60 44 26 4 10 16

2009 177 188 106 47 9 9 4 11 20

2010 214 216 101 54 6 8 2 9 20

• 0 67 • 2011 304 228 75 60 7 4 4 9 16

Peru 1995 –

2000 4 381 4 521 103 78 0 4 7 6 4

2005 4 989 2 299 46 78 5 5 11 1

2009 4 324 2 163 50 49 21 4 2 12 12

2010 4 180 –

• 0 0 • 2011 3 650 –

Puerto Rico 1995 –

2000 –

2005 0 113 – 73 23 0 4 1

2009 0 0 –

2010 4 4 100 50 0 25 25 0 0

• 0 0 • 2011 0 0 –

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

197 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Saint Kitts and 1995 –

Nevis 2000 0 –

2005 2 2 100 50 50

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Saint Lucia 1995 –

2000 3 1 33 100 0 0 0 0 0

2005 2 –

2009 3 3 100 33 67 0 0 0

2010 0 0 –

• 0 0 • 2011 0 0 –

Saint Vincent and 1995 4 –

the Grenadines 2000 3 3 100 100 00000

2005 0 –

2009 2 1 50 00001000

2010 2 0 0

• 0 0 • 2011 0 0 –

Sint Maarten 2009 –

(Dutch part) 2010 0 –

2011 0 0 –

Suriname 1995 –

2000 1 –

2005 8 –

2009 15 12 80 50080420

2010 16 11 69 45 9 27 0 0 18

• 0 64 • 2011 11 11 100 45 18 36 0 0 0

Trinidad and 1995 22 –

Tobago 2000 31 22 71 23 45 14 9 9 0

2005 22 21 95 19 38 29 14 0

2009 60 60 100 48 20 15 0 17 0

2010 44 44 100 43 20 14 0 23 0

• 0 35 • 2011 49 49 100 22 12 12 0 51 2

Turks and Caicos 1995 –

Islands 2000 –

2005 3 – 33 33 33 0 0 0

2009 –

2010 2 0 0

• 0 0 • 2011 1 0 0

United States 1995 –

of America 2000 –

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Uruguay 1995 20 25 125 56 20 16 0 8 0

2000 39 –

2005 19 30 158 57 17 13 3 7 3

2009 37 41 111 46 10 34 0 7 2

2010 41 41 100 56 20 15 0 5 5

• 76 79 • 2011 53 53 100 74 6 11 0 9 0

US Virgin Islands 1995 –

2000 –

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Venezuela 1995 272 –

(Bolivarian 2000 377 –

Republic of) 2005 350 247 71 80 4 2 12 2

2009 428 261 61 80042132

2010 442 248 56 83061100

• 0 80 • 2011 408 400 98 80090100

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Anguilla 2005

2010 0 0 1 0

2011 0 0 0

– – 2012 0 0 0

Antigua and 2005 100 6 6 3 50 100 100 0

Barbuda 2010 86 6 7 5 83 40 100 0

2011 75 6 8 4 67 50 100 5

• 100 100 • 2012 100 4 4 2 50 50 100 1

Argentina 2005 11 242

2010 14 1 121 7 762 672 60

2011 13 1 313 10 491 735 56

– 15 • 2012 15 1 434 9 606 685 48

Aruba 2005

2010 6

2011 8

– 3 • 2012 3.4 1 29 1 100 100

Bahamas 2005 50

2010 100 33 32 16 48 31 75

2011 100 42 42 12 29 42 67

– 100 • 2012 100 32 32 8 25 38 62

Barbados 2005 8 2 25 0

2010 100 6 6 2 33 0 100

2011 0 0 0

– 100 • 2012 100 4 4 1 25 0 100

Belize 2005 100 106 106 25 24 68 68 409

2010 98 142 145 29 20 100 100

2011 84 64 76 24 38 100

• 100 81 • 2012 81 68 84 19 28 100

Bermuda 2005 1 0 0

2010 100 1 1 0 0

2011 100 1 1 0 0

– 100 • 2012 100 3 3 0 0

Bolivia 2005 0 0 9 973 0 50

(Plurinational 2010 22 1 897 8 620 130 6.9 0 87

State of) 2011 45 3 928 8 747 333 8.5 36

• 0 60 • 2012 60 5 049 8 484 164 3.2 100

Bonaire, Saint 2010 0 0 0

Eustatius and Saba 2011 0 0 1 0

2012 0 0 0

Brazil 2005 59 51 552 87 223 8 249 16 0 85 674

2010 63 51 764 81 946 9 338 18 92

2011 64 53 455 84 137 9 088 17 0 100

• 59 55 • 2012 55 45 733 82 755 9 049 20 0 100

British Virgin 2005 0 0 0 27

Islands 2010 0 0 1 0

2011 0 0 0

– – 2012 0 0 0

Canada 2005 26 414 1 616 63 15

2010 48 658 1 385 53 8.1

2011 35 513 1 452 61 12

• 26 42 • 2012 42 716 1 686 57 8

Cayman Islands 2005 1 0 0

2010 75 3 4 0 0

2011 100 2 2 0 0

– 100 • 2012 100 6 6 0 0

Chile 2005 2 633

2010 2 472

2011 11 286 2 535 148 52

– 16 • 2012 16 392 2 460 140 36

Colombia 2005 53 5 537 10 360 353 6.4

2010 43 5 079 11 889 1 231 24 35

2011 53 6 579 12 438 1 292 20 36

• 53 66 • 2012 66 7 791 11 829 1 400 18 34

Costa Rica 2005 67 374 560 50 13 84

2010 99 494 499 54 11 0 0

2011 96 505 524 36 7.1 0 0

• 67 94 • 2012 94 453 480 49 11 0

Cuba 2005 93 729 781 0 0

2010 100 862 838 56 6.5 0 62 1 366

2011 95 780 821 62 7.9 34 89 1 429

• 93 83 • 2012 83 618 748 54 8.7 81 94 1 339

Curaçao 2010 0 0 5 0

2011 0 0 1 0

2012 100 1 1 1 100

Dominica 2005 0

2010 38 3 8 1 33 100 100

2011 67 2 3 0 0

– 75 • 2012 75 6 8 0 0

Dominican 2005 1.5 78 5 312 3 3.8 0 0 953

Republic 2010 60 2 489 4 160 547 22 7.9 3.8 5 041

2011 57 2 540 4 472 460 18 58 93

• 1 61 • 2012 61 2 721 4 440 557 20 69 48

Ecuador 2005 0.21 10 4 808 3 30 0

2010 100 5 183 5 095 427 8.2 100

2011 68 3 640 5 350 576 16

• 0 86 • 2012 86 4 974 5 771 669 13

El Salvador 2005 84 1 544 1 830 188 12 20 38

2010 96 1 667 1 730 180 11 82 63 455

2011 98 1 878 1 917 194 10 85 77

• 84 99 • 2012 99 2 036 2 063 214 11 66 83

Grenada 2005 0 0

2010 100 4 4 1 25 0 0 0

2011 100 2 2 0 0

– 100 • 2012 100 1 1 0 0 0

Guatemala 2005 16 600 3 861 478 80 240

2010 63 2 121 3 351 255 12 100 100

2011 72 2 223 3 088 285 13 16 30

• 16 85 • 2012 85 2 982 3 499 293 9.8 0 95

Guyana 2005 70 456 656 80 18

2010 88 734 836 209 28 77 59 144

2011 93 852 916 199 23 94 83 119

• 70 94 • 2012 94 914 969 284 31 71 59 154

Haiti 2005 0 0 14 344 1 797

2010 67 9 518 14 265 1 892 20 13 9.8 4 112

2011 78 11 213 14 361 2 320 21 11 6.9

• 0 81 • 2012 81 13 518 16 723 2 705 20 59 46 15 283

199 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Honduras 2005 44 1 455 3 333 200 14 0 0 0

2010 54 1 557 2 901 201 13 90 90 27

2011 75 2 443 3 243 261 11 50 72

• 44 76 • 2012 76 2 312 3 046 259 11 52 74 286

Jamaica 2005 83 79 95 28 35 43 54

2010 87 128 147 30 23 100

2011 85 92 108 17 18 82

• 83 69 • 2012 69 65 94 13 20

Mexico 2005 6.9 1 382 19 932 217 16

2010 43 8 915 20 699 1 645 18 100 26

2011 56 11 416 20 528 1 520 13 70 25

• 7 70 • 2012 70 15 005 21 348 1 233 8.2 70 24

Montserrat 2005 100 1 1 0 0

2010 0 0 0

2011 0 0 0

• 100 – 2012 0

Netherlands Antilles 2005 2 2 100

Nicaragua 2005 0 0 2 076 30 0

2010 56 1 440 2 575 60 4.2 67 67 465

2011 55 1 552 2 822 60 3.9 67 67 152

• 0 72 • 2012 72 2 117 2 934 105 5 78 74 230

Panama 2005 86 1 569 1 828 200 13 10 400

2010 96 1 558 1 630 240 15 63 84

2011 95 1 608 1 695 241 15 94 93

• 86 96 • 2012 96 1 600 1 675 224 14 89 65

Paraguay 2005 2 348

2010 33 817 2 461 144 18 0 67

2011 60 1 533 2 549 174 11 25 56

– 73 • 2012 73 1 906 2 623 154 8.1 60 79

Peru 2005 1.9 668 35 541 668 100 1 214

2010 29 9 539 32 477 853 8.9 1.2 1 183

2011 21 7 052 32 844 960 14 68

• 2 18 • 2012 18 5 836 31 705 979 17 87 1 416

Puerto Rico 2005 82 93 113 28 30

2010 95 76 80 14 18 43 50

2011 92 46 50 10 22 50 50

• 82 86 • 2012 86 61 71 11 18 82 36

Saint Kitts and 2005 2

Nevis 2010 100 2 2 0 0

2011 100 1 1 0 0

– 100 • 2012 100 2 2 0 0

Saint Lucia 2005 7.1 1 14 0 0

2010 100 9 9 0 0

2011 100 7 7 1 14 100 100

• 7 100 • 2012 100 11 11 1 9.1 100 100 1

Saint Vincent and 2005 100 7 7 1 14 0 0

the Grenadines 2010 59 10 17 3 30 100

2011 76 13 17 5 38 80 80

• 100 91 • 2012 91 31 34 9 29 67 67

Sint Maarten 2010 100 3 3 0 0

(Dutch part) 2011 100 2 2 0 0

2012 100 1 1 0 0

Suriname 2005 73 87 119 20 23 10

2010 85 173 204 58 34 10 38

2011 89 117 131 38 32 18 55

• 73 91 • 2012 91 121 133 36 30 69

Trinidad and 2005 69 124 179 42 34 29 36 0

Tobago 2010 98 254 258 58 23 19 34 11

2011 95 252 266 84 33 24 19

• 69 97 • 2012 97 311 321 82 26 28 29

Turks and Caicos 2005 5 1 20 0 0

Islands 2010 71 5 7 1 20 100 100

2011 10 1 10 0 0

– 0 • 2012 0 0 8 0

United States 2005 59 8 273 14 080 1 035 13

of America 2010 66 7 404 11 181 627 8.5

2011 83 8 752 10 521 668 7.6

• 59 84 • 2012 84 8 376 9 945 625 7.5

Uruguay 2005 92 574 626 74 13 0

2010 92 646 699 104 16 0 34

2011 94 769 817 110 14 0 31

• 92 95 • 2012 95 775 815 134 17 0 24

US Virgin Islands 2005

2010

2011

– – 2012

Venezuela 2005 39 2 678 6 950 392 15 0 39

(Bolivarian 2010 78 5 213 6 645 479 9.2 33 102

Republic of) 2011 64 4 133 6 477 519 13 32

• 39 73 • 2012 73 4 956 6 777 581 12 89

200 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Anguilla 2005 ––

2010 0 0 – 0 –

2011 0 0 – 0 –

2012 0 0 (0–0) 0 (0–0) 0 – 0 (0–0) 0 –

Antigua and 2005 ––

Barbuda 2010 0 0 0 0 –

2011 0 0 0 0 0

2012 0 0.18 (<0.1–0.27) <0.1 (<0.1–<0.1) 0 0 0.14 (<0.1–0.23) 0 0

Argentina 2005 276 2369 46 1290 160

2010 109 ––

2011 103 ––

2012 63 340 (230–440) 160 (88–260) – 180 (110–260) –

Aruba 2005 ––

2010 ––

2011 0 5 71 –

2012 0.85 (0.57–1.1) 0.57 (0.36–0.81) – 0.27 (<0.1–0.46) –

Bahamas 2005 ––

2010 0 21 95 2 100

2011 1 31 97 1 50

2012 1 1.2 (<0.1–6.1) 1.2 (<0.1–6.1) 27 84 0 (0–0) 0 –

Barbados 2005 ––

2010 0 0 0 0 –

2011 0 0 – 0 –

2012 0 <0.1 (<0.1–0.10) <0.1 (<0.1–0.10) 0 0 0 (0–0) 0 –

Belize 2005 0 0 0 3 20

2010 0 ––

2011 0 ––

2012 0 2.5 (1.7–3.4) 1.6 (1.0–2.2) 0 0 0.96 (0.32–1.6) 0 0

Bermuda 2005 ––

2010 0 1 100 0 –

2011 0 1 100 0 –

2012 0 0 (0–1.7) 0 (0–1.7) 2 200 0 (0–0) 0 –

Bolivia 2005 63 ––

(Plurinational 2010 106 0 0 664 100

State of) 2011 83 98 1.7 597 94

2012 117 150 (88–210) 74 (27–160) 1376 22 75 (60–94) 634 94

Bonaire, Saint 2010 0 0 – 0 –

Eustatius and Sab

2011 1 – 1 100

2012 0 0 (0–0) 0 (0–0) 0 – 0 (0–0) 0 –

Brazil 2005 373 – 5917 61

2010 573 22 <0.1 643 5.9

2011 566 21 <0.1 604 6.0

2012 684 1 700 (1 400–2 000) 850 (620–1 100) 700 1.6 860 (660–1 100) 198 1.7

British Virgin 2005 ––

Islands 2010 0 0 0 0 –

2011 0 0 – 0 –

2012 0 0 (0–0) 0 (0–0) 0 – 0 (0–0) 0 –

Canada 2005 22 1130 150 –

2010 15 987 130 51 71

2011 19 ––

2012 9 7.4 (2.2–13) 6.0 (2.4–12) 1244 140 1.4 (<0.1–7.8) 63 69

Cayman Islands 2005 ––

2010 0 1 50 0 –

2011 0 1 100 0 –

2012 0 0 (0–3.1) 0 (0–3.1) 5 100 0 (0–0) 0 –

Chile 2005 6 49 3.2 226 72

2010 10 65 4.4 276 100

2011 9 71 4.8 277 100

2012 18 19 (7.5–30) 12 (4.4–26) 125 8.4 6.7 (2.2–15) 172 74

Colombia 2005 ––

2010 131 1240 17 495 57

2011 108 2620 36 568 57

2012 105 310 (220–400) 210 (140–320) 2378 33 98 (74–130) 391 51

Costa Rica 2005 3 2 0.49 1 2.2

2010 3 203 64 –

2011 0 32 9.6 16 62

2012 1 6.4 (0.81–12) 5.4 (1.5–14) 273 95 1.0 (<0.1–5.0) 22 100

Cuba 2005 1 169 32 19 39

2010 7 174 36 31 55

2011 10 313 60 76 100

2012 8 11 (3.4–19) 4.3 (0.52–15) 269 61 7.1 (2.7–14) 51 85

Curaçao 2010 0 5 100 –

2011 0 1 100 0 –

2012 0 0 (0–0.98) 0 (0–0.98) 1 100 0 (0–0) 0 –

Dominica 2005 ––

2010 0 1 12 1 –

2011 0 1 50 1 100

2012 0 0 (0–0) 0 (0–5.9) 2 40 0 (0–2.0) 1 50

Dominican 2005 ––

Republic 2010 108 32 1.4 106 20

2011 117 12 0.42 77 15

2012 92 330 (230–430) 220 (140–330) 79 3.1 110 (71–150) 193 35

Ecuador 2005 253 117 3.2 502 63

2010 176 363 10 584 88

2011 354 239 6.3 284 44

2012 223 380 (320–450) 210 (150–280) 529 13 170 (150–190) 827 120

El Salvador 2005 14 12 1.1 14 12

2010 2 0 0 2 2.2

2011 4 238 22 69 83

2012 8 16 (5.9–26) 5.1 (0.61–18) 252 20 11 (4.8–20) 73 74

Grenada 2005 ––

2010 0 ––

2011 0 ––

2012 0 <0.1 (<0.1–<0.1) <0.1 (<0.1–<0.1) – 0 (0–0) –

Guatemala 2005 40 20 0.83 40 25

2010 18 –189.9

2011 27 0 0 27 17

2012 69 140 (100–180) 89 (55–140) 37 1.4 53 (40–69) 74 37

Guyana 2005 ––

2010 5 0 0 0 0

2011 3 2 0.62 55 24

2012 0 48 (25–70) 14 (9.1–20) 3 0.97 33 (11–56) 1 0.41

TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED CASES).

BACT+VE = bacteriologically positive cases.

201 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Haiti 2005 53 0.72 –

2010 41 2 <0.1 39 10

2011 86 ––

2012 81 390 (270–520) 310 (200–440) – 82 (28–140) 81 14

Honduras 2005 3 3 0.13 0 0

2010 9 57 3.1 62 32

2011 5 30 1.5 65 34

2012 6 71 (37–110) 43 (19–84) 41 2.1 28 (13–51) 96 42

Jamaica 2005 0 11 19 2 40

2010 1 40 31 5 26

2011 1 28 64 1 25

2012 0 2.6 (1.7–3.4) 1.7 (1.1–2.4) 16 28 0.82 (0.28–1.4) 0 0

Mexico 2005 394 314 2.1 74 3.7

2010 140 21 0.16 505 40

2011 140 6 <0.1 180 12

2012 114 480 (350–620) 380 (330–440) 13 <0.1 100 (84–130) 148 9.0

Montserrat 2005 1 0 0 0 –

2010 0 0 – 0 –

2011 0 0 – 0 –

2012 0 0 (0–0) 0 (0–0) – 0 (0–0) –

Netherlands Antille

2005 ––

Nicaragua 2005 50 8 0.64 8 3.0

2010 18 50 3.5 150 52

2011 13 200 13 67 24

2012 21 46 (21–70) 14 (1.7–52) – 31 (18–49) –

Panama 2005 5 29 3.3 48 19

2010 10 58 8.2 17 8.1

2011 7 25 2.3 40 22

2012 11 56 (35–78) 27 (17–38) 2 0.26 29 (9.9–49) 7 3.3

Paraguay 2005 13 ––

2010 1 115 8.2 52 24

2011 6 227 15 93 31

2012 7 55 (19–90) 6.5 (0.16–36) 235 15 48 (20–92) 89 27

Peru 2005 2748 – 2336 47

2010 1048 ––

2011 1663 1199 6.5 598 16

2012 1225 2 200 (2 100–2 300) 890 (820–960) 14484 79 1 300 (1 200–1 400) 1902 52

Puerto Rico 2005 0 ––

2010 0 69 100 4 100

2011 3 44 110 0 –

2012 1 1.0 (0–2.6) 0 (0–3.8) 52 98 1.0 (<0.1–2.7) 3 100

Saint Kitts and 2005 ––

Nevis 2010 0 0 0 0 –

2011 0 0 0 0 –

2012 0 <0.1 (<0.1–<0.1) <0.1 (<0.1–<0.1) 0 0 0 (0–0) 0 –

Saint Lucia 2005 ––

2010 0 0 0 0 –

2011 0 2 29 0 –

2012 0 0.24 (0.15–0.34) 0.24 (0.15–0.34) 0 0 0 (0–0) 0 –

Saint Vincent and 2005 6 6 86 0 –

the Grenadines 2010 0 2 22 –

2011 0 1 12 0 –

2012 0 1.2 (0.78–1.6) 0.66 (0.42–0.93) 2 7.4 0.55 (0.18–0.92) 0 0

Sint Maarten 2010 0 ––

(Dutch part) 2011 0 0 0 –

2012 0 <0.1 (<0.1–<0.1) <0.1 (<0.1–<0.1) – 0 (0–0) –

Suriname 2005 1 49 44 0 0

2010 0 1 0.70 –

2011 0 0 0 0 0

2012 0 3.4 (2.4–4.5) 2.5 (1.6–3.5) – 0.96 (0.32–1.6) –

Trinidad and 2005 3 0 0 3 14

Tobago 2010 0 ––

2011 ––

2012 0 11 (8.4–13) 4.5 (2.2–6.4) 6 2.4 6.4 (5.0–7.9) 10 19

Turks and Caicos 2005 ––

Islands 2010 1 ––

2011 ––

2012 0.13 (<0.1–0.18) 0.13 (<0.1–0.18) – 0 (0–0) –

United States 2005 124 10064 110 505 –

of America 2010 107 7593 110 345 –

2011 119 6899 99 304 –

2012 81 81 (63–100) 81 (63–100) 6790 100 – 339 –

Uruguay 2005 ––

2010 1 160 36 22 54

2011 1 422 75 38 72

2012 1 1.3 (0–3.8) 0 (0–5.5) 466 88 1.3 (<0.1–6.9) 42 76

US Virgin Islands 2005 ––

2010 ––

2011 ––

2012 – – – – –

Venezuela 2005 28 163 4.3 15 4.3

(Bolivarian 2010 21 26 0.78 160 36

Republic of) 2011 25 565 17 195 48

2012 21 100 (58–150) 26 (7.2–67) 460 13 77 (43–120) 148 26

TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED CASES).

BACT+VE = bacteriologically positive cases.

202 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

uilla 1995

–

2000

–

2005

–

2010 0000001 0000000

–

2011 00000000 00000000

–

2012 00000000 00000000

–

Anti

ua and 1995

–

Barbuda 2000 0000001 1110000 0.33

2005 1 1 2 2 0.50

2010 00202100 00100000 5.0

2011 00113110 01000000 7.0

2012 00001000 00000000

–

entina 1995

–

2000 97 278 594 402 419 368 330 121 544 479 262 230 179 216 1.2

2005 64 621 530 358 384 340 348 90 530 474 290 198 169 240 1.3

2010 56 536 491 309 302 340 282 2 59 421 426 233 184 153 176 1 1.4

2011 143 664 657 434 397 358 289 9 142 587 470 279 192 169 213 4 1.4

2012 59 533 484 299 180 182 181 15 67 652 614 375 364 321 322 13 0.71

Aruba 1995

–

2000

–

2005

–

2010

–

2011 4 1 1 1 2.5

2012 2 3 1 4 2 1 1 0.56

Bahamas 1995 3357422 0172001 2.4

2000 1279432 2578231 1.0

2005

–

2010 02350200 05110000 1.7

2011 02362210 01330000 2.3

2012 01162020 02511000 1.3

Barbados 1995

–

2000 0002000 0010000 2.0

2005

–

2010 00012000 01002000 1.0

2011 00000000 00000000

–

2012 00000000 00000000

–

Belize 1995 1124011 0620112 0.83

2000 2572635 0212414 2.1

2005 0886853 0444324 1.8

2010 2 9 16 22 24 11 18 4577945 2.5

2011 0 8 14 9 16 2 0 0208410 3.3

2012 12754320 04344100 1.5

Bermuda 1995

–

2000

–

2005

–

2010 00010000 00000000

–

2011 00000000 00000000

–

2012 00000000 00100000

–

Bolivia 1995

–

(

Plurinational 2000 166 1 182 797 518 466 340 366 191 831 588 334 254 192 233 1.5

State of

)

2005 157 1 320 725 439 391 346 415 160 846 533 276 226 182 262 1.5

2010 95 1 150 622 415 395 338 409 119 744 471 238 191 162 264 1.6

2011 100 1 231 685 372 371 302 457 146 778 459 235 183 155 272 1.6

2012 99 1 096 672 368 358 353 380 101 792 480 223 204 193 249 1.5

Bonaire, Saint 2010 0000000 0000000

–

Eustatius and Saba 2011 00000000 00000000

–

2012 00000000 00000000

–

Brazil 1995

–

2000 1 894 7 268 11 568 11 906 8 623 5 085 4 494 1 859 6 719 7 215 5 395 3 582 2 384 2 496 1.7

2005 317 5 074 6 119 6 128 5 259 2 803 2 140 355 3 496 3 663 2 626 1 897 1 112 1 104 2.0

2010 298 4 405 6 381 5 293 4 762 2 875 1 947 43 280 2 677 3 008 2 211 1 720 1 038 979 15 2.2

2011 336 4 877 6 755 5 462 5 054 3 083 2 142 41 356 2 815 3 131 2 230 1 779 1 164 1 069 0 2.2

2012 277 5 027 6 811 5 387 5 128 3 103 2 160 38 303 2 798 3 013 2 173 1 785 1 113 1 030 6 2.3

British Vir

in 1995

–

Islands 2000 1

–

2005

–

2010 00000100 00000000

–

2011 00000000 00000000

–

2012 00000000 00000000

–

Canada 1995 1 28 31 60 34 41 70 7 33 28 22 12 18 51 1.5

2000 5 34 45 46 41 32 79 4 33 40 30 25 12 66 1.3

2005 3 37 45 44 40 20 68 6 28 40 27 24 13 37 1.5

2010 3 30 28 36 32 25 62 0 1 28 24 16 10 19 44 0 1.5

2011 2 34 36 31 40 33 70 0 3 23 29 28 14 9 55 0 1.5

2012 1 33 32 53 51 35 97 0 6 32 34 29 19 11 45 0 1.7

man Islands 1995

–

2000 0031010

–

2005

–

2010 00010000 00001000 1.0

2011 00000100 00000000

–

2012 00221000 00000000

–

Chile 1995 24 148 182 204 155 141 163 24 100 120 108 75 73 107 1.7

2000 6 81 160 198 150 132 126 10 66 96 70 54 58 83 2.0

2005 3 74 128 179 162 115 133 4 55 78 60 56 36 93 2.1

2010 2 90 115 144 159 122 157 0 6 56 76 59 56 40 72 0 2.2

2011 4 88 139 143 164 127 134 0 6 62 75 66 69 48 71 0 2.0

2012 4 91 122 135 170 117 149 5 4 59 69 53 56 60 76 3 2.1

Colombia 1995

–

2000 246 763 1 030 963 743 610 746 194 587 758 523 381 304 510 1.6

2005 178 623 685 666 687 510 695 179 581 533 457 389 292 395 1.4

2010 148 602 765 540 710 610 814 0 146 560 576 428 374 284 471 0 1.5

2011 105 663 714 558 702 594 753 0 98 461 535 324 337 278 390 0 1.7

2012 92 613 744 497 653 616 740 0 79 519 555 376 355 252 432 0 1.5

Costa Rica 1995 1 17 38 24 19 23 22 2 17 15 11 7 9 14 1.9

2000 14 31 53 62 39 28 49 13 21 33 24 20 23 24 1.7

2005 1 43 38 53 34 20 34 1 21 31 18 16 6 14 2.1

2010 2 18 48 33 27 22 28 1 0 18 20 12 14 15 8 1 2.0

2011 0 23 24 29 33 22 36 0 2 18 27 23 19 12 17 0 1.4

2012 2 18 33 28 34 41 23 2 2 11 24 11 12 8 5 3 2.4

Cuba 1995 2 59 118 83 75 75 156 1 17 52 29 39 48 80 2.1

2000 0 71 167 90 74 55 75 2 9 22 26 22 23 39 3.7

2005 2 20 73 90 50 58 51 2 14 17 26 13 22 29 2.8

2010 3 17 61 89 78 53 57 0 1 15 15 14 16 17 26 0 3.4

2011 2 14 51 83 86 50 48 0 1 6 18 18 17 17 26 0 3.2

2012 1 15 45 83 70 45 36 0 0 13 12 16 12 13 13 0 3.7

Cura

ao 2010 00021000 01100000 1.5

2011 0000000 0000000

–

2012 00000000 01000000

–

Dominica 1995

–

2000

–

2005

–

2010 00000310 00012100 1.0

2011 0 0 20000 00000000

–

2012 02001200 00000000

–

203 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Dominican 1995

–

ublic 2000 73 410 481 344 173 125 113 65 317 325 212 115 79 75 1.4

2005 43 399 483 386 228 123 105 57 339 332 209 119 72 54 1.5

2010 29 276 346 292 170 112 85 0 43 239 207 142 102 54 62 0 1.5

2011 20 333 406 318 200 133 112 0 30 242 274 159 103 66 58 0 1.6

2012 15 317 489 315 197 126 111 0 26 230 260 148 119 62 68 0 1.7

Ecuador 1995

–

2000

–

2005 48 446 468 308 237 150 159 48 329 305 199 139 85 127 1.5

2010 32 499 529 314 309 227 246 52 298 308 178 158 113 110 1.8

2011 45 481 547 364 323 272 232 49 340 311 177 141 118 121 1.8

2012 37 506 567 387 359 291 333 59 333 337 184 164 146 153 1.8

El Salvador 1995

–

2000 13 99 124 114 92 62 107 28 81 76 63 63 39 47 1.5

2005 5 97 140 128 104 74 117 6 85 82 59 50 42 70 1.7

2010 5 101 170 96 77 62 101 0 6 63 65 49 58 51 68 0 1.7

2011 3 114 183 106 96 77 115 0 6 61 61 44 52 69 92 0 1.8

2012 5 131 194 122 100 87 115 0 5 81 73 80 90 64 90 0 1.6

Grenada 1995

–

2000

–

2005

–

2010 1 1 1 1 3.0

2011 00001000 00000000

–

2012 1

–

Guatemala 1995 51 235 280 236 165 142 139 51 224 255 221 146 129 94 1.1

2000 36 220 236 216 177 112 140 41 199 167 175 135 87 111 1.2

2005 39 251 258 185 187 127 115 38 339 245 277 176 88 95 0.92

2010 60 187 245 207 172 143 165 29 194 190 179 139 108 103 1.3

2011 18 197 205 172 162 136 152 25 186 192 154 154 102 106 1.1

2012

–

ana 1995 7856967 3576524 1.5

2000 4 20 19 14 7 6 9 1 11 87553 2.0

2005 12 48 130 116 81 41 20 14 41 62 41 30 11 9 2.2

2010 2 32 38 65 49 22 13 0 2 22 25 19 20 10 6 0 2.1

2011 8 26 54 61 54 19 13 0 2 17 19 17 17 7 9 0 2.7

2012 5 30 39 68 64 23 8 0 4 17 10 17 12 7 5 0 3.3

Haiti 1995

–

2000 67 836 898 613 350 147 118 96 914 857 513 275 132 71 1.1

2005 69 1 045 1 035 701 451 222 156 116 1 097 1 099 633 414 170 132 1.0

2010 98 1 225 1 357 718 469 259 160 0 158 1 268 1 223 608 358 207 134 0 1.1

2011 102 1 155 1 342 670 442 206 132 0 148 1 282 1 250 595 363 196 128 0 1.0

2012 126 1 359 1 563 758 473 271 164 160 1 476 1 415 698 416 219 156 1.0

Honduras 1995 42 280 540 204 130 236 58 54 208 292 134 76 136 48 1.6

2000 30 123 371 246 277 214 43 25 21 269 258 270 160 38 1.3

2005 13 238 280 215 152 134 152 27 219 222 125 107 81 104 1.3

2010 15 177 246 207 165 113 157 0 28 186 163 106 103 69 107 0 1.4

2011 17 194 291 227 184 120 184 0 19 181 194 138 99 98 126 0 1.4

2012 18 247 285 192 184 129 146 0 15 180 157 115 88 75 114 0 1.6

Jamaica 1995 2 9 14 9 11 8 9 2765522 2.1

2000 0 6 13 13 15 6 5 1887251 1.8

2005 04661067 0154013 2.8

2010 1 7 15 15 8670 05451020 3.5

2011 02634430 13403110 1.7

2012 1 10 835510 11542000 2.5

Mexico 1995

–

2000 214 1 079 1 387 1 162 1 235 972 1 126 176 663 828 698 832 595 709 1.6

2005 100 1 095 1 376 1 314 1 238 1 042 1 288 125 771 733 710 784 637 784 1.6

2010 125 1 081 1 375 1 380 1 392 1 119 1 303 0 112 791 763 730 852 713 836 0 1.6

2011 128 1 124 1 440 1 503 1 532 1 112 1 299 0 136 776 765 698 889 734 824 0 1.7

2012 133 1 153 1 480 1 522 1 484 1 153 1 284 0 134 778 743 686 840 824 824 0 1.7

Montserrat 1995

–

2000

–

2005 1

–

2010 00000000 00000000

–

2011 00000000 00000000

–

2012 00000000 00000000

–

Netherlands 1995

–

Antilles 2000 0012000 0010010 1.5

2005

–

Nic ar a

ua 1995 23 178 172 175 126 96 92 24 176 215 98 83 64 46 1.2

2000 18 194 174 147 108 64 90 34 188 173 98 76 46 61 1.2

2005 17 163 159 116 106 61 79 23 135 122 103 61 54 47 1.3

2010 22 157 189 141 115 82 108 0 27 154 149 92 75 50 79 0 1.3

2011 10 273 235 156 108 61 94 0 4 61 145 161 108 64 72 0 1.5

2012 00000000 00000000

–

Panama 1995 86 155 193 112 126 42 83 72 120 111 75 57 16 40 1.6

2000 3 44 78 61 37 27 26 6 43 34 35 19 12 16 1.7

2005 5 76 129 129 84 57 49 11 73 81 62 33 30 41 1.6

2010 6 69 127 80 62 61 49 0 7 51 52 46 45 23 29 0 1.8

2011 10 96 104 91 99 63 47 0 11 55 64 58 44 40 48 0 1.6

2012 19 88 103 104 67 51 61 0 9 62 57 45 46 22 44 0 1.7

Para

1995 18 64 71 96 74 57 61 13 65 49 46 35 34 53 1.5

2000 16 112 103 105 86 80 71 12 69 86 41 41 30 46 1.8

2005 23 168 185 136 117 87 99 31 89 98 69 52 29 71 1.9

2010 18 163 244 129 143 103 99 11 18 106 99 39 50 46 45 5 2.2

2011 9 182 238 135 151 124 103 6 14 110 103 55 39 36 62 4 2.2

2012 4 180 230 158 143 116 129 7 16 95 98 60 55 38 60 2 2.3

Peru 1995 147 1 311 849 454 322 200 216 149 1 005 660 373 259 162 152 1.3

2000 552 5 290 2 875 1 546 1 041 801 796 633 3 686 2 472 1 156 609 499 624 1.3

2005 371 3 802 2 670 1 513 1 075 641 708 375 2 674 2 111 1 046 699 333 472 1.4

2010

–

2011

–

2012

–

Puerto Rico 1995 4 3 12 20 15 9 19 1265749 2.4

2000 0 1 4 19 9 10 14 1453713 2.4

2005 0447977 0325417 1.7

2010 00324580 01026240 1.5

2011 01436620 01110310 3.1

2012 015168100 00312310 3.1

Saint Kitts and 1995

–

Nevis 2000

–

2005

–

2010 00001000 00010000 1.0

2011 00000100 00000000

–

2012 00000010 00100000 1.0

Saint Lucia 1995

–

2000 0001012 0101010 1.3

2005 0000212 1101102 0.83

2010 00120120 00010110 2.0

2011 00110320 00000000

–

2012 02014020 01000100 4.5

204 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Saint Vincent and 1995

–

the Grenadines 2000 0104201 1000000 8.0

2005 0002102 0010100 2.5

2010 00103020 00100100 3.0

2011 00222000 00101000 3.0

2012 01513540 01313000 2.4

Sint Maarten 2010 1 20.50

(

Dutch

art

)

2011 1 11.0

2012 00000000 01000000

–

Suriname 1995

–

2000 1663204 2363011 1.4

2005 0 7 8 12 6 3 4 0321212 3.6

2010 0 5 21 35 19 5 10 0 1 4 6 10 6 2 8 0 2.6

2011 0 4 7 15 18 3 5 0 01152210 4.3

2012 0 6 7 15 14 9 7 0 21757102 2.3

Trinidad and 1995 2 6 15 10 12 7 4 0642530 2.8

Toba

o 2000 0 7 18 27 17 7 7 0579524 2.6

2005 0 10 11 13 21 10 3 0493543 2.4

2010 0 11 21 17 32 20 8 0 04775220 4.0

2011 1 14 27 13 15 16 7 0 16734250 3.3

2012 0 7 31 22 28 12 11 0 2 9 11 10 8 4 12 0 2.0

Turks and Caicos 1995

–

Islands 2000

–

2005

–

2010 00010000 00011000 0.50

2011 02320100 00000000

–

2012 0 0 20000 00201000 0.67

United States 1995 19 355 876 1 417 1 121 742 1 099 26 280 579 499 285 202 591 2.3

of America 2000 6 365 602 906 904 577 738 14 246 376 349 253 152 396 2.3

2005 14 383 535 666 767 499 624 11 241 348 276 242 161 322 2.2

2010 5 246 360 371 505 403 466 2 9 195 265 183 165 130 223 0 2.0

2011 12 235 403 374 557 434 486 0 15 160 254 199 150 138 269 1 2.1

2012 10 239 322 333 502 455 529 0 14 161 262 169 175 148 243 1 2.0

Uru

1995 4 28 40 35 49 38 50 2 21 26 18 12 9 17 2.3

2000 0 36 48 45 41 30 34 2 28 22 21 13 12 16 2.1

2005 1 42 48 39 45 34 36 1 33 30 17 9 8 12 2.2

2010 1 46 70 35 46 33 31 0 3 24 36 12 10 5 16 0 2.5

2011 0 58 93 55 45 36 37 0 1 29 55 19 12 11 16 0 2.3

2012 3 38 98 56 52 39 29 0 2 25 26 21 15 13 15 0 2.7

US Vir

in Islands 1995 0001100

–

2000

–

2005

–

2010

–

2011

–

2012

–

Venezuela 1995

–

(

Bolivarian 2000

–

ublic of

)

2005 35 312 395 413 402 265 332 37 351 299 267 183 146 216 1.4

2010 22 320 376 333 391 253 288 26 269 306 188 145 147 188 1.6

2011 28 340 353 303 363 307 241 0 25 252 316 178 178 150 190 0 1.5

2012 23 379 405 353 375 319 273 0 32 276 281 203 167 161 199 0 1.6

205 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

REGION OF THE AMERICAS

a LED = Light emitting diode microscopes

b DST = Drug susceptibility testing

c LPA = Line probe assay

d NRL = National Reference Laboratory

7$%/($/DERUDWRULHV173VHUYLFHVGUXJPDQDJHPHQWDQGLQIHFWLRQFRQWURO

LABORATORIES FREE THROUGH NTP

SMEAR LABS

PER 100K

POPULATION

% OF SMEAR

LABS USING

LED

CULTURE

LABS PER 5M

POPULATION

DST

LABS

PER 5M

POPULATION

LPA

LABS

PER 5M

POPULATION

NUMBER OF

LABS USING

XPERT MTB/RIF

SECOND-

LINE DST

AVAILABLE

NRL

TB DIAGNOSIS

FIRST-

LINE

DRUGS

TB NOTIF.

RATE PER

100 000

HEALTH-CARE

WORKERS

RIFAMPICIN

USED

THROUGHOUT

TREATMENT

Anguilla – No No No No No

Antigua and Barbuda – Out of

country Yes Yes (all suspects) Yes Yes

Argentina 1.7 0 12.5 1.9 0 0 In country Yes Yes (all suspects) Yes Yes

Aruba – Out of

country Yes No No Yes

Bahamas – Out of

country Yes Yes (other criteria) Yes Yes

Barbados – Out of

country Yes Yes (all suspects) Yes Yes

Belize 0.9 0 0 0 0 0 Out of

country No Yes (all suspects) Yes Yes

Bermuda – Out of

country Yes Yes (all suspects) Yes Yes

Bolivia

(Plurinational State of) 5.1 0 24.8 0.5 0 0 Out of

country Yes Yes (all suspects) Yes Yes

Bonaire, Saint Eustatius

and Saba –Out of

country Yes Yes (all suspects) Don't

know Yes

Brazil 2.0 – 5.5 0.9 0.2 13 In country Yes Yes (all suspects) Yes Yes

British Virgin Islands – Out of

country Yes Yes (all suspects) No Yes

Canada – In country Yes Yes (all suspects) Yes Yes

Cayman Islands – Out of

country Yes Yes (all suspects) Yes Yes

Chile 1.0 0 11.2 0.3 0.3 1 In country Yes Yes (all suspects) Yes Yes

Colombia 5.6 0 124.6 0.4 0.5 4 In country Yes Yes (all suspects) Yes Yes

Costa Rica 2.2 0 14.6 1 0 4 No Yes Yes (all suspects) Yes Yes

Cuba – No Yes Yes (all suspects) Yes Yes

Curaçao – Out of

country Yes Yes (all suspects) Yes Yes

Dominica – Out of

country Yes Yes (all suspects) Yes Yes

Dominican Republic 2.0 2 5.8 1 0 0 In country Yes Yes (all suspects) Yes Yes

Ecuador 2.3 0 5.8 0.3 5 In country Yes Yes (all suspects) Yes Yes

El Salvador 3.3 0 8.7 0.8 0 1 Out of

country Yes Yes (all suspects) Yes Yes 83

Grenada – Yes (all suspects) Yes Yes

Guatemala 1.9 18 3.3 1 0 0 Out of

country Yes Yes (all suspects) Yes Yes 14

Guyana 2.5 100 6.3 6.3 6.3 0 In and out

of countr y Yes Yes (all suspects) Yes Yes

Haiti 2.5 6 1.0 1 1 7 Yes Yes (all suspects) Yes Yes

Honduras 2.1 0 3.2 0.6 0 0 Out of

country Yes Yes (all suspects) Yes Yes 109

Jamaica 0.1 100 0 0 0 0 Out of

country Yes Yes (all suspects) Yes Yes 21

Mexico 1.0 0 2.7 0.6 <0.1 6 In and out

of countr y Yes Yes (all suspects) Yes Yes 33

Montserrat – Out of

country No Yes (all suspects) No Yes

Nicaragua 3.2 100 1.7 0.8 0 Out of

country Yes Yes (all suspects) Yes Yes

Panama 1.4 0 14.5 1.3 1.3 3 No Yes Yes

(

if TB is

confirmed) Yes Yes

Paraguay 1.8 23 8.2 0.7 0 0 In country Yes Yes (all suspects) Yes Yes 7

Peru 4.8 0 11.0 1.8 0.2 0 In country Yes Yes (all suspects) Yes Yes

Puerto Rico – Out of

country Yes Yes (all suspects) Yes Yes

Saint Kitts and Nevis – No No Yes (all suspects) Yes Yes

Saint Lucia – Out of

country Yes Yes (all suspects) Yes Yes

Saint Vincent and

the Grenadines –Out of

country Yes Yes (all suspects) Yes Yes

Sint Maarten (Dutch part) – Out of

country No Yes (other criteria) Yes Yes

Suriname 0.6 0 9.4 0 0 2 Out of

country Yes Yes (all suspects) Yes Yes

Trinidad and Tobago – In and out

of countr y Yes Yes (all suspects) Yes Yes

Turks and Caicos Islands –

United States of America – In country Yes Yes (all suspects) Yes Yes

Uruguay <0.1 100 1.5 1.5 1.5 0 Out of

country Yes Yes (all suspects) Yes Yes 31

US Virgin Islands –

Venezuela

(Bolivarian Republic of) 0.8 0 3.5 0.2 0.2 0 In country Yes Yes (all suspects) Yes Yes 2 242

206 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($0HDVXUHGSHUFHQWDJHRI7%FDVHVZLWK0'57%

PRVWUHFHQW\HDUDYDLODEOH

New TB cases Previously treated TB cases

Year Source Coverage Percentage Year Source Coverage Percentage

Anguilla

Antigua and Barbuda

Argentina 2005 Survey National 2.2 (1.2–3.6) 2005 Survey National 15 (9.8–23)

Aruba

Bahamas 2012 Surveillance National 3.7 (<0.1–19) 2012 Surveillance National 0 (0–98)

Barbados

Belize

Bermuda 2012 Surveillance National 0 (0–84) 2012 Surveillance National 0 (0–98)

Bolivia

(Plurinational State of) 1996 Survey National 1.2 (0.44–2.6) 2012 Surveillance National 11 (8.9–14)

Bonaire, Saint Eustatius

and Saba 2011 Surveillance National 50 (1.3–99) 2011 Surveillance National 100 (2.5–100)

Brazil 2008 Survey Sub-national 1.4 (1.0–1.8) 2008 Survey Sub-national 7.5 (5.7–9.9)

British Virgin Islands

Canada 2012 Surveillance National 0.57 (0.23–1.2) 2012 Surveillance National 1.6 (<0.1–8.5)

Cayman Islands 2012 Surveillance National 0 (0–52) 2012 Surveillance National 0 (0–98)

Chile 2001 Survey National 0.69 (0.25–1.5) 2012 Surveillance National 2.9 (0.95–6.7)

Colombia 2005 Survey National 2.4 (1.6–3.6) 2012 Surveillance National 13 (9.6–17)

Costa Rica 2006 Survey National 1.5 (0.42–3.9) 2012 Surveillance National 4.5 (0.12–23)

Cuba 2012 Surveillance National 0.74 (<0.1–2.7) 2012 Surveillance National 12 (4.4–24)

Curaçao 2012 Surveillance National 0 (0–98) 2012 Surveillance National 0 (0–98)

Dominica 2011 Surveillance National 0 (0–98) 2012 Surveillance National 0 (0–98)

Dominican Republic 1995 Survey National 6.6 (4.1–10) 1995 Survey National 20 (13–28)

Ecuador 2002 Survey National 4.9 (3.5–6.7) 2012 Surveillance National 26 (23–29)

El Salvador 2001 Survey National 0.33 (<0.1–1.2) 2012 Surveillance National 11 (4.9–20)

Grenada

Guatemala 2002 Survey National 3 (1.8–4.6) 2002 Survey National 26 (20–34)

Guyana

Haiti

Honduras 2004 Survey National 1.8 (0.76–3.4) 2004 Survey National 12 (5.8–22)

Jamaica

Mexico 2009 Survey National 2.4 (2.1–2.8) 2009 Survey National 6.3 (5.1–7.8)

Montserrat

Nicaragua 2006 Survey National 0.63 (<0.1–2.2) 2010 Surveillance National 11 (6.2–17)

Panama

Paraguay 2008 Survey National 0.31 (<0.1–1.7) 2008 Survey National 15 (6.1–28)

Peru 2012 Surveillance National 3.9 (3.6–4.2) 2012 Surveillance National 35 (33–37)

Puerto Rico 2012 Surveillance National 0 (0–6.5) 2012 Surveillance National 33 (0.84–91)

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and

the Grenadines

Sint Maarten (Dutch part)

Suriname

Trinidad and Tobago

Turks and Caicos Islands

United States of America 2012 Surveillance National 1 (0.80–1.3) 2012 Surveillance National 2.9 (1.4–5.4)

Uruguay 2012 Surveillance National 0 (0–0.79) 2012 Surveillance National 2.4 (<0.1–13)

Venezuela

(Bolivarian Republic of) 1999 Survey National 0.52 (0.14–1.3) 1999 Survey National 13 (7.6–22)

a Empty rows indicate an absence of high-quality survey or surveillance data. In the absence of high-quality national data, high-quality sub-national data are used.

'#56'40/'&+6'44#0'#04')+10

Table A4.1 Estimates of the burden of disease caused by TB, 1990–2012 209

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

Table A4.4 Treatment outcomes, new smear-positive cases, 1995–2011 215

Table A4.5 Treatment outcomes, retreatment cases, 1995–2011 217

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

Table A4.9 Laboratories, NTP services, drug management and infection control, 2012 223

6CDNG# /GCUWTGFRGTEGPVCIGQH6$ECUGUYKVJ/&46$OQUVTGEGPV[GCTCXCKNCDNG 

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

209 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Afghanistan 1990 12 3.7 (0.860–8.5) 31 (7.3–72) 38 (13–77) 327 (112–655) 22 (14–33) 189 (117–279)

1995 18 8.7 (2.9–18) 49 (17–100) 79 (37–140) 447 (208–775) 33 (27–40) 189 (155–227)

2000 21 11 (4.0–21) 53 (19–102) 92 (43–160) 449 (210–775) 39 (32–47) 189 (155–227)

2005 25 9.7 (3.9–18) 39 (16–73) 92 (46–150) 369 (185–617) 47 (38–56) 189 (155–227)

2010 28 10 (4.2–18) 35 (15–65) 99 (50–160) 350 (177–580) 54 (44–64) 189 (156–225)

2011 29 10 (4.4–19) 36 (15–66) 100 (52–170) 352 (177–585) 55 (45–66) 189 (156–225)

2012 30 11 (4.6–20) 37 (15–68) 110 (54–180) 358 (181–595) 56 (47–67) 189 (156–226)

Bahrain 1990 < 1 0.034 (0.032–0.037) 7 (6.5–7.4) 0.16 (0.049–0.350) 33 (9.9–70) 0.13 (0.120–0.150) 27 (24–31)

1995 < 1 0.02 (0.018–0.022) 3.5 (3.2–3.8) 0.081 (0.024–0.170) 14 (4.3–30) 0.049 (0.043–0.056) 8.8 (7.7–9.9)

2000 < 1 0.017 (0.015–0.020) 2.5 (2.2–3.0) 0.37 (0.180–0.630) 56 (27–94) 0.24 (0.210–0.270) 36 (31–40)

2005 < 1 <0.01 (<0.01–<0.01) 0.85 (0.78–0.93) 0.42 (0.170–0.790) 48 (19–89) 0.32 (0.280–0.360) 37 (32–41)

2010 1 <0.01 (<0.01–<0.01) 0.44 (0.38–0.51) 0.34 (0.110–0.690) 27 (9.0–55) 0.28 (0.250–0.320) 23 (20–26)

2011 1 <0.01 (<0.01–<0.01) 0.39 (0.32–0.46) 0.32 (0.120–0.630) 25 (9.0–49) 0.26 (0.230–0.290) 20 (18–23)

2012 1 <0.01 (<0.01–<0.01) 0.34 (0.28–0.41) 0.38 (0.180–0.650) 29 (14–49) 0.26 (0.230–0.290) 20 (17–22)

Djibouti 1990 < 1 0.59 (0.140–1.3) 99 (24–226) 6.2 (2.2–12) 1 050 (368–2 070) 3.7 (2.3–5.3) 619 (395–893)

1995 < 1 0.4 (0.160–0.750) 60 (23–114) 5.4 (2.2–10) 809 (326–1 510) 4.1 (3.4–4.9) 619 (506–744)

2000 < 1 0.41 (0.180–0.740) 57 (25–102) 5.6 (2.4–10) 775 (333–1 400) 4.5 (3.8–5.2) 619 (528–718)

2005 < 1 0.65 (0.260–1.2) 83 (33–156) 7.1 (3.4–12) 920 (444–1 570) 4.8 (3.9–5.8) 619 (506–744)

2010 < 1 0.68 (0.290–1.2) 82 (34–149) 7.7 (3.7–13) 922 (440–1 580) 5.2 (4.3–6.2) 620 (512–738)

2011 < 1 0.67 (0.280–1.2) 79 (34–144) 7.7 (3.6–13) 911 (430–1 570) 5.2 (4.3–6.2) 620 (512–738)

2012 < 1 0.66 (0.280–1.2) 76 (33–139) 7.7 (3.6–13) 897 (418–1 560) 5.3 (4.4–6.3) 620 (512–738)

Egypt 1990 56 1.8 (1.4–2.2) 3.2 (2.5–3.9) 48 (22–84) 85 (39–149) 19 (16–23) 34 (29–40)

1995 61 1.5 (1.2–1.9) 2.5 (1.9–3.2) 37 (19–61) 60 (31–99) 19 (16–23) 32 (27–37)

2000 66 1.1 (0.840–1.4) 1.7 (1.3–2.2) 28 (14–46) 42 (20–70) 17 (14–20) 26 (22–30)

2005 72 0.76 (0.700–0.830) 1.1 (0.97–1.2) 24 (12–41) 34 (17–57) 15 (13–18) 21 (18–25)

2010 78 0.45 (0.420–0.490) 0.58 (0.54–0.62) 23 (12–39) 30 (15–50) 14 (12–16) 18 (15–21)

2011 79 0.56 (0.530–0.600) 0.71 (0.66–0.76) 23 (12–39) 29 (15–49) 14 (12–16) 17 (15–20)

2012 81 0.38 (0.350–0.400) 0.46 (0.43–0.50) 23 (12–39) 29 (15–48) 14 (12–16) 17 (14–19)

Iran (Islamic 1990 56 2.6 (0.870–5.3) 4.6 (1.5–9.4) 29 (12–53) 51 (21–93) 18 (13–23) 31 (23–41)

Republic of) 1995 60 3.2 (1.1–6.5) 5.4 (1.8–11) 35 (15–64) 58 (24–106) 21 (16–28) 35 (26–46)

2000 66 2.5 (0.830–5.1) 3.8 (1.3–7.7) 27 (11–51) 41 (17–77) 17 (12–22) 26 (19–34)

2005 70 2.1 (0.680–4.2) 3 (0.97–6.0) 23 (9.4–42) 32 (13–60) 14 (10–19) 20 (15–27)

2010 74 2.2 (0.730–4.5) 3 (0.98–6.0) 24 (9.9–44) 32 (13–59) 15 (11–19) 20 (14–26)

2011 75 2.3 (0.780–4.7) 3.1 (1.0–6.3) 25 (11–47) 34 (14–62) 16 (11–21) 21 (15–27)

2012 76 2.2 (0.700–4.7) 2.9 (0.92–6.1) 25 (10–47) 33 (13–61) 16 (11–21) 21 (15–28)

Iraq 1990 18 1.2 (0.410–2.4) 6.9 (2.3–14) 17 (4.9–35) 94 (28–200) 9.5 (8.3–11) 54 (47–62)

1995 20 1.2 (0.310–2.6) 5.7 (1.5–13) 16 (4.9–34) 79 (24–167) 11 (9.4–12) 53 (46–60)

2000 24 1.1 (0.180–2.9) 4.7 (0.77–12) 14 (5.0–29) 61 (21–121) 12 (10–14) 50 (44–57)

2005 27 1.1 (0.100–3.1) 3.9 (0.38–11) 19 (8.8–33) 70 (32–122) 13 (11–15) 48 (42–54)

2010 31 0.98 (0.039–3.4) 3.2 (0.13–11) 24 (13–40) 78 (41–128) 14 (12–16) 45 (40–52)

2011 32 0.97 (0.030–3.5) 3 (0.10–11) 23 (12–39) 73 (37–123) 14 (13–16) 45 (39–51)

2012 33 0.96 (0.025–3.5) 2.9 (<0.1–11) 24 (12–40) 73 (36–122) 15 (13–17) 45 (39–51)

Jordan 1990 3 0.041 (0–0.330) 1.2 (0–9.9) 0.61 (0.230–1.2) 18 (6.8–35) 0.48 (0.420–0.550) 14 (13–16)

1995 4 0.04 (0–0.390) 0.93 (0–9.0) 0.65 (0.250–1.2) 15 (5.8–29) 0.51 (0.450–0.580) 12 (10–13)

2000 5 0.039 (0–0.410) 0.81 (0–8.6) 0.48 (0.180–0.930) 10 (3.8–20) 0.38 (0.340–0.440) 8.1 (7.1–9.1)

2005 5 0.036 (0–0.410) 0.7 (0–7.8) 0.47 (0.170–0.910) 9 (3.3–17) 0.38 (0.330–0.430) 7.2 (6.3–8.1)

2010 6 0.037 (0–0.420) 0.57 (0–6.5) 0.57 (0.240–1.0) 8.8 (3.8–16) 0.41 (0.360–0.460) 6.3 (5.5–7.1)

2011 7 0.037 (0–0.420) 0.55 (0–6.3) 0.57 (0.250–1.0) 8.5 (3.7–15) 0.4 (0.350–0.460) 6 (5.2–6.8)

2012 7 0.037 (0–0.420) 0.53 (0–6.0) 0.6 (0.280–1.0) 8.5 (3.9–15) 0.4 (0.360–0.460) 5.8 (5.1–6.5)

Kuwait 1990 2 0.019 (0.017–0.022) 0.94 (0.81–1.1) 0.48 (0.230–0.830) 23 (11–40) 0.32 (0.280–0.360) 15 (14–18)

1995 2 0.023 (0.021–0.024) 1.4 (1.3–1.5) 0.46 (0.160–0.930) 29 (9.9–59) 0.39 (0.340–0.440) 24 (21–28)

2000 2 0.015 (0.014–0.015) 0.76 (0.75–0.78) 0.77 (0.300–1.5) 41 (16–77) 0.59 (0.520–0.670) 31 (27–35)

2005 2 0.023 (0.022–0.023) 0.99 (0.97–1.0) 0.71 (0.240–1.4) 31 (11–62) 0.59 (0.520–0.670) 26 (23–29)

2010 3 0.033 (0.033–0.033) 1.1 (1.1–1.1) 1.7 (0.860–2.9) 58 (29–98) 1.1 (0.960–1.2) 37 (32–42)

2011 3 0.018 (0.018–0.018) 0.58 (0.57–0.58) 0.98 (0.330–2.0) 31 (11–63) 0.77 (0.680–0.870) 25 (22–28)

2012 3 0.031 (0.030–0.031) 0.94 (0.93–0.95) 1.1 (0.360–2.1) 33 (11–65) 0.85 (0.740–0.960) 26 (23–30)

Lebanon 1990 3 0.085 (0.046–0.130) 3.1 (1.7–5.0) 1.2 (0.460–2.3) 45 (17–87) 0.94 (0.820–1.1) 35 (31–39)

1995 3 0.067 (0.034–0.110) 2.2 (1.1–3.7) 1.1 (0.340–2.2) 35 (11–72) 0.88 (0.770–1.0) 29 (26–33)

2000 3 0.04 (0.020–0.069) 1.2 (0.61–2.1) 0.66 (0.220–1.3) 20 (6.9–41) 0.56 (0.490–0.630) 17 (15–20)

2005 4 0.046 (0.025–0.074) 1.2 (0.62–1.8) 0.61 (0.260–1.1) 15 (6.5–28) 0.45 (0.400–0.510) 11 (10–13)

2010 4 0.065 (0.035–0.110) 1.5 (0.80–2.4) 0.83 (0.370–1.5) 19 (8.6–34) 0.6 (0.530–0.680) 14 (12–16)

2011 4 0.073 (0.039–0.120) 1.6 (0.86–2.6) 0.91 (0.410–1.6) 20 (9.1–36) 0.67 (0.590–0.760) 15 (13–17)

2012 5 0.072 (0.038–0.120) 1.5 (0.81–2.5) 0.95 (0.390–1.7) 20 (8.5–37) 0.73 (0.640–0.830) 16 (14–18)

Libyan Arab 1990 4 0.44 (0.170–0.840) 10 (3.9–20) 3.6 (1.7–6.4) 86 (39–150) 1.7 (1.4–2.0) 40 (33–48)

Jamahiriya 1995 5 0.28 (0.120–0.500) 5.9 (2.6–11) 2.9 (1.3–5.1) 61 (27–108) 1.9 (1.5–2.3) 40 (33–48)

2000 5 0.27 (0.120–0.490) 5.3 (2.3–9.4) 3 (1.3–5.4) 57 (24–104) 2.1 (1.7–2.5) 40 (33–48)

2005 6 0.23 (0.120–0.390) 4.2 (2.1–6.9) 2.8 (1.1–5.5) 51 (19–98) 2.2 (1.9–2.6) 40 (34–46)

2010 6 0.32 (0.140–0.570) 5.4 (2.4–9.5) 3.5 (1.5–6.3) 58 (25–104) 2.4 (2.0–2.9) 40 (33–48)

2011 6 0.34 (0.140–0.610) 5.5 (2.3–10) 3.7 (1.8–6.4) 61 (29–105) 2.4 (2.0–2.9) 40 (33–48)

2012 6 0.42 (0.180–0.760) 6.8 (2.9–12) 4.1 (1.9–7.0) 66 (31–113) 2.5 (2.0–2.9) 40 (33–48)

Morocco 1990 25 6.2 (4.8–7.7) 25 (19–31) 57 (24–110) 232 (97–426) 36 (27–47) 147 (110–189)

1995 27 5.2 (3.7–6.8) 19 (14–25) 64 (30–110) 240 (112–415) 41 (33–49) 152 (124–182)

2000 29 4.3 (2.8–6.1) 15 (9.7–21) 46 (20–84) 161 (68–292) 33 (29–38) 117 (102–132)

2005 30 3.5 (2.0–5.5) 12 (6.8–18) 41 (17–75) 137 (57–251) 30 (26–34) 100 (88–113)

2010 32 3.1 (1.5–5.2) 9.8 (4.9–16) 44 (19–79) 138 (59–251) 32 (28–36) 100 (88–114)

2011 32 3 (1.5–5.2) 9.5 (4.6–16) 46 (20–82) 143 (62–257) 33 (29–37) 103 (90–117)

2012 33 3 (1.4–5.1) 9.2 (4.4–16) 46 (19–83) 140 (58–257) 33 (29–38) 103 (90–117)

Oman 1990 2 0.059 (<0.01–0.200) 3.2 (0.14–11) 0.8 (0.360–1.4) 44 (20–78) 0.55 (0.490–0.630) 31 (27–35)

1995 2 0.05 (<0.01–0.230) 2.3 (<0.1–10) 0.4 (0.140–0.790) 18 (6.5–37) 0.32 (0.280–0.360) 15 (13–17)

2000 2 0.041 (<0.01–0.230) 1.8 (0–10) 0.57 (0.280–0.960) 26 (13–44) 0.37 (0.320–0.420) 17 (15–19)

2005 3 0.035 (0–0.250) 1.4 (0–10) 0.36 (0.120–0.730) 14 (4.9–29) 0.3 (0.260–0.340) 12 (10–13)

2010 3 0.028 (0–0.260) 1 (0–9.4) 0.45 (0.170–0.870) 16 (6.1–31) 0.35 (0.310–0.400) 13 (11–14)

2011 3 0.029 (0–0.280) 0.97 (0–9.2) 0.51 (0.200–0.950) 17 (6.7–31) 0.39 (0.340–0.440) 13 (11–15)

2012 3 0.031 (0–0.300) 0.92 (0–9.0) 0.6 (0.260–1.1) 18 (7.8–33) 0.44 (0.380–0.500) 13 (12–15)

Pakistan 1990 111 80 (24–170) 72 (22–152) 650 (250–1 300) 589 (222–1 130) 260 (160–380) 231 (143–341)

1995 127 90 (32–180) 71 (25–139) 740 (330–1 300) 584 (262–1 030) 290 (240–350) 231 (189–278)

2000 144 99 (36–190) 69 (25–135) 820 (370–1 400) 573 (260–1 010) 330 (270–400) 231 (189–278)

2005 158 84 (33–160) 53 (21–101) 760 (380–1 300) 483 (239–810) 370 (300–440) 231 (189–278)

2010 173 64 (28–110) 37 (16–66) 670 (330–1 100) 389 (191–657) 400 (330–480) 231 (190–276)

2011 176 62 (27–110) 35 (15–63) 670 (330–1 100) 381 (185–647) 410 (340–490) 231 (190–276)

2012 179 62 (27–110) 34 (15–61) 670 (320–1 100) 376 (181–641) 410 (340–490) 231 (190–276)

Qatar 1990 < 1 0.031 (0.030–0.032) 6.5 (6.3–6.6) 0.28 (0.110–0.520) 59 (24–108) 0.21 (0.190–0.240) 44 (39–50)

1995 < 1 0.016 (0.016–0.017) 3.3 (3.1–3.4) 0.54 (0.260–0.910) 107 (52–182) 0.35 (0.310–0.400) 70 (61–79)

2000 < 1 <0.01 (<0.01–<0.01) 0.7 (0.62–0.78) 0.43 (0.180–0.780) 72 (30–132) 0.32 (0.280–0.360) 54 (47–61)

2005 < 1 <0.01 (<0.01–<0.01) 0.15 (0.12–0.17) 0.53 (0.230–0.950) 64 (28–115) 0.37 (0.330–0.420) 46 (40–52)

2010 2 <0.01 (<0.01–<0.01) 0.22 (0.15–0.30) 0.82 (0.290–1.6) 47 (17–92) 0.67 (0.580–0.750) 38 (33–43)

2011 2 <0.01 (<0.01–<0.01) 0.19 (0.12–0.27) 0.78 (0.260–1.6) 41 (14–82) 0.64 (0.560–0.720) 33 (29–38)

2012 2 <0.01 (<0.01–<0.01) 0.17 (0.10–0.25) 1.2 (0.560–2.1) 60 (27–105) 0.84 (0.730–0.950) 41 (36–46)

Saudi Arabia 1990 16 0.63 (0.061–1.9) 3.9 (0.37–11) 4 (1.8–7.0) 25 (11–43) 2.8 (2.4–3.1) 17 (15–19)

1995 19 0.71 (0.068–2.1) 3.8 (0.37–11) 3.9 (1.4–7.6) 21 (7.7–41) 3.1 (2.7–3.5) 17 (15–19)

2000 20 0.79 (0.075–2.3) 3.9 (0.37–11) 5.3 (2.2–9.7) 26 (11–48) 4 (3.5–4.5) 20 (17–22)

2005 25 0.95 (0.091–2.8) 3.9 (0.37–11) 5.1 (1.9–9.8) 21 (7.8–40) 4.1 (3.6–4.6) 16 (14–19)

2010 27 1.1 (0.100–3.1) 3.9 (0.37–11) 7.7 (3.7–13) 28 (13–48) 5.1 (4.5–5.8) 19 (17–21)

2011 28 1.1 (0.100–3.2) 3.9 (0.37–11) 6.1 (2.5–11) 22 (9.1–40) 4.5 (4.0–5.1) 16 (14–18)

2012 28 1.1 (0.110–3.2) 3.9 (0.39–11) 4.9 (1.6–10) 17 (5.5–36) 4.2 (3.7–4.8) 15 (13–17)

Somalia 1990 6 5.7 (1.7–12) 90 (27–190) 46 (17–89) 732 (272–1 410) 18 (11–27) 285 (176–421)

1995 6 5 (1.8–9.7) 79 (29–153) 42 (19–73) 663 (305–1 160) 18 (15–22) 285 (233–343)

2000 7 5 (1.9–9.7) 68 (26–131) 45 (21–76) 604 (291–1 030) 21 (17–25) 285 (233–343)

2005 8 4.8 (1.9–8.9) 56 (23–105) 45 (23–76) 537 (267–900) 24 (20–29) 285 (233–343)

2010 10 5.7 (2.3–11) 59 (24–111) 53 (27–89) 555 (279–925) 28 (23–33) 286 (236–340)

2011 10 6.1 (2.4–11) 61 (24–115) 56 (28–94) 566 (283–947) 28 (23–34) 286 (236–340)

2012 10 6.5 (2.5–12) 64 (25–120) 59 (29–99) 581 (287–975) 29 (24–35) 286 (236–340)

Rates are per 100 000 population.

210 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEa

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

South Sudan 2011 10 3.1 (1.3–5.6) 30 (13–54) 28 (13–47) 268 (129–456) 15 (13–18) 146 (121–174)

2012 11 3.2 (1.4–5.8) 30 (13–54) 28 (13–47) 257 (124–437) 16 (13–19) 146 (121–174)

Sudan 1990 26 11 (4.4–22) 44 (17–84) 99 (48–170) 386 (185–659) 44 (36–52) 170 (140–203)

1995 30 9 (3.8–16) 30 (13–55) 89 (45–150) 296 (149–491) 47 (39–56) 158 (130–188)

2000 34 9.3 (4.0–17) 27 (12–49) 90 (45–150) 262 (132–436) 50 (41–59) 144 (119–172)

2005 40 9.3 (4.0–17) 24 (10–42) 90 (45–150) 226 (113–378) 53 (43–63) 133 (110–158)

2010 46 10 (4.3–18) 22 (9.4–40) 96 (48–160) 210 (105–350) 54 (45–65) 119 (98–142)

2011 36 8 (3.4–15) 22 (9.3–40) 76 (38–130) 209 (105–347) 42 (35–51) 117 (96–139)

2012 37 8 (3.3–15) 22 (9.0–40) 77 (39–130) 207 (104–345) 42 (35–51) 114 (94–136)

Syrian Arab 1990 12 0.97 (0.270–2.1) 7.8 (2.2–17) 11 (3.6–22) 86 (29–174) 7.5 (5.3–10) 61 (43–82)

Republic 1995 14 0.85 (0.370–1.5) 5.9 (2.6–11) 9.3 (3.9–17) 65 (27–119) 6.6 (5.4–7.9) 46 (38–55)

2000 16 0.56 (0.280–0.930) 3.4 (1.7–5.7) 7 (2.5–14) 43 (15–85) 5.7 (4.9–6.6) 35 (30–40)

2005 18 0.47 (0.220–0.810) 2.6 (1.2–4.4) 5.9 (2.1–12) 33 (11–65) 4.8 (4.0–5.6) 26 (22–31)

2010 22 0.47 (0.210–0.830) 2.2 (0.99–3.9) 5.6 (2.1–11) 26 (9.8–50) 4.3 (3.5–5.1) 20 (16–24)

2011 22 0.47 (0.210–0.830) 2.2 (0.98–3.8) 5.5 (2.1–10) 25 (9.8–47) 4.1 (3.4–4.9) 19 (16–22)

2012 22 0.46 (0.210–0.820) 2.1 (0.96–3.7) 5.3 (2.1–9.9) 24 (9.7–45) 3.9 (3.2–4.6) 18 (15–21)

Tunisia 1990 8 0.24 (0.130–0.370) 2.9 (1.6–4.6) 3.2 (1.3–5.8) 39 (16–72) 2.3 (2.0–2.6) 29 (25–32)

1995 9 0.3 (0.160–0.470) 3.3 (1.8–5.3) 3.9 (1.7–6.9) 43 (18–77) 2.7 (2.4–3.1) 31 (27–35)

2000 10 0.26 (0.140–0.410) 2.7 (1.5–4.3) 3.3 (1.4–6.0) 35 (15–63) 2.4 (2.1–2.7) 25 (22–28)

2005 10 0.25 (0.140–0.400) 2.5 (1.4–4.0) 3.3 (1.4–5.9) 33 (14–59) 2.4 (2.1–2.7) 23 (21–27)

2010 11 0.31 (0.170–0.500) 2.9 (1.6–4.7) 4.1 (1.7–7.6) 39 (16–71) 3 (2.6–3.4) 28 (25–32)

2011 11 0.33 (0.180–0.520) 3.1 (1.7–4.8) 4.4 (1.8–8.1) 41 (17–75) 3.2 (2.8–3.6) 30 (26–34)

2012 11 0.32 (0.170–0.500) 2.9 (1.6–4.6) 4.5 (1.7–8.5) 41 (16–78) 3.4 (3.0–3.8) 31 (27–35)

United Arab 1990 2 0.017 (0–0.110) 0.95 (0–6.1) 0.39 (0.170–0.710) 22 (9.2–39) 0.22 (0.160–0.280) 12 (8.7–16)

Emirates 1995 2 0.022 (0–0.140) 0.95 (0–6.1) 0.51 (0.220–0.910) 22 (9.2–39) 0.28 (0.200–0.370) 12 (8.7–16)

2000 3 0.029 (0–0.190) 0.95 (0–6.1) 0.65 (0.280–1.2) 22 (9.3–39) 0.36 (0.260–0.480) 12 (8.7–16)

2005 4 0.02 (0–0.150) 0.49 (0–3.6) 0.44 (0.190–0.800) 11 (4.5–19) 0.21 (0.150–0.270) 5 (3.6–6.5)

2010 8 0.022 (0–0.150) 0.26 (0–1.8) 0.52 (0.230–0.930) 6.2 (2.7–11) 0.26 (0.190–0.340) 3.1 (2.3–4.1)

2011 9 0.015 (0–0.097) 0.17 (0–1.1) 0.37 (0.160–0.660) 4.2 (1.8–7.4) 0.21 (0.150–0.270) 2.3 (1.7–3.0)

2012 9 <0.01 (<0.01–0.045) 0.1 (0–0.49) 0.22 (0.077–0.440) 2.4 (0.84–4.8) 0.16 (0.120–0.210) 1.7 (1.2–2.3)

West Bank 1990 2 <0.01 (<0.01–<0.01) 0.45 (0.43–0.46) 0.18 (0.091–0.320) 8.6 (4.4–15) 0.12 (0.110–0.140) 6 (5.2–6.8)

and Gaza Strip 1995 3 0.035 (0.034–0.036) 1.3 (1.3–1.4) 0.27 (0.230–0.800) 10 (8.7–31) 0.22 (0.200–0.250) 8.6 (7.5–9.7)

2000 3 0.018 (0.018–0.019) 0.57 (0.56–0.58) 0.45 (0.340–1.3) 14 (11–41) 0.33 (0.290–0.370) 10 (9.0–12)

2005 4 0.012 (0.012–0.012) 0.34 (0.33–0.35) 0.29 (0.240–0.910) 8.1 (6.8–26) 0.23 (0.200–0.260) 6.5 (5.7–7.3)

2010 4 <0.01 (<0.01–<0.01) 0.23 (0.23–0.24) 0.25 (0.240–0.870) 6.1 (6.0–22) 0.21 (0.190–0.240) 5.3 (4.6–6.0)

2011 4 <0.01 (<0.01–<0.01) 0.23 (0.22–0.23) 0.34 (0.290–1.1) 8.3 (7.1–26) 0.26 (0.230–0.290) 6.3 (5.5–7.1)

2012 4 <0.01 (<0.01–<0.01) 0.23 (0.22–0.23) 0.47 (0.370–1.4) 11 (8.7–32) 0.32 (0.280–0.360) 7.6 (6.7–8.6)

Yemen 1990 12 3.8 (1.1–8.2) 32 (9.3–70) 35 (13–66) 293 (112–558) 16 (10–24) 137 (85–202)

1995 15 3.5 (1.5–6.3) 23 (9.8–42) 36 (18–60) 239 (118–401) 21 (17–25) 137 (112–165)

2000 18 3.3 (1.4–6.0) 19 (8.1–34) 35 (17–59) 198 (97–335) 20 (17–24) 116 (94–139)

2005 20 2.8 (1.2–5.2) 14 (5.9–26) 29 (14–48) 142 (71–239) 16 (13–19) 81 (66–97)

2010 23 1.4 (0.640–2.5) 6.2 (2.8–11) 17 (7.5–29) 73 (33–129) 11 (9.2–13) 49 (40–58)

2011 23 1.4 (0.630–2.5) 6 (2.7–11) 17 (7.4–30) 72 (32–129) 11 (9.4–14) 49 (40–58)

2012 24 1.3 (0.600–2.4) 5.6 (2.5–9.9) 17 (7.1–30) 70 (30–127) 12 (9.6–14) 49 (40–58)

a Rates are per 100 000 population.

