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Tuberculosis control in the Western Pacific Region : 2009 report

December 31, 2009 World Health Organization

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2009 Report

Tuberculosis Control in the Western Pacific Region

Prepared by Dr Angelito Bravo was the lead author of this report. The following WHO staff from the regional and the country offices contributed to the report: Pieter van Maaren, Katsunori Osuga, Bernard Tomas, Masaki Ota, Cornelia Hennig, Liu Yuhong, Giampaolo Mezzabotta, Nguyen Nhat Linh, Jacques Sebert, Jamhoih Tonsing, Michael Voniatis and Rajendra Yadav. Correspondence: stoptb@wpro.who.int Acknowledgements We would like to thank the national TB control programme (NTP) managers and statisticians from all countries and areas of the Western Pacif ic Region for providing data for this publication and to the Stop TB team in the TB Monitoring and Evaluation unit at WHO headquarters responsible for the 2009 Global TB Report.

WHO Library Cataloguing in Publication Data Tuberculosis control in the Western Pacif ic Region: 2009 Report

1. Tuberculosis – epidemiology. 2. Tuberculosis – prevention and control. 3. Tuberculosis – drug therapy. 4. Directly observed therapy – utilization. 5. Tuberculosis, Multidrug-resistant. 6. Western Pacif ic.

ISBN 978 92 9061 438 8

(NLM Classification: WF 200)

© World Health Organization 2009 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22791 2476; fax: +41 22791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce WHO publications, in part or in whole, or to translate them - whether for sale or for noncommercial distribution - should be addressed to Publications, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). For WHO Western Pacif ic Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacif ic, P.O. Box 2932, 1000, Manila, Philippines, fax: +632 521 1036, e-mail: publications@wpro.who.int Layout and design by Alexander Pascual, www.alexdesigns.ph

Contents List of figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv List of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi List of abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Summary Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.1 Estimated burden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2 Progress towards 2010 regional goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2.3 Case notification and trend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.4 Drug resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.5 TB-HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5.1 Estimated prevalence of HIV among new TB cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5.2 Surveillance data on HIV in TB cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

3 TB Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.1 DOTS coverage, case detection, and trend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.2 Treatment outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.3 Laboratory capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Profiles of countries with a high burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4.1 Cambodia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4.2 China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 4.3 The Lao People’s Democratic Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 4.4 Mongolia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.5 Papua New Guinea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.6 The Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4.7 Viet Nam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Summary of the TB burden and epidemiologic indicators of Pacif ic island countries and areas in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Annex 1: Estimation of prevalence and TB mortality rates for future years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Annex 2: Estimation of MDR-TB prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Annex 3: Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 1. Definitions of tuberculosis cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 2. Definitions of treatment outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 3. Indicators to assess treatment outcome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4. Case detection rate and DOTS detection rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 5. Definitions of MDR-TB and XDR-TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Tuberculosis Control in the Western Pacific : 2009 Report

iii

Annex 4: Formulas for estimating tuberculosis incidence, prevalence, and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Annex 5: Directory of partners for countries with high burden of TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Annex 6: Subnational data for 7 countries with a high burden of TB, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Annex 7: Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Annex 8: Notified prevalence of resistance to anti-TB drugs (1997–2007) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

List of f igures Figure 1. Estimated incident cases of all forms of TB by WHO Region, 2007 (N=9 272 799) .........................................................................................3 Figure 2. Prevalence (left) and incidence (right) rates of all forms of TB by country and area, 2007 .............................................................................3 Figure 3. Number of estimated incident cases of all forms of TB among countries with a high burden of TB in the Region, 2007 ................................4 Figure 4. Estimated prevalence (left) and mortality (right) rates in the Region, 1990, 2000–2007..............................................................................4 Figure 5. Case notification rates per 100 000 population for all forms of TB in countries and areas in the Region and neighbouring countries and areas, 2007.................................................................................................................................................5 Figure 6. Case notification rates (all forms of TB and smear-positive cases) in the Region, 1998–2007 .......................................................................6 Figure 7. Smear-positive notification rates, by age and sex, in the Region and the seven countries with a high burden of TB, 2007............................7 Figure 8. Distribution of sex ratio (male to female) of notified smear-positive cases by age group in Cambodia and Viet Nam, 2007 ..........................7 Figure 9. Percentage of MDR-TB among new and re-treatment cases in selected countries and areas within the Region, 2007 ..................................8 Figure 10. Geographical distribution of proportion of MDR-TB among new TB cases by country and area in the Region, 2000–2008 ...........................9 Figure 11. Geographical distribution of proportion of MDR-TB among re-treatment TB cases by country and area in the Region and by province in China, 2000–2008 .........................................................................................................................................................10 Figure 12. Estimated HIV prevalence in incident TB cases (%) in selected countries in the Region, 2007 .....................................................................11 Figure 13. Estimated prevalence of HIV in new TB cases against prevalence of HIV in adults in countries and areas in the Region, 2007 .....................11 Figure 14. Trends in DOTS coverage and case detection in smear-positive cases in the Region, 1995–2007 ................................................................13 Figure 15. Treatment outcomes for new smear-positive cases registered in 2006 in DOTS areas in countries with a high burden of TB in the Region........................................................................................................................................................14 Figure 16. Unfavourable outcomes among new smear-positive cases and re-treatment smear-positive cases registered in 2006 in DOTS areas in the Region ............................................................................................................................................................14 Figure 17. Cambodia ....................................................................................................................................................................................................17 Figure 18. Case notification rates (all forms of TB and smear-positive), Cambodia, 1998–2007...................................................................................19 Figure 19. Geographical distribution of notification rates of all forms of TB cases, Cambodia, 2007 .............................................................................19 Figure 20. Distribution of forms of TB among new cases, Cambodia, 2003–2007 ........................................................................................................19 Figure 21. Distribution of forms of TB among notified cases, Cambodia, 2003–2007...................................................................................................20 Figure 22. China ...........................................................................................................................................................................................................21 Figure 23. Case notification rates (all forms of TB and smear-positive), China, 1998–2007 .........................................................................................22 Figure 24. Geographical distribution of notification rates of all forms of TB cases, China, 2007 ....................................................................................22 Figure 25. Distribution of forms of TB among new cases, China, 2003–2007 ...............................................................................................................23 Figure 26. Distribution of forms of TB among new and re-treatment cases, China, 2003–2007 ...................................................................................23

Tuberculosis Control in the Western Pacific : 2009 Report

Figure 27. The Lao People’s Democratic Republic.........................................................................................................................................................25 Figure 28. Trend of case notification rates (all forms of TB and smear-positive), The Lao People’s Democratic Republic, 1998–2007 ...........................26 Figure 29. Geographical distribution of notification rates of all forms of TB cases, The Lao People’s Democratic Republic, 2007 ..................................27 Figure 30. Distribution of forms of TB among new cases, The Lao People’s Democratic Republic, 2003–2007..............................................................27 Figure 31. Distribution of forms of TB among new and re-treatment cases, The Lao People’s Democratic Republic, 2003–2007 .................................28 Figure 32. Mongolia .....................................................................................................................................................................................................29 Figure 33. Case notification rates (all forms of TB and smear-positive), Mongolia, 1998–2007 ...................................................................................30 Figure 34. Geographical distribution of notification rates of all forms of TB cases, Mongolia, 2007 ..............................................................................31 Figure 35. Distribution of forms of TB among new cases, Mongolia, 2003–2007 .........................................................................................................31 Figure 36. Distribution of forms of TB among notified cases, Mongolia, 2003–2007 ...................................................................................................31 Figure 37. Papua New Guinea ......................................................................................................................................................................................33 Figure 38. Case notification rates (all forms of TB and smear-positive), Papua New Guinea, 1998–2007 .....................................................................34 Figure 39. Geographical distribution of notification rates of all forms of TB cases, Papua New Guinea, 2007 ...............................................................35 Figure 40. Distribution of forms of TB among new cases, Papua New Guinea, 2003–2007 ..........................................................................................35 Figure 41. Distribution of forms of TB among new and re-treatment cases, Papua New Guinea, 2003–2007 ..............................................................36 Figure 42. The Philippines ............................................................................................................................................................................................37 Figure 43. Case notification rates (all forms of TB and smear-positive), The Philippines, 1998–2007...........................................................................38 Figure 44. Geographical distribution of notification rates of all forms of TB cases, The Philippines, 2007 .....................................................................39 Figure 45. Distribution of forms of TB among new cases, The Philippines, 2003–2007 ................................................................................................39 Figure 46. Distribution of forms of TB among new and re-treatment cases, The Philippines, 2003–2007 ....................................................................40 Figure 47. Viet Nam .....................................................................................................................................................................................................41 Figure 48. Case notification rates (all forms of TB and smear-positive), Viet Nam, 1998–2007 ....................................................................................43 Figure 49. Geographical distribution of notification rates of all forms of TB cases, Viet Nam, 2007 ..............................................................................43 Figure 50. Distribution of forms of TB among new cases, Viet Nam, 2003–2007..........................................................................................................44 Figure 51. Distribution of forms of TB among new and re-treatment cases, Viet Nam, 2003–2007 .............................................................................44 Figure 52. Geographic distribution of the Pacif ic island countries and areas ................................................................................................................45 Figure 53. Trend of case notification rates (all forms of TB and smear-positive cases) in selected Pacif ic island countries and areas in the Region, 2000–2007 ....................................................................................................46

Tuberculosis Control in the Western Pacific : 2009 Report

List of tables Table 1. Table 2. Table 3. Table 4. Table 5. Table 6. Table 7. Table 8. Table 9. Main TB indicators 2007 ..............................................................................................................................................................................xii Estimated TB prevalence and mortality in 2010 by countries with a high burden of TB in the Region, and 2010 regional goal .....................5 Case notification number and rates (all forms of TB and smear-positive cases) among countries with a high burden of TB in the Region, 2006–2007 .....................................................................................................................................6 Breakdown of re-treatment cases and number of cases receiving DST in the seven countries with a high burden of TB, 2007 ......................8 Surveillance data on HIV in TB cases in selected countries in the Region, 2007 ...........................................................................................12 Case detection rates of smear-positive cases in countries with a high burden of TB in the Region, 2006–2007 ..........................................13 External quality assessment of sputum smear microscopy in countries with a high burden of TB in the Region, 2007 ................................15 Laboratory services in countries with a high burden of TB in the Region, 2007 ...........................................................................................15 Key indicators, Cambodia, 2007...................................................................................................................................................................18

Table 10. Surveillance and DOTS implementation, Cambodia, 2007 ...........................................................................................................................18 Table 11. Trend of DOTS performance indicators, Cambodia .......................................................................................................................................18 Table 12. Key indicators, China, 2007..........................................................................................................................................................................21 Table 13. Surveillance and DOTS implementation, China, 2006 ..................................................................................................................................21 Table 14. Trend of DOTS performance indicators, China ..............................................................................................................................................22 Table 15. Key indicators, The Lao People’s Democratic Republic, 2007 ........................................................................................................................25 Table 16. Surveillance and DOTS implementation, The Lao People’s Democratic Republic, 2007.................................................................................26 Table 17. Trend of DOTS performance indicators, The Lao People’s Democratic Republic, 2000–2007 ........................................................................26 Table 18. Key indicators, Mongolia, 2007....................................................................................................................................................................29 Table 19. Surveillance and DOTS implementation, Mongolia, 2007 ............................................................................................................................30 Table 20. Trend of DOTS performance indicators, Mongolia, 2000–2007 ....................................................................................................................30 Table 21. Key indicators, Papua New Guinea, 2007 .....................................................................................................................................................33 Table 22. Surveillance and DOTS implementation, Papua New Guinea, 2007 .............................................................................................................34 Table 23. Trend of DOTS performance indicators, Papua New Guinea, 2000–2007 .....................................................................................................34 Table 24. Key indicators, The Philippines, 2007...........................................................................................................................................................37 Table 25. Surveillance and DOTS implementation, The Philippines, 2007 ...................................................................................................................38 Table 26. Trend of DOTS performance indicators, The Philippines, 2000-2007 ............................................................................................................38 Table 27. Key indicators, Viet Nam, 2007 ....................................................................................................................................................................42 Table 28. Surveillance and DOTS implementation, Viet Nam, 2007.............................................................................................................................42 Table 29. Trend of DOTS performance indicators, Viet Nam, 2000–2007.....................................................................................................................42 Table 30. Key indicators of TB control in the Pacif ic island countries and areas in the Region, 2007............................................................................46 Table 31. Estimated burden of TB, 2000 and 2007 ......................................................................................................................................................64 Table 32. Whole country and area case notifications and case detection rates, 2007 ..................................................................................................66 Table 33. DOTS coverage, case notifications and case detection rates, 2007 ...............................................................................................................68 Table 34. Laboratory services, management of MDR-TB and collaborative TB-HIV activities ......................................................................................70 Table 35. Treatment outcomes, 2006 cohort ...............................................................................................................................................................72 Table 36. Re-treatment outcomes, 2006 cohort..........................................................................................................................................................74 Table 37. DOTS treatment success and case detection rates, 1994–2007 ....................................................................................................................76 Table 38. New smear-positive case notification by age and sex, absolute numbers, DOTS and non-DOTS, 2007 .........................................................78 Table 39. New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2007 ..............................................................................80 Table 40. Number of TB cases notified, 1980–2007 ....................................................................................................................................................82

Tuberculosis Control in the Western Pacific : 2009 Report

Table 41. Case notification rates, 1980–2007 .............................................................................................................................................................84 Table 42. New smear-positive cases notified, numbers and rates, 1993–2007 ...........................................................................................................86 Table 43. Notified prevalence of resistance to specific drugs among new TB cases tested for resistance .....................................................................88 Table 44. Notified prevalence of resistance to specific drugs among previously treated TB cases tested for resistance ...............................................90 Table 45. Notified prevalence of resistance to specific drugs among all TB cases tested for resistance .......................................................................92 Table 46. Notified prevalence of extensively drug resistant TB (XDR-TB) among MDR-TB, 2002–2007 .......................................................................94

List of abbreviations ART CTX DOTS DRS DST EQA GLC HIV IDU IPT MDR-TB NAP NTP PLWHA pop ss+ or ssSRLN TB WHO antiretroviral therapy co-trimoxazole prophylaxis directly observed treatment, short-course drug resistance surveillance drug susceptibility testing external quality assessment Green Light Committee human immunodeficiency virus injecting drug users isoniazid preventive therapy multidrug-resistant tuberculosis national AIDS control programme national tuberculosis control programme people living with HIV/AIDS population sputum smear-positive or sputum smear-negative supranational laboratory network tuberculosis World Health Organization

Tuberculosis Control in the Western Pacific : 2009 Report

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Executive summary The 2009 report on tuberculosis (TB) control in the WHO Western Pacif ic Region presents data on disease burden, case notifications in 2007 and treatment outcomes for patients registered in 2006. The report also includes information on drug resistance, TB-HIV co-infection, laboratory services, profiles of seven countries with a high burden of TB in the Region, and a summary of the epidemiologic indicators in Pacif ic island countries and areas in the Region. The report aims to provide an update on the current epidemiological situation of TB and to show progress in TB control in the Region. The report highlights the following: TB burden There were an estimated 1.9 million incident cases of TB (108 per 100 000 population) in 2007, including 0.9 million new smear-positive cases (48 per 100 000 population). In absolute numbers, China, the Philippines, Viet Nam, and Cambodia ranked first to fourth, respectively. These four countries accounted for 93% of the total estimated incident cases in the Region. Cambodia had the highest incidence rate (495 per 100 000 population). Death from TB occurred in approximately 0.3 million cases (16 per 100 000 population). The mortality rate was highest in Cambodia (89 per 100 000 population). Progress towards 2010 regional goal The 2010 regional goal is to decrease by half the TB prevalence and mortality rates from 2000. From 2000 to 2007, the TB prevalence rate declined by 24% at a rate of -4.5% per year and the mortality rate declined by 19% at a rate of -3.7% per year. At the current rate of decline, the prevalence rate will drop from 260 to 169 per 100 000 population by 2010, and the mortality rate from 21 to 15 per 100 000 population. Case notification and trends The Region accounted for approximately 1.4 million cases of all forms of TB notified in 2007 (77 per 100 000 population), corresponding to 25% of the total cases notified globally. There were approximately 0.7 million notified cases of smear-positive TB (38 per 100 000 population), corresponding to 26% of the total smear-positive cases notified globally. The largest number of smear-positive cases was reported from China (0.5 million), followed by the Philippines (87 000) and Viet Nam (54 000). Treatment outcomes Of the 0.7 million new pulmonary smear-positive cases registered for treatment in directly observed treatment, short-course (DOTS) areas in 2006, treatment success rate was 92%. Treatment success rates were above the 85% target in all countries with a high burden of TB, except Papua New Guinea, where it was reported at 73%. Multidrug-resistant TB The proportion of MDR-TB in new TB cases was estimated to be 4%, of which cases from China, the Philippines, and Viet Nam accounted for 97% of the overall total MDR-TB cases. The proportion of MDR-TB in re-treatment cases was estimated to be 24%.

Tuberculosis Control in the Western Pacific : 2009 Report

TB-HIV co-infection Among the reporting countries and areas, 95 300 TB patients, which represents 7.0% of the 1 365 284 TB cases notified (new and relapse), were tested for HIV infection. Out of 95 300 tested, 6679 were found to be HIV positive (7.0%). The overall estimated prevalence of HIV in new TB cases was 2.7% in the Region. Laboratory services In 2007, there were 7997 TB laboratories that performed acid-fast bacilli (AFB) smear microscopy, 6262 (78%) of which participated in external quality assessment (EQA) programmes. In five of the seven countries with a high burden of TB—Cambodia, China, the Lao People’s Democratic Republic, Mongolia, and the Philippines—over 93 % of sputum smear microscopy centres participated in EQA activities.

Tuberculosis Control in the Western Pacific : 2009 Report

Summary Table Table 1. Main TB indicators 2007 Incidence and case DOTS coverage % Est. incidence all forms rate † ss+ rate † CDR new ss+ % 2000 All forms rate † 2007 All forms rate † change* % 2000 All forms rate † 2007 All forms rate † change* % Prevalence Mortality

Population thousands

American Samoa Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Cook Islands Fiji French Polynesia Guam Japan Kiribati Lao PDR Malaysia Marshall Islands Micronesia Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Western Pacif ic Region

67 20 743 390 14 444 1 328 630 7206 481 13 839 263 173 127 967 95 5859 26 572 59 111 2629 10 242 4179 2 84 20 6331 87 960 48 224 187 4436 496 1 100 11 226 87 375 15 1 776 440

100 100 100 100 100 100 100 100 100 100 99 100 100 100 96 89 100 100 100 100 100 100 100 14 100 100 100 100 100 100 83 100 100 100

5 6 59 495 98 62 63 15 21 27 34 21 365 151 103 215 97 205 33 22 7 58 60 250 290 90 19 27 128 24 166 77 171 15 108 3 39 219 44 28 28 7 9 8 3 9 164 67 45 97 44 92 33 6 3 19 27 108 130 40 8 12 58 11 75 35 76 7 48 96 50 129 152 52 82 90 78 67 90 90 78 66 78 80 33 97 76 90 90 60 90 90 31 75 56 49 90 61 80 75 102

8 6 108 758 269 78 87 12 42 40 44 45 546 344 135 431 173 297 44 51 11 135 104 486 600 113 27 39 300 34 422 143 248 103 260

5 6 65 664 194 63 63 31 30 32 36 28 423 289 121 281 100 234 33 25 7 72 71 430 500 126 25 27 180 28 203 102 220 25 197

1 1 1 1 1 1 1 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

1 1 9 111 20 7 8 1 5 5 4 4 62 28 18 47 20 37 4 4 1 10 8 59 57 9 3 4 33 3 40 16 25 11 21 1 7 89 15 5 5 4 4 3 2 3 49 24 18 32 9 29 3 2 1 7 8 60 41 10 3 3 21 2 17 12 24 3 16 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 1 1 1 1 1 1 1 1

est. = estimated; CDR = case detection rate; ss+ = sputum smear-positive; ss- = sputum smear-negative; unk. = sputum smear result unknown; * 2007 value / 2000 value, expressed as a percentage. The 2010 target is 50% † per 100 000 population

xii

Tuberculosis Control in the Western Pacific : 2009 Report

Notified TB cases New pulmonary New and relapse number rate † number ss+ rate † ss-/unk. number

Cure/Success 2006 ss+ cohort Cured % Success %

Est. HIV-TB

Est. MDR-TB Percentage of new retreatment % %

Est. prevalence in adult incident TB cases (%)

3 1115 207 35 601 979 502 5363 342 94 64 53 24 779 334 3905 16 129 158 137 4654 3 47 274 44 11 15 002 140 588 37 554 1359 397 23 18 122 97 400 2 1 365 284

4 5 53 246 74 74 71 11 24 31 19 351 67 61 267 123 177 30 19 7 52 54 237 160 78 31 80 23 171 54 111 13 77 281 136 19 421 465 877 1501 138 52 19 5 9433 103 3080 9578 19 47 1856 3 12 81 14 5 2087 86 566 10 927 504 142 14 12 41 54 457 1 666 412 1 35 134 35 21 29 6 7 3 7 108 53 36 32 42 71 30 5 2 17 25 33 98 23 11 29 14 114 18 62 7 38

3 372 8 7120 430 634 2779 147 7 32 43 9051 78 437 4086 97 62 673 15 108 28 3 5731 49 422 18 778 564 147 5 1 38 17 554 1 548 024 42 40 59 80 78 70 73 100 75 88 90 50 89 13 84 90 92 72 88 66 85 90 20 61 88 46 73 60 84 50 89 85 84 93 94 78 88 66 85 90 53 90 92 48 75 90 88 100 89 70 85 60 73 88 81 84 90 100 75 90 92 100 92

– 3 8 2 – – – 2 – – – 3 16 – – – – 1 – – – 19 1 – 3 – – – – – 8 – 3

– – 2 5 1 2 – – 2 – 1 3 3 3 3 1 – – – – 2 3 4 3 3 – – 3 – – 3 – 4

– – 20 3 26 8 16 – – 20 – 10 20 20 20 21 26 – – – – 20 20 21 14 20 1 – – 20 – – 19 – 24

Tuberculosis Control in the Western Pacific : 2009 Report

xiii

1 Introduction This report is the annual report on tuberculosis (TB) control published by the World Health Organization (WHO), Regional Office for the Western Pacific. Geographically and economically, the Western Pacific Region (the Region)—which covers East Asia and the Pacif ic—has great diversity of natural and human resources, economic dynamism, technological expertise and agricultural productivity. The Region has a total population of 1776 million, representing approximately 27% of the world’s population. Each year, 36 countries and areas in the Region 1 submit data to WHO using a standardized data collection form for reporting surveillance data. Using data on disease burden and case notifications in 2007 and treatment outcomes of patients registered for treatment in 2006, this report presents an assessment of TB epidemiology, burden, estimation and progress towards the regional goal of reducing 2000 prevalence and mortality rates by half by 2010. 2 The outcome targets are detection of at least 70% of new smear-positive cases and successful treatment of at least 85% of detected cases. This report includes data on drug resistance, 3 TB-HIV surveillance and laboratory services within the Region. The report provides country and area-specific data, which include epidemiologic indicators and detailed estimation of prevalence and mortality for Pacif ic island countries and areas, and the seven countries and areas with a high burden of TB. In addition, a list of major partners involved in TB control activities with contact information is listed for each country with a high burden of TB. There are seven annexes. The first four describe methods for estimation of prevalence, mortality and numbers of multidrug-resistant TB 4 (MDR-TB) cases, and provide definitions and formulas used to derive estimates. Annex 5 lists the different partners involved in the seven countries with a high burden of TB. Annex 6 lists all the tables used as reference in this report. The notified prevalence of resistance to anti-TB drugs can be found in Annex 7.

