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Tuberculosis control in the Western Pacific Region : 2006 report

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IFC

2006 Report

Tuberculosis Control in the Western Pacific Region

Prepared by The Stop TB Unit in the WHO Regional Office for the Western Pacific Region, Dongil Ahn, Philippe Glaziou, Yao Hongyan, Pieter van Maaren, Bernard Tomas, Jamhoih Tonsing. 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 Pacific Region for providing data for this publication.

WHO Library Cataloguing in Publication Data Tuberculosis control in the Western Pacific Region : 2006 report. 1. Tuberculosis – epidemiology. 2. Tuberculosis – prevention and control. 3. Tuberculosis – drug therapy. 4. Directly observed therapy – utilization. 5. Tuberculosis, Multidrug-resistant. 6. Western Pacific. ISBN 92 9061 219 3 (NLM Classification: WF 200)

© World Health Organization 2006 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 22 791 2476; fax: +41 22 791 4857; email: 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; email: permissions@who.int). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: publications@wpro.who.int

Contents

List of figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii List of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v 1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. EPIDEMIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2.1 Estimated burden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 Case notification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2.1 Notifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2.2 Notification rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2.3 Age- and sex-specific notification rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 4 4 4 5

2.3 TB-HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.4 Drug resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 3. PROGRESS IN TB CONTROL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.1 DOTS coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.2 Case detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.3 DOTS enrolment and progress in overall case detection . . . . . . . . . . . . . . . . . . . . . . . . . 8 3.4 Treatment outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3.5 Treatment results of retreatment cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Explanatory notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ANNEX 1. Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 ANNEX 2. Formulas for estimating tuberculosis incidence, prevalence and deaths . . . . . . . . . 29 ANNEX 3. Statistical methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

LIST OF FIGURES Figure 1: Figure 2: Figure 3: Figure 4: Figure 5: Figure 6: Case notification rates (all forms) in the Western Pacific Region, 1995–2004 . . . . . . 4 Case notification rates of smear-positive cases, 1995-2004 . . . . . . . . . . . . . . . . . . . . 4 Smear-positive notification rates, by age and sex, 2004. . . . . . . . . . . . . . . . . . . . . . . 5 DOTS coverage 1995-2004 in the Western Pacific Region . . . . . . . . . . . . . . . . . . . . . 7 Trends in DOTS case detection rates of smear-positive cases, 1995-2004. . . . . . . . . 8 Trends in DOTS and non-DOTS case detection rates (new smear-positive cases) in the Western Pacific Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 7: Treatment outcomes for new smear-positive cases registered in 2003 in DOTS and non-DOTS areas in the Western Pacific Region. . . . . . . . . . . . . . . . . . . 9 Figure 8: Treatment outcomes for new smear-positive cases registered in 2003 in DOTS areas in high-burden countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 9: Unfavourable outcomes among new smear-positive cases registered in 2003 in DOTS areas in the Western Pacific Region. . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 10: Treatment outcomes for re-treatment cases registered in 2003 (DOTS areas). . . . . 10

Tuberculosis Control in the Western Pacific Region: 2006 Report

iii

LIST OF TABLES Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12: Table 13: Table 14: Table 15: Table 16: Estimated prevalence rates (all cases) and death rates per 100 000 of TB in the Western Pacific Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Estimated prevalence of HIV in new TB cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Anti-tuberculosis drug resistance, by country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Case detection rates of smear-positive cases in 2004. . . . . . . . . . . . . . . . . . . . . . . . . 7 Estimated burden of TB, 2000 and 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Whole country case notifications and case detection rates, 2004. . . . . . . . . . . . . . . 15 DOTS coverage, case notification and case detection rates, 2004. . . . . . . . . . . . . . 16 Public–Public and Public–Private Mix (PPM), collaborative TB-HIV activities and management of MDR-TB, 2003–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Treatment outcomes, 2003 cohort. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Re-treatment outcomes, 2003 cohort. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 DOTS treatment success and case detection rates, 1994–2004. . . . . . . . . . . . . . . . 20 New smear-positive case notification by age and sex, absolute numbers, DOTS and non-DOTS, 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Number of TB cases notified, 1980–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Case notification rates, 1980–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 New smear-positive cases notified, numbers and rates, 1993–2004. . . . . . . . . . . . . 25

Tuberculosis Control in the Western Pacific Region: 2006 Report

Executive Summary This is the report on tuberculosis (TB) control for the WHO Western Pacific Region. It includes data on estimates of disease burden, case notifications and treatment outcomes reported from 36 of 37 countries and areas in the Region in 2004. Regionally, tuberculosis remains a major public health problem. In 2004, there were an estimated 3.8 million prevalent cases of TB (216 per 100 000 population) in the Region, of which almost 2 million were new cases (111 per 100 000 population). Three countries (China, the Philippines and Viet Nam) accounted for about 90% of the total estimated new cases in the Region. China accounted for 70% of incident TB cases (all forms) in the Region. The human immunodeficiency virus (HIV) epidemic has had an impact in the Region: the prevalence of HIV among TB cases was 13% in Cambodia, 3.7% in Papua New Guinea and 3% in Viet Nam. In addition, drug resistance was found in all settings surveyed in the Region; the prevalence of multidrug resistant-tuberculosis (MDR-TB) in previously untreated cases varied widely across settings ranging from 0.1% to 10.4%. The case detection rate in the Region in 2004 (see Annex 1 for definitions) was 60% for all tuberculosis cases and 67% for new smear-positive cases. In other words, the 1.2 million notified cases (all types) represented 60% of the 2 million estimated cases (all types) and the 579 594 notified new smear-positive cases represented 67% of the estimated new smear-positive cases. Based on preliminary data, the Region has likely reached the 2005 case detection rate target of 70%. Case detection rates in areas with directly observed treatment, short-course (DOTS) have been steadily increasing in the Region since 2002. The 67% increase in case detection in the Region from 2002 to 2004 is primarily due to a dramatic 110% increase in case detection in China. In DOTS areas, the treatment cure and success rates were 87% and 91%, respectively, for the cohort of 426 675 new pulmonary smear-positive cases registered for treatment in 2003. In the Lao People’s Democratic Republic and Papua New Guinea, two countries with a high burden of tuberculosis,1 treatment success rate were below the 85% WHO target. In 2000, the Regional Committee for the Western Pacific endorsed the impact targets of 50% reduction in prevalence and mortality due to TB within 10 years, by 2010. To achieve the impact targets by 2010, the Region needs to accelerate the rate of decline in prevalence and mortality by further improving the quality of DOTS services, and by addressing the current challenges of MDR-TB and HIV.

Seven countries in the Western Pacific Region have a high burden of tuberculosis: Cambodia, China, the Lao People’s Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam Tuberculosis Control in the Western Pacific Region: 2006 Report

1 Introduction The WHO Western Pacific Region covers a broad geographic area comprising more than 27% of the world’s population, in 37 countries and areas. In 2005, WHO sent a standard form for reporting surveillance data to all 37 countries and areas. Information was collected about the number and types of tuberculosis (TB) cases notified in 2004, on the outcomes of treatment among smear-positive and smear-negative as well as re-treatment smear-positive cases registered in 2003, and about policies and practices in use for TB control. In addition, data from drug resistance and TB-HIV surveillance were compiled. Over a decade ago, WHO declared tuberculosis a “global emergency”, not only because of its effect on individuals but also because of its wider social and economic ramifications on a country’s development. Targets were established to measure the progress of implementation of the directly observed treatment, short-course (DOTS) strategy to combat tuberculosis by 2005. These targets include 100% population coverage with DOTS, 70% case detection and 85% treatment success rate. Achieving these targets is an important intermediate step towards reaching the impact targets of 50% reduction in prevalence and mortality due to TB by 2010, compared with 2000. Since 2000, the Western Pacific Region has achieved significant progress: DOTS coverage reached 94% at the end of 2004; the Region has already achieved the cure rate target in DOTS areas; and it will likely reach the 70% case detection target by the end of 2005. The Western Pacific Region publishes an annual TB report sharing current knowledge on the state of TB in the Region. Its primary aim is to present data on TB epidemiology and related information reported from national TB control programmes (NTP). The annual report highlights the similarities and differences within the Region and the strategies that have been adopted to address the TB epidemic.

Tuberculosis Control in the Western Pacific Region: 2006 Report

2 Epidemiology This report is based on case notifications for 2004 and treatment outcomes for patients registered in 2003, as reported by national TB control programmes to the World Health Organization in 2005, using standard data collection forms, with common definitions and variables (Annex 1).

2.1 Estimated burden Estimates of TB prevalence, incidence and mortality in countries are based on a consultative and analytical process that takes into account all available information on case notifications; prevalence of infection and disease; tuberculin surveys; duration of illness; proportion of smear-positive cases; numbers of cases treated and remaining untreated; HIV prevalence and incidence; mortality and demography. The estimates of disease burden are revised annually by WHO to reflect new information gathered through surveillance and from special studies such as prevalence and annual risk of tuberculosis infection (ARTI) studies conducted in countries. The estimates are also applied to previous years, retrospectively, when necessary. The estimated figures are WHO provisional estimates published in the WHO Report 2006: Global Tuberculosis Control. The methodology used for case estimates was described in detail in the “Global Burden of Tuberculosis,”2 published in 1999, and “The Growing Burden of Tuberculosis,”3 published in 2003. In all measurements of TB indicators, population estimates provided by the United Nations Population Division are used,4 recognizing that these sometimes differ from population data in the countries themselves (many of which are based on more recent survey data). In 2004, there were an estimated 3.8 million prevalent cases of TB (216 per 100 000 population) in the Western Pacific Region, of which almost 2 million were new cases (111 per 100 000 population). China accounted for about 70% of all incident TB cases (all forms) in the Region. It was estimated that 307 411 deaths from tuberculosis occurred in the Region in 2004, i.e. 18 deaths from tuberculosis per 100 000 population. The death rate from tuberculosis per 100 000 population was highest in Cambodia (94) as compared to 17 in China. Table 1 shows the rates of change in the estimated prevalence and death rates from 2000 to 2004. TABLE 1: ESTIMATED PREVALENCE RATES (ALL CASES) AND DEATH RATES PER 100 000 OF TB IN THE WESTERN PACIFIC REGION