211 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Afghanistan 1990 12 22 (14–33) 189 (117–279) 0.041 (0.025–0.060) 0.4 (0.22–0.52) 4 332 37 20 (13–32)

1995 18 33 (27–40) 189 (155–227) 0.072 (0.040–0.11) 0.4 (0.23–0.65)

2000 21 39 (32–47) 189 (155–227) 0.1 (0.058–0.16) 0.5 (0.28–0.77) 7 107 35 18 (15–22)

2005 25 47 (38–56) 189 (155–227) 0.16 (0.090–0.24) 0.6 (0.36–0.96) 21 844 88 46 (39–57)

2010 28 54 (44–64) 189 (156–225) 0.25 (0.15–0.38) 0.9 (0.54–1.3) 28 029 99 52 (44–63)

2011 29 55 (45–66) 189 (156–225) 0.28 (0.17–0.41) 1 (0.58–1.4) 27 983 96 51 (43–62)

2012 30 56 (47–67) 189 (156–226) 0.31 (0.19–0.46) 1 (0.63–1.5) 29 381 99 52 (44–63)

Bahrain 1990 < 1 0.13 (0.120–0.150) 27 (24–31) 117 24 87 (77–99)

1995 < 1 0.049 (0.043–0.056) 8.8 (7.7–9.9) 43 7.6 87 (77–99)

2000 < 1 0.24 (0.210–0.270) 36 (31–40) 207 31 87 (77–99)

2005 < 1 0.32 (0.280–0.360) 37 (32–41) 280 32 87 (77–99)

2010 1 0.28 (0.250–0.320) 23 (20–26) 0.011 (<0.01–0.022) 0.8 (0.28–1.7) 246 20 87 (77–99)

2011 1 0.26 (0.230–0.290) 20 (18–23) 0.012 (<0.01–0.023) 0.9 (0.33–1.8) 225 17 87 (77–99)

2012 1 0.26 (0.230–0.290) 20 (17–22) 0.012 (<0.01–0.025) 0.9 (0.25–1.9) 225 17 87 (77–99)

Djibouti 1990 < 1 3.7 (2.3–5.3) 619 (395–893) 0.082 (0.052–0.12) 14 (8.9–20) 2 100 356 57 (40–90)

1995 < 1 4.1 (3.4–4.9) 619 (506–744) 0.43 (0.35–0.52) 65 (53–78)

2000 < 1 4.5 (3.8–5.2) 619 (528–718) 0.74 (0.63–0.86) 102 (87–118) 3 971 549 89 (76–100)

2005 < 1 4.8 (3.9–5.8) 619 (506–744) 0.74 (0.61–0.89) 96 (78–115) 3 109 400 65 (54–79)

2010 < 1 5.2 (4.3–6.2) 620 (512–738) 0.6 (0.49–0.71) 72 (59–85) 4 172 500 81 (68–98)

2011 < 1 5.2 (4.3–6.2) 620 (512–738) 0.57 (0.47–0.68) 68 (56–80) 3 686 435 70 (59–85)

2012 < 1 5.3 (4.4–6.3) 620 (512–738) 0.54 (0.45–0.64) 63 (52–75) 3 474 404 65 (55–79)

Egypt 1990 56 19 (16–23) 34 (29–40) <0.01 (<0.01–0.012) <0.1 (<0.1–<0.1) 2 142 3.8 11 (9.4–13)

1995 61 19 (16–23) 32 (27–37) 0.029 (0.024–0.034) <0.1 (<0.1–<0.1) 11 145 18 58 (49–68)

2000 66 17 (14–20) 26 (22–30) 0.1 (0.085–0.12) 0.2 (0.13–0.18) 10 762 16 63 (54–75)

2005 72 15 (13–18) 21 (18–25) 0.18 (0.15–0.21) 0.3 (0.21–0.29) 11 446 16 75 (64–89)

2010 78 14 (12–16) 18 (15–21) 0.14 (0.12–0.17) 0.2 (0.16–0.21) 9 260 12 66 (57–78)

2011 79 14 (12–16) 17 (15–20) 0.14 (0.12–0.16) 0.2 (0.15–0.20) 8 974 11 65 (56–76)

2012 81 14 (12–16) 17 (14–19) 0.13 (0.11–0.16) 0.2 (0.14–0.19) 8 453 10 62 (54–73)

Iran (Islamic 1990 56 18 (13–23) 31 (23–41) 0.011 (<0.01–0.014) <0.1 (<0.1–<0.1) 9 255 16 53 (40–72)

Republic of) 1995 60 21 (16–28) 35 (26–46) 0.051 (0.037–0.067) <0.1 (<0.1–0.11) 15 936 26 75 (57–100)

2000 66 17 (12–22) 26 (19–34) 0.15 (0.11–0.20) 0.2 (0.16–0.30) 11 850 18 70 (53–96)

2005 70 14 (10–19) 20 (15–27) 0.21 (0.15–0.27) 0.3 (0.21–0.39) 9 212 13 65 (49–89)

2010 74 15 (11–19) 20 (14–26) 0.26 (0.19–0.34) 0.4 (0.25–0.46) 10 362 14 70 (53–96)

2011 75 16 (11–21) 21 (15–27) 0.28 (0.20–0.37) 0.4 (0.27–0.49) 10 980 15 70 (53–96)

2012 76 16 (11–21) 21 (15–28) 0.29 (0.21–0.39) 0.4 (0.28–0.51) 11 042 14 70 (52–97)

Iraq 1990 18 9.5 (8.3–11) 54 (47–62) 0 (0–0) 0 (0–0) 14 735 84 160 (140–180)

1995 20 11 (9.4–12) 53 (46–60) 0 (0–0) 0 (0–0) 9 697 48 90 (80–100)

2000 24 12 (10–14) 50 (44–57) 0 (0–0) 0 (0–0) 9 697 41 81 (71–93)

2005 27 13 (11–15) 48 (42–54) 0 (0–0) 0 (0–0) 9 454 35 72 (64–82)

2010 31 14 (12–16) 45 (40–52) <0.01 (0–0.010) <0.1 (0–<0.1) 9 707 31 69 (61–79)

2011 32 14 (13–16) 45 (39–51) 0 (0–0) 0 (0–0) 8 837 28 62 (54–71)

2012 33 15 (13–17) 45 (39–51) 0 (0–0) 0 (0–0) 8 664 26 59 (52–68)

Jordan 1990 3 0.48 (0.420–0.550) 14 (13–16) 439 13 91 (80–100)

1995 4 0.51 (0.450–0.580) 12 (10–13) 498 12 97 (86–110)

2000 5 0.38 (0.340–0.440) 8.1 (7.1–9.1) 306 6.4 80 (70–91)

2005 5 0.38 (0.330–0.430) 7.2 (6.3–8.1) 367 7 98 (86–110)

2010 6 0.41 (0.360–0.460) 6.3 (5.5–7.1) 338 5.2 83 (74–95)

2011 7 0.4 (0.350–0.460) 6 (5.2–6.8) 328 4.9 81 (72–93)

2012 7 0.4 (0.360–0.460) 5.8 (5.1–6.5) <0.01 (0–<0.01) 0 (0–0) 331 4.7 82 (72–93)

Kuwait 1990 2 0.32 (0.280–0.360) 15 (14–18) 277 13 87 (77–99)

1995 2 0.39 (0.340–0.440) 24 (21–28) 336 21 87 (77–99)

2000 2 0.59 (0.520–0.670) 31 (27–35) <0.01 (<0.01–<0.01) 0.2 (<0.1–0.49) 513 27 87 (77–99)

2005 2 0.59 (0.520–0.670) 26 (23–29) <0.01 (<0.01–<0.01) 0.2 (<0.1–0.41) 517 23 87 (77–99)

2010 3 1.1 (0.960–1.2) 37 (32–42) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.31) 957 32 87 (77–99)

2011 3 0.77 (0.680–0.870) 25 (22–28) 672 22 87 (77–99)

2012 3 0.85 (0.740–0.960) 26 (23–30) <0.01 (<0.01–<0.01) <0.1 (0–<0.1) 737 23 87 (77–99)

Lebanon 1990 3 0.94 (0.820–1.1) 35 (31–39) <0.01 (<0.01–<0.01) 0.3 (0.23–0.30)

1995 3 0.88 (0.770–1.0) 29 (26–33) 0.012 (0.011–0.014) 0.4 (0.35–0.45) 983 32 110 (98–130)

2000 3 0.56 (0.490–0.630) 17 (15–20) 0.014 (0.012–0.015) 0.4 (0.37–0.48) 571 18 100 (90–120)

2005 4 0.45 (0.400–0.510) 11 (10–13) 0.017 (0.015–0.019) 0.4 (0.37–0.47) 391 9.8 86 (76–98)

2010 4 0.6 (0.530–0.680) 14 (12–16) 0.031 (0.027–0.035) 0.7 (0.62–0.80) 513 12 85 (75–97)

2011 4 0.67 (0.590–0.760) 15 (13–17) 0.036 (0.032–0.041) 0.8 (0.71–0.92) 496 11 74 (65–84)

2012 5 0.73 (0.640–0.830) 16 (14–18) 0.041 (0.036–0.047) 0.9 (0.77–1.0) 630 14 86 (76–99)

Libyan Arab 1990 4 1.7 (1.4–2.0) 40 (33–48) 442 10 26 (22–32)

Jamahiriya 1995 5 1.9 (1.5–2.3) 40 (33–48) 1 440 30 76 (63–93)

2000 5 2.1 (1.7–2.5) 40 (33–48) 1 341 26 65 (54–79)

2005 6 2.2 (1.9–2.6) 40 (34–46) 2 098 38 94 (81–110)

2010 6 2.4 (2.0–2.9) 40 (33–48)

2011 6 2.4 (2.0–2.9) 40 (33–48) 0.21 (0.16–0.26) 3.4 (2.6–4.3) 1 518 25 62 (52–76)

2012 6 2.5 (2.0–2.9) 40 (33–48) 1 549 25 63 (53–77)

Morocco 1990 25 36 (27–47) 147 (110–189) 0.025 (0.019–0.033) 0.1 (<0.1–0.13) 27 658 112 76 (59–100)

1995 27 41 (33–49) 152 (124–182) 0.094 (0.076–0.11) 0.4 (0.28–0.42) 29 829 111 73 (61–90)

2000 29 33 (29–38) 117 (102–132) 0.19 (0.16–0.21) 0.7 (0.57–0.74) 28 852 100 86 (76–98)

2005 30 30 (26–34) 100 (88–113) 0.29 (0.26–0.33) 1 (0.85–1.1) 26 269 87 87 (77–99)

2010 32 32 (28–36) 100 (88–114) 0.5 (0.43–0.56) 1.6 (1.4–1.8) 28 359 90 89 (79–100)

2011 32 33 (29–37) 103 (90–117) 0.55 (0.48–0.62) 1.7 (1.5–1.9) 28 640 89 87 (77–99)

2012 33 33 (29–38) 103 (90–117) 0.59 (0.51–0.67) 1.8 (1.6–2.0) 28 635 88 86 (75–98)

Oman 1990 2 0.55 (0.490–0.630) 31 (27–35) <0.01 (<0.01–<0.01) 0.1 (0.10–0.14) 482 27 87 (77–99)

1995 2 0.32 (0.280–0.360) 15 (13–17) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 276 13 87 (77–99)

2000 2 0.37 (0.320–0.420) 17 (15–19) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.11) 321 15 87 (77–99)

2005 3 0.3 (0.260–0.340) 12 (10–13) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 261 10 87 (77–99)

2010 3 0.35 (0.310–0.400) 13 (11–14) <0.01 (<0.01–<0.01) 0.3 (0.26–0.34) 308 11 87 (77–99)

2011 3 0.39 (0.340–0.440) 13 (11–15) 0.011 (<0.01–0.012) 0.4 (0.31–0.41) 337 11 87 (77–99)

2012 3 0.44 (0.380–0.500) 13 (12–15) 0.014 (0.013–0.016) 0.4 (0.38–0.49) 382 12 87 (77–99)

Pakistan 1990 111 260 (160–380) 231 (143–341) 0.026 (0.016–0.038) <0.1 (<0.1–<0.1) 156 759 141 61 (41–99)

1995 127 290 (240–350) 231 (189–278) 0.059 (0.048–0.070) <0.1 (<0.1–<0.1) 13 142 10 4.5 (3.7–5.5)

2000 144 330 (270–400) 231 (189–278) 0.23 (0.19–0.28) 0.2 (0.13–0.19) 11 050 7.7 3.3 (2.8–4.1)

2005 158 370 (300–440) 231 (189–278) 0.8 (0.65–0.98) 0.5 (0.41–0.62) 142 017 90 39 (32–48)

2010 173 400 (330–480) 231 (190–276) 2.4 (2.0–2.9) 1.4 (1.1–1.7) 264 235 153 66 (55–80)

2011 176 410 (340–490) 231 (190–276) 3.1 (2.5–3.7) 1.7 (1.4–2.1) 264 934 150 65 (54–79)

2012 179 410 (340–490) 231 (190–276) 3.8 (3.1–4.6) 2.1 (1.7–2.6) 267 475 149 65 (54–78)

Qatar 1990 < 1 0.21 (0.190–0.240) 44 (39–50) 184 39 87 (77–99)

1995 < 1 0.35 (0.310–0.400) 70 (61–79) 304 61 87 (77–99)

2000 < 1 0.32 (0.280–0.360) 54 (47–61) 279 47 87 (77–99)

2005 < 1 0.37 (0.330–0.420) 46 (40–52) 325 40 87 (77–99)

2010 2 0.67 (0.580–0.750) 38 (33–43) 580 33 87 (77–99)

2011 2 0.64 (0.560–0.720) 33 (29–38) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.12) 553 29 87 (77–99)

2012 2 0.84 (0.730–0.950) 41 (36–46) <0.01 (<0.01–<0.01) <0.1 (0–0.12) 728 36 87 (77–99)

Saudi Arabia 1990 16 2.8 (2.4–3.1) 17 (15–19) 2 415 15 87 (77–99)

1995 19 3.1 (2.7–3.5) 17 (15–19)

2000 20 4 (3.5–4.5) 20 (17–22) 3 452 17 87 (77–99)

2005 25 4.1 (3.6–4.6) 16 (14–19) 3 539 14 87 (77–99)

2010 27 5.1 (4.5–5.8) 19 (17–21) 0.12 (0.092–0.15) 0.4 (0.34–0.56) 4 465 16 87 (77–99)

2011 28 4.5 (4.0–5.1) 16 (14–18) 0.1 (0.077–0.13) 0.4 (0.28–0.46) 3 932 14 87 (77–99)

2012 28 4.2 (3.7–4.8) 15 (13–17) 3 690 13 87 (77–99)

Somalia 1990 6 18 (11–27) 285 (176–421) 0.3 (0.19–0.44) 4.8 (2.9–7.0)

1995 6 18 (15–22) 285 (233–343) 0.56 (0.46–0.68) 8.9 (7.3–11) 2 504 39 14 (12–17)

2000 7 21 (17–25) 285 (233–343) 0.77 (0.63–0.93) 10 (8.6–13) 5 686 77 27 (22–33)

2005 8 24 (20–29) 285 (233–343) 0.85 (0.70–1.0) 10 (8.2–12) 12 904 152 53 (44–65)

2010 10 28 (23–33) 286 (236–340) 0.85 (0.70–1.0) 8.9 (7.3–11) 10 139 105 37 (31–45)

2011 10 28 (23–34) 286 (236–340) 0.85 (0.70–1.0) 8.6 (7.1–10) 11 653 118 41 (35–50)

2012 10 29 (24–35) 286 (236–340) 0.85 (0.70–1.0) 8.3 (6.9–9.9) 11 975 117 41 (34–50)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

212 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEaNUMBER RATEaPERCENT

South Sudan 2011 10 15 (13–18) 146 (121–174) 7 217 70 48 (40–58)

2012 11 16 (13–19) 146 (121–174) 8 403 78 53 (45–64)

Sudan 1990 26 44 (36–52) 170 (140–203) 0.4 (0.33–0.48) 1.6 (1.3–1.9) 212 0.82 0.48 (0.41–0.59)

1995 30 47 (39–56) 158 (130–188) 1.5 (1.2–1.8) 5 (4.1–6.0) 14 320 48 30 (25–37)

2000 34 50 (41–59) 144 (119–172) 3.5 (2.9–4.2) 10 (8.5–12) 24 807 72 50 (42–61)

2005 40 53 (43–63) 133 (110–158) 5.2 (4.3–6.2) 13 (11–16) 27 562 70 52 (44–64)

2010 46 54 (45–65) 119 (98–142) 5.6 (4.6–6.7) 12 (10–15) 26 131 57 48 (40–58)

2011 36 42 (35–51) 117 (96–139) 4.4 (3.6–5.3) 12 (10–14) 19 348 53 46 (38–55)

2012 37 42 (35–51) 114 (94–136) 4.3 (3.5–5.1) 12 (9.5–14) 18 775 50 44 (37–54)

Syrian Arab 1990 12 7.5 (5.3–10) 61 (43–82) 6 018 48 80 (59–110)

Republic 1995 14 6.6 (5.4–7.9) 46 (38–55) 4 404 31 67 (56–82)

2000 16 5.7 (4.9–6.6) 35 (30–40) 5 090 31 89 (77–100)

2005 18 4.8 (4.0–5.6) 26 (22–31) 4 310 24 90 (77–110)

2010 22 4.3 (3.5–5.1) 20 (16–24) 3 666 17 86 (72–100)

2011 22 4.1 (3.4–4.9) 19 (16–22) 3 620 17 88 (74–110)

2012 22 3.9 (3.2–4.6) 18 (15–21) 3 003 14 77 (65–93)

Tunisia 1990 8 2.3 (2.0–2.6) 29 (25–32) <0.01 (<0.01–<0.01) 0 (0–0) 2 054 25 89 (78–100)

1995 9 2.7 (2.4–3.1) 31 (27–35) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 383 27 87 (77–99)

2000 10 2.4 (2.1–2.7) 25 (22–28) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 038 21 86 (76–98)

2005 10 2.4 (2.1–2.7) 23 (21–27) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 079 21 88 (78–100)

2010 11 3 (2.6–3.4) 28 (25–32) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 368 22 79 (70–90)

2011 11 3.2 (2.8–3.6) 30 (26–34) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 015 28 94 (83–110)

2012 11 3.4 (3.0–3.8) 31 (27–35) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 239 30 96 (84–110)

United Arab 1990 2 0.22 (0.160–0.280) 12 (8.7–16) 285 16 130 (100–180)

Emirates 1995 2 0.28 (0.200–0.370) 12 (8.7–16)

2000 3 0.36 (0.260–0.480) 12 (8.7–16) 115 3.8 32 (24–44)

2005 4 0.21 (0.150–0.270) 5 (3.6–6.5) 103 2.5 50 (38–69)

2010 8 0.26 (0.190–0.340) 3.1 (2.3–4.1) 0.012 (<0.01–0.030) 0.2 (<0.1–0.35) 131 1.6 50 (38–69)

2011 9 0.21 (0.150–0.270) 2.3 (1.7–3.0) <0.01 (<0.01–0.021) <0.1 (<0.1–0.23) 103 1.2 50 (38–69)

2012 9 0.16 (0.120–0.210) 1.7 (1.2–2.3) 79 0.86 50 (38–69)

West Bank 1990 2 0.12 (0.110–0.140) 6 (5.2–6.8) 64 3.1 51 (45–59)

and Gaza Strip 1995 3 0.22 (0.200–0.250) 8.6 (7.5–9.7) 77 3 35 (30–39)

2000 3 0.33 (0.290–0.370) 10 (9.0–12) 82 2.6 25 (22–28)

2005 4 0.23 (0.200–0.260) 6.5 (5.7–7.3) 28 0.79 12 (11–14)

2010 4 0.21 (0.190–0.240) 5.3 (4.6–6.0) 31 0.77 15 (13–17)

2011 4 0.26 (0.230–0.290) 6.3 (5.5–7.1) 32 0.78 12 (11–14)

2012 4 0.32 (0.280–0.360) 7.6 (6.7–8.6) 32 0.76 10 (8.8–11)

Yemen 1990 12 16 (10–24) 137 (85–202) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 4 650 39 29 (20–47)

1995 15 21 (17–25) 137 (112–165) 0.031 (0.022–0.042) 0.2 (0.14–0.28) 14 428 96 70 (58–86)

2000 18 20 (17–24) 116 (94–139) 0.11 (0.074–0.14) 0.6 (0.42–0.81) 13 651 78 67 (56–83)

2005 20 16 (13–19) 81 (66–97) 0.18 (0.12–0.25) 0.9 (0.58–1.3) 9 063 45 56 (46–68)

2010 23 11 (9.2–13) 49 (40–58) 0.15 (0.093–0.21) 0.7 (0.41–0.93) 8 916 39 80 (67–97)

2011 23 11 (9.4–14) 49 (40–58) 0.15 (0.096–0.22) 0.7 (0.41–0.94) 8 636 37 76 (64–92)

2012 24 12 (9.6–14) 49 (40–58) 0.16 (0.098–0.23) 0.7 (0.41–0.95) 9 867 41 85 (71–100)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

213 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Afghanistan 1990 4 332 –

1995 –

2000 7 107 2 892 2 358 1 620 237 237 55

2005 21 844 9 949 6 085 4 954 856 856 62

2010 28 029 12 947 7 085 6 248 633 1 116 209 1 325 65

2011 27 983 13 789 6 155 6 286 623 1 130 184 1 314 69

• 37 99 • 2012 29 381 13 319 7 405 6 906 702 1 049 197 1 246 64

Bahrain 1990 117 –

1995 43 17 14 85 0 0 55

2000 207 23 16 8 59

2005 280 101 72 107 0 0 0 0 0 58

2010 246 90 58 98 0 0 0 0 0 61

2011 225 89 47 89 0 0 0 0 0 65

• 24 17 • 2012 225 101 47 77 0 0 0 0 0 68

Djibouti 1990 2 100 –

1995 –

2000 3 971 1 391 518 1 875 184 184 73

2005 3 109 1 120 739 1 058 0 192 61 253 0 60

2010 4 172 1 181 538 2 253 0 200 19 219 0 69

2011 3 686 1 336 569 1 587 0 194 37 231 0 70

• 356 404 • 2012 3 474 1 170 547 1 567 190 72 262 68

Egypt 1990 2 142 –

1995 11 145 4 229 9 204 4 684 753 753 31

2000 10 762 4 606 2 693 2 843 620 620 63

2005 11 446 5 217 2 617 3 163 0 449 289 738 0 67

2010 9 260 4 679 1 158 3 048 0 375 328 703 0 80

2011 8 974 4 508 1 055 3 074 0 337 333 670 0 81

• 4 10 • 2012 8 453 4 295 937 2 915 0 306 300 606 0 82

Iran (Islamic 1990 9 255 –

Republic of) 1995 15 936 5 347 6 432 3 779 477 477 45

2000 11 850 5 361 2 642 3 442 405 405 67

2005 9 212 4 581 1 807 2 530 274 154 428 20 72

2010 10 362 5 188 1 985 2 869 0 320 440 760 0 72

2011 10 980 5 539 1 980 3 076 0 385 515 900 0 74

• 16 14 • 2012 11 042 5 409 2 191 3 105 0 337 441 778 0 71

Iraq 1990 14 735 1 587 12 394 754 11

1995 9 697 3 194 13 962 1 367 68 68 19

2000 9 697 3 194 3 188 2 753 562 562 50

2005 9 454 3 096 2 887 2 703 768 768 52

2010 9 707 3 618 2 693 3 009 0 387 390 777 0 57

2011 8 837 3 059 2 463 2 957 0 358 411 769 0 55

• 84 26 • 2012 8 664 2 760 2 315 3 261 0 328 435 763 0 54

Jordan 1990 439 –

1995 498 187 210 101 6 6 47

2000 306 89 69 145 3 3 56

2005 367 86 76 187 12 6 4 10 0 53

2010 338 117 69 150 0 2 16 18 0 63

2011 328 103 81 128 0 2 16 18 14 56

• 13 5 • 2012 331 85 73 172 0 1 18 19 0 54

Kuwait 1990 277 –

1995 336 175 42 115 0 4 0 4 0 81

2000 513 180 89 244 0 0 0 0 0 67

2005 517 187 95 234 0 1 0 1 0 66

2010 957 385 163 407 0 2 0 2 0 70

2011 672 222 141 309 0 0 0 0 0 61

• 13 23 • 2012 737 328 140 269 0 0 0 0 0 70

Lebanon 1990 –

1995 983 197 528 255 3 3 27

2000 571 202 149 214 6 6 58

2005 391 131 75 181 0 4 0 4 0 64

2010 513 194 99 210 0 10 2 12 0 66

2011 496 188 101 206 1 1 65

• 0 14 • 2012 630 240 131 250 0 9 0 9 0 65

Libyan Arab 1990 442 –

Jamahiriya 1995 1 440 626 814 –

2000 1 341 607 82 652 88

2005 2 098 860 474 762 2 269 271 64

2010 –

2011 1 518 731 305 462 0 20 27 47 71

• 10 25 • 2012 1 549 644 372 533 0 63

Morocco 1990 27 658 –

1995 29 829 14 171 4 095 11 563 78

2000 28 852 12 872 2 934 13 046 81

2005 26 269 12 757 2 142 11 370 0 86

2010 28 359 12 239 2 174 12 730 0 1 216 429 1 645 0 85

2011 28 640 11 822 2 272 13 331 0 1 215 1 130 2 345 0 84

• 112 88 • 2012 28 635 11 572 2 343 13 522 0 1 198 764 1 962 0 83

Oman 1990 482 –

1995 276 135 60 81 0 0 69

2000 321 164 37 112 8 8 82

2005 261 131 37 89 4 4 78

2010 308 152 28 124 0 4 5 9 0 84

2011 337 180 32 122 0 3 0 3 0 85

• 27 12 • 2012 382 205 39 131 0 7 1 8 0 84

Pakistan 1990 156 759 –

1995 13 142 2 578 3 806 3 037 184 184 40

2000 11 050 3 285 5 578 1 846 341 341 37

2005 142 017 48 220 68 337 22 789 2 671 2 754 5 425 41

2010 264 235 104 263 105 623 45 443 0 5 870 5 055 10 925 3 036 50

2011 264 934 105 733 103 824 45 537 0 5 947 5 460 11 407 3 893 50

• 141 149 • 2012 267 475 110 545 109 425 41 410 0 6 095 5 622 11 717 0 50

Qatar 1990 184 –

1995 304 60 135 109 1 1 31

2000 279 53 98 128 0 0 35

2005 325 96 73 156 0 0 0 57

2010 580 223 101 256 0 0 0 0 0 69

2011 553 197 120 236 0 62

• 39 36 • 2012 728 180 331 217 0 0 0 0 0 35

Saudi Arabia 1990 2 415 –

1995 –

2000 3 452 1 595 722 1 023 112 112 69

2005 3 539 1 722 545 1 067 0 205 205 76

2010 4 465 2 302 687 1 311 0 122 84 206 43 77

2011 3 932 2 055 586 1 227 64 83 147 78

• 15 13 • 2012 3 690 2 028 549 1 022 91 143 234 79

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

214 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Somalia 1990 –

1995 2 504 1 572 692 318 134 134 69

2000 5 686 3 776 837 722 351 351 82

2005 12 904 7 068 3 168 2 258 0 410 102 512 0 69

2010 10 139 5 225 2 654 1 885 0 375 330 705 0 66

2011 11 653 5 884 3 159 2 261 0 349 368 717 0 65

• 0 117 • 2012 11 975 6 127 3 188 2 271 0 389 310 699 0 66

South Sudan 2011 7 217 2 797 2 610 1 639 171 366 537 52

2012 8 403 3 120 3 413 1 685 185 521 706 0 48

Sudan 1990 212 –

1995 14 320 8 761 2 655 1 675 474 474 77

2000 24 807 12 311 6 512 3 843 2 141 2 141 65

2005 27 562 12 730 9 212 5 434 0 186 1 616 1 802 58

2010 26 131 9 958 9 144 6 217 812 1 110 1 922 52

2011 19 348 7 266 6 746 4 624 0 712 1 037 1 749 0 52

• 1 50 • 2012 18 775 6 587 6 948 4 561 0 679 1 056 1 735 0 49

Syrian Arab 1990 6 018 –

Republic 1995 4 404 1 295 1 507 1 574 28 28 46

2000 5 090 1 584 1 409 2 000 97 97 53

2005 4 310 1 350 796 2 103 0 61 83 144 63

2010 3 666 1 122 544 1 948 0 52 161 213 0 67

2011 3 620 1 027 393 1 915 0 60 55 115 225 72

• 48 14 • 2012 3 003 809 364 1 702 0 44 32 76 84 69

Tunisia 1990 2 054 –

1995 2 383 1 243 407 733 75

2000 2 038 1 099 179 727 61 61 86

2005 2 079 915 239 874 51 51 79

2010 2 368 1 091 151 1 090 36 36 88

2011 3 015 1 031 317 1 616 51 51 76

• 25 30 • 2012 3 239 1 059 282 1 853 0 45 19 64 0 79

United Arab 1990 285 –

Emirates 1995 –

2000 115 73 3 41 0 0 96

2005 103 62 12 25 0 4 2 6 0 84

2010 131 56 28 47 0 0 1 1 0 67

2011 103 46 27 30 0 0 3 3 0 63

• 16 1 • 2012 79 42 15 20 0 2 6 8 0 74

West Bank 1990 64 –

and Gaza Strip 1995 77 9 58 10 13

2000 82 37 100

2005 28 7 6 15 54

2010 31 13 6 12 0 0 0 0 0 68

2011 32 11 5 13 0 3 0 3 0 69

• 3 1 • 2012 32 17 6 8 0 1 0 1 0 74

Yemen 1990 4 650 –

1995 14 428 3 681 7 390 3 082 275 275 33

2000 13 651 5 565 4 176 3 470 440 440 57

2005 9 063 3 379 2 780 2 553 351 351 55

2010 8 916 3 584 2 313 2 715 0 304 134 438 0 61

2011 8 636 3 135 2 400 2 880 0 221 77 298 0 57

• 39 41 • 2012 9 867 3 321 2 808 3 486 0 252 83 335 54

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

215 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Afghanistan 1995 –

2000 2 892 3 136 108 76 9 3 3 6 2

2005 9 949 10 013 101 83 72125

2009 12 497 12 497 100 8342129

2010 12 947 12 947 100 86 3 2125

• 0 91 • 2011 13 789 13 789 100 88 4 2125

Bahrain 1995 17 –

2000 23 22 96 73 0 27 0 0 0

2005 101 15 15 93 0 7000

2009 131 192 147 98 0 2000

2010 90 162 180 96 0 4 0 0 0

• 0 34 • 2011 89 124 139 34 0 1 0 0 65

Djibouti 1995 1 751 – 60 16 3 1 20 1

2000 1 391 1 391 100 48 14 2 1 21 14

2005 1 120 1 120 100 71911162

2009 1 377 1 277 93 72711173

2010 1 181 1 177 100 68 12 1 1 16 2

• 75 82 • 2011 1 336 1 334 100 65 17 1 1 13 3

Egypt 1995 4 229 2 118 50 38 24 2 3 19 14

2000 4 606 4 611 100 75 12 3 2 5 3

2005 5 217 5 154 99 66 13 3 2 3 13

2009 5 201 5 201 100 72 16 3 2 4 3

2010 4 679 4 682 100 59 27 3 3 4 4

• 62 88 • 2011 4 508 4 508 100 66 21 3 2 3 5

Iran (Islamic 1995 5 347 –

Republic of) 2000 5 361 5 866 109 81 4 6233

2005 4 581 4 581 100 78 5 7334

2009 5 152 5 201 101 77 6 7325

2010 5 188 5 269 102 77 6 7433

• 0 85 • 2011 5 539 5 532 100 79 6 8431

Iraq 1995 3 194 11 553 362 60 20 0 5 10 5

2000 3 194 3 194 100 86 5 3 2 3 1

2005 3 096 3 096 100 76 10 3 2 7 3

2009 3 347 3 347 100 80 10 2 1 6 1

2010 3 618 3 618 100 80 9 3 1 6 1

• 80 89 • 2011 3 059 3 059 100 83 6 3 2 5 1

Jordan 1995 187 193 103 91 1 3123

2000 89 89 100 89 1 2 1 4 2

2005 86 86 100 71 12 5 7 6 0

2009 109 109 100 54 21 6 7 11 0

2010 117 117 100 57 30 1 3 6 3

• 92 92 • 2011 103 103 100 46 47 3 0 5 0

Kuwait 1995 175 175 100 40 31 3 0 1 25

2000 180 180 100 54 15 1 0 9 21

2005 187 187 100 53 10 1 0 7 29

2009 386 386 100 41 44 0 0 4 11

2010 385 385 100 63 24 0 0 3 9

• 71 93 • 2011 222 222 100 84 9 0 0 3 4

Lebanon 1995 197 200 102 35 56 0 0 10 0

2000 202 190 94 89 3 4131

2005 131 131 100 81 11 2160

2009 179 179 100 65 17 6 1 2 10

2010 194 192 99 68 12 2 1 18 0

• 91 80 • 2011 188 188 100 65 15 2 2 16

Libyan Arab 1995 626 – 65 0 1 1 33 0

Jamahiriya 2000 607 –

2005 860 860 100 40 29 2 0 27 2

2009 936 –

2010 792 – 43 21 2 0 31 3

• 65 59 • 2011 731 731 100 42 17 1 0 37 3

Morocco 1995 14 171 14 171 100 75 14 2 1 7 1

2000 12 872 12 872 100 8273171

2005 12 757 12 683 99 7652197

2009 11 907 11 935 100 77 82292

2010 12 239 12 492 102 77 8 2192

• 90 80 • 2011 11 822 11 822 100 73 7 2189

Oman 1995 135 93 69 84 09115

2000 164 112 68 93 04300

2005 131 104 79 90 10 0

2009 164 334 204 49 49 2000

2010 152 152 100 97 03000

• 84 97 • 2011 180 212 118 95 23000

Pakistan 1995 2 578 802 31 51 20 4 1 20 4

2000 3 285 4 074 124 58 16 4 1 17 4

2005 48 220 48 205 100 71 13 3194

2009 101 887 101 809 100 74 17 2142

2010 104 263 104 434 100 75 16 2 1 4 2

• 70 92 • 2011 105 733 105 733 100 75 16 2 1 4 2

Qatar 1995 60 43 72 81 0 5 0 0 14

2000 53 53 100 66 0 8 0 0 26

2005 96 96 100 74 9 1 0 0 16

2009 220 5 2 80 0 0 0 20 0

2010 223 219 98 63 3 0 0 0 33

• 81 49 • 2011 197 294 149 46 2 0 0 32 19

Saudi Arabia 1995 –

2000 1 595 1 285 81 62 11 7 0 13 6

2005 1 722 1 722 100 60 5 7 1 10 17

2009 2 201 2 201 100 54 11 6 1 10 18

2010 2 302 2 302 100 52 10 5 1 14 18

• 0 61 • 2011 2 055 2 055 100 53 9 6 1 16 17

Somalia 1995 1 572 1 278 81 82 4 4 5 5 0

2000 3 776 3 776 100 81 2 4 2 3 9

2005 7 068 7 059 100 85 4 4 1 4 2

2009 6 047 6 047 100 83 2 4 2 3 7

2010 5 225 5 225 100 87 2 3 2 3 4

• 86 86 • 2011 5 884 5 884 100 84 2 4 2 3 6

South Sudan 2010 2 114 – 67 8 5 1 15 3

2011 2 797 2 767 99 62 11 4 1 18 4

Sudan 1995 8 761 8 326 95 44 35 2 7 11 1

2000 12 311 14 599 119 50 25 4 2 9 11

2005 12 730 12 730 100 64 18 3 1 9 5

2009 10 541 10 883 103 62 19 3 1 10 6

2010 9 958 7 729 78 56 24 2 1 12 5

• 79 70 • 2011 7 266 7 266 100 47 23 2 1 13 14

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

216 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Syrian Arab 1995 1 295 1 295 100 45 16 2 9 24 5

Republic 2000 1 584 1 562 99 69 10 4 3 11 4

2005 1 350 1 350 100 76 13 3 2 6 1

2009 1 143 1 144 100 76 12 4 1 4 3

2010 1 122 1 122 100 75 14 3 2 4 2

• 61 84 • 2011 1 027 1 009 98 65 19 3 2 10 1

Tunisia 1995 1 243 –

2000 1 099 1 099 100 8743222

2005 915 910 99 8372124

2009 931 931 100 72 11 3239

2010 1 091 1 091 100 62 24 3146

• 0 87 • 2011 1 031 1 026 100 63 24 3155

United Arab 1995 –

Emirates 2000 73 73 100 56 18 7 4 5 10

2005 62 62 100 42 31 6 0 15 6

2009 71 71 100 21 52 11 1 14 0

2010 56 55 98 24 45 7 0 24 0

• 0 73 • 2011 46 60 130 2 72 3 0 23 0

West Bank 1995 9 13 144 100 0

and Gaza Strip 2000 37 –

2005 7 12 171 58 42 0 0 0 0

2009 10 11 110 18 64 9090

2010 13 12 92 8 75 0 17 0 0

• 100 100 • 2011 11 11 100 18 82 0 0 0 0

Yemen 1995 3 681 3 681 100 43 9 1 1 35 11

2000 5 565 5 565 100 59 13 3 1 14 10

2005 3 379 3 566 106 69 11 3 1 6 10

2009 3 576 3 557 99 7993144

2010 3 584 3 584 100 7793147

• 52 88 • 2011 3 135 3 174 101 7992153

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

217 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Afghanistan 1995 –

2000 237 304 128 73 5 4 4 11 3

2005 856 856 100 87 2 3 1 2 5

2009 1 290 –

2010 1 325 1 325 100 73 6 3 3 1 14

• 0 77 • 2011 1 314 1 937 147 58 19 2 2 2 17

Bahrain 1995 0 –

2000 –

2005 0 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Djibouti 1995 –

2000 184 268 146 27 9 0 3 22 37

2005 253 253 100 58 10 3 2 24 2

2009 210 194 92 67 8 3 2 18 3

2010 219 213 97 53 17 6 2 19 3

• 0 63 • 2011 231 227 98 47 16 4 5 22 6

Egypt 1995 753 –

2000 620 956 154 52 11 7 12 13 5

2005 738 738 100 41 17 10 12 8 12

2009 748 748 100 39 39 6 5 7 4

2010 703 703 100 38 34 6 8 8 6

• 0 72 • 2011 670 599 89 35 36 6 6 10 7

Iran (Islamic 1995 477 –

Republic of) 2000 405 606 150 63 13 6 5 6 7

2005 428 448 105 68 8 9 3 4 8

2009 773 708 92 48 25 8 3 5 11

2010 760 781 103 49 20 8 5 4 15

• 0 72 • 2011 900 892 99 49 22 9 4 4 12

Iraq 1995 68 –

2000 562 –

2005 768 953 124 60 12 4 8 12 4

2009 751 751 100 57 27 3 3 9 1

2010 777 777 100 36 40 4 5 13 3

• 0 75 • 2011 769 769 100 39 36 5 7 12 1

Jordan 1995 6 –

2000 3 6 200 83 17 0 0 0 0

2005 10 –

2009 20 24 120 17 62 4 0 17 0

2010 18 5 28 0 60 0 20 0 20

• 0 80 • 2011 18 15 83 13 67 0 0 20 0

Kuwait 1995 4 –

2000 0 –

2005 1 1 100 0 100 0 0 0 0

2009 1 1 100 0 100 0 0 0 0

2010 2 2 100 0 100 0 0 0 0

• 0 0 • 2011 0 0 –

Lebanon 1995 3 –

2000 6 5 83 80 20

2005 4 4 100 75 25 0 0 0 0

2009 10 10 100 60 20 0 0 0 20

2010 12 12 100 58 17 8 0 17 0

• 0 100 • 2011 1 1 100 100 0

Libyan Arab 1995 –

Jamahiriya 2000 –

2005 271 –

2009 23 –

2010 85 – 11 22 2 0 45 20

• 0 0 • 2011 47 –

Morocco 1995 1 469 – 65 12 4 4 10 7

2000 –

2005 1 650 – 55 17 4 5 14 5

2009 1 605 1 668 104 60 9 4 3 16 8

2010 1 645 2 899 176 40 24 4 3 21 9

• 76 66 • 2011 2 345 2 623 112 38 28 3 3 21 8

Oman 1995 0 –

2000 8 7 88 86 0 0 14 0 0

2005 4 –

2009 7 7 100 57 43 0 0 0 0

2010 9 9 100 44 56 0 0 0 0

• 0 67 • 2011 3 3 100 67 0 33 0 0 0

Pakistan 1995 184 374 203 48 22 2 5 24 0

2000 341 907 266 37 17 6 3 29 8

2005 5 425 5 009 92 61 15 5 3 11 5

2009 9 200 8 801 96 63 18 4 3 8 3

2010 10 925 8 394 77 68 16 3 3 6 3

• 70 80 • 2011 11 407 11 407 100 63 17 4 3 8 4

Qatar 1995 1 3 300 67 0 0 0 0 33

2000 0 –

2005 0 –

2009 0 0 –

2010 0 0 –

• 67 0 • 2011 0 –

Saudi Arabia 1995 –

2000 112 139 124 43 15 7 3 13 19

2005 205 96 47 409951819

2009 144 151 105 45 15 8 1 17 14

2010 206 249 121 31 19 8 2 22 17

• 0 63 • 2011 147 147 100 41 22 9 3 10 15

Somalia 1995 134 –

2000 351 351 100 53155334

2005 512 524 102 7656256

2009 655 655 100 50 10 6 4 3 27

2010 705 705 100 48 14 6 5 4 23

• 0 72 • 2011 717 717 100 43 29 7 6 4 11

South Sudan 2010 434 – 23 34 5 9 23 5

2011 537 527 98 20 38 7 2 28 5

Sudan 1995 474 –

2000 2 141 –

2005 1 802 1 828 101 53 29 3196

2009 1 993 2 147 108 33 38 3 1 15 10

2010 1 922 1 517 79 28 40 2 1 14 16

• 0 55 • 2011 1 749 1 749 100 22 33 3 1 13 27

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Syrian Arab 1995 28 –

Republic 2000 97 189 195 44 10 4 20 15 7

2005 144 144 100 53 14 5 9 19 0

2009 176 176 100 48 22 9 4 15 3

2010 213 213 100 23 58 4 3 11 1

• 0 70 • 2011 115 225 196 20 49 5 5 20 1

Tunisia 1995 –

2000 61 42 69 740521010

2005 51 –

2009 42 –

2010 36 –

• 0 79 • 2011 51 52 102 54 25 2 8 10 2

United Arab 1995 –

Emirates 2000 0 –

2005 6 5 83 80 0 0 0 20 0

2009 0 0 –

2010 1 3 300 0 67 33 0 0 0

• 0 33 • 2011 3 3 100 0 33 0 0 67 0

West Bank 1995 –

and Gaza Strip 2000 –

2005 0 –

2009 2 0 0

2010 0 –

• 0 0 • 2011 3 –

Yemen 1995 275 14 5 29 14 21 14 14 7

2000 440 437 99 64 8 7 6 11 4

2005 351 351 100 48 9 2 3 7 30

2009 314 291 93 70 7 3 4 7 9

2010 438 –

• 43 67 • 2011 298 298 100 62 5 5 3 6 19

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

219 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Afghanistan 2005 21 844

2010 18 5 170 28 238 2 <0.1 100 100

2011 23 6 445 28 167 5 <0.1 80 80

– 25 • 2012 25 7 275 29 578 5 <0.1 100 100 25

Bahrain 2005 46 128 280 6 4.7 0 0

2010 65 161 246 6 3.7 0 0

2011 66 148 225 7 4.7 0 43

• 46 82 • 2012 82 184 225 1 0.54 0 100

Djibouti 2005 7.1 224 3 170 135 60 15 15 0

2010 52 2 163 4 191 248 11 0 11

2011 19 718 3 723 177 25 22

• 7 36 • 2012 36 1 289 3 546 130 10 64 0

Egypt 2005 11 735

2010 47 4 483 9 588 7 0.16 100 100 0

2011 37 3 441 9 307 12 0.35 100 100

– 17 • 2012 17 1 514 8 753 17 1.1 100 100

Iran (Islamic 2005 9 366

Republic of) 2010 8.4 904 10 802 254 28 16 28 161

2011 12 1 343 11 495 291 22 20 37

– 14 • 2012 14 1 574 11 483 283 18 27 41 155

Iraq 2005 9 454

2010 66 6 711 10 097 1 <0.1 100 0 0

2011 84 7 754 9 248 2 <0.1 100 50

– 86 • 2012 86 7 821 9 099 2 <0.1 50 50

Jordan 2005 23 86 371 0 0

2010 99 352 354 0 0 0

2011 78 267 344 1 0.37 100 100

• 23 51 • 2012 51 177 349 0 0

Kuwait 2005 100 517 517 3 0.58 100 100

2010 100 957 957 3 0.31 100 100

2011 100 672 672 0 0

• 100 100 • 2012 100 737 737 3 0.41 100 100

Lebanon 2005 0.77 3 391 3 100 0

2010 52 269 515 7 2.6 100 100 68

2011 48 236 496 9 3.8 100 100

• 1 67 • 2012 67 424 630 3 0.71 100 100 9

Libyan Arab 2005 2 367

Jamahiriya 2010 2 128 212 10 1.4

2011 97 1 498 1 545 128 8.5 0

– 100 • 2012 100 1 549 1 549 105 6.8

Morocco 2005 26 269

2010 0.75 215 28 788 17 7.9 100 100

2011 6.2 1 856 29 770 41 2.2 100 68

– 20 • 2012 20 5 827 29 399 357 6.1 100 100

Oman 2005 98 257 261 10 3.9 100 100

2010 100 313 313 4 1.3 100 100 0

2011 100 337 337 8 2.4 88 88

• 98 100 • 2012 100 383 383 14 3.7 100 100

Pakistan 2005 0 0 144 771 0

2010 2.3 6 283 269 290 28 0.45 39 43

2011 3.1 8 264 270 394 34 0.41 100 56

• 0 4 • 2012 3.8 10 419 273 097 30 0.29 100 73

Qatar 2005 100 325 325 0 0

2010 0 0 580 0

2011 0 0 553 0

• 100 0 • 2012 0.14 1 728 1 100 100 100

Saudi Arabia 2005 3 539

2010 72 3 278 4 549 77 2.3

2011 86 3 469 4 015 77 2.2 14

– 89 • 2012 89 3 420 3 833 79 2.3

Somalia 2005 0 0 13 006 21 38 0

2010 26 2 741 10 469 231 8.4 68 26

2011 34 4 140 12 021 206 5 85 20 0

• 0 44 • 2012 44 5 359 12 285 192 3.6 79 27

South Sudan 2011 47 3 542 7 583 428 12 82 27

2012 51 4 584 8 924 534 12 62 28

Sudan 2005 0.62 180 29 178 150 83 10 10

2010 28 7 532 27 241 247 3.3 160 100

2011 15 3 082 20 385 292 9.5 0 25

• 1 15 • 2012 15 3 070 19 831 231 7.5 0 17

Syrian Arab 2005 7.9 345 4 393 0 0

Republic 2010 2.2 85 3 827 5 5.9 100 0 0

2011 16 586 3 675 7 1.2 100 100

• 8 53 • 2012 53 1 601 3 035 5 0.31 100 100

Tunisia 2005 6.2 129 2 079 2 1.6 100 100

2010 6.6 156 2 368 7 4.5 100 100 24

2011 12 360 3 015 10 2.8 100 100 38

• 6 18 • 2012 18 593 3 258 14 2.4 100 100 54

United Arab 2005 105

Emirates 2010 64 84 132 4 4.8 100 100

2011 76 81 106 3 3.7 100 100

– 62 • 2012 62 53 85 4 7.5

West Bank 2005 0 0 28 0

and Gaza Strip 2010 100 31 31 0 0

2011 100 32 32 0 0

• 0 100 • 2012 100 32 32 0 0

Yemen 2005 0 0 9 063 0

2010 0 0 9 050 0 0

2011 0 0 8 713 0 0

• 0 6 • 2012 6.2 612 9 950 26 4.2 62 0

220 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Afghanistan 2005 ––

2010 19 238 1.8 34 2.6

2011 19 ––

2012 31 1 100 (0–2 900) 750 (21–2 600) – 400 (93–700) 38 3.0

Bahrain 2005 4 2 2.0 0 –

2010 0 162 70 0 –

2011 9 154 99 0 –

2012 4 2.8 (0.57–8.0) 2.8 (0.57–8.0) 160 110 0 (0–0) 1 –

Djibouti 2005 39 0 0 0 0

2010 ––

2011 0 ––

2012 96 81 (40–120) 31 (1.7–58) – 50 (19–81) –

Egypt 2005 ––

2010 ––

2011 134 39 0.70 497 74

2012 116 330 (270–390) 180 (99–260) 31 0.59 150 (130–180) 438 72

Iran (Islamic 2005 27 205 4.5 41 9.6

Republic of) 2010 58 271 4.7 169 22

2011 43 717 13 322 36

2012 50 750 (590–910) 380 (260–530) 411 6.8 380 (270–480) 207 27

Iraq 2005 ––

2010 110 0 0 185 24

2011 84 – 224 29

2012 62 420 (0–870) 180 (5.1–610) 69 2.5 240 (57–430) 159 21

Jordan 2005 19 98 97 33 330

2010 10 74 63 7 39

2011 4 55 30 6 33

2012 13 15 (5.4–25) 10 (3.7–21) 77 91 5.4 (0.70–13) 6 32

Kuwait 2005 6 516 280 1 100

2010 5 437 100 0 0

2011 0 282 100 0 –

2012 4 0 (0–6.1) 0 (0–6.1) – 0 (0–0) –

Lebanon 2005 3 48 37 4 100

2010 7 4 2.1 14 120

2011 3 18 9.6 1 100

2012 6 9.9 (3.5–16) 3.9 (0.47–14) 10 4.2 6.0 (2.0–8.6) 6 67

Libyan Arab 2005 8 4 0.47 –

Jamahiriya 2010 ––

2011 1 ––

2012 36 (1.0–120) 36 (1.0–120) – – –

Morocco 2005 180 180 1.4 –

2010 54 47 0.38 403 24

2011 45 61 0.50 229 9.8

2012 80 300 (190–410) 66 (22–150) 103 0.85 240 (150–350) 416 21

Oman 2005 5 125 95 11 280

2010 1 185 59 8 89

2011 4 219 100 3 100

2012 6 5.9 (1.2–11) 5.9 (2.2–13) 248 100 0 (0–3.0) 8 100

Pakistan 2005 ––

2010 444 9 <0.1 306 2.8

2011 344 ––

2012 1602 11 000 (0–29 000) 7 700 (220–27 000) 461 0.42 3 700 (880–6 600) 154 1.3

Qatar 2005 2 264 190 0 –

2010 4 324 100 0 –

2011 4 9 1.6 0 –

2012 2 6.3 (1.7–16) 6.3 (1.7–16) 10 2.0 0 (0–0) –

Saudi Arabia 2005 ––

2010 14 ––

2011 22 ––

2012 20 84 (64–100) 46 (36–62) – 37 (28–48) –

Somalia 2005 ––

2010 57 488 9.3 79 11

2011 20 261 4.4 14 2.0

2012 0 770 (600–930) 480 (250–720) 0 0 280 (160–410) 0 0

South Sudan 2011 6 –81.5

2012 3 250 (120–390) 120 (6.5–220) – 140 (52–220) –

Sudan 2005 45 – 4 0.22

2010 49 ––

2011 62 36 0.29 82 4.7

2012 116 580 (280–870) 240 (14–460) 43 0.65 330 (130–540) 129 7.4

Syrian Arab 2005 7 0 0 0 0

Republic 2010 25 63 1.7 12 5.6

2011 24 408 12 70 61

2012 13 97 (65–130) 73 (46–110) 155 13 24 (16–33) 23 30

Tunisia 2005 ––

2010 12 6 0.55 6 17

2011 12 2 0.19 10 20

2012 15 19 (7.0–30) 11 (0–23) 3 0.28 7.6 (2.9–12) 12 19

United Arab 2005 4 ––

Emirates 2010 0 ––

2011 1 3 5.0 0 0

2012 2 2.0 (1.5–2.5) 1.0 (0.51–1.5) 26 52 0.95 (0.74–1.2) 3 38

West Bank 2005 ––

and Gaza Strip 2010 0 0 0 0 –

2011 0 0 0 0 0

2012 0 1.1 (0–3.0) 0.81 (<0.1–2.8) 0 0 0.32 (<0.1–0.56) 0 0

Yemen 2005 1 ––

2010 4 89 1.5 34 7.8

2011

–

2012 8 150

(

100–210

)

110

(

31–180

)

183 5.5 49

(

27–73

)

17 5.1

a TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED

CASES).

b BACT+VE = bacteriologically positive cases.

221 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

hanistan 1995

–

2000 52 228 183 149 129 94 80 93 414 565 339 205 99 36 0.52

2005 151 606 560 472 453 470 419 320 1 651 1 959 1 302 869 471 246 0.46

2010 197 986 819 491 490 641 622 0 445 2 107 2 263 1 455 1 112 831 488 0 0.49

2011 204 1 010 895 613 570 700 692 465 2 167 2 325 1 564 1 146 903 535 0.51

2012 188 1 116 801 586 521 585 651 0 400 2 280 2 204 1 482 1 150 850 505 0 0.50

Bahrain 1995 0012313 0112011 1.7

2000 0032534 0120111 2.8

2005 0002304 1103100 1.5

2010 0 10 16 11 12 4 4 0 0 8 15 7111 1.7

2011 1 5 19 13 14 8 2 0 09566010 2.3

2012 0 9 28 16 11 8 2 0 1 2 11 84100 2.7

ibouti 1995

–

2000 17 302 347 139 67 60 42 12 147 156 47 31 17 10 2.3

2005 18 220 252 119 62 47 29 23 123 117 66 23 13 8 2.0

2010 28 211 243 151 67 49 20 0 20 104 120 89 36 24 19 0 1.9

2011 35 212 265 149 97 45 33 0 31 139 118 104 57 30 21 0 1.7

2012 22 208 240 147 81 47 26 20 132 94 73 36 26 18 1.9

Egypt 1995 223 542 665 460 408 463 160 134 288 367 274 256 160 75 1.9

2000 21 641 827 667 476 307 158 55 457 343 257 211 112 48 2.1

2005 25 524 606 421 414 243 123 48 431 298 205 218 132 42 1.7

2010 9 358 617 783 725 407 217 0 8 199 352 423 292 192 97 0 2.0

2011 23 382 611 596 715 387 168 0 7 192 355 387 280 198 94 0 1.9

2012 23 373 597 582 698 379 164 0 8 187 346 379 274 193 92 0 1.9

Iran (Islamic 1995 118 751 754 636 494 737 921 234 1 039 890 664 613 685 788 0.90

Republic of) 2000 29 438 467 387 295 344 642 77 593 410 322 320 407 647 0.94

2005 16 352 531 338 281 260 630 45 394 205 186 260 382 701 1.1

2010 18 292 487 354 296 310 760 0 54 433 288 208 276 398 1 014 0 0.94

2011 13 289 543 398 315 351 877 0 37 473 313 184 296 441 1 009 0 1.0

2012 16 288 601 442 303 317 850 0 43 434 318 206 252 374 965 0 1.1

Iraq 1995 1 125 862 1 409 1 085 863 900 271 725 304 1 208 915 800 886 200 1.3

2000 21 627 317 297 205 135 101 37 338 241 136 134 103 87 1.6

2005 13 424 644 261 245 189 148 44 305 260 151 197 135 80 1.6

2010 42 370 482 384 276 286 228 73 394 294 198 205 220 166 1.3

2011 35 304 395 313 237 223 183 0 66 368 258 164 159 201 153 0 1.2

2012 27 283 317 263 203 203 180 36 340 225 154 186 174 169 1.1

Jordan 1995 0 19 37 17 20 26 11 1 15 4 10 14 12 7 2.1

2000 0816139142 0891225 2.3

2005 08179465 1666585 1.3

2010 2 5 14 10 12 12 6 0 3 14 24 4 3 5 3 0 1.1

2011 09101381350 081184860 1.3

2012 081285770 191271350 1.2

Kuwait 1995 0 15 51 32 17 9 0 0 8 24 9 4 4 2 2.4

2000 0 10 44 32 21 11 5 1 11 24 12 5 3 1 2.2

2005 0 12 45 29 26 8 3 0 13 31 11 3 1 5 1.9

2010 1 16 67 50 48 10 11 0 4 41 78 30 10 11 8 0 1.1

2011 0 13 41 36 35 11 5 0 0 23 30 15 9 2 2 0 1.7

2012 0 14 59 49 35 15 3 0 3 40 73 15 12 6 4 0 1.1

Lebanon 1995 3 26 32 30 16 16 10 1 16 18 13 8 5 3 2.1

2000 5 16 28 20 15 17 14 4 31 26 9 7 4 6 1.3

2005 0 12 19 15 10 12 8 1 25 14 8 3 3 1 1.4

2010 1 8 21 15 12 12 10 0 0 36 48 17 7 4 3 0 0.69

2011 1 14 18 13 15 6 8 0 37 51 12 9 1 3 0.66

2012 2 18 21 13 14 12 6 2 48 72 16 9 4 3 0.56

Libyan Arab 1995 2 112 212 78 46 22 21 5 34 31 19 20 13 11 3.7

Jamahiriya 2000 5 101 239 86 36 29 32 6 43 35 24 24 16 22 3.1

2005 2 114 293 168 52 19 35 8 36 36 35 21 21 20 3.9

2010 –

2011 5 85 173 148 54 18 21 0 8 59 47 37 22 25 29 0 2.2

2012 2 86 136 136 63 31 22 0 10 47 37 19 24 18 13 0 2.8

Morocco 1995 142 2 508 2 872 1 737 819 573 553 191 1 708 1 288 703 461 317 299 1.9

2000 99 2 061 2 423 1 705 855 485 595 170 1 530 1 121 672 398 406 352 1.8

2005 79 2 222 2 515 1 583 1 057 580 591 167 1 330 943 546 403 343 398 2.1

2010 51 1 982 2 553 1 611 1 273 712 515 0 117 1 098 841 426 386 310 364 0 2.5

2011 79 1 929 2 450 1 479 1 175 682 518 0 100 1 153 794 433 371 324 335 0 2.4

2012 54 1 840 2 426 1 423 1 183 672 561 0 77 1 162 832 408 306 286 342 0 2.4

Oman 1995 1 7 12 7 7 10 11 2 18 13 5 5 6 3 1.1

2000 1 8 9 11 12 9 11 2 17 5 7 5 11 6 1.2

2005 1 21 11 24 15 19 5 2 13 5 3 4 5 3 2.7

2010 2 12 27 15 16 8 10 0 3 18 22 6 4 4 5 0 1.5

2011 1 17 25 12 23 10 11 0 5 20 21 9 13 7 6 0 1.2

2012 0 18 33 23 12 8 19 0 0 20 37 10 10 9 6 0 1.2

Pakistan 1995 29 274 230 178 140 124 95 85 375 381 267 178 143 79 0.71

2000 55 498 387 256 232 153 130 130 591 416 274 163 103 56 0.99

2005 621 5 278 4 759 4 263 3 834 3 332 2 453 1 447 6 463 5 611 3 987 2 866 2 060 1 338 1.0

2010 1 548 11 860 10 462 8 320 7 969 6 934 6 066 3 212 14 481 10 513 7 749 6 410 4 879 4 338 1.0

2011 1 216 12 143 10 515 8 435 8 608 7 320 6 323 2 679 14 652 10 684 7 880 6 590 4 977 3 711 1.1

2012 1 317 12 605 10 838 8 848 9 026 7 753 6 492 0 2 630 15 445 10 902 8 263 6 876 5 494 4 056 0 1.1

Qatar 1995 0 8 12 11 13 4 4 1 2 3 1 0 0 1 6.5

2000 07199721 0043100 5.6

2005 19 15 17 19 5 1 5 10 2 1 2 0 3.8

2010 0 59 72 38 22 5 0 0 0 7 16 2 1 1 0 0 7.3

2011 0 36 64 36 14 10 3 0 9 15 6 1 2 1 4.8

2012 0 34 52 45 21 8 0 160 2 6 9 1 1 0 1 20 8.0

Saudi Arabia 1995 –

2000 0 131 268 213 158 86 107 28 172 182 79 51 50 70 1.5

2005 8 182 276 201 175 70 107 31 205 184 98 73 51 61 1.4

2010 14 335 458 242 210 116 102 0 33 239 271 105 70 49 58 0 1.8

2011 4 227 406 225 225 113 106 0 35 200 245 110 64 49 46 0 1.7

2012 13 228 394 214 210 133 96 0 28 207 236 107 50 49 63 0 1.7

Somalia 1995 46 334 730 201 127 278 109 38 158 139 97 40 25 16 3.6

2000 113 740 724 408 254 195 142 85 354 319 219 110 72 41 2.1

2005 125 1 343 1 114 725 458 330 319 169 752 636 436 292 212 157 1.7

2010 109 1 036 886 496 355 266 277 0 91 467 444 341 188 137 132 0 1.9

2011 113 1 147 1 047 587 398 330 277 0 114 495 465 348 260 168 135 0 2.0

2012 129 1 147 1 014 560 449 296 307 0 121 553 554 396 267 165 169 0 1.8

South Sudan 2011 39 251 599 402 259 135 57 0 60 181 318 239 172 59 26 0 1.7

2012 42 356 753 462 267 135 87 58 212 302 221 139 62 24 2.1

Sudan 1995 250 604 796 634 486 362 337 359 490 613 299 403 342 305 1.2

2000 785 1 028 1 511 1 351 1 119 638 677 817 925 1 134 905 771 327 323 1.4

2005 425 1 358 1 990 1 541 1 151 724 493 381 1 102 1 203 978 729 411 244 1.5

2010 209 1 185 1 781 1 335 863 497 391 195 761 979 772 520 279 191 1.7

2011 107 899 1 359 981 689 386 372 0 113 512 620 513 352 188 175 0 1.9

2012 117 869 1 274 802 466 404 331 0 115 536 562 470 299 170 172 0 1.8

222 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Syrian Arab 1995 13 332 255 111 70 59 50 22 158 97 53 44 37 20 2.1

Republic 2000 8 359 289 125 86 76 55 23 195 101 53 46 38 28 2.1

2005 9 266 237 111 112 62 63 27 182 108 59 59 32 23 1.8

2010 7 170 212 101 80 65 49 0 16 164 105 47 41 38 27 0 1.6

2011 8 139 195 116 81 49 45 0 20 113 97 56 35 36 37 0 1.6

2012 7 91 146 90 85 46 41 5 104 75 35 33 32 19 1.7

Tunisia 1995 –

2000 16 139 208 156 109 65 101 7 68 59 43 21 21 58 2.9

2005 5 103 172 133 115 53 81 7 66 61 39 36 16 28 2.6

2010 9 115 194 170 125 93 88 4 64 64 39 34 40 52 2.7

2011 6 110 194 118 126 108 63 0 10 60 60 50 44 35 47 0 2.4

2012 10 88 191 149 114 93 88 0 7 51 56 46 48 46 72 0 2.2

United Arab 1995 –

Emirates 2000 2 4 4 6 5 12 10 3 16 1 3 0 0 4 1.6

2005 –

2010 171373440 12415130 2.3

2011 03735130 46632120 0.92

2012 02445520 05223440 1.1

West Bank 1995 1200103 0100100 3.5

and Gaza Strip 2000 –

2005 1 1 3 1 1 2.5

2010 02021130 00101200 2.2

2011 10111030 00110200 1.8

2012 02212420 01100110 3.2

Yemen 1995 57 400 605 256 201 148 45 83 420 720 348 200 106 92 0.87

2000 110 789 689 493 314 255 127 161 799 627 517 345 247 92 1.0

2005 48 493 553 366 242 149 78 44 426 410 265 181 85 39 1.3

2010 68 507 569 322 231 164 138 0 98 471 409 264 174 106 63 0 1.3

2011 33 406 471 297 193 143 96 0 85 446 375 251 168 113 58 0 1.1

2012 30 436 472 315 232 172 122 75 437 381 246 207 115 81 1.2

223 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EASTERN MEDITERRANEAN REGION

a LED = Light emitting diode microscopes

b DST = Drug susceptibility testing

c LPA = Line probe assay

d NRL = National Reference Laboratory

7$%/($/DERUDWRULHV173VHUYLFHVGUXJPDQDJHPHQWDQGLQIHFWLRQFRQWURO

LABORATORIES FREE THROUGH NTP

SMEAR LABS

PER 100K

POPULATION

% OF SMEAR

LABS USING

LED

CULTURE

LABS PER 5M

POPULATION

DST

LABS

PER 5M

POPULATION

LPA

LABS

PER 5M

POPULATION

NUMBER OF

LABS USING

XPERT MTB/RIF

SECOND-

LINE DST

AVAILABLE

NRL

TB DIAGNOSIS

FIRST-

LINE

DRUGS

TB NOTIF.

RATE PER

100 000

HEALTH-CARE

WORKERS

RIFAMPICIN

USED

THROUGHOUT

TREATMENT

Afghanistan 2.0 2 0.3 0 0 1 Out of

country Yes Yes (all suspects) Yes No

Bahrain 1.4 11 7.6 3.8 7.6 1 Out of

country No Yes (all suspects) Yes Yes

Djibouti 2.1 0 5.8 5.8 5.8 1 In country Yes Yes (all suspects) Yes Yes

Egypt 0.2 0 1.1 <0.1 0 0 In country Yes Yes (all suspects) Yes Yes 0

Iran (Islamic Republic of) 0.5 0 3.6 0.5 0 0 In country Yes Yes (all suspects) Yes Yes

Iraq 0.8 0 1.5 0.2 0 5 Out of

country Yes Yes (all suspects) Yes Yes 1

Jordan 0.2 0 0.7 0.7 0 1 No Yes Yes (all suspects) Yes Yes 0

Kuwait 0.4 0 1.5 1.5 0 0 No Yes Yes (all suspects) Yes Yes 0

Lebanon 6.0 0 3.2 1.1 2.2 3 Out of

country Yes Yes (all suspects) Yes Yes 0

Libya 0.4 – 6.5 1.6 No Yes Yes (all suspects) Yes Yes

Morocco 0.5 13 2.2 0.3 0 0 No Yes Yes (all suspects) Yes Yes

Oman 7.5 0 13.6 1.5 1.5 0 In country Yes Yes (all suspects) Yes Yes 8

Pakistan 0.8 0 0.2 0.1 <0.1 15 Yes Yes (all suspects) Yes Yes

Qatar <0.1 0 2.4 2.4 2.4 1 Yes Yes (all suspects) Yes Yes 0

Saudi Arabia 0.3 1 2.1 2.1 0.4 8 No Yes Yes (all suspects) Yes Yes

Somalia 0.6 0 0 0 0 3 No No Yes (all suspects) Yes Yes

South Sudan 0.6 – Out of

country No Yes (all suspects) Yes Yes

Sudan 0.8 0 0.1 0.1 0 0 No Yes Yes

(

if TB is

confirmed) Yes Yes

Syrian Arab Republic 1.4 – 0.2 0.2 0.2 0 No Yes Yes (all suspects) Yes Yes 30 508

Tunisia 0.7 0 5.1 2.3 0.5 2 In country Yes Yes (all suspects) Yes Yes

United Arab Emirates – No Yes (all suspects) Yes Yes

West Bank and

Gaza Strip 1.5 0 1.2 0 0 0 No Yes Yes (all suspects) Yes Yes 204

Yemen 1.0 – 0.8 0.4 No Yes Yes

(

if TB is

confirmed) Yes Yes 36

224 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($0HDVXUHGSHUFHQWDJHRI7%FDVHVZLWK0'57%

PRVWUHFHQW\HDUDYDLODEOH

New TB cases Previously treated TB cases

Year Source Coverage Percentage Year Source Coverage Percentage

Afghanistan

Bahrain 2012 Surveillance National 1.9 (0.39–5.4) 2012 Surveillance National 100 (2.5–100)

Djibouti

Egypt 2011 Survey National 3.4 (1.9–4.9) 2012 Surveillance National 25 (21–29)

Iran (Islamic Republic of) 1998 Survey National 5 (3.4–7.0) 1998 Survey National 48 (35–62)

Iraq

Jordan 2009 Surveillance National 6.3 (2.4–13) 2009 Surveillance National 29 (3.7–71)

Kuwait 2011 Surveillance National 0 (0–1.3) 2011 Surveillance National 0 (0–98)

Lebanon 2003 Survey National 1.1 (0.13–3.8) 2012 Surveillance National 67 (22–96)

Libya

Morocco 2006 Survey National 0.48 (0.15–1.1) 2006 Survey National 12 (7.8–18)

Oman 2012 Surveillance National 2.4 (0.89–5.2) 2012 Surveillance National 0 (0–37)

Pakistan

Qatar 2010 Surveillance National 1.2 (0.34–3.1) 2010 Surveillance National 0 (0–98)

Saudi Arabia 2010 Survey National 1.8 (1.4–2.4) 2010 Survey National 16 (12–21)

Somalia 2011 Survey National 5.2 (2.7–7.7) 2011 Survey National 41 (23–58)

South Sudan

Sudan

Syrian Arab Republic 2003 Survey National 6.2 (3.9–9.3) 2011 Surveillance National 31 (21–44)

Tunisia 2012 Survey National 0.82 (0–1.7) 2012 Survey National 12 (4.5–19)

United Arab Emirates

West Bank and

Gaza Strip

Yemen 2011 Survey National 1.7 (0.50–3.0) 2011 Survey National 15 (8.1–22)

a Empty rows indicate an absence of high-quality survey or surveillance data. In the absence of high-quality national data, high-quality sub-national data are used.