1 2 3 4

See Table 1 for countries and areas in the Region. The regional goal differs from the Millennium Development Goals. Including preliminary data for 2008. Isolate resistant to at least isoniazid and rifampicin. Tuberculosis Control in the Western Pacific : 2009 Report

2 Epidemiology 2.1 Estimated burden In 2007, there were an estimated 3.5 million prevalent cases of TB (197 per 100 000 population) in the Region. Over 1.9 million of these were new cases (108 per 100 000 population), including 0.9 million new smear-positive cases (48 per 100 000 population). The estimated number of incident cases account for 21% of the global burden of TB (Figure 1). Figure 2 shows the estimated prevalence and incidence rates of TB by country and area. The incidence rate was highest in Cambodia (495 per 100 000 population). Cases from Cambodia, China, the Philippines and Viet Nam together account for 93% of all incident cases. Figure 3 shows the number of incident cases among countries with a high burden of TB in the Region.

Figure 1.

Estimated incident cases of all forms of TB by WHO Region, 2007 (N=9 272 799)

Figure 2.

Prevalence (left) and incidence (right) rates of all forms of TB by country and area, 2007

Tuberculosis Control in the Western Pacific : 2009 Report

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Figure 3.

Number of estimated incident cases of all forms of TB among countries with a high burden of TB in the Region, 2007

Death from TB occurred in approximately 0.3 million cases in 2007 (16 per 100 000 population). The mortality rate was highest in Cambodia (89 per 100 000 population) and lowest in Australia and New Zealand (1 per 100 0000 population). Deaths from TB in Cambodia, China, the Philippines, and Viet Nam account for 93% of all TB mortality in the Region.

2.2 Progress towards 2010 regional goal The 2010 regional goal is to decrease by half the TB prevalence and mortality rates from 2000. From 2000 to 2007, the prevalence rate declined by 24% at a rate of -4.5% per year and the mortality rate declined by 19% at a rate of -3.7% per year (Figure 4). At the current rate of decline, by 2010 the prevalence rate is projected to drop from 260 to 169 per 100 000 population and the mortality rate from 21 to 15 per 100 000 population (see the estimation method in Annex 1) (Table 2). It is evident that with the current trend for prevalence and mortality rates, this goal will not be met.

Figure 4.

Estimated prevalence (left) and mortality (right) rates in the Region, 1990, 2000–2007

Tuberculosis Control in the Western Pacific : 2009 Report

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Table 2.

Estimated TB prevalence and mortality in 2010 by countries with a high burden of TB in the Region, and 2010 regional goal Prevalence rate Country Overall change Annual rate of 2000-2007 decline a Estimate in 2010* 2010 goal† Mortality rate Overall change Annual rate of 2000-2007 decline a Estimate in 2010* 2010 goal†

Cambodia

-12% -28% -16% -21% -12% -17% -11% -24%

-2.0% -5.3% -2.7% -3.9% -1.8% -2.6% -1.7% -4.5%

618 163 264 194 412 457 207 169

379 135 172 149 243 300 124 130

-19% -16% -11% -23% +2% -29% -4% -19%

-3.4% -3.7% -2.2% -6.2% -1.3% -4.9% -0.3% -3.7%

79 14 22 21 51 34 24 15

56 10 14 19 30 29 13

China Lao People’s Democratic Republic Mongolia Papua New Guinea Philippines Viet Nam Western Pacif ic Region a

Average from 2000 through 2007 * Per 100 000 population, assuming current rate of change † Assuming current annual rate of change

2.3 Case notification and trend The Region accounted for approximately 1.4 million cases of all forms of TB notified in 2007 (77 per 100 000 population), corresponding to 25% of the total cases notified globally. There were approximately 0.7 million notified cases of smear-positive TB (38 per 100 000 population), corresponding to 26% of the total smear-positive cases notified globally. The largest number of smear-positive cases was reported from China (0.5 million), followed by the Philippines (87 000) and Viet Nam (54 000). Together with Cambodia, cases from these countries accounted for 94% of all cases notified in the Region. Figure 5 shows case notification rates for all forms of TB in countries and areas in the Region and neighbouring countries and areas in 2007. Two countries with a high burden of TB in the Region, Cambodia and Papua New Guinea, had case notification rates of ≥200 per 100 000 population.

Figure 5.

Case notification rates per 100 000 population for all forms of TB in countries and areas in the Region and neighbouring countries and areas, 2007

The boundaries shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO 2005. All rights reserved Tuberculosis Control in the Western Pacific : 2009 Report

2 | EPIDEMIOLOGY

Since 2002, the case notification rates in the Region have steadily increased from 47 to 75 per 100 000 population in all forms of TB (trend +11.8% per year; 95% CI, +5.4% to +18.2%) and from 22 to 38 per 100 000 population in new smear-positive TB cases (trend +14.7% per year; 95% CI, +6.9% to +22.5%). Compared to 2005 however, the case notification rate in new smear-positive cases in 2006 was relatively unchanged (Figure 4).

Figure 6.

Case notification rates (all forms of TB and smear-positive cases) in the Region, 1998–2007

Table 3 shows case notification rates among countries with a high burden of TB for 2006 and 2007. An increase in the rate can be seen in Papua New Guinea for all forms of TB by 17% and smear-positive cases by 7%. A decrease in the rate can be seen in Mongolia for all forms of TB by 9% and smear-positive cases by 13%.

Table 3.

Case notification number and rates (all forms of TB and smear-positive cases) among countries with a high burden of TB in the Region, 2006–2007 Case notification All forms (new and relapse) 2006 # Rate* # 2007 % change Rate* of rate 2006 # Rate* # Smear-positive 2007 % change Rate* of rate

Cambodia

34 660 940 889 3958 5049 12620 147 305 97 363

244 71 69 194 203 171 113

35 601 979 502 3905 4654 15 002 140 588 97 400

246 74 67 177 237 160 111 77

+1 +4 +3 -9 +17 -6 -2 -3

19 294 468 291 3041 2129 1948 85 740 56 437 671 243

136 35 53 82 31 99 65 38

19 421 465 877 3080 1856 2087 86 566 54 457 666 412

134 35 53 71 33 98 62 38

-2 0 0 -13 +7 -1 -5

China Lao People’s Democratic Republic Mongolia Papua New Guinea Philippines Viet Nam * per 100 000 population # number

Western Pacif ic Region 1 331 512

75 1 365 284

Figure 7 shows the case notification rates (new smear-positive) by age and sex for the Region and the seven countries with a high burden of TB. In general, TB disproportionately affected males and older persons, however in Mongolia and Papua New Guinea, cases were equally distributed in different age groups.

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Figure 7.

Smear-positive notification rates, by age and sex, in the Region and the seven countries with a high burden of TB, 2007

The distribution of sex ratio of notified smear-positive cases by age group showed very different patterns between Cambodia and Viet Nam (Figure 8). The sex ratio is consistently close to 1.0 through all ages, except the age group of 65 years or older in Cambodia, while the ratio is more than 2.0 from ages 25 to 64 in Viet Nam. Further study is needed to analyze the data and explain the difference in these patterns.

Figure 8.

Distribution of sex ratio (male to female) of notified smear-positive cases by age group in Cambodia and Viet Nam, 2007

Tuberculosis Control in the Western Pacific : 2009 Report

2 | EPIDEMIOLOGY

2.4 Drug resistance Figure 9 shows the proportions of MDR-TB cases in new and re-treatment cases estimated to have occurred in selected countries and areas in 2007 (see Annex 2 for estimation method). A total of 135 411 MDR-TB cases were estimated to have occurred in 2007 (see Annex 5).

Figure 9.

Percentage of MDR-TB among new and re-treatment cases in selected countries and areas within the Region, 2007

In 2007, the proportion of MDR-TB in new TB cases was estimated to be 4%. The proportion of MDR-TB in re-treatment cases was estimated to be 24%. MDR-TB cases from China, the Philippines, and Viet Nam accounted for 97% of the total estimated MDR-TB cases among both new and re-treatment cases. The proportion of re-treatment cases among all notified cases in 2007 was 10% (see Annex 7). Table 4 shows a breakdown of re-treatment cases and the percentage of re-treatment cases who received drug susceptibility testing (DST).

Table 4.

Breakdown of re-treatment cases and number of cases receiving DST in the seven countries with a high burden of TB, 2007 Case notification a Relapse number b c After failure After default number number a+b+c # of ss+ retreatment % of re-treat# of re-treatment cases who ment DST received DST

Cambodia

645 46 379 122 293 96 3087 6714

75 2534 17 90 479 599

20 2814 12 35 535 345

743 51 727 151 418 96 4101 7658

56 236 0 180 0 325 0

7.5 0.5 0.0 43.1 0.0 7.9 0.0

China Lao People’s Democratic Republic Mongolia Papua New Guinea Philippines Viet Nam # = number; ss+ = sputum smear-positive

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Based on overall case management data, 10 231 new patients and 1596 re-treatment patients were reported with available DST results in the Region. Of these, 1% (89/10 231) and 29% (468/1596) had MDR-TB, respectively. It is evident that there is a need to scale up the capacity to detect and treat MDR-TB cases in the Region, particularly in countries and areas reported to have a high prevalence of MDR-TB. Figures 10 and 11 show the geographical distribution of the proportion of MDR-TB among new and re-treatment TB cases by country and area in the Region. In China, the proportion of MDR-TB among new cases tested for resistance was greater than 7% in three provinces—Henan (7.8%), Heilongjiang (7.2%), and Inner Mongolia (7.0%). These provinces have implemented a successful DOTS programme for nearly 10 years. This suggests that MDR-TB management in addition to a successful DOTS programme is essential.

Figure 10. Geographical distribution of proportion of MDR-TB among new TB cases by country and area in the Region, 2000–2008*

*The data from Australia, Fiji, Guam, New Caledonia, and Solomon Islands indicate new and re-treatment cases combined. Only data on new cases are available for the Commonwealth of the Northern Mariana Islands and Vanuatu. The boundaries shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved

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2 | EPIDEMIOLOGY

Figure 11. Geographical distribution of proportion of MDR-TB among re-treatment TB cases by country and area in the Region and by province in China, 2000–2008*

Information on MDR-TB in Papua New Guinea is limited. However, a recent report showed that between 2000 and 2006, there were 60 bacteriologically confirmed cases of TB identified among villagers in the Western Province of Papua New Guinea presenting to clinics in the islands in Torres Strait, which lies between mainland Australia and Papua New Guinea. 5 Of the TB strains isolated, 15 (25%) were MDR-TB. No XDR-TB strains were detected. The information on the patients’ history of TB treatment before presenting to the clinics was not known. This report may suggest that the prevalence of MDR-TB in the western province of Papua New Guinea is high. It is critical to improve the quality of DOTS to prevent the emergence of MDR-TB in the community. Based on data from the Global Project on Anti-tuberculosis Drug Resistance Surveillance, the proportion of XDR-TB among MDR-TB cases was 14.6% and 30.9% in Japan (Annex 8). 5 Gilpin CM et al. Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea. MJA, 2008;188:148-152

Tuberculosis Control in the Western Pacific : 2009 Report

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2.5 TB-HIV 2.5.1 Estimated prevalence of HIV among new TB cases

HIV infection fuels the TB epidemic, particularly in countries and areas with a high burden of TB. HIV reduces cell-mediated immunity and is an important risk factor for the development of TB. The annual risk of developing active TB disease in a co-infected person ranges from 5% to 15%, depending on the degree of immune suppression. In the past 10–15 years, TB case numbers have increased by 300%–400% in high HIV-prevalent countries. To a lesser extent, TB-HIV co-infection also affects some countries and areas in the Region. In 2007, the overall estimated prevalence of HIV in new TB cases was 2.7% in the Region. Figure12 shows the prevalence for selected countries.

Figure 12. Estimated HIV prevalence in incident TB cases (%) in selected countries in the Region, 2007

In all countries and areas in the Region, HIV prevalence in new TB cases is consistently higher than the prevalence of HIV in the adult population (Figure 13).

Figure 13. Estimated prevalence of HIV in new TB cases against prevalence of HIV in adults in countries and areas in the Region, 2007

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2.5.2

Surveillance data on HIV in TB cases

In Cambodia, HIV prevalence fell to an estimated 0.8% among the adult population in 2007, down from a peak of 2.0% in 1998. Three national surveys of HIV prevalence in TB patients showed a significant decline, from 11.8% in 2003 to 9.9% in 2005 to 7.8% in 2006. Current estimates for 2007 showed a prevalence of 8.0%. The overall percentage of TB patients tested for HIV in the Region was 7.0% of total notified cases. Across the reporting countries and areas, HIV testing of 95 300 TB patients led to the identification of 6679 HIV-positive cases, representing 7.0% of total tested cases (Table 5).

Table 5.

Surveillance data on HIV in TB cases in selected countries in the Region, 2007 TB cases notified (new and relapse) Tested for HIV # (%) # Positive for HIV (%)

Country and area

Cambodia China Lao People’s Democratic Republic Mongolia Papua New Guinea Philippines Viet Nam Western Pacif ic Region # = number; % = percentage

35 601 979 502 3905 16 129 15 002 140 588 97 400 1 365 284

14 245 34 557 424 10 082 117 46 14 337 95 300

(40.0) (3.5) (10.9) (62.5) (0.8) (0.1) (14.7) (7.0)

2922 1187 155 1629 17 0 627 6679

(20.5) (3.4) (36.6) (16.2) (14.5) (0) (4.4) (7.0)

Tuberculosis Control in the Western Pacific : 2009 Report

3 TB Control 3.1 DOTS coverage, case detection, and trend Overall, DOTS coverage in the Region was 99.6% in 2007 (Table 6) with 28 countries and areas, including six countries with a high burden of TB, reaching 100% coverage. The case detection rates for Mongolia and Papua New Guinea decreased from the previous year by 14% and 32%, respectively. 6 The overall case detection rate for the Region, however, remained the same compared to the previous year.

Table 6.

Case detection rates of smear-positive cases in countries with a high burden of TB in the Region, 2006–2007 Case detection rates (%) DOTS coverage in 2007 (%) DOTS area 2006 2007 % change DOTS + non-DOTS area* 2006 2007 % change

Country

Cambodia China Lao People’s Democratic Republic Mongolia Papua New Guinea Philippines Viet Nam Western Pacif ic Region *

100 100 100 100 14 100 100 99.6

62 80 77 88 22 75 86 77

61 80 78 76 15 75 82 77

-2 0 1 -14 -32 0 -5 0

28 -

31 -

11 -

Countries and areas with 100% DOTS coverage have no non-DOTS area by definition; the figures are the same in the left column.

In 2005, the Region reached the global and regional target of detecting 70% of the estimated new smear-positive TB cases and has sustained high case detection rates since then (Figure 14). In 2007, 20 countries and areas in the Region reached the target, contributing to a regional case detection rate of 77%.

Figure 14. Trends in DOTS coverage and case detection in smear-positive cases in the Region, 1995–2007

A revised internal definition of DOTS coverage for Papua New Guinea was used in 2007, which may explain the decrease. Tuberculosis Control in the Western Pacific : 2009 Report

3 | TB CONTROL

3.2 Treatment outcomes The Region continued to observe treatment success rates beyond the target of 85%. In 2006, treatment success was reported at 92% overall for the approximately 0.7 million new pulmonary smear-positive cases registered for treatment in DOTS areas. Across the Region, 19 countries and areas reached the 85% treatment success target. Because DOTS coverage in the Region was nearly 100%, approximately only 400 cases were not treated under DOTS. The success treatment target was not met in this group due to a high number of non-evaluated cases. Among those countries with a high burden of TB, the treatment success rate was the highest in China (94%), followed by Cambodia (93%) and Viet Nam (92%). The treatment success rate of Papua New Guinea improved from 71% in 2005 to 73% in the 2006 cohort (Figure 15).

Figure 15. Treatment outcomes for new smear-positive cases registered in 2006 in DOTS areas in countries with a high burden of TB in the Region

Overall, unfavourable treatment outcomes of 8% and 13% were reported from the 2006 cohorts of new smear-positive cases and re-treatment smear-positive cases, respectively. Transfer-out accounted more than one third of unfavourable outcomes for both new smear-positive cases and re-treatment smear-positive cases (Figure 16). It should be noted that the cases reported under the category transfer-out can have any of the other treatment outcomes, but detailed information is not available, as follow-up outcomes are not recorded in the TB registers.

Figure 16. Unfavourable outcomes among new smear-positive cases and re-treatment smear-positive cases registered in 2006 in DOTS areas in the Region*

*Number in each segment indicates the respective proportion of treatment outcome.

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4 | TB CONTROL

3.3 Laboratory capacity In 2007, there were 7997 TB laboratories that performed acid-fast bacilli (AFB) smear microscopy, 6262 (78%) of which participated in external quality assessment (EQA) programmes. In five of the seven countries with a high burden of TB—Cambodia, China, the Lao People’s Democratic Republic, Mongolia, and the Philippines—over 93% of sputum smear microscopy centres participated in EQA activities. Between 2006 and 2007, the percentage of laboratories participating in EQA programmes increased significantly in Papua New Guinea (Table 7).

Table 7.

External quality assessment of sputum smear microscopy in countries with a high burden of TB in the Region, 2007 # of labs with unsatisfactory result (%)* Labs in which necessary corrective actions were taken (%)*

Country

# of smear micros- Labs included in % change from copy labs EQA (%) 2006

Cambodia

201 3294 155 37 70 2374 737

93 100 99 100 49 100 -

-7 8 11 0 24 0 -

30 3 46 19 18 30 -

79 100 95 57 100 63

China Lao People’s Democratic Republic

Mongolia Papua New Guinea Philippines Viet Nam

# = number; labs = laboratories; EQA = external quality assessment; - =not available * - Based on data presented at the “Workshop on Strengthening TB Laboratories”, held in Hong Kong, October 2008.

Of the 7997 laboratories, 463 laboratories were capable of performing AFB culture and 224 were capable of performing DST (Table 8). Of these, 327 and 187, respectively, were located in China. All seven countries with high burden of TB, except for the Lao People’s Democratic Republic, have at least one laboratory performing culture testing. Overall, the number of laboratories in the Region capable of doing culture and DST is insufficient, given the threat of MDR-TB and TB-HIV co-infection and the need to detect and treat cases under such conditions.

Table 8.

Laboratory services in countries with a high burden of TB in the Region, 2007 Sputum smear Population (thousand) Culture /5 mil. pop DST

Country

# of labs

/100 000 pop

# of labs

/10 mil. pop

Cambodia

14 444 1 328 630 5859 2629 6331 87 960 87 375 1 776 440

201 3294 155 37 70 2374 737 7997

1.4 0.2 2.6 1.4 1.1 2.7 0.8 0.5

3 327 0 1 1 3 17 463

1.0 1.2 0 1.9 0.8 0.2 1.0 1.3

1 187 0 1 0 3 2 224

0.7 1.4 0 3.8 0 3.4 0.2 1.3

China Lao People’s Democratic Republic Mongolia

Papua New Guinea Philippines Viet Nam Western Pacif ic Region

# = number; labs = laboratories; pop = population; DST = drug susceptibility test; mil =million 1 To provide cultures for diagnosis of paediatric, extrapulmonary and smear-negative HIV-infected TB cases, as well as DST for re-treatment and failure cases, most countries and areas will need one culture facility per 5 million population and one DST facility per 10 million population. However, for countries and areas with large populations, one laboratory for culture and DST in each major administrative area (e.g. province) may be sufficient.

Tuberculosis Control in the Western Pacific : 2009 Report

4 Prof iles of countries with a high burden of TB in the Region Seven countries in the Region have a high burden of TB, accounting for 93% of the regional estimated incident cases. This section highlights epidemiological profiles and trends of TB for these countries.

4.1 Cambodia Based on the 2004 intercensal survey, Cambodia’s population was projected to be 14.3 million by the end of 2007. The population density is 74 per square kilometre. The median age is just less than 20 years, with the proportion of ages 0–24 being twice that of those 25–50. The male-to-female ratio is gradually normalizing after the distortions caused by 30 years of war during the last century. Although 85% of the population lives in rural areas, there is a significant urban drift, especially among young people. Cambodia is one of 22 countries worldwide with a high burden of TB. It has the highest estimated incidence, prevalence and mortality rate in the Region. Although the national HIV prevalence in adults as well as HIV prevalence in incident TB cases has declined considerably in recent years, Cambodia remains affected by a TB/HIV epidemic. Drug resistance is starting to emerge among re-treated cases. Main achievements of the national TB control programme (NTP) include sustaining treatment success rates of over 85% for over a decade, improving access to TB services through community-DOTS approaches, and expanding TB/HIV collaborative activities to increasing number of provinces. Major challenges include: strengthening the laboratory network; addressing infection control issues; and increasing case detection, laboratory capacity and motivation of staff.

Figure 17. Cambodia

Tuberculosis Control in the Western Pacific : 2009 Report

4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Surveillance and epidemiology

Table 9.

Key indicators, Cambodia, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 495 219 664 89 8 0 3 14 444

Table 10.

Surveillance and DOTS implementation, Cambodia, 2007 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 35 601 246 134 49 61 246 134 49 61 93

Table 11.

Trend of DOTS performance indicators, Cambodia 2000 2001 2002 2003 2004 2005 2006 2007

DOTS coverage (%) DOTS notification rate (new and relapse)/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new, %) DOTS case detection rate (new ss+, %) DOTS treatment success (new ss+, %) DOTS re-treatment success (ss+, %)

99 148 116 272 50 91 90

100 147 110 27 48 92 92

100 185 130 35 57 92 89

100 209 140 39 62 93 87

100 223 138 43 62 91 86

100 253 149 49 68 93 76

100 244 136 48 62 93

100 246 134 49 61 -

Since 1998, case notification rates for all forms of TB increased from 36 to 74 per 100 000 population (trend +10% per year). Likewise, the rates for smear-positive cases increased from 110 to 150 per 100 000 population (trend +3% per year) (Figure 18).

Tuberculosis Control in the Western Pacific : 2009 Report

Figure 18. Case notification rates (all forms of TB and smear-positive), Cambodia, 1998–2007

The notification rates for all forms of TB vary among provinces and is highest in Svay Rieng (414/100 000 population), and lowest in Ratanak Kiri (67/100 000 population) (Figure 19). Provincial figures are available in Annex 6. Figure 19. Geographical distribution of notification rates of all forms of TB cases, Cambodia, 2007

The distribution of forms of TB among new cases notified from 2003–2007 is shown in Figure 20. The proportion of smear-positive cases gradually decreased from 69% to 56% while the proportion of extrapulmonary cases gradually increased from 15% to 24%. The proportion of smear-negative cases remained steady with a range of 16% to 20%.