The estimated prevalence and death rates decreased in the Region at an overall yearly rate of –4.8% and –2.7%, respectively. 2

Dye C et al. Global Burden of Tuberculosis. Estimated Incidence, Prevalence, and Mortality by Country. Journal of the American Medical Association , 1999, 282: 677–686. 3 Corbett EL et al. The Growing Burden of Tuberculosis. Global Trends and Interactions with the HIV Epidemic. Archives of Internal Medicine , 2003, 163(9): 1009–1021. 4 World Population Prospects: The 2004 Revision Population Database. New York, United Nations Population Division, 2005 (http://esa.un.org/unpp/, accessed January 2006). Tuberculosis Control in the Western Pacific Region: 2006 Report

2 | EPIDEMIOLOGY 2.2 Case notification 2.2.1 Notifications The population coverage with DOTS was 94% in the Western Pacific Region in 2004. The Region detected 25% of the total number of cases detected globally. The Region accounted for approximately 1.2 million cases of all forms of all notified cases of tuberculosis and 579 594 notified cases of smear-positive tuberculosis in 2004. The largest number was from China, with 790 603 cases (384 886 smear-positive cases). Thus China alone accounted for 16% of all reported tuberculosis cases and 17% of all smear-positive cases reported globally.5

2.2.2 Notification rates The case notification rate per 100 000 population in the Western Pacific Region was 67 for 2004. The notification rate for all cases in the Region has been steady since 1995. After a slight but steady decline since 1996, the Region has experienced a more rapid increase in its notification rate, from 47 to 67 per 100 000 between 2002 and 2004 (Figure 1). FIGURE 1: CASE NOTIFICATION RATES (ALL FORMS) IN THE WESTERN PACIFIC REGION, 1995–2004

The smear-positive notification rate for the Western Pacific Region held steady between 1998 and 2002, at 22 per 100 000. Since 2003, the Region has shown a comparative increase in the smearpositive notification rate, to 33 per 100 000 (Figure 2). FIGURE 2: CASE NOTIFICATION RATES OF SMEAR-POSITIVE CASES, 1995–2004

Global tuberculosis control - surveillance, planning, financing. Geneva, World Health Organization, 2006 (WHO/HTM/TB/ 2006.362). Tuberculosis Control in the Western Pacific Region: 2006 Report

2 | EPIDEMIOLOGY 2.2.3 Age- and sex-specific notification rates The age- and sex-specific notification rates for the Region for 2004 show that males have higher rates overall and display an upward trend in the higher age groups, indicating a shift in the epidemiology of tuberculosis (see Figure 3). FIGURE 3: SMEAR-POSITIVE NOTIFICATION RATES, BY AGE AND SEX, 2004

2.3 TB-HIV The HIV epidemic has reached a generalized stage at the national level in Cambodia and in Papua New Guinea. The prevalence of HIV infection among TB was estimated to be 13% in Cambodia and 3.7% in Papua New Guinea in 2004. In other countries affected by HIV,6 particularly China and Viet Nam, the HIV epidemic is still at the concentrated stage. In China, HIV prevalence data indicate a concentrated spread of infections among injecting drug users (IDUs) and no significant spread to the non-IDU population. Although HIV/AIDS cases have been detected in all provinces, HIV transmission is focused primarily among IDUs in certain provinces. In Viet Nam, the prevalence is highest among IDUs (24% in 2000), but sexual transmission of HIV is increasing among female sex workers. Tuberculosis is the most important life-threatening opportunistic infection associated with HIV. Table 2 shows the regional estimated prevalence of HIV among TB cases in countries with a high TB burden. The overall estimated HIV seropositivity among new adult TB cases is 1.4% in the Western Pacific Region. TABLE 2: ESTIMATED PREVALENCE OF HIV IN NEW TB CASESa

Detailed methodology and year 2000 estimates published in: Corbett EL et al. The Growing Burden of Tuberculosis: Global Trends and Interactions with the HIV Epidemic. Archives of Internal Medicine, 2003, 163(9): 1009–1021.

Global Health Atlas (http://www.who.int/GlobalAtlas/PDFFactory/HIV/index.asp, accessed February 2005). Tuberculosis Control in the Western Pacific Region: 2006 Report

2 | EPIDEMIOLOGY 2.4 Drug resistance Multidrug resistant-tuberculosis (MDR-TB) is posing a threat to tuberculosis control in several countries. In 1994, the Global Project on Anti-tuberculosis Drug Resistance Surveillance was launched by WHO, the International Union Against TB and Lung Disease (The Union) and several other partners. The Global Project methodology for drug resistance surveillance was designed around and continues to operate on three main principles: (1) surveillance must be based on a sample of TB patients representative of all cases in the geographical setting under evaluation; (2) drug resistance must be clearly distinguished according to the treatment history of the patient in order to allow correct interpretation of resistance data; and (3) optimal laboratory performance must be attained through participation in a quality assurance programme, including the international exchange of strains of Mycobacterium tuberculosis. Drug resistance was present in all settings surveyed in the Western Pacific Region. The prevalence of drug resistance varied widely across settings (Table 3). DOTS-Plus pilot programmes are already implemented in the Philippines and in Mongolia, and are starting in two provinces of China. TABLE 3: ANTI-TUBERCULOSIS DRUG RESISTANCE, BY COUNTRY New casesa Year Australia Cambodia China Heilongjiang Henan Hubei Inner Mongolia Liaoning Zhejiang Hong Kong (China) Malaysia Mongolia New Zealand Republic of Korea Singapore Viet Nam aData

Previously treated cases MDRc 1.6 0.0 96 3.1

Numbers 770 638

INHb Any resistance resistance 5.6 4.7 9.9 10.3

Numbers

MDR

2001 2001

2004 2001 1999 2003 1999 1998 2001 1996 1999 2001 1998 2001 1996

1574 1222 859 806 818 802 3470 1001 405 272 2370 823 640 bINH:

4.9 3.3 3.7 5.0 5.4 2.7 2.3 1.0 4.4 4.4 4.9 1.6 6.7

36.1 29.8 17.5 35.0 42.1 14.8 10.2 4.8 29.4 11.4 10.6 5.0 32.5

7.2 7.8 2.1 7.3 10.4 4.5 0.8 0.1 1.0 0.0 2.2 0.5 2.3

421 265 238 308 86 140 169 16 22 283 126 -

30.4 36.6 21.8 41.9 24.4 35.0 11.2 0.0 0.0 7.1 0.8 -

from Australia are for combined cases.

Isoniazid; cMDR: multidrug resistance

Continuous monitoring of trends in high prevalence MDR settings is essential in order to assess current interventions and their impact on the epidemic. To date, it is difficult to interpret trends in high MDR prevalence settings with any certainty. No area reaching MDR prevalence of 6.5% has dropped below that point in subsequent surveys, suggesting that, when a critical threshold of transmission has been reached within a population, it may take a considerable amount of time to reduce the prevalence of MDR-TB. The results of improved TB control interventions under DOTS, and targeted interventions such as DOTS-Plus, may not be as rapidly evident in these settings as they might in a population with a lower prevalence of resistance.

Tuberculosis Control in the Western Pacific Region: 2006 Report

3 Progress in TB control 3.1 DOTS coverage Among the 37 countries and areas in the Western Pacific Region, all have had at least part of their population covered by DOTS units. Figure 4 shows the DOTS population coverage achieved between 1995 and 2004. FIGURE 4: DOTS COVERAGE IN THE WESTERN PACIFIC REGION, 1995-2004

Much of the increase in population coverage in recent years is attributable to DOTS expansion in China.

3.2 Case detection The overall case detection rate (DOTS and non-DOTS) was 60% for all tuberculosis and 67% for smear-positive cases (Table 4); DOTS areas reported 65% of all estimated new smear-positive cases. Case detection has increased 29% between 2003 and 2004 in the Region. TABLE 4: CASE DETECTION RATES OF SMEAR-POSITIVE CASES IN 2004 Case detection rates Smear-positive cases (%) Western Pacific Region Cambodia China Lao People's Democratic Republic Mongolia Papua New Guinea Philippines Viet Nam 67 61 65 55 80 31 73 89

% Increase (from 2003 to 2004) 29 2 44 17 18 -43 7 3 Tuberculosis Control in the Western Pacific Region: 2006 Report

3 | PROGRESS IN TB CONTROL Case detection made steady but slow progress in the Western Pacific Region until 2002. The increase in case detection (+29%) in the Region between 2003 and 2004 is mostly due to a dramatic increase in case detection in China (+44%). The global target of 70% case detection rate by the end of 2005 has likely been reached in the Region (Figure 5).

FIGURE 5: TRENDS IN DOTS CASE DETECTION RATES OF SMEAR-POSITIVE CASES, 1995-2004

Note: The forecast line for the Western Pacific Region is based on preliminary data from 2005 (Q-DOTS quarterly reporting to WHO).