'7412'#04')+10

Table A4.1 Estimates of the burden of disease caused by TB, 1990–2012 227

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

Table A4.4 Treatment outcomes, new smear-positive cases, 1995–2011 239

Table A4.5 Treatment outcomes, retreatment cases, 1995–2011 242

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

Table A4.9 Laboratories, NTP services, drug management and infection control, 2012 252

6CDNG# /GCUWTGFRGTEGPVCIGQH6$ECUGUYKVJ/&46$OQUVTGEGPV[GCTCXCKNCDNG 

226 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

Country notes

EU/EEA countries

Notication and treatment outcome data for European Union and European Economic Area countries are provisional.

Denmark

Data for Denmark exclude Greenland.

France

Data from France include data from 5 overseas departments (French Guiana, Guadeloupe, Martinique, Mayotte and

Réunion).

Russian Federation

e reported number of TB patients with known HIV status in 2010–2012 (Table A4.6) is for new TB patients in the civilian

sector only. It was not possible to calculate the percentage of all TB patients with known HIV status.

227 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Albania 1990 3 0.11 (0.081–0.130) 3.1 (2.3–3.9) 1.2 (0.440–2.4) 36 (13–70) 0.84 (0.600–1.1) 24 (18–32)

1995 3 0.023 (0.018–0.028) 0.68 (0.55–0.83) 1.1 (0.420–2.1) 32 (12–61) 0.82 (0.680–0.970) 24 (20–29)

2000 3 0.027 (0.019–0.037) 0.82 (0.57–1.1) 0.98 (0.380–1.8) 30 (12–56) 0.75 (0.630–0.870) 23 (19–26)

2005 3 0.018 (0.013–0.025) 0.57 (0.39–0.79) 0.87 (0.370–1.6) 27 (11–49) 0.63 (0.530–0.730) 20 (17–23)

2010 3 0.012 (<0.01–0.018) 0.38 (0.23–0.58) 0.74 (0.320–1.3) 24 (10–43) 0.53 (0.450–0.620) 17 (14–20)

2011 3 0.011 (<0.01–0.017) 0.34 (0.20–0.53) 0.72 (0.310–1.3) 23 (9.7–42) 0.52 (0.440–0.610) 17 (14–19)

2012 3 <0.01 (<0.01–0.016) 0.31 (0.16–0.49) 0.68 (0.280–1.3) 22 (8.9–40) 0.51 (0.430–0.590) 16 (14–19)

Andorra 1990 < 1 <0.01 (<0.01–<0.01) 2.4 (0.16–7.6) 0.034 (0.013–0.064) 62 (24–118) 0.026 (0.023–0.030) 49 (43–55)

1995 < 1 <0.01 (<0.01–<0.01) 2.1 (<0.1–8.5) 0.033 (0.015–0.058) 51 (23–91) 0.023 (0.020–0.026) 37 (32–41)

2000 < 1 <0.01 (0–<0.01) 1.3 (0–6.2) 0.021 (<0.01–0.035) 31 (15–54) 0.014 (0.012–0.016) 21 (18–24)

2005 < 1 <0.01 (0–<0.01) 0.86 (0–3.9) 0.017 (<0.01–0.029) 21 (9.8–36) 0.012 (0.010–0.013) 14 (12–16)

2010 < 1 <0.01 (<0.01–<0.01) 0.58 (<0.1–2.3) 0.011 (<0.01–0.020) 14 (6.3–26) <0.01 (<0.01–<0.01) 10 (9.1–12)

2011 < 1 <0.01 (<0.01–<0.01) 0.32 (0.16–0.54) <0.01 (<0.01–0.015) 9 (2.7–19) <0.01 (<0.01–<0.01) 4.4 (3.9–5.0)

2012 < 1 <0.01 (0–<0.01) 0.91 (0–4.9) 0.017 (<0.01–0.028) 21 (11–36) 0.01 (<0.01–0.012) 13 (12–15)

Armenia 1990 4 0.16 (0.110–0.200) 4.4 (3.2–5.8) 1 (0.420–1.8) 28 (12–52) 0.63 (0.470–0.810) 18 (13–23)

1995 3 0.19 (0.160–0.230) 6 (4.9–7.2) 1.9 (0.890–3.3) 59 (28–101) 1.2 (1.0–1.4) 38 (32–44)

2000 3 0.19 (0.170–0.220) 6.3 (5.6–7.0) 2.9 (1.4–4.8) 93 (46–158) 1.9 (1.6–2.1) 61 (53–68)

2005 3 0.26 (0.190–0.320) 8.5 (6.5–11) 3.5 (1.7–6.0) 118 (58–198) 2.3 (2.1–2.6) 77 (68–87)

2010 3 0.23 (0.180–0.280) 7.7 (6.1–9.5) 2.7 (1.2–4.8) 92 (42–161) 1.8 (1.6–2.2) 62 (53–73)

2011 3 0.17 (0.130–0.210) 5.6 (4.5–6.9) 2.3 (1.0–4.2) 79 (34–142) 1.6 (1.3–1.9) 55 (45–65)

2012 3 0.19 (0.150–0.230) 6.3 (5.1–7.6) 2.4 (1.1–4.1) 79 (37–137) 1.5 (1.3–1.8) 52 (43–61)

Austria 1990 8 0.14 (0.140–0.140) 1.8 (1.8–1.9) 2.5 (1.1–4.5) 33 (15–58) 1.7 (1.5–2.0) 23 (20–26)

1995 8 0.074 (0.074–0.074) 0.93 (0.92–0.93) 2.5 (1.2–4.4) 32 (15–55) 1.7 (1.5–1.9) 21 (19–24)

2000 8 0.069 (0.069–0.069) 0.86 (0.86–0.86) 2 (0.890–3.5) 25 (11–43) 1.4 (1.2–1.5) 17 (15–19)

2005 8 0.05 (0.050–0.051) 0.61 (0.61–0.61) 1.5 (0.690–2.7) 19 (8.4–33) 1.1 (0.940–1.2) 13 (11–15)

2010 8 0.032 (0.032–0.033) 0.38 (0.38–0.39) 1 (0.420–1.9) 12 (5.0–23) 0.76 (0.660–0.860) 9 (7.9–10)

2011 8 0.04 (0.040–0.041) 0.48 (0.47–0.49) 1.1 (0.510–2.0) 13 (6.0–23) 0.77 (0.680–0.870) 9.2 (8.0–10)

2012 8 0.035 (0.035–0.036) 0.42 (0.41–0.42) 0.91 (0.370–1.7) 11 (4.4–20) 0.67 (0.590–0.760) 7.9 (6.9–8.9)

Azerbaijan 1990 7 0.82 (0.610–1.1) 11 (8.5–15) 54 (25–94) 744 (343–1 300) 22 (18–26) 305 (252–363)

1995 8 1.8 (1.3–2.3) 23 (17–29) 120 (56–220) 1 600 (717–2 820) 49 (41–59) 637 (526–759)

2000 8 1.8 (1.4–2.2) 22 (17–27) 140 (62–240) 1 690 (768–2 970) 55 (46–66) 682 (563–813)

2005 9 0.82 (0.660–1.0) 9.6 (7.7–12) 66 (31–110) 776 (366–1 340) 29 (24–34) 335 (276–398)

2010 9 0.39 (0.330–0.440) 4.2 (3.7–4.9) 20 (9.9–34) 221 (109–371) 12 (9.8–14) 131 (108–156)

2011 9 0.39 (0.340–0.450) 4.2 (3.7–4.9) 16 (7.3–28) 172 (79–302) 10 (8.6–12) 113 (93–135)

2012 9 0.39 (0.340–0.450) 4.2 (3.7–4.9) 12 (4.1–23) 124 (44–245) 8.9 (7.3–11) 95 (78–114)

Belarus 1990 10 0.5 (0.470–0.540) 4.9 (4.6–5.2) 5.2 (2.2–9.5) 51 (22–93) 3.5 (2.8–4.3) 34 (27–42)

1995 10 0.76 (0.700–0.830) 7.5 (6.9–8.1) 11 (5.1–19) 106 (51–182) 6.9 (5.9–8.1) 68 (58–80)

2000 10 0.8 (0.760–0.850) 8.1 (7.6–8.5) 13 (6.0–23) 130 (60–225) 8.4 (6.9–9.9) 84 (69–100)

2005 10 1.1 (0.990–1.1) 11 (10–12) 11 (4.4–19) 109 (46–199) 6.9 (5.3–8.8) 72 (55–91)

2010 9 0.76 (0.700–0.820) 8 (7.3–8.6) 10 (4.6–18) 107 (48–189) 6.7 (5.3–8.1) 70 (56–86)

2011 9 0.66 (0.600–0.720) 7 (6.3–7.7) 10 (4.6–18) 107 (49–188) 6.6 (5.4–8.0) 70 (57–85)

2012 9 0.57 (0.510–0.630) 6 (5.4–6.7) 10 (4.7–18) 108 (50–188) 6.6 (5.4–8.0) 70 (57–85)

Belgium 1990 10 0.1 (0.097–0.100) 1 (0.97–1.0) 2.6 (1.1–4.6) 26 (11–46) 1.8 (1.6–2.1) 18 (16–21)

1995 10 0.13 (0.130–0.130) 1.3 (1.3–1.3) 2.2 (0.930–3.9) 21 (9.1–39) 1.6 (1.4–1.8) 16 (14–18)

2000 10 0.081 (0.080–0.083) 0.79 (0.78–0.81) 2.1 (0.920–3.7) 20 (9.0–36) 1.5 (1.3–1.7) 14 (13–16)

2005 11 0.062 (0.062–0.063) 0.59 (0.59–0.60) 1.7 (0.690–3.0) 16 (6.6–29) 1.2 (1.1–1.4) 12 (10–13)

2010 11 0.043 (0.043–0.044) 0.4 (0.39–0.40) 1.7 (0.740–2.9) 15 (6.8–27) 1.2 (1.0–1.3) 11 (9.5–12)

2011 11 0.041 (0.041–0.042) 0.38 (0.37–0.38) 1.5 (0.660–2.8) 14 (6.0–25) 1.1 (0.990–1.3) 10 (9.0–12)

2012 11 0.04 (0.039–0.040) 0.36 (0.35–0.36) 1.4 (0.560–2.6) 13 (5.1–24) 1.1 (0.940–1.2) 9.7 (8.5–11)

Bosnia and 1990 5 0.46 (0.440–0.480) 10 (9.7–11) 6.5 (1.9–14) 145 (43–307) 4.2 (2.6–6.2) 94 (58–138)

Herzegovina 1995 4 0.22 (0.210–0.230) 6.3 (5.9–6.6) 4.6 (2.1–8.1) 131 (59–229) 3 (2.4–3.6) 84 (69–101)

2000 4 0.23 (0.210–0.240) 5.9 (5.5–6.3) 2.8 (0.830–5.9) 73 (22–154) 2.4 (2.0–2.9) 63 (51–75)

2005 4 0.21 (0.200–0.230) 5.5 (5.0–6.0) 2.3 (0.640–5.0) 59 (17–129) 2 (1.7–2.4) 52 (43–63)

2010 4 0.2 (0.180–0.220) 5.2 (4.6–5.7) 2.6 (1.1–4.7) 67 (28–123) 1.9 (1.6–2.2) 50 (43–57)

2011 4 0.2 (0.170–0.220) 5.1 (4.6–5.7) 2.7 (1.2–4.8) 70 (31–124) 1.9 (1.6–2.2) 49 (42–56)

2012 4 0.2 (0.180–0.220) 5.2 (4.6–5.8) 2.8 (1.3–4.8) 73 (35–126) 1.9 (1.6–2.1) 49 (42–56)

Bulgaria 1990 9 0.22 (0.210–0.220) 2.4 (2.4–2.5) 4.2 (1.9–7.5) 48 (21–85) 2.9 (2.5–3.3) 33 (29–37)

1995 8 0.34 (0.340–0.350) 4.1 (4.0–4.2) 8.4 (4.2–14) 101 (51–169) 5.2 (4.5–5.9) 62 (54–71)

2000 8 0.59 (0.570–0.600) 7.3 (7.2–7.5) 7 (3.3–12) 88 (42–151) 4.6 (4.0–5.3) 58 (50–66)

2005 8 0.26 (0.260–0.270) 3.4 (3.4–3.5) 6.2 (3.0–11) 81 (39–139) 4.1 (3.6–4.6) 53 (46–61)

2010 7 0.19 (0.190–0.190) 2.6 (2.5–2.6) 3.9 (1.6–7.1) 53 (22–97) 2.8 (2.5–3.2) 38 (33–43)

2011 7 0.16 (0.160–0.160) 2.2 (2.2–2.2) 3.5 (1.4–6.4) 48 (20–88) 2.6 (2.2–2.9) 35 (30–40)

2012 7 0.15 (0.150–0.150) 2 (2.0–2.1) 3.1 (1.3–5.8) 43 (17–80) 2.3 (2.0–2.6) 32 (28–36)

Croatia 1990 5 0.39 (0.380–0.410) 8.2 (8.0–8.5) 4.4 (2.1–7.7) 92 (43–160) 3 (2.6–3.4) 62 (54–70)

1995 5 0.25 (0.240–0.270) 5.4 (5.0–5.7) 3.3 (1.3–6.1) 70 (28–130) 2.4 (2.1–2.8) 52 (45–59)

2000 4 0.19 (0.180–0.200) 4.2 (4.0–4.4) 2.5 (1.0–4.7) 57 (23–105) 1.9 (1.6–2.1) 42 (37–47)

2005 4 0.11 (0.110–0.110) 2.5 (2.5–2.5) 1.6 (0.620–3.0) 36 (14–69) 1.2 (1.1–1.4) 28 (24–31)

2010 4 0.082 (0.082–0.083) 1.9 (1.9–1.9) 1.1 (0.420–2.0) 24 (9.7–46) 0.79 (0.690–0.900) 18 (16–21)

2011 4 0.066 (0.066–0.067) 1.5 (1.5–1.5) 0.96 (0.390–1.8) 22 (9.1–41) 0.71 (0.620–0.810) 16 (14–19)

2012 4 0.061 (0.060–0.062) 1.4 (1.4–1.4) 0.84 (0.340–1.6) 20 (7.9–36) 0.62 (0.540–0.700) 14 (13–16)

Cyprus 1990 < 1 <0.01 (<0.01–<0.01) 0.2 (0.16–0.25) 0.038 (0.011–0.080) 5 (1.5–10) 0.033 (0.029–0.038) 4.4 (3.8–4.9)

1995 < 1 <0.01 (<0.01–<0.01) 0.2 (0.16–0.25) 0.05 (0.017–0.100) 5.8 (2.0–12) 0.041 (0.036–0.047) 4.8 (4.2–5.5)

2000 < 1 0 (0–0) 0 (0–0) 0.045 (0.015–0.091) 4.8 (1.6–9.6) 0.038 (0.033–0.043) 4 (3.5–4.6)

2005 1 <0.01 (<0.01–<0.01) 0.37 (0.32–0.41) 0.051 (0.020–0.095) 4.9 (2.0–9.2) 0.039 (0.034–0.044) 3.8 (3.3–4.3)

2010 1 <0.01 (<0.01–<0.01) 0.11 (0.10–0.13) 0.1 (0.049–0.180) 9.4 (4.4–16) 0.07 (0.061–0.079) 6.4 (5.6–7.2)

2011 1 <0.01 (<0.01–<0.01) 0.21 (0.19–0.23) 0.069 (0.023–0.140) 6.2 (2.1–13) 0.059 (0.051–0.066) 5.3 (4.6–5.9)

2012 1 <0.01 (<0.01–<0.01) 0.2 (0.16–0.25) 0.069 (0.021–0.150) 6.1 (1.8–13) 0.061 (0.053–0.069) 5.4 (4.7–6.1)

Czech Republic 1990 10 0.19 (0.190–0.190) 1.8 (1.8–1.8) 3.1 (1.3–5.6) 30 (12–54) 2.2 (2.0–2.5) 22 (19–24)

1995 10 0.092 (0.091–0.092) 0.89 (0.88–0.89) 2.8 (1.1–5.3) 27 (11–51) 2.1 (1.8–2.4) 20 (18–23)

2000 10 0.12 (0.120–0.120) 1.2 (1.2–1.2) 2.2 (0.880–4.1) 21 (8.6–40) 1.6 (1.4–1.8) 16 (14–18)

2005 10 0.065 (0.064–0.065) 0.63 (0.63–0.63) 1.6 (0.690–2.8) 15 (6.7–28) 1.1 (0.980–1.3) 11 (9.6–12)

2010 11 0.035 (0.035–0.035) 0.33 (0.33–0.34) 0.99 (0.420–1.8) 9.4 (4.0–17) 0.72 (0.630–0.820) 6.8 (6.0–7.7)

2011 11 0.051 (0.050–0.051) 0.48 (0.47–0.48) 0.9 (0.380–1.6) 8.5 (3.6–16) 0.65 (0.570–0.740) 6.2 (5.4–7.0)

2012 11 0.037 (0.037–0.037) 0.35 (0.35–0.35) 0.77 (0.310–1.4) 7.2 (2.9–13) 0.57 (0.500–0.640) 5.3 (4.7–6.0)

Denmark 1990 5 0.054 (0.053–0.056) 1.1 (1.0–1.1) 0.61 (0.300–1.0) 12 (5.8–20) 0.4 (0.350–0.460) 7.8 (6.9–8.9)

1995 5 0.024 (0.023–0.025) 0.47 (0.45–0.48) 0.64 (0.220–1.3) 12 (4.3–24) 0.52 (0.450–0.580) 9.8 (8.6–11)

2000 5 0.021 (0.020–0.021) 0.38 (0.38–0.39) 1 (0.490–1.7) 19 (9.1–33) 0.68 (0.590–0.760) 13 (11–14)

2005 5 0.019 (0.019–0.020) 0.36 (0.35–0.36) 0.67 (0.310–1.2) 12 (5.7–21) 0.45 (0.400–0.510) 8.4 (7.3–9.5)

2010 6 0.035 (0.034–0.036) 0.63 (0.61–0.66) 0.46 (0.170–0.880) 8.3 (3.1–16) 0.36 (0.320–0.410) 6.5 (5.7–7.3)

2011 6 0.017 (0.016–0.018) 0.3 (0.28–0.32) 0.58 (0.260–1.0) 10 (4.6–19) 0.41 (0.360–0.470) 7.4 (6.5–8.4)

2012 6 0.022 (0.021–0.023) 0.4 (0.38–0.42) 0.56 (0.240–1.0) 10 (4.2–18) 0.41 (0.360–0.470) 7.4 (6.5–8.4)

Estonia 1990 2 0.071 (0.070–0.072) 4.5 (4.5–4.6) 0.81 (0.410–1.3) 52 (26–85) 0.49 (0.430–0.550) 31 (27–35)

1995 1 0.15 (0.140–0.150) 10 (9.9–10) 0.93 (0.350–1.8) 65 (24–125) 0.72 (0.630–0.810) 50 (44–57)

2000 1 0.11 (0.110–0.110) 8 (7.9–8.2) 1.3 (0.610–2.3) 97 (45–168) 0.91 (0.800–1.0) 67 (58–75)

2005 1 0.049 (0.048–0.050) 3.7 (3.6–3.8) 0.7 (0.280–1.3) 53 (21–98) 0.55 (0.480–0.620) 42 (36–47)

2010 1 0.036 (0.035–0.036) 2.7 (2.7–2.8) 0.37 (0.130–0.740) 29 (10–57) 0.33 (0.290–0.370) 25 (22–28)

2011 1 0.036 (0.036–0.037) 2.8 (2.8–2.8) 0.44 (0.200–0.780) 34 (15–60) 0.34 (0.300–0.390) 26 (23–30)

2012 1 0.036 (0.036–0.036) 2.8 (2.8–2.8) 0.38 (0.160–0.680) 29 (13–52) 0.3 (0.260–0.340) 23 (20–26)

Finland 1990 5 0.13 (0.130–0.130) 2.5 (2.5–2.5) 1.3 (0.550–2.3) 25 (11–45) 0.89 (0.780–1.0) 18 (16–20)

1995 5 0.092 (0.092–0.092) 1.8 (1.8–1.8) 1.1 (0.500–1.9) 22 (9.8–38) 0.76 (0.670–0.860) 15 (13–17)

2000 5 0.083 (0.083–0.084) 1.6 (1.6–1.6) 0.85 (0.370–1.5) 16 (7.2–30) 0.61 (0.530–0.690) 12 (10–13)

2005 5 0.037 (0.037–0.037) 0.71 (0.71–0.71) 0.55 (0.240–0.980) 10 (4.5–19) 0.39 (0.340–0.440) 7.4 (6.5–8.4)

2010 5 0.016 (0.016–0.016) 0.3 (0.30–0.30) 0.48 (0.190–0.900) 9 (3.6–17) 0.36 (0.310–0.410) 6.7 (5.9–7.6)

2011 5 0.021 (0.021–0.021) 0.39 (0.39–0.39) 0.48 (0.190–0.900) 8.9 (3.6–17) 0.36 (0.310–0.410) 6.7 (5.8–7.5)

2012 5 0.015 (0.015–0.015) 0.29 (0.28–0.29) 0.39 (0.130–0.790) 7.2 (2.4–15) 0.3 (0.260–0.340) 5.5 (4.9–6.3)

France 1990 57 1 (0.980–1.0) 1.8 (1.7–1.8) 16 (7.7–26) 28 (14–47) 11 (11–12) 20 (19–21)

1995 58 0.79 (0.760–0.810) 1.4 (1.3–1.4) 16 (8.5–27) 28 (15–46) 11 (10–12) 19 (18–20)

2000 59 0.65 (0.630–0.670) 1.1 (1.1–1.1) 11 (5.6–19) 19 (9.4–31) 7.7 (7.2–8.1) 13 (12–14)

2005 61 0.43 (0.410–0.440) 0.7 (0.68–0.72) 8.5 (4.0–15) 14 (6.4–24) 6.3 (5.9–6.7) 10 (9.5–11)

2010 63 0.33 (0.320–0.350) 0.53 (0.51–0.55) 8.9 (4.6–15) 14 (7.3–23) 6 (5.6–6.4) 9.5 (8.9–10)

2011 64 0.31 (0.300–0.330) 0.5 (0.47–0.52) 8.7 (4.5–14) 14 (7.1–22) 5.9 (5.5–6.2) 9.2 (8.6–9.8)

2012 64 0.3 (0.280–0.310) 0.46 (0.44–0.49) 7.4 (3.7–12) 12 (5.7–20) 5.3 (4.9–5.6) 8.2 (7.7–8.7)

Rates are per 100 000 population.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Georgia 1990 5 0.48 (0.430–0.550) 8.9 (7.8–10) 38 (18–67) 704 (326–1 220) 15 (14–17) 280 (250–312)

1995 5 0.42 (0.360–0.470) 8.2 (7.2–9.3) 29 (15–48) 571 (290–944) 13 (12–15) 263 (234–293)

2000 5 0.37 (0.320–0.420) 7.7 (6.7–8.8) 24 (13–40) 516 (270–840) 12 (11–14) 256 (228–285)

2005 4 0.17 (0.150–0.200) 3.8 (3.3–4.5) 14 (7.5–23) 315 (168–508) 7.8 (7.0–8.7) 175 (156–195)

2010 4 0.67 (0.370–1.1) 15 (8.4–24) 8.2 (3.8–14) 186 (87–323) 5.6 (5.0–6.2) 128 (114–142)

2011 4 0.2 (0.160–0.240) 4.5 (3.7–5.5) 7.9 (3.7–14) 182 (84–316) 5.5 (4.9–6.1) 125 (112–140)

2012 4 0.2 (0.160–0.240) 4.5 (3.7–5.5) 6.9 (2.9–13) 158 (67–288) 5 (4.5–5.6) 116 (103–130)

Germany 1990 80 1.1 (1.0–1.1) 1.3 (1.3–1.3) 23 (10–42) 29 (13–53) 17 (15–19) 21 (18–24)

1995 83 1.2 (1.2–1.2) 1.4 (1.4–1.5) 19 (7.8–35) 23 (9.3–42) 14 (12–16) 17 (15–19)

2000 84 0.49 (0.490–0.500) 0.59 (0.58–0.60) 15 (6.6–26) 18 (8.0–32) 10 (9.1–12) 12 (11–14)

2005 84 0.32 (0.320–0.330) 0.39 (0.38–0.39) 9.3 (4.1–17) 11 (4.9–20) 6.6 (5.7–7.4) 7.8 (6.9–8.8)

2010 83 0.3 (0.290–0.300) 0.36 (0.35–0.36) 6.4 (2.7–12) 7.7 (3.2–14) 4.7 (4.1–5.3) 5.6 (4.9–6.4)

2011 83 0.29 (0.280–0.290) 0.35 (0.34–0.35) 6.6 (2.9–12) 7.9 (3.5–14) 4.7 (4.1–5.3) 5.7 (5.0–6.4)

2012 83 0.29 (0.280–0.290) 0.35 (0.34–0.35) 6.4 (2.8–12) 7.8 (3.3–14) 4.6 (4.1–5.3) 5.6 (4.9–6.4)

Greece 1990 10 0.16 (0.160–0.170) 1.6 (1.5–1.7) 1.5 (0.690–2.6) 15 (6.8–25) 1 (0.880–1.1) 9.9 (8.7–11)

1995 11 0.16 (0.150–0.170) 1.5 (1.4–1.6) 1.5 (0.620–2.7) 14 (5.8–25) 1.1 (0.950–1.2) 10 (8.9–11)

2000 11 0.089 (0.085–0.092) 0.81 (0.77–0.84) 1 (0.390–2.0) 9.5 (3.6–18) 0.81 (0.710–0.920) 7.4 (6.4–8.3)

2005 11 0.094 (0.090–0.098) 0.85 (0.81–0.89) 1.2 (0.590–2.1) 11 (5.3–19) 0.8 (0.700–0.900) 7.2 (6.3–8.2)

2010 11 0.074 (0.070–0.078) 0.66 (0.63–0.70) 0.62 (0.200–1.3) 5.6 (1.8–11) 0.51 (0.450–0.580) 4.6 (4.0–5.2)

2011 11 0.078 (0.075–0.082) 0.7 (0.67–0.74) 0.7 (0.280–1.3) 6.3 (2.6–12) 0.52 (0.460–0.590) 4.7 (4.1–5.3)

2012 11 0.076 (0.073–0.080) 0.69 (0.65–0.72) 0.71 (0.310–1.3) 6.3 (2.8–11) 0.5 (0.440–0.570) 4.5 (3.9–5.1)

Greenland 1990 < 1 <0.01 (<0.01–0.017) 9.5 (0.61–30) 0.14 (0.053–0.260) 245 (96–462) 0.11 (0.093–0.120) 191 (167–216)

1995 < 1 <0.01 (<0.01–0.017) 9.5 (0.61–30) 0.14 (0.054–0.260) 245 (96–463) 0.11 (0.093–0.120) 191 (167–216)

2000 < 1 <0.01 (<0.01–0.017) 9.5 (0.61–30) 0.14 (0.053–0.260) 245 (95–464) 0.11 (0.094–0.120) 191 (167–216)

2005 < 1 <0.01 (<0.01–0.018) 9.6 (0.54–31) 0.14 (0.056–0.260) 247 (98–463) 0.11 (0.095–0.120) 191 (167–216)

2010 < 1 <0.01 (<0.01–0.038) 14 (<0.1–66) 0.2 (0.092–0.340) 345 (163–595) 0.13 (0.110–0.150) 232 (203–262)

2011 < 1 <0.01 (<0.01–0.038) 14 (<0.1–66) 0.2 (0.092–0.340) 346 (163–596) 0.13 (0.120–0.150) 234 (205–264)

2012 < 1 <0.01 (<0.01–<0.01) 6.7 (1.8–15) 0.11 (0.032–0.230) 190 (57–401) 0.097 (0.085–0.110) 170 (149–193)

Hungary 1990 10 0.55 (0.550–0.550) 5.3 (5.3–5.3) 5.5 (2.3–10) 53 (22–96) 4 (3.5–4.5) 39 (34–44)

1995 10 0.57 (0.570–0.580) 5.5 (5.5–5.6) 6.9 (3.0–12) 67 (29–120) 4.9 (4.3–5.6) 48 (42–54)

2000 10 0.36 (0.350–0.360) 3.5 (3.5–3.5) 5.2 (2.2–9.6) 51 (22–94) 3.8 (3.3–4.3) 37 (33–42)

2005 10 0.18 (0.180–0.180) 1.8 (1.8–1.8) 3 (1.2–5.5) 29 (12–55) 2.2 (1.9–2.5) 22 (19–25)

2010 10 0.1 (0.100–0.100) 1 (1.0–1.0) 2.6 (1.3–4.5) 26 (13–45) 1.7 (1.5–2.0) 17 (15–19)

2011 10 0.075 (0.075–0.075) 0.75 (0.75–0.75) 2.9 (1.4–4.8) 29 (14–48) 1.8 (1.6–2.0) 18 (16–20)

2012 10 0.073 (0.073–0.073) 0.73 (0.73–0.73) 2.9 (1.4–4.8) 29 (14–48) 1.8 (1.6–2.0) 18 (16–20)

Iceland 1990 < 1 <0.01 (<0.01–<0.01) 0.4 (0.40–0.40) 0.03 (0.014–0.053) 12 (5.5–21) 0.021 (0.018–0.023) 8.1 (7.1–9.2)

1995 < 1 <0.01 (<0.01–<0.01) 0.71 (0.71–0.71) 0.017 (<0.01–0.034) 6.3 (2.2–13) 0.014 (0.012–0.016) 5.2 (4.5–5.8)

2000 < 1 <0.01 (<0.01–<0.01) 0.36 (0.36–0.37) 0.023 (0.011–0.038) 8.1 (4.0–14) 0.015 (0.013–0.017) 5.3 (4.7–6.0)

2005 < 1 <0.01 (<0.01–<0.01) 0.33 (0.33–0.33) 0.016 (<0.01–0.028) 5.3 (2.4–9.3) 0.012 (0.010–0.013) 3.9 (3.4–4.4)

2010 < 1 <0.01 (<0.01–<0.01) 0.29 (0.29–0.29) 0.046 (0.024–0.075) 14 (7.5–24) 0.025 (0.022–0.029) 8 (7.0–9.0)

2011 < 1 <0.01 (<0.01–<0.01) 0.28 (0.28–0.28) 0.013 (<0.01–0.027) 4.1 (1.4–8.4) <0.01 (<0.01–0.010) 2.9 (2.5–3.2)

2012 < 1 <0.01 (<0.01–<0.01) 0.27 (0.27–0.27) 0.014 (<0.01–0.028) 4.3 (1.5–8.5) 0.012 (0.010–0.013) 3.5 (3.1–4.0)

Ireland 1990 4 0.051 (0.051–0.052) 1.5 (1.4–1.5) 0.94 (0.360–1.8) 27 (10–51) 0.72 (0.630–0.810) 20 (18–23)

1995 4 0.036 (0.036–0.036) 1 (1.0–1.0) 0.68 (0.260–1.3) 19 (7.1–36) 0.53 (0.460–0.600) 15 (13–17)

2000 4 0.059 (0.058–0.059) 1.5 (1.5–1.5) 0.59 (0.240–1.1) 16 (6.2–29) 0.44 (0.390–0.500) 12 (10–13)

2005 4 0.015 (0.015–0.015) 0.37 (0.37–0.37) 0.68 (0.290–1.2) 16 (7.1–29) 0.49 (0.430–0.550) 12 (10–13)

2010 4 0.027 (0.027–0.027) 0.61 (0.61–0.61) 0.61 (0.250–1.1) 14 (5.5–25) 0.46 (0.400–0.520) 10 (8.9–12)

2011 5 0.02 (0.019–0.020) 0.43 (0.43–0.43) 0.64 (0.280–1.1) 14 (6.2–25) 0.46 (0.400–0.520) 10 (8.9–11)

2012 5 0.018 (0.018–0.018) 0.39 (0.38–0.39) 0.5 (0.180–0.970) 11 (4.0–21) 0.39 (0.340–0.440) 8.6 (7.5–9.7)

Israel 1990 4 0.02 (0.020–0.021) 0.45 (0.43–0.46) 0.39 (0.130–0.780) 8.6 (2.9–17) 0.27 (0.240–0.300) 6 (5.2–6.8)

1995 5 0.072 (0.069–0.074) 1.3 (1.3–1.4) 0.56 (0.190–1.1) 10 (3.6–21) 0.46 (0.400–0.520) 8.6 (7.5–9.7)

2000 6 0.034 (0.034–0.035) 0.57 (0.56–0.58) 0.85 (0.370–1.5) 14 (6.1–25) 0.62 (0.540–0.700) 10 (9.0–12)

2005 7 0.022 (0.022–0.023) 0.34 (0.33–0.35) 0.54 (0.200–1.0) 8.1 (3.1–16) 0.43 (0.370–0.480) 6.5 (5.7–7.3)

2010 7 0.017 (0.017–0.018) 0.23 (0.23–0.24) 0.46 (0.150–0.940) 6.1 (2.0–13) 0.39 (0.340–0.440) 5.3 (4.6–6.0)

2011 8 0.017 (0.017–0.018) 0.23 (0.22–0.23) 0.63 (0.260–1.2) 8.3 (3.5–15) 0.47 (0.420–0.540) 6.3 (5.5–7.1)

2012 8 0.017 (0.017–0.018) 0.23 (0.22–0.23) 0.85 (0.400–1.5) 11 (5.2–19) 0.58 (0.510–0.660) 7.6 (6.7–8.6)

Italy 1990 57 0.61 (0.590–0.630) 1.1 (1.0–1.1) 7 (3.2–12) 12 (5.6–22) 4.9 (4.3–5.5) 8.6 (7.5–9.7)

1995 57 0.68 (0.660–0.690) 1.2 (1.2–1.2) 9.7 (4.6–17) 17 (8.1–29) 6.5 (5.7–7.3) 11 (10–13)

2000 57 0.5 (0.480–0.520) 0.87 (0.84–0.91) 5.1 (1.7–10) 9 (3.0–18) 4 (3.5–4.6) 7.1 (6.2–8.0)

2005 59 0.37 (0.370–0.370) 0.63 (0.63–0.64) 6.1 (2.6–11) 10 (4.4–19) 4.4 (3.9–5.0) 7.5 (6.6–8.5)

2010 61 0.3 (0.300–0.300) 0.49 (0.49–0.50) 4.5 (1.6–9.0) 7.5 (2.6–15) 3.7 (3.2–4.1) 6 (5.3–6.8)

2011 61 0.28 (0.280–0.280) 0.46 (0.46–0.47) 5.3 (2.2–9.8) 8.8 (3.6–16) 3.9 (3.4–4.5) 6.5 (5.7–7.3)

2012 61 0.26 (0.260–0.270) 0.43 (0.43–0.44) 5.7 (2.5–10) 9.4 (4.1–17) 4.1 (3.6–4.6) 6.7 (5.8–7.5)

Kazakhstan 1990 16 2.1 (1.9–2.3) 13 (11–14) 19 (8.3–33) 116 (51–207) 13 (11–15) 79 (66–92)

1995 16 5.2 (4.8–5.6) 33 (31–36) 110 (54–180) 706 (347–1 190) 50 (42–58) 318 (269–372)

2000 15 4.8 (4.3–5.3) 33 (29–37) 97 (50–160) 668 (344–1 100) 51 (43–60) 351 (297–411)

2005 15 4.2 (3.8–4.5) 28 (25–30) 51 (23–92) 340 (149–608) 35 (30–41) 235 (199–275)

2010 16 2.1 (1.9–2.4) 13 (12–15) 42 (19–75) 266 (118–472) 29 (24–34) 182 (154–213)

2011 16 1.7 (1.5–1.9) 11 (9.1–12) 50 (25–85) 312 (154–526) 31 (26–36) 193 (163–225)

2012 16 1.3 (1.0–1.5) 7.8 (6.3–9.3) 31 (12–57) 189 (77–350) 22 (19–26) 137 (116–160)

Kyrgyzstan 1990 4 0.4 (0.340–0.470) 9.1 (7.6–11) 7.5 (3.8–12) 170 (86–283) 4 (3.3–4.8) 92 (76–109)

1995 5 0.72 (0.620–0.830) 16 (13–18) 15 (7.5–25) 326 (164–542) 7.7 (6.4–9.2) 168 (138–200)

2000 5 1.3 (1.1–1.4) 25 (23–28) 22 (11–37) 449 (227–747) 12 (10–15) 249 (205–296)

2005 5 0.82 (0.810–0.830) 16 (16–16) 17 (8.0–29) 334 (159–571) 10 (8.6–12) 208 (171–248)

2010 5 0.61 (0.610–0.610) 11 (11–12) 11 (4.7–20) 204 (89–367) 7.5 (6.2–9.0) 141 (116–168)

2011 5 0.57 (0.560–0.570) 10 (10–11) 11 (5.2–20) 211 (96–370) 7.6 (6.3–9.1) 141 (116–168)

2012 5 0.52 (0.510–0.530) 9.5 (9.3–9.8) 12 (5.5–21) 217 (101–376) 7.7 (6.4–9.2) 141 (116–168)

Latvia 1990 3 0.19 (0.190–0.190) 7.2 (7.1–7.3) 3 (1.6–4.9) 114 (60–186) 1.5 (1.3–1.7) 57 (50–65)

1995 2 0.34 (0.340–0.350) 14 (14–14) 5.9 (3.1–9.6) 237 (125–385) 3.1 (2.7–3.5) 126 (111–142)

2000 2 0.3 (0.290–0.310) 13 (12–13) 4.6 (2.3–7.6) 194 (99–321) 2.9 (2.5–3.2) 121 (106–137)

2005 2 0.18 (0.180–0.190) 8.1 (7.9–8.3) 2.3 (0.990–4.1) 102 (45–183) 1.7 (1.5–1.9) 75 (66–85)

2010 2 0.083 (0.080–0.086) 4 (3.8–4.1) 1.3 (0.540–2.4) 63 (26–117) 1 (0.930–1.2) 50 (45–56)

2011 2 0.068 (0.066–0.070) 3.3 (3.2–3.4) 1.2 (0.520–2.3) 60 (25–111) 0.99 (0.890–1.1) 48 (43–53)

2012 2 0.053 (0.052–0.054) 2.6 (2.5–2.6) 1.6 (0.780–2.6) 76 (38–127) 1.1 (1.0–1.2) 53 (49–58)

Lithuania 1990 4 0.26 (0.260–0.260) 7 (7.0–7.0) 2.5 (1.2–4.4) 69 (32–118) 1.6 (1.4–1.9) 44 (37–52)

1995 4 0.49 (0.490–0.500) 14 (13–14) 4.9 (2.4–8.5) 136 (65–234) 3.2 (2.8–3.7) 89 (77–102)

2000 3 0.37 (0.360–0.370) 11 (10–11) 5.5 (2.7–9.3) 157 (78–265) 3.6 (3.2–4.0) 103 (92–114)

2005 3 0.36 (0.360–0.360) 11 (11–11) 4.2 (2.0–7.2) 127 (60–219) 2.8 (2.5–3.2) 87 (76–97)

2010 3 0.21 (0.210–0.210) 6.9 (6.8–6.9) 3.1 (1.4–5.6) 103 (46–181) 2.2 (1.9–2.5) 73 (63–82)

2011 3 0.15 (0.150–0.150) 5 (4.9–5.0) 3 (1.3–5.2) 97 (44–171) 2.1 (1.8–2.4) 69 (61–78)

2012 3 0.09 (0.088–0.091) 3 (2.9–3.0) 2.8 (1.3–5.0) 93 (42–164) 2 (1.8–2.3) 66 (58–75)

Luxembourg 1990 < 1 <0.01 (<0.01–<0.01) 0.55 (0.54–0.56) 0.083 (0.039–0.140) 22 (10–37) 0.055 (0.048–0.062) 14 (13–16)

1995 < 1 0 (0–0) 0 (0–0) 0.045 (0.015–0.091) 11 (3.7–22) 0.037 (0.032–0.042) 9 (7.9–10)

2000 < 1 <0.01 (<0.01–<0.01) 0.24 (0.23–0.24) 0.076 (0.036–0.130) 17 (8.4–30) 0.051 (0.044–0.057) 12 (10–13)

2005 < 1 <0.01 (<0.01–<0.01) 0.22 (0.21–0.22) 0.06 (0.026–0.110) 13 (5.7–23) 0.043 (0.037–0.048) 9.3 (8.1–11)

2010 < 1 <0.01 (<0.01–<0.01) 0.19 (0.19–0.20) 0.045 (0.019–0.083) 8.9 (3.8–16) 0.033 (0.029–0.038) 6.6 (5.8–7.4)

2011 < 1 <0.01 (<0.01–<0.01) 0.19 (0.19–0.19) 0.036 (0.013–0.071) 7 (2.5–14) 0.029 (0.025–0.033) 5.6 (4.9–6.3)

2012 < 1 <0.01 (<0.01–<0.01) 0.42 (0.41–0.43) 0.053 (0.026–0.089) 10 (4.9–17) 0.034 (0.030–0.039) 6.5 (5.7–7.4)

Malta 1990 < 1 <0.01 (<0.01–<0.01) 0.28 (0.27–0.29) 0.025 (<0.01–0.052) 6.8 (2.2–14) 0.015 (0.013–0.017) 4 (3.5–4.5)

1995 < 1 <0.01 (<0.01–<0.01) 0.27 (0.26–0.28) 0.024 (<0.01–0.049) 6.1 (2.0–12) 0.013 (0.011–0.014) 3.2 (2.8–3.6)

2000 < 1 <0.01 (<0.01–<0.01) 0.25 (0.25–0.25) 0.025 (0.011–0.046) 6.2 (2.7–11) 0.018 (0.016–0.021) 4.5 (4.0–5.1)

2005 < 1 <0.01 (<0.01–<0.01) 0.23 (0.23–0.23) 0.031 (0.011–0.061) 7.5 (2.6–15) 0.025 (0.022–0.029) 6.1 (5.3–6.9)

2010 < 1 <0.01 (<0.01–<0.01) 0.25 (0.24–0.25) 0.043 (0.014–0.087) 10 (3.4–20) 0.033 (0.029–0.038) 7.9 (6.9–8.9)

2011 < 1 <0.01 (<0.01–<0.01) 0.69 (0.69–0.69) 0.044 (0.015–0.089) 10 (3.4–21) 0.035 (0.030–0.039) 8.1 (7.1–9.2)

2012 < 1 <0.01 (<0.01–<0.01) 0.37 (0.36–0.37) 0.069 (0.032–0.120) 16 (7.5–28) 0.048 (0.042–0.055) 11 (9.9–13)

Monaco 1990 < 1 <0.01 (0–<0.01) 0.27 (0–1.5) <0.01 (<0.01–<0.01) 6.4 (3.2–11) <0.01 (<0.01–<0.01) 3.9 (3.4–4.4)

1995 < 1 <0.01 (0–<0.01) 0.26 (0–1.4) <0.01 (<0.01–<0.01) 6 (3.0–10) <0.01 (<0.01–<0.01) 3.7 (3.3–4.2)

2000 < 1 <0.01 (0–<0.01) <0.1 (<0.1–0.17) <0.01 (<0.01–<0.01) 1.7 (0.50–3.6) 0 (0–0) 0 (0–0)

2005 < 1 <0.01 (0–<0.01) <0.1 (0–0.54) <0.01 (<0.01–<0.01) 2 (1.0–3.3) <0.01 (<0.01–<0.01) 1.2 (1.0–1.3)

2010 < 1 <0.01 (0–<0.01) 0.21 (0–1.1) <0.01 (<0.01–<0.01) 5 (2.5–8.4) <0.01 (<0.01–<0.01) 3.1 (2.7–3.5)

2011 < 1 <0.01 (0–<0.01) <0.1 (<0.1–0.24) <0.01 (<0.01–<0.01) 2.4 (0.73–5.2) <0.01 (<0.01–<0.01) 2.1 (1.8–2.4)

2012 < 1 <0.01 (<0.01–<0.01) 0.1 (<0.1–0.24) <0.01 (<0.01–<0.01) 2.7 (0.81–5.7) <0.01 (<0.01–<0.01) 2.1 (1.8–2.4)

Rates are per 100 000 population.

229 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Montenegro 2005 < 1 <0.01 (<0.01–<0.01) 0.57 (0.52–0.62) 0.23 (0.086–0.430) 37 (14–70) 0.18 (0.160–0.200) 29 (26–33)

2010 < 1 <0.01 (<0.01–<0.01) 0.19 (0.13–0.25) 0.17 (0.073–0.320) 28 (12–51) 0.13 (0.110–0.140) 20 (18–23)

2011 < 1 <0.01 (<0.01–<0.01) 0.19 (0.13–0.25) 0.18 (0.082–0.320) 29 (13–51) 0.13 (0.110–0.140) 20 (18–23)

2012 < 1 <0.01 (<0.01–<0.01) 0.19 (0.13–0.25) 0.15 (0.065–0.280) 25 (10–45) 0.11 (0.100–0.130) 18 (16–20)

Netherlands 1990 15 0.034 (0.033–0.035) 0.23 (0.22–0.23) 2.2 (0.920–3.9) 15 (6.2–26) 1.6 (1.4–1.8) 11 (9.3–12)

1995 15 0.044 (0.043–0.045) 0.29 (0.28–0.29) 2.6 (1.1–4.6) 17 (7.4–30) 1.9 (1.6–2.1) 12 (11–14)

2000 16 0.034 (0.033–0.035) 0.21 (0.21–0.22) 1.8 (0.620–3.5) 11 (3.9–22) 1.4 (1.3–1.6) 9 (7.9–10)

2005 16 0.033 (0.032–0.034) 0.2 (0.20–0.21) 1.7 (0.700–3.2) 10 (4.3–19) 1.3 (1.1–1.5) 8 (7.0–9.0)

2010 17 0.032 (0.031–0.032) 0.19 (0.19–0.20) 1.7 (0.780–3.0) 10 (4.7–18) 1.2 (1.1–1.4) 7.2 (6.3–8.2)

2011 17 0.019 (0.019–0.019) 0.11 (0.11–0.12) 1.5 (0.670–2.8) 9.2 (4.0–17) 1.1 (0.990–1.3) 6.8 (5.9–7.7)

2012 17 0.028 (0.028–0.029) 0.17 (0.17–0.17) 1.4 (0.550–2.6) 8.2 (3.3–15) 1.1 (0.930–1.2) 6.3 (5.5–7.2)

Norway 1990 4 0.026 (0.025–0.026) 0.6 (0.59–0.62) 0.43 (0.160–0.820) 10 (3.8–19) 0.33 (0.290–0.370) 7.7 (6.8–8.7)

1995 4 0.019 (0.019–0.020) 0.44 (0.43–0.45) 0.38 (0.170–0.690) 8.8 (3.8–16) 0.27 (0.240–0.310) 6.2 (5.5–7.0)

2000 4 0.01 (0.010–0.011) 0.23 (0.22–0.23) 0.32 (0.110–0.630) 7.1 (2.5–14) 0.25 (0.220–0.290) 5.7 (5.0–6.4)

2005 5 <0.01 (<0.01–0.010) 0.21 (0.21–0.22) 0.42 (0.160–0.790) 9 (3.5–17) 0.32 (0.280–0.360) 6.9 (6.0–7.8)

2010 5 0.01 (<0.01–0.010) 0.21 (0.20–0.21) 0.44 (0.170–0.850) 9.1 (3.4–17) 0.34 (0.300–0.390) 7 (6.1–7.9)

2011 5 <0.01 (<0.01–<0.01) 0.12 (0.12–0.13) 0.52 (0.220–0.940) 10 (4.4–19) 0.37 (0.330–0.420) 7.5 (6.6–8.5)

2012 5 <0.01 (<0.01–<0.01) 0.14 (0.14–0.14) 0.51 (0.220–0.940) 10 (4.3–19) 0.37 (0.330–0.420) 7.5 (6.6–8.5)

Poland 1990 38 1.4 (1.4–1.5) 3.8 (3.6–3.9) 25 (10–47) 66 (27–122) 19 (16–21) 49 (43–55)

1995 38 1.2 (1.2–1.3) 3.2 (3.0–3.3) 26 (11–46) 67 (29–121) 18 (16–21) 48 (42–54)

2000 38 1.1 (1.1–1.2) 2.9 (2.8–3.0) 17 (6.6–31) 44 (17–82) 13 (11–14) 33 (29–37)

2005 38 0.85 (0.820–0.880) 2.2 (2.2–2.3) 13 (5.1–24) 33 (13–62) 9.4 (8.3–11) 25 (22–28)

2010 38 0.61 (0.580–0.630) 1.6 (1.5–1.6) 11 (4.1–20) 28 (11–53) 8.1 (7.1–9.1) 21 (18–24)

2011 38 0.7 (0.670–0.730) 1.8 (1.7–1.9) 13 (6.2–23) 35 (16–61) 9.1 (8.0–10) 24 (21–27)

2012 38 0.67 (0.640–0.700) 1.8 (1.7–1.8) 11 (4.2–20) 28 (11–53) 8.1 (7.1–9.2) 21 (19–24)

Portugal 1990 10 0.31 (0.290–0.330) 3.1 (2.9–3.3) 9.8 (4.2–18) 99 (43–180) 7.1 (6.3–8.1) 72 (63–82)

1995 10 0.35 (0.330–0.370) 3.5 (3.2–3.7) 8.6 (3.7–15) 85 (37–152) 6.4 (5.6–7.3) 64 (56–72)

2000 10 0.29 (0.270–0.310) 2.8 (2.6–3.0) 5.9 (2.2–11) 57 (21–110) 4.9 (4.3–5.5) 47 (41–53)

2005 11 0.18 (0.170–0.190) 1.7 (1.6–1.8) 4.6 (1.8–8.7) 44 (17–83) 3.8 (3.3–4.3) 36 (32–41)

2010 11 0.13 (0.120–0.130) 1.2 (1.1–1.3) 3.4 (1.4–6.4) 32 (13–61) 2.9 (2.5–3.2) 27 (24–31)

2011 11 0.15 (0.140–0.160) 1.4 (1.3–1.5) 3.4 (1.4–6.2) 32 (13–59) 2.8 (2.4–3.1) 26 (23–30)

2012 11 0.14 (0.130–0.140) 1.3 (1.2–1.4) 3.6 (1.6–6.4) 34 (15–61) 2.8 (2.4–3.1) 26 (23–30)

Republic of 1990 4 0.25 (0.230–0.260) 5.6 (5.2–6.1) 3.5 (1.5–6.2) 79 (34–142) 2.3 (1.9–2.8) 54 (44–64)

Moldova 1995 4 0.55 (0.510–0.580) 13 (12–13) 8.9 (4.5–15) 206 (104–342) 4.7 (3.9–5.6) 109 (90–130)

2000 4 0.72 (0.660–0.780) 17 (16–19) 10 (5.2–17) 254 (126–425) 6 (5.0–7.2) 147 (121–175)

2005 4 0.75 (0.700–0.790) 20 (19–21) 9.5 (4.1–17) 252 (108–454) 6.6 (5.4–7.9) 175 (144–209)

2010 4 0.57 (0.550–0.590) 16 (15–16) 8.8 (4.0–15) 245 (112–430) 5.9 (4.9–7.1) 166 (137–198)

2011 4 0.48 (0.470–0.500) 14 (13–14) 8.6 (4.0–15) 242 (113–419) 5.7 (4.7–6.8) 161 (133–192)

2012 4 0.63 (0.620–0.640) 18 (18–18) 8.8 (4.2–15) 249 (120–424) 5.6 (4.6–6.7) 160 (132–190)

Romania 1990 23 1.6 (1.6–1.6) 6.9 (6.9–6.9) 67 (34–110) 287 (145–478) 34 (28–41) 146 (120–174)

1995 23 2.6 (2.6–2.6) 11 (11–11) 81 (41–130) 351 (177–583) 43 (36–52) 189 (155–226)

2000 22 2.1 (2.1–2.1) 9.5 (9.5–9.5) 66 (32–110) 295 (142–504) 41 (33–48) 181 (149–216)

2005 22 1.7 (1.7–1.7) 7.8 (7.8–7.8) 46 (20–84) 209 (88–380) 32 (27–39) 147 (121–175)

2010 22 1.4 (1.4–1.4) 6.5 (6.5–6.5) 34 (15–62) 158 (69–282) 24 (20–28) 109 (89–130)

2011 22 1.3 (1.3–1.3) 5.9 (5.9–6.0) 33 (15–58) 151 (68–266) 22 (18–26) 101 (83–121)

2012 22 1.2 (1.2–1.2) 5.6 (5.5–5.6) 31 (15–55) 144 (67–251) 20 (17–24) 94 (77–112)

Russian 1990 148 12 (12–12) 8.2 (8.1–8.3) 120 (59–200) 81 (40–136) 70 (59–81) 47 (40–55)

Federation 1995 149 24 (24–25) 16 (16–17) 240 (120–400) 163 (82–271) 140 (120–170) 96 (81–112)

2000 147 31 (31–32) 21 (21–22) 300 (150–510) 206 (101–348) 190 (160–220) 127 (108–149)

2005 144 32 (31–33) 22 (22–23) 320 (160–540) 223 (112–372) 190 (160–230) 135 (114–158)

2010 144 23 (22–24) 16 (16–16) 220 (100–380) 152 (69–266) 150 (130–180) 106 (89–123)

2011 143 21 (21–22) 15 (14–15) 190 (85–340) 135 (59–240) 140 (120–160) 97 (82–114)

2012 143 19 (18–20) 13 (13–14) 170 (73–320) 121 (51–221) 130 (110–150) 91 (77–106)

San Marino 1990 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 7 (2.1–15) <0.01 (<0.01–<0.01) 4.8 (4.2–5.4)

1995 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 15 (7.7–25) <0.01 (<0.01–<0.01) 9 (7.8–10)

2000 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 8.5 (4.2–14) <0.01 (<0.01–<0.01) 4.3 (3.7–4.8)

2005 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 1.8 (0.55–3.9) <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

2010 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 2 (0.82–3.7) <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

2011 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 2 (0.83–3.7) <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

2012 < 1 0 (0–0) 0 (0–0) <0.01 (<0.01–<0.01) 2 (0.79–3.7) <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

Serbia 2005 10 0.28 (0.250–0.300) 2.8 (2.5–3.1) 5.1 (2.1–9.3) 51 (21–93) 3.7 (3.2–4.2) 37 (32–42)

2010 10 0.16 (0.150–0.180) 1.7 (1.5–1.9) 3.7 (1.5–6.8) 38 (16–70) 2.7 (2.3–3.0) 28 (24–32)

2011 10 0.16 (0.140–0.170) 1.6 (1.4–1.8) 3.5 (1.5–6.3) 36 (16–66) 2.5 (2.2–2.8) 26 (23–30)

2012 10 0.14 (0.120–0.160) 1.5 (1.3–1.6) 3 (1.2–5.4) 31 (13–57) 2.2 (1.9–2.4) 23 (20–26)

Serbia & 1990 10 0.6 (0.580–0.620) 5.8 (5.6–5.9) 11 (4.5–22) 111 (43–209) 7 (5.0–9.4) 68 (48–91)

Montenegro 1995 11 0.5 (0.480–0.520) 4.5 (4.4–4.7) 12 (5.8–20) 108 (53–183) 6.7 (5.7–7.9) 61 (52–72)

2000 11 0.41 (0.400–0.430) 3.8 (3.6–4.0) 7.7 (3.6–13) 71 (33–123) 5 (4.2–5.8) 46 (38–54)

Slovakia 1990 5 0.11 (0.110–0.110) 2.1 (2.1–2.1) 1.9 (0.600–4.0) 36 (11–75) 1.7 (1.5–1.9) 32 (28–36)

1995 5 0.084 (0.084–0.085) 1.6 (1.6–1.6) 2.4 (1.0–4.5) 46 (19–83) 1.8 (1.6–2.0) 33 (29–37)

2000 5 0.054 (0.053–0.054) 0.99 (0.99–1.0) 1.5 (0.590–2.9) 28 (11–54) 1.2 (1.0–1.3) 22 (19–24)

2005 5 0.046 (0.045–0.046) 0.85 (0.84–0.85) 1.1 (0.450–2.1) 21 (8.3–38) 0.82 (0.720–0.920) 15 (13–17)

2010 5 0.033 (0.033–0.033) 0.61 (0.61–0.62) 0.62 (0.250–1.2) 11 (4.5–22) 0.47 (0.410–0.530) 8.7 (7.6–9.8)

2011 5 0.034 (0.034–0.035) 0.63 (0.63–0.63) 0.61 (0.260–1.1) 11 (4.9–20) 0.43 (0.380–0.490) 8 (7.0–9.0)

2012 5 0.034 (0.034–0.035) 0.63 (0.63–0.63) 0.52 (0.220–0.930) 9.5 (4.1–17) 0.37 (0.320–0.420) 6.8 (5.9–7.7)

Slovenia 1990 2 0.05 (0.049–0.051) 2.5 (2.5–2.5) 1.2 (0.550–2.1) 60 (27–106) 0.83 (0.730–0.940) 41 (36–47)

1995 2 0.032 (0.032–0.033) 1.6 (1.6–1.6) 0.81 (0.330–1.5) 41 (16–76) 0.6 (0.530–0.680) 30 (27–34)

2000 2 0.017 (0.017–0.017) 0.86 (0.85–0.88) 0.56 (0.220–1.1) 28 (11–53) 0.42 (0.370–0.480) 21 (19–24)

2005 2 0.017 (0.016–0.017) 0.83 (0.82–0.84) 0.46 (0.210–0.790) 23 (11–40) 0.31 (0.270–0.350) 15 (14–18)

2010 2 0.019 (0.018–0.019) 0.9 (0.90–0.91) 0.27 (0.110–0.490) 13 (5.4–24) 0.19 (0.170–0.220) 9.5 (8.3–11)

2011 2 0.02 (0.020–0.020) 0.97 (0.96–0.97) 0.31 (0.150–0.540) 15 (7.3–26) 0.21 (0.180–0.240) 10 (8.8–11)

2012 2 0.02 (0.020–0.020) 0.97 (0.96–0.97) 0.19 (0.061–0.380) 9 (3.0–18) 0.15 (0.140–0.170) 7.5 (6.5–8.4)

Spain 1990 39 0.89 (0.870–0.900) 2.3 (2.2–2.3) 11 (3.8–21) 28 (9.8–54) 8.7 (7.7–9.9) 22 (20–25)

1995 39 0.62 (0.610–0.620) 1.6 (1.5–1.6) 13 (5.3–24) 33 (13–60) 10 (8.8–11) 26 (22–29)

2000 40 0.4 (0.400–0.410) 1 (0.99–1.0) 12 (5.1–22) 30 (13–54) 9.2 (8.1–10) 23 (20–26)

2005 43 0.35 (0.350–0.360) 0.81 (0.80–0.82) 11 (4.4–20) 25 (10–45) 8.4 (7.3–9.5) 19 (17–22)

2010 46 0.3 (0.300–0.310) 0.66 (0.65–0.67) 10 (4.4–18) 22 (9.5–40) 7.8 (6.8–8.8) 17 (15–19)

2011 47 0.23 (0.230–0.230) 0.49 (0.49–0.50) 9.6 (4.1–17) 21 (8.8–37) 7.4 (6.4–8.3) 16 (14–18)

2012 47 0.27 (0.260–0.270) 0.57 (0.57–0.58) 8.1 (3.2–15) 17 (6.8–33) 6.5 (5.7–7.4) 14 (12–16)

Sweden 1990 9 0.06 (0.060–0.061) 0.7 (0.70–0.71) 0.87 (0.350–1.6) 10 (4.1–19) 0.64 (0.560–0.720) 7.5 (6.6–8.5)

1995 9 0.024 (0.024–0.024) 0.27 (0.27–0.28) 0.94 (0.430–1.7) 11 (4.9–19) 0.65 (0.570–0.730) 7.3 (6.4–8.3)

2000 9 0.018 (0.018–0.018) 0.2 (0.20–0.21) 0.66 (0.280–1.2) 7.5 (3.2–14) 0.48 (0.420–0.540) 5.4 (4.7–6.1)

2005 9 0.015 (0.015–0.015) 0.17 (0.16–0.17) 0.97 (0.480–1.6) 11 (5.3–18) 0.62 (0.540–0.700) 6.9 (6.0–7.8)

2010 9 0.014 (0.014–0.014) 0.15 (0.14–0.15) 1.1 (0.490–1.8) 11 (5.2–20) 0.72 (0.630–0.810) 7.6 (6.7–8.6)

2011 9 0.014 (0.013–0.014) 0.14 (0.14–0.15) 0.79 (0.280–1.6) 8.4 (3.0–16) 0.63 (0.550–0.710) 6.6 (5.8–7.5)

2012 10 0.013 (0.013–0.013) 0.14 (0.13–0.14) 0.92 (0.370–1.7) 9.6 (3.9–18) 0.68 (0.600–0.770) 7.2 (6.3–8.1)

Switzerland 1990 7 0.086 (0.085–0.087) 1.3 (1.3–1.3) 2.1 (0.940–3.7) 31 (14–56) 1.5 (1.3–1.7) 22 (19–25)

1995 7 0.047 (0.046–0.047) 0.67 (0.66–0.68) 1.3 (0.530–2.4) 18 (7.5–34) 0.95 (0.840–1.1) 14 (12–15)

2000 7 0.034 (0.034–0.035) 0.48 (0.47–0.49) 0.83 (0.290–1.6) 12 (4.1–23) 0.66 (0.580–0.750) 9.3 (8.1–10)

2005 7 0.022 (0.021–0.022) 0.29 (0.29–0.30) 0.82 (0.360–1.5) 11 (4.8–20) 0.59 (0.520–0.670) 8 (7.0–9.0)

2010 8 0.019 (0.019–0.020) 0.25 (0.24–0.25) 0.85 (0.390–1.5) 11 (5.0–19) 0.58 (0.510–0.660) 7.5 (6.5–8.4)

2011 8 0.018 (0.017–0.018) 0.22 (0.22–0.23) 0.9 (0.420–1.5) 11 (5.4–19) 0.6 (0.530–0.680) 7.6 (6.7–8.6)

2012 8 0.017 (0.017–0.018) 0.22 (0.21–0.22) 0.57 (0.190–1.2) 7.1 (2.3–15) 0.48 (0.420–0.540) 6 (5.2–6.8)

Tajikistan 1990 5 0.34 (0.240–0.460) 6.4 (4.5–8.6) 6.4 (3.2–11) 121 (60–203) 3.7 (3.0–4.4) 70 (58–83)

1995 6 0.69 (0.490–0.930) 12 (8.4–16) 20 (9.5–35) 350 (164–604) 8.6 (7.1–10) 148 (122–176)

2000 6 1.2 (0.690–1.9) 20 (11–31) 30 (15–52) 493 (238–839) 14 (11–16) 220 (182–263)

2005 7 0.96 (0.720–1.2) 14 (11–18) 27 (13–44) 393 (198–654) 14 (11–16) 200 (165–238)

2010 8 0.69 (0.520–0.880) 9 (6.8–12) 16 (7.6–27) 206 (99–352) 9.8 (8.1–12) 129 (106–153)

2011 8 0.65 (0.490–0.830) 8.3 (6.2–11) 14 (6.6–25) 181 (85–315) 9.2 (7.6–11) 118 (97–140)

2012 8 0.61 (0.460–0.780) 7.6 (5.7–9.7) 13 (5.8–23) 160 (72–283) 8.6 (7.1–10) 108 (89–128)

Rates are per 100 000 population.

230 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

The Former 1990 2 0.17 (0.160–0.180) 8.4 (7.9–9.0) 3.3 (0.990–7.1) 167 (49–354) 1.6 (1.0–2.4) 81 (50–119)

Yugoslav Republic 1995 2 0.1 (0.094–0.110) 5.1 (4.8–5.4) 1.6 (0.650–2.9) 81 (33–150) 1.1 (0.930–1.4) 58 (47–69)

of Macedonia 2000 2 0.21 (0.200–0.230) 10 (9.6–11) 1.2 (0.540–2.2) 61 (26–109) 0.85 (0.690–1.0) 41 (34–50)

2005 2 0.066 (0.064–0.069) 3.2 (3.1–3.3) 0.69 (0.200–1.5) 33 (9.8–70) 0.62 (0.560–0.680) 30 (27–33)

2010 2 0.034 (0.033–0.035) 1.6 (1.6–1.7) 0.54 (0.190–1.1) 26 (9.0–51) 0.44 (0.380–0.510) 21 (18–24)

2011 2 0.024 (0.023–0.025) 1.1 (1.1–1.2) 0.54 (0.210–1.0) 25 (10–48) 0.41 (0.360–0.480) 20 (17–23)

2012 2 0.017 (0.016–0.018) 0.82 (0.77–0.87) 0.54 (0.240–0.970) 26 (11–46) 0.39 (0.330–0.450) 18 (16–21)

Turkey 1990 54 3.4 (0.780–7.8) 6.2 (1.4–14) 27 (11–51) 51 (20–95) 28 (25–32) 52 (46–59)

1995 59 2.4 (0.860–4.6) 4 (1.5–7.8) 34 (16–57) 58 (28–98) 26 (23–30) 45 (40–51)

2000 63 2 (0.840–3.7) 3.2 (1.3–5.8) 28 (14–48) 45 (22–76) 21 (18–23) 33 (29–37)

2005 68 0.99 (0.590–1.5) 1.5 (0.86–2.2) 19 (8.6–33) 28 (13–48) 23 (20–26) 34 (29–38)

2010 72 0.55 (0.390–0.740) 0.76 (0.53–1.0) 17 (8.1–30) 24 (11–42) 18 (16–21) 25 (22–29)

2011 73 0.47 (0.340–0.610) 0.64 (0.47–0.83) 17 (8.0–30) 24 (11–41) 17 (15–20) 24 (21–27)

2012 74 0.39 (0.300–0.480) 0.52 (0.41–0.65) 17 (7.9–30) 23 (11–40) 16 (14–18) 22 (19–25)

Turkmenistan 1990 4 0.49 (0.400–0.590) 13 (11–16) 5.6 (2.5–9.7) 152 (69–265) 3.5 (2.8–4.2) 95 (76–115)

1995 4 0.83 (0.720–0.950) 20 (17–23) 13 (6.1–22) 302 (145–515) 6.6 (5.4–7.8) 157 (129–187)

2000 5 1.3 (0.820–1.8) 28 (18–40) 18 (8.6–31) 400 (191–685) 9.4 (7.6–11) 209 (170–252)

2005 5 1.1 (0.700–1.6) 23 (15–33) 16 (7.6–27) 333 (160–569) 8.3 (6.8–10) 175 (144–210)

2010 5 0.6 (0.390–0.860) 12 (7.7–17) 8.4 (4.0–14) 166 (79–283) 5.2 (4.3–6.1) 103 (86–121)

2011 5 0.5 (0.330–0.720) 9.9 (6.4–14) 6.8 (3.0–12) 133 (58–238) 4.5 (3.7–5.5) 89 (73–107)

2012 5 0.43 (0.260–0.660) 8.4 (5.0–13) 5.1 (1.8–10) 99 (35–196) 3.9 (3.1–4.8) 75 (59–94)

Ukraine 1990 52 5 (4.7–5.2) 9.6 (9.2–10) 33 (15–60) 65 (28–116) 23 (19–27) 45 (37–53)

1995 51 7.8 (7.5–8.0) 15 (15–16) 69 (35–110) 135 (68–223) 38 (31–45) 74 (62–88)

2000 49 11 (11–11) 23 (23–23) 81 (38–140) 164 (77–284) 53 (44–63) 108 (90–129)

2005 47 12 (12–12) 25 (25–26) 75 (31–140) 159 (65–293) 57 (48–68) 121 (101–144)

2010 46 7.4 (7.3–7.5) 16 (16–16) 68 (32–120) 149 (70–257) 48 (41–57) 105 (88–123)

2011 46 7.1 (7.0–7.2) 16 (15–16) 66 (31–110) 144 (68–248) 46 (38–54) 99 (83–118)

2012 46 6.1 (6.0–6.2) 13 (13–14) 62 (29–110) 137 (65–236) 42 (35–51) 93 (77–112)

United Kingdom of 1990 57 0.44 (0.440–0.450) 0.78 (0.77–0.78) 8.6 (3.5–16) 15 (6.0–28) 6.6 (6.2–7.1) 12 (11–12)

Great Britain and 1995 58 0.51 (0.510–0.520) 0.88 (0.87–0.89) 9.3 (3.9–17) 16 (6.8–29) 6.9 (6.5–7.4) 12 (11–13)

Northern Ireland 2000 59 0.43 (0.420–0.440) 0.73 (0.72–0.74) 9.2 (3.9–17) 16 (6.6–29) 7 (6.5–7.4) 12 (11–13)

2005 60 0.39 (0.380–0.390) 0.64 (0.63–0.65) 13 (6.0–22) 21 (10–37) 9.2 (8.6–9.8) 15 (14–16)

2010 62 0.32 (0.320–0.330) 0.52 (0.52–0.53) 11 (4.2–21) 18 (6.8–34) 8.9 (8.3–9.4) 14 (13–15)

2011 62 0.34 (0.340–0.340) 0.54 (0.54–0.55) 13 (5.4–23) 20 (8.6–36) 9.5 (8.8–10) 15 (14–16)

2012 63 0.34 (0.340–0.340) 0.54 (0.54–0.55) 13 (5.4–23) 20 (8.7–36) 9.4 (8.8–10) 15 (14–16)

Uzbekistan 1990 21 1.7 (1.5–1.9) 8.3 (7.2–9.4) 54 (27–90) 262 (130–438) 26 (21–31) 125 (103–149)

1995 23 2.7 (2.4–3.1) 12 (10–13) 100 (50–170) 447 (216–760) 46 (38–55) 200 (165–238)

2000 25 4.3 (3.7–5.0) 17 (15–20) 160 (77–270) 647 (310–1 100) 71 (59–85) 287 (237–342)

2005 26 3.5 (3.1–4.0) 14 (12–15) 130 (63–210) 485 (240–814) 61 (50–72) 233 (193–278)

2010 28 1.5 (0.850–2.3) 5.3 (3.1–8.3) 63 (32–100) 227 (115–376) 34 (28–40) 122 (101–146)

2011 28 1.1 (0.600–1.6) 3.7 (2.1–5.8) 52 (26–86) 183 (92–304) 29 (24–34) 101 (84–121)

2012 29 0.6 (0.350–0.930) 2.1 (1.2–3.3) 39 (19–65) 135 (67–227) 22 (18–27) 78 (65–93)

a Rates are per 100 000 population.