Figure 20. Distribution of forms of TB among new cases, Cambodia, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases has remained steady with a range of 2% to 3% (Annex 5). Likewise, the proportion of re-treatment cases to all notified cases remained steady with a range of 3% to 4% (Figure 21). Among re-treatment cases, the combination of relapse, after failure and after default cases accounted for a mean of 2% per year of the total notified cases since 2003. Tuberculosis Control in the Western Pacific : 2009 Report

4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Figure 21. Distribution of forms of TB among notified cases, Cambodia, 2003–2007

MDR-TB activities Cambodia submitted a Green Light Committee (GLC) application in 2006 through a joint nongovernmental organization (NGO) and NTP project and received approval for enrolment of 130 MDR-TB patients. Currently, over 60 patients have been initiated on treatment through these NGO-initiated projects that are closely implemented with the NTP in the existing public health facilities. The NTP plans to scale up these initiatives once funds from the Global Fund Round 7 are available, which are expected in mid-2009. A technical working group for MDR-TB has been established under the stewardship of the National Center for Tuberculosis and Leprosy Control (CENAT), and with representations from all key partners. The group is currently working on the national guidelines for programmatic management of MDR-TB. In 2009, a GLC application for the planned expansion will be submitted, national guidelines will be finalized and standard training materials on MDR-TB will be developed. The main challenge relates to strengthening the national and two regional laboratories to perform quality-assured culture and DST services for MDR-TB programme. Key partners • Cambodia Health Committee (CHC) • Christian Action Research and Education (CARE) • Family Health International (FHI) • Japan Anti-Tuberculosis Association (JATA) • Japan International Cooperation Agency (JICA) • National Center for Tuberculosis and Leprosy Control (CENAT) • Programme for Appropriate Technology in Health (PATH) • Reproductive Health Association of Cambodia (RHAC) • Reproductive and Child Health Alliance (RACHA) • The Tuberculosis Control Assistance Programme (TB CAP) • U.S. Agency for International Development (USAID) • U.S. Centers for Disease Control and Prevention (CDC) • World Health Organization (WHO)

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

4.2 China China is the most populous country in the world, with an estimated 1.3 billion citizens. Population growth rates have slowed and life expectancy has risen in recent decades. While a child born in China in the 1950s could expect to live 46 years, one born in 2000 can expect to live for over 71 years. China is maintaining an overall high case detection and treatment success while accelerating efforts to improve access to TB care for all people with TB in order to contribute to a reduction in prevalence and mortality. Capacity building and activities to improve the quality of data and their analysis (sub-national, disaggregated) will contribute to a better understanding and identification of hard-to-reach populations (migrants, ethnic minorities, women, the elderly and populations at risk).

Figure 22. China

Surveillance and epidemiology

Table 12.

Key indicators, China, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 98 44 194 15 1.9 5 26 1 328 630

Table 13.

Surveillance and DOTS implementation, China, 2006 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 979 502 74 35 71 80 74 35 71 80 94 Tuberculosis Control in the Western Pacific : 2009 Report

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Table 14.

Trend of DOTS performance indicators, China 2000 2001 2002 2003 2004 2005 2006 2007

68 27 15 24 31 95 89

68 28 14 25 31 96 93

78 30 14 27 30 93 88

91 43 20 37 43 94 89

96 58 29 52 64 94 89

100 68 36 64 80 94 90

100 71 35 68 79 94

100 74 35 71 80 -

Since 2002, case notification rates for all forms of TB and smear-positive cases have increased significantly, from 36 to 74 per 100 000 population (trend +14% per year) and 15 to 35 per 100 000 population (trend +17% per year), respectively. The rates for smear-positive cases have remained steady from 2005 to 2007 (Figure 23).

Figure 23. Case notification rates (all forms of TB and smear-positive), China, 1998–2007

The notification rates for all forms of TB vary among provinces and is highest in Xizang (178/100 000 population) and lowest in Beijing (15.1/100 000 population) (Figure 24). Provincial figures are available in Annex 6.

Figure 24. Geographical distribution of notification rates of all forms of TB cases, China, 2007

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

The distribution of forms of TB among new cases notified from 2003 to 2007 is shown in Figure 25. The proportion of smear-positive cases increased from 49% to 56% from 2003 to 2005 then started to decline to 50% in 2007. The proportion of smear-negative cases decreased from 45% to 39% between 2004 and 2005 and then started to increase again to 46% in 2007. The proportion of extrapulmonary cases gradually decreased from 6% in 2003 to 4% in 2007.

Figure 25. Distribution of forms of TB among new cases, China, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases has decreased from 11% to 5% (Annex 7). Re-treatment cases accounted for 20% of all notified cases in 2003 (Figure 26). This has gradually decreased to 11% in 2007. Among re-treatment cases, the proportion of the combination of relapse after failure and after default cases has decreased from 10% to 5%.

Figure 26. Distribution of forms of TB among new and re-treatment cases, China, 2003–2007

MDR-TB activities To address the epidemic of MDR-TB, rapid scale-up of programmatic management of MDR-TB is needed, including sustainable financing for human resources, as well as quality-assured laboratories and second-line drugs. Collaboration and coordination between the public health sector and general and specialized hospitals remains a challenge due to current financing arrangements for public health services in the hospitals. In 2008, China laid the foundation for a sound control of MDR-TB by designing and developing a Chinese specific MDR-TB programme based on international guidelines for the programmatic management of drug-resistant tuberculosis in its Global Fund-supported projects. Appropriate technical guidelines, training materials and a revised recording and reporting system to incorporate MDR-TB contribute to quality implementation.

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Key partners • • • • • • • • • All China Women’s Federation Bill and Melinda Gates Foundation China Anti-TB Association China Medical Association, subgroup TB Clinton Foundation Damien Foundation Belgium (DFB) UK Department for International Development (DFID) World Bank World Health Organization (WHO)

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

4.3 The Lao People’s Democratic Republic The Lao People’s Democratic Republic has a population of 5.6 million (2005), a population growth rate of 2%, a sparse population density (23.7 per square kilometre) with large inter-provincial variations, and an average household size of 5.9 persons. The topography breaks into lowland areas along the Mekong River that depend predominantly on paddy rice, and highland areas that depend on upland rice and the gathering of non-timber forest products for livelihoods. The population is young, but there are signs of changes in the demographic structure. The percentage of the population under age 15 decreased from 43.6% to 39% between 1995 and 2005. The nation is rural, with the beginnings of a rural-to-urban shift, as indicated by the increase in urban areas, with the percentage of the population living in rural areas decreasing from 83% to 72.9% from 1995 to 2005. The mountainous geography and the low population density in many areas pose challenges to TB control activities in the Lao People’s Democratic Republic, increasing difficulties in communication, monitoring, and distribution of supplies and equipment. Staff in remote provinces and districts often receive limited support and have fewer resources for TB diagnosis, resulting in a high turn-over of personnel. TB cases residing in distant villages have limited access to a district hospital due to distance and transportation costs. Increased involvement of the private sector in TB control activities is expected due to economic progress in Vientiane and large provincial capitals.

Figure 27. The Lao People’s Democratic Republic

Surveillance and epidemiology

Table 15.

Key indicators, The Lao People’s Democratic Republic, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 151 67 289 24 3.3 3 20 5859

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Table 16.

Surveillance and DOTS implementation, The Lao People’s Democratic Republic, 2007 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 3905 67 53 43 78 67 53 43 78 92

Table 17.

Trend of DOTS performance indicators, The Lao People’s Democratic Republic, 2000–2007 2000 2001 2002 2003 2004 2005 2006 2007

70 31 29 19 40 77 61

75 30 28 19 41 76 52

77 47 33 28 48 75 66

85 49 33 31 48 79 54

98 55 39 35 57 86 78

100 64 47 40 72 90 87

100 69 53 44 77 92

100 67 53 43 78 -

Since 1998, case notification rates increased for all forms and smear-positive TB cases from 43 to 67 per 100 000 population (trend +6% per year) and 30 to 53 per 100 000 population (trend +7% per year), respectively (Figure 28). Both rates have remained steady from 2005 to 2007.

Figure 28. Trend of case notification rates (all forms of TB and smear-positive), The Lao People’s Democratic Republic, 1998–2007

The notification rates for all forms of TB vary among provinces and is highest in Savannakhet (107/100 000 population) and lowest in Huaphanh (10/100 000 population) (Figure 29). Provincial figures are available in Annex 6.

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Figure 29. Geographical distribution of notification rates of all forms of TB cases, The Lao People’s Democratic Republic, 2007

The distribution of forms of TB among new cases notified from 2003–2007 is shown in Figure 27. The proportion of smear-positive cases increased from 71% to 80%, while that of smear-negative and extrapulmonary cases decreased 18% to 12% and 12% to 7%, respectively (Fig. 30).

Figure 30. Distribution of forms of TB among new cases, The Lao People’s Democratic Republic, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases has remained steady with a range of 3% to 4% (Annex 5). Likewise, the proportion of re-treatment cases to all notified cases remained steady with a range of 4% to 7% (Figure 31). Among re-treatment cases, the combination of relapse, after failure and after default cases accounted for a mean of 5% per year of the total notified cases since 2003.

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Figure 31. Distribution of forms of TB among new and re-treatment cases, The Lao People’s Democratic Republic, 2003–2007

MDR-TB activities Activities to address MDR-TB include: conducting various activities for managing MDR-TB; upgrading the National Reference Laboratory to BSL-3 for culture, identification and DST (2009) and conducting drug resistance surveillance (DRS) for the first time. An application to GLC will be submitted to establish an MDR-TB unit (2009–2010), ensuring the procurement and management of second-line drugs. Key partners • Damien Foundation Belgium (DFB) • World Health Organization (WHO)

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4.4 Mongolia Mongolia is the fifth largest country in Asia, with a total area of 1.565 million square kilometres. In 2007, the population reached 2.6 million, giving an overall population density of 1.7 persons per square kilometre, making it the least densely populated country in the world. Major challenges in TB control activities in Mongolia include the distances between health facilities and communities, and the poverty characterizing many TB cases. Most TB cases receive the first two months of treatment in hospital while the continuation phase is completed on an ambulatory basis. Prisoners, the homeless, and unemployed persons are identified as vulnerable groups for TB with treatment success rates among these populations lower when compared to the general population. MDR-TB is a continuing challenge to TB control in Mongolia, especially among prisoners.

Figure 32. Mongolia

Surveillance and epidemiology

Table 18.

Key indicators, Mongolia, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 205 92 234 29 0.1 1 26 2629

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Table 19.

Surveillance and DOTS implementation, Mongolia, 2007 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 4654 177 71 81 76 177 71 81 76 88

Table 20.

Trend of DOTS performance indicators, Mongolia, 2000–2007 2000 2001 2002 2003 2004 2005 2006 2007

100 123 55 57 61 87 71

100 138 64 71 71 87 72

100 150 65 71 72 87 69

100 151 59 78 66 87 72

100 175 69 91 77 88 70

100 174 71 87 78 88 73

100 194 82 98 88 88

100 177 71 81 76 -

Since 1998, case notification rates have increased for all forms and smear-positive TB cases from 119 to 194 per 100 000 population (trend +5% per year) and 56 to 82 per 100 000 population (trend +3% per year), respectively (Figure 33). In 2007, the rates have decreased compared to the previous year by 9% for all forms and 13% for smear-positive TB cases.

Figure 33. Case notification rates (all forms of TB and smear-positive), Mongolia, 1998–2007

The notification rates for all forms of TB vary among provinces and is highest in Darkhan-uul (326/100 000 population) and lowest in Bayanhongor (30/100 000 population) (Figure 34). Provincial figures are available in Annex 6.

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Figure 34. Geographical distribution of notification rates of all forms of TB cases, Mongolia, 2007

The distribution of forms of TB among new cases notified from 2003–2007 is shown in Figure 35. The proportions have remained steady for smear-positive cases with a range of 41% to 45% and extrapulmonary cases with a range of 38% to 42%. The proportion of smear-negative cases decreased from 22% to 15%.

Figure 35. Distribution of forms of TB among new cases, Mongolia, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases gradually increased from 4% to 6% (Annex 7). The proportion of re-treatment cases to all notified cases increased from 6% to 12% (Figure 36). Among re-treatment cases, the combination of relapse, after failure and after default cases accounted for a mean of 7% per year of the total notified cases since 2003.

Figure 36. Distribution of forms of TB among notified cases, Mongolia, 2003–2007

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MDR-TB activities The problem of MDR-TB in the country is becoming increasingly evident since the first survey was conducted in 1999. Three drug resistance surveys were carried out in the past. In 1999, with support from WHO and the Research Institute of Tuberculosis/JATA, a nationwide drug resistance survey was conducted on specimens from newly diagnosed smear-positive TB cases from all provinces and districts nationwide. The MDR rate was 1.0%. In 2001, in collaboration with the Government of the Netherlands, the TB department of the National Center for Communicable Disease (NCCD) conducted a drug resistance survey among prisoners. The sputum specimens from 56 new TB cases were examined for DST. The MDR rate was 16.1%. In 2004, a survey among 164 re-treatment cases found an overall MDR-TB of 47.6%. When disaggregated, MDR-TB was found to be 57% among failures and chronics; 36% among returns after default; 34% among relapse cases; and 27% among cases with an unknown type of re-treatment. In January 2006, the Green Light Committee approved the application submitted by the Ministry of Health, Mongolia in November 2005, to undertake a project on MDR-TB management for 375 patients. The funding for this project is through Global Fund Round 4 and Regional Coordinating Committee (RCC) (extension of Round 1). In June 2006 the first MDR-TB patient was enrolled and by May 2008 a total of 132 patients started on treatment. With support of RCC grant an additional 790 MDR-TB patients will be enrolled in treatment, thus totalling 1165 patients. The TB Surveillance Department of NCCD plays a main role in the DOTS-Plus project. The TB hospital has a 30-bed MDR-TB ward which admits MDR-TB patients for intensive phase regardless of clinical status and has been operating at full capacity. The same is true for the 10-bed TB prison hospital, which manages MDR-TB prison patients during both intensive and continuation phases while the patient is incarcerated. At the NCCD, there is a daily treatment unit for MDR-TB patients where patients come every day to have free lunch and treatment. This unit was established through an RCC grant. Key partners • Japan Anti-Tuberculosis Association (JATA) • Mongolian Anti-Tuberculosis Association • World Health Organization (WHO) • World Vision

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

4.5 Papua New Guinea Papua New Guinea is the largest developing country in the Pacif ic. The country has over 600 islands and has a total population of around 6.6 million (2008). Land mass area is 461 691 square kilometres with the mainland making up 85% and approximately 600 smaller islands constituting the remaining 15%. Administratively, the country has 20 provinces and 87 districts. The country presents a challenging environment for all health programmes, with its rugged terrain, very low population density and poor human resource development. The average population density is just 13 people per square kilometre. The pace of DOTS expansion (DOTS coverage rate and DOTS detection rate) has been slow and the quality of DOTS implementation (DOTS cure rate and DOTS treatment success rate) poor. Although the prevalence and death rates have been estimated by WHO to be decreasing slowly, this may be erroneous because it is based on case notification and not on any prevalence studies. The rate of decline would be difficult to achieve with the rise in number of MDR-cases (causing an increase in the TB prevalence rate) and the worsening of the HIV epidemic (causing an increase in the TB mortality rate). It is therefore essential to strengthen the NTP before these problems are out of control, particularly as the HIV epidemic has the potential to amplify the transmission dynamics of TB and hence the effects of any failures in the TB programme.

Figure 37. Papua New Guinea

Surveillance and epidemiology

Table 21.

Key indicators, Papua New Guinea, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 250 108 430 60 18.5 3 20 6331

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Table 22.

Surveillance and DOTS implementation, Papua New Guinea, 2007 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 15 002 237 33 94 31 80 17 31 15 73

Table 23.

Trend of DOTS performance indicators, Papua New Guinea, 2000–2007 2000 2001 2002 2003 2004 2005 2006 2007

8 53 8 20 7 63 65

13 71 9 30 8 67 60

24 95 17 37 15 53 51

46 98 16 42 17 58 47

47 152 20 65 18 65 53

53 154 23 61 20 71 55

40 132 24 52 22 73

14 80 17 31 15 -

Since 1998, case notification rates for all forms of TB have fluctuated from year to year with a range of 195 to 248 per 100 000 population and a mean of 217 per 100 000 population (Figure 38). The case notification rates for smear-positive cases remained steady with a range of 24 to 41 per 100 000 population and a mean of 34 per 100 000 population.

Figure 38. Case notification rates (all forms of TB and smear-positive), Papua New Guinea, 1998–2007

The notification rates for all forms of TB vary among provinces and is highest in the National Capital District (1185/100 000 population), and lowest in Enga (20/100 000 population) (Figure 39). Provincial figures are available in Annex 6.

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Figure 39. Geographical distribution of notification rates of all forms of TB cases, Papua New Guinea, 2007

The distribution of forms of TB among new The proportion of smear-positive cases smear-negative cases decreased by 10% to the propor tion of ex trapulmonar y

cases notified from 2003–2007 is shown in Figure 40. decreased from 19% to 14%. The proportion of from the previous year (48% to 38%) in contrast cases, which increased by 11% (38% to 47%).

Figure 40. Distribution of forms of TB among new cases, Papua New Guinea, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases decreased from 7% to 1% (Annex 7). The proportion of re-treatment cases to all notified cases remained the same at 8%, compared to the previous year. The proportion was at 3% in 2004, but increased to 12% in 2005 (Figure 41). Among re-treatment cases, the combination of relapse, after failure and after default cases, decreased from 7% to 1% of the total notified cases since 2003.

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Figure 41. Distribution of forms of TB among new and re-treatment cases, Papua New Guinea, 2003–2007

MDR-TB activities The country has not been doing diagnosis of MDR-TB as per guidelines, using laboratory methods, due to the lack of such facilities within the country. In 2008, the Central Public Health Laboratory re-started culture for Mycobacterium tuberculosis but stopped within a few weeks after it was found that appropriate infection control measures were not in place. The Department of Health and Ageing (Canberra, Australia) is currently trying to assist the country to improve infection control measures. WHO has contracted with the Queensland Mycobacterium Reference Laboratory (Brisbane, Australia) to conduct culture and drug sensitivity testing, as an interim measure. Second-line drugs, being expensive, are often in short supply. The country plans to submit proposals to the GLC and Global Drug Facility seeking support for programmatic management of drug resistant TB, but this can happen only after the country is able to start the culture and drug sensitivity testing. Key partners • Australian Agency for International Development (AusAID) • City Pharmacy (Port Moresby) • HOPE Worldwide (Port Moresby) • JTA International (Port Moresby) • The Papua New Guinea Institute of Medical Research (Goroka) • World Health Organization (WHO) • World Vision (Port Moresby)

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4.6 The Philippines The Philippines consists of 7107 islands, with a land area of 300 000 square kilometres. The population as of 2007 is approximately 90 million, giving a population density of 295 per square kilometre. Among the 14 regions of the country, Calabarzon (Region IV-A) has the largest population, with 11.7 million, followed by National Capital Region (NCR), with 11.6 million and Central Luzon (Region III), with 9.7 million. These three regions comprise more than one third (37.3%) of the Philippine population. The Philippines has developed an effective infrastructure for TB control activities. Collaborative efforts between public and private sectors and the establishment of TB diagnostic committees have successfully contributed to a dramatic increase in case detection and a decline in the number of over-diagnosis of smear-negative cases. Efforts are being made to build on the existing system to mainstream programmatic management of MDR-TB activities.

Figure 42. The Philippines

Surveillance and epidemiology

Table 24.

Key indicators, The Philippines, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 290 130 500 41 0.3 4 21 87 960

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Table 25.

Surveillance and DOTS implementation, The Philippines, 2007 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 140 588 160 98 54 75 160 98 54 75 88

Table 26.

Trend of DOTS performance indicators, The Philippines, 2000-2007 2000 2001 2002 2003 2004 2005 2006 2007

90 118 66 39 48 88 -

95 139 77 44 56 88 -

98 150 83 49 61 88 -

100 166 91 55 68 88 76

100 160 96 53 72 87 53

100 165 98 55 75 89 -

100 171 99 58 77 88

100 160 98 54 75 -

Since 1998, case notification rates for all forms of TB decreased from 220 to 160 per 100 000 population. Smear-positive cases have remained steady with a range of 76 to 99 per 100 000 population (Figure 43).

Figure 43. Case notification rates (all forms of TB and smear-positive), The Philippines, 1998–2007

The notification rates for all forms of TB vary among regions and is highest in Western Visayas (224/100 000 population) and lowest in Cordillera Administrative Region (81/100 000 population) (Figure 44). Provincial figures are available in Annex 6.

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Figure 44. Geographical distribution of notification rates of all forms of TB cases, The Philippines, 2007

The distribution of forms of TB among new cases notified from 2003–2007 is shown in Figure 45. The proportion of smear-positive cases increased from 56% to 63%, while the proportion of smear-negative cases decreased from 43% to 36%. The proportion of extrapulmonary cases remained steady at 1%.

Figure 45. Distribution of forms of TB among new cases, The Philippines, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases remained steady with a range of 2% to 3% (Annex 7). Likewise, the proportion of re-treatment cases to all notified cases remained steady also with a range of 2% to 3% (Figure 46). Among re-treatment cases, the combination of relapse, after failure and after default cases accounted for a mean of 3% per year of the total notified cases since 2003.