3.3 DOTS enrolment and progress in overall case detection Figure 6 shows trends in new smear-positive case detection rates in DOTS and non-DOTS areas in the Region during the period 1995 to 2004. Regionally, the total case detection rate was stable from 1997 to 2002, although there was rapid DOTS expansion during this period and rapid increase to 2004. FIGURE 6: TRENDS IN DOTS AND NON-DOTS CASE DETECTION RATES (NEW SMEAR-POSITIVE CASES) IN THE WESTERN PACIFIC REGION

Tubercolosis Control in the Western Pacific Region: 2006 Report

3 | PROGRESS IN TB CONTROL 3.4 Treatment outcomes Regionally, in DOTS areas, the cure and treatment success rates were 87% and 91%, respectively, for the cohort of 426 675 new pulmonary smear-positive cases registered for treatment in 2003. The regional TB control programme has reached the target of 85% cure rate. It is notable that reported failure rates in both DOTS (1%) and non-DOTS (1%) areas are very low (Figure 7). FIGURE 7: TREATMENT OUTCOMES FOR NEW SMEAR-POSITIVE CASES REGISTERED IN 2003 IN DOTS AND NON-DOTS AREAS IN THE WESTERN PACIFIC REGION

FIGURE 8: TREATMENT OUTCOMES FOR NEW SMEAR-POSITIVE CASES REGISTERED IN 2003 IN DOTS AREAS IN HIGH-BURDEN COUNTRIES

FIGURE 9: UNFAVOURABLE OUTCOMES AMONG NEW SMEAR-POSITIVE CASES REGISTERED IN 2003 IN DOTS AREAS IN THE WESTERN PACIFIC REGION

In total, 15 countries and areas out of 36 reported treatment outcomes below the 85% global target, including two countries with a high burden of TB - The Lao People's Democratic Republic and Papua New Guinea (Figure 8). Non-DOTS areas reported a lower success rate for treatment completion than DOTS areas. Figure 9 shows the distribution of unfavourable outcomes in the Region. Defaults (25%) and deaths (25%) together accounted for half of all unfavourable outcomes among new smearpositive TB cases registered under DOTS programmes in the Western Pacific Region in 2003. Tubercolosis Control in the Western Pacific Region: 2006 Report

3 | PROGRESS IN TB CONTROL 3.5 Treatment results of re-treatment cases Figure 10 shows treatment outcomes for re-treatment cases in the Western Pacific Region. The high success rate among re-treatment cases in China accounted for the overall high treatment success rate (87%) among re-treatment cases in the Western Pacific Region. FIGURE 10: TREATMENT OUTCOMES FOR RE-TREATMENT CASES REGISTERED IN 2003 (DOTS AREAS)

Tuberculosis Control in the Western Pacific Region: 2006 Report

Tables Explanatory notes7 Regional summary and country data are presented in the following 12 tables. All rates are per 100 000 population.

Table 5 Estimated burden of TB, 2000 and 2004 Estimates of incidence, prevalence and mortality for 2000 (baseline year for impact targets endorsed by the Regional Committee) and 2004 (the latest year covered by this report). See Annexes 2 and 3 for details of calculations. All estimates include TB in people living with HIV.

Table 6 Whole country case notifications and case detection rates, 2004 Case notifications by history (new or re-treatment), by site (pulmonary or extrapulmonary) and by smear status (smear-positive, smear-negative or unknown). Proportions of case types and estimated case detection rate for whole country (DOTS and non-DOTS combined). • Population, source: World population prospects – the 2004 revision. New York; United Nations Population Division, 2005. • Country total: the total number of TB cases according to the country’s own reporting convention (in many countries this matches the WHO total – new and relapse; other countries include retreatment cases and/or cases with unknown treatment history). • WHO total: new and relapse cases. • Other new: new cases for which the site of disease is not recorded. • Other retreat: re-treatment cases for which the outcome of previous treatment is not known. • Other: cases for which neither treatment history nor site of disease is recorded. • New pulm. lab. confirmed: new pulmonary cases in which diagnosis has been confirmed by smear and/or culture examination. • Detection rate, all cases: notified (new and relapse) cases divided by estimated incident cases (expressed as a percentage). • Detection rate, new SS+: notified new smear-positive cases divided by estimated incident smear-positive cases (expressed as a percentage). • SS+ (% of pulm.): the percentage of all new pulmonary cases that are smear-positive. • SS+ (% of new+relapse): the percentage of new and relapse case that are new smear-positive. • Extrapulm. (% of new+relapse): the percentage of all new and relapse cases that are extrapulmonary. • Retreat. (% of new+retreat.): notified re-treatment cases as a percentage of all notified cases.

Table 7 DOTS coverage, case notifications and case detection rates, 2004 • DOTS coverage: the percentage of the national population living in areas where health services have adopted DOTS.

See Global tuberculosis control - surveillance, planning, financing. Geneva, World Health Organization, 2006 (WHO/HTM/ TB/2006.362). Tuberculosis Control in the Western Pacific Region: 2006 Report

TABLES Table 8 Public–Public and Public–Private Mix (PPM), collaborative TB-HIV activities and management of MDR-TB, 2003–2004 Public–Public and Public–Private Mix (PPM) • Guidelines for other practitioners: — In the final row of the data table, numbers represent the proportion of countries in the Region that have guidelines for management of TB for practitioners working outside public health clinics. — “Yes” or “No” indicates whether guidelines for TB management are available for practitioners working outside public health clinics. • Institutions notifying NTP: — In the final row of the data table, the numbers represent the proportion of countries in the Region where at least some providers of a particular type notified TB cases to the NTP in 2004. — “All”, “Some” or “None” indicates whether any providers of a particular type notified TB cases to the NTP in 2004. Collaborative TB-HIV activities • HIV testing for TB patients (pts): — In the final row of the data table, the numbers represent the proportion of countries in the Region that implemented, at least partially, a national policy of offering HIV testing and counselling to TB pts. — “Yes” indicates that the country implemented a national policy of offering HIV testing and counselling to all TB patients in 2004; “Partially” indicates that the policy was implemented in part of the country. • HIV surveillance among TB pts: — In the final row of the data table, the numbers represent the proportion of countries in the Region that have a national system for HIV surveillance among TB patients. — “Yes” or “No” indicates whether the country has a national system for HIV surveillance among TB patients. • TB pts tested for HIV: the number of TB patients tested for HIV in 2003. • TB pts HIV-positive: the number of TB patients found to be HIV-positive in 2003. • TB pts CPT: the number of HIV-positive TB patients given co-trimoxazole preventive therapy in 2003. • TB pts ART: the number of HIV-positive TB patients given antiretroviral therapy during their TB treatment in 2003. Multidrug resistant-TB • Laboratory-confirmed MDR: number of laboratory-confirmed cases of MDR-TB identified among TB patients diagnosed in 2004. • DST in new cases: number of new TB cases in 2004 for which drug sensitivity testing (DST) was performed at start of treatment. • MDR in new cases: number of new cases identified as MDR-TB based on DST at start of treatment. • Re-treatment DST: number of re-treatment cases registered in 2004 for which DST was performed at start of treatment. • Re-treatment MDR: number of re-treatment cases identified as MDR-TB.

Table 9 Treatment outcomes, 2003 cohort Treatment outcomes of new smear-positive cases treated under DOTS, non-DOTS and re-treatment cases under DOTS.

Tuberculosis Control in the Western Pacific Region: 2006 Report

TABLES Table 10 Re-treatment outcomes, 2003 cohort Re-treatment outcomes of smear-positive cases treated under DOTS after relapse, treatment failure or default.

Table 11 DOTS treatment success and case detection rates, 1994–2004 Treatment success rates (the proportion of registered cases cured or completed treatment) for new smear-positive cases treated under DOTS from 1994 to 2003 and smear-positive case detection rates under DOTS from 1995 to 2004.

Table 12 New smear-positive case notification by age and sex, absolute numbers, DOTS and nonDOTS, 2004 Breakdown by age and sex of new smear-positive cases notified from whole country (DOTS and non-DOTS). Some countries cannot provide the breakdown for all smear-positive notified cases.

Table 13 New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2004 Notification rates of new smear-positive cases by age and sex (DOTS + non-DOTS). Rates are missing where breakdown of smear-positive notified cases is not provided, or when age- and sexspecific population data are not available. In the regional summary row, rates exclude those countries for which breakdown of notified cases or population by age and sex is missing.

Table 14 Number of TB cases notified, 1980–2004

Table 15 Case notification rates, 1980–2004

Table 16 New smear-positive cases notified, numbers and rates, 1993–2004

Tuberculosis Control in the Western Pacific Region: 2006 Report

TABLE 5: ESTIMATED BURDEN OF TB, 2000 AND 2004 Incidence, 2000 All Tuberculosis Control in the Western Pacific Region: 2006 Report