231 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Albania 1990 3 0.84 (0.600–1.1) 24 (18–32) 653 19 78 (59–110)

1995 3 0.82 (0.680–0.970) 24 (20–29) 641 19 78 (66–94)

2000 3 0.75 (0.630–0.870) 23 (19–26) 604 18 81 (69–95)

2005 3 0.63 (0.530–0.730) 20 (17–23) 506 16 81 (69–95)

2010 3 0.53 (0.450–0.620) 17 (14–20) 431 14 81 (69–95)

2011 3 0.52 (0.440–0.610) 17 (14–19) 422 13 81 (69–95)

2012 3 0.51 (0.430–0.590) 16 (14–19) 408 13 81 (69–95)

Andorra 1990 < 1 0.026 (0.023–0.030) 49 (43–55) 23 42 87 (77–99)

1995 < 1 0.023 (0.020–0.026) 37 (32–41)

2000 < 1 0.014 (0.012–0.016) 21 (18–24) 12 18 87 (77–99)

2005 < 1 0.012 (0.010–0.013) 14 (12–16) 10 12 87 (77–99)

2010 < 1 <0.01 (<0.01–<0.01) 10 (9.1–12) 7 9 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 4.4 (3.9–5.0) 3 3.9 87 (77–99)

2012 < 1 0.01 (<0.01–0.012) 13 (12–15) 9 11 87 (77–99)

Armenia 1990 4 0.63 (0.470–0.810) 18 (13–23) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 590 17 94 (73–130)

1995 3 1.2 (1.0–1.4) 38 (32–44) <0.01 (<0.01–<0.01) 0.2 (0.17–0.24) 1 000 31 82 (70–98)

2000 3 1.9 (1.6–2.1) 61 (53–68) 0.028 (0.025–0.032) 0.9 (0.81–1.0) 1 333 43 71 (63–81)

2005 3 2.3 (2.1–2.6) 77 (68–87) 0.06 (0.053–0.068) 2 (1.8–2.2) 2 206 73 95 (84–110)

2010 3 1.8 (1.6–2.2) 62 (53–73) 0.048 (0.040–0.056) 1.6 (1.4–1.9) 1 410 48 76 (65–90)

2011 3 1.6 (1.3–1.9) 55 (45–65) 0.041 (0.034–0.049) 1.4 (1.1–1.6) 1 261 43 78 (65–94)

2012 3 1.5 (1.3–1.8) 52 (43–61) 0.038 (0.032–0.045) 1.3 (1.1–1.5) 1 213 41 79 (67–95)

Austria 1990 8 1.7 (1.5–2.0) 23 (20–26) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 521 20 87 (77–99)

1995 8 1.7 (1.5–1.9) 21 (19–24) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 481 19 87 (77–99)

2000 8 1.4 (1.2–1.5) 17 (15–19) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 185 15 87 (77–99)

2005 8 1.1 (0.940–1.2) 13 (11–15) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 928 11 87 (77–99)

2010 8 0.76 (0.660–0.860) 9 (7.9–10) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 659 7.8 87 (77–99)

2011 8 0.77 (0.680–0.870) 9.2 (8.0–10) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.10) 671 8 87 (77–99)

2012 8 0.67 (0.590–0.760) 7.9 (6.9–8.9) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 620 7.3 93 (82–110)

Azerbaijan 1990 7 22 (18–26) 305 (252–363) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 620 36 12 (10–14)

1995 8 49 (41–59) 637 (526–759) 0.035 (0.029–0.041) 0.5 (0.37–0.53) 1 630 21 3.3 (2.8–4.0)

2000 8 55 (46–66) 682 (563–813) 0.19 (0.16–0.22) 2.3 (1.9–2.8) 5 187 64 9.4 (7.9–11)

2005 9 29 (24–34) 335 (276–398) 0.22 (0.18–0.26) 2.5 (2.1–3.0) 6 034 70 21 (18–26)

2010 9 12 (9.8–14) 131 (108–156) 0.12 (0.10–0.14) 1.3 (1.1–1.6) 7 550 83 64 (53–77)

2011 9 10 (8.6–12) 113 (93–135) 0.11 (0.089–0.13) 1.2 (0.97–1.4) 9 146 99 88 (74–110)

2012 9 8.9 (7.3–11) 95 (78–114) 0.094 (0.077–0.11) 1 (0.83–1.2) 6 363 68 72 (60–87)

Belarus 1990 10 3.5 (2.8–4.3) 34 (27–42) 3 039 30 86 (70–110)

1995 10 6.9 (5.9–8.1) 68 (58–80) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 4 854 48 70 (60–82)

2000 10 8.4 (6.9–9.9) 84 (69–100) 0.017 (0.014–0.020) 0.2 (0.14–0.20) 6 799 68 81 (68–98)

2005 10 6.9 (5.3–8.8) 72 (55–91) 0.13 (0.096–0.16) 1.3 (1.0–1.6) 5 308 55 76 (61–100)

2010 9 6.7 (5.3–8.1) 70 (56–86) 0.26 (0.20–0.31) 2.7 (2.2–3.3) 5 098 54 76 (63–96)

2011 9 6.6 (5.4–8.0) 70 (57–85) 0.27 (0.22–0.32) 2.8 (2.3–3.4) 4 697 50 71 (59–87)

2012 9 6.6 (5.4–8.0) 70 (57–85) 0.28 (0.23–0.34) 3 (2.4–3.6) 4 783 51 72 (60–89)

Belgium 1990 10 1.8 (1.6–2.1) 18 (16–21) 0.01 (<0.01–0.011) 0.1 (<0.1–0.12) 1 577 16 87 (77–99)

1995 10 1.6 (1.4–1.8) 16 (14–18) 0.038 (0.033–0.043) 0.4 (0.33–0.42) 1 380 14 87 (77–99)

2000 10 1.5 (1.3–1.7) 14 (13–16) 0.041 (0.036–0.046) 0.4 (0.35–0.45) 1 278 12 87 (77–99)

2005 11 1.2 (1.1–1.4) 12 (10–13) 0.041 (0.036–0.047) 0.4 (0.34–0.45) 1 076 10 87 (77–99)

2010 11 1.2 (1.0–1.3) 11 (9.5–12) 0.044 (0.038–0.050) 0.4 (0.35–0.45) 1 028 9.4 87 (77–99)

2011 11 1.1 (0.990–1.3) 10 (9.0–12) 0.042 (0.037–0.048) 0.4 (0.34–0.44) 985 8.9 87 (77–99)

2012 11 1.1 (0.940–1.2) 9.7 (8.5–11) 0.041 (0.036–0.046) 0.4 (0.32–0.42) 909 8.2 85 (75–97)

Bosnia and 1990 5 4.2 (2.6–6.2) 94 (58–138) 4 073 90 96 (65–160)

Herzegovina 1995 4 3 (2.4–3.6) 84 (69–101) 2 132 61 72 (60–88)

2000 4 2.4 (2.0–2.9) 63 (51–75) 2 476 65 100 (86–130)

2005 4 2 (1.7–2.4) 52 (43–63) 2 111 54 100 (87–130)

2010 4 1.9 (1.6–2.2) 50 (43–57) 1 321 34 69 (60–81)

2011 4 1.9 (1.6–2.2) 49 (42–56) 1 360 35 72 (63–84)

2012 4 1.9 (1.6–2.1) 49 (42–56) 1 409 37 76 (66–88)

Bulgaria 1990 9 2.9 (2.5–3.3) 33 (29–37) <0.01 (<0.01–<0.01) 0 (0–0) 2 256 26 78 (68–89)

1995 8 5.2 (4.5–5.9) 62 (54–71) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 245 39 62 (55–71)

2000 8 4.6 (4.0–5.3) 58 (50–66) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 349 42 72 (64–83)

2005 8 4.1 (3.6–4.6) 53 (46–61) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 225 42 79 (69–91)

2010 7 2.8 (2.5–3.2) 38 (33–43) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 412 33 86 (75–98)

2011 7 2.6 (2.2–2.9) 35 (30–40) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 172 30 85 (74–97)

2012 7 2.3 (2.0–2.6) 32 (28–36) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 081 29 90 (79–100)

Croatia 1990 5 3 (2.6–3.4) 62 (54–70) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 576 54 87 (77–99)

1995 5 2.4 (2.1–2.8) 52 (45–59) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 114 45 87 (77–99)

2000 4 1.9 (1.6–2.1) 42 (37–47) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 630 36 87 (77–99)

2005 4 1.2 (1.1–1.4) 28 (24–31) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 050 24 87 (77–99)

2010 4 0.79 (0.690–0.900) 18 (16–21) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 688 16 87 (77–99)

2011 4 0.71 (0.620–0.810) 16 (14–19) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 619 14 87 (77–99)

2012 4 0.62 (0.540–0.700) 14 (13–16) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1)

Cyprus 1990 < 1 0.033 (0.029–0.038) 4.4 (3.8–4.9) 29 3.8 87 (77–99)

1995 < 1 0.041 (0.036–0.047) 4.8 (4.2–5.5) 36 4.2 87 (77–99)

2000 < 1 0.038 (0.033–0.043) 4 (3.5–4.6) 33 3.5 87 (77–99)

2005 1 0.039 (0.034–0.044) 3.8 (3.3–4.3) 34 3.3 87 (77–99)

2010 1 0.07 (0.061–0.079) 6.4 (5.6–7.2) 61 5.5 87 (77–99)

2011 1 0.059 (0.051–0.066) 5.3 (4.6–5.9) 51 4.6 87 (77–99)

2012 1 0.061 (0.053–0.069) 5.4 (4.7–6.1) 63 5.6 100 (92–120)

Czech Republic 1990 10 2.2 (2.0–2.5) 22 (19–24) <0.01 (<0.01–<0.01) 0 (0–0) 1 937 19 87 (77–99)

1995 10 2.1 (1.8–2.4) 20 (18–23) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 834 18 87 (77–99)

2000 10 1.6 (1.4–1.8) 16 (14–18) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 414 14 87 (77–99)

2005 10 1.1 (0.980–1.3) 11 (9.6–12) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 973 9.5 87 (77–99)

2010 11 0.72 (0.630–0.820) 6.8 (6.0–7.7) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 627 5.9 87 (77–99)

2011 11 0.65 (0.570–0.740) 6.2 (5.4–7.0) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 569 5.4 87 (77–99)

2012 11 0.57 (0.500–0.640) 5.3 (4.7–6.0) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 565 5.3 99 (88–110)

Denmark 1990 5 0.4 (0.350–0.460) 7.8 (6.9–8.9) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 350 6.8 87 (77–99)

1995 5 0.52 (0.450–0.580) 9.8 (8.6–11) 0.011 (<0.01–0.013) 0.2 (0.19–0.24) 448 8.6 87 (77–99)

2000 5 0.68 (0.590–0.760) 13 (11–14) <0.01 (<0.01–0.010) 0.2 (0.15–0.20) 587 11 87 (77–99)

2005 5 0.45 (0.400–0.510) 8.4 (7.3–9.5) <0.01 (<0.01–<0.01) 0.1 (0.11–0.14) 395 7.3 87 (77–99)

2010 6 0.36 (0.320–0.410) 6.5 (5.7–7.3) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 313 5.6 87 (77–99)

2011 6 0.41 (0.360–0.470) 7.4 (6.5–8.4) <0.01 (<0.01–<0.01) 0.1 (0.11–0.14) 359 6.4 87 (77–99)

2012 6 0.41 (0.360–0.470) 7.4 (6.5–8.4) <0.01 (<0.01–<0.01) 0.1 (0.11–0.14)

Estonia 1990 2 0.49 (0.430–0.550) 31 (27–35) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 423 27 87 (77–99)

1995 1 0.72 (0.630–0.810) 50 (44–57) <0.01 (<0.01–<0.01) 0.2 (0.16–0.21) 624 44 87 (77–99)

2000 1 0.91 (0.800–1.0) 67 (58–75) 0.021 (0.018–0.024) 1.5 (1.4–1.7) 791 58 87 (77–99)

2005 1 0.55 (0.480–0.620) 42 (36–47) 0.044 (0.038–0.050) 3.3 (2.9–3.7) 479 36 87 (77–99)

2010 1 0.33 (0.290–0.370) 25 (22–28) 0.04 (0.035–0.045) 3.1 (2.7–3.5) 283 22 87 (77–99)

2011 1 0.34 (0.300–0.390) 26 (23–30) 0.043 (0.038–0.048) 3.3 (2.9–3.7) 296 23 87 (77–99)

2012 1 0.3 (0.260–0.340) 23 (20–26) 0.039 (0.034–0.044) 3 (2.7–3.4) 259 20 87 (77–99)

Finland 1990 5 0.89 (0.780–1.0) 18 (16–20) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 772 15 87 (77–99)

1995 5 0.76 (0.670–0.860) 15 (13–17) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 661 13 87 (77–99)

2000 5 0.61 (0.530–0.690) 12 (10–13) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 527 10 87 (77–99)

2005 5 0.39 (0.340–0.440) 7.4 (6.5–8.4) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 339 6.5 87 (77–99)

2010 5 0.36 (0.310–0.410) 6.7 (5.9–7.6) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 312 5.8 87 (77–99)

2011 5 0.36 (0.310–0.410) 6.7 (5.8–7.5) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 312 5.8 87 (77–99)

2012 5 0.3 (0.260–0.340) 5.5 (4.9–6.3) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 261 4.8 87 (77–99)

France 1990 57 11 (11–12) 20 (19–21) 0.87 (0.82–0.93) 1.5 (1.4–1.6) 9 030 16 80 (75–85)

1995 58 11 (10–12) 19 (18–20) 0.76 (0.72–0.81) 1.3 (1.2–1.4) 8 723 15 80 (75–85)

2000 59 7.7 (7.2–8.1) 13 (12–14) 0.41 (0.38–0.43) 0.7 (0.64–0.73) 6 122 10 80 (75–85)

2005 61 6.3 (5.9–6.7) 10 (9.5–11) 0.42 (0.39–0.44) 0.7 (0.63–0.72) 5 003 8.1 80 (75–85)

2010 63 6 (5.6–6.4) 9.5 (8.9–10) 0.42 (0.40–0.45) 0.7 (0.63–0.71) 4 801 7.6 80 (75–85)

2011 64 5.9 (5.5–6.2) 9.2 (8.6–9.8) 0.4 (0.38–0.43) 0.6 (0.60–0.68) 4 681 7.4 80 (75–85)

2012 64 5.3 (4.9–5.6) 8.2 (7.7–8.7) 0.37 (0.34–0.39) 0.6 (0.54–0.61)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

232 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Georgia 1990 5 15 (14–17) 280 (250–312) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 537 28 10 (9.0–11)

1995 5 13 (12–15) 263 (234–293) 0.012 (0.011–0.013) 0.2 (0.21–0.26) 1 625 32 12 (11–14)

2000 5 12 (11–14) 256 (228–285) 0.024 (0.022–0.027) 0.5 (0.46–0.57) 4 397 93 36 (32–41)

2005 4 7.8 (7.0–8.7) 175 (156–195) 0.031 (0.028–0.035) 0.7 (0.62–0.78) 4 503 101 58 (52–65)

2010 4 5.6 (5.0–6.2) 128 (114–142) 0.043 (0.038–0.048) 1 (0.88–1.1) 4 678 107 83 (75–94)

2011 4 5.5 (4.9–6.1) 125 (112–140) 0.048 (0.043–0.054) 1.1 (0.98–1.2) 4 547 104 83 (74–93)

2012 4 5 (4.5–5.6) 116 (103–130) 0.05 (0.045–0.056) 1.2 (1.0–1.3) 3 940 90 78 (70–88)

Germany 1990 80 17 (15–19) 21 (18–24) 0.081 (0.071–0.092) 0.1 (<0.1–0.11) 14 653 18 87 (77–99)

1995 83 14 (12–16) 17 (15–19) 0.083 (0.073–0.094) 0.1 (<0.1–0.11) 12 198 15 87 (77–99)

2000 84 10 (9.1–12) 12 (11–14) 0.054 (0.047–0.061) <0.1 (<0.1–<0.1) 9 064 11 87 (77–99)

2005 84 6.6 (5.7–7.4) 7.8 (6.9–8.8) 0.043 (0.037–0.048) <0.1 (<0.1–<0.1) 5 700 6.8 87 (77–99)

2010 83 4.7 (4.1–5.3) 5.6 (4.9–6.4) 0.034 (0.029–0.038) <0.1 (<0.1–<0.1) 4 059 4.9 87 (77–99)

2011 83 4.7 (4.1–5.3) 5.7 (5.0–6.4) 0.034 (0.030–0.038) <0.1 (<0.1–<0.1) 4 089 4.9 87 (77–99)

2012 83 4.6 (4.1–5.3) 5.6 (4.9–6.4) 0.034 (0.030–0.039) <0.1 (<0.1–<0.1) 4 043 4.9 87 (77–99)

Greece 1990 10 1 (0.880–1.1) 9.9 (8.7–11) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 877 8.6 87 (77–99)

1995 11 1.1 (0.950–1.2) 10 (8.9–11) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 939 8.8 87 (77–99)

2000 11 0.81 (0.710–0.920) 7.4 (6.4–8.3) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 703 6.4 87 (77–99)

2005 11 0.8 (0.700–0.900) 7.2 (6.3–8.2) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 693 6.3 87 (77–99)

2010 11 0.51 (0.450–0.580) 4.6 (4.0–5.2) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 445 4 87 (77–99)

2011 11 0.52 (0.460–0.590) 4.7 (4.1–5.3) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 454 4.1 87 (77–99)

2012 11 0.5 (0.440–0.570) 4.5 (3.9–5.1) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1)

Greenland 1990 < 1 0.11 (0.093–0.120) 191 (167–216)

1995 < 1 0.11 (0.093–0.120) 191 (167–216)

2000 < 1 0.11 (0.094–0.120) 191 (167–216)

2005 < 1 0.11 (0.095–0.120) 191 (167–216)

2010 < 1 0.13 (0.110–0.150) 232 (203–262) 114 202 87 (77–99)

2011 < 1 0.13 (0.120–0.150) 234 (205–264) 115 203 87 (77–99)

2012 < 1 0.097 (0.085–0.110) 170 (149–193) 84 148 87 (77–99)

Hungary 1990 10 4 (3.5–4.5) 39 (34–44) 0.024 (0.021–0.027) 0.2 (0.20–0.26) 3 588 35 90 (79–100)

1995 10 4.9 (4.3–5.6) 48 (42–54) 0.028 (0.024–0.031) 0.3 (0.23–0.30) 4 339 42 88 (78–100)

2000 10 3.8 (3.3–4.3) 37 (33–42) 0.015 (0.013–0.017) 0.2 (0.13–0.17) 3 073 30 81 (71–92)

2005 10 2.2 (1.9–2.5) 22 (19–25) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 808 18 82 (72–93)

2010 10 1.7 (1.5–2.0) 17 (15–19) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 543 15 90 (79–100)

2011 10 1.8 (1.6–2.0) 18 (16–20) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 279 13 72 (63–82)

2012 10 1.8 (1.6–2.0) 18 (16–20) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 159 12 65 (57–75)

Iceland 1990 < 1 0.021 (0.018–0.023) 8.1 (7.1–9.2) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 18 7.1 87 (77–99)

1995 < 1 0.014 (0.012–0.016) 5.2 (4.5–5.8) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 12 4.5 87 (77–99)

2000 < 1 0.015 (0.013–0.017) 5.3 (4.7–6.0) <0.01 (<0.01–<0.01) 0.2 (0.16–0.21) 13 4.6 87 (77–99)

2005 < 1 0.012 (0.010–0.013) 3.9 (3.4–4.4) <0.01 (<0.01–<0.01) 0.2 (0.21–0.27) 10 3.4 87 (77–99)

2010 < 1 0.025 (0.022–0.029) 8 (7.0–9.0) <0.01 (<0.01–<0.01) 0.6 (0.49–0.63) 22 6.9 87 (77–99)

2011 < 1 <0.01 (<0.01–0.010) 2.9 (2.5–3.2) <0.01 (<0.01–<0.01) 0.2 (0.17–0.22) 8 2.5 87 (77–99)

2012 < 1 0.012 (0.010–0.013) 3.5 (3.1–4.0) <0.01 (<0.01–<0.01) 0.2 (0.21–0.28) 10 3.1 87 (77–99)

Ireland 1990 4 0.72 (0.630–0.810) 20 (18–23) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 624 18 87 (77–99)

1995 4 0.53 (0.460–0.600) 15 (13–17) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 458 13 87 (77–99)

2000 4 0.44 (0.390–0.500) 12 (10–13) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 386 10 87 (77–99)

2005 4 0.49 (0.430–0.550) 12 (10–13) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.11) 423 10 87 (77–99)

2010 4 0.46 (0.400–0.520) 10 (8.9–12) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.11) 396 8.9 87 (77–99)

2011 5 0.46 (0.400–0.520) 10 (8.9–11) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.11) 398 8.8 87 (77–99)

2012 5 0.39 (0.340–0.440) 8.6 (7.5–9.7) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.10) 341 7.5 87 (77–99)

Israel 1990 4 0.27 (0.240–0.300) 6 (5.2–6.8) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 234 5.2 87 (77–99)

1995 5 0.46 (0.400–0.520) 8.6 (7.5–9.7) 0.012 (0.010–0.013) 0.2 (0.19–0.25) 398 7.5 87 (77–99)

2000 6 0.62 (0.540–0.700) 10 (9.0–12) 0.019 (0.017–0.022) 0.3 (0.28–0.37) 537 8.9 87 (77–99)

2005 7 0.43 (0.370–0.480) 6.5 (5.7–7.3) 0.014 (0.012–0.016) 0.2 (0.19–0.24) 371 5.6 87 (77–99)

2010 7 0.39 (0.340–0.440) 5.3 (4.6–6.0) 0.014 (0.013–0.016) 0.2 (0.17–0.22) 340 4.6 87 (77–99)

2011 8 0.47 (0.420–0.540) 6.3 (5.5–7.1) 0.018 (0.016–0.020) 0.2 (0.21–0.27) 412 5.5 87 (77–99)

2012 8 0.58 (0.510–0.660) 7.6 (6.7–8.6) 0.022 (0.019–0.025) 0.3 (0.25–0.33) 506 6.6 87 (77–99)

Italy 1990 57 4.9 (4.3–5.5) 8.6 (7.5–9.7) 0.052 (0.046–0.059) <0.1 (<0.1–0.10) 4 246 7.5 87 (77–99)

1995 57 6.5 (5.7–7.3) 11 (10–13) 0.13 (0.11–0.15) 0.2 (0.20–0.26) 5 627 9.9 87 (77–99)

2000 57 4 (3.5–4.6) 7.1 (6.2–8.0) 0.056 (0.049–0.064) 0.1 (<0.1–0.11) 3 501 6.1 87 (77–99)

2005 59 4.4 (3.9–5.0) 7.5 (6.6–8.5) 0.065 (0.057–0.073) 0.1 (0.10–0.12) 3 844 6.6 87 (77–99)

2010 61 3.7 (3.2–4.1) 6 (5.3–6.8) 0.055 (0.049–0.063) <0.1 (<0.1–0.10) 3 175 5.2 87 (77–99)

2011 61 3.9 (3.4–4.5) 6.5 (5.7–7.3) 0.06 (0.053–0.068) 0.1 (<0.1–0.11) 3 421 5.6 87 (77–99)

2012 61 4.1 (3.6–4.6) 6.7 (5.8–7.5) 0.062 (0.055–0.071) 0.1 (<0.1–0.12)

Kazakhstan 1990 16 13 (11–15) 79 (66–92) <0.01 (<0.01–<0.01) <0.1 (0–<0.1) 10 969 68 86 (74–100)

1995 16 50 (42–58) 318 (269–372) 0.03 (0.025–0.035) 0.2 (0.16–0.22) 11 310 73 23 (20–27)

2000 15 51 (43–60) 351 (297–411) 0.23 (0.19–0.27) 1.6 (1.3–1.9) 25 843 177 50 (43–60)

2005 15 35 (30–41) 235 (199–275) 0.28 (0.24–0.33) 1.9 (1.6–2.2) 28 629 190 81 (69–96)

2010 16 29 (24–34) 182 (154–213) 0.3 (0.26–0.36) 1.9 (1.6–2.2) 23 399 147 81 (69–96)

2011 16 31 (26–36) 193 (163–225) 0.35 (0.29–0.41) 2.2 (1.8–2.5) 25 074 156 81 (69–96)

2012 16 22 (19–26) 137 (116–160) 0.26 (0.22–0.31) 1.6 (1.4–1.9) 18 006 111 81 (69–96)

Kyrgyzstan 1990 4 4 (3.3–4.8) 92 (76–109) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 306 52 57 (48–69)

1995 5 7.7 (6.4–9.2) 168 (138–200) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 393 74 44 (37–53)

2000 5 12 (10–15) 249 (205–296) 0.016 (0.013–0.019) 0.3 (0.27–0.38) 6 205 125 50 (42–61)

2005 5 10 (8.6–12) 208 (171–248) 0.059 (0.048–0.070) 1.2 (0.96–1.4) 6 329 126 60 (51–73)

2010 5 7.5 (6.2–9.0) 141 (116–168) 0.17 (0.14–0.21) 3.2 (2.7–3.8) 5 652 106 75 (63–91)

2011 5 7.6 (6.3–9.1) 141 (116–168) 0.22 (0.19–0.27) 4.2 (3.4–5.0) 5 980 111 78 (66–95)

2012 5 7.7 (6.4–9.2) 141 (116–168) 0.29 (0.24–0.34) 5.3 (4.4–6.3) 6 195 113 80 (67–97)

Latvia 1990 3 1.5 (1.3–1.7) 57 (50–65) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 906 34 59 (52–68)

1995 2 3.1 (2.7–3.5) 126 (111–142) 0.02 (0.018–0.023) 0.8 (0.71–0.91) 1 541 62 49 (44–56)

2000 2 2.9 (2.5–3.2) 121 (106–137) 0.06 (0.053–0.068) 2.6 (2.2–2.9) 1 982 84 69 (61–79)

2005 2 1.7 (1.5–1.9) 75 (66–85) 0.089 (0.078–0.10) 4 (3.5–4.5) 1 409 63 84 (74–96)

2010 2 1 (0.930–1.2) 50 (45–56) 0.089 (0.079–0.099) 4.3 (3.8–4.8) 913 44 87 (78–98)

2011 2 0.99 (0.890–1.1) 48 (43–53) 0.089 (0.079–0.099) 4.3 (3.8–4.8) 864 42 87 (78–97)

2012 2 1.1 (1.0–1.2) 53 (49–58) 0.1 (0.093–0.11) 5 (4.5–5.4) 959 47 87 (80–95)

Lithuania 1990 4 1.6 (1.4–1.9) 44 (37–52) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 471 40 90 (77–110)

1995 4 3.2 (2.8–3.7) 89 (77–102) 0.013 (0.011–0.015) 0.4 (0.31–0.41) 2 362 65 73 (64–85)

2000 3 3.6 (3.2–4.0) 103 (92–114) 0.037 (0.033–0.041) 1.1 (0.95–1.2) 2 657 76 74 (66–83)

2005 3 2.8 (2.5–3.2) 87 (76–97) 0.058 (0.051–0.065) 1.8 (1.6–2.0) 2 114 64 74 (66–84)

2010 3 2.2 (1.9–2.5) 73 (63–82) 0.067 (0.058–0.076) 2.2 (1.9–2.5) 1 751 57 79 (69–90)

2011 3 2.1 (1.8–2.4) 69 (61–78) 0.07 (0.061–0.079) 2.3 (2.0–2.6) 1 748 57 83 (73–95)

2012 3 2 (1.8–2.3) 66 (58–75) 0.071 (0.062–0.080) 2.3 (2.0–2.6) 1 635 54 82 (72–93)

Luxembourg 1990 < 1 0.055 (0.048–0.062) 14 (13–16) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 48 13 87 (77–99)

1995 < 1 0.037 (0.032–0.042) 9 (7.9–10) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 32 7.8 87 (77–99)

2000 < 1 0.051 (0.044–0.057) 12 (10–13) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.17) 44 10 87 (77–99)

2005 < 1 0.043 (0.037–0.048) 9.3 (8.1–11) <0.01 (<0.01–<0.01) 0.2 (0.10–0.21) 37 8.1 87 (77–99)

2010 < 1 0.033 (0.029–0.038) 6.6 (5.8–7.4) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.15) 29 5.7 87 (77–99)

2011 < 1 0.029 (0.025–0.033) 5.6 (4.9–6.3) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.13) 25 4.8 87 (77–99)

2012 < 1 0.034 (0.030–0.039) 6.5 (5.7–7.4) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.15) 45 8.6 130 (120–150)

Malta 1990 < 1 0.015 (0.013–0.017) 4 (3.5–4.5) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 13 3.5 87 (77–99)

1995 < 1 0.013 (0.011–0.014) 3.2 (2.8–3.6) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 11 2.8 87 (77–99)

2000 < 1 0.018 (0.016–0.021) 4.5 (4.0–5.1) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.10) 16 3.9 87 (77–99)

2005 < 1 0.025 (0.022–0.029) 6.1 (5.3–6.9) <0.01 (<0.01–<0.01) 0.2 (0.16–0.20) 22 5.3 87 (77–99)

2010 < 1 0.033 (0.029–0.038) 7.9 (6.9–8.9) <0.01 (<0.01–<0.01) 0.3 (0.22–0.28) 29 6.8 87 (77–99)

2011 < 1 0.035 (0.030–0.039) 8.1 (7.1–9.2) <0.01 (<0.01–<0.01) 0.3 (0.22–0.28) 30 7 87 (77–99)

2012 < 1 0.048 (0.042–0.055) 11 (9.9–13) <0.01 (<0.01–<0.01) 0.3 (0.30–0.39) 42 9.8 87 (77–99)

Monaco 1990 < 1 <0.01 (<0.01–<0.01) 3.9 (3.4–4.4) 1 3.4 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 3.7 (3.3–4.2) 1 3.3 87 (77–99)

2000 < 1 0 (0–0) 0 (0–0) 0 0

2005 < 1 <0.01 (<0.01–<0.01) 1.2 (1.0–1.3)

2010 < 1 <0.01 (<0.01–<0.01) 3.1 (2.7–3.5) 1 2.7 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 2.1 (1.8–2.4)

2012 < 1 <0.01 (<0.01–<0.01) 2.1 (1.8–2.4)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

233 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Montenegro 2005 < 1 0.18 (0.160–0.200) 29 (26–33) 156 25 87 (77–99)

2010 < 1 0.13 (0.110–0.140) 20 (18–23) <0.01 (0–<0.01) 0.2 (0–1.2) 110 18 87 (78–98)

2011 < 1 0.13 (0.110–0.140) 20 (18–23) 110 18 87 (78–97)

2012 < 1 0.11 (0.100–0.130) 18 (16–20) <0.01 (0–<0.01) <0.1 (0–0.54) 98 16 87 (78–97)

Netherlands 1990 15 1.6 (1.4–1.8) 11 (9.3–12) 0.013 (0.012–0.015) <0.1 (<0.1–0.10) 1 369 9.2 87 (77–99)

1995 15 1.9 (1.6–2.1) 12 (11–14) 0.058 (0.051–0.065) 0.4 (0.33–0.42) 1 619 10 87 (77–99)

2000 16 1.4 (1.3–1.6) 9 (7.9–10) 0.05 (0.044–0.057) 0.3 (0.28–0.36) 1 244 7.8 87 (77–99)

2005 16 1.3 (1.1–1.5) 8 (7.0–9.0) 0.046 (0.040–0.052) 0.3 (0.25–0.32) 1 127 6.9 87 (77–99)

2010 17 1.2 (1.1–1.4) 7.2 (6.3–8.2) 0.048 (0.042–0.054) 0.3 (0.25–0.33) 1 046 6.3 87 (77–99)

2011 17 1.1 (0.990–1.3) 6.8 (5.9–7.7) 0.046 (0.040–0.052) 0.3 (0.24–0.31) 981 5.9 87 (77–99)

2012 17 1.1 (0.930–1.2) 6.3 (5.5–7.2) 0.043 (0.038–0.049) 0.3 (0.23–0.29) 920 5.5 87 (77–99)

Norway 1990 4 0.33 (0.290–0.370) 7.7 (6.8–8.7) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 285 6.7 87 (77–99)

1995 4 0.27 (0.240–0.310) 6.2 (5.5–7.0) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 236 5.4 87 (77–99)

2000 4 0.25 (0.220–0.290) 5.7 (5.0–6.4) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 221 4.9 87 (77–99)

2005 5 0.32 (0.280–0.360) 6.9 (6.0–7.8) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 276 6 87 (77–99)

2010 5 0.34 (0.300–0.390) 7 (6.1–7.9) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 297 6.1 87 (77–99)

2011 5 0.37 (0.330–0.420) 7.5 (6.6–8.5) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 324 6.6 87 (77–99)

2012 5 0.37 (0.330–0.420) 7.5 (6.6–8.5) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1)

Poland 1990 38 19 (16–21) 49 (43–55) 0.019 (0.016–0.021) <0.1 (<0.1–<0.1) 16 136 42 87 (77–99)

1995 38 18 (16–21) 48 (42–54) 0.051 (0.045–0.058) 0.1 (0.12–0.15) 15 958 41 87 (77–99)

2000 38 13 (11–14) 33 (29–37) 0.039 (0.034–0.044) 0.1 (<0.1–0.12) 10 931 29 87 (77–99)

2005 38 9.4 (8.3–11) 25 (22–28) 0.034 (0.030–0.038) <0.1 (<0.1–0.10) 8 203 21 87 (77–99)

2010 38 8.1 (7.1–9.1) 21 (18–24) 0.031 (0.028–0.036) <0.1 (<0.1–<0.1) 7 002 18 87 (77–99)

2011 38 9.1 (8.0–10) 24 (21–27) 0.037 (0.032–0.041) 0.1 (<0.1–0.11) 7 946 21 87 (77–99)

2012 38 8.1 (7.1–9.2) 21 (19–24) 0.032 (0.028–0.037) <0.1 (<0.1–0.10) 7 054 18 87 (77–99)

Portugal 1990 10 7.1 (6.3–8.1) 72 (63–82) 0.11 (0.094–0.12) 1.1 (0.95–1.2) 6 214 63 87 (77–99)

1995 10 6.4 (5.6–7.3) 64 (56–72) 0.37 (0.33–0.42) 3.7 (3.2–4.2) 5 577 55 87 (77–99)

2000 10 4.9 (4.3–5.5) 47 (41–53) 0.35 (0.31–0.40) 3.4 (3.0–3.9) 4 227 41 87 (77–99)

2005 11 3.8 (3.3–4.3) 36 (32–41) 0.38 (0.33–0.43) 3.6 (3.1–4.1) 3 308 31 87 (77–99)

2010 11 2.9 (2.5–3.2) 27 (24–31) 0.33 (0.29–0.37) 3.1 (2.7–3.5) 2 487 23 87 (77–99)

2011 11 2.8 (2.4–3.1) 26 (23–30) 0.32 (0.28–0.36) 3 (2.7–3.4) 2 406 23 87 (77–99)

2012 11 2.8 (2.4–3.1) 26 (23–30) 0.33 (0.29–0.37) 3.1 (2.7–3.5) 2 490 23 89 (79–100)

Republic of 1990 4 2.3 (1.9–2.8) 54 (44–64) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.11) 1 728 40 74 (62–89)

Moldova 1995 4 4.7 (3.9–5.6) 109 (90–130) 0.018 (0.015–0.022) 0.4 (0.35–0.51) 2 925 67 62 (52–75)

2000 4 6 (5.0–7.2) 147 (121–175) 0.061 (0.051–0.073) 1.5 (1.2–1.8) 2 935 71 49 (41–59)

2005 4 6.6 (5.4–7.9) 175 (144–209) 0.18 (0.14–0.21) 4.7 (3.8–5.6) 5 141 136 78 (65–95)

2010 4 5.9 (4.9–7.1) 166 (137–198) 0.31 (0.26–0.37) 8.7 (7.1–10) 4 135 116 70 (59–85)

2011 4 5.7 (4.7–6.8) 161 (133–192) 0.33 (0.27–0.40) 9.4 (7.7–11) 4 233 119 74 (62–90)

2012 4 5.6 (4.6–6.7) 160 (132–190) 0.34 (0.28–0.40) 9.6 (7.9–11) 4 409 125 79 (66–95)

Romania 1990 23 34 (28–41) 146 (120–174) 0.075 (0.062–0.089) 0.3 (0.26–0.38) 16 256 70 48 (40–58)

1995 23 43 (36–52) 189 (155–226) 0.36 (0.30–0.43) 1.6 (1.3–1.9) 23 271 101 54 (45–65)

2000 22 41 (33–48) 181 (149–216) 0.47 (0.38–0.56) 2.1 (1.7–2.5) 27 470 123 68 (57–82)

2005 22 32 (27–39) 147 (121–175) 0.66 (0.55–0.79) 3 (2.5–3.6) 26 106 118 81 (67–98)

2010 22 24 (20–28) 109 (89–130) 0.76 (0.63–0.91) 3.5 (2.9–4.2) 18 379 84 77 (65–94)

2011 22 22 (18–26) 101 (83–121) 0.67 (0.55–0.80) 3.1 (2.5–3.7) 16 992 78 77 (64–93)

2012 22 20 (17–24) 94 (77–112) 0.6 (0.49–0.72) 2.8 (2.3–3.3) 16 036 74 79 (66–95)

Russian 1990 148 70 (59–81) 47 (40–55) 50 641 34 73 (62–86)

Federation 1995 149 140 (120–170) 96 (81–112) 0.014 (0.012–0.017) <0.1 (<0.1–<0.1) 84 980 57 60 (51–70)

2000 147 190 (160–220) 127 (108–149) 0.41 (0.35–0.48) 0.3 (0.24–0.33) 140 677 96 75 (65–89)

2005 144 190 (160–230) 135 (114–158) 5.8 (4.9–6.8) 4 (3.4–4.7) 127 930 89 66 (56–78)

2010 144 150 (130–180) 106 (89–123) 8.7 (7.4–10) 6.1 (5.1–7.1) 125 310 87 83 (71–98)

2011 143 140 (120–160) 97 (82–114) 9.1 (7.7–11) 6.3 (5.3–7.4) 112 910 79 81 (69–95)

2012 143 130 (110–150) 91 (77–106) 9.3 (7.9–11) 6.5 (5.5–7.5) 105 753 74 81 (70–96)

San Marino 1990 < 1 <0.01 (<0.01–<0.01) 4.8 (4.2–5.4) 1 4.1 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 9 (7.8–10) 2 7.8 87 (77–99)

2000 < 1 <0.01 (<0.01–<0.01) 4.3 (3.7–4.8) 1 3.7 87 (77–99)

2005 < 1 <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

2010 < 1 <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

2011 < 1 <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

2012 < 1 <0.01 (<0.01–<0.01) 1.5 (1.3–1.7)

Serbia 2005 10 3.7 (3.2–4.2) 37 (32–42) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 3 208 32 87 (77–100)

2010 10 2.7 (2.3–3.0) 28 (24–32) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 333 24 87 (77–100)

2011 10 2.5 (2.2–2.8) 26 (23–30) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 2 174 23 87 (77–100)

2012 10 2.2 (1.9–2.4) 23 (20–26) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 872 20 87 (77–100)

Serbia & 1990 10 7 (5.0–9.4) 68 (48–91) 4 194 41 60 (45–84)

Montenegro 1995 11 6.7 (5.7–7.9) 61 (52–72) 2 798 25 41 (35–49)

2000 11 5 (4.2–5.8) 46 (38–54) 2 864 26 58 (49–69)

Slovakia 1990 5 1.7 (1.5–1.9) 32 (28–36) 1 448 27 87 (77–99)

1995 5 1.8 (1.6–2.0) 33 (29–37) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 540 29 87 (77–99)

2000 5 1.2 (1.0–1.3) 22 (19–24) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 010 19 87 (77–99)

2005 5 0.82 (0.720–0.920) 15 (13–17) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 710 13 87 (77–99)

2010 5 0.47 (0.410–0.530) 8.7 (7.6–9.8) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 409 7.5 87 (77–99)

2011 5 0.43 (0.380–0.490) 8 (7.0–9.0) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 378 6.9 87 (77–99)

2012 5 0.37 (0.320–0.420) 6.8 (5.9–7.7) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 321 5.9 87 (77–99)

Slovenia 1990 2 0.83 (0.730–0.940) 41 (36–47) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 722 36 87 (77–99)

1995 2 0.6 (0.530–0.680) 30 (27–34) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 525 26 87 (77–99)

2000 2 0.42 (0.370–0.480) 21 (19–24) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 368 18 87 (77–99)

2005 2 0.31 (0.270–0.350) 15 (14–18) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.10) 269 13 87 (77–99)

2010 2 0.19 (0.170–0.220) 9.5 (8.3–11) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 169 8.2 87 (77–99)

2011 2 0.21 (0.180–0.240) 10 (8.8–11) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 181 8.8 87 (77–99)

2012 2 0.15 (0.140–0.170) 7.5 (6.5–8.4) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 134 6.5 87 (77–99)

Spain 1990 39 8.7 (7.7–9.9) 22 (20–25) 0.4 (0.35–0.45) 1 (0.90–1.2) 7 600 20 87 (77–99)

1995 39 10 (8.8–11) 26 (22–29) 0.84 (0.73–0.95) 2.1 (1.9–2.4) 8 764 22 87 (77–99)

2000 40 9.2 (8.1–10) 23 (20–26) 0.71 (0.62–0.81) 1.8 (1.5–2.0) 7 993 20 87 (77–99)

2005 43 8.4 (7.3–9.5) 19 (17–22) 0.77 (0.67–0.87) 1.8 (1.6–2.0) 7 281 17 87 (77–99)

2010 46 7.8 (6.8–8.8) 17 (15–19) 0.7 (0.61–0.79) 1.5 (1.3–1.7) 6 765 15 87 (77–99)

2011 47 7.4 (6.4–8.3) 16 (14–18) 0.66 (0.58–0.75) 1.4 (1.2–1.6) 6 392 14 87 (77–99)

2012 47 6.5 (5.7–7.4) 14 (12–16) 0.58 (0.51–0.66) 1.3 (1.1–1.4) 5 677 12 87 (77–99)

Sweden 1990 9 0.64 (0.560–0.720) 7.5 (6.6–8.5) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 557 6.5 87 (77–99)

1995 9 0.65 (0.570–0.730) 7.3 (6.4–8.3) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 564 6.4 87 (77–99)

2000 9 0.48 (0.420–0.540) 5.4 (4.7–6.1) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 417 4.7 87 (77–99)

2005 9 0.62 (0.540–0.700) 6.9 (6.0–7.8) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 539 6 87 (77–99)

2010 9 0.72 (0.630–0.810) 7.6 (6.7–8.6) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 623 6.6 87 (77–99)

2011 9 0.63 (0.550–0.710) 6.6 (5.8–7.5) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 544 5.8 87 (77–99)

2012 10 0.68 (0.600–0.770) 7.2 (6.3–8.1) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 593 6.2 87 (77–99)

Switzerland 1990 7 1.5 (1.3–1.7) 22 (19–25) 0.011 (<0.01–0.013) 0.2 (0.15–0.19) 1 278 19 87 (77–99)

1995 7 0.95 (0.840–1.1) 14 (12–15) 0.015 (0.013–0.017) 0.2 (0.18–0.24) 830 12 87 (77–99)

2000 7 0.66 (0.580–0.750) 9.3 (8.1–10) <0.01 (<0.01–<0.01) 0.1 (0.11–0.14) 577 8.1 87 (77–99)

2005 7 0.59 (0.520–0.670) 8 (7.0–9.0) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 514 6.9 87 (77–99)

2010 8 0.58 (0.510–0.660) 7.5 (6.5–8.4) <0.01 (<0.01–0.010) 0.1 (0.10–0.13) 508 6.5 87 (77–99)

2011 8 0.6 (0.530–0.680) 7.6 (6.7–8.6) <0.01 (<0.01–0.011) 0.1 (0.10–0.13) 524 6.6 87 (77–99)

2012 8 0.48 (0.420–0.540) 6 (5.2–6.8) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.11) 416 5.2 87 (77–99)

Tajikistan 1990 5 3.7 (3.0–4.4) 70 (58–83) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.12) 2 460 46 67 (56–81)

1995 6 8.6 (7.1–10) 148 (122–176) 0.03 (0.025–0.036) 0.5 (0.42–0.62) 2 029 35 24 (20–29)

2000 6 14 (11–16) 220 (182–263) 0.14 (0.11–0.16) 2.2 (1.8–2.7) 2 779 45 20 (17–25)

2005 7 14 (11–16) 200 (165–238) 0.25 (0.20–0.30) 3.6 (3.0–4.3) 5 460 80 40 (34–49)

2010 8 9.8 (8.1–12) 129 (106–153) 0.22 (0.18–0.26) 2.8 (2.3–3.4) 6 994 92 71 (60–86)

2011 8 9.2 (7.6–11) 118 (97–140) 0.21 (0.17–0.25) 2.7 (2.2–3.2) 7 035 90 76 (64–93)

2012 8 8.6 (7.1–10) 108 (89–128) 0.2 (0.16–0.24) 2.5 (2.0–3.0) 6 508 81 75 (63–91)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

234 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEaNUMBER RATEaPERCENT

The Former 1990 2 1.6 (1.0–2.4) 81 (50–119)

Yugoslav Republic 1995 2 1.1 (0.930–1.4) 58 (47–69) 786 40 69 (58–85)

of Macedonia 2000 2 0.85 (0.690–1.0) 41 (34–50) 641 31 75 (63–92)

2005 2 0.62 (0.560–0.680) 30 (27–33) 598 29 97 (88–110)

2010 2 0.44 (0.380–0.510) 21 (18–24) 384 18 87 (75–100)

2011 2 0.41 (0.360–0.480) 20 (17–23) 335 16 81 (70–94)

2012 2 0.39 (0.330–0.450) 18 (16–21) 346 16 89 (78–100)

Turkey 1990 54 28 (25–32) 52 (46–59) 24 468 45 87 (77–99)

1995 59 26 (23–30) 45 (40–51) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 22 981 39 87 (77–99)

2000 63 21 (18–23) 33 (29–37) 0.019 (0.016–0.021) <0.1 (<0.1–<0.1) 18 038 29 87 (77–99)

2005 68 23 (20–26) 34 (29–38) 0.05 (0.044–0.057) <0.1 (<0.1–<0.1) 19 744 29 87 (77–99)

2010 72 18 (16–21) 25 (22–29) 0.033 (0.029–0.037) <0.1 (<0.1–<0.1) 15 879 22 87 (77–99)

2011 73 17 (15–20) 24 (21–27) 0.033 (0.029–0.037) <0.1 (<0.1–<0.1) 15 054 21 87 (77–99)

2012 74 16 (14–18) 22 (19–25) 0.033 (0.028–0.037) <0.1 (<0.1–<0.1) 14 139 19 87 (77–99)

Turkmenistan 1990 4 3.5 (2.8–4.2) 95 (76–115) 2 325 63 67 (55–83)

1995 4 6.6 (5.4–7.8) 157 (129–187) 1 939 46 30 (25–36)

2000 5 9.4 (7.6–11) 209 (170–252) 4 038 90 43 (36–53)

2005 5 8.3 (6.8–10) 175 (144–210) 3 191 67 38 (32–47)

2010 5 5.2 (4.3–6.1) 103 (86–121) 3 230 64 62 (53–74)

2011 5 4.5 (3.7–5.5) 89 (73–107)

2012 5 3.9 (3.1–4.8) 75 (59–94)

Ukraine 1990 52 23 (19–27) 45 (37–53) 16 465 32 71 (60–86)

1995 51 38 (31–45) 74 (62–88) 0.15 (0.12–0.18) 0.3 (0.24–0.34) 21 459 42 57 (48–68)

2000 49 53 (44–63) 108 (90–129) 2.5 (2.0–2.9) 5 (4.1–5.9) 32 945 67 62 (52–75)

2005 47 57 (48–68) 121 (101–144) 5.8 (4.8–6.9) 12 (10–15) 39 608 84 69 (58–83)

2010 46 48 (41–57) 105 (88–123) 5.7 (4.8–6.7) 12 (10–15) 33 857 74 70 (60–83)

2011 46 46 (38–54) 99 (83–118) 5.3 (4.4–6.3) 12 (9.6–14) 34 237 75 75 (63–90)

2012 46 42 (35–51) 93 (77–112) 4.8 (3.9–5.7) 10 (8.6–13) 40 990 90 96 (81–120)

United Kingdom of 1990 57 6.6 (6.2–7.1) 12 (11–12) 0.071 (0.066–0.077) 0.1 (0.11–0.13) 5 908 10 89 (84–95)

Great Britain and 1995 58 6.9 (6.5–7.4) 12 (11–13) 0.087 (0.061–0.12) 0.2 (0.10–0.20) 6 176 11 89 (84–95)

Northern Ireland 2000 59 7 (6.5–7.4) 12 (11–13) 0.12 (0.088–0.16) 0.2 (0.15–0.27) 6 220 11 89 (84–95)

2005 60 9.2 (8.6–9.8) 15 (14–16) 0.25 (0.19–0.32) 0.4 (0.31–0.53) 8 173 14 89 (84–95)

2010 62 8.9 (8.3–9.4) 14 (13–15) 0.3 (0.23–0.38) 0.5 (0.37–0.62) 7 907 13 89 (84–95)

2011 62 9.5 (8.8–10) 15 (14–16) 0.32 (0.25–0.41) 0.5 (0.40–0.66) 8 439 14 89 (84–95)

2012 63 9.4 (8.8–10) 15 (14–16) 0.33 (0.25–0.41) 0.5 (0.40–0.66) 8 269 13 88 (82–94)

Uzbekistan 1990 21 26 (21–31) 125 (103–149) 0.057 (0.047–0.067) 0.3 (0.23–0.33) 9 414 46 37 (31–44)

1995 23 46 (38–55) 200 (165–238) 0.22 (0.18–0.26) 1 (0.79–1.1) 9 866 43 22 (18–26)

2000 25 71 (59–85) 287 (237–342) 0.57 (0.47–0.68) 2.3 (1.9–2.7) 15 750 63 22 (19–27)

2005 26 61 (50–72) 233 (193–278) 0.69 (0.57–0.82) 2.7 (2.2–3.2) 21 513 83 35 (30–43)

2010 28 34 (28–40) 122 (101–146) 0.56 (0.46–0.67) 2 (1.7–2.4) 16 883 61 50 (42–60)

2011 28 29 (24–34) 101 (84–121) 0.51 (0.42–0.61) 1.8 (1.5–2.2) 15 345 55 54 (45–65)

2012 29 22 (18–27) 78 (65–93) 0.44 (0.37–0.53) 1.6 (1.3–1.9) 14 832 52 66 (56–80)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

235 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Albania 1990 653 –

1995 641 139 223 226 53 53 38

2000 604 171 188 234 11 8 19 48

2005 506 196 134 167 9 34 43 59

2010 431 145 105 165 0 16 14 30 0 58

2011 422 180 105 128 0 9 9 18 0 63

• 19 13 • 2012 408 185 100 106 0 17 12 29 0 65

Andorra 1990 23 –

1995 –

2000 12 1 9 2 0 0 0 10

2005 10 5 1 4 0 0 0 83

2010 7 0 4 3 0 0 0 0 0 0

2011 3 1 2 0 0 0 1 1 0 33

• 42 11 • 2012 9 2 3 3 0 0 0 0 1 40

Armenia 1990 590 –

1995 1 000 436 451 75 38 38 49

2000 1 333 621 505 153 54 22 76 55

2005 2 206 581 1 049 365 211 116 327 36

2010 1 410 339 639 351 0 81 370 451 0 35

2011 1 261 329 582 289 0 61 321 382 0 36

• 17 41 • 2012 1 213 315 553 255 0 90 305 395 0 36

Austria 1990 1 521 –

1995 1 481 467 765 249 38

2000 1 185 324 652 209 0 30 30 33

2005 928 234 519 175 0 26 26 31

2010 659 76 213 69 0 0 29 29 301 26

2011 671 94 217 85 0 4 16 20 271 30

• 20 7 • 2012 620 95 218 97 0 12 28 40 198 30

Azerbaijan 1990 2 620 –

1995 1 630 669 620 93 47 47 52

2000 5 187 890 3 978 245 74 0 74 18

2005 6 034 1 561 2 508 651 1 314 1 886 3 200 38

2010 7 550 1 997 2 275 965 0 1 153 844 1 997 1 160 47

2011 9 146 1 426 2 740 1 130 0 1 201 954 2 155 2 649 34

• 36 68 • 2012 6 363 1 301 2 313 1 002 1 747 1 777 3 524 36

Belarus 1990 3 039 –

1995 4 854 1 845 2 148 518 343 343 46

2000 6 799 2 547 2 985 442 825 0 825 46

2005 5 308 1 235 3 710 363 1 049 1 049 25

2010 5 098 1 269 2 647 429 0 658 456 1 114 95 32

2011 4 697 1 217 2 439 387 654 421 1 075 33

• 30 51 • 2012 4 783 1 277 2 184 381 941 463 1 404 37

Belgium 1990 1 577 –

1995 1 380 400 534 366 80 80 43

2000 1 278 409 454 326 89 0 89 47

2005 1 076 380 406 290 68 68 48

2010 1 028 244 340 230 0 87 87 214 42

2011 985 240 273 192 0 59 59 280 47

• 16 8 • 2012 909 235 237 179 0 78 78 258 50

Bosnia and 1990 4 073 –

Herzegovina 1995 2 132 865 997 140 130 130 46

2000 2 476 759 1 287 261 169 24 193 37

2005 2 111 640 1 106 258 107 49 156 0 37

2010 1 321 441 529 161 158 32 69 101 0 45

2011 1 360 547 611 162 0 40 25 65 0 47

• 90 37 • 2012 1 409 569 554 176 2 108 11 119 0 51

Bulgaria 1990 2 256 –

1995 3 245 1 087 1 709 449 39

2000 3 349 2 524 0 442 383 0 383 100

2005 3 225 1 214 1 511 376 124 77 201 45

2010 2 412 806 748 747 0 111 237 348 0 52

2011 2 172 716 708 628 0 120 235 355 0 50

• 26 29 • 2012 2 081 741 618 606 1 115 199 314 0 55

Croatia 1990 2 576 –

1995 2 114 1 204 703 165 42 42 63

2000 1 630 –

2005 1 050 372 575 103 0 94 94 39

2010 688 183 382 87 36 7 43 32

2011 619 201 343 75 37

• 54 0 • 2012 –

Cyprus 1990 29 –

1995 36 6 11 13 0 0 35

2000 33 4 10 17 0 0 29

2005 34 9 13 12 0 3 3 41

2010 61 8 12 13 0 0 0 0 28 40

2011 51 11 14 5 1 0 3 3 20 44

• 4 6 • 2012 63 15 28 11 0 0 6 6 9 35

Czech Republic 1990 1 937 –

1995 1 834 487 1 026 300 21 21 32

2000 1 414 420 679 290 25 0 25 38

2005 973 308 461 204 0 34 34 40

2010 627 200 333 94 0 0 51 51 0 38

2011 569 188 307 74 0 0 31 31 0 38

• 19 5 • 2012 565 208 268 89 0 0 40 40 0 44

Denmark 1990 350 –

1995 448 128 186 128 6 6 41

2000 587 171 244 144 28 0 28 41

2005 395 129 145 121 0 29 29 47

2010 313 115 102 39 57 46 46 0 53

2011 359 124 100 45 90 22 22 0 55

• 7 0 • 2012 –

Estonia 1990 423 –

1995 624 369 124 60 71 71 75

2000 791 255 320 67 116 0 116 44

2005 479 162 217 46 54 40 94 43

2010 283 99 134 17 0 33 46 79 0 42

2011 296 123 124 18 0 31 45 76 0 50

• 27 20 • 2012 259 105 110 19 0 25 31 56 0 49

Finland 1990 772 –

1995 661 244 193 224 56

2000 527 205 136 157 29 0 29 60

2005 339 130 114 95 0 22 22 0 53

2010 312 82 146 84 0 0 15 15 0 36

2011 312 82 143 87 0 0 13 13 0 36

• 15 5 • 2012 261 78 104 70 0 5 13 18 4 43

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

236 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

France 1990 9 030 –

1995 8 723 3 449 2 969 2 305 54

2000 6 122 1 815 1 364 1 665 0 0 57

2005 5 003 1 941 1 557 1 389 0 371 371 116 55

2010 4 801 960 1 015 765 12 0 315 315 2 049 49

2011 4 681 906 1 016 710 7 0 261 261 2 042 47

• 16 0 • 2012 –

Georgia 1990 1 537 –

1995 1 625 221 1 087 121 196 196 17

2000 4 397 601 2 213 1 324 259 422 681 21

2005 4 503 1 509 1 524 1 261 207 1 945 2 152 2 50

2010 4 678 2 140 1 088 1 155 0 291 1 118 1 409 4 66

2011 4 547 2 026 1 141 1 056 0 324 986 1 310 0 64

• 28 90 • 2012 3 940 1 648 1 186 944 0 161 1 034 1 195 1 58

Germany 1990 14 653 –

1995 12 198 3 852 6 473 1 873 37

2000 9 064 –

2005 5 700 1 379 2 801 1 211 148 345 493 161 33

2010 4 059 910 1 713 789 16 96 271 367 535 35

2011 4 089 951 1 787 735 17 73 227 300 526 35

• 18 5 • 2012 4 043 928 1 580 812 10 52 195 247 661 37

Greece 1990 877 –

1995 939 –

2000 703 235 339 81 48 48 41

2005 693 197 322 107 0 74 74 67 38

2010 445 178 129 49 0 0 44 44 89 58

2011 454 236 156 57 3 0 35 35 2 60

• 9 0 • 2012 –

Greenland 1990 –

1995 –

2000 –

2005 –

2010 114 38 59 7 10 2 12 39

2011 115 34 73 5 3 3 32

• 0 148 • 2012 84 33 44 5 2 2 43

Hungary 1990 3 588 –

1995 4 339 796 3 292 251 19

2000 3 073 412 2 361 221 79 292 371 15

2005 1 808 423 1 137 117 131 216 347 27

2010 1 543 270 1 147 70 0 56 198 254 0 19

2011 1 279 260 910 53 0 55 166 221 1 22

• 35 12 • 2012 1 159 273 831 35 0 20 64 84 0 25

Iceland 1990 18 –

1995 12 2 3 7 0 0 40

2000 13 1 7 4 1 0 1 12

2005 10 2 3 5 0 1 1 40

2010 22 6 12 4 0 0 0 0 0 33

2011 8 1 2 5 0 0 1 1 0 33

• 7 3 • 2012 10 2 5 3 0 0 1 1 0 29

Ireland 1990 624 –

1995 458 –

2000 386 138 150 96 2 20 22 48

2005 423 130 156 99 2 38 40 36 45

2010 396 84 122 112 1 31 31 77 41

2011 398 85 110 82 3 27 27 118 44

• 18 7 • 2012 341 77 97 75 1 25 25 91 44

Israel 1990 234 –

1995 398 –

2000 537 216 213 100 0 8 0 8 0 50

2005 371 142 168 55 0 6 1 7 0 46

2010 340 103 162 74 0 1 3 4 0 39

2011 412 135 207 66 0 4 6 10 0 39

• 5 7 • 2012 506 142 254 102 0 8 3 11 0 36

Italy 1990 4 246 –

1995 5 627 1 413 2 700 1 514 34

2000 3 501 687 891 522 269 356 625 44

2005 3 844 1 275 1 506 1 047 0 293 293 16 46

2010 3 175 586 779 328 0 0 74 74 1 482 43

2011 3 421 587 790 641 0 0 100 100 1 403 43

• 7 0 • 2012 –

Kazakhstan 1990 10 969 –

1995 11 310 3 022 5 966 1 002 1 320 1 320 34

2000 25 843 8 903 11 324 2 555 3 061 2 032 5 093 44

2005 28 629 6 911 14 472 920 3 209 11 800 15 009 3 117 32

2010 23 399 4 769 8 745 2 127 0 4 062 5 151 9 213 3 696 35

2011 25 074 4 157 8 242 1 997 0 4 739 1 230 5 969 5 939 34

• 68 111 • 2012 18 006 3 884 7 892 1 844 9 4 377 3 517 7 894 0 33

Kyrgyzstan 1990 2 306 –

1995 3 393 832 1 685 749 127 127 33

2000 6 205 1 296 2 929 1 683 297 258 555 31

2005 6 329 1 972 2 141 1 805 411 436 847 0 48

2010 5 652 1 645 2 028 1 635 0 344 643 987 45

2011 5 980 1 537 2 125 1 518 0 349 686 1 035 451 42

• 52 113 • 2012 6 195 1 594 2 448 1 809 344 721 1 065 0 39

Latvia 1990 906 –

1995 1 541 504 693 226 118 118 42

2000 1 982 637 793 285 267 108 375 45

2005 1 409 536 554 148 171 34 205 49

2010 913 339 400 86 0 88 21 109 0 46

2011 864 293 410 85 0 76 21 97 0 42

• 34 47 • 2012 959 342 438 100 0 79 34 113 0 44

Lithuania 1990 1 471 –

1995 2 362 979 1 049 206 128 128 48

2000 2 657 776 1 051 503 327 182 509 42

2005 2 114 964 793 357 0 460 460 55

2010 1 751 719 633 221 0 177 187 364 1 53

2011 1 748 681 664 187 0 213 156 369 3 51

• 40 54 • 2012 1 635 726 548 156 0 204 146 350 1 57

Luxembourg 1990 48 –

1995 32 –

2000 44 21 19 0 4 4 52

2005 37 14 20 3 0 0 0 41

2010 29 0 18 6 0 0 0 0 5 0

2011 25 4 4 3 0 0 1 1 14 50

• 13 9 • 2012 45 0 0 0 0 1 0 1 44

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

237 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Malta 1990 13 –

1995 11 5 4 2 0 0 56

2000 16 5 9 2 0 0 0 36

2005 22 5 10 6 0 1 1 1 33

2010 29 4 6 10 0 0 3 3 9 40

2011 30 7 8 7 0 0 3 3 8 47

• 3 10 • 2012 42 9 20 12 0 0 1 1 1 31

Monaco 1990 1 –

1995 1 –

2000 0 0 0 0 0 0 0

2005 –

2010 1 1 –

2011 –

• 3 0 • 2012 –

Montenegro 2005 156 64 66 13 13 14 27 49

2010 110 39 49 14 0 8 4 12 0 44

2011 110 48 40 12 0 10 2 12 0 55

16 • 2012 98 45 36 13 0 4 9 13 0 56

Netherlands 1990 1 369 –

1995 1 619 575 1 522 513 27

2000 1 244 289 528 427 0 70 70 35

2005 1 127 237 491 385 14 30 44 33

2010 1 046 176 370 463 4 16 27 43 17 32

2011 981 177 353 425 3 12 26 38 11 33

• 9 6 • 2012 920 163 300 444 0 11 38 49 2 35

Norway 1990 285 –

1995 236 62 57 89 28 28 52

2000 221 37 103 79 2 10 12 26

2005 276 48 119 102 0 14 14 7 29

2010 297 49 110 115 0 42 42 23 31

2011 324 40 134 139 1 37 37 10 23

• 7 0 • 2012 –

Poland 1990 16 136 –

1995 15 958 6 955 7 285 647 1 071 1 071 49

2000 10 931 3 180 6 392 477 882 0 882 33

2005 8 203 2 823 4 591 789 0 1 077 1 077 38

2010 7 002 2 484 3 625 501 0 392 507 899 0 41

2011 7 946 2 587 4 344 584 0 431 532 963 0 37

• 42 18 • 2012 7 054 2 433 3 729 503 0 389 488 877 0 39

Portugal 1990 6 214 –

1995 5 577 2 019 1 531 1 759 268 268 57

2000 4 227 1 863 1 005 1 178 177 304 481 65

2005 3 308 1 302 974 905 122 228 350 5 57

2010 2 487 912 791 679 16 89 139 228 0 54

2011 2 406 876 813 629 7 81 134 215 0 52

• 63 23 • 2012 2 490 920 805 670 7 88 100 188 0 53

Republic of 1990 1 728 –

Moldova 1995 2 925 665 1 958 154 148 148 25

2000 2 935 651 1 788 122 374 0 374 27

2005 5 141 1 696 2 237 568 640 1 137 1 777 43

2010 4 135 1 267 2 073 405 0 377 1 312 1 689 13 38

2011 4 233 1 272 2 140 424 0 372 1 108 1 480 25 37

• 40 125 • 2012 4 409 1 346 2 062 396 0 559 932 1 491 46 39

Romania 1990 16 256 –

1995 23 271 10 469 8 303 3 422 1 077 1 077 56

2000 27 470 10 202 10 180 3 474 3 614 156 3 770 50

2005 26 106 10 801 8 038 3 568 3 697 3 241 6 938 2 57

2010 18 379 7 951 5 113 2 899 0 2 416 2 699 5 115 0 61

2011 16 992 7 386 4 528 2 629 0 2 449 2 220 4 669 0 62

• 70 74 • 2012 16 036 7 077 4 342 2 481 0 2 136 2 188 4 324 0 62

Russian 1990 50 641 –

Federation 1995 84 980 37 512 42 241 5 227 47

2000 140 677 27 467 102 228 5 313 5 669 12 478 18 147 21

2005 127 930 32 605 74 301 12 320 8 704 26 449 35 153 30

2010 125 310 31 416 67 894 3 513 7 081 8 737 37 243 45 980 6 669 32

2011 112 910 29 191 65 106 10 023 8 590 46 569 55 159 31

• 34 74 • 2012 105 753 27 467 60 058 10 017 0 8 211 44 168 52 379 0 31

San Marino 1990 1 –

1995 2 –

2000 1 1 0 0 0 0 0 100

2005 –

2010 –

2011 –

• 4 0 • 2012 –

Serbia 2005 3 208 1 105 1 584 479 40 260 300 0 41

2010 2 333 977 700 501 0 148 52 200 7 58

2011 2 174 905 745 401 0 120 42 162 3 55

20 • 2012 1 872 819 787 130 0 134 45 179 2 51

Serbia (without Kosovo) 2005 2 146 873 714 245 55

2010 1 449 690 431 202 119 119 62

2011 1 299 654 372 155 91 91 64

2012 1 170 569 369 86 86 61

Kosovo 2005 1 062 232 596 234 28

2010 884 287 269 299 29 29 52

2011 875 251 349 246 29 29 42

2012 702 250 404 48 48 38

Serbia & 1990 4 194 –

Montenegro 1995 2 798 1 497 930 173 198 198 62

• 0 2000 2 864 0 2 486 175 203 0 203 0

Slovakia 1990 1 448 –

1995 1 540 788 555 177 20 20 59

2000 1 010 236 469 203 102 18 120 33

2005 710 162 356 134 58 50 108 31

2010 409 112 190 59 0 25 30 55 23 37

2011 378 96 170 57 0 29 21 50 26 36

• 27 6 • 2012 321 96 144 39 0 25 24 49 17 40

Slovenia 1990 722 –

1995 525 303 83 109 30 30 78

2000 368 145 133 59 31 16 47 52

2005 269 109 110 30 20 9 29 50

2010 169 64 67 30 0 8 3 11 0 49

2011 181 82 73 26 0 11 11 0 53

• 36 6 • 2012 134 47 64 13 0 10 4 14 0 42

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Spain 1990 7 600 –

1995 8 764 2 605 6 159 30

2000 7 993 3 423 4 446 124 0 0 0 43

2005 7 281 2 511 3 880 890 0 1 078 1 078 39

2010 6 765 2 076 2 621 1 680 0 0 324 324 388 44

2011 6 392 2 186 2 242 1 616 0 0 370 370 348 49

• 20 12 • 2012 5 677 1 984 1 855 1 508 0 0 314 314 330 52

Sweden 1990 557 –

1995 564 102 235 216 11 11 30

2000 417 118 147 152 0 40 40 45

2005 539 134 208 197 0 30 30 39

2010 623 117 226 209 0 0 52 52 71 34

2011 544 99 182 173 0 3 42 45 87 35

• 7 6 • 2012 593 101 233 229 0 0 39 39 30 30

Switzerland 1990 1 278 –

1995 830 185 515 126 5 5 26

2000 577 86 216 102 63 63 173 28

2005 514 84 187 110 49 49 133 31

2010 508 82 149 91 40 40 186 35

2011 524 90 170 119 54 54 145 35

• 19 5 • 2012 416 87 124 84 47 47 121 41

Tajikistan 1990 2 460 –

1995 2 029 1 042 617 370 370 63

2000 2 779 434 1 918 427 18

2005 5 460 1 745 2 175 1 417 123 2 066 2 189 45

2010 6 994 2 290 2 038 1 631 0 338 647 985 697 53

2011 7 035 2 174 2 148 1 613 0 355 574 929 745 50

• 46 81 • 2012 6 508 2 041 1 911 1 532 0 327 421 748 697 52

The Former 1990 –

oslav Re

ubli

1995 786 319 376 66 25 25 46

of Macedonia 2000 641 167 308 150 16 0 16 35

2005 598 178 236 141 43 60 103 43

2010 384 141 135 92 0 16 36 52 0 51

2011 335 132 99 76 0 28 27 55 0 57

• 0 16 • 2012 346 147 95 78 0 22 9 31 4 61

Turkey 1990 24 468 –

1995 22 981 4 383 17 534 1 064 20

2000 18 038 4 315 8 544 4 371 808 808 34

2005 19 744 7 450 5 944 5 359 991 1 559 2 550 56

2010 15 879 5 375 4 191 5 617 0 696 672 1 368 0 56

2011 15 054 4 927 3 925 5 565 0 637 625 1 262 0 56

• 45 19 • 2012 14 139 4 585 3 829 5 121 0 604 552 1 156 0 54

Turkmenistan 1990 2 325 –

1995 1 939 544 1 327 1 67 67 29

2000 4 038 1 017 2 709 241 71 1 894 1 965 27

2005 3 191 995 1 498 656 42 100 142 40

2010 3 230 1 153 1 248 473 274 82 82 48

2011 –

• 63 0 • 2012 –

Ukraine 1990 16 465 –

1995 21 459 8 263 9 793 1 514 1 889 1 889 46

2000 32 945 10 738 17 258 1 739 3 210 0 3 210 38

2005 39 608 –

2010 33 857 9 976 17 599 3 355 365 2 562 2 552 5 114 36

2011 34 237 10 502 14 106 3 367 3 213 3 049 8 439 11 488 43

• 32 90 • 2012 40 990 11 030 17 398 3 344 3 650 4 579 8 229 5 568 39

United Kingdom of 1990 5 908 –

Great Britain and 1995 6 176 4 162 2 014 –

Northern Ireland 2000 6 220 1 204 2 037 2 478 0 0 0 37

2005 8 173 1 821 2 752 3 600 0 460 460 40

2010 7 907 1 201 2 551 3 443 24 576 576 688 32

2011 8 439 1 204 2 827 3 783 36 524 524 589 30

• 10 13 • 2012 8 269 1 251 2 751 3 676 53 482 482 538 31

Uzbekistan 1990 9 414 –

1995 9 866 2 735 5 798 1 333 32

2000 15 750 3 825 10 142 1 760 23 324 347 27

2005 21 513 5 695 7 857 6 324 1 637 7 378 9 015 42

2010 16 883 4 711 6 735 4 288 0 1 149 3 447 4 596 0 41

2011 15 345 4 198 5 958 3 839 0 506 568 1 074 844 41

• 46 52 • 2012 14 832 4 030 6 137 3 965 0 655 1 978 2 633 45 40

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

239 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Albania 1995 139 –

2000 171 –

2005 196 196 100 43 35 4 2 5 11

2009 171 171 100 64 25 2 1 4 4

2010 145 145 100 49 42 3 0 3 3

• 0 93 • 2011 180 180 100 65 28 2 0 4 1

Andorra 1995 –

2000 1 2 200 50 50 0

2005 5 5 100 80 0 0 0 0 20

2009 2 3 150 33 67 0 0 0 0

2010 0 0 –

• 0 100 • 2011 1 1 100 0 100 0 0 0 0

Armenia 1995 436 507 116 52 2 8 36 1 0

2000 621 447 72 81 6 4 3 7 0

2005 581 581 100 59 13 3 5 14 4

2009 440 440 100 60 12 7 3 8 10

2010 339 339 100 55 16 4 15 8 1

• 55 63 • 2011 329 329 100 44 19 6 25 6 0

Austria 1995 467 383 82 2 81 10 0 7 1

2000 324 298 92 0 73 9 0 6 11

2005 234 230 98 17 58 7 0 7 11

2009 90 226 251 8 59 9 0 8 16

2010 76 206 271 6 59 6 0 6 23

• 82 71 • 2011 94 221 235 7 64 6 0 7 15

Azerbaijan 1995 669 538 80 58 7 12 19 4

2000 890 890 100 89 0 1 2 3 4

2005 1 561 1 561 100 48 11 4 4 12 22

2009 1 487 1 480 100 47 15 3 7 16 12

2010 1 997 1 919 96 47 30 3 4 10 6

• 65 78 • 2011 1 426 2 208 155 33 44 3 6 10 4

Belarus 1995 1 845 –

2000 2 547 –

2005 1 235 –

2009 1 201 2 160 180 64 0 10 4 1 20

2010 1 269 2 184 172 66 0 8 22 1 2

• 0 60 • 2011 1 217 2 169 178 59 1 6 31 1 1

Belgium 1995 400 –

2000 409 358 88 25 41 10 1 17 6

2005 380 304 80 21 45 10 0 0 24

2009 280 485 173 14 62 8 0 11 4

2010 244 473 194 15 61 7 0 11 7

• 0 77 • 2011 240 405 169 28 50 7 0 10 6

Bosnia and 1995 865 865 100 97 1 0 1 1 1

Herzegovina 2000 759 756 100 77 18 1 1 2 1

2005 640 1 035 162 93 3 1 0 0 2

2009 609 852 140 97 2 0 0 0 0

2010 441 441 100 91 7 1 0 0 0

• 97 70 • 2011 547 693 127 43 27 5 1 1 24

Bulgaria 1995 1 087 –

2000 2 524 –

2005 1 214 1 342 111 82 3 4 2 7 1

2009 894 1 055 118 78 7 9 2 4 1

2010 806 946 117 84 2 8 2 3 1

• 0 86 • 2011 716 853 119 84 2 8 1 3 2

Croatia 1995 1 204 –

2000 –

2005 372 391 105 40 7 7 0 1 45

2009 302 234 77 48 15 26 0 3 7

2010 183 181 99 58 17 14 0 4 7

• 0 0 • 2011 201 –

Cyprus 1995 6 6 100 100 0 0 0 0 0

2000 4 –

2005 9 8 89 38 25 12 0 0 25

2009 14 28 200 29 0 0 0 0 71

2010 8 20 250 25 0 0 0 0 75

• 100 64 • 2011 11 22 200 55 9 14 0 0 23

Czech Republic 1995 487 487 100 57 3 0 3 2 35

2000 420 396 94 59 11 17 1 1 11

2005 308 315 102 62 10 6 0 2 20

2009 218 402 184 66 2 21 0 7 4

2010 200 361 180 66 3 17 0 7 7

• 60 69 • 2011 188 377 201 66 3 17 0 9 5

Denmark 1995 128 –

2000 171 110 64 37 49 5 0 0 9

2005 129 128 99 44 39 6 1 2 8

2009 101 175 173 22 31 4 1 1 42

2010 115 217 189 31 33 11 2 0 22

• 0 0 • 2011 124 –

Estonia 1995 369 –

2000 255 257 101 67 2 11 1 6 12

2005 162 162 100 70 2 8 1 10 10

2009 135 240 178 57 1 15 2 6 18

2010 99 191 193 65 3 10 2 4 17

• 0 59 • 2011 123 202 164 57 2 11 1 5 23

Finland 1995 244 –

2000 205 –

2005 130 –

2009 93 227 244 33 34 17 0 1 14

2010 82 184 224 48 27 9 0 2 15

• 0 67 • 2011 82 181 221 39 29 18 1 0 14

France 1995 3 449 –

2000 1 815 –

2005 1 941 –

2009 1 019 –

2010 960 –

• 0 0 • 2011 906 –

Georgia 1995 221 221 100 41 18 8 3 29 2

2000 601 807 134 38 25 3 9 25 0

2005 1 509 1 489 99 60 13 3 5 13 7

2009 2 055 2 352 114 57 19 3 12 7 3

2010 2 140 2 500 117 59 17 3 12 7 2

• 58 76 • 2011 2 026 2 513 124 57 19 2 15 5 2

Germany 1995 3 852 –

2000 454 – 61 16 16 1 2 4

2005 1 379 1 199 87 39 32 9 0 2 18

2009 1 025 2 220 217 33 44 12 0 1 9

2010 910 2 064 227 32 44 12 0 2 9

• 0 70 • 2011 951 2 113 222 29 42 11 0 2 17

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

240 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Greece 1995 –

2000 235 –

2005 197 –

2009 198 –

2010 178 –

• 0 0 • 2011 236 –

Greenland 1995 –

2000 –

2005 –

2009 24 –

2010 38 –

• 0 0 • 2011 34 –

Hungary 1995 796 –

2000 412 651 158 28 36 10 3 12 11

2005 423 412 97 32 13 13 12 9 20

2009 363 597 164 45 12 10 19 7 7

2010 270 515 191 64 5 12 0 10 9

• 0 0 • 2011 260 0 0

Iceland 1995 2 2 100 0 100 0 0 0 0

2000 1 2 200 0 100 0 0 0 0

2005 2 2 100 0 100 0 0 0 0

2009 3 4 133 0 75 0 0 0 25

2010 6 16 267 0 88 6 0 0 6

• 100 0 • 2011 1 0 0

Ireland 1995 –

2000 138 73 53 33 51 12 0 4 0

2005 130 107 82 3 62 9 3 1 22

2009 95 188 198 5 62 9 0 1 23

2010 84 164 195 0 73 7 0 1 19

• 0 64 • 2011 85 153 180 54 10 5 0 3 29

Israel 1995 –

2000 216 336 156 65 18 15 0 0 1

2005 142 227 160 69 15 11 0 3 2

2009 119 202 170 72 14 10 0 1 3

2010 103 99 96 69 7 11 0 0 13

• 0 77 • 2011 135 242 179 69 9 10 0 2 10

Italy 1995 1 413 295 21 73 6 3 2 11 4

2000 687 223 32 37 36 1 0 9 16

2005 1 275 –

2009 885 –

2010 586 –

• 80 0 • 2011 587 –

Kazakhstan 1995 3 022 –

2000 8 903 8 781 99 76 3 5 10 3 3

2005 6 911 6 884 100 70 1 5 12 5 8

2009 5 213 5 355 103 62 0 4 30 3 2

2010 4 769 4 919 103 61 0 3 7 2 27

• 0 61 • 2011 4 157 4 306 104 61 0 4 6 2 27

Kyrgyzstan 1995 832 –

2000 1 296 1 233 95 73 9 3 4 5 6

2005 1 972 1 897 96 81 4 3 5 5 2

2009 1 609 1 543 96 79 4 3 4 6 4

2010 1 645 –

• 0 78 • 2011 1 537 1 537 100 75 3 3 11 5 3

Latvia 1995 504 475 94 61 0 9 3 21 7

2000 637 637 100 68 4 12 3 7 7

2005 536 536 100 72 1 11 1 7 8

2009 367 592 161 72 3 9 1 5 11

2010 339 596 176 72 3 8 1 6 10

• 61 73 • 2011 293 559 191 72 1 10 0 5 11

Lithuania 1995 979 –

2000 776 776 100 73 10 4 12 2

2005 964 958 99 70 0 11 3 11 6

2009 742 1 033 139 73 0 10 2 9 6

2010 719 959 133 68 0 11 1 11 8

• 0 73 • 2011 681 1 000 147 73 0 11 1 8 7

Luxembourg 1995 37 – 100 0 0 0 0 0

2000 21 –

2005 14 0 0

2009 –

2010 0 14 – 0 0 7 0 0 93

• 100 0 • 2011 4 6 150 0 0 17 0 0 83

Malta 1995 5 5 100 80 20 0 0 0 0

2000 5 4 80 0 100 0 0 0 0

2005 5 5 100 0 100 0 0 0 0

2009 12 10 83 0 80 0 0 0 20

2010 4 5 125 0 80 0 0 0 20

• 100 58 • 2011 7 12 171 0 58 0 0 8 33

Monaco 1995 –

2000 0 –

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Montenegro 2005 64 63 98 10 21 70