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4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Figure 46. Distribution of forms of TB among new and re-treatment cases, The Philippines, 2003–2007

MDR-TB activities The Philippines has had the first GLC approved DOTS-Plus project at the Makati Medical Centre since 2000. Since then, the project that was initially limited to a private DOTS facility, has expanded into the public sector and the community, and over the last two years has been implemented as Programmatic Management of Drug-resistant Tuberculosis (PMDT). Two years ago, the country developed national guidelines for the implementation of PMDT and, in September 2008, the Interim Guidelines for Quality Assured TB Culture in the Philippines was published and distributed. By the end of 2008, six MDR-TB treatment centres have been operating, five in Metro Manila and one in Cebu City. In the meantime, TB laboratory strengthening was undertaken. The National TB Reference Laboratory is now able to perform quality assured culture and proficient, approved DST over the last year, while the Tropical Disease Foundation laboratory continues to perform QA culture, proficient, approved DST and also introduced on a pilot basis the Line Probe Assay technique for rapid diagnosis in the latter part of 2008. In addition, two more laboratories in Metro Manila started providing QA TB culture services (one public and one private), as did a public laboratory in Cebu towards the end of 2008. Since 2000, more than 1500 MDR-TB cases have been enrolled for treatment under the DOTS-Plus project and the PMDT with a treatment success rate of 74% (2007). The NTP, in collaboration with its partners and local government units, has plans to expand the PMDT nationwide within the next six years, with the goal of treating a total of approximately 12 000 MDR-TB cases. Key Partners • • • • • • Japan Anti-Tuberculosis Association (JATA) Philippines Philippine Business for Social Progress (PBSP) Philippine Coalition Against Tuberculosis (PhilCAT) Tropical Disease Foundation, Inc. (TDFI) World Health Organization (WHO) World Vision Development Foundation

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4.7 Viet Nam The estimated population of Viet Nam rose to 84 155 800 in 2006, with 49.1% males. The population density is 252 people per square kilometre, with most (73%) living in rural areas. Over the past few years, Viet Nam has witnessed a gradual change in its population structure. In 2006, the percentage of the population ages 0–14 was 26.4%, a decrease of 8.6% in comparison with 1999. However, the proportion of those over 64 years increased rapidly (by 11%) over the same six-year period. The ageing trend in the population is remarkable. In 2008, TB control in Viet Nam made landmark steps towards greater openness and collaboration with new partners. Key milestones of this process have been the workshop on TB prevalence survey in March which disclosed that TB prevalence in Viet Nam is 1.5 times higher than previously estimated; the launch of the Viet Nam Stop TB Partnership in June; the very fruitful collaboration with the National AIDS Programme (VAAC) for the production of joint guidelines on TB/HIV and the organization of two workshops with the provinces and other stakeholders; and the involvement of nongovernmental organizations and mass organizations in the preparation of the proposal for Round 9 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and their active participation in all gatherings of stakeholders, such as the sub-Country Coordinating Mechanism (CCM) meetings. Challenges for 2009 are persistent lack of decline in the number of new cases; insufficient political commitment at the central and local level, requiring energetic advocacy; completing a comprehensive and substantial application to Round 9 of GFATM; strong and effective action to tackle poor collaboration with the private sector; reaching out to patients in remote areas and closed settings; scaling up programmatic management of MDR-TB, TB/HIV and Practical Approaches to Lung Health (PAL); and strengthening community participation through greater involvement of mass and grass-root organizations.

Figure 47. Viet Nam

Tuberculosis Control in the Western Pacific : 2009 Report

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Surveillance and epidemiology

Table 27.

Key indicators, Viet Nam, 2007 Population (thousand) TB Burden Incidence (all forms/100 000 population) Incidence (ss+/100 000 population) Prevalence (all forms/100 000 population) Mortality (deaths/100 000 population) Prevalence of HIV in adult incident TB cases (%) New multidrug-resistant TB cases (%) Previously treated multidrug-resistant TB cases (%) 171 76 220 24 8.1 3 19 87 375

Table 28.

Surveillance and DOTS implementation, Viet Nam, 2007 Number of notified cases (new and relapse) Notification rate (new and relapse/100 000 population) Notification rate (new ss+/100 000 population) Case detection rate (all new, %) Case detection rate (new ss+, %) DOTS notification rate (new and relapse/100 000 population) DOTS notification rate (new ss+/100 000 population) DOTS case detection rate (all new %) DOTS case detection rate (new ss+, %) DOTS treatment success (2006 cohort new ss+, %) 54 457 111 62 61 82 111 62 61 82 92

Table 29.

Trend of DOTS performance indicators, Viet Nam, 2000–2007 2000 2001 2002 2003 2004 2005 2006 2007

100 114 68 58 82 92 79

100 114 68 59 83 93 85

100 118 70 61 87 92 85

100 113 68 60 85 92 85

100 118 70 62 89 93 84

100 113 66 60 84 92 83

100 113 65 61 85 92

100 111 62 61 82 -

Since 1998, case notification rates for all forms of TB and new smear-positive cases have remained steady with a range of 111 to 117 per 100 000 population and 62 to 71 per 100 000 population, respectively (Figure 44).

Tuberculosis Control in the Western Pacific : 2009 Report

4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

Figure 48. Case notification rates (all forms of TB and smear-positive), Viet Nam, 1998–2007

The notification rates for all forms of TB vary among provinces and is highest in Ho Chi Minh (223/100 000 population) and lowest in Son La (35/100 000 population) (Figure 49). Provincial figures are available in Annex 6.

Figure 49. Geographical distribution of notification rates of all forms of TB cases, Viet Nam, 2007

Tuberculosis Control in the Western Pacific : 2009 Report

4 | PROF ILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

The distribution of forms of TB among new cases notified from 2003–2007 is shown in Figure 50. The proportion of smear-positive cases decreased from 64% to 60%, while the proportion of extrapulmonary cases increased from 17% to 21%. The proportion of smear-negative cases remained steady at 19%.

Figure 50. Distribution of forms of TB among new cases, Viet Nam, 2003–2007

Since 2003, the proportion of relapse cases among all forms of cases remained steady with a range of 6% to 7% (Annex 7). Likewise, the proportion of re-treatment cases to all notified cases remained steady with a range of 7% to 8% (Figure 51). Among re-treatment cases, the combination of relapse, after failure and after default cases accounted for a mean of 8% per year of the total notified cases since 2003.

Figure 51. Distribution of forms of TB among new and re-treatment cases, Viet Nam, 2003–2007

MDR-TB activities PMDT implementation, supported by The Royal Netherlands Embassy and GFATM Round 6 funds, started in May 2009 at Ho Chi Minh City TB Hospital by enrolling 100 MDR-TB patients. The MDR-TB prevalence countrywide is 2.7% in new cases and 19.3% in re-treatment cases. Viet Nam is estimated to produce about 4000 detectable new MDR-TB cases per year and is among MDR high burden countries (13th position). Key partners • • • • • • • • • Embassy of the United States NTP, Viet Nam PATH United States The Netherlands Embassy US Centers for Disease Control and Prevention (CDC) United States Agency for International Development (USAID) Viet Nam Red Cross Viet Nam Women’s Union World Health Organization (WHO)

Tuberculosis Control in the Western Pacific : 2009 Report

5 Summary of the TB burden and epidemiologic indicators of Pacific island countries and areas in the Region The Pacif ic island countries and areas include American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, Northern Mariana Islands, Marshall Islands, Federated States of Micronesia, Nauru, New Caledonia, Niue, Palau, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, and Wallis and Futuna (Figure 52). The Pacif ic island countries and areas are divided into 4 groups: Chamorro, Micronesia, Polynesia and Melanesia.

Figure 52. Geographic distribution of the Pacif ic island countries and areas

Tuberculosis Control in the Western Pacific : 2009 Report

5 | IC ISLAND COUNTRIES AND AREAS IN THE REGION

Table 30 shows the key indicators of TB control in Pacific island countries and areas. There were an estimated 1895 new TB cases in Pacif ic island countries and areas, representing 0.10% of the total TB cases in the Region. Incidence rates were highest in Kiribati (364 per 100 000 population) and lowest in American Samoa (5 per 100 000 population). The estimated incidence rate for Niue and Tokelau was zero.

Table 30.

Key indicators of TB control in the Pacif ic island countries and areas in the Region, 2007 Estimated incidence Population (thousand) All forms Number Rate* Number ss+ Rate

Country and area

Treatment outcome† (% success) 66 85 90 90 75 90 85 100 89 60 90 100 75 90 100

American Samoa Cook Islands Fiji

67 13 839 263 173 95 59 111 84 10 242 2 20 187 496 1 100 11 226 15

3 2 174 71 59 347 128 108 49 3 52 0 12 35 634 0 24 18 174 2

5 15 21 27 34 365 215 97 58 33 22 0 60 19 128 0 24 166 77 15

0 1 78 21 6 156 57 49 16 3 13 0 6 16 285 0 11 8 78 1

0 7 9 8 3 164 97 44 19 33 6 0 27 8 58 0 11 75 35 7

French Polynesia Guam Kiribati Marshall Islands Micronesia

Northern Mariana Islands Nauru New Caledonia Niue Palau Samoa Solomon Islands Tokelau Tonga

Tuvalu Vanuatu Wallis and Futuna

* - Rates are per 100 000 population; † - Treatment outcome for new smear positive cases, DOTS All forms = includes new and relapse cases; ss+ = smear-positive

Case notification rates vary across Pacif ic island countries and areas (Figure 53). The fluctuation of rates over time can be attributed to small population sizes. Case notification rates for all forms of TB were highest in Kiribati (351 per 100 000 population) and lowest in American Samoa (4 per 100 000 population). Case notification rates for smear-positive cases were highest in Tuvalu (114 per 100 000 population) and lowest in Guam (3 per 100 000 population).

Figure 53. Trend of case notification rates (all forms of TB and smear-positive cases) in selected Pacif ic island countries and areas in the Region, 2000–2007

Tuberculosis Control in the Western Pacific : 2009 Report

5 | IC ISLAND COUNTRIES AND AREAS IN THE REGION

Tuberculosis Control in the Western Pacific : 2009 Report

5 | IC ISLAND COUNTRIES AND AREAS IN THE REGION

Tuberculosis Control in the Western Pacific : 2009 Report

Annexes Annex 1: Estimation of prevalence and TB mortality rates for future years A linear regression model for each country and area was fitted on log-transformed TB prevalence data that were collected annually from the respective countries and areas:

with r the prevalence rate per 100 000 population and t expressed in years. The slope can be interpreted as a constant rate of change per year assuming an exponential decline of the un-transformed prevalence rate. To estimate numbers of prevalent cases in future years for which data were not yet available, predicted values of prevalence rates and their respective 95% confidence intervals were estimated. For the estimation of mortality rates in future years, a linear regression model was fitted as above by substituting prevalence rates with TB mortality rates.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Annex 2: Estimation of MDR-TB prevalence Based on drug resistance data reported from 114 countries and two special administrative regions of China, logistic regression models were fitted to estimate the proportion of MDR-TB among new, previously treated, and combined TB cases for a further 69 countries for which surveyed data were not available. The estimated number of new TB cases by country and area was used to calculate the number of MDR-TB cases that occurred among new cases. To estimate the number of previously treated cases for each country and area, the ratio of notified re-treatment cases to notified new cases in 2006 was multiplied by the total number of new cases estimated to have occurred in the same year; therefore, the total number of estimated case included estimated re-treatment cases. The method and models were described in detail in: Zignol M et al. Global Incidence of Multidrug-resistant Tuberculosis. Journal of Infectious Diseases, 2006, 194:479-85; and The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. Anti-Tuberculosis Drug Resistance in the World. Fourth Global Report. Geneva, World Health Organization, 2008 (WHO/HTM/ TB//2008.394).

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Annex 3: Definitions 1. Definitions of tuberculosis cases A case of tuberculosis: A patient in whom tuberculosis (TB) has been bacteriologically confirmed or has been diagnosed by a clinician. Any person given treatment for TB should be recorded. All forms: The sum of new smear-positive pulmonary, relapse, new smear-negative pulmonary and extrapulmonary cases. New smear-positive pulmonary TB: 7 A patient who has never received treatment for TB, or who has taken anti-TB drugs for less than 30 days and who has one of the following: • • • two or more initial sputum smear examinations positive for acid fast bacilli (AFB); one sputum examination positive for AFB plus radiographic abnormalities consistent with active pulmonary TB as determined by a clinician; or one sputum specimen positive for AFB and at least one sputum that is culture-positive for AFB.

New smear-negative pulmonary tuberculosis: A case of pulmonary TB that does not meet the above definition for smear-positive TB. Extrapulmonary tuberculosis: TB of organs other than the lungs, e.g., pleura, lymph nodes, abdomen, genito-urinary tract, skin, joints, bones, meninges. Diagnosis should be based on one culture-positive specimen, or histological or strong clinical evidence consistent with active extrapulmonary TB, followed by a decision by a clinician to treat with a full course of anti-TB chemotherapy. (A patient diagnosed with both pulmonary and extrapulmonary TB should be classified as a case of pulmonary TB.) Re-treatment case: Patient previously treated for TB, undergoing treatment for a new episode of bacteriologically positive (sputum smear or culture) TB. Relapse: A patient previously treated for TB and declared cured or treatment completed, who is later diagnosed with bacteriologically positive (culture smear) TB.

2. Definitions of treatment outcome Cured Completed treatment Treatment success Died Failure Defaulted Transferred out Not evaluated Former smear-positive patient who was smear-negative in the last month of treatment, and on at least one previous occasion. A patient who has completed treatment but who does not meet the criteria to be classified either as a cure or a failure. The sum of patients who are cured and those who have completed treatment. A patient who dies for any reason during the course of treatment. Smear-positive patient who remained smear-positive at five months or later during treatment. A patient who has interrupted treatment for two consecutive months or more. A patient who has been transferred to another recording and reporting unit and for whom the treatment outcome is not known. A patient who did not have the treatment outcome evaluated. Note: In countries where culture is current practice, patients can be classified as cured or failed based on the culture results.

The case definition of new smear-positive changed in 2007 and will be applied in future regional reports. Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

3. Indicators to assess treatment outcome Cure rate: Proportion of cured cases out of all cases registered in a given period (2006, in this report). Treatment success rate: The sum of the proportion of patients who were cured and patients who completed treatment out of all cases registered in a given period. The global target is an 85% cure rate and a greater treatment success rate. The cure rate and treatment success rate are expressed as a percentage of registered cases. The number of new cases registered for treatment in 2006 (reported in 2008) is compared to the number of cases notified as smear-positive in 2006 (reported in 2007). Differences may arise because NTPs do not compile data at the end of each calendar year, diagnoses may be incorrect, patients are lost between diagnosis and the start of treatment, or records may be lost. All registered cases should be evaluated. Data on the six standard, mutually exclusive outcomes of treatment are compiled. These figures are reported as percentages of all registered cases, so that the possible outcomes plus the fraction of cases not evaluated add up to 100%. When a country or area states the number of patients registered for treatment, but gives no outcomes, no result is reported, rather than reporting zero treatment success. Although treatment outcomes are expressed as percentages, they are referred to as rates. The six possible outcomes plus the fraction of cases not evaluated add up to 100%. If the number of registered cases is lower than the sum of the six outcomes or is missing, the denominator for treatment success will be the number evaluated or the number of smear-positive cases notified in the previous year, whichever is greater.

4. Case detection rate and DOTS detection rate Directly observed treatment, short-course (DOTS) The recommended strategy for TB control is comprised of: • political commitment with increased and sustained financing; • case detection through quality-assured bacteriology; • standardized treatment with supervision and patient support; • an effective drug supply and management system; and • monitoring and evaluation system, and impact measurement. Targets for TB control established by the World Health Assembly (1991) • To cure 85% of the sputum smear-positive TB cases detected. • To detect 70% of the estimated new sputum smear-positive TB cases. Case notifications represent only a fraction of the true number of cases in a country or area because the coverage by effective NTP may be incomplete. The estimated cases detection rate is defined as: Case detection rate (%) = DOTS detection rate (%) = Annual new smear-positive notifications (country and area) Estimated annual new smear-positive incidence (country and area) Annual new smear-positive notifications under DOTS Estimated annual new smear-positive incidence (country and area

Case detection under DOTS: Note: The case detection rate and DOTS detection rate are identical when a country or area has a 100% DOTS detection rate DOTS enrolment rate. Updated estimated incidence for 2006 used in this report was provided by World Health Organization (WHO). Population with access to DOTS: The country and area’s population who live in administrative areas where DOTS services are available. DOTS enrolment rate (%): This rate indicates a proportion of cases enrolled in DOTS, out of notified cases. DOTS enrolment rate (all forms) (%) = DOTS enrolment rate (new ss+) (%) = Annual notifications of all forms under DOTS Total annual notifications of all forms Annual notification of new ss+ under DOTS Total annual notifications of new ss+

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5. Definitions of MDR-TB and XDR-TB MDR-TB, or multidrug-resistant TB XDR-TB, or extensively drug-resistant TB Strains of TB that are resistant to at least the two main first-line anti-TB drugs—isoniazid and rifampicin. TB that is resistant to any fluoroquinolone, and at least one of three injectable second-line drugs (capreomycin, kanamycin, and amikacin), in addition to MDR-TB. The WHO Global Task Force on XDR-TB agreed on this definition of XDR-TB in October 2006.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Annex 4: Formulas for estimating tuberculosis incidence, prevalence, and mortality Formulas T Ts and Is  d ds

Definitions

1. I =

N = Population I = Incidence of tuberculosis (TB) = number of new cases of TB per year

2. P = tl and Ps= tsls 3. Is = λk N

P = Prevalence of TB T = TB case notifications (per year) D = Deaths from TB IRR = TB incidence rate ratio (TB incidence rate in HIV-positive persons/TB incidence in HIV-negative persons) d = Proportion of cases notified (case detection rate) t = Average duration of TB disease (years) λ = Rate of infection with Mycobacterium tuberculosis (MTB) (annual rate of infection per person per year) k = Ratio of incidence of smear-positive TB to rate of MTB infection t = Proportion of TB patients who die from TB (case fatality rate [CFR]) m = Prevalence of infection with MTB

4. D = fl and Ds= fls 5. I = Ia++Ia-+In or I = ma+ra+Na++ma-ra-Na-+mnrnNn

IRR 

  ma ra I / N  a a    ma ra Ia / Na

Ia  Ia 

IRR 1  a

N ( IRR  1) Na

 Na Na

r = Rate of progression to TB disease in MTB-infected individuals (per person per year) s = Sputum smear-positive TB (no subscript implies all forms) a = Adult (15–49 years old)

*  Ia

Ia   Ia  Na  Na 

n = Other age groups (<15 or >49), assumed HIV-uninfected + = HIV-positive - = HIV-negative * = Attributable to HIV infection h = Prevalence of HIV in new TB cases p = Prevalence of HIV in the general population

9. Da* = Da+-f - (I+-Ia*) pIRR  1  pIRR  1

10.

h

Adapted from: Corbett EL et al. The Growing Burden of Tuberculosis. Global Trends and Interactions with the HIV Epidemic. Archives of Internal Medicine, 2003, 163(9):1009–21.

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Annex 5: Directory of partners for countries with high burden of TB 8 Cambodia US Agency for International Development (USAID) #1, St. 96, Khan Daun Penh, Phnom Penh The Tuberculosis Control Assistance Program (TB CAP) National Center for TB and Leprosy services (CENAT) St. 278-95, Beong Keng Kang II, Phnom Penh Cambodia Health Committee (CHC) #64, St. 592, Beong Kok II, Toul Kork, Phnom Penh University Research Co. (URC) Phnom Penh Center, Second floor, Corner of Sihanouk & Sothearos Bld, Tonle Bassac, Phnom Penh Christian Action Research and Action (CARE) #52, W5 352, Phnom Penh Programme for Appropriate Technology in Health (PATH) #22, St. 184, Phnom Penh Family Health International (FHI) #11, St. 302, Beong Keng Kang I, Phnom Penh

Reproductive Health Association of Cambodia (RHAC) #6, St. 150, Sangat Veal Vong, Phnom Penh Reproductive and Child Health Alliance (RACHA) #160, St. 71, Tonle Bassac, Phnom Penh

US-Centers for Disease Control and Prevention National Institute of Public Health, P.O Box 1300, Phnom Penh

Japan Anti-Tuberculosis Association (JATA) # 6, St. 288, Beong Keng Kang II, Phnom Penh Japan International Cooperation Agency (JICA) National Center for TB and Leprosy services (CENAT) St. 278-95, Beong Keng Kang II, Phnom Penh

China Damien Foundation Belgium Rm 0601 Guangming Hotel Liangmaqiao Road, Beijing 100016 Jaucot Alex alex.jaucot@damien-bel.org.cn Tel: (8610)84512250 ext 14 Fax: (8610)64637144 China Medical Association, subgroup TB # 97 Machang, Tongzhou District, Beijing 101149 Fu Yu Tel: (8610)69546690 ext 609 Fax: (8610)80882505 World Bank 16th floor, China World Tower 2. No.1 Jianguomenwai Avenue, Beijing 10004 Zhang Shuo szhang2@worldbank.org Tel: (8610) 58617786 Fax: (8610) 58617800 DFID China 30th floor South Tower Kerry Centre, Chao Yang District 1 Guang Hua Road Beijing 100020 Tel: (8610) 8529 6882 Fax: (8610) 8529 6002/3/4/5 Qiao Jianrong jr-qiao@dfid.gov.uk Tel: (8610) 85296882 2005

Clinton Foundation 5-1-42 Tayuan Diplomatic Office Bldg. #1 Xindong Road, Beijing 100600 Herb Harwell Herbhar@gmail.com Tel: (8610)85324950 ext 126 Fax: (8610)85324953

Bill and Melinda Gates Foundation Room 1201, China Resources Building, 8 Jiangguomenbei Avenue, Beijing 100005 Daniel P. Chin Daniel.chin@gatesfoundation.org Tel: (8610) 58111888 Fax: (8610) 58111999

China Anti-TB Association Nanwei Road, Xuanwu district, Beijing 100050 DuanMu Hongjin wanly@chinatb.org Tel: (8650)83133137

All China Women’s Association

Contact persons, e-mail, telephone and fax numbers are current as of March 2009 Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Lao People’s Democratic Republic Damien Foundation Belgium Dr Guido Groenen guido.groenen@skynet.be

Mongolia World Vision 1st khoroo, Sansar mega center “B” part, 5th floor, Ulaanbaatar Amgalan Badamjav, amgalan_badamjav@wvi. org; Tel: (976)70155323/(976)70155322 Mongolian Anti-tuberculosis Association Room 308, Building of “San” University, Bayangol district, Ulaanbaatar Solongo Bekhbat, mvpho@magicnet.mn Tel: (976)11366617

Papua New Guinea World Vision (Port Moresby) Marlon Villanueva marlon_villanueva@wvi.org JTA International (Port Moresby) Ms Ingrid Glastonbury ingrid.glastonbury@jtai.com.au City Pharmacy (Port Moresby) Sourav Mukherjee sourav@cpl.com.pg PNG Institute of Medical Research (Goroka) Geraldine.Maibani Geraldine.Maibani@pngimr.org.pg HOPE worldwide (Port Moresby) Jessica Lesley jlesley@online.net.pg

Philippines Philippine Coalition Against Tuberculosis (PhilCAT) Quezon Institute, E. Rodriquez Avenue Quezon City, Metro Manila Amelia Sarmiento agsarmiento@philcat.org Tropical Disease Foundation, Inc. (TDFI) International TB Center Urban Road Makati, Metro Manila Dr Thelma Tupasi tetupasi@tdf.org.ph Philippine Business for Social Progress (PBSP) Supported by USAID Intramuros City of Manila, Metro Manila JAGutierrez@pbsp.org.ph World Vision Development Fund Quezon Avenue Quezon City, Metro Manila

RIT/JATA Philippines Tayuman Street and Rizal Ave corner 2nd Floor Santa Cruz, City of Manila Metro Manila Dr Christina Giango

Viet Nam NTP, Viet Nam 463 Hoang Hoa Tham Street, Ba Dinh District, Hanoi Prof Dinh Ngoc Sy vnntp463@hn.vnn.vn Tel: 84.4.37614890 Fax: 84.4.832 5865 US Centers for Disease Control and Prevention Rose Garden, 6 Ngoc Khanh Street, Hanoi Dr Mitchell Wolfe msw6@cdc.gov Tel: 84.4.38314604 Fax: 84.4.38314580 Viet Nam Women’s Union 39 Hang Chuoi, Hanoi Tel: 84.4.39713436 Fax: 84.4.39713143