Prevalence, 2000 Smear-positive HIV+ All formsa All forms HIV+

TB mortality, 2000 All formsa All forms HIV+ All formsa

Incidence, 2004 All forms HIV+ Smearpositivea Smear-positive HIV+

Prevalence, 2004 All formsa All forms HIV+

TB mortality, 2004 All formsa All forms HIV+

formsa

All forms HIV+

Smearpositivea

Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 20 1114 187 67 570 1 342 844 6 274 80 116 5567 44 537 67 8545 376 24 790 39 80 4983 4 160 406 1 52 14 12 841 231 095 41 248 60 1783 312 0 34 3 143 144 336 5 1 933 693 34 6 56 530 105 34 34 34 75 84 35 75 162 85 108 75 75 200 34 75 11 34 75 75 242 305 88 34 44 75 34 34 34 75 183 34 115 0 17 0 5694 3884 0 1 1 2 12 124 0 6 2 259 0 0 0 0 1 3 0 0 0 135 90 148 0 31 0 0 0 0 0 1552 0 11 964 0 0 0 45 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 3 0 0 0 1 0 0 0 0 0 2 0 1 9 500 84 29 837 603 891 3 123 36 52 2504 20 029 30 3845 169 11 130 17 36 2242 2 72 182 0 23 6 5765 103 984 18 547 27 799 140 0 15 2 64 64 796 2 868 966 15 3 25 234 47 15 15 15 33 38 16 34 73 38 48 34 34 90 15 33 5 15 34 34 109 137 40 15 20 34 15 15 15 34 82 15 51 0 0 6 0 0 0 1993 16 1359 0 0 0 0 0 0 0 1 0 4 0 43 0 0 0 2 0 1 0 91 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 47 1 32 0 52 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 543 1 0 0 4187 0 36 1131 187 62 6 56 0 8 0 2847 1942 0 1 1 1 6 62 0 3 1 130 0 0 0 0 1 2 0 0 0 68 45 74 0 16 0 0 0 0 0 776 0 5982 0 0 0 22 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 4 111 14 251 648 1 46 12 19 479 5392 5 1489 33 3854 5 11 902 0 26 41 0 4 2 2985 44 146 5310 9 202 40 0 4 1 15 18 817 1 349 014 7 1 4 20 6 6 5 12 7 4 5 28 7 17 10 11 36 4 12 1 7 5 11 56 58 11 5 5 10 7 4 6 8 24 7 21 0 2 0 2175 1462 0 0 0 1 1 12 0 2 0 73 0 0 0 0 0 0 0 0 0 55 35 29 0 3 0 0 0 0 0 411 0 4262 0 0 0 17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 18 1132 197 70 370 1 324 633 5 239 72 98 5223 37 814 57 9019 373 25 527 35 65 5018 4 137 424 0 46 12 13 455 239 459 43 029 52 1691 274 0 29 3 122 146 695 4 1 925 332 28 6 54 510 101 28 28 28 59 75 30 59 156 82 103 59 59 192 28 59 11 28 59 59 233 293 90 28 40 59 28 28 28 59 176 28 111 0 20 0 5488 7037 0 1 1 2 12 105 0 27 2 383 0 0 11 0 1 4 0 0 0 302 190 239 0 41 0 0 0 0 0 2681 0 16 548 0 0 0 40 1 0 0 0 1 0 0 0 0 1 2 0 0 0 0 1 0 0 0 0 5 0 1 0 1 0 0 0 0 0 3 0 1 8 507 89 31 118 595 381 2 107 32 44 2349 17 006 26 4056 167 11 449 16 29 2257 2 62 191 0 21 5 6025 107 738 19 339 24 757 123 0 13 1 55 65 745 2 864 745 13 3 24 226 46 13 13 13 26 34 13 27 70 37 46 27 27 86 13 26 5 13 27 27 104 132 41 13 18 27 13 13 13 27 79 13 50 0 0 7 0 0 0 1921 14 2463 0 0 0 1 0 0 0 1 0 4 0 37 0 0 0 9 0 1 0 134 1 0 0 0 0 4 0 0 0 0 0 1 0 0 0 0 0 0 0 106 2 66 0 84 0 0 0 14 0 0 0 0 0 0 0 0 0 0 0 938 1 0 0 5792 0.3 31 1147 230 49 6 63 0 10 0 2744 3518 0 1 0 1 6 53 0 13 1 192 0 0 5 0 1 2 0 0 0 151 95 119 0 20 0 0 0 0 0 1340 0 8 274 0 0 0 20 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 2 0 0 3 113 19 12 980 217 130 1 40 12 17 450 4709 4 1470 45 4037 3 5 633 1 28 42 0 6 1 2448 39 357 4940 9 191 20 0 5 1 11 18 680 0 307 411 5 1 5 94 17 5 5 5 10 6 4 4 25 10 16 4 4 24 4 12 1 6 8 7 42 48 10 5 4 4 6 5 5 5 22 2 18 0 2 0 1901 2176 0 0 0 1 1 12 0 9 0 109 0 0 2 0 1 0 0 0 0 64 66 28 0 4 0 0 0 0 0 686 0 5 064 0 0 0 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0

HIV prevalence in adult incident TB cases (%) 0.1 3.9 0.1 13 0.9 0.1 1.0 2.3 2.6 0.4 0.6 0.03 0.5 1.0 2.5 0.03 0.03 0.4 0.1 1.5 2.1 0.1 0.1 0.1 3.7 0.1 0.9 0.4 5.2 0.1 0.1 0.1 0.1 0.1 3.0 0.1 1.4

100 575 789 3 454 091 271 11 403 97 5686 58 499 67 384 45 101 6 413 1 52 57 50 41 86 46 75 86 87 94 52 11 68 75

13 386 105

97 790 709 2 892 422 221 9 343 142 152 5334 50 394 57 414 35 65 5 432 1 53 18 51 41 56 91 77 39 59 90 59 59 35 11 57 68 91

176 113

18 859 357 31 927 139

18 407 318 33 037 133

7115 285 226 105

5460 209 272 117

29 149 33 286 628 419 475 554 64 910 139 77 1846 343 1 44 7 181 10 43 46 82 68 44 68 94 68

25 879 448 378 094 463 59 383 125 78 1744 274 1 43 6 133 4 43 41 59 57 42 57 64 28

197 461 251 4 397 754 261

192 674 232 3 764 564 216

a Incidence, prevalence and mortality estimates include patients with HIV. Estimates labelled "HIV+" are estimates of TB in HIV-positive adults (ages 15-49 years). Estimates for all years are recalculated as new information becomes available and techniques are refined, so may differ from those published previously.

TABLE 6: WHOLE COUNTRY CASE NOTIFICATIONS AND CASE DETECTION RATES, 2004 TB cases notified from whole country (DOTS + non-DOTS) Population, thousands 63 19 942 366 13 798 1 307 989 18 841 253 167 6963 127 923 97 5792 457 24 894 60 110 2614 13 233 3989 1 79 20 5772 81 617 47 645 184 4273 466 1 102 10 207 83 123 15 1 740 099 1 264 413 1 161 201 67 579 594 33 400 509 81 372 45 99 681 1134 1581 89 380 11 272 590 745 117 99 126 115 98 389 55 118 59 58 389 28 70 32 17 106 23 16 218 0 1 6676 2 522 0 251 0 59 58 389 1528 340 1516 340 35 73 506 152 12 33 660 107 182 68 168 13 3 0 22 0 0 12 0 892 152 61 376 0 53 5 12 743 130 609 41 735 61 373 0 53 5 12 743 130 530 34 671 26 9 0 67 25 221 160 73 15 112 0 14 5 1896 78 163 11 501 6 3 0 18 25 33 96 24 14 86 0 34 0 5234 47 937 16 446 30 129 0 5 0 4176 1275 3556 0 0 37 0 0 0 2 9 0 0 0 1437 3155 3168 79 387 763 2581 3333 0 0 0 0 0 0 5 0 0 0 0 0 0 24 176 0 24 5 1896 78 163 14 674 Country total number 5 1082 186 31 105 884 892 1 134 62 51 6260 29 736 311 3216 360 15 429 122 112 4656 New and relapse (WHO total) Number 5 1059 176 30 838 790 603 1 134 60 51 6143 29 736 310 3173 323 14 986 119 118 4570 Rate 8 5 48 223 60 6 16 24 31 88 23 318 55 71 60 199 108 175 New pulmonary SS+ Number 2 285 115 18 978 384 886 1 62 30 22 1694 10 471 142 2241 128 7843 39 35 1808 New extraSS- / unk. pulmonary number Rate number 3 1 31 138 29 6 7 12 13 24 8 146 39 28 32 65 32 69 1 337 15 5800 284 433 0 38 12 9 3073 12 384 59 472 129 5136 38 51 866 2 414 38 5415 39 395 0 31 9 10 677 5907 107 343 38 1543 37 26 1718 0 0 0 0 0 8 0 0 0 Other new number 0 Relapse number 0 23 8 645 81 889 0 3 9 2 699 974 2 117 28 464 5 6 178 0 53 1 15 0 27 0 52 3 357 2 16 33 0 0 3 59 1 3 0 0 43 31 0 0 4 0 48 0 65 0 0 0 0 0 0 41 Re-treatment cases After failure number 0 After default number 0 4 1 29 197 86 459 0 0 7830 0 0 2 Other retreat. number 0 7 Other number New pulm. lab. confirm. number 2 541 120 18 978 384 886 1 62 30 30 3545 15 747 142 2241 207 7843 39 69 1808

Incidence and case detection rates Estimated incidence all forms number 18 1132 197 70 370 1 324 633 5 239 72 98 5223 37 814 57 9019 373 25 527 35 65 5018 4 137 424 0 46 12 13 455 239 459 43 029 52 1691 274 0 29 3 122 146 695 4 1 925 332 SS+ number 8 507 89 31 118 595 381 2 107 32 44 2349 17 006 26 4056 167 11 449 16 29 2257 2 62 191 0 21 5 6025 107 738 19 339 24 757 123 0 13 1 55 65 745 2 864 745 60 67 59 94 67 107 89 65 77 90 124 67 123 43 59 45 88 0 114 43 95 55 81 24 59 0 67 95 31 73 59 29 100 27 62 41 52 57 Case detection rate new and relapse % 28 94 89 44 60 19 56 84 52 118 79 540 35 87 59 338 183 91 new SS+ % 25 56 129 61 65 43 58 93 50 72 62 550 55 76 69 246 120 80 SS+ (% of pulm.) 67 46 88 77 58 100 62 71 71 36 46 71 83 50 60 51 41 68

Proportions Retreat. Extra SS+ (% of pulm. (% (% of new+ of new+ new+ relapse) relapse) retreat.) 40 27 65 62 49 100 46 50 43 28 35 46 71 40 52 33 30 40 25 30 26 100 15 60 33 33 45 33 1 10 12 20 11 2 18 13 4 23 15 20 11 20 35 11 12 10 31 22 38 49 35 9 2 15 4 13 3 1 6 10 6 7 18 6 3 4 40 39 22 18 5 3 5 3 19

American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region Tuberculosis Control in the Western Pacific Region: 2006 Report

0 12 9

51 59 50

20 16 7

3 8 15

(SS+) — sputum smear-positive; (SS–) — sputum smear-negative; unk. — sputum smear result unknown; retreat. — re-treatment; pulm. lab. confirmed — pulmonary case confirmed by positive smear or culture. See Explanatory notes for further details. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 7: DOTS COVERAGE, CASE NOTIFICATIONS AND CASE DETECTION RATES, 2004 TB cases reported from DOTS services DOTS coverage % American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 94 1 097 378 63 560 632 32 370 103 73 346 45 93 252 750 1153 86 742 9218 567 793 100 100 115 98 389 55 118 59 58 389 28 70 32 17 106 23 16 218 0 1 6676 2 522 0 251 0 59 58 389 100 100 1516 340 35 73 506 152 12 33 660 107 182 68 168 13 0 22 0 0 12 0 892 152 100 100 100 100 95 47 100 100 61 373 0 53 5 8751 130 530 12 357 26 9 0 67 25 152 160 26 15 112 0 14 5 1151 78 163 4044 6 3 0 18 25 20 96 8 14 86 0 34 0 3959 47 937 6680 30 129 0 5 0 3396 1275 127 0 0 37 0 0 0 2 9 0 0 0 245 3155 1506 79 4 344 1010 1550 0 0 0 0 0 0 5 0 0 0 0 0 0 24 176 0 24 5 1151 78 163 5126 100 63 100 100 96 98 100 100 100 100 71 100 98 100 100 100 90 100 New and relapse (WHO total) Number 5 655 176 30 838 763 035 1 134 60 51 4579 21 755 310 3173 323 14 986 119 118 4570 Rate 8 3 48 223 58 6 16 24 31 66 17 318 55 71 60 199 108 175 New pulmonary SS+ Number 2 168 115 18 978 377 546 1 62 30 22 1290 7572 142 2,241 128 7843 39 35 1808 New extraSS- / unk. pulmonary number Rate number 3 1 31 138 29 6 7 12 13 19 6 146 39 28 32 65 32 69 1 236 15 5800 269 226 0 38 12 9 2271 9129 59 472 129 5136 38 51 866 2 231 38 5415 37 566 0 31 9 10 501 4278 107 343 38 1543 37 26 1718 0 0 0 0 0 8 0 0 0 Other new number 0 Relapse number 0 20 8 645 78 697 0 3 9 2 517 776 2 117 28 464 5 6 178 0 53 1 15 0 27 0 52 3 357 2 16 33 0 0 3 59 1 3 0 0 43 5 0 0 3 0 43 0 49 0 0 0 0 0 0 41 1 29 197 85 409 0 0 7592 0 0 2 Re-treatment cases After failure number 0 After default number 0 Other retreat. number 0 6 Other number New pulm. lab. confirm. number 2 351 120 18 978 377 546 1 62 30 30 2636 11 527 142 2241 207 7843 39 69 1808