2009 53 78 147 49 37 8 0 4 3

2010 39 39 100 46 41 5 0 3 5

86 • 2011 48 56 117 25 61 12 0 0 2

Netherlands 1995 575 715 124 17 55 8 5 15

2000 289 301 104 23 53 6 0 3 15

2005 237 208 88 9 75 7 0 1 8

2009 203 454 224 11 69 9 0 3 8

2010 176 469 266 1 76 7 0 4 12

• 72 81 • 2011 177 437 247 1 81 5 0 3 11

Norway 1995 62 87 140 43 34 14 1 8 0

2000 37 37 100 49 22 14 3 3 11

2005 48 47 98 62 30 2 0 4 2

2009 42 146 348 45 37 4 1 0 13

2010 49 139 284 68 24 3 1 0 5

• 77 0 • 2011 40 –

Poland 1995 6 955 –

2000 3 180 214 7 50 22 11 6 6 5

2005 2 823 2 823 100 65 12 5 1 9 8

2009 2 658 4 391 165 48 19 5 0 10 17

2010 2 484 3 998 161 47 19 6 0 9 19

• 0 60 • 2011 2 587 4 699 182 43 17 9 0 9 22

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

241 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Portugal 1995 2 019 1 240 61 45 23 4 4 4 19

2000 1 863 1 924 103 9 71 6 0 5 9

2005 1 302 1 393 107 13 76 6 0 4 2

2009 1 043 1 565 150 9 75 6 0 3 7

2010 912 –

• 69 80 • 2011 876 1 387 158 9 72 5 0 3 12

Republic of 1995 665 –

Moldova 2000 651 651 100 1 62 0 0 0 37

2005 1 696 1 690 100 60 2 9 11 11 7

2009 1 318 1 318 100 49 5 10 17 14 5

2010 1 267 1 267 100 52 5 11 5 13 13

• 0 62 • 2011 1 272 1 272 100 57 5 9 18 10 1

Romania 1995 10 469 11 597 111 38 13 6 7 6 31

2000 10 202 10 158 100 28 42 4 8 8 9

2005 10 801 10 929 101 71 11 5 4 6 4

2009 8 987 10 737 119 72 14 4 4 6 1

2010 7 951 9 445 119 70 14 5 4 6 2

• 51 85 • 2011 7 386 8 886 120 71 14 5 3 5 1

Russian 1995 37 512 54 0 54 11 15 6 11 4

Federation 2000 27 467 3 616 13 64 4 6 13 9 4

2005 32 605 25 692 79 55 3 13 14 11 4

2009 33 351 32 316 97 52 3 11 20 8 5

2010 31 416 30 123 96 50 3 12 23 7 5

• 65 54 • 2011 29 191 36 747 126 48 5 9 10 7 20

San Marino 1995 –

2000 1 1 100 0 0 100 0 0 0

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Serbia 2005 1 105 1 154 104 72 13 5 1 5 4

2009 1 055 1 392 132 80 6 6 1 4 2

2010 977 988 101 79 8 6 1 4 2

87 • 2011 905 894 99 80 7 7 0 4 2

Serbia & 1995 1 497 1 956 131 34 18 2 3 10 33

Montenegro 2000 0 267 – 82 7 4 0 6 1

Slovakia 1995 788 807 102 64 16 4 16

2000 236 238 101 81 0 14 1 2 1

2005 162 158 98 66 26 6 0 1 1

2009 121 174 144 82 0 14 0 2 2

2010 112 177 158 84 0 12 0 3 1

• 64 91 • 2011 96 138 144 91 1 7 0 0 2

Slovenia 1995 303 270 89 64 26 4 2 1 3

2000 145 145 100 33 51 8 0 5 3

2005 109 109 100 47 38 12 0 1 3

2009 85 149 175 24 63 9 1 1 3

2010 64 123 192 28 57 11 0 1 3

• 90 81 • 2011 82 151 184 37 44 18 0 1 1

Spain 1995 2 605 –

2000 3 423 –

2005 2 511 –

2009 2 236 –

2010 2 076 3 574 172 39 32 6 0 1 23

• 0 73 • 2011 2 186 3 335 153 42 31 7 0 1 19

Sweden 1995 102 –

2000 118 112 95 0 79 11 0 2 8

2005 134 133 99 0 74 6 1 1 18

2009 107 255 238 0 85 6 0 1 8

2010 117 289 247 70 15 5 0 1 9

• 0 83 • 2011 99 247 249 51 32 5 1 2 9

Switzerland 1995 185 –

2000 86 –

2005 84 –

2009 74 –

2010 82 –

• 0 0 • 2011 90 –

Tajikistan 1995 1 042 348 33 69 18 7 3 2 0

2000 434 665 153 74 3 15 8 0 0

2005 1 745 1 729 99 74 9 4 6 7 0

2009 1 972 1 972 100 75 6 4 8 5 1

2010 2 290 2 290 100 76 4 5 11 3 1

• 88 80 • 2011 2 174 2 174 100 74 6 5 11 3 1

The Former 1995 319 222 70 61 9 13 9 9 0

Yugoslav Republic 2000 167 152 91 51 35 4 2 7 1

of Macedonia 2005 178 179 101 62 22 2 0 14 0

2009 198 199 101 85 5 4 2 5 0

2010 141 143 101 83 7 4 3 2 1

• 70 95 • 2011 132 130 98 78 16 3 0 2 0

Turkey 1995 4 383 –

2000 4 315 3 461 80 0 73 3 0 6 19

2005 7 450 7 450 100 45 44 2 0 5 3

2009 6 007 6 007 100 61 30 3 1 2 3

2010 5 375 5 375 100 63 29 3 1 3 2

• 0 90 • 2011 4 927 4 927 100 60 31 3 1 3 3

Turkmenistan 1995 544 544 100 55 18 11 7 2 7

2000 1 017 1 017 100 79 2 9 6 3 1

2005 995 995 100 70 14 6 4 5 1

2009 1 370 1 375 100 83 1 5 6 5 1

2010 1 153 –

• 73 0 • 2011 –

Ukraine 1995 8 263 9 564 116 83 6 7 4

2000 10 738 –

2005 –

2009 13 632 13 111 96 52 7 13 16 8 3

2010 9 976 13 279 133 51 9 13 17 8 3

• 83 58 • 2011 10 502 13 714 131 48 10 13 18 7 4

United Kingdom of 1995 –

Great Britain and 2000 1 204 –

Northern Ireland 2005 1 821 1 348 74 0 68 7 0 1 24

2009 1 256 2 569 205 0 82 6 0 5 7

2010 1 201 2 602 217 0 81 5 0 6 8

• 0 80 • 2011 1 204 2 952 245 0 80 6 0 6 8

Uzbekistan 1995 2 735 2 598 95 78 0 9 7 4 3

2000 3 825 1 030 27 27 53 3 6 5 6

2005 5 695 5 336 94 72 9 6 6 7 1

2009 4 959 4 959 100 77 5 6 5 5 3

2010 4 711 4 711 100 76 5 6 6 5 3

• 78 78 • 2011 4 198 4 198 100 73 5 6 6 6 4

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

242 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Albania 1995 53 –

2000 19 –

2005 43 30 70 37 37 3 0 10 13

2009 21 21 100 38 38 10 0 10 5

2010 30 30 100 43 47 3 0 7 0

• 0 83 • 2011 18 18 100 28 56 6 0 6 6

Andorra 1995 –

2000 0 –

2005 0 –

2009 2 2 100 0 100 0 0 0 0

2010 0 0 –

• 0 0 • 2011 1 1 100 0 0 0 0 0 100

Armenia 1995 38 6 16 50 0 0 17 33 0

2000 76 54 71 52 15 7 7 19 0

2005 327 327 100 13 28 7 12 37 4

2009 542 542 100 9 54 8 4 15 10

2010 451 451 100 5 62 6 10 13 4

• 50 68 • 2011 382 382 100 5 63 4 9 15 3

Austria 1995 –

2000 30 10 33 0 80 0 0 0 20

2005 26 27 104 11 56 11 0 11 11

2009 25 37 148 3 38 5 0 30 24

2010 29 29 100 14 45 0 0 0 41

• 0 43 • 2011 20 21 105 0 43 14 5 5 33

Azerbaijan 1995 47 –

2000 74 74 100 59 7 5 11 14 4

2005 3 200 1 314 41 28 9 6 6 13 38

2009 2 384 1 687 71 39 14 6 9 19 13

2010 1 997 4 194 210 14 49 3 4 15 15

• 0 71 • 2011 2 155 4 005 186 8 63 3 5 12 8

Belarus 1995 343 –

2000 825 –

2005 1 049 –

2009 878 616 70 38 4 13 7 1 37

2010 1 114 792 71 20 28 10 36 1 5

• 0 29 • 2011 1 075 1 020 95 21 8 7 59 3 3

Belgium 1995 80 –

2000 89 55 62 16 45 13 0 15 11

2005 68 47 69 17 21 19 0 0 43

2009 76 – 11 57 9 0 12 12

2010 87 85 98 8 55 6 0 12 19

• 0 61 • 2011 59 56 95 16 45 9 0 16 14

Bosnia and 1995 130 –

Herzegovina 2000 193 122 63 79 15 3 1 2 0

2005 156 106 68 85 8 4 1 2 1

2009 113 116 103 52 32 5 3 3 5

2010 101 101 100 83 12 2 1 1 1

• 0 63 • 2011 65 104 160 19 43 7 0 3 28

Bulgaria 1995 –

2000 383 –

2005 201 198 99 57 10 7 11 14 2

2009 372 384 103 32 38 12 5 8 5

2010 348 348 100 32 31 13 6 12 5

• 0 66 • 2011 355 355 100 30 36 9 5 11 8

Croatia 1995 42 –

2000 –

2005 94 92 98 20 13 9 1 1 57

2009 62 22 35 27 23 36 5 5 5

2010 43 37 86 59 16 14 3 8

• 0 0 • 2011 –

Cyprus 1995 0 –

2000 0 –

2005 3 2 67 0 100 0 0 0 0

2009 3 6 200 17 0 0 0 0 83

2010 0 0 –

• 0 100 • 2011 3 3 100 67 33 0 0 0 0

Czech Republic 1995 21 –

2000 25 38 152 53 11 8 3 0 26

2005 34 31 91 16 39 3 0 3 39

2009 62 – 34 34 18 0 2 13

2010 51 49 96 41 33 16 0 0 10

• 0 75 • 2011 31 32 103 44 31 12 0 9 3

Denmark 1995 6 –

2000 28 15 54 27 60 7 0 0 7

2005 29 22 76 27 64 5 0 5 0

2009 10 42 420 12 40 2 2 0 43

2010 46 35 76 20 40 11 3 0 26

• 0 0 • 2011 22 –

Estonia 1995 71 –

2000 116 59 51 54 2 3 0 3 37

2005 94 89 95 21 20 3 4 26 25

2009 80 82 102 34 17 15 6 9 20

2010 79 81 103 28 11 11 2 15 32

• 0 31 • 2011 76 75 99 15 16 21 1 11 36

Finland 1995 –

2000 29 –

2005 22 –

2009 14 – 29 7 0 0 0 64

2010 15 13 87 38 8 0 0 0 54

• 0 25 • 2011 13 12 92 25 0 8 0 0 67

France 1995 –

2000 0 –

2005 371 –

2009 –

2010 315 –

• 0 0 • 2011 261 –

Georgia 1995 196 298 152 8 24 12 9 45 2

2000 681 470 69 23 31 10 8 29 0

2005 2 152 2 037 95 19 35 7 10 23 6

2009 566 1 521 269 26 34 5 17 15 3

2010 1 409 1 421 101 26 35 5 17 11 4

• 32 61 • 2011 1 310 1 321 101 27 34 4 23 8 4

Germany 1995 –

2000 63 – 51 21 16 3 5 5

2005 493 432 88 30 36 9 0 7 18

2009 252 344 137 21 44 12 0 5 17

2010 367 364 99 25 47 12 1 6 10

• 0 58 • 2011 300 289 96 17 41 10 0 6 27

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

243 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Greece 1995 –

2000 48 –

2005 74 –

2009 3 –

2010 44 –

• 0 0 • 2011 35 –

Greenland 1995 –

2000 –

2005 –

2009 6 –

2010 12 –

• 0 0 • 2011 3 –

Hungary 1995 –

2000 371 122 33 16 20 15 9 11 30

2005 347 333 96 12 37 13 8 11 18

2009 211 208 99 35 26 13 12 6 8

2010 254 254 100 13 49 11 0 17 9

• 0 0 • 2011 221 0 0

Iceland 1995 0 –

2000 1 1 100 0 100 0 0 0 0

2005 1 –

2009 1 1 100 0 100 0 0 0 0

2010 0 0 –

• 0 100 • 2011 1 1 100 0 100 0 0 0 0

Ireland 1995 –

2000 22 10 45 40 0 10 10 40 0

2005 40 14 35 7 57 7 0 0 29

2009 16 52 325 4 58 8 0 0 31

2010 31 33 106 0 55 15 0 3 27

• 0 54 • 2011 27 26 96 50 4 15 0 0 31

Israel 1995 –

2000 8 8 100 12 25 62 0 0 0

2005 7 7 100 71 14 14 0 0 0

2009 9 9 100 56 11 11 0 0 22

2010 4 5 125 80 0 20 0 0 0

• 0 50 • 2011 10 10 100 40 10 10 0 20 20

Italy 1995 31 – 42 6 26 10 13 3

2000 625 26 4 31 15 4 12 8 31

2005 293 –

2009 –

2010 74 –

• 48 0 • 2011 100 –

Kazakhstan 1995 1 320 –

2000 5 093 2 901 57 62 4 10 14 5 5

2005 15 009 4 085 27 46 1 13 14 6 19

2009 9 371 9 392 100 22 27 9 34 6 3

2010 9 213 8 734 95 23 24 9 4 5 35

• 0 36 • 2011 5 969 5 026 84 36 0 11 4 5 44

Kyrgyzstan 1995 127 –

2000 555 278 50 59 15 8 8 6 4

2005 847 845 100 40 31 8 9 11 1

2009 758 924 122 28 43 7 6 7 9

2010 987 –

• 0 56 • 2011 1 035 523 51 49 6 9 22 8 5

Latvia 1995 118 –

2000 375 205 55 39 2 19 3 8 29

2005 205 205 100 50 1 10 1 9 29

2009 147 148 101 43 1 14 0 14 28

2010 109 110 101 60 2 6 0 12 20

• 0 51 • 2011 97 97 100 45 5 10 1 12 26

Lithuania 1995 128 –

2000 509 282 55 45 0 21 8 22 5

2005 460 455 99 27 2 25 4 22 19

2009 404 404 100 30 0 24 5 22 20

2010 364 364 100 31 1 18 4 22 25

• 0 33 • 2011 369 369 100 33 0 16 2 23 25

Luxembourg 1995 –

2000 4 –

2005 0 –

2009 –

2010 0 0 –

• 0 0 • 2011 1 0 0

Malta 1995 0 –

2000 0 1 – 0 100 0 0 0 0

2005 1 1 100 0 100 0 0 0 0

2009 2 2 100 0 50 0 0 0 50

2010 3 3 100 0 67 0 0 0 33

• 0 100 • 2011 3 3 100 0 100 0 0 0 0

Monaco 1995 –

2000 0 –

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Montenegro 2005 27 10 37 20 20 60

2009 11 11 100 45 27 9 0 0 18

2010 12 14 117 50 36 0 0 0 14

83 • 2011 12 12 100 67 17 8 0 0 8

Netherlands 1995 –

2000 70 18 26 28 22 6 0 6 39

2005 44 28 64 11 68 4 0 7 11

2009 46 49 107 4 67 2 0 4 22

2010 43 44 102 5 61 9 0 7 18

• 0 80 • 2011 38 46 121 0 80 0 0 2 17

Norway 1995 28 –

2000 12 3 25 33 0 67 0 0 0

2005 14 9 64 44 33 22 0 0 0

2009 30 – 33 47 13 0 0 7

2010 42 40 95 20 52 15 5 0 8

• 0 0 • 2011 37 –

Poland 1995 1 071 –

2000 882 56 6 64 12 14 0 4 5

2005 1 077 985 91 22 31 6 0 32 9

2009 688 942 137 30 32 5 0 14 18

2010 899 899 100 28 33 8 0 10 21

• 0 53 • 2011 963 963 100 25 28 10 0 12 24

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

244 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Portugal 1995 268 133 50 38 17 6 6 9 24

2000 481 209 43 10 66 4 0 7 14

2005 350 293 84 8 66 10 1 9 6

2009 271 265 98 7 62 7 0 8 16

2010 228 –

• 55 61 • 2011 215 204 95 3 58 4 0 2 32

Republic of 1995 148 –

Moldova 2000 374 1 0 0 0 0 100 0 0

2005 1 777 1 713 96 22 19 13 16 17 13

2009 1 663 1 663 100 15 20 15 26 20 4

2010 1 689 1 702 101 15 17 14 5 17 32

• 0 38 • 2011 1 480 1 500 101 18 20 13 28 17 4

Romania 1995 1 077 –

2000 3 770 2 605 69 24 20 9 20 17 11

2005 6 938 6 737 97 39 13 10 10 14 14

2009 5 401 5 391 100 38 19 10 12 16 4

2010 5 115 5 118 100 37 18 11 12 17 6

• 0 58 • 2011 4 669 4 667 100 39 19 11 11 15 5

Russian 1995 12 – 42 17 25 8 8 0

Federation 2000 18 147 1 694 9 25 24 10 21 9 11

2005 35 153 10 855 31 33 4 16 26 16 5

2009 32 569 16 726 51 31 3 13 32 12 9

2010 45 980 14 609 32 31 4 12 33 12 9

• 58 42 • 2011 55 159 26 062 47 20 22 10 15 10 23

San Marino 1995 –

2000 0 –

2005 –

2009 –

2010 –

• 0 0 • 2011 –

Serbia 2005 300 284 95 46 26 10 2 12 3

2009 203 244 120 61 13 9 0 12 5

2010 200 203 101 55 21 9 1 10 3

78 • 2011 162 164 101 60 18 5 1 8 9

Serbia & 1995 198 –

Montenegro 2000 203 21 10 67 10 10 0 14 0

Slovakia 1995 20 –

2000 120 46 38 78 0 11 2 4 4

2005 108 101 94 50 38 7 0 3 3

2009 79 79 100 34 48 14 1 0 3

2010 55 55 100 44 40 15 0 0 2

• 0 88 • 2011 50 50 100 48 40 2 4 2 4

Slovenia 1995 30 –

2000 47 24 51 29 46 4 0 12 8

2005 29 27 93 44 41 4 0 4 7

2009 8 8 100 12 75 0 0 0 12

2010 11 11 100 18 45 36 0 0 0

• 0 100 • 2011 11 11 100 27 73 0 0 0 0

Spain 1995 –

2000 0 –

2005 1 078 –

2009 –

2010 324 351 108 25 31 9 0 2 33

• 0 56 • 2011 370 388 105 26 30 13 0 2 28

Sweden 1995 11 –

2000 40 9 22 0 78 0 0 11 11

2005 30 16 53 0 75 0 0 0 25

2009 45 – 0 69 13 0 7 11

2010 52 52 100 21 54 2 0 0 23

• 0 78 • 2011 45 45 100 22 56 2 0 4 16

Switzerland 1995 5 –

2000 63 –

2005 49 –

2009 51 –

2010 40 –

• 0 0 • 2011 54 –

Tajikistan 1995 370 –

2000 –

2005 2 189 1 762 80 29 47 9 8 6 1

2009 533 1 618 304 29 43 11 10 6 1

2010 985 1 732 176 33 38 11 11 4 1

• 0 71 • 2011 929 1 674 180 29 41 10 13 5 1

The Former 1995 25 –

Yugoslav Republic 2000 16 –

of Macedonia 2005 103 97 94 24 33 7 2 32 2

2009 56 56 100 39 39 7 2 11 2

2010 52 52 100 29 37 17 4 12 2

• 0 78 • 2011 55 55 100 38 40 9 4 7 2

Turkey 1995 –

2000 808 –

2005 2 550 1 593 62 24 46 5 2 12 11

2009 1 445 1 459 101 29 44 3 2 9 13

2010 1 368 1 368 100 25 43 5 2 7 17

• 0 68 • 2011 1 262 1 262 100 22 46 4 2 10 16

Turkmenistan 1995 67 –

2000 1 965 495 25 66 9 7 11 6 1

2005 142 142 100 42 26 13 10 9 0

2009 –

2010 82 –

• 0 0 • 2011 –

Ukraine 1995 1 889 –

2000 3 210 –

2005 –

2009 5 477 10 424 190 18 29 14 22 12 5

2010 5 114 9 812 192 17 29 14 23 10 7

• 0 34 • 2011 11 488 6 413 56 26 8 16 33 9 7

United Kingdom of 1995 –

Great Britain and 2000 0 –

Northern Ireland 2005 460 147 32 0 57 4 0 3 36

2009 791 – 0 79 7 0 5 9

2010 576 576 100 0 74 7 0 7 12

• 0 80 • 2011 524 492 94 0 80 6 0 6 8

Uzbekistan 1995 –

2000 347 764 220 20 55 8 8 9 0

2005 9 015 3 999 44 28 41 9 7 14 1

2009 2 451 2 451 100 30 39 11 7 9 5

2010 4 596 4 527 98 25 48 10 5 9 4

• 0 72 • 2011 1 074 1 074 100 40 32 9 10 8 1

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

245 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Albania 2005 15 81 540 1 1.2

2010 42 186 445 0 0 5

2011 39 170 431 2 1.2 100 100

• 15 55 • 2012 55 233 420 7 3 100 100 2

Andorra 2005 10

2010 0 0 7 0

2011 0 0 4 0

–

11 • 2012 11 1 9 0 0

Armenia 2005 12 270 2 322 6 2.2 83 33

2010 70 1 242 1 780 17 1.4 47 41

2011 95 1 499 1 582 49 3.3 80 80

• 12 100 • 2012 100 1 518 1 518 79 5.2 70 70 0

Austria 2005 954

2010 688

2011 687

–

2012 648

Azerbai

an 2005 7 920

2010 75 6 290 8 394 48 0.76 62

2011 74 7 448 10 100 36 0.48 61 41

–

96 • 2012 96 7 849 8 140 129 1.6 49 21

Belarus 2005 6 357 139

2010 93 5 153 5 554 190 3.7 257

2011 100 5 118 5 118 217 4.2 29 32

–

100 • 2012 100 5 246 5 246 229 4.4 67 258

Bel

ium 2005 82 937 1 144 52 5.5

2010 87 969 1 115 66 6.8

2011 81 845 1 044 44 5.2

• 82 56 • 2012 56 556 987 43 7.7

Bosnia and 2005 2 160

Herze

ovina 2010 0 0 1 390 0

2011 4.7 65 1 385 0 0 0

–

4 • 2012 3.9 56 1 420 0 0

Bul

aria 2005 0.7 23 3 302

2010 67 1 773 2 649 2 0.11 0 100

2011 71 1 698 2 407 5 0.29 0 100

• 1 66 • 2012 66 1 513 2 280 3 0.2 0 100

Croatia 2005 1 144

2010 695 1 1

2011 619 4 3

–

2012

rus 2005 0 0 37 0

2010 61

2011 54 1

• 0

–

2012 69

Czech Re

ublic 2005 19 189 1 007 2 1.1

2010 26 177 678 5 2.8

2011 26 153 600 4 2.6

• 19 22 • 2012 22 136 605 6 4.4

Denmar

2005 424 8

2010 0 0 359 0

2011 73 277 381 10 3.6

–

2012

Estonia 2005 94 490 519 33 6.7 0

2010 91 298 329 34 11 47

2011 92 315 341 46 15 61

• 94 93 • 2012 93 271 290 45 17 62

Finland 2005 0.83 3 361 3 100

2010 0.92 3 327 3 100

2011 0.92 3 325 3 100

• 1

–

2012 274

France 2005 5 374

2010 24 1 233 5 116 121 9.8

2011 27 1 354 4 942 95 7

–

2012

Geor

ia 2005 10 674 6 448 13 1.9 54 100

2010 32 1 841 5 796 35 1.9 63 77

2011 46 2 550 5 533 50 2 56 76 61

• 10 38 • 2012 38 1 881 4 974 33 1.8 79 79 97

German

2005 6 045

2010 4 330

2011 4 316

–

2012 4 238

Greece 2005 767

2010 489

2011 489

–

2012

Greenland 2005

2010 116

2011 115

–

2012 84

Hun

2005 2 024

2010 <0.1 1 1 741 1 100 100

2011 <0.1 1 1 445 1 100 100

–

2012 1 223

Iceland 2005 91 10 11 1 10 100 100

2010 95 21 22 1 4.8 0 0

2011 100 9 9 0 0

• 91 100 • 2012 100 11 11 0 0

Ireland 2005 6.1 28 461 11 39

2010 23 98 427 15 15

2011 30 128 425 21 16

• 6 27 • 2012 27 97 366 14 14

Israel 2005 85 316 372 17 5.4

2010 90 308 343 13 4.2

2011 92 384 418 24 6.2

• 85 99 • 2012 99 503 509 16 3.2

Ital

2005 4 137

2010 3 249

2011 3 521

–

2012

Kazakhstan 2005 77 31 187 40 429 183 0.59 41 7.7

2010 84 23 854 28 550 333 1.4 26 7.5 1 063

2011 85 22 480 26 304 352 1.6 20 9.1 1 329

• 77 98 • 2012 98 21 184 21 523 441 2.1 16 58 862

zstan 2005 6 765

2010 2.9 183 6 295 183 100 68 37

2011 100 6 666 6 666 153 2.3 60 86 4

–

100 • 2012 100 6 916 6 916 151 2.2 67 78 5

246 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Latvia 2005 85 1 226 1 443 53 4.3 55

2010 85 794 934 71 8.9 76

2011 85 752 885 71 9.4 41 66

• 85 85 • 2012 85 844 993 114 14 39 57

Lithuania 2005 2 574 7

2010 1 938 19

2011 1 904

–

2012 1 781

Luxembour

2005 37

2010 29

2011 26

–

2012 45

Malta 2005 4.3 1 23 0 0

2010 81 26 32 3 12 0

2011 91 30 33 5 17 4

• 4 98 • 2012 98 42 43 4 9.5

Monaco 2005

2010 1

2011

–

2012

Montene

ro 2005 4.7 8 170 0 0

2010 74 84 114 1 1.2 0 100

2011 82 92 112 0 0

• 5 77 • 2012 77 82 107 0 0

Netherlands 2005 22 252 1 157 61 24

2010 38 413 1 073 48 12 21

2011 49 490 1 007 31 6.3

• 22 42 • 2012 42 407 958 28 6.9

Norw a

2005 0 0 290

2010 339

2011 361

• 0

–

2012 3

Poland 2005 9 280

2010 0.29 22 7 509 22 100

2011 0.31 26 8 478 26 100

–

0 • 2012 0.34 26 7 542

Portu

al 2005 70 2 485 3 536 571 23

2010 65 1 720 2 626 303 18 100 100

2011 86 2 185 2 540 315 14

• 70 65 • 2012 65 1 672 2 590 291 17

ublic of 2005 100 6 469 6 278 9 0.14

Moldova 2010 95 5 192 5 447 308 5.9 9.7 31 0

2011 94 5 017 5 341 285 5.7

• 103 100 • 2012 100 5 348 5 341 303 5.7 34

Romania 2005 37 10 860 29 347 160 1.5

2010 37 7 833 21 078 241 3.1 41 89 133

2011 50 9 608 19 212 244 2.5 59 90 145

• 37 53 • 2012 53 9 699 18 224 229 2.4 76 90 174

Russian 2005 55 85 537 154 379 3 533 4.1

Federation 2010 84 669 162 553 3 633 200

2011 79 494 159 479 4 104

• 55

–

2012 75 995 149 921 4 880

San Marino 2005

2010

2011

–

2012

Serbia 2005 <0.1 3 3 468 3 100 430 400

2010 0.67 16 2 385 12 75 0 100 4

2011 3.2 72 2 216 6 8.3 0 100

• 0 2 • 2012 2 39 1 917 6 15 0 100

Slovakia 2005 95 720 760 1 0.14 0 100

2010 100 439 439 1 0.23 100 100 0

2011 99 395 399 0 0

• 95 93 • 2012 93 322 345 0 0 0

Slovenia 2005 38 107 278 0 0

2010 76 130 172 1 0.77

2011 77 147 192 0 0

• 38 75 • 2012 75 104 138 0 0

ain 2005 8 359

2010 69 4 909 7 089 456 9.3

2011 68 4 569 6 762 414 9.1

–

70 • 2012 70 4 179 5 991 370 8.9

Sweden 2005 0 0 569

2010 675

2011 586

• 0

–

2012 632

Switzerland 2005 563

2010 548

2011 578

–

2012 463

ikistan 2005 8.9 670 7 526 1 0.15 0 0

2010 53 4 049 7 641 100 2.5 73 54 0

2011 82 6 241 7 609 115 1.8 70 57 315

• 9 92 • 2012 92 6 375 6 929 88 1.4 80 89 157

The Former 2005 0.3 2 658 2 100 0 100

oslav Re

ublic 2010 9.3 39 420 0 0 0

of Macedonia 2011 12 45 362 0 0 0

• 0 41 • 2012 41 145 355 0 0 0

Turke

2005 0 0 21 303 0

2010 3.5 581 16 551 14 2.4 36 64

2011 46 7 241 15 679 29 0.4 48 93

• 0 59 • 2012 59 8 646 14 691 45 0.52 49 78

Turkmenistan 2005 3 291

2010 100 3 230 3 230 0 0

2011

–

2012

Ukraine 2005 39 608 1 526 0

2010 95 34 621 36 409 5 752 17 39 5 029

2011 74 31 776 42 676 4 157 13 63

–

75 • 2012 75 34 181 45 569 4 726 14 72 71 14 352

United Kin

dom of 2005 8 633

Great Britain and 2010 8 483 378

Northern Ireland 2011 8 963 326

–

2012 8 751

Uzbekistan 2005 120 35 801 28 891 147 0.41 0 0

2010 100 20 330 20 330 427 2.1 92 37

2011 100 15 913 15 913 546 3.4 96 32 2 630

• 124 100 • 2012 100 16 810 16 810 820 4.9 95 13 2 010

247 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Albania 2005 1 161 75 12 28

2010 2 186 76 19 63

2011 5 194 87 11 61

2012 1 1.7

(

0–4.9

)

1.7

(

<0.1–9.1

)

172 76 0

(

0–6.3

)

15 52

Andorra 2005 0 9 150

–

2010 0 4 100 0

–

2011 0 1 100 1 100

2012 0 0

(

0–4.9

)

(

0–4.9

)

4 100 0

(

0–0

)

–

Armenia 2005 162 576 99 182 56

2010 177 361 87 99 22

2011 79 439 96 90 24

2012 92 250

(

220–280

)

(

61–110

)

420 94 170

(

150–190

)

91 23

Austria 2005 13 570 110 16 62

2010 15 203 99 15 52

2011 19 257 95 11 55

2012 27 18

(

6.7–30

)

(

5.1–20

)

254 93 7.3

(

0.91–21

)

25 62

Azerbai

an 2005 800 453 29 366 11

2010 552 801 19 960 48

2011 811 569 25 151 7.0

2012 596 2 800

(

2 600–3 000

)

810

(

670–960

)

–

2 000

(

1 800–2 200

)

–

Belarus 2005

–

2010 1576 1972 90 1697 150

2011 1594 2084 94 948 88

2012 1604 2 200

(

2 100–2 200

)

1 200

(

1 100–1 300

)

2164 90 960

(

920–1 000

)

1183 84

Bel

ium 2005 11 588 89 41 60

2010 19 466 97 52 60

2011 15 524 94 35 59

2012 20 15

(

5.8–25

)

6.3

(

2.5–13

)

503 95 8.9

(

2.5–21

)

53 68

Bosnia and 2005 11 1035 100 106 68

Herze

ovina 2010 2 600 100 47 47

2011 7 704 99 41 63

2012 7 13

(

2.0–24

)

1.6

(

<0.1–8.9

)

724 97 12

(

3.2–28

)

66 55

Bul

aria 2005 47 482 40 691 340

2010 56 801 85 165 47

2011 55 588 62 145 41

2012 49 100

(

78–130

)

(

18–51

)

687 71 73

(

52–98

)

142 45

Croatia 2005 6 586 100 61 65

2010 0

–

2011 8 353 96 40

–

2012

–

rus 2005 1 16 84 0 0

2010 0 14 70 0

–

2011 1 25 96 2 67

2012 0 1.7

(

0–5.0

)

1.7

(

<0.1–8.8

)

40 93 0

(

0–5.1

)

233

Czech Re

ublic 2005 13 562 100 20 59

2010 9 352 97 28 55

2011 7 392 96 16 52

2012 4 9.8

(

2.3–17

)

7.3

(

2.7–16

)

371 93 2.5

(

<0.1–12

)

26 65

Denmar

2005 5 307 140 18 62

2010 2 209 98 30 65

2011 3 257 100 14 64

2012 1

–

Estonia 2005 79 316 110 71 76

2010 63 197 100 61 77

2011 78 210 100 52 68

2012 62 70

(

56–85

)

(

31–56

)

193 100 28

(

20–36

)

46 82

Finland 2005 3 198 85 22 100

2010 6 184 96 7 47

2011 5 237 97 8 62

2012 3 2.7

(

0–5.6

)

2.7

(

0.55–7.6

)

206 99 0

(

0–4.2

)

14 78

France 2005 24 1291 47 112 30

2010 23 1187 120 91 29

2011 40 1232 73 110 42

2012 39

–

Geor

ia 2005 195 799 53 515 24

2010 359 1987 80 558 40

2011 475 2197 83 675 52

2012 346 630

(

570–690

)

260

(

220–300

)

1931 84 370

(

330–420

)

541 45

German

2005 105 3094 98 251 51

2010 48 2215 110 184 50

2011 56 2382 91 148 49

2012 64 62

(

44–81

)

(

25–52

)

2198 89 26

(

13–43

)

116 47

Greece 2005 12 497 170 0 0

2010 2 115 37 15 34

2011 5 148 44 11 31

2012

–

Greenland 2005

–

2010 1

–

2011

–

2012 1.6

(

1.0–2.2

)

1.4

(

0.69–2.0

)

–

0.24

(

0.18–0.29

)

–

Hun

2005 26 442 62 88 25

2010 19 474 92 80 31

2011 30 411 73 68 31

2012 12 31

(

15–46

)

(

11–42

)

411 79 7.3

(

3.0–14

)

31 37

Iceland 2005 0 7 140 1 100

2010 0 19 120 0

–

2011 0 4 80 0 0

2012 1 1.0

(

1.0–1.0

)

(

0–4.2

)

4 100 1.0

(

<0.1–1.0

)

1 100

Ireland 2005 3 200 110 10 25

2010 2 200 130 22 71

2011 3 176 85 15 56

2012 5 1.8

(

0–4.4

)

1.8

(

0.22–6.6

)

190 97 0

(

0–4.9

)

17 68

Israel 2005 16 259 110 6 86

2010 12 245 120 2 50

2011 11 275 99 9 90

2012 17 22

(

12–32

)

(

11–30

)

318 98 3.7

(

0.48–8.5

)

655

Ital

2005

–

2010

–

2011

–

2012

–

Kazakhstan 2005

–

2010 7387 5214 100 4655 51

2011 7408 5293 83 4790 80

2012 7608 7 000

(

6 900–7 200

)

2 700

(

2 600–2 800

)

8154 140 4 300

(

4 300–4 400

)

10443 130

zstan 2005 989 837 20 152 18

2010 566 225 14 264 27

2011 806

–

2012 958 1 800

(

1 600–2 000

)

1 100

(

910–1 200

)

1659 99 730

(

690–770

)

831 78

TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED CASES).

BACT+VE = bacteriologically positive cases.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Latvia 2005 160 873 100 182 89

2010 87 613 100 102 94

2011 105 562 96 82 85

2012 110 120

(

100–140

)

(

69–110

)

666 97 36

(

26–48

)

100 88

Lithuania 2005 338 1293 100 440 96

2010 310 959 100 360 99

2011 296 1031 100 369 100

2012 271 300

(

270–330

)

150

(

120–170

)

1017 100 150

(

140–170

)

350 100

Luxembour

2005 0 36 110

–

2010 0 17 120 0

–

2011 2 7 100 1 100

2012 0 0

(

0–0.98

)

(

0–0

)

–

(

0–0.98

)

1 100

Malta 2005 0 11 140

–

2010 1 11 220 2 67

2011 0 17 89 0 0

2012 0 0

(

0–0

)

(

0–7.2

)

13 81 0

(

0–0.98

)

1 100

Monaco 2005

–

2010 1

–

2011

–

2012

–

Montene

ro 2005 2 82 88 14 52

2010 0 61 100 12 100

2011 1 57 100 13 110

2012 0 0

(

0–0

)

(

0–5.0

)

58 98 0

(

0–6.8

)

538

Netherlands 2005 7 709 130 30 68

2010 11 741 160 29 67

2011 15 695 99 22 58

2012 11 9.1

(

3.5–15

)

7.4

(

3.5–13

)

628 99 1.8

(

<0.1–9.0

)

28 57

Norw a

2005 3 193 150 8 57

2010 8 139 100 21 50

2011 4 229 97 22 59

2012 6

–

Poland 2005 72 5409 120

–

2010 30 3238 81 468 52

2011 41 4416 88 577 60

2012 31 48

(

31–65

)

(

18–47

)

4073 90 18

(

9.0–32

)

535 61

Portu

al 2005 28 1407 77 172 49

2010 19 982 77 94 41

2011 22 1155 73 97 45

2012 17 35

(

21–50

)

(

15–41

)

1219 72 9.7

(

3.2–22

)

102 54

ublic of 2005 338 536 32 652 37

Moldova 2010 1082 1381 49 1140 67

2011 1001 1379 74 1006 68

2012 894 1 700

(

1 600–1 800

)

810

(

730–890

)

1264 67 930

(

880–980

)

933 63

Romania 2005 530 1594 13 1300 19

2010 502 3338 39 2011 39

2011 530 3855 41 2171 46

2012 500 800

(

610–980

)

320

(

210–480

)

3645 40 480

(

350–630

)

1864 43

Russian 2005

–

Federation 2010 13692 35862 72 13405 29

2011 13785 34007 78 13620 25

2012 13612 46 000

(

43 000–49 000

)

20 000

(

18 000–22 000

)

32647 79 25 000

(

23 000–28 000

)

12324 24

San Marino 2005

–

2010

–

2011

–

2012

–

Serbia 2005 9 1112 76 121 40

2010 12 811 67 113 56

2011 9 863 91 100 62

2012 9 20

(

7.0–33

)

(

4.9–29

)

716 84 6.5

(

1.3–18

)

83 46

Slovakia 2005 8 248 82 56 52

2010 1 185 100 32 58

2011 5 147 92 29 58

2012 4 1.8

(

0–5.3

)

(

0–6.2

)

142 95 1.8

(

<0.1–9.3

)

27 55

Slovenia 2005 1 217 110 28 97

2010 0 123 100 9 82

2011 0 171 100 11 100

2012 0 0

(

0–0

)

(

0–3.5

)

114 100 0

(

0–3.7

)

12 86

ain 2005

–

2010 49 1009 34 110 34

2011 41 1013 24 96 26

2012 37 31

(

13–49

)

8.5

(

1.0–31

)

802 21 22

(

10–41

)

69 22

Sweden 2005 4 425 150 17 57

2010 18 288 100 24 46

2011 17 375 100 31 69

2012 14 11

(

5.0–18

)

8.1

(

4.1–14

)

453 100 3.2

(

0.40–11

)

24 62

Switzerland 2005 5 326 150 30 61

2010 9 270 130 33 82

2011 8 304 98 40 74

2012 8 8.6

(

2.4–15

)

2.6

(

0.53–7.4

)

246 98 6.1

(

1.7–14

)

31 66

ikistan 2005

–

2010 333 160 7.0 223 23

2011 604 161 7.4 415 45

2012 694 910

(

800–1 000

)

490

(

390–620

)

919 45 420

(

390–450

)

496 66

The Former 2005 4 106 51 19 18

oslav Re

ublic 2010 7 153 110 28 54

of Macedonia 2011 1 130 72 25 45

2012 4 4.8

(

0.47–9.1

)

(

0–5.7

)

155 81 4.8

(

1.4–11

)

26 84

Turke

2005 191 3237 38 508 20

2010 250 4342 64 615 45

2011 262 4221 63 602 48

2012 291 520

(

460–580

)

270

(

230–310

)

4742 71 250

(

220–290

)

641 55

Turkmenistan 2005

–

2010 38 81 7.0 63 77

2011 158 306

–

156

–

2012

–

Ukraine 2005

–

2010 5336 9194 66 4840 95

2011 4305 10352 61 4413 38

2012 6934 6 800

(

6 500–7 000

)

4 100

(

3 900–4 300

)

11185 77 2 600

(

2 600–2 700

)

5925 72

United Kin

dom of 2005 39 3428 100 271 59

Great Britain and 2010 60 3970 150 247 43

Northern Ireland 2011 81 4549 95 234 45

2012 81 69

(

54–85

)

(

42–70

)

4570 97 15

(

8.1–25

)

244 51

Uzbekistan 2005 86 0 0 435 4.8

2010 1023 2845 60 1180 26

2011 1385 484 9.5 123 11

2012 1728 4 000 (3 700–4 300) 2 400 (1 800–3 000) 2703 56 1 600 (1 400–1 900) 798 30

TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED CASES).

BACT+VE = bacteriologically positive cases.

249 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Albania 1995 0 0 0 0 19 40 30 0 1 0 0 13 20 16 1.8

2000 2 19 21 14 24 19 16 3 11 10 8 8 5 11 2.1

2005 0 26 21 16 31 20 37 0 0 3 9 5 5 5 18 0 3.4

2010 0 28 17 14 16 16 15 0 2 11 7 6 3 2 8 0 2.7

2011 0 29 26 18 30 9 22 0 1 14 10 6 2 1 12 0 2.9

2012 0 33 34 16 15 11 23 0 0 17 9 6 3 6 12 0 2.5

Andorra 1995 –

2000 0010000 –

2005 00110000 01110000 0.67

2010 00000000 00000000 –

2011 00001000 00000000 –

2012 00000110 00000000 –

Armenia 1995 1 18 16 11 10 8 1 1 1 7 2 1 1 5.0

2000 2 152 130 131 63 26 21 1 24 27 24 8 8 4 5.5

2005 3 170 104 83 84 30 24 0 3 27 21 10 11 4 7 0 6.0

2010 0 36 75 49 68 27 15 0 1 24 17 4 7 8 8 0 3.9

2011 0 28 65 52 71 42 8 0 0 19 16 9 7 7 5 0 4.2

2012 1 23 67 60 56 34 18 0 0 13 19 12 2 5 5 0 4.6

Austria 1995 4 37 95 82 89 71 73 6 22 52 32 21 18 59 2.1

2000 1 17 30 59 42 23 41 1 11 22 12 11 6 22 2.5

2005 1 32 23 22 41 24 30 0 0 13 11 8 3 5 10 0 3.5

2010 04412138100 15422560 2.0

2011 0 8 11 9 13 11 13 0 0 11 6 4 1 3 4 0 2.2

2012 1587199130 110844150 1.9

Azerbaijan 1995 0 13 29 14 6 4 1 0 5 18 0 0 0 0 2.9

2000 0 9 24 33 42 30 0 0 3 3 6 3 0 0 9.2

2005 77 109 297 215 209 187 88 0 90 64 98 47 32 24 24 0 3.1

2010 0 328 371 267 280 30 27 3 141 100 57 73 9 18 3.2

2011 –

2012 4 230 223 170 176 95 48 0 8 115 89 35 50 35 23 0 2.7

Belarus 1995 –

2000 –

2005 71 180 273 287 118 62 25 53 50 43 11 62 4.1

2010 0 65 173 224 293 163 58 0 1 28 52 56 37 28 91 0 3.3

2011 1 53 156 228 290 138 48 3 37 67 47 39 27 83 3.0

2012 0 44 174 250 266 158 73 0 1 34 64 47 45 28 93 0 3.1

Belgium 1995 3 23 49 63 52 54 102 3 12 24 32 17 10 34 2.6

2000 3 20 57 39 55 32 56 6 15 15 19 4 13 27 2.6

2005 1 26 50 32 27 15 47 0 2 27 31 15 12 4 23 0 1.7

2010 4 20 39 30 29 21 19 0 6 13 18 19 11 5 10 0 2.0

2011 8 25 50 33 25 18 27 0 3 13 14 9 3 5 7 0 3.4

2012 3 25 33 18 27 22 18 0 5 23 23 17 9 7 5 0 1.6

Bosnia and 1995 0 15 61 90 140 139 100 0 40 67 64 49 77 23 1.7

Herzegovina 2000 4 56 82 99 66 58 77 4 30 46 29 29 48 124 1.4

2005 1 22 58 61 78 44 80 1 2 35 39 33 28 28 130 0 1.2

2010 1 27 37 34 61 46 51 0 0 27 19 16 10 18 94 0 1.4

2011 2 33 32 52 75 61 62 0 3 17 27 17 13 25 128 0 1.4

2012 1 23 32 58 74 62 92 1 0 33 26 21 10 25 116 1 1.5

Bulgaria 1995 –

2000 0 13 16 20 3 9 10 0 11 14 7 3 4 6 1.6

2005 9 98 150 195 195 150 136 0 9 90 111 59 29 37 70 0 2.3

2010 1 40 115 143 133 90 65 0 3 42 59 43 23 15 34 0 2.7

2011 2 38 100 110 122 92 61 0 2 41 40 36 28 14 30 0 2.7

2012 0 46 89 130 131 82 57 0 0 37 50 44 24 16 35 0 2.6

Croatia 1995 6 38 97 210 132 178 141 10 50 57 57 38 60 130 2.0

2000 –

2005 1 24 27 48 72 47 34 0 1 12 18 15 11 6 56 0 2.1

2010 0 10 19 18 38 25 24 1 3 8 4 2 1 30 2.7

2011 0 12 5 20 31 31 21 0 0 12 14 14 8 7 26 0 1.5

2012 –

Cyprus 1995 0110112 0111201 1.0

2000 –

2005 03111010 01000000 7.0

2010 02100000 00310001 0.60

2011 00340010 01020000 2.7

2012 00421100 03210010 1.1

Czech Republic 1995 2 10 22 83 88 53 90 0 9 11 20 13 19 88 2.2

2000 0 7 31 52 89 61 59 0 15 13 9 10 7 57 2.7

2005 0 8 24 57 55 45 46 0 0 3 14 16 7 5 28 0 3.2

2010 0 12 19 36 29 29 19 0 0 6 10 11 7 2 20 0 2.6

2011 0 10 29 20 38 28 24 0 0 4 9 4 4 3 15 0 3.8

2012 0 7 21 24 42 33 22 0 1 3 11 8 3 7 26 0 2.5

Denmark 1995 0 7 16 28 18 9 11 2 7 13 8 4 3 2 2.3

2000 5 10 20 24 16 11 14 5 16 15 14 6 7 8 1.4

2005 0 12 12 18 23 9 7 0 2 11 5 13 9 3 5 0 1.7

2010 0 8 22 10 13 16 2 0 0 4 5 15 8 8 4 0 1.6

2011 051418321640 05597270 2.5

2012 –

Estonia 1995 –

2000 0 6 31 53 56 35 15 0 9 11 14 11 4 10 3.3

2005 0 9 25 19 40 12 7 0 0 6 11 8 11 6 8 0 2.2

2010 03721251280 03533630 3.3

2011 0 4 22 16 14 18 13 0 0 4 8 12 3 3 6 0 2.4

2012 061513211790 05724150 3.4

Finland 1995 1 1 10 25 28 24 61 1 1 6 7 4 10 65 1.6

2000 0 3 8 22 19 28 53 0 1 5 3 4 6 49 2.0

2005 15431411250 034106200 1.9

2010 0106898180 032412110 2.6

2011 0144711270 123531130 1.9

2012 029759210 140423110 2.1

France 1995 30 156 431 502 414 297 496 36 138 226 176 90 92 365 2.1

2000 10 136 248 247 211 125 244 18 108 127 89 46 43 155 2.1

2005 12 127 212 222 196 134 205 0 16 104 134 82 56 38 180 0 1.8

2010 10 60 139 114 99 76 110 0 10 47 76 49 45 25 97 0 1.7

2011 12 88 112 116 94 73 101 0 7 58 67 48 36 23 65 0 2.0

2012 –

Georgia 1995 2 20 30 25 40 18 12 2 8 17 17 18 7 5 2.0

2000 4 76 111 113 63 45 28 1 49 37 33 17 10 5 2.9

2005 0 226 272 268 207 76 60 4 109 105 58 46 17 47 2.9

2010 5 340 529 341 264 143 77 0 5 135 118 62 52 28 41 0 3.9

2011 5 271 478 333 251 139 93 0 8 136 132 59 32 35 54 0 3.4

2012 4 200 314 248 235 150 81 0 5 101 116 72 43 32 47 0 3.0

Germany 1995 14 179 453 539 460 442 625 17 115 251 167 89 104 397 2.4

2000 –

2005 6 59 113 171 167 92 167 0 4 51 104 73 43 37 103 0 1.9

2010 1 43 92 97 141 87 136 0 3 44 63 61 38 26 76 0 1.9

2011 1 43 96 106 141 69 131 0 2 44 92 59 54 26 86 0 1.6

2012 4 43 99 113 147 105 99 0 5 49 99 37 47 24 55 1 1.9

250 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Greece 1995 –

2000 1 10 22 32 24 19 46 0 2 9 10 5 6 25 2.7

2005 1 14 25 22 14 12 23 5 0 13 18 8 7 2 17 0 1.8

2010 1 19 27 20 18 19 22 3 3 2 13 4 4 4 15 1 2.8

2011 2 30 30 26 24 19 38 2 1 9 14 9 3 5 20 1 2.8

2012 –

Greenland 1995 –

2000 –

2005 –

2010 05755220 15004200 2.2

2011 01020331 0811230 1.3

2012 0635151 2303103 1.8

Hungary 1995 –

2000 0 8 24 85 104 58 27 1 7 17 19 22 10 30 2.9

2005 0 6 24 67 117 67 39 0 1 5 13 11 22 15 33 0 3.2

2010 1 9 15 36 51 52 23 0 0 9 16 14 9 15 20 0 2.3

2011 0 11 18 34 46 53 28 0 0 3 9 8 9 12 29 0 2.7

2012 2 7 15 29 64 41 25 0 0 8 14 15 11 14 28 0 2.0

Iceland 1995 0000001 0000001 1.0

2000 01 –

2005 00010010 00000000 –

2010 00103000 00110000 2.0

2011 00000000 00000010 –

2012 00001000 00100000 1.0

Ireland 1995 –

2000 0 10 7 7 6 4 12 0 13 8 13 6 7 15 0.74

2005 16102110760 091033080 1.8

2010 08184115110 07823250 2.1

2011 0791011780 08778210 1.6

2012 179991240 15664220 2.0

Israel 1995 –

2000 0 20 26 23 23 13 38 0 3 10 16 6 3 3 32 0 2.0

2005 1 4 15 18 15 5 26 0 0 6 14 7 7 5 19 0 1.4

2010 1 13 28 12 8 4 6 0 0 1 8 10 2 0 10 0 2.3

2011 0 29 30 11 5 9 9 0 0 10 10 7 4 4 7 0 2.2

2012 0 9 33 20 3 6 13 0 0 4 20 11 4 2 17 0 1.4

Italy 1995 9 59 202 157 94 124 289 7 52 93 57 40 51 168 2.0

2000 12 63 96 75 58 54 112 6 38 58 33 13 19 39 2.3

2005 8 93 191 137 101 61 115 24 3 80 145 56 25 19 70 9 1.8

2010 14 40 75 66 32 31 58 2 25 41 57 41 22 22 54 6 1.2

2011 0 51 88 81 52 24 59 0 5 41 73 37 18 14 43 1 1.5

2012 –

Kazakhstan 1995 –

2000 36 1 057 1 409 1 379 923 439 218 84 999 1 079 599 275 202 204 1.6

2005 31 917 1 142 983 795 274 175 0 46 751 767 436 286 121 187 0 1.7

2010 15 675 754 595 511 251 127 0 33 566 520 263 205 122 132 0 1.6

2011 6 602 716 516 515 235 91 0 15 439 495 260 190 109 117 0 1.6

2012 9 508 586 514 479 233 98 0 16 415 411 241 177 97 100 0 1.7

Kyrgyzstan 1995 3 109 171 165 65 38 30 1 70 94 34 18 15 19 2.3

2000 4 128 227 205 115 52 46 6 128 146 100 41 30 29 1.6

2005 1 247 303 269 194 66 84 0 15 215 236 141 70 33 98 0 1.4

2010 5 261 260 188 141 64 48 0 5 223 199 98 71 40 42 0 1.4

2011 6 225 204 179 168 77 41 0 13 200 191 84 60 50 39 0 1.4

2012 4 210 255 207 184 86 30 0 8 195 173 108 55 42 37 0 1.6

Latvia 1995 0 20 44 71 70 40 30 0 22 49 55 47 27 29 1.2

2000 0 53 106 124 111 64 34 2 25 41 27 28 7 15 3.4

2005 1 22 71 104 117 55 34 0 0 17 31 31 23 18 12 0 3.1

2010 0 20 44 65 71 39 15 0 0 6 19 25 12 10 13 0 3.0

2011 0 11 42 58 50 33 18 0 0 7 16 19 14 12 13 0 2.6

2012 0 19 62 67 59 36 15 0 1 14 15 14 16 15 9 0 3.1

Lithuania 1995 4 46 132 225 176 90 77 5 6 53 45 32 16 42 3.8

2000 1 38 97 145 155 74 68 0 20 37 39 32 22 48 2.9

2005 0 42 118 186 187 108 67 0 1 25 41 57 49 23 54 0 2.8

2010 1 34 75 128 157 89 54 0 1 20 36 31 43 18 32 0 3.0

2011 1 25 52 126 158 77 55 0 0 20 31 37 38 16 45 0 2.6

2012 0 35 73 143 148 91 60 0 1 8 28 55 36 20 28 0 3.1

Luxembourg 1995 –

2000 –

2005 00221120 00211100 1.6

2010 00000000 00000000 –

2011 01001100 01000000 3.0

2012 00000000 00000000 –

Malta 1995 0001000 0010012 0.25

2000 0101101 –

2005 01111100 00000000 –

2010 00300000 00100000 3.0

2011 02400000 01000000 6.0

2012 12220000 01100000 3.5

Monaco 1995 –

2000 –

2005 –

2010 –

2011 –

2012 –

Montenegro 2005 035715480 00734080 1.9

2010 01144710 13323180 0.86

2011 012811730 14243110 2.0

2012 034510340 04512130 1.8

Netherlands 1995 22 79 119 75 28 9 10 24 56 50 13 10 8 7 2.0

2000 0 34 63 41 25 10 21 4 29 22 16 9 5 10 2.0

2005 0 23 42 23 26 14 19 0 3 14 19 11 9 1 4 0 2.4

2010 0 22 29 22 20 9 17 0 1 9 14 13 5 4 11 0 2.1

2011 2 22 35 19 23 14 13 0 2 13 13 7 7 4 3 0 2.6

2012 1 15 31 14 18 9 15 0 4 7 18 15 4 6 6 0 1.7

Norway 1995 04863512 0472038 1.6

2000 0193624 131 25 2.1

2005 09464430 04721030 1.8

2010 09971420 05732000 1.9

2011 03733110 014601010 0.82

2012 –

Poland 1995 3 122 295 795 565 369 377 4 129 163 225 111 107 414 2.2

2000 1 99 303 812 782 361 434 1 99 158 211 170 82 421 2.4

2005 3 109 199 389 639 292 310 0 3 95 142 112 151 63 316 0 2.2

2010 3 70 205 310 574 393 237 0 2 59 118 82 104 82 245 0 2.6

2011 5 69 187 314 560 439 275 0 1 67 96 90 130 99 255 0 2.5

2012 1 82 183 306 471 438 267 0 1 54 96 106 102 100 226 0 2.6

251 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Portugal 1995 11 215 363 328 200 173 164 7 139 172 87 33 42 85 2.6

2000 8 147 375 349 208 140 140 5 114 154 87 41 25 64 2.8

2005 5 85 227 284 181 90 93 5 7 67 109 66 29 11 42 1 2.9

2010 3 55 110 199 152 70 76 0 3 54 62 54 36 10 28 0 2.7

2011 3 56 87 177 172 75 74 3 4 43 58 56 30 12 25 1 2.8

2012 1 56 103 187 153 79 75 1 6 52 62 66 28 19 32 0 2.5

Republic of 1995 0 55 115 166 95 65 15 2 42 38 31 19 10 12 3.3

Moldova 2000 2 52 31 36 13 13 6 1 16 32 45 23 14 6 1.1

2005 2 211 337 345 313 106 31 0 3 97 92 57 61 23 18 0 3.8

2010 0 119 243 244 248 113 21 0 6 47 90 46 47 23 20 0 3.5

2011 2 94 257 250 267 107 21 0 3 66 79 51 41 20 14 0 3.6

2012 0 99 234 256 284 131 31 0 3 58 95 48 56 26 25 0 3.3

Romania 1995 387 1 662 2 322 3 608 2 587 1 751 784 355 1 352 1 240 871 479 396 417 2.6

2000 46 832 1 508 1 799 1 684 916 533 53 701 766 484 341 207 321 2.5

2005 36 752 1 511 1 786 1 999 952 638 4 55 758 780 493 374 219 442 2 2.5

2010 21 669 865 1 336 1 293 895 567 0 40 503 477 400 275 172 438 0 2.4

2011 19 623 813 1 192 1 104 837 541 0 26 475 513 407 214 196 426 0 2.3

2012 17 556 764 1 297 1 053 831 495 0 22 431 433 371 188 184 435 0 2.4

Russian 1995 –

Federation 2000 1 295 526 596 402 151 54 1 43 73 74 38 31 44 6.7

2005 –

2010 8 2 228 6 276 5 571 5 361 2 787 920 0 28 1 247 2 554 1 719 1 182 745 790 0 2.8

2011 15 1 826 5 726 5 338 4 928 2 664 845 36 1 139 2 394 1 643 1 166 719 752 2.7

2012 17 1 568 5 472 5 115 4 446 2 629 839 0 31 997 2 292 1 595 1 081 637 748 0 2.7

San Marino 1995 –

2000 1 –

2005 –

2010 –

2011 –

2012 –

Serbia 2005 3 62 96 118 156 112 132 0 6 69 76 55 49 22 149 0 1.6

2010 2 76 70 93 116 83 109 0 5 66 74 46 39 34 164 0 1.3

2011 2 60 73 74 122 112 101 0 5 46 59 43 30 20 129 0 1.6

2012 1 70 72 77 98 86 77 0 4 46 66 38 31 35 118 0 1.4

Serbia & 1995 10 108 204 317 296 350 386 11 127 167 133 83 158 275 1.8

Montenegro 2000 –

Slovakia 1995 4 18 44 123 108 63 152 5 16 17 22 24 33 159 1.9

2000 2 6 15 31 50 16 32 0 5 9 7 5 4 54 1.8

2005 0 3 13 16 25 25 20 0 0 1 8 9 5 6 27 0 1.8

2010 1 7 7 18 17 17 15 0 0 1 6 7 2 3 11 0 2.7

2011 06862016130 023461110 2.6

2012 02917201270 023461130 2.3

Slovenia 1995 1 13 39 63 36 26 27 0 7 24 11 9 5 42 2.1

2000 0 3 11 36 22 14 17 0 3 9 3 4 3 20 2.5

2005 0 4 10 16 15 11 14 0 0 4 4 6 5 4 16 0 1.8

2010 0471096120 01524130 3.0

2011 0391612850 005421170 1.8

2012 02648650 02301190 1.9

Spain 1995 22 132 337 242 150 112 228 23 90 129 64 39 34 98 2.6

2000 –

2005 13 166 394 367 230 140 230 2 10 142 252 151 63 24 108 2 2.1

2010 6 139 306 291 286 146 184 1 14 130 251 151 54 23 76 0 1.9

2011 15 135 325 292 277 162 197 2 15 142 249 161 75 30 100 0 1.8

2012 10 112 259 299 276 156 220 3 15 101 202 161 70 24 74 1 2.1

Sweden 1995 1 5 12 8 5 4 27 0 10 13 5 5 4 14 1.2

2000 0 9 10 12 11 4 25 1 9 8 10 2 2 15 1.5

2005 0 7 21 16 10 5 16 0 1 10 15 12 5 3 13 0 1.3

2010 1 10 28 8 5 5 13 0 2 9 16 11 4 2 3 0 1.5

2011 1 14 15 12 8 3 8 0 0 12 9 10 2 2 3 0 1.6

2012 0816898130 0111037260 1.6

Switzerland 1995 0 12 23 26 23 13 27 1 13 20 9 1 2 15 2.0

2000 0517107660 181172150 1.5

2005 28101111270 061183140 1.5

2010 061296580 071564130 1.3

2011 28161013730 261324220 1.9

2012 0318865110 071571240 1.4

Tajikistan 1995 –

2000 –

2005 8 308 279 164 104 54 48 0 26 225 185 151 89 43 53 0 1.2

2010 12 398 366 214 129 93 74 0 23 320 272 111 109 87 82 0 1.3

2011 8 343 365 181 128 75 77 0 31 314 229 104 100 105 114 0 1.2

2012 8 346 320 169 124 75 72 0 16 243 243 105 99 94 127 0 1.2

The Former 1995 2 15 42 45 33 29 24 2 32 30 20 11 17 17 1.5

Yugoslav Republic 2000 5 8 14 20 19 20 14 1 15 14 17 5 5 10 1.5

of Macedonia 2005 2 14 20 23 20 18 13 1 2 17 13 10 7 5 13 0 1.7

2010 0 6 19 24 24 12 11 0 0 9 12 7 7 4 6 0 2.1

2011 3 17 11 19 21 10 6 0 1 14 9 6 3 1 11 0 1.9

2012 0 16 14 12 19 15 13 0 0 12 14 9 6 10 7 0 1.5

Turkey 1995 –

2000 –

2005 33 1 148 1 295 1 028 963 534 429 0 50 699 474 243 175 166 213 0 2.7

2010 23 631 779 703 778 514 407 0 33 485 384 193 141 101 203 0 2.5

2011 22 550 693 608 696 482 412 0 25 409 385 195 117 121 212 0 2.4

2012 20 507 655 575 650 476 398 0 30 369 308 168 97 105 227 0 2.5

Turkmenistan 1995 1 11 188 0 79 30 0 2 15 146 0 47 25 0 1.3

2000 16 103 185 144 127 31 21 19 73 140 76 31 34 17 1.6

2005 2 148 181 146 97 51 13 0 3 100 101 72 46 27 8 0 1.8

2010 1 130 212 183 141 51 26 2 112 112 74 46 38 25 1.8

2011 –

2012 –

Ukraine 1995 10 385 1 076 2 064 1 515 1 087 437 21 314 380 327 182 185 280 3.9

2000 21 693 1 552 2 385 2 007 1 062 532 41 487 590 447 298 218 405 3.3

2005 –

2010 7 417 2 559 2.9

2011 8 539 1 991 2 209 1 796 881 377 0 11 348 741 603 388 230 380 0 2.9

2012 9 546 2 028 2 393 1 926 965 389 10 334 771 609 401 218 431 3.0

United Kingdom of 1995 –

Great Britain and 2000 8 86 130 96 87 75 138 9 95 114 60 31 31 67 1.5

Northern Ireland 2005 9 135 200 166 95 95 124 0 14 115 163 80 39 28 83 1 1.6

2010 7 132 169 135 108 60 108 0 15 110 131 81 42 40 58 0 1.5

2011 3 137 193 137 97 69 100 0 19 120 129 75 45 26 49 0 1.6

2012 8 156 184 137 118 88 88 0 17 109 141 81 55 17 52 0 1.7

Uzbekistan 1995 –

2000 6 351 749 510 346 213 107 11 261 547 288 213 112 111 1.5

2005 25 596 831 723 522 263 313 40 538 597 375 288 217 367 1.4

2010 8 487 574 529 479 293 297 0 22 365 512 308 248 239 350 0 1.3

2011 8 378 493 453 440 306 253 0 11 335 418 233 245 293 332 0 1.2

2012 10 360 506 403 449 313 273 0 9 319 367 237 201 261 322 0 1.3

252 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

a LED = Light emitting diode microscopes

b DST = Drug susceptibility testing

c LPA = Line probe assay

d NRL = National Reference Laboratory

7$%/($/DERUDWRULHV173VHUYLFHVGUXJPDQDJHPHQWDQGLQIHFWLRQFRQWURO

LABORATORIES FREE THROUGH NTP

SMEAR LABS

PER 100K

POPULATION

% OF SMEAR

LABS USING

LED

CULTURE

LABS PER 5M

POPULATION

DST

LABS

PER 5M

POPULATION

LPA

LABS

PER 5M

POPULATION

NUMBER OF

LABS USING

XPERT MTB/RIF

SECOND-

LINE DST

AVAILABLE

NRL

TB DIAGNOSIS

FIRST-

LINE

DRUGS

TB NOTIF.