Tuberculosis Control in the Western Pacific : 2009 Report

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Embassy of Netherlands Daeha Office Tower, 6th Floor, 360 Kim Ma Street, Hanoi Ger Steenbergen ger.steenbergen@minbuza.nl Tel: 84.4.38315650 Fax: 84.4.832 5865 US Embassy 7 Lang Ha Street, Hanoi Dr Michael Lademarco lademarcoMF@state.gov Tel : 84.4.38314580 Fax: 84.4.38505028

US Agency for International Development (USAID) ‘15/F Tung Shing Square, #2 Ngo Quyen Street, Hanoi Ellen Lynch Tel: 84.4.39351265

Viet Nam Red Cross 82 Nguyen Du Street, Hanoi Tel: 84.4.38224030 Fax: 84.4.9424285

Programme for Appropriate Technology in Health (PATH) US Floor 2nd, Hanoi Towers 49 Hai Ba Trung Street, Hanoi Michelle Gardner mgardner@path.org Tel: 84.4.39362215 Fax: 84.4.39362216

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Annex 6: Subnational data for 7 countries with a high burden of TB, 2007 All forms of TB notified Sub-national area Number Rate per 100 000 population

Cambodia

Banteay Meanchey Battambang Kampong Cham Kampong Chhnang Kampong Speu Kampong Thom Kampot Kandal Kep Koh Kong Kratie Mondul Kiri Oddar Meanchey Pailin Phnom Penh Preah Vihear Prey Veng Pursat Ratanak Kiri Siemreap Kampong Som Stung Treng Svay Rieng Takeo

1767 1937 3953 1184 1848 1503 1363 3279 88 202 541 44 379 131 3298 304 3676 1417 86 3120 451 188 2279 2563 43 518 2392 27 793 23 351 24032 68 777 45 183 41 361 9388 39 814 38 494 83 737 51 145 50 823 24 192 47 479 37 798

216 187 207 220 242 212 220 256 218 97 154 98 369 372 236 189 346 320 67 346 202 171 414 277 71 15 99 66 92 74 96 110 112 58 101 89 90 80 101 63 87

China

Anhui Beijing Chongqing Fujian Gansu Guangdong Guangxi Guizhou Hainan Hebei Heilongjiang Henan Hongkong + Hubei Hunan Inner Mongolia Jiangsu Jiangxi

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

All forms of TB notified Sub-national area Number Rate per 100 000 population

Jilin Liaoning Macau + Ningxia Qinghai Shaanxi Shandong Shanghai Shanxi Sichuan Taiwan Tianjin Xinjiang Xizang Yunnan Zhejiang

21 765 23 839 3783 4996 24 318 40 603 8013 23 388 70 390 4310 29 310 4993 20 906 37 928

80 56 63 91 65 44 44 69 86 40 127 178 47 76

Lao People's Democratic Republic

Vientiane Municipality Phongsaly Luangnamtha Oudomxay Bokeo Luangprabang Huaphanh Xayabury Xiengkhuang Vientiane Borikhamxay Khammuane Savannakhet Saravane Sekong Champasack Attapeu

746 44 134 170 99 150 30 155 36 232 83 326 922 221 43 518 75 74 70 24 70 212 72 23 37 21

103 25 89 62 66 35 10 44 15 52 35 93 107 65 49 82 64 83 74 30 122 286 134 47 47 36 59

Mongolia

Arhangay Bayan-olgiy Bayanhongor Bulgan Dornod Dornogovi DUNDGOVI Zavkhan Govi-altay

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

All forms of TB notified Sub-national area Number Rate per 100 000 population

Hentiy Hovd Hovsgol Omnogovi Ovorhangay Selenge Suhbaatar Tov Uvs Govisumber Orkhon Darkhan-uul Ulaanbaatar Papua New Guinea National Capital District Central Eastern Highlands East New Britain East Sepik Enga Gulf Madang Manus Milne bay Morobe North Solomons New Ireland Oro Southern Highlands Simbu Western Highlands West New Britain West Sepik Western Philippines Autonomous region in Muslim Mindanao (ARMM) Cordillera Administrative region (CAR) National Capital region (NCR) Region I (Ilocos region) Region II (Cagayan Valley) Region III (Central Luzon) Region IV-A (Calabarzon) Region IV-B (Mimaropa) Region IX (Western Mindanao) Region V (Bicol region) 60 Tuberculosis Control in the Western Pacific : 2009 Report

176 45 150 28 89 268 115 108 55 30 130 294 2487 3858 648 559 917 826 71 1360 661 18 593 1053 423 115 447 278 296 224 890 315 427 4015 1294 21 308 6457 5023 14 274 15 598 2303 6736 11 125

255 51 122 59 81 295 219 122 69 226 147 326 243 1185 300 111 350 207 20 1063 150 35 237 161 218 80 279 38 100 43 377 144 222 121 81 191 132 157 149 140 83 205 206

| ANNEXES

All forms of TB notified Sub-national area Number Rate per 100 000 population

Region VI (Western Visayas) Region VII (Central Visayas) Region VIII (Eastern Visayas) Region X (Northern Mindanao) Region XI (Davao Region) Region XII (Soccsksargen) CARAGA Viet Nam An Giang Ba Ria - Vung Tau Bac Giang Bac Kan Bac Lieu Bac Ninh Ben Tre Binh Dinh Binh Duong Binh Phuoc Binh Thuan Ca Mau Can Tho Cao Bang Da Nang city Dak Lak Dong Nai Dong Thap Gia Lai Ha Giang Ha Nam Ha Noi Ha Tay Ha Tinh Hai Duong Hai Phong Ho Chi Minh city Hoa Binh Hung Yen Khanh Hoa Kien Giang Kon Tum Lai Chau Lam Dong Lang Son Lao Cai Long An

16 011 9672 6194 5899 6896 5565 4813 4474 1220 2348 107 980 777 1354 1971 1691 813 1509 1394 2046 282 1504 799 3311 2698 578 276 985 2573 1932 1398 1379 2163 14 052 502 1156 1363 2543 281 164 488 735 236 1937

224 146 148 144 165 146 200 202 125 148 36 117 74 98 128 143 98 131 111 178 57 188 47 146 160 49 40 117 79 76 108 80 123 223 61 104 117 152 72 49 42 99 40 134 61

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| ANNEXES

All forms of TB notified Sub-national area Number Rate per 100 000 population

Nam Dinh Nghe An Ninh Binh Ninh Thuan Phu Tho Phu Yen Quang Binh Quang Nam Quang Ngai Quang Ninh Quang Tri Soc Trang Son La Tay Ninh Thai Binh Thai Nguyen Thanh Hoa Thua Thien - Hue Tien Giang Tra Vinh Tuyen Quang Vinh Long Vinh Phuc Yen Bai Dien Bien Dac Nong Hau Giang

1623 2540 689 817 990 756 815 1631 1362 1047 546 1741 363 2129 1774 816 3895 1153 1966 1444 303 1237 572 352 173 163 1168

83 81 74 142 72 87 96 109 106 96 87 133 35 203 96 72 108 101 116 132 43 115 50 48 38 37 145

+ Listed as countries and areas; - = no data available

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| ANNEXES

Annex 7: Tables Table 31. Estimated burden of TB, 1990 and 2007 Incidence 1990 All forms* number rate Smear-positive* number rate

Prevalence 1990 All forms* number rate

TB Mortality 1990 All forms* number rate

Incidence 2007 All forms* number rate

All forms HIV+ number rate

10 1120 148 56 742 1 338 563 5355 258 0 366 66 69 58 085 369 7278 21 435 143 182 4552 8 159 346 1 31 10 10 307 240 889 70 946 51 1493 980 1 32 28 207 133 898 9 1 954 134

21 7 58 585 116 94 69 0 51 34 51 47 513 179 118 302 188 205 85 93 10 59 71 64 250 393 165 32 50 312 69 34 296 139 202 63 129

5 503 67 25 258 602 242 2410 116 0 165 30 31 26 128 166 3 275 9635 64 82 2 049 4 72 155 1 14 4 4636 108 400 31 926 23 672 441 1 14 13 93 60 245 4 878 939

10 3 26 260 52 42 31 0 23 15 23 21 231 80 53 136 85 92 38 42 5 26 32 29 112 177 74 14 22 141 31 15 133 62 91 28 58

20 1139 234 90 001 3 758 426 5475 258 0 495 131 137 76 340 737 17 449 28 851 286 254 10 580 16 191 351 3 62 14 20 579 489 394 95 626 58 1560 1960 2 43 56 415 241 512 17 4 842 675

42 7 91 928 327 96 69 0 68 67 103 62 1026 428 159 605 263 477 170 112 10 118 142 96 498 799 223 36 52 625 139 45 593 278 365 126 320

2 112 27 11 567 285 172 461 19 0 65 14 14 7 033 83 1538 3890 32 32 1 069 2 18 35 0 6 2 2816 53 419 8024 8 169 221 1 6 6 47 21 727 2 397 633

5 1 10 119 25 8 5 0 9 7 11 6 116 38 21 68 33 48 19 10 1 13 13 12 68 87 19 5 6 70 33 6 62 31 33 15 26

3 1295 230 71 504 1 305 770 4461 301 2 174 71 59 26 994 347 8851 27 439 128 108 5400 3 52 299 0 49 12 15 796 255 084 43 222 35 1176 634 0 24 18 174 149 588 2 1 919 306

5 6 59 495 98 62 63 15 21 27 34 21 365 151 103 215 97 205 33 22 7 0 58 60 250 290 90 19 27 128 0 24 166 77 171 15 108

– 41 0 5560 24 705 – – – 4 – – 126 – 295 4433 – – 8 – – 4 – – – 2930 874 413 – 40 – – – – – 12 052 – 51 483

– 0 0 38 2 – – – 0 – – 0 – 5 17 – – 0 – – 0 – – – 46 1 1 – 1 – – – – – 14 – 3

* Incidence prevalence and mortality estimates include patients with HIV. Estimates labelled “HIV+” are estimates of TB in HIV-positive adults (age 15-49). Estimates for all years are re-calculated as new information becomes available and techniques are refined so they may differ from those published previously. See Explanatory notes on page 67 for further details. Data can be downloaded from http://stoptb.wpro.who.int.

Tuberculosis Control in the Western Pacific : 2009 Report

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Incidence, 2007 Smear-positive* number Smear-positive HIV+

Prevalence, 2007 All forms* number rate

All forms HIV+ number rate

rate number rate

HIV prevalence All forms* All forms HIV+ in adult incident number rate number rate TB cases (%)

TB mortality, 2007

MDR, 2007

Percentage of new re-treatment

Number among All cases Smear-positive

0 579 151 31 621 585 126 2 007 135 1 78 21 6 12 135 156 3 954 11 904 57 49 2429 3 13 134 0 16 6 6815 114 701 19 409 16 525 285 0 11 8 78 66 109 1 858 539

0 3 39 219 44 28 28 7 9 8 3 9 164 67 45 97 44 92 33 6 3 0 19 27 108 130 40 8 12 58 0 11 75 35 76 7

– 14 0 1946 8647 – – – 1 – – 44 – 103 1552 – – 3 – – 1 – – – 1026 306 144 – 14 – – – – – 4218 –

– 0 0 13 1 – – – 0 – – 0 – 2 6 – – 0 – – 0 – – – 16 0 0 – 0 – – – – – 5 – 1

3 1303 252 95 974 2 582 469 4561 301 4 255 83 63 35 767 402 16 906 32 251 166 111 6142 3 60 303 0 60 14 27 197 440 035 60 969 47 1190 891 0 29 21 231 192 092 4

5 6 65 664 194 63 63 31 30 32 36 28 423 289 121 281 100 234 33 25 7 0 72 71 430 500 126 25 27 180 0 28 203 102 220 25

– 20 0 2780 12 353 – – – 2 – – 63 – 147 2217 – – 4 – – 2 – – – 1465 437 206 – 20 – – – – – 6026 –

– 0 0 19 1 – – – 0 – – 0 – 3 8 – – 0 – – 0 – – – 23 0 0 – 0 – – – – – 7 – 1

0 129 27 12 925 200 614 384 22 1 29 8 4 3331 46 1410 4830 19 10 762 0 4 30 0 6 2 3817 36 305 4887 5 122 105 0 2 2 27 20 678 0 290 546

0 1 7 89 15 5 5 4 4 3 2 3 49 24 18 32 9 29 3 2 1 0 7 8 60 41 10 3 3 21 0 2 17 12 24 3

– 4 0 1843 6774 – – – 1 – – 14 – 99 1296 – – 1 – – 0 – – – 1049 271 45 – 4 – – – – – 3101 –

– 0 0 13 1 – – – 0 – – 0 – 2 5 – – 0 – – 0 – – – 17 0 0 – 0 – – – – – 4 – 1

– 3.2 0.0 8 1.9 – – – 2.0 – – 0.5 – 3.3 16 – – 0.1 – – 1.2 – – – 18.5 0.3 1.0 – 3.4 – – – – – 8.1 – 2.7

– – 2 0 5 1 2 – – 2 – 1 3 3 0 3 3 1 – – 0 – – 2 3 4 3 3 0 – – 3 – – 3 – 4

– – 20 3 26 8 16 – – 20 – 10 20 20 0 20 21 26 – – 0 – – 20 20 21 14 20 1 – – 20 – – 19 – 24

– 38 7 94 112 348 82 12 – 0 2 0 389 13 386 27 6 6 198 – 0 1 – 0 0 864 12 125 2337 1 4 – – 1 – – 6468 – 135 411

– – 5 94 76 154 61 8 – – 1 – 285 8 217 12 4 4 169 – – 1 – – 0 553 6451 1696 1 3 – – 0 – – 4199 – 89 926

48 18 019

3 500 160 197 25 741

16 14 503

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 32.

Case notifications and case detection rates, DOTS and non-DOTS combined, 2007 Notified TB cases, DOTS and non-DOTS combined ALL FORMS New and relapse Population thousands All notified number number rate New pulmonary ss+ number rate ss-/unk. number Re-treatment cases New extra- Other pulmonary new Relapse number number number After failure number

67 20 743 390 14 444 1 328 630 7206 481 13 839 263 173 127 967 95 5859 26 572 59 111 2629 10 242 4179 2 84 20 6331 87 960 48 224 187 4436 496 1 100 11 226 87 375 15 1 776 440

3 1133 209 36 495 1 045 939 5545 401 94 64 54 25 311 352 4010 16 918 163 145 4970 4 47 287 0 44 11 16 183 142 576 45 597 1405 397 0 23 18 122 98 344 2 1 446 866

3 1115 207 35 601 979 502 5363 342 94 64 53 24 779 334 3905 16 129 158 137 4654 3 47 274 0 44 11 15 002 140 588 37 554 1359 397 0 23 18 122 97 400 2 1 365 284

4 5 53 246 74 74 71 11 24 31 19 351 67 61 267 123 177 30 19 7 0 52 54 237 160 78 31 80 0 23 171 54 111 13 77

0 281 136 19 421 465 877 1501 138 52 19 5 9433 103 3080 9578 19 47 1856 3 12 81 0 14 5 2087 86 566 10 927 504 142 0 14 12 41 54 457 1 666 412

0 1 35 134 35 21 29 6 7 3 7 108 53 36 32 42 71 30 5 2 0 17 25 33 98 23 11 29 0 14 114 18 62 7 38

3 372 8 7120 430 634 2779 147 7 32 43 9051 78 437 4086 97 62 673 0 15 108 0 28 3 5731 49 422 18 778 564 147 0 5 1 38 17 554 1 548 024

0 428 51 8412 36 612 693 29 34 11 4 5142 147 266 2107 36 28 1832 0 16 75 0 2 3 7088 1513 5005 181 99 0 4 2 43 18 675 0 88 538

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 2 0 0 8

0 34 12 648 46 379 390 28 1 2 1 1153 6 122 358 6 0 293 0 4 4 0 0 0 96 3087 2844 110 9 0 0 1 0 6714 0 62 302

0 0 0 75 2534 1 0 0 0 0 0 0 17 33 1 1 90 0 0 0 0 0 0 479 202 1 0 0 0 0 0 599 0 4033

ss+ = sputum smear-positive; ss- = sputum smear-negative; unk. = sputum smear result unknown; re-treat. = re-treatment; pulm. lab. confirm. = pulmonary case confirmed by positive smear or culture. See Explanatory notes on page 67 for further details. Data can be downloaded from http://stoptb.wpro.who.int.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Incidence and case detection rates Re-treatment cases After Other New pulm. lab. condefault re-treat. Other number number number firm. Estimated incidence all forms number Case detection rate ss+ (% of pulm.)

Proportions ss+ Extrapulm. Re-treat. (% of (% of (% of new+ new+ new+ rerelapse) relapse) treat.)

ss+ all new new ss+ number % %

0 2 0 20 2814 21 4 0 0 0 0 0 12 214 2 4 35 0 0 0 0 0 0 535 436 6 0 0 0 0 0 345 0 4450

0 11 0 799 61 089 160 14 0 0 1 532 18 0 542 2 0 191 1 0 13 0 0 0 1181 974 3 101 32 0 0 0 0 0 0 68 661

0 5 2 0 0 41 0 0 0 0 0 76 0 0 3 0 0 0 0 0 0 0 0 4304 7 0 0 0 0 0 0 4438

0 634 136 19 421 465 877 3273 250 57 62 38 14 657 103 3080 15 506 33 31 1856 0 32 158 0 14 5 2647 86 464 16 230 861 142 0 14 14 79 1 631 675

3 1295 230 71 504 1 305 770 4461 301 2 174 71 59 26 994 347 8851 27 439 128 108 5400 3 52 299 0 49 12 15 796 255 084 43 222 35 1176 634 0 24 18 174 149 588 2 1 919 306

0 579 151 31 621 585 126 2007 135 1 78 21 6 12 135 156 3954 11 904 57 49 2429 3 13 134 0 16 6 6815 114 701 19 409 16 525 285 0 11 8 78 66 109 1 858 539

90 83 85 49 71 111 104 54 87 88 88 95 43 57 119 127 81 90 82 90 90 90 94 54 80 106 61 95 97 70 61 90 68 49 90 61 80 75 102 67 90 90 78 66 78 80 33 97 76 90 90 60 90 90 31 75 56 96 50 129 152 52 82 90 78 43 94 73 52 35 48 88 37 10 51 57 88 70 16 43 73 100 44 43 33 63 27 64 37 47 49 74 92 52 76 50 55 25 66 55 48 28 40 55 30 9 38 31 79 59 12 34 40 100 26 30 32 45 14 62 29 37 36 61 67 34 56 50 49 6 34 27 5 27 47 1 13 13 25 17 11 35 19 38 25 24 4 13 8 36 17 8 21 44 7 13 23 20 39

American Samoa 4 Australia 6 Brunei Darussalam 4 Cambodia 11 China 10 China, Hong Kong SAR 13 China, Macao SAR Cook Islands 1 Fiji 3 French Polynesia 4 Guam 7 Japan 7 Kiribati 4 Lao People’s Democratic Republic 7 Malaysia 7 Marshall Islands 4 Micronesia 12 Mongolia 25 Nauru 9 New Caledonia 6 New Zealand Niue Northern Mariana Islands Palau 8 Papua New Guinea 4 Philippines 16 Republic of Korea Samoa 11 Singapore 2 Solomon Islands Tokelau Tonga 6 Tuvalu Vanuatu 8 Viet Nam Wallis and Futuna 10 Western Pacif ic Region

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 33.

DOTS coverage, case notifications and case detection rates, 2007 TB cases reported from DOTS services New and relapse (WHO total) number rate number New pulmonary ss+ rate ss-/unk. number New extrapulmonary number Other new number Re-treatment cases. After Relapse After failure default number number number

DOTS coverage %

100 100 100 100 100 100 100 100 100 100 99 100 100 100 96 89 100 100 100 100 100 100 100 14 100 100 100 100 0 100 100 83 100 100 100

3 1115 207 35 601 979 502 4157 342 94 64 53 24 674 334 3905 16 129 158 137 4654 3 47 274 0 44 11 5049 140 588 8707 1359 397 0 23 18 122 97 400 2 1 325 173

4 5 53 246 74 58 71 11 24 31 19 351 67 61 267 123 177 30 19 7 0 52 54 80 160 18 31 80 0 23 171 54 111 13 75

0 281 136 19 421 465 877 1 204 138 52 19 5 9400 103 3080 9578 19 47 1856 3 12 81 0 14 5 1051 86 566 2764 504 142 0 14 12 41 54 457 1 656 883

0 1 35 134 35 17 29 6 7 3 7 108 53 36 32 42 71 30 5 2 0 17 25 17 98 6 11 29 0 14 114 18 62 7 37

3 372 8 7120 430 634 2115 147 7 32 43 9021 78 437 4086 97 62 673 0 15 108 0 28 3 1794 49 422 4681 564 147 0 5 1 38 17 554 1 529 296

0 428 51 8412 36 612 546 29 34 11 4 5102 147 266 2107 36 28 1832 0 16 75 0 2 3 2108 1513 113 181 99 0 4 2 43 18 675 0 78 479

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 2 0 0 8

0 34 12 648 46 379 292 28 1 2 1 1151 6 122 358 6 0 293 0 4 4 0 0 0 96 3087 1149 110 9 0 0 1 0 6714 0 60 507

0 0 0 75 2534 0 0 0 0 0 0 0 17 33 1 1 90 0 0 0 0 0 0 479 2 1 0 0 0 0 0 599 0 3832

0 2 0 20 2814 17 4 0 0 0 0 0 12 214 2 4 35 0 0 0 0 0 0 535 151 6 0 0 0 0 0 345 0 4161

ss+ = sputum smear-positive; ss- = sputum smear-negative; unk. = sputum smear result unknown; re-treat. = re-treatment; pulm. lab. Confirmed = pulmonary case confirmed by positive smear or culture. See Explanatory notes on page 67 for further details. Data can be downloaded from http://stoptb.wpro.who.int.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Estimated incidence and case detection rate Estimated incidence Other retreat. number Other number New pulm. lab. confirm. number all forms number ss+ number Case detection rate all new % new ss+ %

Proportions ss+ Re-treat. ss+ (% of Extrapulm. (% of (% of new+ (% of new+repulm.) relapse) new+ relapse) treat.)