Incidence and case detection rates Estimated incidence all forms number 18 1132 197 70 370 1 324 633 5 239 72 98 5223 37 814 57 9019 373 25 527 35 65 5018 4 137 424 0 46 12 13 455 239 459 43 029 52 1,691 274 0 29 3 122 146 695 4 1 925 332 SS+ number 8 507 89 31 118 595 381 2 107 32 44 2349 17 006 26 4056 167 11 449 16 29 2257 2 62 191 0 21 5 6025 107 738 19 339 24 757 123 0 13 1 55 65 745 2 864 745 57 65 60 94 67 107 89 65 77 90 124 67 123 43 59 45 88 0 114 43 65 55 29 24 59 0 67 95 19 73 21 29 100 23 62 38 52 57 Case detection rate new and relapse % 28 58 89 44 58 19 56 84 52 88 58 540 35 87 59 338 183 91 new SS+ % 25 33 129 61 63 43 58 93 50 55 45 550 55 76 69 246 120 80 SS+ (% of pulm.) 67 42 88 77 58 100 62 71 71 36 45 71 83 50 60 51 41 68

Proportions Retreat. Extra SS+ (% of pulm. (% (% of new+ of new+ new+ relapse) relapse) retreat.) 40 26 65 62 49 100 46 50 43 28 35 46 71 40 52 33 30 40 25 30 26 100 13 60 33 33 45 39 1 1 12 20 3 2 21 12 4 23 15 20 11 20 35 11 12 10 31 22 38 49 35 9 2 15 4 13 4 1 6 10 6 7 18 6 3 4 40 35 22 18 5 4 5 3 19

16 Tuberculosis Control in the Western Pacific Region: 2006 Report

0 5 9

51 59 51

20 16 7

3 8 15

(SS+) — sputum smear-positive; (SS–) — sputum smear-negative; unk.— sputum smear result unknown; retreat. — re-treatment; pulm. lab. confirmed — pulmonary case confirmed by positive smear or culture. See Explanatory notes for further details. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 8: PUBLIC-PUBLIC AND PUBLIC-PRIVATE MIX (PPM), COLLABORATIVE TB-HIV ACTIVITIES AND MANAGEMENT OF MDR-TB, 2003-2004 TB cases reported from DOTS services Guidelines for other practitioners American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) Malaysia Marshall Islands Micronesia Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands Tuberculosis Control in the Western Pacific Region: 2006 Report

Collaborative TB-HIV activities, 2003 or 2004 HIV testing for TB pts No Some All Some Some All All All All No All No All No Some All All Some All No Some All All All No No No No No No No No All All Partially Yes No No No Partially Yes Yes Yes No Yes Partially Yes Yes Partially Partially No Yes No Yes No All Some Some All No No Some No All Yes No No No No No HIV surveillance among TB pts No No Yes No No No No Yes Yes Yes No No Yes Yes Yes No No No Yes No Yes Yes Yes No No No No No 0 361 15 316 0 8 510 16 141 53 4 1 1263 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 8 0 2 1 1 0 3 0 1 0 0 230 110 2 0 122 17 12 3122 0 4 0 0 2 0 15 0 9 0 0 0 0 0 5 0 0 35 TB pts tested for HIV number 0 190 12 1 0 1 TB pts HIV-positive number TB pts CPT number TB pts ART number

Multidrug-resistant TB, 2004 LaboratoryDST confirmed in new cases MDR number number 0 12 0 0 12 181 MDR in Re-treatment Re-treatment MDR new cases DST number number number 0 5 0 0 5 0 0 2 0

Institutions notifying NTP Private hospitals or clinics No All All Some Some All Private practitioners No All All No Some All All All All All No No Some Some No No All All All All No Some All All Public hospitals No All All All Some All All All All All All All Some All All All No No All All All All No Some All All All Some All All All All All Some All All All All All Some Some No All Some No Some All All All All All Some Some All All All All All All No No Some Some Prisons No All All No Some Military Insurance

Yes No Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes Yes No No Yes No Yes

0 59 51 29 3566 0 0 207 0 26 28 8 2 278 0 5 1 0 269 2636 838

0 4 0 0 16 0 0 5 0 2 1 4 0 3 0 1 0 0 2 71 2

0 1 11 0 513 0 0 22 0 8 4 40

0 1 0 0 19 0 0 2 0 2 1 14 0

10 0 0 0 0 278 117

0 0 0 0 0 39 0

Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Western Pacific Region

No No 50

Some No 53

Some No 50

All No 72

No No 56

No No 47

No No 28

No No 42

No No 31 19 872 1285 15 11 410 8196 116 1009 80

ART — antiretroviral therapy; CPT — co-trimoxazole preventive therapy; pts — patients; DST — Drug susceptibility testing; MDR — Multidrug resistance. The regional row for the first nine columns represents the proportion of countries that provided an affirmative response ("Yes", "All", "Some" or "Partially"). See Explanatory notes on page 12 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 http://stoptb.wpro.who.int.

TABLE 9: TREATMENT OUTCOMES, 2003 COHORT New smear-positive cases, DOTS Number of cases Notified Regist'd American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 63 19 942 366 13 798 18 841 253 167 6963 127 923 97 5792 457 24 894 60 110 2614 13 233 3989 1 79 20 5772 81 617 47 645 184 4273 466 1 102 10 207 83 123 15 1 740 099 426 675 99 87 4 2 1 2 2 1 91 22 243 12 928 58 51 8 1 1 2 14 22 59 94 156 80 7 3 3 3 2 2 87 40 55 842 100 100 70 90 5 2 18 3 5 1 0 2 3 2 0 0 75 92 0 2 6011 100 80 0 6 0 5 0 5 0 2 0 3 0 0 100 85 583 139 171 101 68 77 19 17 7 0 6 4 1 2 0 0 77 87 242 208 5 0 80 70 20 20 0 0 0 7 0 1 0 1 0 70 100 12 185 0 16 5 1067 68 377 4342 100 100 101 94 99 75 80 41 81 81 0 0 17 8 2 6 0 4 3 1 0 0 1 1 1 0 20 19 5 4 13 0 6 3 11 6 0 11 0 0 75 80 58 88 82 6597 1249 100 102 75 36 25 5 1 4 0 55 75 36 2 5 0 0 0 75 2963 3890 23 57 67 24 19 2 11 5 2 4 6 2 29 9 7 7 3 20 100 0 0 60 0 20 0 0 0 0 0 0 0 20 0 0 0 3 0 0 47 76 69 100 60 2 272 121 19 098 0 78 36 25 1470 7278 99 1868 130 6716 20 26 1541 100 101 100 100 100 84 100 100 100 100 171 96 73 50 74 70 85 69 90 27 84 86 0 83 0 5 26 14 9 2 3 0 65 4 8 11 4 5 13 10 8 5 9 5 4 3 1 0 1 0 0 4 9 2 9 5 4 4 4 3 5 0 0 2 0 9 4 6 6 0 4 2 0 4 6 0 0 0 0 0 0 2 0 2 4 0 0 0 86 83 96 78 76 88 79 88 72 90 92 87 8 8 100 75 25 324 3631 324 2303 100 63 2 17 2 16 6 1 0 3 0 0 90 63 0 0 4 33 255 734 2 136 35 453 4 8 235 67 49 100 46 74 37 50 0 51 11 23 0 7 11 25 25 50 20 5 14 0 14 6 13 0 38 6 11 5 0 3 0 0 0 0 11 3 3 0 8 0 12 25 13 7 4 7 0 4 6 4 0 0 3 0 0 0 17 3 8 0 0 0 78 72 100 54 86 63 75 50 72 % of notif Complregist'd Cured eted 100 567 100 101 100 100 17 45 90 91 65 15 3 3 9 6 3 1 0 0 0 1 1 2 2 1 7 33 1 1 % of cohort Died TransFailed Default ferred Not eval. 0 1 0 0 2 % Success 100 82 60 93 94 10 127 0 10 127 0 100 61 5 1 1 3 1 29 66 65 166 255 5 72 10 2 6 5 77 Number of cases Notified Regist'd

New smear-positive cases, non-DOTS % of notif Complregist'd Cured eted % of cohort Died TransFailed Default ferred

Smear-positive re-treatment cases, DOTS % of cohort % Number Not Success Regist'd Trans- Not ComplDied Failed Default Cured eval. ferred eval. eted 1 14 8 833 78 265 0 6 6 50 0 0 83 17 17 0 0 33 0 0 0 0 29 25 80 82 100 57 13 7 6 0 7 0 6 3 0 0 0 3 3 0 7 0 2 2 0 0 13 1 1 0 0 50 0 3 0 0 0 50 83 % Success 100 86 38 87 89