RATE PER

100 000

HEALTH-CARE

WORKERS

RIFAMPICIN

USED

THROUGHOUT

TREATMENT

Albania 0.5 0 1.6 1.6 1.6 0 No Yes Yes (all suspects) Yes Yes

Andorra 10.2 0 510.5 510.5 0 0 In and out

of countr y Yes Yes (all suspects) Yes Yes

Armenia 1.0 0 1.7 1.7 1.7 0 In country Yes Yes (all suspects) Yes Yes

Austria –

Azerbaijan 0.8 4 3.8 1.6 0.5 7 Yes Yes (all suspects) Yes Yes

Belarus 2.1 2 15.4 4.3 4.3 8 In country Yes Yes (all suspects) Yes Yes 25

Belgium 1.0 – 51.5 6.3 3.6 19 Yes Yes (other criteria) Yes Yes

Bosnia and Herzegovina 0.4 100 17.0 3.9 0 0 Out of

country Yes Yes (all suspects) Yes Yes

Bulgaria 0.5 0 21.3 9.6 2.7 0 In country Yes Yes (all suspects) Yes Yes

Croatia –

Cyprus –

Czech Republic 0.4 – 21.6 8.9 8.9 In country Yes Yes (all suspects) Yes Yes

Denmark 0.2 – 0.9 0.9 0.9 In country Yes Yes (all suspects) Yes Yes

Estonia 0.4 100 7.7 7.7 7.7 2 In country Yes Yes (all suspects) Yes Yes 12

Finland 0.2 100 10.2 0.9 2.8 1 In country Yes Yes (all suspects) Yes Yes

France 0.4 – 18.0 5.5 1.6 20 In country Yes Yes (all suspects) Yes Yes

Georgia 0.3 9 2.3 1.1 2.3 1 In country Yes Yes (all suspects) Yes Yes 107

Germany 0.3 – 11.4 5.1 4.5 141 Yes Yes (all suspects) Yes Yes

Greece –

Greenland –

Hungary 0.1 0 6.0 3.5 1 3 Yes Yes (all suspects) Yes Yes

Iceland 0.3 100 15.3 15.3 15.3 0 Out of

country Yes Yes

(

if TB is

confirmed) Yes Yes

Ireland 0.2 27 10.9 3.3 2.2 3 Out of

country Yes Yes (all suspects) No Yes

Israel 0.2 – 12.4 1.3 0.7 1 In country Yes Yes (all suspects) Yes Yes

Italy –

Kazakhstan 2.9 0 6.8 6.8 3.4 4 In country Yes Yes (all suspects) Yes Yes 204

Kyrgyzstan 2.2 0 10.0 2.7 1.8 7 In and out

of countr y Yes Yes (all suspects) Yes Yes 34

Latvia 0.8 0 9.7 2.4 2.4 2 In country Yes Yes (all suspects) Yes Yes

Lithuania 0.4 8 9.9 9.9 3.3 7 In and out

of countr y Yes Yes

(

if TB is

confirmed) Yes Yes

Luxembourg 0.2 100 9.5 9.5 9.5 0 Out of

country Yes Yes (all suspects) Yes Yes

Malta 0.2 0 11.7 0 0 0 Out of

country No Yes (all suspects) Yes Yes

Monaco –

Montenegro 0.2 0 8.1 8.1 0 0 Out of

country Yes Yes

(

if TB is

confirmed) Yes Yes 56

Netherlands 0.3 – 11.1 1.5 1.2 2 In country Yes Yes (all suspects) No Yes

Norway 0.3 0 9.0 3 4 3 In and out

of countr y Yes Yes (all suspects) Yes Yes

Poland 0.2 0 10.6 6 1.4 3 Yes Yes (all suspects) Yes Yes

Portugal 0.5 – 22.2 10.4 Yes Yes (all suspects) Yes Yes

Republic of Moldova 1.7 0 5.7 5.7 4.3 24 Yes Yes (all suspects) Yes Yes

Romania 0.5 1 20.9 9.9 0.9 0 In and out

of countr y Yes Yes (all suspects) Yes Yes 51

Russian Federation 0.7 – 4.1 3.8 In country No Yes (all suspects) Yes Yes

San Marino –

Serbia 0.3 0 15.2 2.1 0.5 0 Out of

country Yes Yes

(

if TB is

confirmed) Yes Yes 8

Slovakia 0.1 14 6.4 1.8 1.8 2 In and out

of countr y Yes Yes (all suspects) Yes Yes

Slovenia 0.1 67 7.3 2.4 2.4 1 In and out

of countr y Yes Yes (all suspects) Yes Yes

Spain – Yes Yes (all suspects) Yes Yes

Sweden <0.1 – 2.6 2.6 2.6 0 In country Yes Yes (all suspects) Yes Yes

Switzerland 0.5 – 14.4 6.3 14 In country Yes Yes (all suspects) No Yes

Tajikistan 1.1 4 1.9 0.6 0.6 3 In country Yes Yes

(

if TB is

confirmed) Yes Yes 34

The Former Yugoslav

Republic of Macedonia 0.3 0 7.1 2.4 0 0 Out of

country Yes Yes

(

if TB is

confirmed) Yes Yes 22

Turkey 0.5 – 10.7 5.1 0.6 18 In country Yes Yes (all suspects) Yes Yes 25

Turkmenistan –

Ukraine 1.8 5 9.4 4.5 0 15 Yes Yes (all suspects) Yes Yes 61

United Kingdom of Great

Britain and Northern

Ireland

–Yes Yes (all suspects) Yes Yes

Uzbekistan 1.0 1 1.2 0.5 0.5 7 In country Yes Yes (all suspects) Yes Yes 29

253 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

EUROPEAN REGION

7$%/($0HDVXUHGSHUFHQWDJHRI7%FDVHVZLWK0'57%

PRVWUHFHQW\HDUDYDLODEOH

New TB cases Previously treated TB cases

Year Source Coverage Percentage Year Source Coverage Percentage

Albania 2012 Surveillance National 0.58 (<0.1–3.2) 2012 Surveillance National 0 (0–22)

Andorra 2011 Surveillance National 0 (0–98) 2011 Surveillance National 0 (0–98)

Armenia 2007 Survey National 9.4 (7.0–12) 2007 Survey National 43 (38–49)

Austria 2011 Surveillance National 3.5 (1.6–6.5) 2011 Surveillance National 18 (2.3–52)

Azerbaijan 2007 Survey Sub-national 22 (19–27) 2007 Survey Sub-national 56 (50–62)

Belarus 2012 Surveillance National 35 (33–37) 2012 Surveillance National 69 (66–71)

Belgium 2011 Surveillance National 1.3 (0.54–2.7) 2011 Surveillance National 11 (3.2–27)

Bosnia and Herzegovina 2011 Surveillance National 0.14 (0–0.79) 2011 Surveillance National 9.8 (2.7–23)

Bulgaria 2012 Surveillance National 2.3 (1.3–3.8) 2012 Surveillance National 23 (17–31)

Croatia 2011 Surveillance National 0.28 (<0.1–1.6) 2011 Surveillance National 2.5 (<0.1–13)

Cyprus 2011 Surveillance National 4 (0.10–20) 2011 Surveillance National 0 (0–84)

Czech Republic 2011 Surveillance National 1.5 (0.56–3.3) 2011 Surveillance National 6.3 (0.16–30)

Denmark 2011 Surveillance National 1.2 (0.24–3.4) 2011 Surveillance National 0 (0–23)

Estonia 2012 Surveillance National 20 (14–26) 2012 Surveillance National 50 (35–65)

Finland 2012 Surveillance National 1.5 (0.30–4.2) 2012 Surveillance National 0 (0–23)

France 2009 Surveillance National 0.45 (0.24–0.77) 2009 Surveillance National 13 (7.4–21)

Georgia 2012 Surveillance National 9.2 (7.9–11) 2012 Surveillance National 31 (27–35)

Germany 2012 Surveillance National 1.5 (1.0–2.0) 2012 Surveillance National 10 (5.5–17)

Greece 2010 Surveillance National 0.87 (<0.1–4.7) 2010 Surveillance National 6.7 (0.17–32)

Greenland

Hungary 2010 Surveillance National 2.1 (1.0–3.8) 2010 Surveillance National 8.8 (3.6–17)

Iceland 2012 Surveillance National 0 (0–60) 2012 Surveillance National 100 (2.5–100)

Ireland 2012 Surveillance National 1.1 (0.13–3.8) 2012 Surveillance National 0 (0–20)

Israel 2012 Surveillance National 4.7 (2.7–7.7) 2012 Surveillance National 33 (4.3–78)

Italy 2011 Surveillance Sub-national 3.9 (2.7–5.6) 2011 Surveillance Sub-national 5.4 (3.5–8.0)

Kazakhstan 2012 Surveillance National 23 (22–24) 2012 Surveillance National 55 (54–56)

Kyrgyzstan 2011 Survey National 26 (23–30) 2012 Surveillance National 68 (65–72)

Latvia 2012 Surveillance National 11 (8.8–14) 2012 Surveillance National 32 (23–42)

Lithuania 2012 Surveillance National 11 (9.5–14) 2012 Surveillance National 44 (39–49)

Luxembourg 2011 Surveillance National 0 (0–41) 2011 Surveillance National 0 (0–98)

Malta 2012 Surveillance National 0 (0–25) 2012 Surveillance National 0 (0–98)

Monaco

Montenegro 2012 Surveillance National 0 (0–6.2) 2012 Surveillance National 0 (0–52)

Netherlands 2012 Surveillance National 1.6 (0.77–2.9) 2012 Surveillance National 3.6 (<0.1–18)

Norway 2011 Surveillance National 1.3 (0.27–3.8) 2011 Surveillance National 0 (0–15)

Poland 2012 Surveillance National 0.49 (0.30–0.76) 2012 Surveillance National 2.1 (1.0–3.6)

Portugal 2011 Surveillance National 1.5 (0.86–2.3) 2011 Surveillance National 5.2 (1.7–12)

Republic of Moldova 2012 Surveillance National 24 (21–26) 2012 Surveillance National 62 (59–65)

Romania 2004 Survey National 2.8 (1.8–4.2) 2004 Survey National 11 (8.0–15)

Russian Federation 2011 Surveillance Sub-national 23 (21–25) 2011 Surveillance Sub-national 49 (44–53)

San Marino

Serbia 2012 Surveillance National 0.84 (0.31–1.8) 2012 Surveillance National 3.6 (0.75–10)

Slovakia 2012 Surveillance National 0 (0–2.6) 2012 Surveillance National 3.7 (<0.1–19)

Slovenia 2012 Surveillance National 0 (0–3.2) 2012 Surveillance National 0 (0–26)

Spain 2001, 2005 Surveillance Sub-national 0.22 (<0.1–0.80) 2001, 2005 Surveillance Sub-national 7.1 (3.3–13)

Sweden 2012 Surveillance National 2.4 (1.2–4.3) 2012 Surveillance National 8.3 (1.0–27)

Switzerland 2012 Surveillance National 1.2 (0.25–3.5) 2012 Surveillance National 13 (3.6–30)

Tajikistan 2011 Survey National 13 (9.8–16) 2012 Surveillance National 56 (52–60)

The Former Yugoslav

Republic of Macedonia 2012 Surveillance National 0 (0–2.4) 2012 Surveillance National 15 (4.4–35)

Turkey 2012 Surveillance National 3.2 (2.7–3.7) 2012 Surveillance National 22 (19–25)

Turkmenistan 2002 Survey Sub-national 3.8 (1.1–9.5) 2002 Survey Sub-national 18 (11–27)

Ukraine 2012 Surveillance National 14 (14–15) 2012 Surveillance National 32 (31–33)

United Kingdom of Great

Britain and Northern

Ireland

2011 Surveillance National 1.3 (1.0–1.7) 2011 Surveillance National 5.6 (3.0–9.3)

Uzbekistan 2011 Survey National 23 (18–29) 2011 Survey National 62 (52–71)

a Empty rows indicate an absence of high-quality survey or surveillance data. In the absence of high-quality national data, high-quality sub-national data are used.

5176*'#56#5+#4')+10

Table A4.1 Estimates of the burden of disease caused by TB, 1990–2012 257

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

Table A4.4 Treatment outcomes, new smear-positive cases, 1995–2011 260

Table A4.5 Treatment outcomes, retreatment cases, 1995–2011 261

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

Table A4.9 Laboratories, NTP services, drug management and infection control, 2012 265

6CDNG# /GCUWTGFRGTEGPVCIGQH6$ECUGUYKVJ/&46$OQUVTGEGPV[GCTCXCKNCDNG 

256 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

Country notes

Bangladesh

Estimates of TB disease burden have not been ocially approved by the national TB programme (NTP) in Bangladesh. A

joint reassessment by WHO and the NTP will be undertaken following the completion of the prevalence survey planned

for 2014.

India

Estimates of TB disease burden for India have not yet been ocially approved by the Ministry of Health & Family Welfare,

Government of India and should therefore be considered provisional.

257 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SOUTH-EAST ASIA REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEa

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Bangladesh 1990 107 66 (20–140) 61 (18–130) 560 (220–1 100) 525 (202–998) 240 (150–360) 225 (139–331)

1995 120 72 (27–140) 60 (22–116) 620 (290–1 100) 518 (244–893) 270 (220–320) 225 (184–270)

2000 132 77 (29–150) 58 (22–111) 670 (320–1 100) 507 (243–866) 300 (240–360) 225 (184–270)

2005 143 74 (29–140) 52 (20–98) 670 (330–1 100) 469 (231–790) 320 (260–390) 225 (184–270)

2010 151 69 (28–130) 46 (19–85) 660 (330–1 100) 437 (220–727) 340 (280–410) 225 (185–268)

2011 153 70 (28–130) 46 (19–84) 660 (340–1 100) 435 (220–722) 340 (280–410) 225 (185–268)

2012 155 70 (29–130) 45 (19–84) 670 (340–1 100) 434 (218–721) 350 (290–410) 225 (185–268)

Bhutan 1990 < 1 1 (0.410–2.0) 194 (77–365) 10 (4.7–17) 1 860 (881–3 190) 4.2 (3.6–4.8) 784 (673–903)

1995 < 1 0.55 (0.230–1.0) 109 (45–200) 6 (3.0–10) 1 180 (599–1 960) 2.9 (2.5–3.3) 561 (482–646)

2000 < 1 0.41 (0.180–0.740) 73 (31–132) 4.3 (2.2–6.9) 754 (392–1 230) 2.3 (1.9–2.6) 402 (345–463)

2005 < 1 0.35 (0.160–0.600) 53 (25–92) 3.5 (1.8–5.7) 536 (279–875) 1.9 (1.6–2.2) 287 (247–331)

2010 < 1 0.11 (0.068–0.160) 15 (9.5–22) 2.2 (1.1–3.8) 313 (149–536) 1.5 (1.3–1.7) 206 (177–237)

2011 < 1 0.11 (0.068–0.160) 15 (9.4–22) 2 (0.840–3.5) 269 (115–486) 1.4 (1.2–1.6) 192 (165–222)

2012 < 1 0.1 (0.062–0.150) 14 (8.4–21) 1.7 (0.580–3.3) 225 (79–446) 1.3 (1.1–1.5) 180 (154–207)

Democratic 1990 20 4.7 (4.3–5.0) 23 (21–25) 97 (26–210) 479 (130–1 050) 77 (44–120) 383 (219–592)

People's Republic 1995 22 4.6 (4.2–5.0) 21 (19–23) 100 (28–230) 479 (130–1 050) 83 (48–130) 383 (219–592)

of Korea 2000 23 4 (3.7–4.3) 17 (16–19) 110 (30–240) 479 (130–1 050) 87 (50–140) 383 (219–592)

2005 24 3 (2.7–3.2) 12 (12–13) 110 (31–250) 479 (130–1 050) 91 (52–140) 383 (219–592)

2010 25 2.5 (2.3–2.6) 10 (9.5–11) 120 (33–270) 494 (134–1 080) 97 (85–110) 395 (348–445)

2011 25 2.5 (2.4–2.6) 10 (9.6–11) 120 (34–270) 505 (137–1 110) 100 (92–110) 404 (372–437)

2012 25 2.2 (2.1–2.4) 9 (8.6–9.5) 130 (34–280) 511 (139–1 120) 100 (92–110) 409 (373–447)

India 1990 869 330 (220–480) 38 (25–55) 4 000 (3 600–4 500) 465 (415–518) 1 900 (1 600–2 200) 216 (182–254)

1995 956 370 (240–520) 38 (25–55) 4 400 (4 000–5 000) 465 (414–519) 2 100 (1 800–2 300) 216 (189–245)

2000 1 042 400 (260–570) 39 (25–55) 4 600 (4 000–5 200) 438 (382–498) 2 300 (2 000–2 500) 216 (195–239)

2005 1 127 400 (290–530) 36 (26–47) 4 100 (3 300–5 000) 365 (295–443) 2 400 (2 100–2 600) 209 (188–231)

2010 1 206 320 (210–460) 27 (17–38) 3 200 (2 200–4 500) 269 (181–374) 2 200 (2 000–2 500) 185 (167–204)

2011 1 221 300 (190–420) 24 (16–35) 3 000 (2 100–4 200) 249 (168–346) 2 200 (2 000–2 400) 181 (163–199)

2012 1 237 270 (170–390) 22 (14–32) 2 800 (1 900–3 900) 230 (155–319) 2 200 (2 000–2 400) 176 (159–193)

Indonesia 1990 179 95 (33–190) 53 (18–106) 790 (330–1 400) 442 (186–806) 370 (270–480) 206 (149–271)

1995 194 120 (42–230) 61 (21–120) 940 (400–1 700) 483 (205–878) 400 (310–500) 205 (159–256)

2000 209 120 (42–220) 55 (20–107) 990 (460–1 700) 474 (222–821) 430 (340–520) 204 (164–249)

2005 224 84 (34–160) 38 (15–70) 830 (410–1 400) 369 (183–621) 450 (360–540) 199 (160–242)

2010 241 67 (30–120) 28 (12–50) 740 (360–1 300) 306 (148–521) 450 (380–540) 189 (156–224)

2011 244 67 (30–120) 27 (12–49) 730 (350–1 200) 301 (145–512) 460 (380–540) 187 (155–222)

2012 247 67 (30–120) 27 (12–48) 730 (350–1 200) 297 (144–506) 460 (380–540) 185 (153–220)

Maldives 1990 < 1 0.059 (0.052–0.067) 27 (24–31) 0.67 (0.260–1.3) 311 (119–593) 0.32 (0.200–0.480) 150 (92–221)

1995 < 1 0.033 (0.027–0.040) 14 (11–17) 0.48 (0.230–0.820) 197 (95–336) 0.29 (0.230–0.350) 118 (96–142)

2000 < 1 0.015 (0.010–0.019) 5.4 (3.8–7.1) 0.22 (0.082–0.430) 81 (30–157) 0.17 (0.130–0.200) 60 (49–73)

2005 < 1 <0.01 (<0.01–<0.01) 2 (1.6–2.5) 0.23 (0.100–0.410) 78 (34–138) 0.15 (0.120–0.180) 51 (42–62)

2010 < 1 <0.01 (<0.01–<0.01) 2.3 (2.0–2.5) 0.17 (0.065–0.310) 51 (20–96) 0.12 (0.097–0.140) 36 (30–44)

2011 < 1 <0.01 (<0.01–<0.01) 1.9 (1.7–2.1) 0.14 (0.051–0.280) 43 (15–85) 0.11 (0.088–0.130) 33 (27–39)

2012 < 1 <0.01 (<0.01–<0.01) 2 (1.8–2.2) 0.22 (0.100–0.380) 65 (30–113) 0.14 (0.110–0.170) 41 (33–49)

Myanmar 1990 42 48 (17–97) 115 (39–230) 380 (170–650) 894 (414–1 550) 170 (120–220) 393 (290–512)

1995 45 53 (19–110) 118 (41–234) 400 (190–680) 881 (421–1 500) 180 (140–230) 404 (314–505)

2000 48 51 (19–100) 106 (39–207) 400 (200–670) 831 (415–1 390) 200 (160–240) 412 (333–498)

2005 50 35 (15–65) 70 (29–129) 320 (170–530) 647 (333–1 060) 200 (170–240) 403 (340–472)

2010 52 26 (12–46) 51 (23–89) 270 (210–340) 525 (404–661) 200 (170–230) 384 (329–444)

2011 52 26 (12–45) 49 (23–86) 260 (200–330) 506 (390–637) 200 (170–230) 381 (326–439)

2012 53 25 (12–44) 48 (23–84) 260 (200–320) 489 (377–616) 200 (170–230) 377 (322–435)

Nepal 1990 18 7.5 (2.2–16) 41 (12–88) 66 (25–130) 364 (140–692) 30 (18–44) 163 (101–241)

1995 21 6.1 (2.5–11) 29 (12–54) 61 (30–100) 295 (147–493) 34 (27–40) 163 (133–196)

2000 23 5 (2.2–8.9) 21 (9.4–38) 58 (26–100) 248 (113–436) 38 (31–45) 163 (133–196)

2005 25 4.9 (2.1–8.9) 20 (8.4–35) 59 (26–110) 235 (101–424) 41 (34–50) 163 (133–196)

2010 27 5.3 (2.4–9.4) 20 (8.8–35) 64 (28–110) 238 (105–425) 44 (36–52) 163 (135–194)

2011 27 5.4 (2.4–9.6) 20 (8.8–35) 64 (28–110) 236 (103–423) 44 (37–53) 163 (135–194)

2012 27 5.5 (2.5–9.8) 20 (9.0–36) 66 (29–120) 241 (106–429) 45 (37–53) 163 (135–195)

Sri Lanka 1990 17 1.3 (0.750–2.0) 7.5 (4.3–12) 20 (7.4–40) 118 (43–231) 11 (7.2–17) 66 (42–96)

1995 18 1.6 (0.970–2.5) 9 (5.3–14) 23 (11–38) 125 (63–207) 12 (9.9–14) 66 (54–79)

2000 19 1.9 (1.1–2.8) 10 (6.0–15) 22 (11–36) 115 (57–192) 12 (10–15) 66 (54–79)

2005 20 1.4 (1.0–1.8) 6.9 (5.2–8.8) 22 (10–37) 108 (52–185) 13 (11–16) 66 (54–79)

2010 21 0.59 (0.480–0.710) 2.8 (2.3–3.4) 22 (11–38) 108 (52–184) 14 (11–16) 66 (55–79)

2011 21 0.41 (0.330–0.500) 2 (1.6–2.4) 23 (11–39) 108 (52–184) 14 (11–17) 66 (55–79)

2012 21 0.24 (0.180–0.310) 1.1 (0.84–1.4) 23 (11–39) 109 (52–185) 14 (12–17) 66 (55–79)

Thailand 1990 57 11 (4.9–20) 20 (8.6–35) 130 (63–220) 227 (111–383) 78 (65–93) 138 (114–164)

1995 59 11 (4.7–20) 19 (8.0–34) 130 (64–210) 217 (109–362) 77 (63–91) 130 (107–154)

2000 62 20 (7.9–37) 31 (13–59) 180 (86–300) 286 (139–487) 110 (88–130) 171 (141–203)

2005 66 15 (6.6–27) 23 (10–42) 150 (77–260) 236 (117–395) 100 (84–120) 154 (127–184)

2010 66 10 (4.5–18) 16 (6.8–28) 120 (55–210) 179 (83–309) 85 (70–100) 128 (106–153)

2011 67 9.5 (4.1–17) 14 (6.2–26) 110 (51–200) 168 (76–296) 82 (68–98) 124 (102–147)

2012 67 9.2 (3.8–17) 14 (5.8–25) 110 (47–190) 159 (71–282) 80 (66–95) 119 (98–142)

Timor-Leste 2005 < 1 0.67 (0.290–1.2) 67 (29–121) 7.2 (3.1–13) 722 (306–1 310) 5 (4.0–6.0) 498 (406–601)

2010 1 0.62 (0.280–1.1) 57 (26–102) 7.2 (2.8–14) 666 (259–1 260) 5.4 (4.4–6.4) 498 (409–596)

2011 1 0.67 (0.300–1.2) 62 (28–109) 7.6 (3.1–14) 689 (279–1 280) 5.5 (4.5–6.5) 498 (409–596)

2012 1 0.82 (0.360–1.5) 74 (33–132) 8.4 (3.8–15) 758 (342–1 340) 5.6 (4.6–6.6) 498 (409–596)

a Rates are per 100 000 population.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEaNUMBER RATEaPERCENT

Bangladesh 1990 107 240 (150–360) 225 (139–331) 0.048 (0.030–0.071) <0.1 (<0.1–<0.1) 48 673 45 20 (14–33)

1995 120 270 (220–320) 225 (184–270) 0.054 (0.044–0.065) <0.1 (<0.1–<0.1) 56 437 47 21 (17–26)

2000 132 300 (240–360) 225 (184–270) 0.089 (0.073–0.11) <0.1 (<0.1–<0.1) 75 557 57 25 (21–31)

2005 143 320 (260–390) 225 (184–270) 0.19 (0.16–0.23) 0.1 (0.11–0.16) 123 118 86 38 (32–47)

2010 151 340 (280–410) 225 (185–268) 0.31 (0.25–0.36) 0.2 (0.17–0.24) 153 892 102 45 (38–55)

2011 153 340 (280–410) 225 (185–268) 0.34 (0.28–0.41) 0.2 (0.18–0.27) 154 358 101 45 (38–55)

2012 155 350 (290–410) 225 (185–268) 0.24 (0.20–0.29) 0.2 (0.13–0.19) 168 683 109 49 (41–59)

Bhutan 1990 < 1 4.2 (3.6–4.8) 784 (673–903) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 1 154 215 27 (24–32)

1995 < 1 2.9 (2.5–3.3) 561 (482–646) <0.01 (<0.01–<0.01) 0.2 (0.14–0.19) 1 299 255 45 (39–53)

2000 < 1 2.3 (1.9–2.6) 402 (345–463) <0.01 (<0.01–<0.01) 0.4 (0.38–0.51) 1 140 202 50 (44–59)

2005 < 1 1.9 (1.6–2.2) 287 (247–331) <0.01 (<0.01–<0.01) 1.2 (1.0–1.4) 1 007 155 54 (47–63)

2010 < 1 1.5 (1.3–1.7) 206 (177–237) 0.019 (0.016–0.022) 2.6 (2.3–3.0) 1 311 183 89 (77–100)

2011 < 1 1.4 (1.2–1.6) 192 (165–222) 0.021 (0.018–0.025) 2.9 (2.5–3.4) 1 235 169 88 (76–100)

2012 < 1 1.3 (1.1–1.5) 180 (154–207) 0.024 (0.021–0.028) 3.3 (2.8–3.8) 1 130 152 85 (73–99)

Democratic 1990 20 77 (44–120) 383 (219–592)

People's Republic 1995 22 83 (48–130) 383 (219–592) 0.033 (0.018–0.054) 0.2 (<0.1–0.25)

of Korea 2000 23 87 (50–140) 383 (219–592) 0.087 (0.043–0.15) 0.4 (0.19–0.65) 34 131 149 39 (25–68)

2005 24 91 (52–140) 383 (219–592) 0.11 (0.054–0.18) 0.5 (0.23–0.77) 42 722 179 47 (30–82)

2010 25 97 (85–110) 395 (348–445) 0.13 (0.085–0.18) 0.5 (0.34–0.72) 84 648 345 87 (78–99)

2011 25 100 (92–110) 404 (372–437) 0.13 (0.084–0.18) 0.5 (0.34–0.75) 91 433 371 92 (85–100)

2012 25 100 (92–110) 409 (373–447) 0.13 (0.086–0.19) 0.5 (0.35–0.76) 91 885 371 91 (83–100)

India 1990 869 1 900 (1 600–2 200) 216 (182–254) 19 (16–22) 2.2 (1.8–2.6) 1 519 182 175 81 (69–96)

1995 956 2 100 (1 800–2 300) 216 (189–245) 90 (78–100) 9.4 (8.2–11) 1 218 183 127 59 (52–67)

2000 1 042 2 300 (2 000–2 500) 216 (195–239) 170 (150–190) 16 (14–18) 1 115 718 107 49 (45–55)

2005 1 127 2 400 (2 100–2 600) 209 (188–231) 170 (160–190) 16 (14–17) 1 156 248 103 49 (44–55)

2010 1 206 2 200 (2 000–2 500) 185 (167–204) 130 (120–150) 11 (10–12) 1 339 866 111 60 (54–66)

2011 1 221 2 200 (2 000–2 400) 181 (163–199) 130 (120–140) 11 (9.6–12) 1 323 949 108 60 (54–66)

2012 1 237 2 200 (2 000–2 400) 176 (159–193) 130 (120–140) 10 (9.4–12) 1 289 836 104 59 (54–66)

Indonesia 1990 179 370 (270–480) 206 (149–271) 74 470 42 20 (15–28)

1995 194 400 (310–500) 205 (159–256) 35 529 18 8.9 (7.1–12)

2000 209 430 (340–520) 204 (164–249) 0.085 (0.068–0.10) <0.1 (<0.1–<0.1) 84 591 40 20 (16–25)

2005 224 450 (360–540) 199 (160–242) 1.7 (1.3–2.1) 0.8 (0.59–0.94) 254 601 113 57 (47–71)

2010 241 450 (380–540) 189 (156–224) 5.7 (4.3–7.3) 2.4 (1.8–3.0) 300 659 125 66 (56–80)

2011 244 460 (380–540) 187 (155–222) 6.7 (5.0–8.5) 2.7 (2.1–3.5) 318 949 131 70 (59–85)

2012 247 460 (380–540) 185 (153–220) 7.5 (5.6–9.7) 3.1 (2.3–3.9) 328 824 133 72 (61–87)

Maldives 1990 < 1 0.32 (0.200–0.480) 150 (92–221) <0.01 (<0.01–<0.01) 0.2 (0.10–0.43) 152 70 47 (32–76)

1995 < 1 0.29 (0.230–0.350) 118 (96–142) <0.01 (<0.01–<0.01) 0.3 (0.13–0.40) 231 94 80 (66–98)

2000 < 1 0.17 (0.130–0.200) 60 (49–73) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.21) 132 48 80 (66–98)

2005 < 1 0.15 (0.120–0.180) 51 (42–62) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.15) 122 41 80 (66–98)

2010 < 1 0.12 (0.097–0.140) 36 (30–44) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.10) 95 29 80 (66–98)

2011 < 1 0.11 (0.088–0.130) 33 (27–39) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 87 26 80 (66–98)

2012 < 1 0.14 (0.110–0.170) 41 (33–49) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 110 33 80 (66–98)

Myanmar 1990 42 170 (120–220) 393 (290–512) 0.9 (0.66–1.2) 2.1 (1.6–2.8) 12 416 29 7.5 (5.8–10)

1995 45 180 (140–230) 404 (314–505) 6.2 (4.8–7.7) 14 (11–17) 18 229 40 10 (8.0–13)

2000 48 200 (160–240) 412 (333–498) 15 (12–18) 30 (24–36) 30 840 64 15 (13–19)

2005 50 200 (170–240) 403 (340–472) 22 (18–25) 43 (36–50) 107 009 213 53 (45–63)

2010 52 200 (170–230) 384 (329–444) 21 (18–24) 40 (34–46) 131 590 253 66 (57–77)

2011 52 200 (170–230) 381 (326–439) 20 (17–23) 38 (32–43) 136 737 261 69 (59–80)

2012 53 200 (170–230) 377 (322–435) 19 (16–21) 35 (30–41) 141 170 267 71 (62–83)

Nepal 1990 18 30 (18–44) 163 (101–241) <0.01 (<0.01–0.013) <0.1 (<0.1–<0.1) 10 142 56 34 (23–56)

1995 21 34 (27–40) 163 (133–196) 0.081 (0.066–0.097) 0.4 (0.32–0.47) 19 804 96 59 (49–72)

2000 23 38 (31–45) 163 (133–196) 0.52 (0.42–0.62) 2.2 (1.8–2.7) 29 519 127 78 (65–95)

2005 25 41 (34–50) 163 (133–196) 1.4 (1.1–1.6) 5.4 (4.4–6.5) 33 448 132 81 (67–99)

2010 27 44 (36–52) 163 (135–194) 1.5 (1.2–1.7) 5.4 (4.5–6.5) 35 114 131 80 (67–97)

2011 27 44 (37–53) 163 (135–194) 1.4 (1.1–1.7) 5.1 (4.2–6.1) 35 434 130 80 (67–97)

2012 27 45 (37–53) 163 (135–195) 1.1 (0.94–1.4) 4.2 (3.4–5.0) 35 195 128 78 (66–95)

Sri Lanka 1990 17 11 (7.2–17) 66 (42–96) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 6 666 38 58 (40–92)

1995 18 12 (9.9–14) 66 (54–79) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 5 956 33 49 (41–60)

2000 19 12 (10–15) 66 (54–79) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 8 413 45 67 (56–83)

2005 20 13 (11–16) 66 (54–79) 0.011 (<0.01–0.013) <0.1 (<0.1–<0.1) 9 451 47 72 (60–88)

2010 21 14 (11–16) 66 (55–79) 0.014 (0.011–0.016) <0.1 (<0.1–<0.1) 9 934 48 72 (61–88)

2011 21 14 (11–17) 66 (55–79) 0.015 (0.012–0.019) <0.1 (<0.1–<0.1) 10 181 49 73 (62–89)

2012 21 14 (12–17) 66 (55–79) 0.017 (0.014–0.020) <0.1 (<0.1–0.10) 9 155 43 66 (55–80)

Thailand 1990 57 78 (65–93) 138 (114–164) 2.4 (2.0–2.9) 4.3 (3.5–5.1) 46 510 82 60 (50–72)

1995 59 77 (63–91) 130 (107–154) 12 (9.7–14) 20 (16–24) 45 428 77 59 (50–72)

2000 62 110 (88–130) 171 (141–203) 25 (21–30) 40 (33–48) 34 187 55 32 (27–39)

2005 66 100 (84–120) 154 (127–184) 19 (16–23) 29 (24–35) 57 895 88 57 (48–69)

2010 66 85 (70–100) 128 (106–153) 13 (11–16) 20 (17–24) 67 128 101 79 (66–95)

2011 67 82 (68–98) 124 (102–147) 13 (11–15) 19 (16–23) 65 824 99 80 (67–97)

2012 67 80 (66–95) 119 (98–142) 12 (10–14) 18 (15–22) 60 304 90 76 (64–92)

Timor-Leste 2005 < 1 5 (4.0–6.0) 498 (406–601) 3 767 378 76 (63–93)

2010 1 5.4 (4.4–6.4) 498 (409–596)

2011 1 5.5 (4.5–6.5) 498 (409–596) 4 386 400 80 (67–98)

2012 1 5.6 (4.6–6.6) 498 (409–596) 3 828 344 69 (58–84)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

259 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SOUTH-EAST ASIA REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Bangladesh 1990 48 673 –

1995 56 437 20 524 19 297 2 060 729 729 52

2000 75 557 38 484 29 396 5 914 1 763 1 763 57

2005 123 118 84 848 23 076 11 318 3 876 3 876 79

2010 153 892 105 772 21 625 23 506 0 2 989 4 806 7 795 0 83

2011 154 358 98 948 21 921 27 329 0 2 701 4 665 7 366 3 459 82

• 45 109 • 2012 168 683 106 790 24 451 30 549 0 3 065 4 936 8 001 3 828 81

Bhutan 1990 1 154 –

1995 1 299 367 657 265 10 10 36

2000 1 140 347 430 363 36 36 45

2005 1 007 308 272 387 40 11 51 53

2010 1 311 457 275 518 0 61 21 82 0 62

2011 1 235 382 225 573 0 55 15 70 0 63

• 215 152 • 2012 1 130 420 127 519 64 15 79 77

Democratic 1990 –

Peo

le's Re

ubli

1995 –

of Korea 2000 34 131 16 440 13 801 3 787 103 103 54

2005 42 722 17 796 18 123 5 381 58 1 364 7 752 9 116 50

2010 84 648 31 240 36 285 13 715 3 408 11 650 15 058 46

2011 91 433 31 279 37 457 16 828 5 869 7 638 13 507 46

• 0 371 • 2012 91 885 31 904 35 959 17 321 6 701 7 514 14 215 47

India 1990 1 519 182 –

1995 1 218 183 264 515 880 589 68 979 690 690 23

2000 1 115 718 349 374 650 345 98 006 17 993 80 072 98 065 35

2005 1 156 248 508 890 399 066 171 838 1 381 75 073 148 580 223 653 0 56

2010 1 339 866 630 165 366 381 231 121 1 508 110 691 182 281 292 972 63

2011 1 323 949 642 321 340 203 226 965 1 952 112 508 191 923 304 431 65

• 175 104 • 2012 1 289 836 629 589 317 616 234 029 2 139 106 463 177 749 284 212 66

Indonesia 1990 74 470 –

1995 35 529 31 768 34 0 106 106 100

2000 84 591 52 338 15 035 833 1 448 1 448 78

2005 254 601 158 640 85 373 6 142 4 446 4 446 65

2010 300 659 183 366 101 247 11 659 0 4 387 2 202 6 589 0 64

2011 318 949 197 797 101 750 14 054 5 348 2 359 7 707 66

• 42 133 • 2012 328 824 202 319 104 866 15 697 5 942 2 600 8 542 66

Maldives 1990 152 –

1995 231 114 89 18 10 10 56

2000 132 65 31 32 4 0 4 68

2005 122 66 23 29 0 4 1 5 0 74

2010 95 41 20 33 0 1 2 3 0 67

2011 87 47 12 28 0 0 1 1 0 80

• 70 33 • 2012 110 52 17 41 0 0 1 1 0 75

Myanmar 1990 12 416 –

1995 18 229 8 681 7 058 653 1 837 1 837 55

2000 30 840 17 254 8 659 2 304 2 623 2 623 67

2005 107 009 36 541 35 601 30 252 4 615 982 5 597 51

2010 131 590 42 318 56 840 27 976 4 456 5 813 10 269 43

2011 136 737 42 324 62 038 27 769 4 606 6 403 11 009 41

• 29 267 • 2012 141 170 42 909 73 042 20 661 0 4 558 6 979 11 537 0 37

Nepal 1990 10 142 –

1995 19 804 8 591 7 938 2 489 786 786 52

2000 29 519 13 683 9 074 4 955 1 807 1 807 60

2005 33 448 14 617 9 474 7 013 0 2 344 629 2 973 61

2010 35 114 15 569 9 718 7 210 0 2 617 495 3 112 0 62

2011 35 434 15 000 9 662 7 484 926 2 362 520 2 882 0 61

• 56 128 • 2012 35 195 15 057 9 128 7 865 865 2 280 440 2 720 0 62

Sri Lanka 1990 6 666 2 769 3 241 656 46

1995 5 956 3 049 1 677 982 248 248 65

2000 8 413 4 314 2 261 1 561 277 372 649 66

2005 9 451 4 868 2 198 1 917 0 266 244 510 202 69

2010 9 934 4 635 2 145 2 548 0 219 161 380 387 68

2011 10 181 4 490 2 405 2 612 0 248 147 395 426 65

• 38 43 • 2012 9 155 4 269 1 889 2 349 0 245 188 433 403 69

Thailand 1990 46 510 –

1995 45 428 20 273 22 606 1 419 1 130 1 130 47

2000 34 187 17 754 12 439 2 953 1 041 1 041 59

2005 57 895 29 762 18 837 7 501 1 795 1 795 61

2010 67 128 33 450 20 927 10 135 0 1 885 1 111 2 996 731 62

2011 65 824 33 169 20 726 10 014 0 1 915 1 852 3 767 0 62

• 82 90 • 2012 60 304 30 998 17 537 8 852 1 887 904 2 791 1 030 64

Timor-Leste 2005 3 767 1 035 2 142 554 36 16 52 33

2010 –

2011 4 386 1 610 2 401 337 0 38 31 69 0 40

344 • 2012 3 828 1 545 1 823 420 0 40 9 49 46

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

260 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Bangladesh 1995 20 524 10 867 53 66 5 5 2 10 12

2000 38 484 38 484 100 77 4 4 1 9 5

2005 84 848 84 848 100 9114122

2009 109 402 109 075 100 9114122

2010 105 772 105 659 100 9014122

• 71 92 • 2011 98 948 98 932 100 9114122

Bhutan 1995 367 433 118 78 20 0 0 1 1

2000 347 347 100 75 15 4 3 3 0

2005 308 340 110 8475310

2009 434 434 100 8663320

2010 457 454 99 8733312

• 97 91 • 2011 382 381 100 8833511

Democratic 1995 –

People's Republic 2000 16 440 14 571 89 73 9 3 7 5 3

of Korea 2005 17 796 17 796 100 8452422

2009 29 366 29 366 100 8552422

2010 31 240 31 240 100 8643421

• 0 90 • 2011 31 279 31 279 100 8733421

India 1995 264 515 264 722 100 1 25 0 0 0 75

2000 349 374 349 328 100 31 4 1 1 7 57

2005 508 890 507 204 100 83 2 5 2 7 1

2009 624 617 624 617 100 85 2 4 2 6 1

2010 630 165 630 165 100 8534261

• 25 88 • 2011 642 321 642 321 100 8534251

Indonesia 1995 31 768 3 018 10 73 18 2 0 6 1

2000 52 338 52 338 100 70 17 2 1 4 5

2005 158 640 158 640 100 83 82142

2009 169 213 169 213 100 84 7 2142

2010 183 366 183 366 100 84 7 2 1 4 3

• 91 90 • 2011 197 797 197 797 100 84 6 2 1 4 3

Maldives 1995 114 114 100 96 2 3000

2000 65 59 91 97 0 2002

2005 66 70 106 86 0 6 0 3 6

2009 45 45 100 47022444

2010 41 44 107 82 0 9 2 0 7

• 97 81 • 2011 47 48 102 81 0 2 0 0 17

Myanmar 1995 8 681 7 872 91 53 14 4 4 18 7

2000 17 254 16 792 97 7395292

2005 36 541 36 652 100 77 7 6 3 5 2

2009 41 357 41 811 101 77 86352

2010 42 318 42 200 100 77 8 5342

• 67 86 • 2011 42 324 42 310 100 77 9 5342

Nepal 1995 8 591 8 053 94 56 17 3 2 18 6

2000 13 683 12 992 95 79 55172

2005 14 617 14 617 100 87 1 5132

2009 15 442 15 468 100 87 3 4 1 3 2

2010 15 569 15 569 100 8823133

• 73 90 • 2011 15 000 15 000 100 8824132

Sri Lanka 1995 3 049 3 058 100 75 4 3 0 13 4

2000 4 314 4 314 100 75 4 4 1 15 2

2005 4 868 4 841 99 83 3 5 1 6 1

2009 4 764 4 754 100 83 3 6 2 4 3

2010 4 635 4 635 100 83 4 7 1 4 1

• 79 87 • 2011 4 490 4 490 100 83 3 5 1 5 2

Thailand 1995 20 273 20 273 100 36 28 2 0 9 24

2000 17 754 23 061 130 65382715

2005 29 762 29 919 101 7058279

2009 32 810 27 597 84 8157132

2010 33 450 30 317 91 7967232

• 64 85 • 2011 33 169 30 711 93 7967133

Timor-Leste 2005 1 035 1 035 100 61 21 5 1 11 2

2009 1 206 –

2010 1 530 – 80 8 4 1 4 4

91 • 2011 1 610 1 610 100 8653032

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

261 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SOUTH-EAST ASIA REGION

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Bangladesh 1995 729 1 179 162 71 3 5 8 11 2

2000 1 763 1 815 103 70 2 4 2 7 14

2005 3 876 3 876 100 73 6 4 2 5 9

2009 4 099 6 637 162 66 16 6 2 5 6

2010 7 795 7 814 100 47 33 5 2 5 8

• 75 82 • 2011 7 366 7 369 100 46 36 5 2 4 7

Bhutan 1995 10 22 220 50 9 0 23 14 5

2000 36 –

2005 51 52 102 65 10 6 8 2 10

2009 76 76 100 70 12 8 7 3 1

2010 82 81 99 78 6 1 7 5 2

• 59 76 • 2011 70 67 96 70 6 7 12 1 3

Democratic 1995 –

People's Republic 2000 103 1 285 1 248 75 11 2 4 2 5

of Korea 2005 9 116 9 116 100 70 6 3 12 5 4

2009 14 576 14 576 100 74 9 2 11 2 2

2010 15 058 15 058 100 76 8 4 8 3 2

• 0 84 • 2011 13 507 13 507 100 77 8 5 7 2 1

India 1995 690 551 80 64 6 4 3 13 9

2000 98 065 48 133 49 55 15 7 5 16 2

2005 223 653 224 143 100 47 24 7 4 16 1

2009 289 756 289 756 100 45 29 7 4 13 1

2010 292 972 292 972 100 45 30 7 4 13 2

• 70 75 • 2011 304 431 304 431 100 43 31 7 4 12 3

Indonesia 1995 106 76 72 22 9 0 0 1 67

2000 1 448 2 530 175 50 22 3 3 7 15

2005 4 446 4 812 108 63 15 3 4 8 7

2009 5 688 5 687 100 53 20 4 3 12 8

2010 6 589 6 589 100 53 20 5 3 11 8

• 32 71 • 2011 7 707 7 707 100 53 18 5 3 11 9

Maldives 1995 10 –

2000 4 5 125 100 0

2005 5 5 100 80 20 0 0 0 0

2009 5 1 20 0 0 0 0 0 100

2010 3 0 0

• 0 0 • 2011 1 0 0

Myanmar 1995 1 837 1 443 79 55 8 4 4 19 9

2000 2 623 3 001 114 65 9 7 4 12 3

2005 5 597 6 556 117 58 14 10 6 7 5

2009 9 717 9 540 98 44 28 11 5 7 4

2010 10 269 10 106 98 41 32 11 5 7 3

• 64 72 • 2011 11 009 11 087 101 38 34 12 6 8 3

Nepal 1995 786 –

2000 1 807 2 047 113 73 3 4 8 7 4

2005 2 973 2 973 100 81 2 4 6 4 3

2009 3 117 3 063 98 82 3 6 3 4 3

2010 3 112 3 112 100 82 3 5 3 4 4

• 0 85 • 2011 2 882 2 882 100 83 2 5 4 3 3

Sri Lanka 1995 248 –

2000 649 521 80 44 20 6 1 26 3

2005 510 504 99 67552183

2009 409 408 100 66781135

2010 380 380 100 7167294

• 0 75 • 2011 395 395 100 6968395

Thailand 1995 1 130 –

2000 1 041 –

2005 1 795 2 285 127 52 6 12 5 7 18

2009 3 929 2 542 65 58 10 11 5 7 9

2010 2 996 2 580 86 55 11 12 5 7 10

• 0 69 • 2011 3 767 2 737 73 57 12 11 5 7 8

Timor-Leste 2005 52 56 108 9602020

2009 52 –

2010 56 – 7792472

77 • 2011 69 69 100 71 6 4 6 13

a TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

262 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Bangladesh 2005 0 0 123 118

2010 1.1 1 778 158 698 4 0.22 100 100 64

2011 1.2 1 900 159 023 53 2.8 100 100 0

• 0 1 • 2012 1.2 2 086 173 619 63 3 100 100 0

Bhutan 2005 0 0 1 018 1 0 0

2010 1 332

2011 1 250

• 0 – 2012 1 145

Democratic 2005 50 474

People's Republic 2010 0 0 96 298 0

of Korea 2011 0 0 99 071 0

– – 2012 99 399

India 2005 2.3 29 488 1 304 828 6 411 22

2010 32 480 752 1 522 147 41 476 8.6 90 57

2011 45 688 530 1 515 872 44 702 6.5 91 59

• 2 56 • 2012 56 821 807 1 467 585 44 063 5.4 92 59

Indonesia 2005 254 601

2010 0.91 2 751 302 861 1 106 40 63 29

2011 1.9 6 003 321 308 2 547 42 67 39

– 1 • 2012 0.81 2 676 331 424 754 28 18 29

Maldives 2005 123

2010 0 0 97 0 0

2011 6.8 6 88 0 0

– 1 • 2012 0.9 1 111 1 100 0 0 0

Myanmar 2005 2 2 109 107 991 611 29 50 31 0

2010 3.2 4 362 137 403 961 22 100 94 514

2011 3.1 4 496 143 140 900 20 100 80 361

• 2 13 • 2012 13 19 219 148 149 5 161 27 83

Nepal 2005 0 0 34 077

2010 0 0 35 609 0

2011 42 15 000 35 954 55 0.37 100 100

• 0 42 • 2012 42 15 057 35 635 217 1.4 100 100

Sri Lanka 2005 9 695 2 0 0

2010 10 1 015 10 095 13 1.3 100 54 3

2011 18 1 832 10 328 21 1.1 71 100 7

– 36 • 2012 36 3 379 9 343 23 0.68 22 48 8

Thailand 2005 57 895

2010 82 55 692 68 239 8 959 16 71 54

2011 74 49 770 67 676 7 326 15 75 59

– 72 • 2012 72 44 035 61 208 5 807 13 77 62

Timor-Leste 2005 0 0 3 783

2010

2011 6.2 276 4 417 4 1.4 100

• 0 20 • 2012 20 766 3 837 4 0.52 100

263 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SOUTH-EAST ASIA REGION

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Bangladesh 2005 ––

2010 339 – 339 4.3

2011 509 71 <0.1 761 10

2012 513 4 200 (3 100–5 200) 1 900 (920–3 300) 41 <0.1 2 300 (1 900–2 700) 557 7.0

Bhutan 2005 2 2 0.65 3 5.9

2010 17 108 24 30 37

2011 21 48 13 26 37

2012 16 25 (20–30) 12 (8.8–15) 52 12 13 (8.8–17) 2 2.5

Democratic 2005 ––

People's Republic 2010 ––

of Korea 2011 37 –430.32

2012 25 3 800 (3 000–4 600) 1 500 (1 100–1 900) – 2 300 (1 600–3 000) 31 0.22

India 2005 34 ––

2010 2967 ––

2011 4237 ––

2012 16588 64 000 (49 000–79 000) 21 000 (18 000–25 000) – 43 000 (32 000–54 000) –

Indonesia 2005 ––

2010 182 0 0 324 4.9

2011 383 5 <0.1 695 9.0

2012 428 6 900 (5 200–8 500) 5 800 (4 300–7 700) 2 <0.1 1 000 (690–1 500) 821 9.6

Maldives 2005 ––

2010 0 0 0 0 0

2011 0 0 0 0 0

2012 0 1.7 (1.3–2.1) 1.5 (1.1–1.9) 0 0 0.16 (0.11–0.21) 0 0

Myanmar 2005 ––

2010 192 ––

2011 690 ––

2012 778 6 000 (4 600–7 500) 4 900 (3 600–6 500) – 1 200 (790–1 600) –

Nepal 2005 ––

2010 229 126 0.81 193 6.2

2011 213 0 0 0 0

2012 354 990 (660–1 300) 570 (320–950) 188 1.2 420 (270–620) 640 24

Sri Lanka 2005 32 659 12 417 82

2010 11 839 18 378 99

2011 13 1080 24 408 100

2012 5 21 (0–43) 11 (0.28–61) 1069 23 9.6 (4.4–18) 238 55

Thailand 2005 ––

2010 ––

2011 510 ––

2012 492 1 800 (1 400–2 200) 800 (480–1 200) – 960 (780–1 200) –

Timor-Leste 2005 ––

2010 5 ––

2011 2 0 0 2 2.9

2012 3 82 (62–100) 74 (54–94) – 7.9 (5.4–10) 3 6.1

a TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED

CASES).

b BACT+VE = bacteriologically positive cases.

264 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Bangladesh 1995 29 505 983 1 001 748 648 424 64 309 546 360 236 132 38 2.6

2000 256 3 640 5 643 5 750 4 718 3 667 2 837 495 3 029 3 238 2 247 1 315 778 370 2.3

2005 524 8 170 10 443 11 423 11 038 8 476 7 453 751 6 776 6 785 5 538 3 960 2 281 1 230 2.1

2010 365 10 460 12 535 11 409 12 758 11 176 11 536 0 653 9 221 8 279 6 185 5 458 3 484 2 250 0 2.0

2011 309 9 606 11 616 10 152 11 728 10 746 11 301 0 623 8 849 7 679 5 683 4 946 3 457 2 253 0 2.0

2012 316 9 479 12 021 10 837 12 744 11 843 12 236 0 650 9 355 8 175 6 342 6 044 4 043 2 705 0 1.9

Bhutan 1995 2 42 65 36 35 24 11 12 43 44 25 12 9 8 1.4

2000 6 65 41 30 24 12 2 7 57 34 31 23 3 2 1.1

2005 1 47 58 26 23 14 12 9 45 38 13 11 9 2 1.4

2010 108 50 25 12 26 13 0 17 104 45 18 18 10 9 0 1.1

2011 2 88 39 26 14 20 19 2 92 40 19 12 4 5 1.2

2012 6 82 56 30 11 17 11 6 92 58 14 18 9 10 1.0

Democratic 1995 –

People's Republic 2000 293 928 1 508 2 927 2 519 1 167 651 167 683 1 121 2 004 1 524 591 357 1.6

of Korea 2005 167 1 409 2 422 2 688 2 040 1 185 485 166 1 127 1 756 1 890 1 381 764 336 1.4

2010 447 2 524 4 046 4 849 4 061 2 629 1 153 407 1 493 2 461 2 910 2 276 1 347 637 1.7

2011 314 2 218 4 066 5 493 4 542 2 474 1 024 227 1 390 2 264 3 093 2 409 1 271 494 1.8

2012 293 2 439 4 015 5 055 4 373 2 699 1 150 227 1 447 2 475 3 005 2 623 1 527 576 1.7

India 1995 16 334 391 287 216 123 68 32 179 169 80 49 30 11 2.6

2000 1 588 20 963 31 090 30 829 24 230 15 308 8 534 2 250 14 495 17 287 11 768 7 516 4 594 2 697 2.2

2005 3 185 62 620 74 678 76 870 64 843 43 038 24 726 6 292 45 136 45 629 28 577 17 042 10 513 5 408 2.2

2010 4 871 78 278 82 757 90 440 81 210 60 766 38 442 8 544 53 415 49 425 34 035 22 719 15 527 9 735 2.3

2011 4 649 78 096 82 762 89 706 82 921 63 625 42 443 8 336 53 958 49 227 34 698 23 977 17 182 10 731 2.2

2012 4 697 75 502 79 594 88 111 82 356 63 814 41 322 8 260 53 975 47 511 33 378 23 267 17 300 10 502 2.2

Indonesia 1995 6 203 297 306 302 228 109 16 160 244 282 192 90 33 1.4

2000 –

2005 846 15 215 20 906 18 401 17 847 13 509 6 390 946 13 916 16 393 13 022 10 927 7 539 2 783 1.4

2010 714 16 501 24 645 21 090 20 977 17 329 7 910 0 816 14 800 17 838 14 629 13 142 9 524 3 451 0 1.5

2011 787 17 406 25 429 22 353 22 885 19 404 9 089 927 15 840 18 703 15 900 14 533 10 556 3 985 1.5

2012 824 17 304 25 460 23 057 23 751 20 204 9 554 879 15 875 18 484 16 146 15 215 11 321 4 245 1.5

Maldives 1995 1 28 11 10 8 10 6 1 13 8 4 6 6 2 1.8

2000 09102553 01145452 1.1

2005 0985665 11071224 1.4

2010 08604560 12341010 2.4

2011 012738130 04312120 2.6

2012 08624540 07633220 1.3

Myanmar 1995 42 713 1 423 1 401 977 677 298 58 535 729 729 450 343 154 1.8

2000 88 1 459 2 636 2 781 2 161 1 235 836 72 1 040 1 592 1 397 987 592 378 1.8

2005 132 3 401 5 877 5 888 4 585 2 557 1 764 147 2 376 3 047 2 563 2 101 1 218 885 2.0

2010 106 3 043 6 578 6 688 5 607 3 632 2 308 196 2 452 3 454 2 752 2 525 1 838 1 139 1.9

2011 120 2 923 6 182 6 319 5 680 3 954 2 500 187 2 401 3 317 2 760 2 554 2 010 1 407 1.9

2012 146 2 898 6 263 6 469 5 837 3 945 2 626 0 192 2 357 3 368 2 721 2 600 2 023 1 464 0 1.9

Nepal 1995 –

2000 170 1 904 1 763 1 713 1 491 1 294 772 176 1 267 1 078 833 575 419 228 2.0

2005 148 1 946 1 685 1 722 1 806 1 759 820 195 1 208 1 111 797 658 532 230 2.1

2010 165 2 110 1 832 1 724 1 856 1 857 1 126 0 192 1 177 1 036 819 681 642 352 0 2.2

2011 245 1 914 1 755 1 723 1 732 1 710 1 180 0 247 1 182 978 752 624 604 354 0 2.2

2012 250 1 906 1 756 1 644 1 708 1 773 1 203 210 1 227 1 036 666 638 643 397 2.1

Sri Lanka 1995 10 163 361 519 521 365 261 15 207 206 142 122 81 56 2.7

2000 25 266 459 695 793 484 360 23 312 264 176 202 144 113 2.5

2005 9 341 520 724 918 657 424 19 295 261 189 200 154 130 2.9

2010 14 268 539 602 884 683 448 15 255 233 171 183 186 154 2.9

2011 12 246 459 585 828 653 479 0 13 270 217 191 192 191 154 0 2.7

2012 7 243 420 504 799 672 456 0 17 242 200 162 211 200 136 0 2.7

Thailand 1995 59 1 191 2 936 2 948 2 434 2 607 2 346 52 741 888 782 936 1 175 1 178 2.5

2000 27 859 2 570 2 380 2 117 1 908 2 213 32 624 1 035 780 873 1 016 1 321 2.1

2005 44 1 344 3 814 4 393 4 003 2 831 3 407 57 907 1 662 1 334 1 367 1 259 1 938 2.3

2010 55 1 506 3 695 5 253 5 042 3 625 4 189 82 1 087 1 930 1 749 1 467 1 494 2 276 2.3

2011 38 1 546 3 650 5 139 5 140 3 734 4 080 76 1 214 1 773 1 658 1 586 1 402 2 133 2.4

2012 35 1 444 3 277 4 705 4 867 3 780 3 863 82 995 1 491 1 613 1 424 1 364 2 058 2.4

Timor-Leste 2005 8 136 149 116 119 52 47 8 127 90 76 60 18 29 1.5

2010 –

2011 14 199 177 137 114 99 146 0 16 176 182 113 85 77 75 0 1.2

2012 7 196 172 128 119 114 129 0 12 154 143 120 75 84 92 0 1.3

265 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

SOUTH-EAST ASIA REGION

a LED = Light emitting diode microscopes

b DST = Drug susceptibility testing

c LPA = Line probe assay

d NRL = National Reference Laboratory

7$%/($/DERUDWRULHV173VHUYLFHVGUXJPDQDJHPHQWDQGLQIHFWLRQFRQWURO

LABORATORIES FREE THROUGH NTP

SMEAR LABS

PER 100K

POPULATION

% OF SMEAR

LABS USING

LED

CULTURE

LABS PER 5M

POPULATION

DST

LABS

PER 5M

POPULATION

LPA

LABS

PER 5M

POPULATION

NUMBER OF

LABS USING

XPERT MTB/RIF

SECOND-

LINE DST

AVAILABLE

NRL

TB DIAGNOSIS

FIRST-

LINE

DRUGS

TB NOTIF.

RATE PER

100 000

HEALTH-CARE

WORKERS

RIFAMPICIN

USED

THROUGHOUT

TREATMENT

Bangladesh 0.7 2 <0.1 <0.1 <0.1 12 Out of

country Yes Yes (all suspects) Yes Yes

Bhutan 4.7 0 6.7 6.7 Out of

country Yes Yes

(

if TB is

confirmed) Yes Yes

Democratic People's

Republic of Korea 1.3 0 0.2 0.2 0 0 Out of

country Yes Yes (all suspects) Yes Yes

India 1.1 2 0.3 0.2 0.1 32 Yes Yes (all suspects) Yes Yes

Indonesia 2.3 0 0.9 0.1 <0.1 9 In country Yes Yes (other criteria) Yes Yes

Maldives 20.7 0 14.8 0 0 0 Out of

country Yes Yes (all suspects) Yes Yes

Myanmar 0.9 14 0.2 0.2 0.2 3 In and out

of countr y Yes Yes (all suspects) Yes Yes

Nepal 1.9 2 0.4 0.4 9 In country Yes Yes (all suspects) Yes Yes

Sri Lanka 1.0 0 0.7 0.2 0.2 1 Out of

country Yes Yes (all suspects) Yes Yes 53

Thailand 1.6 6 4.9 1.3 0.9 14 In country Yes Yes (all suspects) Yes Yes

Timor-Leste 1.6 – 1 No Yes Yes (all suspects) Yes No

266 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($0HDVXUHGSHUFHQWDJHRI7%FDVHVZLWK0'57%

PRVWUHFHQW\HDUDYDLODEOH

New TB cases Previously treated TB cases

Year Source Coverage Percentage Year Source Coverage Percentage

Bangladesh 2011 Survey National 1.4 (0.70–2.5) 2011 Survey National 29 (24–34)

Bhutan

Democratic People's

Republic of Korea

India 2001, 2004, 2006, 2009 Survey Sub-national 2.2 (1.9–2.6) 2006, 2009 Survey Sub-national 15 (11–19)

Indonesia 2004, 2006, 2010 Survey Sub-national 1.9 (1.4–2.5) 2006, 2010 Survey Sub-national 12 (8.1–17)

Maldives

Myanmar 2008 Survey National 4.2 (3.1–5.6) 2008 Survey National 10 (6.9–14)

Nepal 2011 Survey National 2.3 (1.3–3.8) 2011 Survey National 15 (10–23)

Sri Lanka 2006 Survey National 0.18 (0–0.99) 2011 Surveillance National 2.2 (1.0–4.1)

Thailand 2006 Survey National 1.7 (1.0–2.6) 2006 Survey National 35 (28–42)

Timor-Leste

a Empty rows indicate an absence of high-quality survey or surveillance data. In the absence of high-quality national data, high-quality sub-national data are used.

9'56'402#%+(+%4')+10

Table A4.1 Estimates of the burden of disease caused by TB, 1990–2012 269

6CDNG# +PEKFGPEGPQVKßECVKQPCPFECUGFGVGEVKQPTCVGUCNNHQTOU¿ 

6CDNG# %CUGPQVKßECVKQPU¿ 

6CDNG# 6TGCVOGPVQWVEQOGUPGYUOGCTRQUKVKXGECUGU¿ 

6CDNG# 6TGCVOGPVQWVEQOGUTGVTGCVOGPVECUGU¿ 

6CDNG# *+8VGUVKPICPFRTQXKUKQPQH%26#46CPF+26¿ 

6CDNG# 6GUVKPIHQT/&46$CPFPWODGTQHEQPßTOGFECUGUQH/&46$¿ 

6CDNG# 0GYUOGCTRQUKVKXGECUGPQVKßECVKQPD[CIGCPFUGZ¿ 

6CDNG# .CDQTCVQTKGU062UGTXKEGUFTWIOCPCIGOGPVCPFKPHGEVKQPEQPVTQN 

6CDNG# /GCUWTGFRGTEGPVCIGQH6$ECUGUYKVJ/&46$OQUVTGEGPV[GCTCXCKNCDNG 

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

Estimates of mortality, prevalence and incidence

Estimated values are shown as best estimates followed by lower and upper bounds. e lower and upper bounds are dened

as the 2.5th and 97.5th centiles of outcome distributions produced in simulations. See ANNEX 1 for further details.

Estimated numbers are shown rounded to two signicant gures. Estimated rates are shown rounded to three signicant

gures unless the value is under 100, in which case rates are shown rounded to two signicant gures.

Estimates for all years are recalculated as new information becomes available and techniques are rened, so

they may dier from those published in previous reports in this series. e main updates implemented in this

report are explained in Box 2.1 of Chapter 2. Estimates published in previous global TB control reports should no

longer be used.

Data source

Data shown in this annex are taken from the WHO global TB database on 1 October 2013. Data shown in the main part of

the report were taken from the database in July 2013. As a result, data in this annex may dier slightly from those in the

main part of the report.

Data for all years can be downloaded from www.who.int/tb/data.