0 11 0 799 61 089 138 14 0 0 1 527 18 0 542 2 0 191 1 0 13 0 0 0 974 660 32 0 0 0 0 0 0 65 012

0 5 2 0 0 0 0 0 0 0 0 76 0 0 3 0 0 0 0 0 0 0

0 634 136 19 421 465 877 2474 250 57 62 38 14 597 103 3080 14 692 33 31 1856 0 32 158 0 14 5 1147 86 464

3 1295 230 71 504 1 305 770 4461 301 2 174 71 59 26 994 347 8851 27 439 128 108 5400 3 52 299 0 49 12 15 796 255 084 43 222 35 1176 634 0 24 18 174 149 588 2 1 919 306

0 579 151 31 621 585 126 2007 135 1 78 21 6 12 135 156 3954 11 904 57 49 2429 3 13 134 0 16 6 6815 114 701 19 409 16 525 285 0 11 8 78 66 109 1 858 539

90 83 85 49 71 87 104 54 87 88 87 95 43 57 119 127 81 90 82 90 90 90 31 54 17 106 61 95 97 70 61 90 66 49 90 61 80 60 102 67 90 90 77 66 78 80 33 97 76 90 90 60 90 90 15 75 14 96 50 129 152 52 82 90 77 43 94 73 52 36 48 88 37 10 51 57 88 70 16 43 73 100 44 43 33 63 37 64 37 47 49 74 92 52 76 50 55 25 66 55 48 29 40 55 30 9 38 31 79 59 12 34 40 100 26 30 32 45 21 62 32 37 36 61 67 34 56 50 50 6 34 27 5 27 42 1 1 13 25 17 11 35 19 38 25 24 4 13 8 36 17 8 21 44 7 13 23 20 39

American Samoa 4 Australia 6 Brunei Darussalam 4 Cambodia 11 China 10 China, Hong Kong SAR 13 China, Macao SAR Cook Islands 1 Fiji 3 French Polynesia 4 Guam 7 Japan 7 Kiribati 4 Lao People’s Democratic Republic 7 Malaysia 7 Marshall Islands 4 Micronesia 12 Mongolia 25 Nauru 9 New Caledonia 6 New Zealand Niue Northern Mariana Islands Palau 2 Papua New Guinea 4 Philippines 21 Republic of Korea Samoa 11 Singapore 2 Solomon Islands Tokelau Tonga 6 Tuvalu Vanuatu 8 Viet Nam Wallis and Futuna 10 Western Pacif ic Region

858 7 0 0 0 0 0 0 951

4063 861 142 0 14 14 79 1 616 335

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 34.

Laboratory services, collaborative TB/HIV activities and management of MDR-TB, Western Pacif ic, 2006–2007

Laboratory services, 2007 number of labs working with NTP Smear labs included in EQA TB patients tested for HIV

Collaborative TB/HIV activities 2006 HIV+ TB patients, CPT HIV+ TB patients, ART

smear

culture

DST

TB patients, HIV-positive

3 423 4 4721 1440 4511 399 0 67 26 40 0 404 13 039 103 18 1 0 25 131 0 50 9 0 0 4 0 0 0 0 14 230 2 39 650

0 15 4 1628 108 33 4 0 3 0 0 0 91 1438 0 0 1 0 0 10 0 0 0 0 0 0 0 0 0 0 708 0 4043

0 3 0 954 26 21 0 0 2 0 0 0 91 0 0 0 1 0 0 0 0 0

0 1 0 385 60 15 2 0 2 0 0 0 85 0 0 0 1 0 0 0 0 0 0

0 0 0 0 0 0 0 1098

0 0 0 0 0 0 0 551

ART indicates antiretroviral therapy; CPT, co-trimoxazole preventive therapy; DST, drug susceptibility testing; EQA, external quality assurance; HIV+, HIV-positive; pts, patients. See Explanatory notes on pages 187 for further details. Some countries provided the number of TB patients found to be HIV-positive, but did not provide the number of TB patients tested. The regional total of TB patients tested is therefore lower than the number of patients actually tested, and cannot be used to calculated a regional estimate of HIV prevalence in TB patients. Data can be downloaded from www.who.int/tb

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Collaborative TB/HIV activities 2007 TB patients tested for HIV HIV+ TB patients, CPT HIV+ TB patients, Lab-confirmed ART MDR

Management of MDR-TB, 2007

TB patients, HIV-positive

DST in new cases

MDR in new cases

Re-treatment Re-treatment DST MDR

3 460 0 14 245 34 557 4075 360 57 19 58 16 104 424 10 082 98 11 0 21 106 0 41 11 117 46

0 15 0 2922 1187 41 4 0 0 0 75 155 1629 0 0 3 0 0 4 0 0 0 17 0

0 0 1 101 679 17 0

0 0 610 519 9 1

0 25 0 16 79 25 5 0

0 793 148 0 50 3238 251 2 42 38 4457 0 0 29 9 0 42 271 0 14 4 0 16

0 17 0 0 13 19 4 0 0 0 26 0 0 0 1 2 0 0 0 0 0 0 0 4

0 39 2 56 236 145 31 0 2 1 443 0 0 10 180 0 4 17 0 0 0 0 325

0 American Samoa 8 Australia 0 Brunei Darussalam 16 Cambodia 66 China 6 China, Hong Kong SAR 1 China, Macao SAR Cook Islands 0 Fiji 0 French Polynesia 0 Guam 32 Japan 0 Kiribati 0 Lao People’s Democratic Republic Malaysia 1 Marshall Islands Micronesia 65 Mongolia 0 Nauru 0 New Caledonia 2 New Zealand 0 Niue 0 Northern Mariana Islands 0 Palau 0 Papua New Guinea 270 Philippines Republic of Korea Samoa

0 0

0 0 58 0

149 0 0 0 0 0 0 0 0 0

75 0 0 0 0 0 0 0 0 0 0

0 41 1 1 123 0 0 2 0 0 0 0 568

4 3 0 23 0 0 14 377 2 95 300 0 0 0 0 0 627 0 6679 0 1946 0 1214 0 948 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

827 0 0 0 0 0 0 10 231

3 0 0 0 0 0 0 89

105 0 0 0 0 0 0 1596

1 Singapore 0 Solomon Islands 0 Tokelau 0 Tonga 0 Tuvalu 0 Vanuatu Viet Nam 0 Wallis and Futuna 468 Western Pacif ic Region

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 35.

Treatment outcomes, 2006 cohort New smear-positive cases, DOTS Number of cases Notified Regist'd % of cohort % of notif regist’d Completed Transferred Not eval. Number of cases Default % Success Notified Regist'd

Cured

Died

Failed

3 238 128 19 294 468 291 1238 144 0 73 24 21 10 068 129 3041 9414 45 41 2129 2 9 97 0 15 6 1481 85 740 3431 13 537 124 0 14 4 42 56 437 0 662 273

0 370 153 19 349 470 436 1238 144 73 26 21 8562 126 3047 9414 44 78 2129 2 9 101 0 26 5 1494 85 797 3422 537 124 0 14 4 42 56 470 4 663 261 100 100 100 100 100 100 75 75 90 50 89 2 50 3 0 0 0 0 3 0 2 0 0 0 1 0 1 0 25 25 2 0 1 0 0 0 2 0 3 0 0 0 1 0 1 100 75 90 92 100 92 8970 0 346 0 173 86 101 100 100 100 100 42 40 59 80 78 70 73 42 20 15 8 2 14 16 0 20 3 2 1 14 3 0 0 2 1 1 0 1 0 0 21 4 3 1 5 15 20 0 2 15 0 2 0 0 0 2 0 1 0 85 60 73 88 81 84 90 0 0 8082 467 0 0 155 120 100 100 100 100 100 108 100 85 98 100 100 98 190 100 100 100 104 13 84 90 92 72 88 66 85 90 20 61 88 46 73 60 84 50 89 70 0 0 33 29 3 3 2 29 4 50 72 0 3 2 6 0 6 5 3 1 5 4 4 12 5 21 10 5 6 11 6 2 0 11 7 4 11 1 7 0 1 2 0 0 0 2 0 0 0 0 0 0 1 11 0 1 0 2 1 3 3 30 4 0 6 1 2 3 0 5 3 0 1 3 7 1 1 0 8 11 2 3 2 2 0 0 0 0 1 3 0 0 0 15 0 0 40 7 0 0 0 0 8 85 84 93 94 78 88 66 85 90 53 90 92 48 75 90 88 100 89 70 91 0 47 0 299 299 31 0

Not eval. indicates not evaluated (percentage of registered cases for which outcomes were not recorded); success, sum of cured and completed; cases regist'd, the denominator for calculating treatment outcomes. The number of cases registered for treatment in 2005 is used as the denominator for calculating treatment outcomes unless it is less than the sum of outcomes, in which case the sum of outcomes is used. If the number of cases registered is not reported, then the number of cases notified in 2004 is used, or the sum of outcomes if the latter is greater. Data can be downloaded from www.who.int/tb

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

New smear-positive cases, non-DOTS % of cohort % .% of notif ComDe- Trans- Not Sucregist’d Cured pleted Died Failed fault ferred eval. cess

Smear-positive re-treatment cases, DOTS % of cohort Number ComTrans- Not % Regist’d Cured pleted- Died Failed Default ferred eval. Success

0 67 3 1389 78 146 100 3 1 2 1 0 2 91 4 509 33 7 100 48 85 47 45 79 0 37 5 25 45 4 0 6 2 5 3 0 0 2 2 13 0 1 0 2 1 7 0 7 0 4 5 2 0 0 0 0 0 2 6

American Samoa 87 Australia 100 Brunei Darussalam 85 Cambodia 89 China 72 China, Hong Kong SAR 91 China, Macao SAR Cook Islands Fiji

4 52 9 19 32 0 13 2 26 28 1029 15 170 995 16 5 531 7 20

50 13 20 78 19 31 20 41 71 0

0 31 60 5 17 6 0 30 0 90

50 12 7 8 5 6 0 9 29 10

0 2 0 4 1 0 0 12 0 0

0 9 13 2 6 0 0 5 0 0

0 1 0 4 6 0 0 2 0 0

0 0 32 0 0 47 56 80 1 0 0

50 French Polynesia Guam 45 Japan 80 Kiribati 82 Lao People’s Democratic Republic 35 Malaysia 38 Marshall Islands 20 Micronesia 72 Mongolia 0 Nauru 71 New Caledonia 90 New Zealand 0 Niue 0 Northern Mariana Islands 0 Palau Papua New Guinea

3293 2261 164 5

63 69 47 60

17 3 29 40

5 1 18 0

4 1 0 0

5 5 4 0

2 21 1 0

3 0 1 0

80 Philippines 72 Republic of Korea Samoa 76 Singapore 100 Solomon Islands 0 Tokelau 0 Tonga 0 Tuvalu 0 Vanuatu

7500 4 4 3 6 1 2 2 82 8 96 162

79 80

4 6

6 3

5 3

3 2

3 5

0 1

83 Viet Nam 0 Wallis and Futuna 87 Western Pacif ic Region

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 36.

Re-treatment outcomes, 2006 cohort Relapse, DOTS % of cohort Number regist’d Cured Completed Died Failed Default Transferred Not eval. % Number Success regist’d Cured After failure, DOTS % of cohort Completed Died Failed

0 54 3 660 47 526 312 25

0 9 100 80 85 68 44

0 76 0 5 5 7 44

0 6 0 7 2 6 4

0 0 0 2 2 10 0

0 2 0 3 1 6 0

0 7 0 3 5 1 0 0 0 0 0 2 8

0 85 100 85 89 75 88

0 0 0 51 0 0

0 0 0 4 0 0

0 0 0 14 0 0

0 0 0 27 0 0

4 0 688 4 133 381 16 2 274 0 5 9 0 0 0 2225 1174 109 5 0 0 0 0 6571 0 60 180

50 0 18 75 78 35 31 50 52 0 60

0 0 37 0 5 3 6 0 16 0 89

50 0 15 25 8 5 6 0 12 0 40 11 0 0 0 5 2 24 0 0 0 0 0 6 0 3

0 0 3 0 4 0 0 12 0

0 0 8 0 2 5 0 4 0

0 0 1 0 2 5 0 3 0

0 18 0 0 46 56 50 1 0 0

50 0 54 75 83 38 38 50 68 0 60 89 0 0 0

0 0 0 17 23 3 91 0

0 0 0 65 26 0 47 0

0 0 0 0 17 0 20 0

0 0 0 18 17 0 7 0

0 0 0 6 0 0 20 0

0 0 0 67 64 57 60 0 0 0 0 81 0 82

0 0 0 15 2 16 40 0 0 0 0 4 0 6

0 0 0 4 1 0 0 0 0 0 0 4 0 3

0 0 0 4 5 2 0 0 0 0 0 3 0 2

0 0 0 3 27 0 0 0 0 0 0 3 0 5 1 0 3 0 2 0

0 0 0 597 0 4 0 0 0 0 0 558 0 1344

0 0 0 55 0 100 0 0 0 0 0 64 0 58

0 0 0 18 0 0 0 0 0 0 0 3 0 11

0 0 0 5 0 0 0 0 0 0 0 5 0 6

0 0 0 9 0 0 0 0 0 0 0 16 0 13

82 66 72 100 0 0 0 0 85 0 87

Not eval. indicates not evaluated (percentage of registered cases for which outcomes were not recorded); success, sum of cured and completed; cases regist'd, the denominator for calculating treatment outcomes. The number of cases registered for treatment in 2005 is used as the denominator for calculating treatment outcomes unless it is missing or is less than the sum of outcomes, in which case the sum of outcomes is used. Data can be downloaded from www.who.int/tb

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

After failure, DOTS % of cohort Default Transferred Not eval. % Success Number regist’d Cured Completed

After default, DOTS % of cohort Died Failed Default Transferred Not eval. % Success

0 0 0 4 0 0

0 0 0 0 0 0 0

0 0 0 55 0 0

0 1 0 17 25 7

0 0 0 76 20 57

0 0 0 18 4 43

0 0 0 6 12 0

0 0 0 0 24 0

0 0 0 0 32 0

0 100 0 0 4 0 0 4 0 0

0 American Samoa 0 Australia 0 Brunei Darussalam 94 Cambodia China 24 China, Hong Kong SAR 100 China, Macao SAR Cook Islands Fiji

0 0 0 0 13 0 4 0

0 0 0 12 9 0 1 0 0 17 100 1

0 0 0 65 43 0 67 0

0 0 0 20 164 0 35 0

0 0 0 85 26 0 40 0

0 0 0 5 9 0 26 0

0 0 0 0 4 0 9 0

0 0 0 0 1 0 9 0

0 0 0 5 6 0 11 0

0 0 0 5 5 0 6 0 0 0 49

0 French Polynesia 0 Guam Japan 0 Kiribati 90 Lao People’s Democratic Republic 34 Malaysia Marshall Islands 0 Micronesia 66 Mongolia 0 Nauru New Caledonia New Zealand

0 0 0 6 0 0 0 0 0 0 0 5 0 6 0 0 4 0 0 0 0 0 0 0 6 0 4 2 1 0 2

0 0 0 74 0 100 0 0 0 0 0 67 0 69

0 0 0 242 120 16 0 0 0 0 0 363 0 1010

0 0 0 53 53 69 0 0 0 0 0 58 0 50

0 0 0 25 4 25 0 0 0 0 0 17 0 16

0 0 0 10 0 0 0 0 0 0 0 10 0 7

0 0 0 3 1 0 0 0 0 0 0 1 0 2

0 0 0 9 23 0 0 0 0 0 0 10 0 11

0 0 0 0 19 6 0 0 0 0 0 3 0 5 8 0 0 0 0

0 Niue 0 Northern Mariana Islands 0 Palau Papua New Guinea 78 Philippines 57 Republic of Korea Samoa 94 Singapore 0 Solomon Islands 0 Tokelau 0 Tonga 0 Tuvalu 0 Vanuatu 75 Viet Nam 0 Wallis and Futuna 66 Western Pacif ic Region

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 37.

DOTS treatment success and case detection rates, 1994–2007 DOTS new smear-positive treatment success (%) 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

100 66 91 96 94 96 91 96 81 100 86 67 100 86 95 100 91 100

50 75 85 95 97 85

100 84 76 93 96 78 78 67

100 74 63 91 95 76 89 85 97 93 70 91 77 78 91 93 87 25 89 30

100 66 56 92 96 78 86 85 80 71 75 86 76 79 86 100 87 100 84 9 74 100 67 88 77 88 89 92 88 93 100 93

100 78 84 92 93 79 89 100 78 82 68 76 94 75 76 100 91 87 50 85 60 100 71 38 53 88 83 84 87 90 83

100 82 60 93 94 78 88 86 83 96 76 88 79 72 90 92 87 75 36 75 80 58 88 82 77 87

67 85 71 91 94 80 89

75 80 71 93 94 77 93 100 71 66 85 90 53 90 92 48 75 90 88 100 89 70 85 60 73 88 81 84 90 100 75 90 92 100 92 92 85 84 93 94 78 88

90 74

92 85 94 76

80 100 57 94 86 56 90 80 88 94 68 88 100 65 87 80 100 81 87

89 85 60 93 90 70 87 50 88 67 94 60 73 100 71 89 83 91 83 85 73

83 70 69 83 80 78 75 86 84 70 55 65 80

88 79 90 82 95 86 50 77

80 67 75 93 82 76 80 86 65 75 73 82 92 75 92 94 80 88 91 91 90 93 85 93 93 95 92 94 71 100 83 82 86 94 95 72 84 66 87

81 63 88 92 85 81 93 88 92 92

100 79 92 100 90 91 75 92 90 93 100 91

100 81 92

Treatment success = sum of cured and completed; DOTS new smear-positive case detection rate = notified (new and relapse) cases divided by estimated incident cases. The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from http://stoptb.wpro.who.int.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

DOTS new smear-positive case detection rate (%) 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

90 22 40 15 88 90 51 34 29 136 90 54 90 44 32 164 90 54 90 63 90 48 32 150

90 29 90 54 30 64

90 23 90 50 31 67 95

90 19 90 48 31 61 98 90 71 90 32 40 41 73 26 13 71 90 90 41 90 8 52 60 28 35 67 58 84 90 38

90 25 90 57 30 65 90 90 75 90 90 37 52 47 70 31 38 72 90 90 51 90 90 90 15 57 107 51 33 196 38 87 90 39

90 9 90 62 43 66 99 83 90 46 63 48 69 35 47 66 90 90 62 90 90 17 64 26 69 57 43 95 49 86 90 50

90 32 90 62 64 64 101 90 69 90 90 51 90 57 67 68 65 77 90 65 90 90 18 69 23 65 87 49 70 73 89 65

90 39 90 68 80 61 107 90 74 90 90 67 79 72 72 84 62 78 90 50 90 90 20 71 20 66 102 56 98 60 44 84 90 77

90 42 90 62 80 60 110 90 90 90 78 82 77 80 79 82 88 90 90 65 90 90 22 75 18 80 101 42 127 49 53 86 77

American Samoa 40 Australia 90 Brunei Darussalam 61 Cambodia 80 China 60 China, Hong Kong SAR 102 China, Macao SAR Cook Islands 67 Fiji 90 French Polynesia 90 Guam 77 Japan 66 Kiribati 78 Lao People’s Democratic Republic 80 Malaysia 33 Marshall Islands 97 Micronesia 76 Mongolia 90 Nauru 90 New Caledonia 60 New Zealand Niue 90 Northern Mariana Islands 90 Palau 15 Papua New Guinea 75 Philippines 14 Republic of Korea Samoa 96 Singapore 50 Solomon Islands Tokelau 129 Tonga 152 Tuvalu 52 Vanuatu 82 Viet Nam 90 Wallis and Futuna 77 Western Pacif ic Region

58 90

58 90 90 23

7 24 64 12 8 90 68 33

33 40 18

37 45 29 67 90

34 40 73 19 24 61 90 90 40 90

19 6 90 31 60

90 0 30 73 62

90 0 60 45 27 24

90 1 3 56 71 30 85 39 126 7 9 62 89 26 80 28 70 16 32 123 31 82 37 8 10 7 44

106

30 15

59 28

78 31

83 33

83 31

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 38.

New smear-positive case notification by age and sex, absolute numbers, DOTS and non-DOTS, 2007

Male 0–14 15–24 25–34 35–44 45–54 55–64 65+ 0–14

Female 15–24 25–34 35–44

American Samoa Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Cook Islands Fiji French Polynesia Guam Japan Kiribati Lao People’s Democratic Republic Malaysia Marshall Islands Micronesia Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Western Pacif ic Region 1726 59 827 71 557 85 284 1 1 48 2 1 3 3587 2 7431 1 2 4 8391 2 8451 1 83 198 75 836 91 686 2102 39 574 37 234 34 619 2 5046 1 5 2 2 7026 2 1 59 6 1939 8 2354 1 1923 3 1 1 5 15 15 18 16 63 12 98 9 80 8 105 6 1 5 13 12 13 25 25 9 16 466 16 178 8524 589 1 171 11 781 953 112 13 810 1144 3 4 2 67 12 846 1308 1 50 8481 906 6 4862 1684 32 380 34 148 4389 570 153 5594 807 84 5291 466 2 2 1 1 4 1 1 2 11 216 142 15 150 1291 1 8 280 1 1 11 1 1 372 7 258 2224 1 5 270 1 7 7 2 7 2 2 512 10 307 2082 2 4 232 1 2 7 1 4 3 4 2 8 1 14 7 1 8 158 668 6 418 1839 5 1174 10 361 1394 1 1 48 34 3678 3 350 1395 3 8 7 226 1 5 23 134 13 126 1098 3 11 273 318 6 175 1101 3 6 250 231 8 215 849 2 2 139 4 2 1 4 7 1 11 1 4 1 6 5 3 0 50 878 5 30 5 883 44 011 63 14 33 10 1526 46 374 80 12 20 15 2190 56 224 110 14 15 21 2102 54 960 177 30 14 10 1761 56 288 175 16 37 17 1644 70 376 425 13 4 0 64 1235 1 2 26 6 749 29 960 59 10 37 6 1351 24 914 94 4 20 12 1698 23 542 74 6

For some countries, breakdown of notified cases by age and sex is missing, or is provided for a subset of cases. See Explanatory notes on page 187 for further details. Data can be downloaded from www.who.int/tb

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Female 45–54 55–64 65+ 0–14 15–24 25–34

All 35–44 45–54 55–64 65+

Male/female ratio

American Samoa 12 15 2105 18 129 64 8 5 1 156 9 293 782 3 2 80 7 9 1839 17 647 37 3 1 3 1 212 4 206 585 3 2 36 29 1 6 1 36 4612 387 23 10 6 1 1 15 3313 347 11 5 3 2217 1716 39 5 48 846 50 1 10 326 12 913 1159 28 27 5 1 6 2170 28 916 3 1 1891 26 189 2 4144 33 688 3 2 107 3828 1 9 5526 99 401 10 9785 108 791 4 2 1 23 2 1459 21 339 137 6 2 2 1 1832 2 207 514 4 10 18 442 1 6 27 1 276 28 276 2389 4 19 553 1 1 25 1 8 2 1 324 17 375 1760 31 41 2 196 19 101 1610 88 21 1 2 5 10 314 119 903 1 8 10 621 1 112 114 102 025 125 374 2.3 690 13 433 3325 4 11 520 7 0 114 2113 6 2 8 1 56 11 1632 73 971 122 24 18 1 70 16 2877 71 288 174 16 11 3 40 27 3888 79 766 184 20 13 7 2 743 18 522 2931 4 6 371 1 3 15 4 1 10 5 2 103 17 458 1695 121 19 3 10 1 2 65 11 794 1253 91 13 1 3 3 6937 9 7079 3400 144 11 5 2 4 11 170 3 12 4 5.0 0.8 1.3 4.0 1.3 2.4 1.5 3.0 1.0 1.8 1.0 0.6 2.8 27 36 4207 73 089 241 38 9 2 1 824 15 711 2621 8 2 238 21 19 3600 73 935 212 19 2 3 1 1386 14 567 1979 4 3 84 63 60 19 3103 91 715 562 19 6 2 1 5510 5 557 1909 1.2 1.6 1.1 2.4 2.2 2.5 0.9 0.5 0.7 2.3 1.1 1.5 2.0 0.7 0.7 1.2 Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Cook Islands Fiji French Polynesia Guam Japan Kiribati Lao People’s Democratic Republic Malaysia Marshall Islands Micronesia Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Western Pacif ic Region

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 39.