18 Tuberculosis Control in the Western Pacific Region: 2006 Report

1 307 989 257 287

Not eval. — 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 2003 is 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 2003 is used, or the sum of outcomes if the latter is greater. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 10: RE-TREATMENT OUTCOMES, 2003 COHORT Relapse, DOTS % of cohort Number Regist'd American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 12 152 70 11 5 4 4 5 0 81 1110 47 14 7 16 10 4 1 62 605 56 8 5 1 17 10 2 64 2 5444 100 81 0 6 0 5 0 4 0 2 0 2 0 0 100 87 488 60 7 7 17 5 4 0 66 79 87 8 1 0 4 0 0 95 180 5 80 70 20 22 0 0 6 0 2 0 1 0 70 100 12 0 83 8 8 83 16 0 63 19 19 0 63 Tuberculosis Control in the Western Pacific Region: 2006 Report

After failure, DOTS % of cohort Transferred Not eval. 0 0 13 1 50 0 % Success 100 86 38 89 0 0 0 0 Number Regist'd Cured Completed Died Failed Default Transferred Not eval. % Success Number Regist'd Cured Completed

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

Cured

Completed 100 57 13 6

Died

Failed Default

1 14 8 754 0 6 6 233 734 2 86 29 351 3 4 146 2 5 0 0 0 75 2454 1608 23 61 68 69 49 100 53 76 40 67 0 55 100 50 29 25 84

7 0 5 0 2

7 0 2

0 83 11 23 7 10 30 33 50 19

17 17 4 14 12 7 13 25 7

0 0

50 83 80 72 100 60 86 71 100 50 75 100 60 0 0 0 0 0 0 39 71 19 7 16 16 4 29 0 0 58 71 330 62 4 1 1 18 15 0 66 0 58 45 26 3 17 5 3 0 71 7 0 28 18 14 11 0 21 4 32 32 29 0 29 29 0 0 14 29 43 6 74 1 4 31 0 45 50 16 50 10 0 10 35 67 30 9 17 7 12 0 31 100 0 16 0 3 16 2 14 7 17 11 16 0 9 0 0 0 50 61 44 83 36 1 0 100 0 0 0 0 0 100 21 52 0 14 14 19 0 0 52

11 5 1 0 1 0 10

1 3 6 0 8 25 6

4 7 3 3 3 0 3

0 0 0 17 3 5 0 0 0 0

24 19 2

11 5 2

4 4 2

29 8 5

7 3 21

3 0 0

47 80 70 509 7

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 2003 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 http://stoptb.wpro.who.int.

TABLE 11: DOTS TREATMENT SUCCESS AND CASE DETECTION RATES, 1994-2004 DOTS new smear-positive treatment success (%) 1994 1995 100 66 84 94 90 91 96 86 67 94 96 86 95 91 96 50 91 100 90 74 85 83 70 75 69 83 64 80 78 62 75 86 84 70 55 62 81 75 1996 1997 1998 50 75 85 95 97 1999 100 84 76 93 96 80 92 85 94 78 76 88 84 78 90 82 95 86 50 77 85 97 93 76 70 91 82 89 78 91 93 87 25 89 30 80 64 80 71 50 88 76 80 86 65 89 75 73 82 92 75 92 94 80 88 91 90 91 91 90 93 85 93 93 95 92 94 67 75 93 82 71 100 83 82 86 94 95 92 85 81 93 88 92 92 77 88 89 92 88 93 100 93 72 84 66 87 63 88 81 2000 100 74 63 91 95 2001 100 66 56 92 96 100 85 80 71 78 75 86 77 86 79 86 100 87 100 84 9 74 100 67 88 2002 100 78 84 92 93 100 78 82 68 79 76 94 78 89 76 100 91 87 50 85 60 100 71 38 53 88 83 84 87 90 83 79 92 100 91 91 15 28 32 33 32 37 38 75 92 30 59 78 83 77 87 49 75 80 58 88 82 0 34 47 57 0 65 29 26 57 80 73 65 94 98 64 63 36 83 115 53 96 1 3 56 47 7 10 57 61 48 13 78 99 41 82 42 22 87 55 78 83 75 40 82 163 52 87 47 39 8 20 7 48 8 57 115 75 36 24 31 29 86 83 96 78 76 88 79 88 72 90 92 87 19 7 31 6 31 60 67 85 64 24 155 68 57 93 33 33 194 161 40 164 189 45 60 47 2003 100 82 60 93 94 40 15 34 28 0 49 93 44 32 0 49 106 48 32 31 56 90 1995 1996 0

DOTS new smear-positive case detection rate (%) 1997 63 23 1998 1999 33 31 123 53 29 0 51 90 2000 23 24 100 50 31 0 50 81 83 61 22 180 40 95 73 63 42 62 216 28 41 94 59 30 221 40 93 74 89 24 73 110 27 37 0 83 2001 23 20 111 48 31 74 61 2002 12 25 129 57 30 39 64 82 65 63 33 294 46 80 70 109 68 74 112 32 47 469 95 154 16 61 2003 24 9 138 61 43 0 70 63 0 62 41 369 47 77 70 124 85 68 57 19 56 0 74 90 18 68 23 49 44 108 0 81 70 85 344 50 65 107 89 67 123 24 59 0 67 95 19 73 21 2004 25 33 129 61 63 43 58 93 50 55 45 550 55 76 69 246 120 80

20 Tuberculosis Control in the Western Pacific Region: 2006 Report

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 that published in previous reports. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 12: NEW SMEAR-POSITIVE CASE NOTIFICATION BY AGE AND SEX, ABSOLUTE NUMBERS, DOTS AND NON-DOTS, 2004 Male 0–14 American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 2062 49 424 67 398 74 000 73 345 60 898 72 748 2393 34 361 36 925 31 860 27 718 22 864 28 467 4 455 83 785 104 323 105 860 101 063 83 762 101 215 2.2 1 54 7 3486 11 7364 2 9110 6 8743 3 5257 5 8206 3 66 5 1740 8 2398 2 2218 2 2551 2 2226 2 4970 4 120 12 5226 19 9762 4 11 328 8 11 294 5 7483 7 13 176 1.5 2.6 1 6 12 11 32 12 56 8 84 11 75 9 120 5 0 10 6 22 15 20 18 13 17 14 19 8 51 3 1 16 18 33 47 32 74 21 101 25 94 17 171 8 3.0 0.7 28 312 18 153 6792 709 138 10 328 1278 90 12 229 1365 Tuberculosis Control in the Western Pacific Region: 2006 Report

Female 45–54 55–64 2 65+ 0-14 15-24 25-34 35-44 45-54 1 32 10 1538 50 797 1 2 4 3 477 3759 3 276 14 1535 1 43 2 16 0 0 6 4289 1604 0 6 6 7 12 0 227 1 3 18 0 0 0 0 30 291 26 0 0 28 1659 0 0 6 6 658 25 951 0 8 4 0 97 182 31 75 5 925 7 4 283 2 10 0 1 164 3507 662 17 11 1276 25 150 0 6 6 1 112 364 9 137 7 1014 5 4 249 1 14 0 2 161 5090 848 5 12 1882 20 613 0 3 1 2 87 230 12 155 12 852 3 1 162 0 4 0 1 1 66 5008 497 7 8 2176 16 995 0 5 4 3 56 222 7 172 3 694 3 1 62 0 5 0 1 1 38 4327 343 18 3210 362 3 2183 1520 58 603 44 317 10 299 1371 299 15 418 2126 3 2 1836 14 038 0 2 2 1 34 294 6 165 2 605 0 3 24 1 1 0 0 19 4 1270 15 739 0 1 1 1 140 1,861 1 118 9 532 1 1 23 0 14 0 0 0 0 64 3034 0 0 1 0 9 8 15 27 0 418 3 3 24 0 3 0 0 24 16 1508 61 416 0 16 5 0 156 375 48 197 13 2120 12 8 570 4 20 0 1 33 24 2742 68 744 0 12 8 2 206 826 19 319 14 3119 9 4 505 2 28 0 4 55-64 65+ 0-14 15-24 25-34

All 35-44 45-54 1 22 24 4143 66 021 0 11 4 4 215 829 24 389 30 3041 6 3 391 3 14 0 3 1 156 17 237 1862 22 24 4118 63 251 0 11 4 9 282 1156 17 490 34 2584 6 1 174 2 11 0 5 2 99 15 740 1592 55-64 2 14 13 3595 55 884 0 9 3 3 209 1657 15 425 14 2045 2 5 78 2 6 0 1 2 61 10 736 1382 9 6472 3124 51 14 2808 66 536 1 3 5 4 617 5620 4 394 23 2067 1 2 66 2 30 0 0 65+

15–24

25–34

35–44

Male/ female ratio 2.0 1.9 1.7 1.1 2.2 1.5 0.7 1.8 2.2 2.3 0.9 1.7 2.4 2.2 1.0 0.5 1.2 2.8 1.3 1.8 1.5 1.1 2.2 1.7

0 0 36 1375 0 0 1 0 3 2 8 15 0 191 2 0 6 0 3 0 0

18 10 850 35 465 0 8 1 0 59 193 17 122 8 1195 5 4 287 2 10 0 0

16 13 1466 43 594 0 6 2 1 94 462 10 182 7 2105 4 0 256 1 14 0 2

17 12 2261 45 408 0 8 3 2 128 599 12 234 18 2189 3 2 229 3 10 0 2

15 16 1942 46 256 0 6 0 6 226 934 10 318 31 1890 3 0 112 2 6 0 4 1 61 11 413 1249