269 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

American Samoa 1990 < 1 <0.01 (<0.01–<0.01) 5.1 (2.1–9.5) 0.022 (0.010–0.037) 46 (22–79) 0.012 (<0.01–0.015) 26 (21–31)

1995 < 1 <0.01 (<0.01–<0.01) 2.4 (0.95–4.4) 0.011 (<0.01–0.019) 21 (10–37) <0.01 (<0.01–<0.01) 12 (9.4–14)

2000 < 1 <0.01 (<0.01–<0.01) 0.82 (0.35–1.5) <0.01 (<0.01–0.010) 9.4 (3.6–18) <0.01 (<0.01–<0.01) 6.9 (5.6–8.4)

2005 < 1 <0.01 (<0.01–<0.01) 2.4 (0.99–4.5) 0.013 (<0.01–0.023) 23 (11–38) <0.01 (<0.01–<0.01) 13 (10–15)

2010 < 1 <0.01 (<0.01–<0.01) 0.9 (0.14–2.3) <0.01 (<0.01–0.014) 11 (3.0–25) <0.01 (<0.01–<0.01) 7.8 (6.3–9.4)

2011 < 1 <0.01 (<0.01–<0.01) 0.95 (0.17–2.4) <0.01 (<0.01–0.014) 12 (3.2–25) <0.01 (<0.01–<0.01) 7.8 (6.3–9.4)

2012 < 1 <0.01 (<0.01–<0.01) 0.88 (0.23–2.0) <0.01 (<0.01–0.012) 11 (3.6–22) <0.01 (<0.01–<0.01) 7.3 (5.9–8.9)

Australia 1990 17 0.061 (0.061–0.062) 0.36 (0.35–0.36) 1.7 (0.750–2.9) 9.7 (4.4–17) 1.2 (1.0–1.3) 6.8 (6.0–7.7)

1995 18 0.027 (0.027–0.028) 0.15 (0.15–0.16) 1.7 (0.740–3.0) 9.4 (4.1–17) 1.2 (1.1–1.4) 6.8 (6.0–7.7)

2000 19 0.036 (0.035–0.036) 0.19 (0.18–0.19) 1.7 (0.740–3.0) 8.7 (3.9–16) 1.2 (1.1–1.4) 6.2 (5.5–7.0)

2005 21 0.041 (0.041–0.042) 0.2 (0.20–0.20) 1.6 (0.650–3.0) 7.8 (3.2–14) 1.2 (1.1–1.4) 5.9 (5.1–6.6)

2010 22 0.051 (0.050–0.051) 0.23 (0.23–0.23) 2 (0.830–3.6) 8.8 (3.7–16) 1.4 (1.3–1.6) 6.5 (5.7–7.3)

2011 23 0.04 (0.040–0.041) 0.18 (0.18–0.18) 1.9 (0.740–3.5) 8.2 (3.3–15) 1.4 (1.2–1.6) 6.3 (5.5–7.1)

2012 23 0.045 (0.044–0.045) 0.19 (0.19–0.19) 2 (0.860–3.7) 8.8 (3.7–16) 1.5 (1.3–1.7) 6.5 (5.7–7.4)

Brunei 1990 < 1 <0.01 (<0.01–<0.01) 3 (2.9–3.2) 0.2 (0.070–0.400) 78 (27–154) 0.16 (0.140–0.190) 64 (56–72)

Darussalam 1995 < 1 <0.01 (<0.01–<0.01) 3 (2.9–3.2) 0.21 (0.064–0.440) 71 (22–150) 0.18 (0.160–0.210) 63 (55–71)

2000 < 1 0.014 (0.014–0.015) 4.3 (4.2–4.5) 0.55 (0.270–0.930) 165 (81–280) 0.35 (0.310–0.400) 106 (93–120)

2005 < 1 0.011 (0.010–0.011) 2.9 (2.8–3.0) 0.23 (0.080–0.470) 64 (22–128) 0.19 (0.160–0.210) 51 (45–58)

2010 < 1 0.012 (0.012–0.013) 3 (2.9–3.2) 0.4 (0.180–0.700) 99 (45–174) 0.27 (0.240–0.310) 68 (60–77)

2011 < 1 0.012 (0.012–0.013) 3 (2.9–3.2) 0.36 (0.140–0.660) 87 (36–162) 0.26 (0.230–0.300) 65 (57–74)

2012 < 1 0.013 (0.012–0.013) 3 (2.9–3.2) 0.37 (0.140–0.700) 90 (35–169) 0.28 (0.240–0.320) 68 (59–77)

Cambodia 1990 9 14 (4.9–28) 157 (54–314) 150 (96–220) 1 670 (1 060–2 410) 53 (38–69) 580 (423–761)

1995 11 15 (5.3–29) 139 (49–274) 180 (130–230) 1 670 (1 220–2 180) 62 (48–78) 578 (448–724)

2000 12 16 (5.7–31) 128 (47–251) 200 (160–240) 1 620 (1 310–1 960) 71 (56–87) 577 (458–710)

2005 13 13 (5.1–23) 94 (38–175) 160 (140–190) 1 230 (1 020–1 460) 68 (57–81) 510 (424–604)

2010 14 9.8 (4.5–17) 68 (31–120) 130 (110–150) 875 (737–1 020) 63 (54–72) 437 (376–503)

2011 15 9.5 (4.4–17) 65 (30–114) 120 (100–140) 817 (690–954) 62 (53–71) 424 (364–489)

2012 15 9.3 (4.3–16) 63 (29–110) 110 (96–130) 764 (645–892) 61 (52–70) 411 (353–474)

China 1990 1 165 220 (190–240) 19 (17–21) 2 500 (2 300–2 700) 215 (201–230) 1 800 (1 400–2 200) 153 (121–189)

1995 1 238 170 (140–200) 13 (11–16) 2 400 (2 200–2 700) 195 (176–216) 1 600 (1 300–1 900) 129 (106–154)

2000 1 280 110 (84–140) 8.7 (6.5–11) 2 200 (1 900–2 500) 170 (146–196) 1 400 (1 200–1 600) 109 (92–126)

2005 1 318 75 (72–77) 5.7 (5.5–5.9) 1 800 (1 600–2 100) 140 (121–160) 1 200 (1 100–1 400) 92 (80–105)

2010 1 360 52 (50–53) 3.8 (3.7–3.9) 1 500 (1 300–1 700) 108 (94–123) 1 100 (930–1 200) 78 (68–88)

2011 1 368 48 (46–50) 3.5 (3.4–3.6) 1 400 (1 200–1 600) 104 (91–119) 1 000 (900–1 200) 75 (66–85)

2012 1 377 44 (43–46) 3.2 (3.1–3.3) 1 400 (1 200–1 600) 99 (86–113) 1 000 (880–1 100) 73 (64–82)

China, Hong Kong 1990 6 0.37 (0.360–0.370) 6.3 (6.2–6.4) 9.8 (4.0–18) 169 (69–314) 7.5 (6.6–8.5) 129 (113–146)

SAR 1995 6 0.38 (0.380–0.380) 6.2 (6.1–6.2) 8.7 (3.1–17) 142 (50–280) 7.1 (6.3–8.1) 116 (102–132)

2000 7 0.27 (0.270–0.280) 4 (4.0–4.0) 8.2 (2.8–17) 120 (40–243) 6.9 (6.1–7.8) 101 (89–115)

2005 7 0.24 (0.240–0.250) 3.5 (3.5–3.6) 9 (3.8–16) 130 (55–237) 6.5 (5.7–7.4) 94 (83–107)

2010 7 0.19 (0.180–0.190) 2.6 (2.6–2.7) 7.7 (3.2–14) 110 (46–202) 5.7 (5.0–6.4) 81 (71–91)

2011 7 0.19 (0.180–0.190) 2.6 (2.6–2.7) 7.3 (3.0–14) 103 (42–191) 5.4 (4.8–6.2) 77 (67–87)

2012 7 0.19 (0.190–0.190) 2.6 (2.6–2.7) 7.7 (3.4–14) 108 (47–195) 5.5 (4.8–6.3) 77 (68–88)

China, Macao 1990 < 1 0.036 (0.018–0.060) 10 (5.1–17) 0.6 (0.290–1.0) 167 (81–285) 0.39 (0.350–0.450) 110 (96–124)

SAR 1995 < 1 0.022 (<0.01–0.050) 5.4 (1.3–12) 0.55 (0.180–1.1) 137 (45–278) 0.46 (0.410–0.520) 116 (102–131)

2000 < 1 0.02 (<0.01–0.052) 4.6 (0.74–12) 0.65 (0.250–1.2) 151 (57–289) 0.52 (0.450–0.580) 120 (105–135)

2005 < 1 0.015 (<0.01–0.051) 3.3 (0.16–11) 0.66 (0.300–1.2) 141 (64–249) 0.46 (0.400–0.520) 98 (86–111)

2010 < 1 0.015 (<0.01–0.058) 2.8 (<0.1–11) 0.64 (0.280–1.1) 119 (52–214) 0.45 (0.400–0.510) 85 (74–96)

2011 < 1 0.015 (<0.01–0.059) 2.8 (<0.1–11) 0.59 (0.240–1.1) 108 (44–200) 0.44 (0.380–0.490) 80 (70–91)

2012 < 1 0.015 (<0.01–0.059) 2.8 (<0.1–11) 0.65 (0.280–1.2) 117 (50–211) 0.46 (0.410–0.530) 83 (73–94)

Cook Islands 1990 < 1 <0.01 (<0.01–<0.01) 0.79 (0.73–0.85) <0.01 (<0.01–<0.01) 12 (3.4–25) 0 (0–0) 0 (0–0)

1995 < 1 <0.01 (<0.01–<0.01) 1.1 (0.63–1.7) <0.01 (<0.01–<0.01) 17 (5.0–35) <0.01 (<0.01–<0.01) 13 (11–14)

2000 < 1 <0.01 (<0.01–<0.01) 0.51 (0.26–0.84) <0.01 (<0.01–<0.01) 7.6 (2.3–16) <0.01 (<0.01–<0.01) 6.5 (5.7–7.3)

2005 < 1 <0.01 (<0.01–<0.01) 0.62 (0.34–0.98) <0.01 (<0.01–<0.01) 7.5 (2.9–14) <0.01 (<0.01–<0.01) 5.9 (5.2–6.7)

2010 < 1 <0.01 (<0.01–<0.01) 0.4 (0.34–0.46) <0.01 (<0.01–<0.01) 6 (1.8–13) 0 (0–0) 0 (0–0)

2011 < 1 <0.01 (0–<0.01) 0.53 (<0.1–1.9) <0.01 (<0.01–<0.01) 7.4 (1.1–20) <0.01 (<0.01–<0.01) 5.6 (4.9–6.4)

2012 < 1 <0.01 (<0.01–<0.01) 0.6 (0.33–0.97) <0.01 (<0.01–<0.01) 7.2 (2.9–14) <0.01 (<0.01–<0.01) 5.6 (4.9–6.3)

Fiji 1990 < 1 0.051 (0.020–0.097) 7 (2.7–13) 1.8 (0.890–3.0) 244 (123–407) 0.81 (0.710–0.920) 112 (98–126)

1995 < 1 0.039 (0.018–0.069) 5.1 (2.3–8.9) 1.3 (0.650–2.1) 165 (84–273) 0.6 (0.530–0.680) 77 (68–87)

2000 < 1 0.03 (0.021–0.040) 3.7 (2.6–4.9) 0.91 (0.470–1.5) 112 (58–184) 0.44 (0.390–0.500) 54 (48–62)

2005 < 1 0.022 (0.020–0.024) 2.7 (2.4–2.9) 0.66 (0.340–1.1) 80 (42–131) 0.33 (0.290–0.370) 40 (35–45)

2010 < 1 0.016 (0.016–0.017) 1.9 (1.9–2.0) 0.39 (0.200–0.640) 45 (23–75) 0.24 (0.210–0.270) 28 (24–32)

2011 < 1 0.015 (0.015–0.016) 1.8 (1.7–1.8) 0.32 (0.140–0.570) 37 (16–66) 0.23 (0.200–0.260) 26 (23–29)

2012 < 1 0.015 (0.014–0.015) 1.7 (1.6–1.7) 0.26 (0.088–0.530) 30 (10–61) 0.21 (0.190–0.240) 24 (21–27)

French Polynesia 1990 < 1 <0.01 (<0.01–0.016) 1.9 (<0.1–7.8) 0.095 (0.042–0.170) 48 (21–85) 0.068 (0.059–0.077) 34 (30–39)

1995 < 1 <0.01 (<0.01–0.015) 2.3 (0.19–6.8) 0.13 (0.048–0.240) 59 (22–113) 0.1 (0.088–0.110) 47 (41–53)

2000 < 1 <0.01 (<0.01–<0.01) 1.2 (0.36–2.7) 0.083 (0.025–0.180) 35 (10–74) 0.071 (0.062–0.081) 30 (26–34)

2005 < 1 <0.01 (<0.01–0.015) 1.6 (<0.1–6.1) 0.099 (0.043–0.180) 39 (17–70) 0.072 (0.063–0.082) 28 (25–32)

2010 < 1 <0.01 (<0.01–<0.01) 0.78 (0.25–1.6) 0.059 (0.018–0.120) 22 (6.6–46) 0.047 (0.041–0.053) 18 (15–20)

2011 < 1 <0.01 (<0.01–0.022) 1.7 (0–8.0) 0.11 (0.052–0.190) 41 (19–70) 0.074 (0.064–0.083) 27 (24–31)

2012 < 1 <0.01 (<0.01–<0.01) 0.98 (0.12–2.7) 0.071 (0.026–0.140) 26 (9.4–51) 0.058 (0.050–0.065) 21 (18–24)

Guam 1990 < 1 <0.01 (<0.01–0.012) 2.7 (<0.1–9.5) 0.088 (0.037–0.160) 67 (28–124) 0.066 (0.058–0.075) 50 (44–57)

1995 < 1 <0.01 (<0.01–0.023) 3.9 (<0.1–16) 0.14 (0.062–0.250) 96 (43–170) 0.099 (0.087–0.110) 68 (60–77)

2000 < 1 <0.01 (<0.01–<0.01) 1.9 (0.22–5.3) 0.077 (0.028–0.150) 49 (18–96) 0.062 (0.054–0.070) 40 (35–45)

2005 < 1 <0.01 (<0.01–0.022) 2.9 (0–14) 0.12 (0.059–0.200) 74 (37–124) 0.072 (0.063–0.082) 46 (40–52)

2010 < 1 <0.01 (<0.01–0.036) 4.6 (<0.1–23) 0.19 (0.095–0.310) 118 (59–196) 0.12 (0.100–0.130) 73 (64–82)

2011 < 1 <0.01 (<0.01–0.012) 2.7 (0.33–7.6) 0.13 (0.049–0.240) 78 (31–148) 0.094 (0.083–0.110) 59 (51–66)

2012 < 1 <0.01 (<0.01–<0.01) 2.2 (0.68–4.5) 0.11 (0.036–0.220) 66 (22–134) 0.078 (0.069–0.089) 48 (42–54)

Japan 1990 122 3.8 (3.7–3.9) 3.1 (3.0–3.2) 83 (35–150) 68 (29–123) 60 (52–67) 49 (43–55)

1995 124 3.3 (3.2–3.3) 2.6 (2.6–2.7) 66 (26–120) 53 (21–99) 50 (43–56) 40 (35–45)

2000 126 2.8 (2.7–2.8) 2.2 (2.2–2.2) 64 (28–110) 51 (23–91) 45 (40–51) 36 (32–41)

2005 127 2.3 (2.3–2.4) 1.8 (1.8–1.9) 43 (18–79) 34 (14–62) 31 (27–35) 25 (22–28)

2010 127 2.2 (2.1–2.3) 1.7 (1.7–1.8) 37 (16–66) 29 (12–52) 26 (23–30) 20 (18–23)

2011 127 2.3 (2.2–2.3) 1.8 (1.7–1.8) 35 (15–64) 28 (12–50) 25 (22–29) 20 (18–23)

2012 127 2.1 (2.0–2.2) 1.7 (1.6–1.7) 33 (13–61) 26 (11–48) 24 (21–28) 19 (17–22)

Kiribati 1990 < 1 0.039 (0.029–0.051) 55 (41–72) 0.18 (0.080–0.310) 249 (113–437) 0.083 (0.066–0.100) 116 (93–143)

1995 < 1 0.044 (0.031–0.058) 57 (41–76) 0.59 (0.260–1.0) 770 (347–1 360) 0.39 (0.310–0.460) 505 (410–609)

2000 < 1 0.013 (<0.01–0.016) 15 (11–20) 0.4 (0.140–0.790) 487 (174–957) 0.31 (0.250–0.380) 372 (296–456)

2005 < 1 0.015 (0.015–0.016) 17 (16–17) 0.68 (0.300–1.2) 747 (335–1 320) 0.44 (0.360–0.530) 488 (396–588)

2010 < 1 0.016 (<0.01–0.025) 17 (9.5–26) 0.47 (0.160–0.930) 477 (166–949) 0.36 (0.290–0.430) 366 (298–441)

2011 < 1 0.017 (<0.01–0.026) 17 (9.5–26) 0.66 (0.300–1.2) 664 (298–1 170) 0.43 (0.350–0.520) 432 (351–521)

2012 < 1 0.017 (<0.01–0.026) 17 (9.5–26) 0.63 (0.270–1.1) 628 (270–1 130) 0.43 (0.350–0.520) 429 (349–517)

Lao People's 1990 4 1.7 (1.1–2.6) 41 (25–60) 63 (32–110) 1 490 (746–2 490) 21 (13–31) 492 (304–725)

Democratic 1995 5 1.4 (0.860–2.0) 29 (18–42) 60 (32–95) 1 220 (664–1 950) 20 (12–29) 403 (249–593)

Republic 2000 5 1.1 (0.700–1.7) 21 (13–31) 52 (30–79) 961 (557–1 470) 18 (11–26) 330 (204–486)

2005 6 0.91 (0.560–1.3) 16 (9.7–23) 43 (26–63) 737 (453–1 090) 16 (9.7–23) 270 (167–398)

2010 6 0.76 (0.470–1.1) 12 (7.3–17) 36 (23–52) 565 (366–807) 14 (8.8–21) 221 (137–326)

2011 7 0.73 (0.450–1.1) 11 (6.9–17) 35 (23–50) 540 (353–767) 14 (8.6–20) 213 (131–313)

2012 7 0.72 (0.430–1.1) 11 (6.5–16) 34 (22–48) 514 (335–729) 14 (8.4–20) 204 (126–301)

Malaysia 1990 18 1.2 (0.370–2.5) 6.6 (2.0–14) 44 (23–71) 242 (128–392) 23 (21–26) 127 (113–142)

1995 21 1.4 (0.480–2.7) 6.6 (2.3–13) 39 (21–63) 189 (102–303) 22 (20–25) 108 (97–120)

2000 23 1.6 (0.710–2.9) 6.9 (3.0–12) 35 (18–56) 148 (79–239) 22 (20–24) 95 (86–103)

2005 26 1.5 (0.810–2.4) 5.8 (3.2–9.1) 33 (18–54) 129 (68–210) 22 (20–24) 86 (79–94)

2010 28 1.5 (1.0–2.2) 5.4 (3.6–7.6) 32 (15–54) 112 (54–190) 23 (21–25) 82 (75–89)

2011 29 1.6 (1.1–2.1) 5.4 (3.8–7.3) 31 (14–54) 107 (49–186) 23 (21–25) 81 (74–88)

2012 29 1.6 (1.2–2.1) 5.4 (4.1–7.0) 29 (13–53) 101 (43–183) 24 (22–26) 80 (74–87)

Marshall Islands 1990 < 1 0.013 (<0.01–0.062) 28 (<0.1–130) 0.12 (<0.01–0.470) 251 (3.3–1 000) 0.065 (<0.01–0.190) 137 (14–396)

1995 < 1 0.018 (<0.01–0.069) 35 (0.72–134) 0.17 (<0.01–0.550) 332 (19–1 080) 0.097 (0.024–0.220) 190 (46–432)

2000 < 1 0.033 (<0.01–0.070) 62 (18–135) 0.28 (0.099–0.540) 532 (190–1 040) 0.14 (0.084–0.200) 263 (161–389)

2005 < 1 0.033 (<0.01–0.130) 64 (1.3–245) 0.34 (0.027–1.0) 651 (53–1 980) 0.19 (0.050–0.420) 363 (96–803)

2010 < 1 0.047 (<0.01–0.200) 89 (0.54–385) 0.47 (0.019–1.6) 903 (36–3 100) 0.26 (0.051–0.650) 502 (97–1 230)

2011 < 1 0.051 (<0.01–0.220) 98 (0.78–414) 0.51 (0.022–1.7) 973 (43–3 290) 0.28 (0.054–0.690) 536 (103–1 320)

2012 < 1 0.058 (<0.01–0.240) 111 (1.4–448) 0.57 (0.028–1.9) 1 080 (54–3 560) 0.3 (0.058–0.740) 572 (110–1 400)

Rates are per 100 000 population.

270 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Micronesia 1990 < 1 0.035 (0–0.220) 36 (0–227) 0.45 (<0.01–1.9) 464 (2.8–2 010) 0.36 (0.100–0.800) 379 (104–827)

(Federated 1995 < 1 0.077 (0.019–0.180) 72 (18–163) 0.68 (0.220–1.4) 629 (203–1 290) 0.35 (0.200–0.540) 325 (185–505)

States of) 2000 < 1 0.07 (0.024–0.140) 65 (22–130) 0.6 (0.250–1.1) 560 (237–1 020) 0.3 (0.210–0.400) 279 (200–371)

2005 < 1 0.053 (0.016–0.110) 50 (15–104) 0.47 (0.180–0.900) 446 (172–848) 0.25 (0.170–0.360) 240 (158–338)

2010 < 1 0.032 (<0.01–0.100) 31 (1.8–100) 0.33 (0.045–0.870) 314 (44–844) 0.21 (0.092–0.380) 206 (89–371)

2011 < 1 0.028 (<0.01–0.098) 27 (1.1–95) 0.32 (0.046–0.870) 313 (44–837) 0.21 (0.089–0.370) 200 (86–360)

2012 < 1 0.025 (<0.01–0.093) 24 (0.62–90) 0.28 (0.028–0.810) 270 (27–782) 0.2 (0.086–0.360) 194 (83–349)

Mongolia 1990 2 0.52 (0.400–0.650) 24 (18–30) 20 (9.3–36) 938 (425–1 650) 8.8 (7.5–10) 405 (345–470)

1995 2 0.42 (0.300–0.560) 18 (13–24) 14 (7.1–24) 625 (308–1 050) 7.2 (6.3–8.2) 314 (274–356)

2000 2 0.32 (0.190–0.470) 13 (8.1–20) 10 (5.3–17) 431 (221–710) 6.1 (5.5–6.7) 254 (228–281)

2005 3 0.24 (0.120–0.400) 9.4 (4.6–16) 8.5 (4.1–14) 335 (162–569) 5.7 (5.2–6.1) 225 (207–243)

2010 3 0.2 (0.079–0.390) 7.5 (2.9–14) 9.6 (4.9–16) 353 (181–580) 6.1 (5.7–6.5) 224 (209–240)

2011 3 0.2 (0.077–0.390) 7.4 (2.8–14) 10 (5.3–16) 364 (191–591) 6.1 (5.7–6.6) 223 (208–239)

2012 3 0.2 (0.075–0.390) 7.2 (2.7–14) 11 (5.7–17) 380 (204–608) 6.2 (5.8–6.7) 223 (208–239)

Nauru 1990 < 1 <0.01 (<0.01–<0.01) 9.1 (5.0–14) 0.01 (<0.01–0.019) 111 (43–213) <0.01 (<0.01–<0.01) 88 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 4.7 (2.5–7.5) <0.01 (<0.01–<0.01) 54 (22–99) <0.01 (<0.01–<0.01) 40 (35–46)

2000 < 1 <0.01 (<0.01–<0.01) 7.2 (3.5–12) <0.01 (<0.01–0.012) 72 (35–122) <0.01 (<0.01–<0.01) 46 (40–52)

2005 < 1 <0.01 (<0.01–<0.01) 23 (10–41) 0.022 (0.011–0.036) 216 (109–359) 0.013 (0.011–0.014) 125 (110–142)

2010 < 1 <0.01 (<0.01–<0.01) 3.7 (2.3–5.4) <0.01 (<0.01–0.012) 55 (17–116) <0.01 (<0.01–<0.01) 34 (30–39)

2011 < 1 <0.01 (<0.01–<0.01) 8.1 (4.1–14) <0.01 (<0.01–0.015) 86 (41–147) <0.01 (<0.01–<0.01) 57 (50–65)

2012 < 1 <0.01 (<0.01–<0.01) 9.5 (4.4–17) <0.01 (<0.01–0.015) 91 (46–151) <0.01 (<0.01–<0.01) 54 (47–61)

New Caledonia 1990 < 1 <0.01 (<0.01–0.024) 4.7 (0.40–14) 0.21 (0.079–0.400) 123 (47–236) 0.16 (0.140–0.190) 98 (85–110)

1995 < 1 <0.01 (<0.01–<0.01) 2.1 (0.56–4.6) 0.11 (0.033–0.240) 59 (18–125) 0.1 (0.088–0.110) 53 (46–60)

2000 < 1 <0.01 (<0.01–0.034) 3.3 (0–16) 0.17 (0.080–0.280) 79 (38–134) 0.11 (0.095–0.120) 51 (45–58)

2005 < 1 <0.01 (<0.01–<0.01) 1.1 (0.13–3.1) 0.067 (0.024–0.130) 29 (11–57) 0.054 (0.047–0.061) 24 (21–27)

2010 < 1 <0.01 (<0.01–0.011) 1.2 (<0.1–4.5) 0.076 (0.032–0.140) 31 (13–56) 0.056 (0.049–0.064) 23 (20–26)

2011 < 1 <0.01 (<0.01–0.014) 1.3 (<0.1–5.5) 0.084 (0.037–0.150) 33 (15–60) 0.06 (0.052–0.068) 24 (21–27)

2012 < 1 <0.01 (<0.01–<0.01) 0.74 (0.23–1.6) 0.053 (0.016–0.110) 21 (6.2–44) 0.044 (0.038–0.049) 17 (15–20)

New Zealand 1990 3 0.019 (0.018–0.019) 0.55 (0.54–0.55) 0.58 (0.270–1.0) 17 (7.9–30) 0.4 (0.350–0.450) 12 (10–13)

1995 4 0.021 (0.021–0.021) 0.58 (0.57–0.58) 0.67 (0.320–1.2) 18 (8.7–31) 0.45 (0.390–0.510) 12 (11–14)

2000 4 0.012 (0.012–0.012) 0.32 (0.31–0.32) 0.49 (0.170–0.980) 13 (4.5–25) 0.4 (0.350–0.450) 10 (9.0–12)

2005 4 <0.01 (<0.01–<0.01) 0.15 (0.15–0.15) 0.51 (0.200–0.950) 12 (4.9–23) 0.38 (0.330–0.430) 9.2 (8.1–10)

2010 4 <0.01 (<0.01–<0.01) 0.12 (0.12–0.12) 0.48 (0.210–0.870) 11 (4.8–20) 0.35 (0.300–0.390) 7.9 (6.9–9.0)

2011 4 <0.01 (<0.01–<0.01) 0.1 (0.10–0.10) 0.5 (0.220–0.880) 11 (5.1–20) 0.35 (0.310–0.400) 7.9 (7.0–9.0)

2012 4 <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 0.47 (0.200–0.840) 10 (4.5–19) 0.34 (0.300–0.380) 7.6 (6.6–8.6)

Niue 1990 < 1 <0.01 (<0.01–<0.01) 2.9 (2.8–3.0) <0.01 (<0.01–<0.01) 43 (13–91) 0 (0–0) 0 (0–0)

1995 < 1 <0.01 (<0.01–<0.01) 3 (3.0–3.1) <0.01 (<0.01–<0.01) 45 (13–96) 0 (0–0) 0 (0–0)

2000 < 1 <0.01 (<0.01–<0.01) 3.1 (3.1–3.2) <0.01 (<0.01–<0.01) 47 (14–99) 0 (0–0) 0 (0–0)

2005 < 1 <0.01 (<0.01–<0.01) 1.7 (1.7–1.8) <0.01 (<0.01–<0.01) 26 (7.6–54) 0 (0–0) 0 (0–0)

2010 < 1 <0.01 (<0.01–<0.01) 1.4 (1.3–1.4) <0.01 (<0.01–<0.01) 20 (6.1–43) 0 (0–0) 0 (0–0)

2011 < 1 <0.01 (<0.01–<0.01) 19 (4.7–42) <0.01 (<0.01–<0.01) 170 (59–341) <0.01 (<0.01–<0.01) 81 (71–91)

2012 < 1 <0.01 (<0.01–<0.01) 3.1 (1.7–4.9) <0.01 (<0.01–<0.01) 46 (14–97) <0.01 (<0.01–<0.01) 37 (32–42)

Northern Mariana 1990 < 1 <0.01 (<0.01–<0.01) 3.1 (0.91–6.5) 0.038 (0.011–0.081) 86 (26–183) 0.032 (0.028–0.036) 73 (64–83)

Islands 1995 < 1 <0.01 (<0.01–<0.01) 4.4 (1.5–8.8) 0.071 (0.021–0.150) 123 (36–261) 0.055 (0.048–0.062) 96 (84–109)

2000 < 1 <0.01 (<0.01–0.018) 6.9 (0.13–26) 0.12 (0.050–0.210) 172 (74–312) 0.086 (0.076–0.098) 126 (110–143)

2005 < 1 <0.01 (<0.01–0.019) 6.3 (<0.1–30) 0.1 (0.052–0.180) 163 (81–273) 0.066 (0.057–0.074) 102 (89–115)

2010 < 1 <0.01 (<0.01–<0.01) 3.2 (0.37–8.9) 0.049 (0.019–0.093) 91 (35–172) 0.037 (0.032–0.042) 68 (60–77)

2011 < 1 <0.01 (<0.01–<0.01) 3.6 (0.15–13) 0.054 (0.023–0.097) 101 (43–182) 0.038 (0.033–0.043) 71 (62–81)

2012 < 1 <0.01 (<0.01–<0.01) 3.5 (0.17–12) 0.052 (0.022–0.094) 97 (42–175) 0.037 (0.032–0.042) 69 (60–78)

Palau 1990 < 1 <0.01 (<0.01–<0.01) 3.4 (1.0–7.1) <0.01 (<0.01–0.017) 50 (12–112) <0.01 (<0.01–<0.01) 45 (36–54)

1995 < 1 <0.01 (<0.01–<0.01) 17 (7.3–31) 0.034 (0.013–0.065) 197 (76–376) 0.025 (0.021–0.031) 147 (119–178)

2000 < 1 <0.01 (<0.01–<0.01) 26 (11–48) 0.049 (0.023–0.085) 256 (119–444) 0.03 (0.024–0.036) 156 (127–189)

2005 < 1 <0.01 (<0.01–<0.01) 10 (3.8–20) 0.022 (<0.01–0.039) 110 (48–198) 0.013 (0.011–0.016) 67 (54–81)

2010 < 1 <0.01 (<0.01–<0.01) 23 (9.0–43) 0.045 (0.022–0.076) 221 (108–372) 0.024 (0.019–0.029) 116 (94–140)

2011 < 1 <0.01 (<0.01–<0.01) 8.8 (3.8–16) 0.021 (<0.01–0.039) 100 (40–187) 0.015 (0.012–0.018) 73 (59–88)

2012 < 1 <0.01 (<0.01–<0.01) 4.4 (2.9–6.2) 0.014 (<0.01–0.029) 65 (19–138) <0.01 (<0.01–<0.01) 24 (20–29)

Papua New 1990 4 3.4 (1.2–6.9) 82 (28–165) 30 (12–55) 715 (289–1 330) 13 (8.5–18) 308 (203–435)

Guinea 1995 5 3 (1.0–5.9) 63 (22–125) 29 (12–54) 620 (250–1 160) 15 (10–21) 322 (212–453)

2000 5 2.8 (0.910–5.8) 52 (17–107) 32 (12–61) 586 (219–1 130) 19 (12–26) 349 (230–492)

2005 6 3.4 (1.1–6.9) 55 (18–112) 37 (14–71) 607 (230–1 160) 22 (14–31) 358 (236–505)

2010 7 3.7 (1.2–7.5) 54 (18–110) 39 (14–76) 568 (208–1 100) 24 (16–34) 348 (229–491)

2011 7 3.7 (1.2–7.6) 53 (17–109) 38 (14–76) 549 (194–1 080) 24 (16–34) 346 (228–488)

2012 7 3.9 (1.3–7.8) 54 (18–109) 39 (13–77) 541 (187–1 080) 25 (16–35) 348 (230–490)

Philippines 1990 62 34 (26–44) 55 (42–70) 620 (480–790) 1 000 (768–1 270) 240 (150–360) 393 (243–580)

1995 70 35 (30–40) 50 (43–58) 630 (480–800) 904 (692–1 140) 250 (200–300) 360 (294–432)

2000 78 31 (29–34) 40 (38–43) 600 (480–740) 775 (616–953) 260 (210–310) 329 (269–395)

2005 86 30 (28–32) 35 (32–37) 540 (470–630) 633 (544–729) 260 (210–310) 301 (246–361)

2010 93 25 (24–27) 27 (25–29) 470 (410–530) 502 (441–566) 260 (210–310) 275 (227–328)

2011 95 24 (23–26) 26 (24–28) 460 (400–520) 484 (425–546) 260 (210–310) 270 (223–322)

2012 97 23 (22–25) 24 (22–26) 450 (390–500) 461 (405–520) 260 (210–310) 265 (219–316)

Republic of Korea 1990 43 3.7 (0.170–13) 8.7 (0.40–29) 96 (78–110) 223 (182–267) 73 (64–83) 171 (150–194)

1995 45 2.7 (0.044–10) 5.9 (0.10–23) 90 (74–110) 202 (166–243) 48 (42–55) 108 (95–123)

2000 46 1.2 (0.460–2.4) 2.7 (1.0–5.2) 85 (69–100) 184 (150–221) 25 (22–28) 54 (48–62)

2005 47 2.7 (0.040–11) 5.8 (<0.1–23) 79 (64–94) 167 (136–201) 49 (43–56) 105 (92–119)

2010 48 2.5 (0.190–7.5) 5.1 (0.40–16) 73 (60–88) 152 (124–182) 51 (44–57) 105 (92–118)

2011 49 2.7 (0.120–9.1) 5.6 (0.25–19) 72 (59–87) 149 (121–179) 53 (47–60) 109 (96–124)

2012 49 2.6 (0.160–8.5) 5.4 (0.32–17) 71 (58–86) 146 (119–175) 53 (46–60) 108 (95–122)

Samoa 1990 < 1 <0.01 (<0.01–0.015) 5 (2.1–9.0) 0.086 (0.037–0.160) 53 (23–96) 0.059 (0.047–0.071) 36 (29–44)

1995 < 1 <0.01 (<0.01–0.013) 4.2 (1.6–7.9) 0.075 (0.030–0.140) 44 (18–81) 0.051 (0.039–0.063) 30 (23–37)

2000 < 1 <0.01 (<0.01–0.011) 3.1 (1.1–6.3) 0.059 (0.022–0.110) 34 (12–65) 0.041 (0.030–0.053) 23 (17–30)

2005 < 1 <0.01 (<0.01–<0.01) 2.3 (0.98–4.1) 0.045 (0.018–0.083) 25 (10–46) 0.032 (0.026–0.039) 18 (14–22)

2010 < 1 <0.01 (<0.01–0.010) 3 (1.2–5.6) 0.053 (0.025–0.092) 29 (13–50) 0.031 (0.025–0.038) 17 (13–21)

2011 < 1 <0.01 (<0.01–0.011) 3.1 (1.3–5.8) 0.055 (0.026–0.095) 29 (14–51) 0.032 (0.026–0.039) 17 (14–21)

2012 < 1 <0.01 (<0.01–0.011) 3.2 (1.3–6.0) 0.057 (0.027–0.099) 30 (14–52) 0.033 (0.027–0.040) 18 (14–21)

Singapore 1990 3 0.12 (0.120–0.120) 4 (3.8–4.1) 2.5 (1.0–4.6) 82 (33–152) 1.8 (1.6–2.1) 61 (53–69)

1995 3 0.13 (0.120–0.130) 3.6 (3.4–3.8) 2.9 (1.2–5.4) 84 (35–154) 2.2 (1.9–2.5) 62 (55–71)

2000 4 0.12 (0.110–0.140) 3.2 (2.8–3.6) 2.7 (1.1–4.9) 68 (29–125) 2 (1.7–2.2) 51 (44–57)

2005 4 0.082 (0.071–0.094) 1.8 (1.6–2.1) 2.1 (0.890–3.9) 47 (20–86) 1.6 (1.4–1.8) 35 (31–40)

2010 5 0.097 (0.082–0.110) 1.9 (1.6–2.2) 2.3 (0.850–4.4) 45 (17–86) 1.8 (1.6–2.0) 35 (31–40)

2011 5 0.087 (0.073–0.100) 1.7 (1.4–1.9) 2.3 (0.770–4.6) 44 (15–88) 1.9 (1.7–2.1) 36 (32–41)

2012 5 0.089 (0.075–0.110) 1.7 (1.4–2.0) 3.9 (1.9–6.6) 73 (35–125) 2.6 (2.3–3.0) 50 (44–56)

Solomon Islands 1990 < 1 0.22 (0.063–0.480) 71 (20–154) 1.9 (0.690–3.8) 619 (222–1 210) 0.97 (0.600–1.4) 312 (193–460)

1995 < 1 0.2 (0.077–0.370) 54 (21–103) 1.7 (0.810–2.9) 473 (225–810) 0.86 (0.710–1.0) 240 (196–288)

2000 < 1 0.17 (0.068–0.330) 42 (16–79) 1.5 (0.710–2.6) 364 (173–624) 0.76 (0.620–0.910) 185 (151–222)

2005 < 1 0.13 (0.053–0.240) 27 (11–50) 1.2 (0.560–2.0) 251 (120–429) 0.67 (0.540–0.800) 142 (116–171)

2010 < 1 0.09 (0.039–0.160) 17 (7.5–30) 0.9 (0.420–1.6) 171 (79–297) 0.57 (0.470–0.680) 108 (89–129)

2011 < 1 0.085 (0.038–0.150) 16 (7.0–28) 0.86 (0.400–1.5) 160 (74–279) 0.55 (0.460–0.660) 103 (85–123)

2012 < 1 0.082 (0.036–0.150) 15 (6.6–27) 0.83 (0.380–1.5) 151 (70–264) 0.54 (0.440–0.640) 97 (80–116)

Tokelau 1990 < 1 <0.01 (<0.01–<0.01) 6.4 (2.0–13) <0.01 (<0.01–<0.01) 85 (24–185) <0.01 (<0.01–<0.01) 72 (57–90)

1995 < 1 <0.01 (0–<0.01) 4.9 (<0.1–22) <0.01 (<0.01–<0.01) 54 (2.4–185) <0.01 (<0.01–<0.01) 39 (13–80)

2000 < 1 <0.01 (<0.01–<0.01) 4.1 (0.57–11) <0.01 (<0.01–<0.01) 32 (5.3–82) <0.01 (<0.01–<0.01) 13 (3.5–28)

2005 < 1 0 (0–0) <0.1 (0–0.10) 0 (0–<0.01) 0.26 (<0.1–0.54) 0 (0–0) 0 (0–0)

2010 < 1 0 (0–0) 0 (0–<0.1) 0 (0–0) 0 (0–0)

2011 < 1 0 (0–0) 0 (0–<0.1) 0 (0–0) 0 (0–0)

2012 < 1 0 (0–0) 0 (0–<0.1) 0 (0–0) 0 (0–0)

Tonga 1990 < 1 <0.01 (<0.01–0.010) 5.9 (2.7–10) 0.056 (0.027–0.097) 59 (28–102) 0.036 (0.030–0.042) 38 (32–45)

1995 < 1 <0.01 (<0.01–<0.01) 4.2 (2.0–7.3) 0.045 (0.019–0.081) 46 (20–84) 0.032 (0.027–0.037) 33 (28–39)

2000 < 1 <0.01 (<0.01–<0.01) 3.6 (1.4–6.8) 0.038 (0.015–0.073) 39 (15–74) 0.027 (0.021–0.034) 28 (22–35)

2005 < 1 <0.01 (<0.01–<0.01) 3 (1.3–5.5) 0.033 (0.013–0.060) 32 (13–60) 0.023 (0.018–0.028) 22 (18–27)

2010 < 1 <0.01 (<0.01–<0.01) 2.6 (1.0–5.0) 0.029 (0.013–0.052) 28 (13–50) 0.017 (0.015–0.020) 17 (14–20)

2011 < 1 <0.01 (<0.01–<0.01) 2.6 (1.0–4.9) 0.028 (0.013–0.049) 27 (12–47) 0.016 (0.014–0.019) 16 (13–18)

2012 < 1 <0.01 (<0.01–<0.01) 2.5 (1.1–4.6) 0.027 (0.014–0.045) 26 (13–43) 0.015 (0.013–0.018) 14 (12–17)

Rates are per 100 000 population.

271 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($(VWLPDWHVRIWKHEXUGHQRIGLVHDVHFDXVHGE\7%±

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEa

MORTALITY (EXCLUDING HIV) PREVALENCE (INCLUDING HIV) INCIDENCE (INCLUDING HIV)

Tuvalu 1990 < 1 <0.01 (<0.01–0.019) 98 (27–212) 0.083 (0.029–0.160) 921 (327–1 820) 0.048 (0.031–0.069) 536 (347–766)

1995 < 1 <0.01 (<0.01–0.021) 73 (5.1–227) 0.066 (<0.01–0.170) 711 (101–1 900) 0.04 (0.017–0.074) 437 (181–805)

2000 < 1 <0.01 (<0.01–0.014) 68 (19–146) 0.059 (0.021–0.120) 626 (226–1 230) 0.034 (0.022–0.048) 357 (231–510)

2005 < 1 <0.01 (<0.01–0.010) 50 (15–105) 0.047 (0.017–0.089) 480 (180–923) 0.028 (0.019–0.039) 291 (198–402)

2010 < 1 <0.01 (<0.01–<0.01) 18 (7.3–33) 0.022 (<0.01–0.044) 222 (75–448) 0.018 (0.014–0.021) 178 (145–215)

2011 < 1 <0.01 (<0.01–<0.01) 12 (3.8–24) 0.017 (<0.01–0.036) 176 (53–371) 0.015 (0.012–0.018) 152 (124–184)

2012 < 1 <0.01 (<0.01–<0.01) 37 (16–68) 0.037 (0.017–0.065) 377 (172–658) 0.024 (0.019–0.029) 241 (196–290)

Vanuatu 1990 < 1 0.016 (<0.01–0.032) 11 (3.9–22) 0.22 (0.062–0.470) 148 (43–319) 0.19 (0.150–0.230) 127 (103–154)

1995 < 1 0.011 (<0.01–0.019) 6.5 (2.9–11) 0.16 (0.049–0.340) 97 (29–204) 0.11 (0.085–0.130) 63 (51–76)

2000 < 1 0.03 (0.013–0.054) 16 (6.9–29) 0.31 (0.140–0.550) 166 (74–295) 0.2 (0.160–0.250) 110 (89–132)

2005 < 1 0.029 (0.012–0.052) 14 (5.9–25) 0.28 (0.130–0.490) 134 (63–232) 0.17 (0.140–0.210) 83 (68–99)

2010 < 1 0.024 (0.011–0.043) 10 (4.5–18) 0.25 (0.110–0.440) 105 (47–185) 0.16 (0.130–0.200) 69 (57–83)

2011 < 1 0.022 (<0.01–0.039) 9.1 (4.1–16) 0.24 (0.100–0.420) 97 (42–175) 0.16 (0.130–0.190) 67 (55–80)

2012 < 1 0.02 (<0.01–0.035) 7.9 (3.6–14) 0.22 (0.090–0.410) 89 (36–165) 0.16 (0.130–0.190) 65 (53–77)

Viet Nam 1990 69 36 (21–55) 52 (30–79) 360 (150–670) 525 (212–976) 170 (120–240) 251 (172–344)

1995 76 32 (20–47) 42 (26–61) 340 (150–610) 451 (198–805) 170 (120–220) 220 (155–295)

2000 81 27 (18–38) 33 (22–47) 290 (130–510) 353 (156–629) 160 (120–210) 197 (142–260)

2005 85 23 (16–31) 27 (19–37) 240 (110–440) 288 (125–517) 150 (110–190) 176 (131–229)

2010 89 19 (13–26) 22 (15–29) 210 (87–390) 238 (97–440) 140 (100–180) 155 (115–201)

2011 90 19 (13–25) 21 (14–28) 200 (82–380) 227 (91–424) 140 (100–180) 151 (112–197)

2012 91 18 (12–25) 20 (13–27) 200 (78–370) 218 (86–410) 130 (99–170) 147 (109–192)

Wallis and Futuna 1990 < 1 <0.01 (<0.01–<0.01) 17 (9.2–27) 0.028 (0.011–0.052) 201 (80–378) 0.022 (0.019–0.024) 156 (137–176)

Islands 1995 < 1 <0.01 (<0.01–<0.01) 4.2 (2.3–6.6) <0.01 (<0.01–0.019) 62 (19–132) <0.01 (<0.01–<0.01) 49 (43–55)

2000 < 1 <0.01 (<0.01–<0.01) 4.2 (3.6–4.9) <0.01 (<0.01–0.019) 63 (19–132) <0.01 (<0.01–<0.01) 15 (13–17)

2005 < 1 <0.01 (<0.01–<0.01) 4.7 (2.6–7.5) 0.01 (<0.01–0.021) 70 (21–148) <0.01 (<0.01–<0.01) 57 (50–64)

2010 < 1 <0.01 (<0.01–<0.01) 2.8 (1.4–4.6) <0.01 (<0.01–0.012) 42 (13–88) <0.01 (<0.01–<0.01) 36 (31–41)

2011 < 1 <0.01 (<0.01–<0.01) 2.6 (1.5–4.1) <0.01 (<0.01–0.011) 41 (13–85) <0.01 (<0.01–<0.01) 17 (15–19)

2012 < 1 <0.01 (<0.01–<0.01) 13 (5.6–23) 0.016 (<0.01–0.026) 117 (59–193) <0.01 (<0.01–<0.01) 65 (57–74)

a Rates are per 100 000 population.

272 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

American Samoa 1990 < 1 0.012 (<0.01–0.015) 26 (21–31) 9 19 75 (62–93)

1995 < 1 <0.01 (<0.01–<0.01) 12 (9.4–14)

2000 < 1 <0.01 (<0.01–<0.01) 6.9 (5.6–8.4) 3 5.2 75 (62–93)

2005 < 1 <0.01 (<0.01–<0.01) 13 (10–15) 6 10 80 (66–99)

2010 < 1 <0.01 (<0.01–<0.01) 7.8 (6.3–9.4) 4 7.2 92 (76–110)

2011 < 1 <0.01 (<0.01–<0.01) 7.8 (6.3–9.4) 3 5.4 70 (58–86)

2012 < 1 <0.01 (<0.01–<0.01) 7.3 (5.9–8.9)

Australia 1990 17 1.2 (1.0–1.3) 6.8 (6.0–7.7) 0.028 (0.024–0.031) 0.2 (0.14–0.18) 1 016 5.9 87 (77–99)

1995 18 1.2 (1.1–1.4) 6.8 (6.0–7.7) 0.047 (0.041–0.053) 0.3 (0.23–0.29) 1 073 5.9 87 (77–99)

2000 19 1.2 (1.1–1.4) 6.2 (5.5–7.0) 0.029 (0.026–0.033) 0.2 (0.13–0.17) 1 043 5.4 87 (77–99)

2005 21 1.2 (1.1–1.4) 5.9 (5.1–6.6) 0.028 (0.025–0.032) 0.1 (0.12–0.16) 1 046 5.1 87 (77–99)

2010 22 1.4 (1.3–1.6) 6.5 (5.7–7.3) 0.036 (0.031–0.041) 0.2 (0.14–0.18) 1 257 5.6 87 (77–99)

2011 23 1.4 (1.2–1.6) 6.3 (5.5–7.1) 0.036 (0.031–0.040) 0.2 (0.14–0.18) 1 239 5.4 87 (77–99)

2012 23 1.5 (1.3–1.7) 6.5 (5.7–7.4) 0.038 (0.033–0.043) 0.2 (0.14–0.19) 1 305 5.7 87 (77–99)

Brunei 1990 < 1 0.16 (0.140–0.190) 64 (56–72) 143 56 87 (77–99)

Darussalam 1995 < 1 0.18 (0.160–0.210) 63 (55–71)

2000 < 1 0.35 (0.310–0.400) 106 (93–120) 307 93 87 (77–99)

2005 < 1 0.19 (0.160–0.210) 51 (45–58) <0.01 (<0.01–<0.01) 0.6 (<0.1–2.0) 163 44 87 (77–99)

2010 < 1 0.27 (0.240–0.310) 68 (60–77) <0.01 (0–<0.01) 0.3 (0–1.4) 237 59 87 (77–99)

2011 < 1 0.26 (0.230–0.300) 65 (57–74) <0.01 (<0.01–<0.01) 0.9 (0.12–2.3) 230 57 87 (77–99)

2012 < 1 0.28 (0.240–0.320) 68 (59–77) <0.01 (0–<0.01) 0.4 (0–2.1) 243 59 87 (77–99)

Cambodia 1990 9 53 (38–69) 580 (423–761) 0.99 (0.72–1.3) 11 (8.0–14) 6 501 72 12 (9.4–17)

1995 11 62 (48–78) 578 (448–724) 5.1 (4.0–6.4) 48 (37–60) 14 603 136 23 (19–30)

2000 12 71 (56–87) 577 (458–710) 7.9 (6.3–9.7) 65 (51–80) 18 891 155 27 (22–34)

2005 13 68 (57–81) 510 (424–604) 5.8 (4.8–6.8) 43 (36–51) 35 535 266 52 (44–63)

2010 14 63 (54–72) 437 (376–503) 3.1 (2.7–3.6) 22 (19–25) 40 460 282 64 (56–75)

2011 15 62 (53–71) 424 (364–489) 3.1 (2.6–3.5) 21 (18–24) 38 555 264 62 (54–73)

2012 15 61 (52–70) 411 (353–474) 2.7 (2.3–3.1) 18 (15–21) 40 185 270 66 (57–77)

China 1990 1 165 1 800 (1 400–2 200) 153 (121–189) 0.18 (0.14–0.22) <0.1 (<0.1–<0.1) 375 481 32 21 (17–27)

1995 1 238 1 600 (1 300–1 900) 129 (106–154) 1.4 (1.2–1.7) 0.1 (0.10–0.14) 515 764 42 32 (27–39)

2000 1 280 1 400 (1 200–1 600) 109 (92–126) 4.2 (3.6–4.9) 0.3 (0.28–0.38) 454 372 35 33 (28–38)

2005 1 318 1 200 (1 100–1 400) 92 (80–105) 6.3 (5.5–7.2) 0.5 (0.42–0.54) 899 729 68 74 (65–85)

2010 1 360 1 100 (930–1 200) 78 (68–88) 7.6 (6.7–8.6) 0.6 (0.49–0.63) 908 399 67 86 (76–98)

2011 1 368 1 000 (900–1 200) 75 (66–85) 7.6 (6.7–8.6) 0.6 (0.49–0.63) 899 669 66 88 (78–100)

2012 1 377 1 000 (880–1 100) 73 (64–82) 7.3 (6.4–8.2) 0.5 (0.47–0.60) 890 645 65 89 (79–100)

China, Hong Kong 1990 6 7.5 (6.6–8.5) 129 (113–146) 6 510 112 87 (77–99)

SAR 1995 6 7.1 (6.3–8.1) 116 (102–132) 6 212 101 87 (77–99)

2000 7 6.9 (6.1–7.8) 101 (89–115) 6 015 88 87 (77–99)

2005 7 6.5 (5.7–7.4) 94 (83–107) 0.054 (0.036–0.075) 0.8 (0.53–1.1) 5 660 82 87 (77–99)

2010 7 5.7 (5.0–6.4) 81 (71–91) 0.036 (0.022–0.053) 0.5 (0.31–0.75) 4 935 70 87 (77–99)

2011 7 5.4 (4.8–6.2) 77 (67–87) 0.049 (0.033–0.069) 0.7 (0.46–0.97) 4 739 67 87 (77–99)

2012 7 5.5 (4.8–6.3) 77 (68–88) 0.044 (0.026–0.067) 0.6 (0.37–0.94) 4 809 67 87 (77–99)

China, Macao 1990 < 1 0.39 (0.350–0.450) 110 (96–124) 343 95 87 (77–99)

SAR 1995 < 1 0.46 (0.410–0.520) 116 (102–131) 402 101 87 (77–99)

2000 < 1 0.52 (0.450–0.580) 120 (105–135) 449 104 87 (77–99)

2005 < 1 0.46 (0.400–0.520) 98 (86–111) <0.01 (0–<0.01) 0.3 (0–1.3) 398 85 87 (77–99)

2010 < 1 0.45 (0.400–0.510) 85 (74–96) <0.01 (<0.01–<0.01) 0.6 (<0.1–1.7) 394 74 87 (77–99)

2011 < 1 0.44 (0.380–0.490) 80 (70–91) <0.01 (<0.01–<0.01) 0.5 (<0.1–1.5) 380 70 87 (77–99)

2012 < 1 0.46 (0.410–0.530) 83 (73–94) <0.01 (<0.01–<0.01) 0.4 (<0.1–1.5) 404 73 87 (77–99)

Cook Islands 1990 < 1 0 (0–0) 0 (0–0) 0 0

1995 < 1 <0.01 (<0.01–<0.01) 13 (11–14) 2 11 87 (77–99)

2000 < 1 <0.01 (<0.01–<0.01) 6.5 (5.7–7.3) 1 5.6 87 (77–99)

2005 < 1 <0.01 (<0.01–<0.01) 5.9 (5.2–6.7) 1 5.2 87 (77–99)

2010 < 1 0 (0–0) 0 (0–0) 0 0

2011 < 1 <0.01 (<0.01–<0.01) 5.6 (4.9–6.4) 1 4.9 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 5.6 (4.9–6.3) 1 4.9 87 (77–99)

Fiji 1990 < 1 0.81 (0.710–0.920) 112 (98–126) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 226 31 28 (25–32)

1995 < 1 0.6 (0.530–0.680) 77 (68–87) <0.01 (<0.01–<0.01) <0.1 (<0.1–0.10) 203 26 34 (30–39)

2000 < 1 0.44 (0.390–0.500) 54 (48–62) <0.01 (<0.01–<0.01) 0.2 (0.14–0.18) 144 18 33 (29–37)

2005 < 1 0.33 (0.290–0.370) 40 (35–45) <0.01 (<0.01–<0.01) 0.2 (0.21–0.27) 132 16 41 (36–46)

2010 < 1 0.24 (0.210–0.270) 28 (24–32) <0.01 (<0.01–<0.01) 0.2 (0.13–0.17) 189 22 79 (70–90)

2011 < 1 0.23 (0.200–0.260) 26 (23–29) <0.01 (<0.01–<0.01) 0.2 (0.13–0.17) 215 25 95 (84–110)

2012 < 1 0.21 (0.190–0.240) 24 (21–27) <0.01 (<0.01–<0.01) 0.2 (0.13–0.17) 210 24 99 (87–110)

French Polynesia 1990 < 1 0.068 (0.059–0.077) 34 (30–39) 59 30 87 (77–99)

1995 < 1 0.1 (0.088–0.110) 47 (41–53)

2000 < 1 0.071 (0.062–0.081) 30 (26–34) 62 26 87 (77–99)

2005 < 1 0.072 (0.063–0.082) 28 (25–32) 63 25 87 (77–99)

2010 < 1 0.047 (0.041–0.053) 18 (15–20) 41 15 87 (77–99)

2011 < 1 0.074 (0.064–0.083) 27 (24–31) 64 24 87 (77–99)

2012 < 1 0.058 (0.050–0.065) 21 (18–24) 50 18 87 (77–99)

Guam 1990 < 1 0.066 (0.058–0.075) 50 (44–57)

1995 < 1 0.099 (0.087–0.110) 68 (60–77)

2000 < 1 0.062 (0.054–0.070) 40 (35–45) 54 35 87 (77–99)

2005 < 1 0.072 (0.063–0.082) 46 (40–52) 63 40 87 (77–99)

2010 < 1 0.12 (0.100–0.130) 73 (64–82) <0.01 (0–<0.01) 1.2 (0–5.5) 101 63 87 (77–99)

2011 < 1 0.094 (0.083–0.110) 59 (51–66) 82 51 87 (77–99)

2012 < 1 0.078 (0.069–0.089) 48 (42–54) <0.01 (0–<0.01) 0.3 (0–2.9) 68 42 87 (77–99)

Japan 1990 122 60 (52–67) 49 (43–55) 0.24 (0.21–0.28) 0.2 (0.18–0.23) 51 821 42 87 (77–99)

1995 124 50 (43–56) 40 (35–45) 0.22 (0.20–0.25) 0.2 (0.16–0.20) 43 078 35 87 (77–99)

2000 126 45 (40–51) 36 (32–41) 0.15 (0.13–0.17) 0.1 (0.11–0.14) 39 384 31 87 (77–99)

2005 127 31 (27–35) 25 (22–28) 0.13 (0.11–0.15) 0.1 (<0.1–0.11) 27 194 21 87 (77–99)

2010 127 26 (23–30) 20 (18–23) 0.1 (0.091–0.12) <0.1 (<0.1–<0.1) 22 693 18 87 (77–99)

2011 127 25 (22–29) 20 (18–23) 0.1 (0.089–0.12) <0.1 (<0.1–<0.1) 22 119 17 87 (77–99)

2012 127 24 (21–28) 19 (17–22) 0.098 (0.085–0.11) <0.1 (<0.1–<0.1) 20 857 16 86 (76–98)

Kiribati 1990 < 1 0.083 (0.066–0.100) 116 (93–143) 68 96 82 (67–100)

1995 < 1 0.39 (0.310–0.460) 505 (410–609)

2000 < 1 0.31 (0.250–0.380) 372 (296–456) 252 304 82 (67–100)

2005 < 1 0.44 (0.360–0.530) 488 (396–588) 332 367 75 (62–93)

2010 < 1 0.36 (0.290–0.430) 366 (298–441) <0.01 (<0.01–<0.01) 2.5 (1.7–3.4) 286 293 80 (66–98)

2011 < 1 0.43 (0.350–0.520) 432 (351–521) 343 346 80 (66–98)

2012 < 1 0.43 (0.350–0.520) 429 (349–517) 346 343 80 (66–98)

Lao People's 1990 4 21 (13–31) 492 (304–725) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.15) 1 826 43 8.7 (5.9–14)

Democratic 1995 5 20 (12–29) 403 (249–593) 0.026 (0.015–0.039) 0.5 (0.30–0.81) 830 17 4.2 (2.9–6.8)

Republic 2000 5 18 (11–26) 330 (204–486) 0.092 (0.051–0.15) 1.7 (0.95–2.7) 2 227 41 13 (8.5–20)

2005 6 16 (9.7–23) 270 (167–398) 0.17 (0.093–0.28) 3 (1.6–4.8) 3 766 65 24 (16–39)

2010 6 14 (8.8–21) 221 (137–326) 0.23 (0.12–0.37) 3.6 (1.9–5.8) 4 061 63 29 (19–46)

2011 7 14 (8.6–20) 213 (131–313) 0.24 (0.13–0.39) 3.7 (2.0–6.0) 4 360 67 31 (21–51)

2012 7 14 (8.4–20) 204 (126–301) 0.25 (0.13–0.41) 3.8 (2.0–6.2) 4 118 62 30 (21–49)

Malaysia 1990 18 23 (21–26) 127 (113–142) 0.18 (0.16–0.20) 1 (0.88–1.1) 11 702 64 51 (45–57)

1995 21 22 (20–25) 108 (97–120) 1.1 (0.96–1.2) 5.2 (4.6–5.7) 11 778 57 53 (47–58)

2000 23 22 (20–24) 95 (86–103) 1.9 (1.7–2.1) 8 (7.3–8.8) 15 057 64 68 (62–75)

2005 26 22 (20–24) 86 (79–94) 2.2 (2.0–2.3) 8.3 (7.6–9.1) 15 415 60 69 (64–76)

2010 28 23 (21–25) 82 (75–89) 2.3 (2.1–2.5) 8.1 (7.4–8.8) 18 517 65 80 (74–87)

2011 29 23 (21–25) 81 (74–88) 2.3 (2.1–2.5) 7.8 (7.2–8.5) 19 808 69 85 (78–93)

2012 29 24 (22–26) 80 (74–87) 2.3 (2.2–2.6) 8 (7.4–8.7) 21 851 75 93 (85–100)

Marshall Islands 1990 < 1 0.065 (<0.01–0.190) 137 (14–396)

1995 < 1 0.097 (0.024–0.220) 190 (46–432)

2000 < 1 0.14 (0.084–0.200) 263 (161–389) 34 65 25 (17–41)

2005 < 1 0.19 (0.050–0.420) 363 (96–803) 111 213 59 (27–220)

2010 < 1 0.26 (0.051–0.650) 502 (97–1 230) 193 368 73 (30–380)

2011 < 1 0.28 (0.054–0.690) 536 (103–1 320) <0.01 (0–0.019) 6.1 (0–36) 139 265 49 (20–260)

2012 < 1 0.3 (0.058–0.740) 572 (110–1 400) <0.01 (0–0.015) 2.6 (0–29) 145 276 48 (20–250)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

273 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATE

NUMBER

(THOUSANDS) RATE

NUMBER RATE

PERCENT

Micronesia 1990 < 1 0.36 (0.100–0.800) 379 (104–827) 367 381 100 (46–370)

(Federated 1995 < 1 0.35 (0.200–0.540) 325 (185–505) 172 160 49 (32–87)

States of) 2000 < 1 0.3 (0.210–0.400) 279 (200–371) 91 85 30 (23–42)

2005 < 1 0.25 (0.170–0.360) 240 (158–338) 98 92 38 (27–58)

2010 < 1 0.21 (0.092–0.380) 206 (89–371) 164 158 77 (43–180)

2011 < 1 0.21 (0.089–0.370) 200 (86–360) 148 143 72 (40–170)

2012 < 1 0.2 (0.086–0.360) 194 (83–349) 144 139 72 (40–170)

Mongolia 1990 2 8.8 (7.5–10) 405 (345–470) 1 659 76 19 (16–22)

1995 2 7.2 (6.3–8.2) 314 (274–356) 2 780 121 39 (34–44)

2000 2 6.1 (5.5–6.7) 254 (228–281) 3 109 130 51 (46–57)

2005 3 5.7 (5.2–6.1) 225 (207–243) <0.01 (<0.01–<0.01) <0.1 (<0.1–<0.1) 4 601 182 81 (75–88)

2010 3 6.1 (5.7–6.5) 224 (209–240) <0.01 (<0.01–<0.01) 0.2 (0.21–0.24) 4 458 164 73 (68–79)

2011 3 6.1 (5.7–6.6) 223 (208–239) <0.01 (<0.01–<0.01) 0.3 (0.27–0.31) 4 217 153 69 (64–74)

2012 3 6.2 (5.8–6.7) 223 (208–239) 0.011 (<0.01–0.011) 0.4 (0.35–0.41) 4 128 148 66 (62–71)

Nauru 1990 < 1 <0.01 (<0.01–<0.01) 88 (77–99) 7 76 87 (77–99)

1995 < 1 <0.01 (<0.01–<0.01) 40 (35–46)

2000 < 1 <0.01 (<0.01–<0.01) 46 (40–52) 4 40 87 (77–99)

2005 < 1 0.013 (0.011–0.014) 125 (110–142) 11 109 87 (77–99)

2010 < 1 <0.01 (<0.01–<0.01) 34 (30–39) 3 30 87 (77–99)

2011 < 1 <0.01 (<0.01–<0.01) 57 (50–65) 5 50 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 54 (47–61)

New Caledonia 1990 < 1 0.16 (0.140–0.190) 98 (85–110) 143 85 87 (77–99)

1995 < 1 0.1 (0.088–0.110) 53 (46–60) 87 46 87 (77–99)

2000 < 1 0.11 (0.095–0.120) 51 (45–58) 94 45 87 (77–99)

2005 < 1 0.054 (0.047–0.061) 24 (21–27) 47 21 87 (77–99)

2010 < 1 0.056 (0.049–0.064) 23 (20–26) 49 20 87 (77–99)

2011 < 1 0.06 (0.052–0.068) 24 (21–27) 52 21 87 (77–99)

2012 < 1 0.044 (0.038–0.049) 17 (15–20) 38 15 87 (77–99)

New Zealand 1990 3 0.4 (0.350–0.450) 12 (10–13) <0.01 (<0.01–<0.01) 0.1 (<0.1–0.11) 348 10 87 (77–99)

1995 4 0.45 (0.390–0.510) 12 (11–14) <0.01 (<0.01–<0.01) 0.2 (0.17–0.22) 391 11 87 (77–99)

2000 4 0.4 (0.350–0.450) 10 (9.0–12) <0.01 (<0.01–<0.01) 0.2 (0.13–0.17) 344 8.9 87 (77–99)

2005 4 0.38 (0.330–0.430) 9.2 (8.1–10) <0.01 (<0.01–<0.01) 0.1 (0.12–0.16) 332 8 87 (77–99)

2010 4 0.35 (0.300–0.390) 7.9 (6.9–9.0) <0.01 (<0.01–<0.01) 0.1 (0.11–0.15) 301 6.9 87 (77–99)

2011 4 0.35 (0.310–0.400) 7.9 (7.0–9.0) <0.01 (<0.01–<0.01) 0.1 (0.11–0.15) 305 6.9 87 (77–99)

2012 4 0.34 (0.300–0.380) 7.6 (6.6–8.6) <0.01 (<0.01–<0.01) 0.1 (0.11–0.14) 293 6.6 87 (77–99)

Niue 1990 < 1 0 (0–0) 0 (0–0) 0 0

1995 < 1 0 (0–0) 0 (0–0) 0 0

2000 < 1 0 (0–0) 0 (0–0) 0 0

2005 < 1 0 (0–0) 0 (0–0) 0 0

2010 < 1 0 (0–0) 0 (0–0) 0 0

2011 < 1 <0.01 (<0.01–<0.01) 81 (71–91) 1 70 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 37 (32–42) 0 0 0

Northern Mariana 1990 < 1 0.032 (0.028–0.036) 73 (64–83) 28 64 87 (77–99)

Islands 1995 < 1 0.055 (0.048–0.062) 96 (84–109) 48 83 87 (77–99)

2000 < 1 0.086 (0.076–0.098) 126 (110–143) 75 110 87 (77–99)

2005 < 1 0.066 (0.057–0.074) 102 (89–115) 57 89 87 (77–99)

2010 < 1 0.037 (0.032–0.042) 68 (60–77) 32 59 87 (77–99)

2011 < 1 0.038 (0.033–0.043) 71 (62–81) 33 62 87 (77–99)

2012 < 1 0.037 (0.032–0.042) 69 (60–78) 32 60 87 (77–99)

Palau 1990 < 1 <0.01 (<0.01–<0.01) 45 (36–54)

1995 < 1 0.025 (0.021–0.031) 147 (119–178) 19 110 75 (62–93)

2000 < 1 0.03 (0.024–0.036) 156 (127–189)

2005 < 1 0.013 (0.011–0.016) 67 (54–81) 10 50 75 (62–93)

2010 < 1 0.024 (0.019–0.029) 116 (94–140) 19 93 80 (66–98)

2011 < 1 0.015 (0.012–0.018) 73 (59–88) 12 58 80 (66–98)

2012 < 1 <0.01 (<0.01–<0.01) 24 (20–29) 4 19 80 (66–98)

Papua New 1990 4 13 (8.5–18) 308 (203–435) 0.1 (0.067–0.14) 2.4 (1.6–3.4) 2 497 60 19 (14–30)

Guinea 1995 5 15 (10–21) 322 (212–453) 0.46 (0.30–0.65) 9.7 (6.4–14) 8 041 171 53 (38–80)

2000 5 19 (12–26) 349 (230–492) 1 (0.68–1.4) 19 (13–27) 10 520 196 56 (40–85)

2005 6 22 (14–31) 358 (236–505) 1.4 (0.92–2.0) 23 (15–32) 12 564 206 58 (41–87)

2010 7 24 (16–34) 348 (229–491) 1.1 (0.75–1.6) 17 (11–23) 14 531 212 61 (43–92)

2011 7 24 (16–34) 346 (228–488) 1.2 (0.76–1.6) 16 (11–23) 14 893 212 61 (44–93)

2012 7 25 (16–35) 348 (230–490) 1.1 (0.71–1.5) 15 (9.9–21) 20 557 287 82 (59–120)

Philippines 1990 62 240 (150–360) 393 (243–580) 0.024 (0.015–0.036) <0.1 (<0.1–<0.1) 317 008 512 130 (88–210)

1995 70 250 (200–300) 360 (294–432) 0.025 (0.020–0.030) <0.1 (<0.1–<0.1) 119 186 171 48 (40–58)

2000 78 260 (210–310) 329 (269–395) 0.077 (0.063–0.092) 0.1 (<0.1–0.12) 119 914 154 47 (39–57)

2005 86 260 (210–310) 301 (246–361) 0.18 (0.15–0.22) 0.2 (0.17–0.25) 137 100 160 53 (44–65)

2010 93 260 (210–310) 275 (227–328) 0.39 (0.32–0.46) 0.4 (0.34–0.49) 166 323 178 65 (54–79)

2011 95 260 (210–310) 270 (223–322) 0.46 (0.38–0.55) 0.5 (0.40–0.58) 195 560 206 76 (64–92)

2012 97 260 (210–310) 265 (219–316) 0.46 (0.38–0.55) 0.5 (0.39–0.57) 216 627 224 84 (71–100)

Republic of Korea 1990 43 73 (64–83) 171 (150–194) 0.051 (0.045–0.058) 0.1 (0.10–0.14) 63 904 149 87 (77–99)

1995 45 48 (42–55) 108 (95–123) 0.044 (0.038–0.049) 0.1 (<0.1–0.11) 42 117 94 87 (77–99)

2000 46 25 (22–28) 54 (48–62) 0.023 (0.020–0.026) <0.1 (<0.1–<0.1) 21 782 47 87 (77–99)

2005 47 49 (43–56) 105 (92–119) 0.089 (0.078–0.10) 0.2 (0.17–0.21) 42 892 91 87 (77–99)

2010 48 51 (44–57) 105 (92–118) 0.13 (0.12–0.15) 0.3 (0.24–0.31) 44 063 91 87 (77–99)

2011 49 53 (47–60) 109 (96–124) 0.14 (0.13–0.16) 0.3 (0.26–0.33) 46 253 95 87 (77–99)

2012 49 53 (46–60) 108 (95–122) 0.15 (0.13–0.17) 0.3 (0.27–0.35) 43 702 89 82 (73–94)

Samoa 1990 < 1 0.059 (0.047–0.071) 36 (29–44) 44 27 75 (62–93)

1995 < 1 0.051 (0.039–0.063) 30 (23–37) 45 26 89 (71–110)

2000 < 1 0.041 (0.030–0.053) 23 (17–30) 43 25 110 (82–140)

2005 < 1 0.032 (0.026–0.039) 18 (14–22) 24 13 75 (62–92)

2010 < 1 0.031 (0.025–0.038) 17 (13–21) 14 7.5 45 (37–56)

2011 < 1 0.032 (0.026–0.039) 17 (14–21) 20 11 62 (51–78)

2012 < 1 0.033 (0.027–0.040) 18 (14–21) 22 12 66 (55–82)

Singapore 1990 3 1.8 (1.6–2.1) 61 (53–69) <0.01 (<0.01–<0.01) 0.2 (0.21–0.27) 1 591 53 87 (77–99)

1995 3 2.2 (1.9–2.5) 62 (55–71) 0.044 (0.038–0.049) 1.3 (1.1–1.4) 1 889 54 87 (77–99)

2000 4 2 (1.7–2.2) 51 (44–57) 0.06 (0.053–0.068) 1.5 (1.3–1.7) 1 728 44 87 (77–99)

2005 4 1.6 (1.4–1.8) 35 (31–40) 0.06 (0.052–0.068) 1.3 (1.2–1.5) 1 376 31 87 (77–99)

2010 5 1.8 (1.6–2.0) 35 (31–40) 0.07 (0.061–0.079) 1.4 (1.2–1.6) 1 560 31 87 (77–99)

2011 5 1.9 (1.7–2.1) 36 (32–41) 0.072 (0.063–0.081) 1.4 (1.2–1.6) 1 641 32 87 (77–99)

2012 5 2.6 (2.3–3.0) 50 (44–56) 0.098 (0.086–0.11) 1.9 (1.6–2.1) 2 301 43 87 (77–99)

Solomon Islands 1990 < 1 0.97 (0.600–1.4) 312 (193–460) 382 122 39 (27–64)

1995 < 1 0.86 (0.710–1.0) 240 (196–288) 352 98 41 (34–50)

2000 < 1 0.76 (0.620–0.910) 185 (151–222) 302 73 40 (33–49)

2005 < 1 0.67 (0.540–0.800) 142 (116–171) 397 85 60 (50–73)

2010 < 1 0.57 (0.470–0.680) 108 (89–129) 338 64 59 (50–72)

2011 < 1 0.55 (0.460–0.660) 103 (85–123) 398 74 72 (60–87)

2012 < 1 0.54 (0.440–0.640) 97 (80–116) 361 66 67 (57–82)

Tokelau 1990 < 1 <0.01 (<0.01–<0.01) 72 (57–90) 1 62 86 (69–110)

1995 < 1 <0.01 (<0.01–<0.01) 39 (13–80) 2 132 340 (160–1 000)

2000 < 1 <0.01 (<0.01–<0.01) 13 (3.5–28) 0 0 0

2005 < 1 0 (0–0) 0 (0–0) 0 0

2010 < 1 0 (0–0) 0 (0–0) 0 0

2011 < 1 0 (0–0) 0 (0–0) 0 0

2012 < 1 0 (0–0) 0 (0–0)

Tonga 1990 < 1 0.036 (0.030–0.042) 38 (32–45) 23 24 64 (54–76)

1995 < 1 0.032 (0.027–0.037) 33 (28–39) 20 21 63 (54–75)

2000 < 1 0.027 (0.021–0.034) 28 (22–35) 24 24 88 (70–110)

2005 < 1 0.023 (0.018–0.028) 22 (18–27) 18 18 79 (65–99)

2010 < 1 0.017 (0.015–0.020) 17 (14–20) 11 11 63 (54–75)

2011 < 1 0.016 (0.014–0.019) 16 (13–18) 9 8.6 55 (47–66)

2012 < 1 0.015 (0.013–0.018) 14 (12–17) 11 10 73 (62–87)

Rates are per 100 000 population.

NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

274 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($,QFLGHQFHQRWLILFDWLRQDQGFDVHGHWHFWLRQUDWHVDOOIRUPV±

INCIDENCE (INCLUDING HIV) INCIDENCE HIV-POSITIVE NOTIFIED NEW AND RELAPSE

CASE DETECTION

YEAR POPULATION

(MILLIONS)

NUMBER

(THOUSANDS) RATEaNUMBER

(THOUSANDS) RATEaNUMBER RATEaPERCENT

Tuvalu 1990 < 1 0.048 (0.031–0.069) 536 (347–766) 23 255 48 (33–74)

1995 < 1 0.04 (0.017–0.074) 437 (181–805) 36 390 89 (48–220)

2000 < 1 0.034 (0.022–0.048) 357 (231–510) 16 170 48 (33–74)

2005 < 1 0.028 (0.019–0.039) 291 (198–402) 12 124 43 (31–63)

2010 < 1 0.018 (0.014–0.021) 178 (145–215) 14 142 80 (66–98)

2011 < 1 0.015 (0.012–0.018) 152 (124–184) 12 122 80 (66–98)

2012 < 1 0.024 (0.019–0.029) 241 (196–290) 19 193 80 (66–98)

Vanuatu 1990 < 1 0.19 (0.150–0.230) 127 (103–154) 140 95 75 (62–93)

1995 < 1 0.11 (0.085–0.130) 63 (51–76) 79 47 75 (62–93)

2000 < 1 0.2 (0.160–0.250) 110 (89–132) 152 82 75 (62–93)

2005 < 1 0.17 (0.140–0.210) 83 (68–99) 76 36 44 (37–54)

2010 < 1 0.16 (0.130–0.200) 69 (57–83) 116 49 71 (59–86)

2011 < 1 0.16 (0.130–0.190) 67 (55–80) 110 45 68 (57–83)

2012 < 1 0.16 (0.130–0.190) 65 (53–77) 125 51 78 (66–95)

Viet Nam 1990 69 170 (120–240) 251 (172–344) 50 203 73 29 (21–42)

1995 76 170 (120–220) 220 (155–295) 0.083 (0.059–0.11) 0.1 (<0.1–0.15) 55 739 73 33 (25–47)

2000 81 160 (120–210) 197 (142–260) 1.7 (1.3–2.3) 2.2 (1.6–2.9) 89 792 111 56 (43–78)

2005 85 150 (110–190) 176 (131–229) 7.6 (5.6–9.9) 8.9 (6.6–12) 94 916 112 63 (49–86)

2010 89 140 (100–180) 155 (115–201) 9.2 (6.8–12) 10 (7.6–13) 97 448 109 70 (54–95)

2011 90 140 (100–180) 151 (112–197) 9.2 (6.8–12) 10 (7.6–13) 98 804 110 73 (56–98)

2012 91 130 (99–170) 147 (109–192) 9.3 (6.9–12) 10 (7.6–13) 102 112 112 76 (59–100)

Wallis and Futuna 1990 < 1 0.022 (0.019–0.024) 156 (137–176)

Islands 1995 < 1 <0.01 (<0.01–<0.01) 49 (43–55) 6 42 87 (77–99)

2000 < 1 <0.01 (<0.01–<0.01) 15 (13–17)

2005 < 1 <0.01 (<0.01–<0.01) 57 (50–64) 7 49 87 (77–99)

2010 < 1 <0.01 (<0.01–<0.01) 36 (31–41)

2011 < 1 <0.01 (<0.01–<0.01) 17 (15–19) 2 15 87 (77–99)

2012 < 1 <0.01 (<0.01–<0.01) 65 (57–74)

a Rates are per 100 000 population.

b NOTIFIED NEW AND RELAPSE includes cases for which the treatment history is unknown.