New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2007 Male 0–14 15–24 25–34 35–44 45–54 55–64 65+ 0–14 Female 15–24 25–34 35–44

0 0 2 1 1 0 1 0 0 1 5 5 1 0 0

2 14 51 38 14 34 8 0 2 23 50 60 92 5 4

2 27 158 44 16 40 11 10 0 4 60 105 67 112 5 0

1 51 294 46 19 39 14 9 15 6 104 115 81 124 11 2

1 91 425 63 29 66 9 13 0 8 200 127 0 134 7 1

1 85 607 95 47 62 4 0 13 359 166 38 90 30 2

3 262 1008 140 105 80 24 0 33 383 249 0 76 26 3

0 0 3 1 0 6 5 3 0 0 1 6 24 7 0 0

2 18 44 28 13 24 14 4 0 2 19 44 91 92 0 5

3 15 137 25 16 11 7 5 0 4 40 53 84 105 0 3

1 40 202 20 10 12 12 25 0 3 69 48 37 73 5 3

1 3 0 0 5 0 2 0

28 96 17 5 29 17 12 39

36 170 24 6 38 14 13 100

31 269 27 16 46 0 32 140

29 354 35 24 57 0 24 199

40 385 40 32 81 42 38 241

8 312 83 57 80 168 51 310

3 2 1 0 5 0 2 0

25 51 18 5 25 29 26 22

32 82 21 5 66 15 50 32

22 104 11 6 35 22 8 31

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Female 45–54 55–64 65+ 0–14 15–24 25–34

All 35–44 45–54 55–64 65+

American Samoa 1 84 337 22 9 17 11 0 10 2 135 57 44 64 0 2 1 122 450 31 10 14 3 36 15 2 180 73 76 62 0 3 2 33 476 39 29 29 9 26 16 12 180 80 0 48 11 1 0 0 2 1 1 3 3 1 0 0 1 5 14 4 0 0 2 16 47 33 14 29 11 2 0 2 21 47 74 92 2 4 2 21 147 35 16 24 9 8 0 4 50 79 76 109 3 1 1 46 245 33 14 23 13 17 8 4 86 82 58 98 8 2 1 88 376 43 19 41 10 7 5 5 167 93 22 98 4 2 1 99 515 64 29 40 4 17 7 7 264 121 57 76 16 2 2 152 660 87 64 52 16 14 9 21 270 159 0 60 18 2 Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Cook Islands Fiji French Polynesia Guam Japan Kiribati Lao People’s Democratic Republic Malaysia Marshall Islands Micronesia Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau 15 124 11 6 62 0 74 50 27 12 145 15 4 51 0 21 86 34 4 114 59 18 68 0 57 159 41 2 3 1 0 5 0 2 0 1 26 74 17 5 27 23 19 31 34 34 126 23 6 51 15 31 66 40 26 187 20 11 40 11 20 85 40 22 238 23 15 59 0 48 123 51 26 263 27 18 66 19 30 161 66 6 202 69 36 74 76 54 229 83 Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Western Pacif ic Region

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 40.

Number of TB cases notified, 1980–2007 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

2 1457 196 2576 0 8065 1101 8 210 76 55 70 916 146 7630 11 218 6 0 1160 0 108 474 1 0 17 2525 89 803 59 2710 266 0 64 33 178 43 062 23 36 100

6 1386 285 1980 7729 585 2 180 66 41 65 867 187 10 970 7 1094 2 128 448 0 26 10 2508

6 1270 245 8158 7527 233 12 163 65 49 63 940 193 4706 11 944 12 67 1325 8 120 437 2 75 17 2742

8 1219 276 7572 7301 455 15 185 78 48 62 021 127 4700 11 634 15 73 1514 0 171 415 3 74 14 2955 91 572 41 2065 302 0 50 23 196 43 185 17 36 100

12 1299 256 10 241 7843 671 3 165 80 54 61 521 111 6528 10 577 12 75 1652 0 144 404 1 58 20 3505 85 669 37 2143 337 0 54 9 188 43 875 14 36 100

5 088 238 10 145 7545 571 8 230 78 37 58 567 103 4258 10 569 15 66 2994 0 104 359 0 64 26 3453 87 169 43 1952 377 2 49 32 124 46 941 14 36 100

8 906 212 10 325 7432 420 3 199 85 49 56 690 129 1514 10 735 37 60 2819 8 98 320 5 16 13 2877 88 789 65 1760 292 0 35 27 131 47 557

9 907 189 9106 7269 389 2 173 80 34 56 496 110 3468 11 068 32 98 2433 6 74 296 0 56 38 2251 87 419 29 1616 334 9 24 22 90 55 505 34

13 954 126 10 691 7021 320 0 162 63 41 54 357 208 7279 10 944 11 77 2538 8 111 295 3 27 17 4261 74 460 29 1666 372 1 14 24 118 52 463 1 36 100

5 952 128 7 906 6704 274 2 218 73 75 53 112 121 2952 10 686 7 68 2233 0 128 303 28 3 3396 70 012 37 1617 488 0 36 26 144 52 270 30 35 97

9 1016 143 6501 6510 343 0 226 59 51 821 68 1826 11 702 367 1659 7 143 348 0 28

3 950 10 903 6283 329 1 247 49 50 612 91 1951 11 059 26 350 1611 140 335

1 1011 180 16 148 6534 294 6 240 83 60 48 956 100 994 11 420 52 111 1516 140 317 2 67

4 991 160 13 270 6537 285 5 183 78 70 48 461 99 2093 12 285 61 151 1418 104 274 1 25 7451 46 999 49 1830 367 33 28 114 52 994 11 33 92

98 654 117 557 151 564 226 899 265 095 251 600 304 639 310 607 375 481 345 000 320 426 344 218

6 2497 63 904 44 1591 382 1 23 23 140 50 203 3401 57 864 44 1841 309 1 20 30 230 59 784 22 32 89 31 86

4 2540 48 070 26 1778 364 1 29 30 193 56 594 4 35 97

Philippines 112 307 116 821 104 715 106 300 151 863 151 028 153 129 163 740 183 113 217 272 317 008 207 371 236 172 178 134 98 532 100 878 49 2425 313 1 49 18 92 43 506 24 33 92 43 2179 324 0 45 12 173 51 206 5 36 100

Western Pacif ic Region 356 452 355 337 461 550 462 181 540 985 615 153 651 840 655 006 716 427 741 913 894 073 760 863 754 463 718 783 35 97 36 100

From 1995 on, number shown is all notified new and relapse cases (DOTS and non-DOTS). The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from www.who.int/tb

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

4 1057 15 172 363 804 6319 4 225 89 94 44 425 253 1135 11 708 173 1730 4 97 352 2 46 41 5335 180 044 38 155 45 1677 332 0 23 19 152 51 763 11 724 290 33 92 87 391 0 48 19 8041 119 186 42 117 45 1889 352 2 20 36 79 55 739 6 824 954 29 81 830 11 778 172 2780 43 078 1073 14 603 515 764 6212 402 2 203

6 1145 160

3 899 16 946 445 704 7673 465 0 166 105 44 016 276 2149 14 115 49 123 2915 90 365 0 97 11 291 162 360 34 661 22 2120 295 30 18 178 87 468 834 599 30 83

4 1073 272 19 266 449 518 5605 3 192 93 40 800 255 2420 14 908 41 3348 2 78 447 1 66 32 13 003 145 807 32 075 31 1805 289 0 22 14 120 88 879 820 469 32 89

3 1043 307 18 891 454 372 6015 449 1 144 62 54 39 384 252 2227 15 057 34 91 3109 4 94 344 0 75 10 520 119 914 21 782 43 1728 302 0 24 16 152 89 792 786 285 34 94

3 980 216 19 170 470 221 6788 465 2 183 62 63 35 489 189 2418 14 830 56 104 3526 3 61 377 0 58 12 658 107 133 37 268 22 1536 292 0 12 16 175 90 728 1 805 105 35 97

2 1013 230 24 610 462 609 6277 388 1 148 64 51 32 828 196 2621 14 389 51 127 3829 5 65 329 4 53 11 11 197 118 408 34 967 31 1516 256 29 13 101 95 044 19 811 482 35 97

3 949 206 28 216 615 868 5914 371 0 185 50 22 31 638 284 2748 15 671 60 99 3918 3 38 386 0 45 9 12 798 132 759 33 843 27 1581 293 0 16 30 104 92 741 15 36 100

5 1059 176 30 838 790 603 5684 309 1 134 60 50 29 736 310 3162 14 986 117 118 4542 61 371 0 53 5 12 743 130 530 34 389 34 1414 340 12 115 98 173

6 1046 163 35 535 894 428 5660 355 1 132 63 63 27 194 332 3777 15 342 111 98 4601 11 47 332 0 57 10 12 564 137 100 38 290 24 1356 397 0 18 12 76 94 916 7

4 1159 202 34 660 940 889 5536 374 1 114 69 44 25 304 378 3958 16 051 138 104 5049 12 48 344 0 51 12 12 620 147 305 37 861 25 1313 371 0 18 9 126 97 363

3 1115 207 35 601 979 502 5363 342 94 64 53 24 779 334 3905 16 129 158 137 4654 3 47 274 0 44 11 15 002 140 588 37 554 1359 397 0 23 18 122 97 400 2

14 857 504 758 6501 570 1 200 86 42 122 327 1440 12 691 59 126 4062 104 352 2 51 5 3195 165 453 39 315 31 1951 299 0 22 126 74 711 8 873 425 31 86

15 629 466 394 7072 575 2 171 91 42 190 464 1923 13 539 107 3592 88 321 0 93 15 7977 195 767 33 215 32 1977 318 21 184 77 838 14 870 920 31 86

980 890 1 160 130 1 274 124 1 331 512 1 365 284 32 89 36 100 35 97 34 94

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 41.

Case notification rates, 1980–2007 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

6 10 102 38 160 437 45 33 50 52 61 267 246 82 20 70 0 76 15 29 139 79 234 236 38 112 116 0 66 410 152 81 200 27

18 9 143 29 150 226 11 28 42 38 56 333 78 22 64 26 88 14 0 139 80 77 237 255 32 98 132 64 51 221 77 80 200 27

17 8 120 114 10 144 87 68 24 41 44 54 335 145 83 36 86 76 104 81 14 64 355 134 82 207 257 28 86 132 0 47 145 141 93 40 34

22 8 131 102 11 137 163 85 27 47 42 52 214 141 78 43 91 84 0 114 13 100 308 108 86 205 230 26 80 119 0 53 274 156 76 130 34

32 8 118 132 14 145 229 17 24 47 46 51 182 191 69 33 90 89 0 94 13 35 214 150 99 286 212 24 81 128 0 58 106 146 76 104 39

13 7 107 125 21 138 186 45 32 45 31 48 164 121 67 39 77 157 0 67 11 0 213 191 95 278 214 27 72 139 126 53 370 94 79 101 44

19 6 92 123 24 135 131 17 28 48 40 47 200 42 67 92 68 143 96 62 10 190 49 94 77 275 215 41 64 104 0 38 307 97 79 46

21 6 80 104 23 131 117 11 24 44 27 46 166 93 67 76 109 120 70 46 9 0 157 269 59 287 210 18 57 116 559 26 245 65 90 243 45

29 6 52 118 27 126 92 0 23 34 32 44 304 190 64 25 84 121 91 68 9 125 70 118 109 314 177 18 58 125 62 15 263 83 83 7 49

11 6 51 84 27 119 76 11 30 38 57 43 172 75 61 15 72 103 0 76 9 68 21 84 363 165 23 55 160 0 38 280 99 81 216 50

19 6 56 67 33 114 92 0 31 30 42 95 45 65 381 75 77 84 10 0 64

6 6 109 30 109 86 6 34 25 41 124 46 59 54 354 71 80 10

2 6 66 155 27 111 75 33 32 41 43 39 135 23 60 105 110 66 78 9 89 135

8 6 57 124 29 109 72 28 24 38 50 39 132 47 63 122 146 61 57 8 44 155 167 272 106 30 56 107 34 289 70 75 78 46

39 60 518 149 27 53 122 62 24 244 94 76 59 80 331 134 27 59 96 63 21 315 150 88 158 50

25 58 368 110 16 56 110 64 30 312 122 82 29 49

Rates are per 100 000 population. From 1995 on, number shown is notification rate of new and relapse cases. The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from www.who.int/tb.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

8 6 137 30 104 22 30 42 66 36 332 25 58 163 73 41 51 10 88 83 247 116 268 86 27 50 94 0 24 195 90 72 77 46 45 11 0 83 111 171 174 94 27 54 97 135 21 367 46 76 42 51 18 57 160 116 34 6 128 42 100 98 11 26

11 6 52

5 5 138 36 118 108 0 21 46 35 340 43 64 95 114 119 44 10 0 150 221 222 75 13 56 75 31 179 98 114 50

7 6 84 154 36 85 18 24 40 32 309 47 66 79 136 20 37 12 51 99 169 248 195 69 18 46 71 0 22 138 65 114 49

5 5 92 148 36 90 102 6 18 26 35 31 300 43 65 65 85 126 40 44 9 0 109 195 157 47 24 43 73 0 24 157 80 114 47

5 5 63 147 37 101 104 13 23 26 40 28 221 45 62 106 97 142 30 28 10 0 81 229 138 79 12 37 68 0 12 156 90 113 7 47

3 5 66 186 36 92 85 7 18 26 32 26 225 49 59 95 118 153 50 29 8 228 72 56 198 149 74 17 36 58 29 126 51 117 127 47

5 5 58 209 47 86 80 0 23 20 13 25 320 50 63 110 91 155 30 17 10 0 59 45 221 164 71 15 37 65 0 16 290 51 112 100 57

8 5 48 225 61 81 66 7 16 24 30 23 343 57 59 211 108 178 26 9 0 68 25 215 158 72 19 33 74 12 55 117 67

9 5 44 255 68 80 75 7 16 25 37 21 361 67 60 196 89 178 109 20 8 0 71 50 207 162 80 13 31 84 0 18 115 35 112 46 73

6 6 53 244 71 78 78 7 14 27 26 20 404 69 61 238 94 194 118 20 8 0 62 59 203 171 79 13 30 77 0 18 86 57 113 75

4 5 53 246 74 74 71 11 24 31 19 351 67 61 267 123 177 30 19 7 0 52 54 237 160 78 31 80 0 23 171 54 111 13 77

127 41 103 136 6 26 39 33 417 30 60 115 117 169 53 9 91 85 29 66 236 87 18 54 80 0 23 72 100 55 54

130 38 111 136 11 22 41 33 582 39 62 99 148 44 9 0 149 83 161 273 73 19 53 83 21 103 103 96 53

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 42.

New smear-positive cases notified, numbers and rates, 1990–2007 Number of cases 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

1 557 68

6 226 0

2 203 13 865 2091 276 0 74 34 11 935 52 1494 7802 11 14 1356 26 106 0 26 2107 69 476 10 359 7 482 140 16 38 54 889

3 285 102 15 744 1536 0 65 33 12 909 59 1706 8207 17 1513 2 22 94 1 15 20 2140 73 373 9 559 17 465 93 0 10 0 43 53 805

2 251 84 14 822 1940 160 0 62 29 43 11 853 54 1526 8156 11 15 1389 4 20 74 0 27 1933 67 056 8 216 13 248 109 0 15 0 63 53 169

2 228 95 14 361 1857 157 2 73 0 47 11 408 64 1563 8309 15 8 1631 2 19 68 0 19 1351 59 341 11 805 11 357 118 0 8 0 57 54 238 1

1 210 112 17 258 1892 147 1 74 28 31 10 807 82 1829 7958 18 22 1670 2 21 88 1 21 9 1345 65 148 11 345 19 549 108 23 0 38 56 698 1

2 113 121 18 923 1794 138 0 78 21 0 10 843 99 1866 7989 20 26 1541 1 12 106 0 16 5 2310 72 670 10 976 12 583 138 0 11 0 40 55 937 7

2 285 115 18 978 1693 128 1 62 30 22 10 471 142 2226 7843 39 35 1808 15 111 0 14 5 1896 78 163 11 471 11 501 152 8 59 58 394

11 058 2429 108 5 61 4 62 38 40 17 890 99 6954 12 16 770 184

11 101 0 141 2 68

12 065 1774 258 1 69 37

12 686 1943 325 2 66 41 13 571 50 1234 7496 9 1171 24 83 0 21 7 1195 80 163 9 957 14 436 113 11 66 50 016 1

84 898 104 729 134 488 203 670 236 021 202 817 201 775 204 765 204 591 194 972 267 414 384 886

14 367 478

12 867 144 886 7271 12 14 769 26 90 1 26 4 447 86 695 11 420 9 519 90 0 14 50 48 911 3

6861

6688 9

0 16 91 0 8 92 279 16 630 21 513 155 16 2

145 2 28 61 0 11 87 401 13 266 18 861 114 0 17 1 62

455 21 78 0 14 9 1652 94 768 11 754 15 455 109 1 9 6 30 37 550 3

81 222 813 241 737 314 271 388 142 416 954 379 698 383 613 376 109 371 806 372 528 453 812 579 566

Rates are per 100 000 population. The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from www.who.int/tb

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Rate (per 100 000 population) 2005 2006 2007 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

3 241 101 21 001 472 719 1561 136 1 63 21 27 10 931 124 2806 8 446 48 32 1868 0 16 83 0 15 3 1805 81 647 11 638 11 552 169 0 11 5 35 55 492 1 671 612

3 269 128 19 294 468 291 1537 144 0 73 24 21 10 159 129 3041 9 414 45 41 2129 2 9 97 0 15 6 1948 85 740 11 513 13 537 124 0 14 4 42 56 437 671 243

0 281 136 19 421 465 877 1501 138 0 52 19 5 9433 103 3080 9 578 19 47 1856 3 12 81 0 14 5 2087 86 566 10 927 504 142 0 14 12 41 54 457 1 666 412 0 0 12 6 10 33 10 0

2 3 24

11 1 0

4 1 113 16 32 64 0 9 15 9 64 30 35 21 13 56 13 3 0 40 41 95 22 4 13 36 16 21 71 23

5 2 31 126 16 23 0 8 14 10 71 33 36 33 62 20 10 2 51 22 106 41 98 21 10 12 23 0 10 0 23 69 23

4 1 25 116 16 29 36 0 8 12 28 9 64 29 35 21 14 56 40 9 2 0 39 36 88 18 7 6 26 0 15 0 33 67 22

3 1 28 110 16 28 35 13 9 0 30 9 75 29 35 28 7 66 20 9 2 0 27 24 76 25 6 9 28 0 8 0 29 68 7 22

2 1 32 130 15 28 32 7 9 11 19 8 94 34 33 34 20 67 20 9 2 57 29 46 24 82 24 11 13 25 23 0 19 70 7 22

3 1 34 140 21 26 30 0 10 8 0 8 112 34 32 37 24 61 10 5 3 0 21 25 40 90 23 7 14 31 0 11 0 20 68 47 26

3 1 31 138 29 24 27 7 8 12 13 8 157 40 31 70 32 71 7 3 0 18 25 32 94 24 6 12 33 8 28 70 33

5 1 27 150 36 22 29 7 8 8 16 9 135 50 33 85 29 72 0 7 2 0 19 15 30 97 24 6 13 36 0 11 48 16 65 7 38

5 1 34 136 35 22 30 0 9 9 12 8 138 53 36 78 37 82 20 4 2 0 18 30 31 99 24 7 12 26 0 14 38 19 65 38

0 1 35 134 35 21 29 6 7 3 7 108 53 36 32 42 71 30 5 2 0 17 25 33 98 23 11 29 0 14 114 18 62 7 38

100 7 41 27 28 8 22 8 18 28 14 132 36 24 13 241 9

97 11 0 34 11 9

103 17 28 62 6 9 17

106 19 30 77 11 8 18 11 63 25 35 8 48 12 2 0 34 39 24 112 22 8 12 30 11 37 66 7 25

11 10

10 184 18 34 23 13 32 13 2 45 43 23 9 124 25 5 14 24 0 14 28 66 21 24

32 8

0 9 3 0 50 141 38 13 16 45 17 21

6 20 15 2 0 66 130 30 11 26 32 0 18 10 37

19 11 2 0 24 53 35 138 26 9 13 30 68 9 61 17 51 21

Tuberculosis Control in the Western Pacific : 2009 Report

Annex 8: Notified prevalence of resistance to anti-TB drugs (1997–2007) Table 43. Notified prevalence of resistance to specific drugs among new TB cases tested for resistance Patients tested combined only 638 1043 1222 1574 764 876 combined only combined only 3271 2705 265 combined only 250 18 965 2636 895 combined only 29 1619 28 1122 224 4 767 2315 837 2909 2472 223 572 856 858 1005 646 524 Susceptible Any resistance . 89.7 82.1 70.2 63.9 84.6 65.0 . . 88.9 91.4 84.2 . 89.6 22.2 79.5 87.8 93.5 . 96.6 69.3 1 497 26 4 198 321 58 362 233 42 66 187 364 569 118 313

| ANNEXES

Country and Area Sub-national Year Australia Cambodia China China China China China Fiji Guam Hong Kong (China) Japan Macao (China) New Caledonia New Zealand Northern Mariana Islands Philippines Republic of Korea Singapore Solomon Islands Vanuatu Viet Nam Countrywide Countrywide Beijing Henan Heilongjiang Shanghai Inner Mongolia Countrywide Countrywide Hong Kong Countrywide Macao Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide

Method

% . 10.3 17.9 29.8 36.1 15.4 35.7 . . 11.1 8.6 15.8 . 10.4 22.2 20.5 12.2 6.5 . 3.4 30.7

Any H

% .

Any R

% .

Any E

% .

Any S

% .

Mono

% .

Mono H

% .

Mono R

% .

2005 Surveillance 2001 2004 2001 2004 2004 2001 Survey Survey Survey Survey Survey Survey

41 91 208 266 89 164

6.4 8.7 17.0 16.9 11.7 20.3 . .

4 44 117 167 37 84

0.6 4.2 9.6 10.6 4.8 9.6 . .

1 43 53 93 23 72

0.2 4.1 4.3 5.9 3.0 8.9 . .

32 95 271 383 62 187

5.0 9.1 22.2 24.3 8.1 21.3 . .

54 113 190 340 57 148

8.5 10.8 15.5 21.6 7.5 18.4 . .