11 11 1759 41 846 0 7 1 2 175 1363 9 260 12 1440 2 2 54 1 5 0 1 2 43 7526 1020

For some countries, breakdown of notified cases by age and sex is missing, or is provided for only a subset of cases. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 13: NEW SMEAR-POSITIVE CASE NOTIFICATION RATES BY AGE AND SEX, DOTS AND NON-DOTS, 2004 Male 0–14 American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 1 34 45 52 68 89 116 1 25 26 23 27 34 37 1 29 36 38 48 62 73 2 0 30 40 74 106 18 165 76 244 63 300 140 400 7 1 23 21 53 34 17 39 26 69 46 119 58 207 5 0 27 31 64 70 17 101 52 155 55 207 100 296 0 6 4 21 10 31 14 35 23 74 38 92 75 73 0 10 2 46 5 55 4 55 5 94 10 86 27 45 0 8 3 33 8 42 9 45 14 84 24 89 49 60 2 2 0 26 81 19 31 160 30 27 259 32 29 349 39 37 387 51 8 312 97 3 2 1 31 43 19 36 80 21 20 106 12 19 129 11 17 160 17 4 127 63 2 2 0 28 62 19 34 120 25 23 183 22 24 238 25 28 271 33 6 209 77 0 1 10 4 5 6 17 3 16 2 11 3 31 8 0 0 11 4 5 5 0 1 0 2 13 1 0 5 0 0 10 4 5 6 9 2 8 2 12 2 15 6 0 1 32 98 0 110 35 129 0 114 94 103 57 100 15 4 34 98 52 109 17 90 22 61 137 44 46 41 7 3 33 98 27 110 26 109 11 87 116 73 51 67 5 51 108 131 149 200 296 6 42 53 52 56 86 88 5 47 81 92 103 144 184 1 21 44 83 168 239 283 1 13 33 52 86 132 104 1 17 39 67 126 181 187 0 3 5 7 11 15 36 0 3 4 3 3 3 13 0 3 4 5 7 9 23 0 3 0 9 4 0 9 10 9 14 16 14 14 0 57 29 12 32 13 69 60 0 0 10 17 0 9 32 9 5 6 18 12 32 33 8 27 19 6 16 19 0 1 0 10 10 0 9 21 9 10 11 16 13 15 46 18 19 26 9 42 39 0 0 1 1 1 29 50 32 1 37 181 38 1 44 323 40 1 75 431 55 1 121 683 82 3 176 1080 114 0 0 1 1 0 19 39 25 1 29 155 23 0 45 237 19 1 50 387 21 0 36 498 29 1 70 457 30 0 0 1 1 1 24 45 29 1 33 168 31 1 45 277 30 1 65 407 39 1 89 574 56 2 123 668 68 15–24 25–34 35–44 45–54 55–64 65+ 0–14 15–24 25–34

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

All 35–44 45–54 55–64 65+

22 Tuberculosis Control in the Western Pacific Region: 2006 Report

Rates are per 100 000 population of each age/sex group. Rates are calculated excluding those countries for which breakdown of notified cases or population by age and sex is missing. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 14: NUMBER OF TB CASES NOTIFIED, 1980-2004

1980 1981 American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region Tuberculosis Control in the Western Pacific Region: 2006 Report

1982 1983 1984 1985 1986 1987 1988 1989 1990 6 1270 245 8158 98 654 19 163 65 49 7527 63 940 193 4706 233 11 944 12 67 1325 8 120 437 2 75 17 2742 104 715 100 878 43 2179 324 0 45 12 173 51 206 5 461 557 8 1219 276 7572 117 557 29 185 78 48 7301 62 021 127 4700 455 11 634 15 73 1514 0 171 415 3 74 14 2955 106 300 91 572 41 2065 302 0 50 23 196 43 185 17 462 195 12 1299 256 10 241 151 564 20 165 80 54 7843 61 521 111 6528 671 10 577 12 75 1652 0 144 404 1 58 20 3505 151 863 85 669 37 2143 337 0 54 9 188 43 875 14 541 002 5 1088 238 10 145 226 899 36 230 78 37 7545 58 567 103 4258 571 10 569 15 66 2994 0 104 359 0 64 26 3453 151 028 87 169 43 1952 377 2 49 32 124 46 941 14 615 181 651 854 8 906 212 10 325 265 095 17 199 85 49 7432 56 690 129 1514 420 10 735 37 60 2819 8 98 320 5 16 13 2877 153 129 88 789 65 1760 292 0 35 27 131 47 557 9 907 189 9106 251 600 16 173 80 34 7269 56 496 110 3468 389 11 068 32 98 2433 6 74 296 0 56 38 2251 163 740 87 419 29 1616 334 9 24 22 90 55 505 34 655 020 13 954 126 10 691 304 639 20 162 63 41 7021 54 357 208 7279 320 10 944 11 77 2538 8 111 295 3 27 17 4261 183 113 74 460 29 1666 372 1 14 24 118 52 463 1 716 447 28 3 3396 217 272 70 012 37 1617 488 0 36 26 144 52 270 30 741 912 894 074 2497 317 008 63 904 44 1591 382 1 23 23 140 50 203 5 952 128 7906 310 607 1 218 73 75 6704 53 112 121 2952 274 10 686 7 68 2233 0 128 303 367 1659 7 143 348 0 28 6510 51 821 68 1826 343 11 702 9 1016 143 6501 375 481 1 226 59

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 3 950 10 903 345 000 8 247 49 6283 50 612 91 1951 329 11 059 26 350 1611 140 335 1 1011 180 16 148 320 426 12 240 83 60 6534 48 956 100 994 294 11 420 52 111 1516 140 317 2 67 6 3401 207 371 57 864 44 1841 309 1 20 30 230 59 784 22 760 870 4 2540 236 172 48 070 26 1778 364 1 29 30 193 56 594 4 754 469 33 28 114 52 994 11 718 784 25 7451 178 134 46 999 49 1,830 367 4 991 160 13 270 344 218 6 183 78 70 6 537 48 461 99 2093 285 12 285 61 151 1418 104 274 1 173 1730 4 97 352 2 46 41 5335 180 044 38 155 45 1677 332 0 23 19 152 51 763 11 724 290 87 391 0 48 19 8041 119 186 42 117 45 1889 352 2 20 36 79 55 739 6 824 952 126 74 711 8 873 424 184 77 838 14 870 918 834 604 820 483 786 293 805 104 104 352 2 51 5 3195 165 453 39 315 31 1951 299 0 22 21 30 18 178 87 468 88 321 0 93 15 7977 195 767 33 215 32 1977 318 11 291 162 360 34 661 22 2120 295 90 365 0 97 172 2780 11 708 15 172 363 804 4 225 89 94 6319 44 425 253 1135 830 402 11 778 6212 43 078 6501 42 122 327 1440 570 12 691 59 126 4062 107 3592 7 072 42 190 464 1923 575 13 539 7673 44 016 276 2153 465 14 115 49 123 2915 3348 2 78 447 1 66 32 13 003 145 807 32 075 31 1805 289 0 22 14 120 88 879 10 520 119 914 21 782 43 1728 302 0 24 16 152 89 792 12 658 107 133 37 268 22 1536 292 0 12 16 175 90 728 29 13 101 95 044 19 811 482 14 908 41 5605 40 800 255 2434 203 14 603 515 764 14 857 504 758 0 200 86 4 1057 1073 0 6 1145 160 15 629 466 394 0 171 91 16 946 445 704 1 166 105 3 899 4 1073 272 19 266 449 518 3 192 93 3 1043 307 18 891 454 372 2 144 62 54 6015 39 384 252 2234 449 15 057 34 91 3109 4 94 344 0 75 3 980 216 19 170 470 221 2 183 62 63 6788 35 489 189 2418 465 14 830 56 104 3526 3 61 377 0 58 2 1013 230 24 610 462 609 1 148 64 51 6277 32 828 196 2621 388 14 389 51 127 3829 5 65 329 4 53 11 11 197 118 408 34 967 31 1516 256 3 949 206 28 216 615 868 0 185 50 22 5914 31 638 284 2766 371 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 15 980 908 1 161 201 115 98 389 1516 340 61 373 0 53 5 12 743 130 530 34 671 5 1059 176 30 838 790 603 1 134 60 51 6143 29 736 310 3173 323 14 986 119 118 4570

2 1457 196 2576 0 37 210 76 55 8065 70 916 146 7630 1101 11 218 6 0 1160 0 108 474 1 0 17 2525 112 307 89 803 59 2710 266 0 64 33 178 43 062 23 356 481

6 1386 285 1980 10 180 66 41 7729 65 867 187 585 10 970 7 1094 2 128 448 0 26 10 2508 116 821 98 532 49 2425 313 1 49 18 92 43 506 24 355 345

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

TABLE 15: CASE NOTIFICATION RATES, 1980-2004

24 Tuberculosis Control in the Western Pacific Region: 2006 Report

1980 1981 American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 139 78 234 236 38 112 116 0 66 410 152 81 200 27 70 0 76 15 31 64 26 88 14 0 147 80 76 237 255 32 98 132 67 51 221 77 80 200 27 208 33 50 52 160 61 267 238 437 82 20 226 78 22 57 28 42 38 150 56 333 6 10 102 39 18 9 143 29

1982 1983 1984 1985 1986 1987 1988 1989 1990 17 8 120 116 10 107 24 41 44 144 54 334 141 87 82 36 86 76 104 81 14 69 397 133 81 207 257 28 86 132 0 47 145 141 93 40 34 22 8 131 103 11 162 27 47 42 137 52 214 137 163 78 43 91 84 0 114 13 110 362 106 85 205 230 26 80 119 0 53 274 156 76 130 34 32 8 118 132 14 111 24 47 46 145 51 182 185 229 69 33 90 89 0 94 13 39 258 147 98 287 212 24 81 128 0 58 106 146 76 104 39 13 7 107 125 21 198 32 45 31 138 48 164 118 186 67 39 77 157 0 67 11 0 254 186 94 278 214 27 72 139 127 53 370 94 79 101 44 46 19 6 92 122 24 93 28 48 40 135 47 200 41 131 67 92 68 143 95 62 10 216 56 91 77 276 215 41 64 104 0 38 307 97 79 21 6 80 104 23 88 24 44 27 131 46 166 91 117 67 76 109 120 69 46 9 0 173 263 59 288 210 18 57 115 575 26 245 65 90 243 45 29 6 52 118 27 110 23 34 32 126 44 305 186 92 65 25 84 121 90 68 9 141 74 116 109 314 177 18 58 125 64 15 263 83 83 7 49 69 20 85 364 165 23 55 159 0 38 280 99 81 216 50 59 61 519 149 27 53 121 66 24 244 94 76 11 6 51 84 27 5 30 38 57 119 43 173 73 76 61 15 72 103 0 76 9 381 75 74 84 10 0 63 114 42 95 44 92 66 19 6 56 67 33 5 31 30