275 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

American Samoa 1990 9 –

1995 –

2000 3 2 0 1 0 0 100

2005 6 3 2 0 0 1 0 1 0 60

2010 4 0 3 1 0 0 0 0 0 0

2011 3 0 3 0 0 0 0 0 0 0

• 19 0 • 2012 –

Australia 1990 1 016 –

1995 1 073 –

2000 1 043 251 362 369 17 17 41

2005 1 046 241 339 450 16 27 43 42

2010 1 257 274 410 457 5 41 24 65 70 40

2011 1 239 301 436 463 2 20 29 49 17 41

• 6 6 • 2012 1 305 290 408 498 63 26 20 46 20 42

Brunei 1990 143 –

Darussalam 1995 –

2000 307 84 166 42 15 15 34

2005 163 101 30 27 5 0 5 0 77

2010 237 146 30 43 13 5 0 5 0 83

2011 230 109 52 48 13 8 0 8 0 68

• 56 59 • 2012 243 119 79 31 0 14 0 14 0 60

Cambodia 1990 6 501 –

1995 14 603 11 101 1 465 1 428 605 605 88

2000 18 891 14 822 1 108 2 147 814 814 93

2005 35 535 21 001 7 057 6 759 718 588 1 306 75

2010 40 460 17 454 8 301 14 239 0 466 1 168 1 634 0 68

2011 38 555 15 812 7 686 14 690 0 367 1 115 1 482 0 67

• 72 270 • 2012 40 185 14 838 8 509 15 290 0 446 73 519 1 102 64

China 1990 375 481 –

1995 515 764 134 488 203 088 1 560 18 693 18 693 40

2000 454 372 204 765 229 943 19 664 53 480 73 144 47

2005 899 729 472 719 329 157 42 845 49 707 90 780 140 487 5 301 59

2010 908 399 429 899 432 868 6 325 0 39 307 14 909 54 216 0 50

2011 899 669 377 005 481 514 6 540 0 34 610 12 215 46 825 0 44

• 32 65 • 2012 890 645 316 332 536 050 6 479 0 31 784 10 033 41 817 0 37

China, Hong Kong 1990 6 510 –

SAR 1995 6 212 –

2000 6 015 1 940 3 115 772 188 594 782 38

2005 5 660 1 561 3 179 701 0 219 500 719 0 33

2010 4 935 1 475 2 352 792 0 316 197 513 0 39

2011 4 739 1 380 2 244 815 0 300 187 487 0 38

• 112 67 • 2012 4 809 1 463 2 206 817 0 323 160 483 0 40

China, Macao 1990 343 –

SAR 1995 402 141 94 70 49 49 60

2000 449 160 180 50 12 12 47

2005 398 136 162 43 0 14 17 31 43 46

2010 394 123 175 49 0 21 39 60 26 41

2011 380 148 126 46 0 21 2 23 39 54

• 95 73 • 2012 404 156 139 31 0 26 2 28 52 53

Cook Islands 1990 0 0 0 0 0 0 0 0 0

1995 2 2 0 0 0 0 0 0 0 100

2000 1 0 1 0 0 0 0 0 0 0

2005 1 1 0 0 0 0 0 0 0 100

2010 0 0 0 0 0 0 0 0 0

2011 1 1 0 0 0 0 0 0 0 100

• 0 5 • 2012 1 0 0 0 0 1 0 1 0

Fiji 1990 226 84 105 37 44

1995 203 68 99 34 2 0 2 41

2000 144 62 42 40 0 0 0 60

2005 132 63 29 40 68

2010 189 89 45 45 0 10 2 12 0 66

2011 215 107 62 44 0 2 5 7 0 63

• 31 24 • 2012 210 111 54 40 0 5 8 13 0 67

French Polynesia 1990 59 –

1995 –

2000 62 29 19 10 1 1 60

2005 63 21 25 14 3 0 3 0 46

2010 41 13 18 6 0 4 0 4 0 42

2011 64 22 27 13 0 2 0 2 0 45

• 30 18 • 2012 50 26 10 8 0 6 0 6 0 72

Guam 1990 –

1995 –

2000 54 43 5 6 1 1 90

2005 63 27 26 9 0 1 1 2 0 51

2010 101 39 51 9 0 2 0 2 0 43

2011 82 28 39 11 0 3 0 3 1 42

• 0 42 • 2012 68 23 37 8 0 0 0 0 0 38

Japan 1990 51 821 –

1995 43 078 14 367 25 172 2 803 736 736 36

2000 39 384 11 853 19 118 7 046 1 367 1 367 38

2005 27 194 10 931 10 056 5 340 867 1 125 1 992 52

2010 22 693 8 237 8 630 4 632 0 1 194 568 1 762 49

2011 22 119 7 937 8 231 4 826 0 1 125 562 1 687 0 49

• 42 16 • 2012 20 857 7 663 7 675 4 609 0 910 426 1 336 50

Kiribati 1990 68 –

1995 –

2000 252 54 47 106 3 3 53

2005 332 124 79 126 3 7 10 61

2010 286 118 91 71 0 6 8 14 0 56

2011 343 140 109 87 0 7 11 18 0 56

• 96 343 • 2012 346 134 122 73 9 8 2 10 0 52

Lao People's 1990 1 826 –

Democratic 1995 830 478 404 95 2 2 54

Republic 2000 2 227 1 526 457 180 64 64 77

2005 3 766 2 801 484 275 139 41 180 67 85

2010 4 061 3 119 394 323 163 22 185 62 89

2011 4 360 3 271 516 349 170 27 197 54 86

• 43 62 • 2012 4 118 3 062 484 351 168 38 206 53 86

Malaysia 1990 11 702 –

1995 11 778 6 688 4 021 1 069 210 210 62

2000 15 057 8 156 5 517 1 384 0 0 60

2005 15 415 8 446 4 862 1 702 0 332 651 983 73 63

2010 18 517 11 135 4 338 2 545 0 499 820 1 319 0 72

2011 19 808 11 862 4 501 2 888 0 557 858 1 415 0 72

• 64 75 • 2012 21 851 13 311 4 993 2 945 0 602 859 1 461 0 73

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

276 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Marshall Islands 1990 –

1995 –

2000 34 11 25 9 0 0 31

2005 111 48 31 28 4 1 5 0 61

2010 193 59 64 65 0 2 8 10 3 48

2011 139 44 30 57 0 8 12 20 0 59

• 0 276 • 2012 145 54 53 29 0 4 2 6 5 50

Micronesia 1990 367 –

(Federated 1995 172 9 79 18 2 2 10

States of) 2000 91 15 69 4 3 3 18

2005 98 32 35 19 5 7 14 21 48

2010 164 53 79 25 0 3 10 13 4 40

2011 148 45 73 28 0 2 2 4 0 38

• 381 139 • 2012 144 43 77 22 0 2 2 4 0 36

Mongolia 1990 1 659 –

1995 2 780 455 1 330 976 82 82 25

2000 3 109 1 389 732 862 126 126 65

2005 4 601 1 868 897 1 620 0 216 125 341 0 68

2010 4 458 1 837 701 1 675 0 245 343 588 0 72

2011 4 217 1 723 684 1 578 0 232 316 548 0 72

• 76 148 • 2012 4 128 1 716 617 1 611 0 184 325 509 0 74

Nauru 1990 7 –

1995 –

2000 4 4 0 0 0 0 100

2005 11 0 11 0

2010 3 1 1 1 0 0 0 0 0 50

2011 5 3 1 1 0 0 0 0 0 75

• 76 0 • 2012 –

New Caledonia 1990 143 –

1995 87 21 81 9 4 4 21

2000 94 20 15 29 4 4 57

2005 47 16 15 15 1 6 7 0 52

2010 49 20 16 13 0 8 8 0 56

2011 52 13 18 19 0 2 0 2 0 42

• 85 15 • 2012 38 13 11 12 1 1 0 1 0 54

New Zealand 1990 348 –

1995 391 78 222 34 4 4 26

2000 344 74 133 130 7 0 7 36

2005 332 83 114 95 29 11 8 19 42

2010 301 86 68 134 6 7 4 11 56

2011 305 88 81 121 13 2 4 6 52

• 10 7 • 2012 293 68 99 112 3 11 4 15 0 41

Niue 1990 0 –

1995 0 0 1 0 0 0

2000 0 0 0

2005 0 0

2010 0 0 0 0 0 0 0 0 0

2011 1 0 0 0 1 0 0 0 0

• 0 0 • 2012 0 0 0 0 0 0 0 0 0

Northern Mariana 1990 28 –

Islands 1995 48 14 26 8 0 0 35

2000 75 27 37 11 0 0 42

2005 57 15 35 7 0 0 0 0 0 30

2010 32 17 13 2 0 0 0 0 0 57

2011 33 15 16 2 0 0 0 0 0 48

• 64 60 • 2012 32 10 17 4 1 0 2 2 0 37

Palau 1990 –

1995 19 9 6 4 0 0 60

2000 –

2005 10 3 6 1 0 0 0 33

2010 19 9 10 0 0 0 0 0 0 47

2011 12 4 6 1 0 1 0 1 0 40

• 0 19 • 2012 4 3 1 0 0 0 0 0 0 75

Papua New 1990 2 497 –

Guinea 1995 8 041 1 652 3 767 2 349 273 273 30

2000 10 520 1 933 4 405 3 227 955 955 30

2005 12 564 1 805 5 105 4 198 1 456 1 456 26

2010 14 531 2 584 5 907 5 798 242 1 582 1 824 30

2011 14 893 1 882 6 494 6 373 0 144 1 431 1 575 0 22

• 60 287 • 2012 20 557 2 862 9 195 8 277 0 223 1 931 2 154 0 24

Philippines 1990 317 008 –

1995 119 186 94 768 140 712 8 8 8 40

2000 119 914 67 056 52 858 56

2005 137 100 81 647 50 347 1 149 0 3 957 3 957 62

2010 166 323 89 198 72 440 1 610 0 3 075 8 066 11 141 0 55

2011 195 560 93 580 96 529 2 234 0 3 217 10 528 13 745 0 49

• 512 224 • 2012 216 627 94 006 115 263 3 274 0 4 084 13 535 17 619 0 45

Republic of Korea 1990 63 904 –

1995 42 117 11 754 19 360 2 082 2 082 38

2000 21 782 8 216 11 304 2 262 2 262 42

2005 42 892 11 638 18 460 5 171 0 3 021 4 077 7 098 4 602 39

2010 44 063 11 596 18 660 8 795 0 2 838 4 038 6 876 2 174 38

2011 46 253 11 714 18 386 9 457 0 3 032 4 238 7 270 3 664 39

• 149 89 • 2012 43 702 12 137 18 938 8 470 0 4 157 5 830 9 987 0 39

Samoa 1990 44 –

1995 45 15 30 6 0 0 33

2000 43 13 18 12 0 0 42

2005 24 11 8 5 0 0 0 0 0 58

2010 14 6 5 3 0 0 0 0 0 55

2011 20 6 12 2 0 0 0 0 33

• 27 12 • 2012 22 15 4 3 0 0 0 0 0 79

Singapore 1990 1 591 –

1995 1 889 455 1 187 127 120 120 28

2000 1 728 248 869 165 55 55 22

2005 1 376 552 570 174 0 60 93 153 20 49

2010 1 560 530 735 213 0 82 48 130 0 42

2011 1 641 592 717 224 0 108 54 162 0 45

• 53 43 • 2012 2 301 678 1 219 306 0 98 63 161 0 36

Solomon Islands 1990 382 –

1995 352 109 133 97 13 13 45

2000 302 109 128 65 0 0 46

2005 397 169 161 62 0 5 0 5 0 51

2010 338 133 98 105 0 2 3 5 0 58

2011 398 159 108 127 0 4 7 11 0 60

• 122 66 • 2012 361 157 87 112 0 5 11 16 0 64

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

277 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($&DVHQRWLILFDWLRQV±

NEW CASES

YEAR SMEAR-

POSITIVE

SMEAR-NEGATIVE/

UNKNOWN

EXTRA-

PULMONARY OTHER RELAPSE RE-TREAT EXCL.

RELAPSE

TOTAL

RETREAT

HISTORY

UNKNOWN

NEW AND

RELAPSE

% SMEAR-

POS AMONG

NEW PULM

NEW AND RELAPSE

NOTIFICATION RATE

1990–2012

Tokelau 1990 1 –

1995 2 1 1 0 0 0 50

2000 0 0 0 0 0 0

2005 0 0 0 0 0 0 0 0 0

2010 0 0 0 0 0 0 0 0 0

2011 0 0 0 0 0 0 0 0 0

• 62 0 • 2012 –

Tonga 1990 23 –

1995 20 9 2 9 0 0 82

2000 24 15 5 3 1 1 75

2005 18 11 3 4 79

2010 11 6 3 2 0 0 0 0 0 67

2011 9 6 3 0 0 0 0 0 0 67

• 24 10 • 2012 11 9 1 1 0 0 0 0 0 90

Tuvalu 1990 23 –

1995 36 6 13 16 1 1 32

2000 16 0 7 7 0

2005 12 5 3 4 3 3 62

2010 14 5 2 7 0 0 0 0 0 71

2011 12 4 4 4 0 0 1 1 0 50

• 255 193 • 2012 19 8 2 9 0 0 1 1 0 80

Vanuatu 1990 140 –

1995 79 30 27 21 1 1 53

2000 152 63 56 28 5 5 53

2005 76 35 21 17 0 3 5 8 0 62

2010 116 44 33 35 3 1 0 1 0 57

2011 110 49 14 46 0 1 2 3 0 78

• 95 51 • 2012 125 51 22 51 0 1 1 2 0 70

Viet Nam 1990 50 203 –

1995 55 739 37 550 8 379 6 194 3 616 3 616 82

2000 89 792 53 169 17 993 13 137 5 493 5 493 75

2005 94 916 55 492 16 429 16 670 0 6 325 976 7 301 0 77

2010 97 448 52 145 18 237 17 651 0 6 834 1 574 8 408 2 581 74

2011 98 804 50 751 20 373 18 077 2 678 6 925 1 714 8 639 71

• 0 0 • 2012 102 112 51 033 21 706 18 904 3 210 7 259 1 794 9 053 70

Wallis and Futuna 1990 –

Islands 1995 6 3 2 0 1 1 60

2000 –

2005 7 1 6 14

2010 –

2011 2 2 0 0 0 0 0 0 0 100

• 0 0 • 2012 –

a Rates are per 100 000 population.

b NEW AND RELAPSE includes cases for which the treatment history is unknown.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

American Samoa 1995 4 – 10000000

2000 2 2 100 0 100 0 0 0 0

2005 3 4 133 75 25

2009 0 3 – 0 100 0 0 0 0

2010 0 0 –

• 100 0 • 2011 0 –

Australia 1995 –

2000 251 238 95 27 45 9 0 3 16

2005 241 241 100 12 68 10 2 8

2009 267 606 227 6 73 3 0 1 16

2010 274 629 230 8 72 3 0 2 15

• 0 77 • 2011 301 527 175 7 70 6 0 1 16

Brunei 1995 –

Darussalam 2000 84 84 100 42 21 17 0 4 17

2005 101 101 100 66 5 7 0 2 20

2009 140 164 117 63 8 9 0 0 20

2010 146 176 121 61 20 7 0 0 12

• 0 66 • 2011 109 109 100 66 0 9 0 0 25

Cambodia 1995 11 101 4 363 39 83 8 2 1 4 2

2000 14 822 14 775 100 88 4 4 0 4 1

2005 21 001 21 001 100 89 4 3 0 2 2

2009 17 863 17 863 100 92 3 2 0 1 1

2010 17 454 17 454 100 91 3 2 0 1 2

• 91 93 • 2011 15 812 15 884 100 90 4 2 0 1 3

China 1995 134 488 131 413 98 72 22 2 1 1 3

2000 204 765 213 766 104 93 1 2 1 3

2005 472 719 472 719 100 92 2 2 1 1 3

2009 449 152 449 039 100 93 2 1 1 1 2

2010 429 899 429 790 100 94 2 1 1 0 2

• 93 95 • 2011 377 005 377 005 100 94 2 1 1 1 2

China, Hong Kong 1995 –

SAR 2000 1 940 1 940 100 55 5 5 6 4 24

2005 1 561 1 561 100 60 3 5 9 3 20

2009 1 444 1 441 100 59 11 15 0 3 12

2010 1 475 1 487 101 57 11 15 0 4 13

• 0 69 • 2011 1 380 1 378 100 59 10 14 0 4 13

China, Macao 1995 141 –

SAR 2000 160 160 100 81 8 6 0 4 1

2005 136 136 100 93 0 4 0 1 3

2009 116 115 99 86 2 3 0 2 7

2010 123 219 178 93 0 3 0 1 3

• 0 86 • 2011 148 147 99 86 0 5 0 1 7

Cook Islands 1995 2 2 100 100 0 0 0 0 0

2000 0 –

2005 1 1 100 100 0 0 0 0 0

2009 1 0 0

2010 0 0 –

• 100 0 • 2011 1 1 100 0 0 0 0 0 100

Fiji 1995 68 73 107 78 8 7 0 3 4

2000 62 62 100 81 5 5 0 8 2

2005 63 68 108 71 0 10 0 10 9

2009 83 79 95 89 5 4 0 1 1

2010 89 89 100 65 2 6 0 24 3

• 86 93 • 2011 107 107 100 81 12 1 0 3 3

French Polynesia 1995 33 – 67030219

2000 29 62 214 0 97 2 2 0 0

2005 21 18 86 89 11 0 0 0

2009 17 18 106 89 6 0 6 0

2010 13 13 100 92 0 8 0 0 0

• 67 80 • 2011 22 20 91 80 0 5 0 15 0

Guam 1995 –

2000 43 43 100 93 0 7 0 0 0

2005 27 27 100 85 0 11 0 0 4

2009 31 47 152 96 0 2 0 0 2

2010 39 51 131 84 0 16 0 0 0

• 0 79 • 2011 28 28 100 79 0 14 0 0 7

Japan 1995 14 367 –

2000 11 853 10 348 87 30 15 5 4 1 44

2005 10 931 10 931 100 38 22 11 3 1 26

2009 8 853 8 772 99 21 31 19 1 4 24

2010 8 237 8 242 100 20 32 21 1 3 24

• 0 0 • 2011 7 937 –

Kiribati 1995 31 – 45 42 13 0

2000 54 54 100 83 7 7 2 0 0

2005 124 123 99 62 31 7 0 1 0

2009 145 144 99 84 13 3 0 0 0

2010 118 117 99 88 5 5 2 0 0

• 87 94 • 2011 140 140 100 74 21 4 1 1 0

Lao People's 1995 478 343 72 62 8 6 2 19 4

Democratic 2000 1 526 1 588 104 68 9 7 0 9 7

Republic 2005 2 801 2 802 100 85 5 5 1 3 1

2009 3 034 3 034 100 91 2 4 1 2 1

2010 3 119 3 119 100 89 3 6 0 2 0

• 70 92 • 2011 3 271 3 271 100 87 5 0 5 2 1

Malaysia 1995 6 688 13 398 200 69 0 6 2 8 14

2000 8 156 7 915 97 0 78 8 0 10 4

2005 8 446 8 446 100 69 1 9 0 5 16

2009 9 981 9 981 100 78 1 9 0 4 9

2010 11 135 11 135 100 79 1 9 0 4 7

• 69 79 • 2011 11 862 11 862 100 78 1 9 0 4 8

Marshall Islands 1995 163 – 3 21 7 0 67 1

2000 11 11 100 64 27 0 0 9 0

2005 48 47 98 85 2 2 2 9

2009 52 58 112 71 14 9 0 3 3

2010 59 71 120 63 17 8 0 1 10

• 25 88 • 2011 44 50 114 86 2 6 0 6

Micronesia 1995 9 10 111 80 0 10 0 10 0

(Federated 2000 15 14 93 93 0 7 0 0 0

States of) 2005 32 20 62 75 5 10 5 0 5

2009 61 60 98 65 23 3 2 0 7

2010 53 59 111 97 0 3 0 0 0

• 80 96 • 2011 45 51 113 80 16 4 0 0 0

Mongolia 1995 455 455 100 66 7 8 6 10 2

2000 1 389 1 389 100 83 4 3 3 4 3

2005 1 868 1 868 100 82 6 3 5 3 2

2009 1 809 1 809 100 84 4 2 7 2 0

2010 1 837 1 837 100 83 3 2 8 3 0

• 74 86 • 2011 1 723 1 723 100 82 3 2 7 4 1

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

279 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($7UHDWPHQWRXWFRPHVQHZVPHDUSRVLWLYHFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Nauru 1995 –

2000 4 4 100 25 75

2005 0 3 – 0 67 33 0 0 0

2009 1 0 0

2010 1 3 300 0 67 0 0 0 33

• 0 0 • 2011 3 –

New Caledonia 1995 21 32 152 75 12 3 9

2000 20 45 225 33 56 9 2 0

2005 16 16 100 88 6 6 0 0 0

2009 15 15 100 0 93 0 0 7 0

2010 20 21 105 0 76 19 0 5 0

• 75 35 • 2011 13 23 177 0 35 9 0 0 57

New Zealand 1995 78 –

2000 74 73 99 5 25 23 47

2005 83 84 101 0 60 6 0 1 33

2009 90 92 102 76 7 1 16

2010 86 86 100 74 17 8

• 0 56 • 2011 88 141 160 0 56 7 0 1 36

Niue 1995 0 –

2000 0 –

2005 0 0 –

2009 0 –

2010 0 0 –

• 0 0 • 2011 0 –

Northern Mariana 1995 14 –

Islands 2000 27 27 100 81 0 0 0 0 19

2005 15 15 100 73 0 0 0 0 27

2009 16 16 100 0 81 0 0 0 19

2010 17 17 100 0 82 0 0 0 18

• 0 89 • 2011 15 19 127 89 11 0 0 0

Palau 1995 9 9 100 56 11 0 0 11 22

2000 –

2005 3 3 100 100 0 0 0 0 0

2009 6 8 133 62 12 25 0 0 0

2010 9 16 178 75 12 12 0 0 0

• 67 57 • 2011 4 7 175 29 29 14 0 14 14

Papua New 1995 1 652 4 904 297 56 4 0 15 25

Guinea 2000 1 933 422 22 39 24 2 0 26 9

2005 1 805 1 292 72 57 14 4 1 19 5

2009 2 238 2 584 115 58 13 4 2 16 6

2010 2 584 2 530 98 48 10 3 2 14 23

• 56 69 • 2011 1 882 2 322 123 53 16 4 3 19 5

Philippines 1995 94 768 90 297 95 54 6 1 1 5 34

2000 67 056 50 196 75 73 15 2 1 6 3

2005 81 647 81 125 99 82 7 2 1 4 3

2009 88 806 88 806 100 82 7 2 1 4 4

2010 89 198 89 198 100 85 7 2 1 4 2

• 60 90 • 2011 93 580 93 580 100 83 7 2 1 4 3

Republic of Korea 1995 11 754 11 675 99 74 2 2 3 5 14

2000 8 216 3 231 39 81 2 2 1 3 12

2005 11 638 3 752 32 81 2 1 1 4 11

2009 11 285 3 813 34 81 2 1 1 3 12

2010 11 596 2 828 24 85 4 1 0 3 6

• 76 80 • 2011 11 714 2 288 20 78 2 1 0 3 16

Samoa 1995 15 15 100 13 67 20 0 0 0

2000 13 13 100 85 8 8 0 0 0

2005 11 11 100 91 0 9 0 0 0

2009 8 10 125 90 0 10 0 0 0

2010 6 6 100 100 0 0 0 0 0

• 80 83 • 2011 6 6 100 83 0 17 0 0 0

Singapore 1995 455 122 27 71 15 2 0 11 0

2000 248 242 98 71 14 0 14 0

2005 552 548 99 83 14 0 2 1

2009 552 937 170 65 17 15 0 1 2

2010 530 948 179 62 17 17 0 1 3

• 86 83 • 2011 592 979 165 69 14 15 0 1 1

Solomon Islands 1995 109 368 338 65 6 0 4 26

2000 109 109 100 73 7 5 0 4 11

2005 169 169 100 56 30 8 0 4 2

2009 138 138 100 67 22 4 1 3 3

2010 133 133 100 57 30 1 3 5 4

• 65 90 • 2011 159 156 98 54 36 3 3 1 4

Tokelau 1995 1 –

2000 0 –

2005 0 –

2009 0 0 –

2010 0 –

• 0 0 • 2011 0 –

Tonga 1995 9 20 222 75 0 10 5 0 10

2000 15 15 100 93 0 0 7 0 0

2005 11 11 100 73 0 18 0 0 9

2009 6 6 100 83 0 17 0 0 0

2010 6 6 100 83 0 17 0 0 0

• 75 100 • 2011 6 6 100 100 0 0 0 0 0

Tuvalu 1995 6 –

2000 0 7 – 86 14 0

2005 5 6120 10000000

2009 8 8 100 88 0 0 0 0 12

2010 5 5 100 100 0

• 0 75 • 2011 4 4 100 75 25 0

Vanuatu 1995 30 13 43 38 46 15 0 0 0

2000 63 26 41 77 12 8 0 4 0

2005 35 42 120 64 17 10 7 2 0

2009 47 47 100 81 15 4 0 0 0

2010 44 44 100 66 14 16 0 2 2

• 85 82 • 2011 49 49 100 53 29 10 4 2 2

Viet Nam 1995 37 550 38 189 102 84 5 3 2 4 2

2000 53 169 53 169 100 90 2 3 1 2 2

2005 55 492 55 492 100 90 2 3 1 1 2

2009 51 291 51 387 100 90 2 3 1 2 2

2010 52 145 52 147 100 91 2 3 1 2 2

• 89 93 • 2011 50 751 50 751 100 91 2 3 1 2 2

Wallis and Futuna 1995 3 –

Islands 2000 –

2005 1 –

2009 2 –

2010 2 – 0 100 0 0 0 0

• 0 0 • 2011 2 –

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

American Samoa 1995 –

2000 0 –

2005 1 1 100 100 0

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 –

Australia 1995 –

2000 17 11 65 9 73 9 0 0 9

2005 43 43 100 16 56 5 5 19

2009 61 65 107 6 60 3 2 8 22

2010 65 58 89 5 64 5 0 3 22

• 0 66 • 2011 49 67 137 1 64 6 0 3 25

Brunei 1995 –

Darussalam 2000 15 –

2005 5 5 100 40 40 20 0 0 0

2009 0 0 –

2010 5 5100 10000000

• 0 63 • 2011 8 8 100 62 0 25 0 0 12

Cambodia 1995 605 436 72 59 26 5 3 3 4

2000 814 827 102 85 5 6 1 4 0

2005 1 306 1 306 100 49 27 9 2 3 11

2009 1 429 1 429 100 34 45 3 1 1 15

2010 1 634 1 524 93 30 44 4 1 1 20

• 85 74 • 2011 1 482 409 28 66 8 7 5 5 10

China 1995 18 693 54 052 289 90 2 2 3 1 1

2000 73 144 43 252 59 86 2 1 1 1 8

2005 140 487 89 239 64 85 5 3 3 1 4

2009 59 583 59 853 100 86 4 2 2 1 4

2010 54 216 54 469 100 86 4 2 2 1 5

• 92 90 • 2011 46 825 46 825 100 87 4 2 3 1 4

China, Hong Kong 1995 –

SAR 2000 782 218 28 27 26 4 17 18 8

2005 719 716 100 40 18 4 9 7 22

2009 509 481 94 26 38 15 0 6 14

2010 513 512 100 34 34 12 0 4 16

• 0 62 • 2011 487 453 93 27 35 15 0 7 16

China, Macao 1995 49 –

SAR 2000 12 37 308 68 16 11 0 5 0

2005 31 37 119 51 24 11 0 0 14

2009 45 46 102 43 35 11 0 7 4

2010 60 35 58 51 14 14 0 11 9

• 0 96 • 2011 23 28 122 79 18 4 0 0 0

Cook Islands 1995 0 –

2000 0 –

2005 0 0 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Fiji 1995 2 –

2000 0 –

2005 0 –

2009 2 5 250 40 40 20 0 0 0

2010 12 12 100 50 17 17 0 17 0

• 0 57 • 2011 7 7 100 29 29 14 14 14 0

French Polynesia 1995 2 – 50 0 50 0 0 0

2000 1 –

2005 3 4 133 75 25 0

2009 5 5 100 0 100 0 0 0 0

2010 4 4 100 0 75 25 0 0 0

• 50 100 • 2011 2 4 200 75 25 0 0 0 0

Guam 1995 –

2000 1 –

2005 2 2 100 50 0 0 0 50 0

2009 1 1 100 100 0 0 0 0 0

2010 2 2 100 100 0 0 0 0 0

• 0 100 • 2011 3 3 100 67 33 0 0 0 0

Japan 1995 736 –

2000 1 367 1 169 86 31 15 5 6 1 41

2005 1 992 1 992 100 29 16 8 2 2 43

2009 1 751 1 452 83 15 32 15 1 6 31

2010 1 762 1 466 83 14 32 17 1 5 31

• 0 0 • 2011 1 687 –

Kiribati 1995 –

2000 3 9 300 89 0 11 0 0 0

2005 10 3 30 100 0

2009 4 6 150 83 17 0 0 0 0

2010 14 20 143 25 45 30 0 0 0

• 0 74 • 2011 18 19 106 21 53 5 0 21 0

Lao People's 1995 2 1 50 100 0 0 0 0 0

Democratic 2000 64 64 100 41 8 11 8 11 22

Republic 2005 180 181 101 75 12 6 2 5 1

2009 184 184 100 85 3 8 2 1 0

2010 185 184 99 76 7 12 3 3 0

• 100 81 • 2011 197 170 86 72 9 2 8 3 6

Malaysia 1995 210 –

2000 0 –

2005 983 1 056 107 46 9 8 1 9 27

2009 1 181 1 181 100 33 27 9 1 6 23

2010 1 319 1 319 100 35 24 12 1 12 17

• 0 54 • 2011 1 415 1 415 100 34 20 9 1 8 28

Marshall Islands 1995 –

2000 0 –

2005 5 20 400 60 10 30

2009 2 8 400 12 75 0 0 12 0

2010 10 4 40 25 25 50 0 0 0

• 0 100 • 2011 20 20 100 30 70 0 0 0 0

Micronesia 1995 2 9450 10000000

(Federated 2000 3 20 667 25 60 5 10 0 0

States of) 2005 21 9 43 11 89 0

2009 9 16 178 0 19 75 0 0 6

2010 13 10 77 20 10 10 0 20 40

• 100 100 • 2011 4 1 25 0 100 0 0 0 0

Mongolia 1995 82 23 28 61 0 9 13 13 4

2000 126 126 100 57 14 8 8 7 6

2005 341 443 130 39 34 9 11 4 3

2009 569 380 67 60 13 4 17 4 2

2010 588 234 40 19 61 9 6 2 4

• 61 74 • 2011 548 548 100 39 35 5 15 4 2

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($7UHDWPHQWRXWFRPHVUHWUHDWPHQWFDVHV±

% OF COHORT

TREATMENT SUCCESS (%)

1995–2011 YEAR NUMBER

NOTIFIED

SIZE OF

COHORT

COHORT AS

% NOTIFIED CURED COMPLETED DIED FAILED DEFAULTED NOT

EVALUATED

Nauru 1995 –

2000 0 –

2005 0 –

2009 0 1 – 100 0

2010 0 0 –

• 0 0 • 2011 0 –

New Caledonia 1995 4 4 100 100 0

2000 4 –

2005 7 7 100 86 0 14 0 0 0

2009 9 9 100 0 89 0 0 0 11

2010 8 8 100 0 88 12 0 0 0

• 100 0 • 2011 2 1 50 0 0 100 0 0 0

New Zealand 1995 4 –

2000 7 23 329 0 30 4 65

2005 19 18 95 0 67 0 0 0 33

2009 9 9 100 67 11 22

2010 11 11 100 73 18 9

• 0 50 • 2011 6 6 100 0 50 0 0 0 50

Niue 1995 0 –

2000 –

2005 0 –

2009 –

2010 0 0 –

• 0 0 • 2011 0 –

Northern Mariana 1995 0 –

Islands 2000 0 –

2005 0 0 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Palau 1995 0 –

2000 –

2005 0 0 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 1 0 0

Papua New 1995 273 –

Guinea 2000 955 68 7 29 35 4 1 21 9

2005 1 456 65 4 42 14 15 6 20 3

2009 1 388 530 38 36 22 5 5 29 3

2010 1 824 444 24 35 11 5 5 18 27

• 0 52 • 2011 1 575 398 25 32 20 7 5 22 14

Philippines 1995 8 –

2000 –

2005 3 957 –

2009 9 575 4 362 46 48 13 4 4 5 26

2010 11 141 4 554 41 53 15 5 5 6 16

• 0 65 • 2011 13 745 4 583 33 47 18 5 4 6 20

Republic of Korea 1995 2 082 2 004 96 39 1 1 2 3 53

2000 2 262 131 6 59 2 3 3 12 21

2005 7 098 3 331 47 72 3 2 0 6 18

2009 6 880 2 420 35 69 3 2 1 5 21

2010 6 876 1 813 26 76 4 2 0 6 12

• 40 74 • 2011 7 270 1 346 19 70 3 1 0 5 19

Samoa 1995 0 –

2000 0 –

2005 0 0 –

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 0 0 –

Singapore 1995 120 –

2000 55 –

2005 153 149 97 79 15 0 5 1

2009 132 130 98 37 39 20 0 1 3

2010 130 127 98 47 31 17 0 2 3

• 0 76 • 2011 162 160 99 43 33 22 0 2 0

Solomon Islands 1995 13 –

2000 0 –

2005 5 5 100 20 40 20 20 0 0

2009 2 2 100 50 50 0 0 0 0

2010 5 5 100 80 0 20 0 0 0

• 0 100 • 2011 11 10 91 30 70 0 0 0 0

Tokelau 1995 0 –

2000 0 –

2005 0 –

2009 0 0 –

2010 0 –

• 0 0 • 2011 0 –

Tonga 1995 0 9 – 10000000

2000 1 1 100 100 0

2005 0 –

2009 0 0 –

2010 0 0 –

• 100 0 • 2011 0 0 –

Tuvalu 1995 1 –

2000 –

2005 3 0 0

2009 0 0 –

2010 0 0 –

• 0 0 • 2011 1 0 0

Vanuatu 1995 1 –

2000 5 5 100 100 0 0 0 0 0

2005 8 0 0

2009 3 3 100 100 0 0 0 0 0

2010 1 1 100 100 0 0 0 0 0

• 0 100 • 2011 3 3 100 67 33 0 0 0 0

Viet Nam 1995 3 616 2 384 66 80 2 5 8 2 4

2000 5 493 8 806 160 74 5 6 5 3 7

2005 7 301 7 374 101 79 4 5 6 3 3

2009 8 131 357 4 67 6 8 2 10 7

2010 8 408 398 5 61 8 8 4 12 6

• 81 82 • 2011 8 639 8 641 100 79 3 5 5 3 5

Wallis and Futuna 1995 1 –

Islands 2000 –

2005 –

2009 0 –

2010 0 –

• 0 0 • 2011 0 –

TREATMENT SUCCESS = percent cured + percent completed then rounded to the nearest digit.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

American Samoa 2005 0 0 6

2010 75 3 4 0 0

2011 100 3 3 0 0

• 0 – 2012

Australia 2005 42 448 1 073 22 4.9 9.1 0

2010 54 686 1 281 24 3.5

2011 59 750 1 268 19 2.5

• 42 56 • 2012 56 740 1 325 8 1.1

Brunei 2005 100 163 163 2 1.2 0 0

Darussalam 2010 100 237 237 1 0.42 100 100 2

2011 100 230 230 3 1.3 100 100 0

• 100 100 • 2012 100 243 243 2 0.82 100 100 0

Cambodia 2005 2.9 1 044 36 123 86 8.2

2010 77 32 236 41 628 2 112 6.6 65 45 491

2011 82 32 544 39 670 1 656 5.1 88 79 1 305

• 3 80 • 2012 80 32 359 40 258 1 433 4.4 98 88 1 145

China 2005 990 509

2010 16 145 919 923 308 4 542 3.1 45

2011 23 208 681 911 884 4 715 2.3 36

– 34 • 2012 34 309 385 900 678 5 866 1.9 59

China, Hong Kong 2005 68 4 209 6 160 35 0.83 49 54

SAR 2010 75 3 833 5 132 24 0.63 17 29

2011 74 3 656 4 926 28 0.77

• 68 75 • 2012 75 3 707 4 969 22 0.59

China, Macao 2005 91 378 415 1 0.26 0 100

SAR 2010 92 399 433 3 0.75 33 33

2011 94 360 382 2 0.56 50 50

• 91 89 • 2012 89 360 406 4 1.1 0 25

Cook Islands 2005 0 0 1 0

2010 0 0 0

2011 100 1 1 0 0

• 0 100 • 2012 100 1 1 0 0

Fiji 2005 100 132 132 1 0.76 0 0

2010 82 157 191 3 1.9 100 100 0

2011 73 160 220 3 1.9 100 100

• 100 58 • 2012 58 127 218 5 3.9 100 60 1

French Polynesia 2005 48 30 63 0 0

2010 27 11 41 0 0

2011 27 17 64 1 5.9 100 100

• 48 44 • 2012 44 22 50 0 0

Guam 2005 72 46 64 0 0

2010 62 63 101 1 1.6 100 100

2011 65 53 82 0 0

• 72 68 • 2012 68 46 68 0 0

Japan 2005 28 319

2010 52 12 098 23 261 53 0.44

2011 49 11 221 22 681 75 0.67

– 16 • 2012 16 3 328 21 283 62 1.9

Kiribati 2005 13 44 339 2 4.5 0 0

2010 54 159 294 0 0 2

2011 77 274 354 0 0

• 13 43 • 2012 43 150 348 0 0

Lao People's 2005 3 807

Democratic 2010 38 1 533 4 083 182 12 100

Republic 2011 46 2 012 4 387 222 11 76

– 48 • 2012 48 1 999 4 156 234 12 78 303

Malaysia 2005 73 11 661 16 066 1 468 13

2010 91 17 577 19 337 1 628 9.3 22 22

2011 89 18 472 20 666 1 629 8.8 48 48

• 73 97 • 2012 97 22 124 22 710 1 347 6.1 32 1 120

Marshall Islands 2005 77 86 112 0 0

2010 68 137 201 0 0

2011 91 137 151 1 0.73 0 100

• 77 60 • 2012 60 88 147 0 0

Micronesia 2005 6.2 7 112 0 0

(Federated 2010 49 85 174 0 0

States of) 2011 97 145 150 0 0

• 6 100 • 2012 100 146 146 0 0 0

Mongolia 2005 <0.1 1 4 726 1 100 100 100

2010 89 4 256 4 801 2 <0.1 100 100 0

2011 80 3 612 4 533 3 <0.1 100 100 0

• 0 78 • 2012 78 3 465 4 453 4 0.12 75 75 0

Nauru 2005 0 0 11 0

2010 0 0 3 0

2011 0 0 5 0

• 0 – 2012

New Caledonia 2005 40 21 53 0 0

2010 0 0 57 0

2011 0 0 52

• 40 – 2012 38

New Zealand 2005 41 140 340 8 5.7

2010 60 183 305 3 1.6

2011 57 175 309 3 1.7

• 41 58 • 2012 58 171 297 3 1.8

Niue 2005 0 0 0

2010 0 0 0

2011 100 1 1 0 0

– – 2012 0

Northern Mariana 2005 98 56 57 0 0

Islands 2010 100 32 32 0 0

2011 94 31 33 0 0

• 98 79 • 2012 79 27 34 1 3.7 0 0

Palau 2005 90 9 10 0 0

2010 95 18 19 0 0

2011 83 10 12 1 10 0 0

• 90 100 • 2012 100 4 4 0 0

Papua New 2005 12 564

Guinea 2010 13 2 122 16 113 222 10 135

2011 29 4 671 16 324 531 11 256

– 17 • 2012 17 3 713 22 488 364 9.8 89 325

Philippines 2005 137 100

2010 0.94 1 634 174 389 2 0.12 0 0 16

2011 1.9 3 917 206 088 9 0.23 226

– 1 • 2012 0.89 2 040 230 162 4 0.2

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($+,9WHVWLQJDQGSURYLVLRQRI&37$57DQG,37–

% OF TB PATIENTS WITH

KNOWN HIV STATUS

2005–2012

YEAR

% OF TB

PATIENTS WITH

KNOWN HIV

STATUS

NUMBER OF TB

PATIENTS WITH

KNOWN HIV

STATUS

PATIENTS

NOTIFIED

(NEW AND

RETREAT)

NUMBER OF

HIV-POSITIVE

TB PATIENTS

% OF TESTED

TB PATIENTS

HIV-POSITIVE

% OF HIV-

POSITIVE TB

PATIENTS ON

CPT

% OF HIV-

POSITIVE TB

PATIENTS ON

ART

NUMBER OF

HIV-POSITIVE

PEOPLE

PROVIDED IPT

Republic of Korea 2005 46 969

2010 48 101 135

2011 50 491 129

– – 2012 49 532

Samoa 2005 0 0 24 0

2010 21 3 14 0 0 0

2011 0 0 20 0

• 0 0 • 2012 0 0 22 0

Singapore 2005 1 469

2010 74 1 184 1 608 50 4.2

2011 79 1 332 1 695 61 4.6

– 84 • 2012 84 1 978 2 364 47 2.4

Solomon Islands 2005 0 0 397 0

2010 11 39 341 0 0 0

2011 17 70 405 0 0

• 0 12 • 2012 12 45 372 0 0

Tokelau 2005 0 0 0

2010 0 0 0

2011 0 0 0

– – 2012

Tonga 2005 18

2010 73 8 11 0 0

2011 100 9 9 0 0

– 100 • 2012 100 11 11 0 0

Tuvalu 2005 0 0 15 0

2010 0 0 14 0

2011 31 4 13 0 0

• 0 45 • 2012 45 9 20 0 0

Vanuatu 2005 0 0 81 0

2010 7.8 9 116 0 0

2011 45 50 112 0 0

• 0 52 • 2012 52 65 126 0 0

Viet Nam 2005 15 14 128 95 892 595 4.2

2010 43 42 356 99 022 3 515 8.3 62 43 1 317

2011 59 59 176 100 518 4 703 7.9 72 48

• 15 66 • 2012 66 68 259 103 906 4 775 7 73 47 5 663

Wallis and Futuna 2005 7 0

2010 10 0 0

2011 400 8 2 0 0

– – 2012

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

American Samoa 2005 ––

2010 0 0 – 0 –

2011 0 1 – 0 –

2012 – – – – –

Australia 2005 12 ––

2010 33 868 160 48 74

2011 28 652 99 26 53

2012 18 17 (9.2–25) 14 (8.1–23) 861 130 3.0 (0.36–9.9) 31 67

Brunei 2005 ––

Darussalam 2010 0 181 100 5 100

2011 0 205 130 8 100

2012 0 0 (0–0) 0 (0–4.4) 166 100 0 (0–3.2) 14 100

Cambodia 2005 ––

2010 31 5 <0.1 93 5.7

2011 56 18 <0.1 190 13

2012 75 380 (190–580) 330 (160–590) 16 0.11 56 (21–110) 86 17

China 2005 ––

2010 2792 ––

2011 1601 9940 2.6 –

2012 3007 59 000 (52 000–66 000) 49 000 (38 000–60 000) 11472 3.6 11 000 (9 000–12 000) 4861 12

China, Hong Kong 2005 41 3271 96 163 23

SAR 2010 28 1897 61 211 41

2011 23 1992 79 207 43

2012 26 48 (30–66) 36 (22–55) 2061 76 12 (4.6–27) 232 48

China, Macao 2005 9 265 190 19 61

SAR 2010 6 221 89 39 65

2011 5 258 110 24 100

2012 8 8.3 (3.0–14) 2.3 (0.27–8.1) 261 110 6.0 (2.3–11) 28 100

Cook Islands 2005 ––

2010 0 0 – 0 –

2011 0 0 0 0 –

2012 1 1.0 (<0.1–1.0) 0 (0–0) 0 – 1.0 (<0.1–1.0) 1 100

Fiji 2005 ––

2010 0 4 4.5 4 33

2011 0 18 17 0 0

2012 0 0 (0–0) 0 (0–14) 15 9.1 0 (0–13) 1 7.7

French Polynesia 2005 0 – 3 100

2010 0 27 87 4 100

2011 0 47 110 1 50

2012 0 0 (0–0) 0 (0–4.2) 30 91 0 (0–3.6) 4 67

Guam 2005 1 39 110 0 0

2010 2 56 110 2 100

2011 0 43 110 2 67

2012 0 0 (0–6.7) 0 (0–6.7) 31 100 0 (0–0) 0 –

Japan 2005 ––

2010 68 7684 54 694 39

2011 60 7400 51 670 40

2012 64 240 (180–300) 110 (65–170) 8564 66 130 (96–180) 583 44

Kiribati 2005 1 1 0.81 –

2010 0 0 0 0 0

2011 0 ––

2012 0 15 (12–18) 13 (9.5–16) 0 0 2.3 (1.9–2.7) 0 0

Lao People's 2005 ––

Democratic 2010 2 ––

Republic 2011 4 ––

2012 10 220 (180–260) 170 (130–220) 14 0.46 48 (40–56) 48 23

Malaysia 2005 1 15010 180 1056 110

2010 64 ––

2011 141 ––

2012 74 18 (0–54) 18 (0.46–100) – 0 (0–250) –

Marshall Islands 2005 2 52 110 3 60

2010 1 68 96 3 30

2011 1 50 100 4 20

2012 3 4.4 (0–9.3) 4.4 (0.92–12) 73 140 0 (0–5.9) 0 0

Micronesia 2005 1 35 110 21 100

(Federated 2010 1 50 70 3 23

States of) 2011 1 44 98 0 0

2012 3 6.8 (5.4–8.2) 5.9 (4.3–7.3) 5 8.6 0.93 (0.78–1.1) 0 0

Mongolia 2005 0 0 0 16 4.7

2010 187 40 2.2 561 95

2011 185 157 9.1 602 110

2012 210 170 (140–190) 33 (15–58) 196 11 130 (120–150) 681 130

Nauru 2005 ––

2010 ––

2011 0 0 0 –

2012 – – – – –

New Caledonia 2005 ––

2010 0 20 62 0 0

2011 0 24 140 0 0

2012 0 0 (0–0) 0 (0–3.1) 28 120 0 (0–0.98) 0 0

New Zealand 2005 4 247 150 14 74

2010 4 243 180 10 91

2011 2 229 160 5 83

2012 4 3.7 (0–9.2) 0.75 (<0.1–4.1) 221 150 3.0 (<0.1–11) 12 80

Niue 2005 ––

2010 0 ––

2011 0 ––

2012 0 0 (0–0) 0 (0–0) – 0 (0–0) –

Northern Mariana 2005 2 24 100 1 –

Islands 2010 0 17 100 0 –

2011 0 19 100 0 –

2012 0 0 (0–0) 0 (0–6.1) 15 100 0 (0–2.0) 0 0

Palau 2005 0 3 100 0 –

2010 0 11 58 0 –

2011 1 8 100 0 0

2012 0 0 (0–2.8) 0 (0–2.8) 3 100 0 (0–0) 0 –

Papua New 2005 ––

Guinea 2010 ––

2011 15 ––

2012 58 1 100 (930–1 300) 590 (430–740) – 500 (420–590) –

Philippines 2005 274 4 <0.1 138 3.5

2010 522 3 <0.1 297 2.7

2011 1148 25 <0.1 2325 17

2012 679 12 000 (9 300–15 000) 8 500 (6 000–11 000) 35 <0.1 3 700 (2 500–5 100) 2038 12

a TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED

CASES).

b BACT+VE = bacteriologically positive cases.

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($7HVWLQJIRU0'57%DQGQXPEHURIFRQILUPHGFDVHVRI0'57%±

NEW PULMONARY CASES PREVIOUSLY TREATED CASES

YEAR

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

BACT+VE

TESTED FOR

MDR-TB

% OF

BACT+VE

TESTED FOR

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

NUMBER OF

NOTIFIED

TESTED FOR

MDR-TB

% OF NOT IFIED

TESTED FOR

MDR-TB

TOTAL

CONFIRMED

CASES OF

MDR-TB

ESTIMATED CASES

OF MDR-TB AMONG

NOTIFIED

Republic of Korea 2005 ––

2010 450 ––

2011 516 3431 17 968 13

2012 1212 2 200 (1 800–2 700) 840 (660–1 100) – 1 400 (1 000–1 900) –

Samoa 2005 ––

2010 0 0 0 0 –

2011 0 ––

2012 0 0 (0–4.1) 0 (0–4.1) 15 79 0 (0–0) –

Singapore 2005 3 895 96 105 69

2010 3 923 97 79 61

2011 6 952 97 104 64

2012 22 36 (21–51) 31 (18–48) 1178 98 5.2 (1.1–15) 93 58

Solomon Islands 2005 ––

2010 0 1 0.75 1 20

2011 0 0 0 0 0

2012 0 12 (9.1–15) 12 (8.8–15) 9 5.7 0 (0–3.3) 16 100

Tokelau 2005 ––

2010 0 0 – 0 –

2011 ––

2012 – – – – –

Tonga 2005 ––

2010 0 0 0 0 –

2011 0 0 0 0 –

2012 0 0.49 (0.36–0.61) 0.49 (0.36–0.61) 0 0 0 (0–0) 0 –

Tuvalu 2005 ––

2010 0 0 0 0 –

2011 0 ––

2012 2 0.72 (0.60–0.85) 0.49 (0.36–0.61) 1 11 0.23 (0.19–0.27) –

Vanuatu 2005 ––

2010 0 ––

2011 0 0 0 0 0

2012 0 0.47 (0.39–0.54) 0 (0–8.7) 0 0 0.47 (0.39–0.54) 0 0

Viet Nam 2005 ––

2010 101 ––

2011 601 ––

2012 273 3 800 (3 000–4 600) 2 100 (1 500–2 800) – 1 700 (1 300–2 300) –

Wallis and Futuna 2005 ––

Islands 2010 ––

2011 0 0 0 0 –

2012 – – – – –

a TOTAL CONFIRMED CASES OF MDR-TB includes cases with unknown previous treatment history (i.e. not included under NEW CASES or PREVIOUSLY TREATED

CASES).

b BACT+VE = bacteriologically positive cases.

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

American Samoa 1995 –

2000 1 1 1 2.0

2005 12 –

2010 00000000 00000000 –

2011 –

2012 –

Australia 1995 –

2000 3 16 35 25 24 19 49 0 15 19 12 15 5 14 2.1

2005 0 32 27 23 11 12 30 2 18 26 11 10 6 14 1.6

2010 2 42 33 22 25 9 27 0 4 36 43 12 2 5 12 0 1.4

2011 2 38 44 26 19 12 37 0 3 26 40 23 7 7 17 0 1.4

2012 3 26 40 17 25 16 37 0 1 27 48 15 11 9 15 0 1.3

Brunei 1995 –

Darussalam 2000 064155715 0469634 1.6

2005 0 9 19 19 12 9 0 0 9 11 8 3 2 0 2.1

2010 0 17 15 13 18 7 18 0 2 7 15 12 8 4 10 0 1.5

2011 0 11 11 11 10 11 13 0 2 5 9 6 7 3 10 0 1.6

2012 0 10 13 15 13 8 19 0 0 5 6 9 10 6 5 0 1.9

Cambodia 1995 161 453 1 244 1 147 1 253 1 257 707 123 388 1 133 1 435 1 426 1 180 578 0.99

2000 26 519 1 323 1 618 1 456 1 373 1 058 38 457 1 157 1 649 1 798 1 459 892 0.99

2005 49 894 1 600 2 349 2 043 1 964 1 811 45 790 1 413 2 089 2 323 2 058 1 573 1.0

2010 39 750 1 564 1 760 2 105 1 531 1 599 60 752 1 321 1 303 1 732 1 607 1 331 1.2

2011 34 791 1 469 1 557 1 972 1 439 1 339 39 690 1 211 1 092 1 528 1 473 1 242 1.2

2012 31 673 1 256 1 414 1 904 1 434 1 526 22 612 1 088 957 1 424 1 302 1 198 1.2

China 1995 1 102 12 791 18 306 15 487 13 105 13 489 10 130 1 169 10 890 13 250 8 376 5 679 4 579 2 841 1.8

2000 1 131 19 111 29 399 25 206 25 593 21 429 21 771 1 420 14 536 18 496 12 377 9 899 7 102 6 296 2.0

2005 1 416 43 005 49 558 55 400 54 872 53 822 69 779 1 864 31 180 27 759 24 728 19 889 18 203 21 244 2.3

2010 759 42 851 38 880 50 246 52 925 56 754 64 514 0 926 27 064 21 022 20 422 16 075 17 441 20 020 0 2.5

2011 645 37 514 34 597 43 087 47 949 51 315 55 881 0 733 22 859 18 347 17 119 14 103 15 218 17 638 0 2.6

2012 511 29 018 28 324 34 505 40 428 44 821 49 413 0 580 17 786 15 549 13 485 11 981 13 384 16 547 0 2.5

China, Hong Kong 1995 –

SAR 2000 4 78 102 160 211 236 578 5 65 115 86 44 45 211 2.4

2005 3 76 84 108 200 168 453 3 67 81 92 57 34 135 2.3

2010 2 52 84 99 184 166 413 0 3 49 101 76 64 49 133 0 2.1

2011 2 72 52 63 172 189 384 0 3 56 89 69 60 53 116 0 2.1

2012 4 63 67 95 174 178 430 0 1 45 110 76 51 54 115 0 2.2

China, Macao 1995 0 7 19 20 13 12 16 0 9 18 12 4 5 6 1.6

SAR 2000 0 10 8 25 22 9 17 0 10 4 6 6 3 13 2.2

2005 3 6 9 21 23 17 22 0 5 9 7 8 1 5 2.9

2010 0 17 5 7 22 20 11 0 0 7 6 10 5 7 6 0 2.0

2011 0 20 22 22 47 39 24 0 0 28 25 17 18 6 6 0 1.7

2012 0 10 12 13 22 32 17 0 1 12 11 13 3 7 3 0 2.1

Cook Islands 1995 0000010 0000100 1.0

2000 0000000 0000000 –

2005 0100000 0000000 –

2010 00000000 00000000 –

2011 00000000 01000000 –

2012 00000000 00000000 –

Fiji 1995 08109423 11092343 1.1

2000 08613542 0757140 1.6

2005 7 9 18 18 14 16 6 7 7 9 6 4 6 5 2.0

2010 1715116240 1111251850 1.1

2011 0121689940 1131775230 1.2

2012 2 14 12 9 12 5 7 0 2 11 10 7 6 7 7 0 1.2

French Polynesia 1995 –

2000 1334443 1410100 3.1

2005 0222042 0230113 1.2

2010 03101110 01103010 1.2

2011 03115130 03301010 1.8

2012 01223330 02303400 1.2

Guam 1995 –

2000 2166969 0312522 2.6

2005 0244224 0311202 2.0

2010 02355730 10433030 1.8

2011 01027440 01110340 1.8

2012 01045260 00002120 3.6

Japan 1995 15 342 627 995 1 847 2 059 4 089 14 258 476 298 476 637 2 234 2.3

2000 2 246 572 676 1 494 1 509 3 816 5 222 464 213 292 384 1 958 2.4

2005 9 197 488 605 868 1 418 3 867 5 187 428 249 224 309 2 077 2.1

2010 1 128 252 382 469 911 3 326 6 89 232 194 155 183 1 909 2.0

2011 0 96 215 367 465 812 3 256 0 5 94 213 203 148 223 1 840 0 1.9

2012 2 94 209 309 415 741 3 230 0 2 79 180 169 111 175 1 947 0 1.9

Kiribati 1995 –

2000 2933382 2563413 1.2

2005 3 15 15 12 17 4 1 5 22 12 7 7 3 1 1.2

2010 32713109620 515748540 1.5

2011 4 17 9 3 10 9 3 0 6 26 12 9 16 12 4 0 0.65

2012 4 19 12 16 17 11 5 0 4 15 11 10 7 2 1 0 1.7

Lao People's 1995 6 56 71 68 78 90 55 3 49 49 69 54 52 26 1.4

Democratic 2000 7 92 128 166 201 177 176 10 59 95 131 122 91 71 1.6

Republic 2005 13 136 223 296 373 300 352 7 101 186 205 244 192 178 1.5

2010 8 157 254 287 416 385 380 13 133 152 215 269 225 225 1.5

2011 8 145 275 323 474 416 375 14 141 204 208 267 215 206 1.6

2012 10 144 236 326 424 381 365 11 119 197 192 246 210 201 1.6

Malaysia 1995 59 640 879 775 788 374 1 072 58 446 448 345 316 149 339 2.2

2000 32 694 1 138 1 177 908 814 891 41 464 564 424 367 356 286 2.3

2005 244 1 179 2 218 2 277 1 980 1 427 1 507 208 1 044 1 061 947 816 586 572 2.1

2010 129 884 1 438 1 599 1 453 967 981 0 152 704 881 592 542 425 388 0 2.0

2011 63 948 1 564 1 559 1 594 1 245 1 054 0 77 837 876 584 599 459 403 0 2.1

2012 74 1 060 1 575 1 677 1 762 1 409 1 260 0 105 903 1 010 710 693 590 483 0 2.0

Marshall Islands 1995 –

2000 3541353 7730220 1.1

2005 2445611 1924342 0.92

2010 010146620 59224800 0.97

2011 17233310 15825210 0.83

2012 03869220 05725320 1.2

Micronesia 1995 0103100 0010001 2.5

(Federated 2000 0201001 4311011 0.36

States of) 2005 –

2010 38124400 58934200 0.71

2011 48562010 55231210 1.4

2012 38542010 56231300 1.2

Mongolia 1995 37 99 111 68 19 13 15 30 70 78 33 15 9 25 1.4

2000 6 181 260 171 68 38 23 32 200 213 113 41 26 17 1.2

2005 7 271 253 232 147 52 36 15 320 270 145 63 32 25 1.1

2010 3 285 255 231 154 50 40 0 12 296 246 112 83 42 28 0 1.2

2011 2 246 289 205 170 71 41 0 10 250 192 121 61 40 25 0 1.5

2012 7 257 268 191 184 63 37 0 11 250 208 97 82 28 33 0 1.4

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($1HZVPHDUSRVLWLYHFDVHQRWLILFDWLRQE\DJHDQGVH[±

MALE FEMALE

YEAR 0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

0–14 15–24 25–34 35–44 45–54 55–64 65+

UN-

KNOWN

MALE:FEMALE

RATIO

Nauru 1995 –

2000 1 1 1 0.50

2005 –

2010 00000000 00010000 –

2011 00011000 00000010 2.0

2012 –

New Caledonia1995 3234223 2113301 1.7

2000 1134234 1811324 0.90

2005 0210030 0121204 0.60

2010 01231430 01010130 2.3

2011 00031230 00110110 2.2

2012 2 3 2 1 1 1 1 2.7

New Zealand 1995 0433577 1234224 1.6

2000 06568107 16650410 1.3

2005 461066510 11196612 1.3

2010 0613465110 212765360 1.1

2011 1125577110 48845380 1.2

2012 079246140 34823150 1.6

Niue 1995 –

2000 –

2005 0000000 0000000 –

2010 –

2011 –

2012 00000000 00000000 –

Northern Mariana 1995 11351033 0026411 1.9

Islands 2000 1489932 010177311 0.92

2005 0013412 0001111 2.8

2010 02003300 02013210 0.89

2011 00001530 00102300 1.5

2012 00031100 00310000 1.2

Palau 1995 0230210 0000100 8.0

2000 –

2005 2 1 –

2010 01211110 10110000 2.3

2011 00010200 00100000 3.0

2012 00000000 00011010 –

Papua New 1995 –

Guinea 2000 8 87 70 30 21 12 5 6 77 45 21 15 5 1 1.4

2005 28 183 205 108 94 48 12 38 200 204 124 65 35 2 1.0

2010 37 279 260 196 135 87 27 64 313 292 191 97 52 9 1.0

2011 50 278 265 152 122 71 18 53 302 272 146 97 55 15 1.0

2012 54 415 387 250 182 121 37 0 55 398 395 208 156 95 29 80 1.0

Philippines 1995 2 43 56 61 46 47 26 1 20 32 26 20 19 11 2.2

2000 –

2005 482 7 358 11 275 13 253 12 531 7 646 4 279 374 3 710 5 268 5 565 4 603 3 274 2 029 2.3

2010 511 9 320 12 224 13 716 13 651 8 923 4 742 0 454 4 825 5 489 5 301 4 643 3 329 2 070 0 2.4

2011 573 9 725 12 804 14 474 14 002 9 568 4 845 448 5 155 5 848 5 521 4 880 3 501 2 236 2.4

2012 583 9 754 12 576 14 140 13 996 9 676 5 097 466 5 104 5 954 5 584 5 068 3 605 2 380 2.3

Republic of Korea 1995 27 1 131 1 613 1 425 1 207 1 307 1 225 46 908 863 431 296 408 867 2.1

2000 19 821 1 085 988 853 731 901 25 546 544 393 220 295 795 1.9

2005 22 687 1 171 1 326 1 336 1 005 1 669 27 590 842 491 370 373 1 729 1.6

2010 22 537 705 1 049 1 496 1 029 1 997 0 23 472 686 509 487 368 2 216 0 1.4

2011 13 491 712 1 019 1 414 1 145 2 132 0 37 446 688 520 432 421 2 244 0 1.4

2012 11 500 699 956 1 562 1 238 2 255 5 22 436 664 444 377 397 2 569 2 1.5

Samoa 1995 0111032 1220011 1.1

2000 0311121 0211000 2.2

2005 0401100 0202010 1.2

2010 1 1 1 3 2 1 3 1.0

2011 01000000 02101010 0.20

2012 04311100 11011010 2.0

Singapore 1995 0 9 40 60 62 70 94 1 8 18 21 22 19 31 2.8

2000 1 8 9 34 51 26 64 1 9 8 7 9 5 16 3.5

2005 0 8 25 61 94 96 118 0 5 20 33 29 20 43 2.7

2010 0 11 21 38 105 86 120 0 1 15 21 26 21 21 44 0 2.6

2011 0 21 21 44 108 119 126 0 0 11 25 23 23 20 51 0 2.9

2012 1 31 36 54 106 124 143 0 0 26 46 27 26 19 39 0 2.7

Solomon Islands 1995 2 14 6 5 7 9 3 3 17 11 7 12 13 0 0.73

2000 3 13 4 8 8 10 6 8 15 13 7 7 5 2 0.91

2005 4 14 18 9 15 12 11 9 23 21 12 11 9 1 0.97

2010 4 16 18 16 8 3 3 0 4 19 17 11 5 4 5 0 1.0

2011 3 15 22 12 7 8 6 0 3 13 27 15 10 16 2 0 0.85

2012 3 20 19 10 12 8 6 0 5 20 18 11 8 12 5 0 0.99

Tokelau 1995 –

2000 –

2005 –

2010 00000000 00000000 –

2011 –

2012 –

Tonga 1995 0100012 0011021 0.80

2000 211 15 111 11 2.0

2005 0210210 0210020 1.2

2010 00010130 00001000 5.0

2011 00100010 20110000 0.50

2012 00002020 02001110 0.80

Tuvalu 1995 1010010 0110010 1.0

2000 –

2005 1 1 1 2 0.67

2010 0100120 0010000 4.0

2011 1 1 1 1 3.0

2012 1 1 1 2 1 2 0.60

Vanuatu 1995 0625340 0502300 2.0

2000 27511052 53157331 0.86

2005 1455041 0512412 1.3

2010 46315200 35335310 0.91

2011 23465420 05754200 1.1

2012 04342220 312554230 0.50

Viet Nam 1995 –

2000 51 2 367 6 147 8 209 6 713 5 150 7 712 64 1 334 2 320 2 754 2 594 2 847 4 907 2.2

2005 54 3 408 7 105 8 738 8 606 4 958 7 573 47 1 747 2 293 2 116 2 298 2 023 4 604 2.7

2010 59 3 205 7 036 7 851 8 564 5 790 6 248 0 53 1 870 2 454 1 681 1 864 1 863 3 751 0 2.9

2011 61 3 099 6 677 7 763 8 474 6 107 5 821 0 64 1 863 2 325 1 681 1 814 1 878 3 124 0 3.0

2012 58 2 993 6 689 7 680 8 481 6 315 5 920 0 84 1 841 2 481 1 626 1 683 1 884 3 298 0 3.0

Wallis and Futuna 1995 –

Islands 2000 –

2005 –

2010 –

2011 2 –

2012 –

 GLOBAL TUBERCULOSIS REPORT 2013 Data for all years can be downloaded from www.who.int/tb/data

a LED = Light emitting diode microscopes

b DST = Drug susceptibility testing

c LPA = Line probe assay

d NRL = National Reference Laboratory

7$%/($/DERUDWRULHV173VHUYLFHVGUXJPDQDJHPHQWDQGLQIHFWLRQFRQWURO

LABORATORIES FREE THROUGH NTP

SMEAR LABS

PER 100K

POPULATION

% OF SMEAR

LABS USING

LED

CULTURE

LABS PER 5M

POPULATION

DST

LABS

PER 5M

POPULATION

LPA

LABS

PER 5M

POPULATION

NUMBER OF

LABS USING

XPERT MTB/RIF

SECOND-

LINE DST

AVAILABLE

NRL

TB DIAGNOSIS

FIRST-

LINE

DRUGS

TB NOTIF.

RATE PER

100 000

HEALTH-CARE

WORKERS

RIFAMPICIN

USED

THROUGHOUT

TREATMENT

American Samoa –

Australia – In country Yes Yes (all suspects) Yes Yes

Brunei Darussalam 0.2 0 12.1 12.1 12.1 0 Out of

country Yes Yes (all suspects) Yes Yes 26

Cambodia 1.4 10 1.0 0.3 0 6 No Yes Yes (all suspects) Yes Yes

China 0.2 2 3.7 0.7 <0.1 16 In country Yes Yes (all suspects) Yes Yes

China, Hong Kong SAR 0.4 3 9.1 1.4 1.4 9 In country Yes Yes (all suspects) Yes Yes

China, Macao SAR 0.4 0 9.0 9 0 0 In country No Yes (all suspects) Yes Yes

Cook Islands – Out of

country Yes Yes (other criteria) No Yes

Fiji 0.5 0 5.7 0 0 3 No Yes Yes (all suspects) Yes Yes 41

French Polynesia – Out of

country Yes Yes

(

if TB is

confirmed) Yes Yes

Guam – Out of

country Yes Yes (all suspects) Yes Yes

Japan – In and out

of countr y Yes No No Yes

Kiribati 2.0 0 49.6 0 0 0 Out of

country Yes Yes (all suspects) Yes Yes 93

Lao People's Democratic

Republic 2.4 0 2.3 0.8 0.8 0 No Yes Yes (all suspects) Yes No

Malaysia 2.6 4 6.2 0.2 0.3 0 In country Yes Yes (all suspects) Yes Yes 106

Marshall Islands 5.7 33 95.1 95.1 95.1 1 Out of

country No Yes (all suspects) Yes Yes

Micronesia

(Federated States of) 3.9 0 0 0 0 0 In and out

of countr y Yes Yes (all suspects) Yes Yes

Mongolia 1.4 8 3.6 1.8 1.8 0 In country Yes Yes (all suspects) Yes Yes 53

Nauru –

New Caledonia – Out of

country Yes Yes (all suspects) Yes Yes

New Zealand – In country Yes Yes (all suspects) Yes Yes

Niue –

Northern Mariana Islands – Out of

country No Yes (all suspects) Yes Yes

Palau 9.6 0 240.9 240.9 240.9 1 Out of

country Yes Yes (all suspects) Yes Yes 0

Papua New Guinea 1.6 0 0 0 0 6 Yes Yes

(

if TB is

confirmed) Yes Yes

Philippines 2.7 0 0.7 0.2 <0.1 17 In country Yes Yes (all suspects) Yes Yes

Republic of Korea 1.0 – 51.0 0.7 2 2 Yes Yes (all suspects) Yes Yes 204

Samoa – Out of

country Yes Yes (all suspects) Yes Yes

Singapore – In country Yes No No Yes

Solomon Islands 1.5 0 0 0 0 0 Out of

country Yes Yes (all suspects) Yes Yes 0

Tokelau –

Tonga – Out of

country Yes Yes (all suspects) Yes Yes

Tuvalu – Out of

country Yes Yes (all suspects) Yes Yes

Vanuatu 4.0 100 0 0 0 0 Out of

country Yes Yes (all suspects) Yes Yes 111

Viet Nam 0.9 0 1.4 0.1 0.1 22 In country Yes Yes (for smear-

positive TB) Yes No

Wallis and Futuna Islands –

 Data for all years can be downloaded from www.who.int/tb/data GLOBAL TUBERCULOSIS REPORT 2013

WESTERN PACIFIC REGION

7$%/($0HDVXUHGSHUFHQWDJHRI7%FDVHVZLWK0'57%

PRVWUHFHQW\HDUDYDLODEOH

New TB cases Previously treated TB cases

Year Source Coverage Percentage Year Source Coverage Percentage

American Samoa

Australia 2012 Surveillance National 1.9 (1.1–3.0) 2012 Surveillance National 6.5 (0.79–21)

Brunei Darussalam 2012 Surveillance National 0 (0–2.2) 2012 Surveillance National 0 (0–23)

Cambodia 2007 Survey National 1.4 (0.71–2.5) 2007 Survey National 11 (4.0–22)

China 2007 Survey National 5.7 (4.5–7.0) 2007 Survey National 26 (22–30)

China, Hong Kong SAR 2012 Surveillance National 0.97 (0.59–1.5) 2012 Surveillance National 2.6 (0.95–5.5)

China, Macao SAR 2012 Surveillance National 0.77 (<0.1–2.7) 2012 Surveillance National 21 (8.3–41)

Cook Islands 2012 Surveillance National 0 (0–98) 2012 Surveillance National 100 (2.5–100)

Fiji 2006 Surveillance National 0 (0–8.2) 2006 Surveillance National 0 (0–98)

French Polynesia 2012 Surveillance National 0 (0–12) 2012 Surveillance National 0 (0–60)

Guam 2012 Surveillance National 0 (0–11) 2012 Surveillance National 12 (9.2–15)

Japan 2002 Surveillance National 0.7 (0.42–1.1) 2002 Surveillance National 9.8 (7.1–13)

Kiribati

Lao People's Democratic

Republic

Malaysia 1997 Survey Sub-national 0.1 (0–0.56) 1997 Survey Sub-national 0 (0–17)

Marshall Islands 2012 Surveillance National 4.1 (0.86–12) 2012 Surveillance National 0 (0–98)

Micronesia

(Federated States of)

Mongolia 2007 Survey National 1.4 (0.66–2.5) 2012 Surveillance National 26 (23–30)

Nauru

New Caledonia 2012 Surveillance National 0 (0–12) 2012 Surveillance National 0 (0–98)

New Zealand 2011 Surveillance National 0.44 (<0.1–2.4) 2011 Surveillance National 20 (0.51–72)

Niue

Northern Mariana Islands 2012 Surveillance National 0 (0–22) 2012 Surveillance National 0 (0–98)

Palau 2012 Surveillance National 0 (0–71) 2012 Surveillance National 23 (20–27)

Papua New Guinea

Philippines 2004 Survey National 4 (2.9–5.5) 2004 Survey National 21 (14–29)

Republic of Korea 2004 Survey National 2.7 (2.1–3.4) 2004 Survey National 14 (10–19)

Samoa 2012 Surveillance National 0 (0–22) 2012 Surveillance National 0 (0–98)

Singapore 2012 Surveillance National 1.6 (0.97–2.5) 2012 Surveillance National 3.2 (0.67–9.1)

Solomon Islands 2012 Surveillance National 0 (0–21)

Tokelau

Tonga

Tuvalu

Vanuatu 2006 Surveillance National 0 (0–12)

Viet Nam 2006 Survey National 2.7 (2.0–3.7) 2006 Survey National 19 (14–25)

Wallis and Futuna Islands

a Empty rows indicate an absence of high-quality survey or surveillance data. In the absence of high-quality national data, high-quality sub-national data are used.

For further information about tuberculosis contact:

Information Resource Centre HTM/GTB

World Health Organization

20 Avenue Appia, 1211–Geneva–27, Switzerland

Email: tbdocs@who.int

Web site: www.who.int/tb

ISBN 978 92 4 1564656

The World Health Organization monitors the

global tuberculosis epidemic in support of

national TB control programmes.

GTBR13_cover M_spine20_5 91355 9789241564656 Eng

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