30 35 40 61 25 40

4.7 3.4 3.3 3.9 3.3 5.0 . .

3 11 17 34 6 13

0.5 1.1 1.4 2.2 0.8 1.6 . .

2006 Surveillance 2002 Survey

2005 Surveillance 2002 Surveillance 2005 Surveillance 2005 Survey

164 77 28

5.0 2.8 10.6 .

36 28 7

1.1 1.0 2.6 .

27 23 4

0.8 0.9 1.5 .

274 188 27

8.4 7.0 10.2 .

262 184 28

8.0 6.8 10.6 .

66 33 14

2.0 1.2 5.3 .

7 5 1

0.2 0.2 0.4 .

2006 Surveillance 2006 Surveillance 2004 2004 Survey Survey

17 3 130 261 30

6.8 16.7 13.5 9.9 3.4 .

1 2 44 98 5

0.4 11.1 4.6 3.7 0.6 .

1 0 41 70 7

0.4 0.0 4.2 2.7 0.8 .

18 2 115 70 35

7.2 11.1 11.9 2.7 3.9 .

17 1 122 203 44

6.8 5.6 12.6 7.7 4.9 .

8 0 57 145 16

3.2 0.0 5.9 5.5 1.8 .

0 0 4 25 3

0.0 0.0 0.4 0.9 0.3 .

2005 Surveillance 2004 Survey

2006 Surveillance 2006 Survey

1 310

3.4 19.1

0 53

0.0 3.3

0 42

0.0 2.6

0 375

0.0 23.2

1 291

3.4 18.0

1 114

3.4 7.0

0 5

0.0 0.3

H = isoniazid; R = rifampicin; E = ethanbutol; S = streptomicin; Mono = mono-resistant to; HR = resistant only to H and R; HRE = resistant to H, R and E; HRS = resistant to H, R and S; HRES = resistant to H, R, E, and S; Poly = resistant to more than one drug other than MDR; HE = resistant to H and E; HS = resistant to H and S; HES = resistant to H, E, and S; RE = resistant to R and E; RS = resistant to R and S; RES = resistant to R, E, and S; ES = resistant to E and S.

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Mono E % . 0 0.0 14 1.3 10 0.8 3 0.2 0 0.0 5 0.6 . . 1 0.0 2 0.1 0 0.0 . 0 0.0 0 0.0 1 0.1 7 0.3 2 0.2 . 0 0.0 3 0.2

Mono S % MDR . 21 3.3 53 5.1 123 10.1 242 15.4 26 3.4 90 11.2 . . 188 5.7 144 5.3 13 4.9 . 9 3.6 1 5.6 60 6.2 26 1.0 23 2.6 . 0 0.0 169 10.4 0 44 1 28 19 6 0 24 95 113 30 61

% . 0.0 2.3 7.8 7.2 3.9 7.0 . . 0.9 0.7 2.3 . 0.4

% . 0 0.0 1.4 1.5 1.5 0.9 1.6 . .

HRE

% .

HRS

% .

HRES

% .

Poly

% .

% . 1 0.2 1.1 0.2 0.0 0.1 1.1 . . 5 0 0 0.2 0.0 0.0 . 0 0 5 0.0 0.0 0.5 0.6 0.2 . 0 0 0.0 0.0

% .

HES

% .

% . 0 5 1 1 0 1 0.0 0.5 0.1 0.1 0.0 0.1 . . 1 0 0 0.0 0.0 0.0 . 0 0 1 1 0 0.0 0.0 0.1 0.0 0.0 . 0 0 0.0 0.0

% . 1 4 4 0.2 0.4 0.3 1.1 0.1 0.7 . . 0 2 0 0.0 0.1 0.0 . 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0 . 0 4 0.0 0.2

RES

% .

% . 0 9 1 2 0 3 0.0 0.9 0.1 0.1 0.0 Australia Cambodia Beijing Henan Heilongjiang Shanghai

0 1 5 63 17 29

0.0 0.1 0.4 4.0 2.2 3.6 . .

0 5 47 4 1 4

0.0 0.5 3.8 0.3 0.1 0.5 . .

0 3 25 22 5 13

0.0 0.3 2.0 1.4 0.7 1.6 . .

12 50 79 116 31 75

1.9 4.8 6.5 7.4 4.1 9.3 . .

10 21 62 93 29 44

1.6 2.0 5.1 5.9 3.8 5.5 . .

0 0 9 1 0 12

0.0 0.0 0.7 0.1 0.0 1.5 . .

0 0 0 1 0 0

0.0 0.0 0.0 0.1 0.0 0.0 . .

15 18 24 7 13

11 2 0 1 9

18 1 6

0.4 Inner Mongolia . . Fiji Guam Hong Kong (China) Japan Macao (China) New Caledonia New Zealand Northern Mariana Islands Philippines Republic of Korea Singapore

5 2 0

0.2 0.1 0.0 .

3 3 0

0.1 0.1 0.0 .

9 3 3

0.3 0.1 1.1 .

11 11 3

0.3 0.4 1.1 .

72 30 8

2.2 1.1 3.0 .

60 21 7

1.8 0.8 2.6 .

5 4 1

0.2 0.1 0.4 .

0 2 0

0.0 0.1 0.0 .

1 1 0

0.0 0.0 0.0 .

0.0

0 0 5 33 0

0.0 0.0 0.5 1.3 0.0 .

0 0 5 4 0

0.0 0.0 0.5 0.2 0.0 .

1 0 19 10 2

0.4 0.0 2.0 0.4 0.2 .

8 1 37 47 12

3.2 5.6 3.8 1.8 1.3 .

8 1 21 26 9

3.2 5.6 2.2 1.0 1.0 .

0 0 8 3 1

0.0 0.0 0.8 0.1 0.1 .

0 0 0 0 0

0.0 0.0 0.0 0.0 0.0 .

0 0 2 0 0

0.0 0.0 0.2 0.0 0.0

2 11.1 39 71 2 4.0 2.7 0.2 . 0.0 2.7

2 11.1 10 24 0 1.0 0.9 0.0 . 0 0 0.0 0.0

16 2

. Solomon Islands 0 6 0.0 0.4 Vanuatu Viet Nam

0 0

0.0 0.0

0 20

0.0 1.2

0 24

0.0 1.5

0.0

0 143

0.0 8.8

0 9

0.0 0.6

0 0

0.0 0.0

162 10.0

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 44.

Notified prevalence of resistance to specific drugs among previously treated TB cases tested for resistance Any resistance . 82.3 64.9 39.2 32.5 72.5 29.9 17 54 161 286 55 252 . . 76.7 74.8 73.7 38 105 5 . 93.8 1 6.3 23.3 25.2 26.3 17.7 35.1 60.8 67.9 27.5 65.3

Country and Area Sub-national Australia Cambodia China China China China China Fiji Guam Hong Kong (China) Japan Macao (China) New Caledonia New Zealand Northern Mariana Islands Philippines Republic of Korea Singapore Solomon Islands Vanuatu Viet Nam Countrywide Countrywide Beijing Henan Heilongjiang Shanghai Inner Mongolia Countrywide Countrywide Hong Kong Countrywide Macao Countrywide Countrywide

Year 2005 2001 2004 2001 2004 2004 2001 2006 2002 2005 2002 2005 2005 2006

Method Surveillance Survey Survey Survey Survey Survey Survey Surveillance Survey Surveillance Surveillance Surveillance Survey Surveillance

SuscepPatients tested tible combined only 96 154 265 421 200 386 combined only combined only 163 417 19 combined only 16 . 79 100 104 137 145 92 . . 125 312 14 . 15

Any H . 16 38 125 202 43 218 . . 28 79 4 . 1

Any R .

Any E .

Any S .

Mono .

Mono H .

Mono R .

16.7 24.7 47.2 48.0 21.5 56.5

3 23 113 170 30 175 . .

3.1 14.9 42.6 40.4 15.0 45.3

0 14 48 103 20 123 . .

0.0 9.1 18.1 24.5 10.0 31.8

7 33 114 136 25 115 . .

7.3 21.4 43.0 32.3 12.5 29.9

10 17 38 101 19 52 . .

10.4 11.0 14.3 24.0 9.5 16.9

9 7 11 37 11 23 . .

9.4 4.5 4.2 8.8 5.5 7.5

0 2 8 24 2 16 . .

0.0 1.3 3.0 5.7 1.0 5.2

17.2 18.9 21.1

16 46 3 .

9.8 11.0 15.8

9 35 1 .

5.5 8.4 5.3

25 60 3 .

15.3 14.4 15.8

15 49 2 .

9.2 11.8 10.5

7 26 1 .

4.3 6.2 5.3

1 2 0 .

0.6 0.5 0.0

6.3

0.0

6.3

0.0

Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide

2006 2004 2004 2005 2004 2006 2006

Surveillance Survey Survey Surveillance Survey Surveillance Survey

new only 129 278 105 combined only new only 207

. 81 201 94 . . 85 41.1 62.8 72.3 89.5

. 48 77 11 . . 122 58.9 37.2 27.7 10.5

. 40 67 4 . . 90 43.5 31.0 24.1 3.8

. 33 47 3 . . 44 21.3 25.6 16.9 2.9

. 12 27 1 . . 30 14.5 9.3 9.7 1.0

. 22 16 7 . . 105 50.7 17.1 5.8 6.7

. 17 29 9 . . 38 18.4 13.2 10.4 8.6

. 10 20 2 . . 8 3.9 7.8 7.2 1.9

. 5 7 2 . . 2 1.0 3.9 2.5 1.9

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Mono E . 0 0 4 0 1 0 . . 1 1 0 . 0

Mono S % .

MDR .

HR .

HRE .

HRS .

HRES .

Poly .

HE .

HS .

HES .

RE .

RS .

RES .

ES .

% Australia 0.0 1.9 0.4 0.0 0.5 0.3 Cambodia Beijing Henan Heilongjiang Shanghai Inner Mongolia Fiji Guam 0.0 0.0 0.0 Hong Kong (China) Japan Macao (China) New Caledonia 0.0 New Zealand Northern Mariana Islands 0.0 0.0 0.0 Philippines Republic of Korea Singapore Solomon Islands Vanuatu 0.0 Viet Nam

0.0 0.0 1.5 0.0 0.5 0.0

1 8 15 40 5 13 . .

1.0 5.2 5.7 9.5 2.5 4.2

3 18 97 128 25 142 . .

3.1 11.7 36.6 30.4 12.5 36.8

1 6 20 25 6

1.0 3.9 7.5 5.9 3.0

0 2 2

0.0 1.3 0.8

2 7

2.1 4.5

0 3

0.0 1.9

4.2

0 3 0 3 0 2 . .

0.0 1.9 0.0 0.7 0.0 0.6

4 8 13 32 7 17 . .

4.2 5.2 4.9 7.6 3.5 5.5

0 2 4 2 0 3 . .

0.0 1.3 1.5 0.5 0.0 1.0

0 1 2 1 0 1 . .

0.0 0.6 0.8 0.2 0.0 0.3

0 2 5 17 2 9 . .

0.0 1.3 1.9 4.0 1.0 2.9

0 0 1 0 1 2 . .

0.0 0.0 0.4 0.0 0.5 0.6

0 3 1 0 1 1 . .

19 12.3 26 9.8

41 15.5 6 2 6 . . 1.4 1.0 1.9

34 12.8 39 7 9.3 3.5

58 13.8 10 5.0

55 13.1 11 5.5

34 11.0 . .

48 15.6 . .

41 13.3 . .

35 11.4 . .

0.6 0.2 0.0

6 20 1 .

3.7 4.8 5.3

13 41 3 .

8.0 9.8 15.8

3 6 1 .

1.8 1.4 5.3

0 6 0 .

0.0 1.4 0.0

4 10 1 .

2.5 2.4 5.3

6 19 1 .

3.7 4.6 5.3

10 15 0 .

6.1 3.6 0.0

0 3 0 .

0.0 0.7 0.0

8 6 0 .

4.9 1.4 0.0

0 3 0 .

0.0 0.7 0.0

1 1 0 .

0.6 0.2 0.0

0 0 0 .

0.0 0.0 0.0

1 2 0 .

0.6 0.5 0.0

0 0 0 .

0.0

. 0 0 0 . . 2 1.0 0.0 0.0 0.0

. 2 2 5 . . 26 12.6 1.6 0.7 4.8

. 27 39 1 . . 40 19.3 20.9 14.0 1.0

. 7 14 0 . . 5 2.4 5.4 5.0 0.0

. 4 16 0 . . 0 0.0 3.1 5.8 0.0

. 8 4 0 . . 15 7.2 6.2 1.4 0.0

. 8 5 1 . . 20 9.7 6.2 1.8 1.0

. 4 9 1 . . 44 21.3 3.1 3.2 1.0

. 0 4 0 . . 0 0.0 0.0 1.4 0.0

. 3 3 1 . . 34 16.4 2.3 1.1 1.0

. 0 1 0 . . 8 3.9 0.0 0.4 0.0

. 0 0 0 . . 0 0.0 0.0 0.0 0.0

. 1 0 0 . . 2 1.0 0.8 0.0 0.0

. 0 1 0 . . 0 0.0 0.0 0.4 0.0

. 0 0 0 . . 0

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 45.

Notified prevalence of resistance to specific drugs among all TB cases tested for resistance Any resistance 82 83 241 528 853 173 565 0 2 477 338 47 1 27 . 77.5 86.3 93.1 100.0 246 398 69 0 . 66.1 619 33.9 22.5 13.7 6.9 0.0

Country and Area Australia Cambodia China China China China China Fiji Guam Hong Kong (China) Japan Macao (China) New Caledonia New Zealand Northern Mariana Islands Philippines Republic of Korea Singapore Solomon Islands Vanuatu Viet Nam

Sub-national Countrywide Countrywide Beijing Henan Heilongjiang Shanghai Inner Mongolia Countrywide Countrywide Hong Kong Countrywide Macao Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide Countrywide

Year 2005 2001 2004 2001 2004 2004 2001 2006 2002 2005 2002 2005 2005 2006 2006 2004 2004 2005 2004 2006 2006

Method Surveillance Survey Survey Survey Survey Survey Survey Surveillance Survey Surveillance Surveillance Surveillance Survey Surveillance Surveillance Survey Survey Surveillance Survey Surveillance Survey

Patients Susceptested tible 808 734 1197 1487 1995 964 1262 38 47 4350 3122 284 5 266 new only 1094 2914 1000 84 new only 1826 726 651 956 962 1142 791 697 38 45 3873 2784 237 4 239 . 848 2516 931 84 . 1207

% 89.9 88.7 79.9 64.7 57.2 82.1 55.2 100.0 95.7 89.0 89.2 83.5 80.0 89.8

% 10.1 11.3 20.1 35.5 42.8 17.9 44.8 0.0 4.3 11.0 10.8 16.5 20.0 10.2

Any H 71 57 129 333 470 128 382 0 4 228 156 32 1 18 . 170 328 34 0 . 400

% 8.8 7.8 10.8 22.4 23.6 13.3 30.3 0.0 8.5 5.2 5.0 11.3 20.0 6.8

Any R 14 7 67 230 337 67 259 0 2 57 74 10 0 1 .

% 1.7 1.0 5.6 15.5 16.9 7.0 20.5 0.0 4.3 1.3 2.4 3.5 0.0 0.4

Any E 7 1 57 101 196 43 193 0 1 36 58 5 0 1 .

% 0.9 0.1 4.8 6.8 9.8 4.5 15.3 0.0 2.1 0.8 1.9 1.8 0.0 0.4

Any S 35 39 128 385 519 87 299 0 2 353 248 30 1 18 .

% 4.3 5.3 10.7 25.9 26.0 9.0 23.7 0.0 4.3 8.1 7.9 10.6 20.0 6.8

Mono 53 64 130 228 441 76 200 0 0 336 233 30 0 18 .

% 6.6 8.7 10.9 15.3 22.1 7.9 18.0 0.0 0.0 7.7 7.5 10.6 0.0 6.8

Mono H 43 39 42 51 98 36 63 0 0 92 59 15 0 9 .

% 5.3 5.3 3.5 3.4 4.9 3.7 5.7 0.0 0.0 2.1 1.9 5.3 0.0 3.4

Mono R 1 3 13 25 58 8 29 0 0 12 7 1 0 0 .

% 0.1 0.4 1.1 1.7 2.9 0.8 2.6 0.0 0.0 0.3 0.2 0.4 0.0 0.0

15.5 11.3 3.4 0.0

77 145 8 0 .

7.0 5.0 0.8 0.0

53 97 8 0 .

4.8 3.3 0.8 0.0

137 86 42 0 .

12.5 3.0 4.2 0.0

139 232 53 0 .

12.7 8.0 5.3 0.0

67 165 18 0 .

6.1 5.7 1.8 0.0

9 32 5 0 .

0.8 1.1 0.5 0.0

21.9

5.3

3.9

480

26.3

329

18.0

122

6.7

0.4

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Mono E 0 0 14 14 3 1 5 0 0 2 3 0 0 0 . 1 7 2 0 . 5

% 0.0 0.0 1.2 0.9 0.2 0.1 0.4 0.0 0.0 0.0 0.1 0.0 0.0 0.0

Mono S 9 22 61 138

% 1.1 3.0 5.1 9.3

MDR 12 3 42

% 1.5 0.4 3.5

HR 1 1 21 38 49 13 47 0 0 8 8 1 0 0 .

% 0.1 0.1 1.8 2.6 2.5 1.3 4.2 0.0 0.0 0.2 0.3 0.4 0.0 0.0

HRE 1 0 3 7 121 27 77 0 0 3 9 0 0 0 .

% 0.1 0.0 0.3 0.5 6.1 2.8 6.9 0.0 0.0 0.1 0.3 0.0 0.0 0.0

HRS 5 2 12 88 10 3 10 0 0 13 13 4 0 0 .

% 0.6 0.3 1.0 5.9 0.5 0.3 0.9 0.0 0.0 0.3 0.4 1.4 0.0 0.0

HRES 5 0 6 59 61 12 54 0 0 17 30 4 0 1 .

% 0.6 0.0 0.5 4.0 3.1 1.2 4.8 0.0 0.0 0.4 1.0 1.4 0.0 0.4

Poly 17 16 69 105 171 42 110 0 0 100 45 8

% 2.1 2.2 5.8 7.1 8.6 4.4 9.9 0.0 0.0 2.3 1.4 2.8

HE 1 1 14 2 3 1 11 0 0 5 3 0 0 0 .

% 0.1 0.1 1.2 0.1 0.2 0.1 1.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0

HS 15 14 29 75 125 36 61 0 0 85 27 7

% 1.9 1.9 2.4 5.0 6.3 3.7 5.5 0.0 0.0 2.0 0.9 2.5

HES 0 0 2 13 3 0 15 0 0 5 7 1 0 0 .

% 0.0 0.0 0.2 0.9 0.2 0.0 1.3 0.0 0.0 0.1 0.2 0.4 0.0 0.0

RE 0 0 6 3 2 0 2 0 0 2 1 0 0 0 .

% 0.0 0.0 0.5 0.2 0.1 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0

RS 1 1 6 9 35 3 15 0 0 1 2 0 0 0 .

% 0.1 0.1 0.5 0.6 1.8 0.3 1.3 0.0 0.0 0.0 0.1 0.0 0.0 0.0

RES 0 0 0 1 1 1 2 0 0 1 4 0 0 0 .

% 0.0 0.0 0.0 0.1 0.1 0.1 0.2 0.0 0.0 0.0 0.1 0.0 0.0 0.0

ES 0 0 12 2 2 1 4 0 0 1 1 0 0 0 .

% 0.0 0.0 1.0 0.1 0.1 0.1 Australia Cambodia Beijing Henan Heilongjiang Shanghai

192 12.9 241 12.1 55 5.7

282 14.1 31 103 0 0 230 164 14 0 9 . 3.2 9.2 0.0 0.0 5.3 5.3 4.9 0.0 3.4

203 16.1 0 2 41 60 9 0 1 . 0.0 4.3 0.9 1.9 3.2 0.0 0.4

0.4 Inner Mongolia 0.0 0.0 0.0 0.0 Fiji Guam Hong Kong (China) Japan

0.0 Macao (China) 0.0 New Caledonia 0.0 New Zealand Northern Mariana Islands 0.2 0.0 0.0 0.0 Philippines Republic of Korea Singapore Solomon Islands Vanuatu 0.3 Viet Nam

1 20.0 8 . 3.0

0.1 0.2 0.2 0.0

62 28 28 0 .

5.7 1.0 2.8 0.0

66 110 3 0 . 84

6.0 3.8 0.3 0.0

17 38 0 0 .

1.6 1.3 0.0 0.0

9 49 0 0 .

0.8 1.7 0.0 0.0

13 8 0 0 .

1.2 0.3 0.0 0.0

27 15 3 0 .

2.5 0.5 0.3 0.0

41 56 13 0 .

3.7 1.9 1.3 0.0

5 20 2 0 . 0

0.5 0.7 0.2 0.0

24 29 10 0 .

2.2 1.0 1.0 0.0

8 4 1 0 .

0.7 0.1 0.1 0.0

1 1 0 0 .

0.1 0.0 0.0 0.0

1 1 0 0 .

0.1 0.0 0.0 0.0

0 1 0 0 .

0.0 0.0 0.0 0.0

2 0 0 0 .

0.3

195 10.7

4.6

0.3

0.0

1.9

2.4

206 11.3

0.0

177

9.7

0.9

0.0

0.3

0.0

Tuberculosis Control in the Western Pacific : 2009 Report

| ANNEXES

Table 46.

Notified prevalence of extensively drug resistant TB (XDR-TB) among MDR-TB, 2002–2007 MDR tested MDR for XDR

Country and Area Representative survey or surveillance data Australia Hong Kong (China) Japan Macao (China) New Zealand Republic of Korea Singapore

Source

Year

Method

FLQ

lower upper %FLQ 95%CI 95% CI

XDR

lower upper %XDR 95% CI 95% CI

Global Project, SRLs Australia Global Project, SRL Hong Kong Global Project, SRL Japan Global Project Global Project Global Project Global Project

20022005 2005 2002 2005 2005 2004 20022005

surveillance surveillance sentinel surveillance surveillance survey surveillance

43 41 60 9 4 110 14

43 41 55 9 4 110 14

4 12 21 1 2 13 1

9.3 29.3 38.2 11.1 50 11.8 7.1 0.1 19.3

1 6 17 0 0 2 0

2.3 14.6 30.9 0 0 1.8 0 0 6.4

Risk groups and MDR-TB treatment programmes Philippines Global Project GLC programme 20052006 Confirmed MDR for Tx 293 149 50.9 45 56.7 10 3.4 1.6 6.2

FLQ = resistant to fluroquinolone; CI = confidence interval; SRL = Supranational Reference Laboratory; Tx = treatment; GLC: Green Light Committee

Tuberculosis Control in the Western Pacific : 2009 Report

5 | ANNEXES

This report can also be downloaded at: http://stoptb.wpro.who.int/

Tuberculosis Control in the Western Pacific : 2009 Report

Key facts

Organisation World Health Organization (WHO)

Document type Publications

Adoption date December 31, 2009

Source World Health Organization