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 6 6 108 29 43 34 25 109 41 124 46 86 60 54 354 71 80 10 2 6 66 155 27 63 33 41 43 111 39 133 23 75 61 105 110 66 78 9 106 134 38 81 332 134 27 59 95 67 21 315 150 88 158 49 25 59 369 110 16 56 109 68 30 312 122 82 29 48 34 289 70 75 78 46 152 168 272 106 30 56 107 8 6 57 124 29 31 24 38 50 109 39 129 47 71 64 122 146 61 57 8 54 163 73 38 51 10 110 84 242 117 269 86 27 50 94 0 24 195 91 72 77 45 45 11 0 84 109 172 174 94 27 54 97 142 21 367 46 76 42 51 71 100 55 54 102 103 96 53 50 49 47 47 53 10 114 86 28 66 237 87 18 54 80 0 23 21 30 179 97 114 44 9 0 150 82 162 274 73 19 53 83 223 223 75 13 56 74 44 10 0 150 160 116 59 137 30 20 30 42 66 104 36 322 25 18 97 58 100 34 103 33 398 30 136 61 115 117 168 99 148 111 33 553 39 135 63 119 35 322 43 107 64 96 114 119 135 17 37 12 61 98 168 251 196 69 18 46 71 0 22 138 64 115 199 158 47 24 43 72 0 24 157 79 114 234 139 79 12 37 68 0 12 156 90 114 29 126 51 118 125 47 66 80 86 32 291 47 26 128 42 127 41 0 26 39 8 6 6 0 11 6 52 131 38 0 22 41 139 36 5 21 46 5 5 7 6 84 154 36 16 24 40 5 5 92 148 36 11 18 26 35 91 31 281 42 101 65 65 85 124 33 44 9 0 108 5 5 63 147 37 11 22 26 40 101 28 206 45 104 63 105 97 140 24 28 10 0 80 3 5 66 185 36 5 18 26 32 92 26 210 47 86 60 92 118 150 39 29 8 262 71 56 202 150 74 17 36 58 5 5 58 209 47 0 22 20 13 86 25 298 49 82 64 104 91 152 23 17 10 0 59 46 226 166 71 15 37 65 0 16 290 51 113 98 57

2004 8 5 48 223 60 6 16 24 31 88 23 318 55 71 60 199 108 175 26 9 0 67 25 221 160 73 35 73

55 118 67

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 http://stoptb.wpro.who.int

TABLE 16: NEW SMEAR-POSITIVE CASES NOTIFIED, NUMBERS AND RATES, 1993-2004 Number of cases 1993 American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) 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 Pacific Region 222 809 241 672 16 2 92 279 16 630 21 513 155 87 401 13 266 18 861 114 0 17 1 62 8 11 Tuberculosis Control in the Western Pacific Region: 2006 Report

Rate (per 100 000 population) 2000 2001 2 228 95 14 361 204 591 2 73 0 47 1857 11 408 64 1563 157 8309 15 8 1631 2 19 68 0 19 1351 59 341 11 805 11 357 118 0 8 0 57 54 238 1 371 806 23 0 38 56 811 1 372 641 2002 1 210 112 17 258 194 972 1 74 28 31 1892 10 807 82 1829 147 7958 18 22 1670 2 21 88 1 21 9 1933 67 056 8216 13 248 109 0 15 0 63 53 169 376 109 1345 65 148 11 345 19 549 108 2003 2 113 121 18 923 267 414 0 78 21 0 1794 10 843 99 1868 138 7989 20 26 1541 1 12 106 0 16 5 2310 72 670 10 976 12 583 138 0 11 0 40 55 937 7 453 814 579 594 14 15 59 58 389 17 21 506 152 15 112 0 14 5 1896 78 163 11 501 141 38 13 16 45 131 30 11 26 32 0 18 10 37 49 65 9 3 0 2004 2 285 115 18 978 384 886 1 62 30 22 1694 10 471 142 2241 128 7843 39 35 1808 0 6 19 15 2 0 11 2 0 25 52 35 139 26 9 13 30 71 9 61 17 51 21 20 28 66 21 24 37 66 7 25 23 23 22 21 72 13 2 57 44 22 9 124 25 5 14 24 0 14 11 16 12 2 0 34 38 24 112 22 8 12 29 42 95 22 4 13 35 13 3 0 40 27 36 24 8 19 35 41 14 129 13 234 10 34 33 7 21 8 1993 2 3 24 100 9 5 0 18 28 0 11 28 10 175 18 61 35 23 13 32 8 48 30 11 60 25 76 35 32 9 61 30 64 36 22 13 55 61 17 10 2 61 22 105 41 99 21 10 12 23 0 10 0 23 69 36 89 18 7 6 26 0 15 0 33 68 25 77 25 6 9 27 0 8 0 29 68 7 22 23 0 19 70 7 22 36 33 23 10 67 33 9 98 11 103 17 0 9 17 1994 8 1995 1996 0 1997 11 1 0 106 19 0 8 18 114 16 5 9 15 1998 4 1 1999 5 2 31 126 16 0 8 14 2000 3 1 25 116 16 0 8 12 28 29 9 60 29 36 35 21 14 56 33 9 2 0 39 2001 3 1 28 110 16 11 9 0 30 28 9 70 29 35 35 28 7 65 16 9 2 0 26 2002 2 1 32 130 15 5 9 11 19 28 8 88 33 33 33 33 20 65 16 9 2 65 28 46 24 83 24 11 13 24 2003 3 1 34 140 21 0 9 8 0 26 8 104 33 30 33 35 24 60 8 5 3 0 21 25 41 91 23 7 14 30 0 11 0 20 68 46 26 33 28 70 12 33 6 3 0 18 25 33 96 24 2004 3 1 31 138 29 6 7 12 13 24 8 146 39 28 32 65 32 69

1994 4

1995

1996 0

1997 6 226 0

1998 2 203 13 865 202 817 1 74 34 2091 11 935 52 1494 276 7802 11 9 14 1356 26 106 0 26 2107 69 476 10 359 7 482 140 16 38 54 889 379 699

1999 3 285 102 15 744 201 775 0 65 33 1536 12 909 59 1719 8207 17 1513 2 22 94 1 15 20 2140 73 373 9559 17 465 93 0 10 0 43 53 805 383 626

1 557 68

2 251 84 14 822 204 765 0 62 29 43 1940 11 853 54 1526 160 8156 11 15 1389 4 20 74 0 27

11 058 84 898 4 58 104 729 1 0 38 40 2429 17 890 99 108 6954 12 6861 16 770 184

11 101 134 488 68

12 065 203 670 0 69 37

12 686 236 021 0 66 41 1943 13 571 50 1234 325 7496

0 14 367 478 141 6688 9

1774 12 867 144 886 258 7271 12 14 769 26 90 1 26 4 447 86 695 11 420 9 519 90 0 14 50 48 911 3 388 141

0 16 91 0

145 2 28 61 0

455 21 78 0 14 9 1652 94 768 11 754 15 455 109 1 9 6 30 37 550 3 314 269

1171 24 83 0 21 7 1195 80 163 9957 14 436 113 11 66 50 016 1 416 952

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 http://stoptb.wpro.who.int

Annexes ANNEX 1. Definitions8 1. Definitions of tuberculosis cases

ANNEXES

A case of tuberculosis: A patient in whom tuberculosis has been bacteriologically confirmed or has been diagnosed by a clinician. Any person given treatment for tuberculosis should be recorded. All types: The sum of new smear-positive pulmonary, relapse, new smear-negative pulmonary and extrapulmonary cases. New smear-positive pulmonary tuberculosis: A patient who has never received treatment for tuberculosis, or who has taken anti-tuberculosis 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 tuberculosis 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 tuberculosis that does not meet the above definition for smear-positive tuberculosis. Extrapulmonary tuberculosis: Tuberculosis 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 tuberculosis, followed by a decision by a clinician to treat with a full course of antituberculosis chemotherapy. (A patient diagnosed with both pulmonary and extrapulmonary tuberculosis should be classified as a case of pulmonary tuberculosis.) Re-treatment case: Patient previously treated for tuberculosis, undergoing treatment for a new episode of bacteriologically positive (sputum smear or culture) tuberculosis. Relapse: A patient previously treated for tuberculosis and declared cured or treatment completed, who is later diagnosed with bacteriologically positive (culture smear) tuberculosis.

2. Definitions of treatment outcome Cured: Former smear-positive patient who was smear-negative in the last month of treatment, and on at least one previous occasion. Completed treatment: A patient who has completed treatment but who does not meet the criteria to be classified either as a cure or a failure. 8 World Health Organization, International Union Against Tuberculosis and Lung Disease, and Royal Netherlands Tuberculosis

Association. Revised international definitions in tuberculosis control. The International Journal of Tuberculosis and Lung Disease, 2001, 5(3): 213–215.

Tuberculosis Control in the Western Pacific Region: 2006 Report

ANNEXES Treatment success: The sum of patients who are cured and those who have completed treatment. Died: A patient who dies for any reason during the course of treatment. Failure: Smear-positive patient who remained smear-positive at five months or later during treatment. Defaulted: A patient who has interrupted treatment for two consecutive months or more. Transferred out: A patient who has been transferred to another recording and reporting unit and for whom the treatment outcome is not known. Not evaluated: 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.

3. Indicators to assess treatment outcome Cure rate: Proportion of cured cases out of all cases registered in a given period (2002, in this report). Treatment success rates: 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 2003 (reported in 2004) is compared with the number of cases notified as smear-positive in 2002 (reported in 2003). Differences may arise because national TB control programmes (NTP) do not compile data at the end of each calendar year, diagnosis 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 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 sum 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 DOTS The recommended strategy for tuberculosis control is comprised of: • Government commitment to ensuring sustained, comprehensive tuberculosis control activities. • Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services. • Standardized short-course chemotherapy using regimens of six to eight months, for at least all confirmed smear-positive cases. Good case management includes directly observed treatment during the intensive phase for all new sputum smear-positive cases, the continuation phase of rifampicin-containing regimens and the whole re-treatment regimen. • A regular, uninterrupted drug supply of all essential anti-tuberculosis drugs. Tuberculosis Control in the Western Pacific Region: 2006 Report

ANNEXES • A standardized recording and reporting system that allows assessment of case-finding and treatment results for each patient and of the tuberculosis control programme performance overall.

Targets for tuberculosis control established by the World Health Assembly (1991) • To cure 85% of the sputum smear-positive tuberculosis cases detected. • To detect 70% of the estimated new sputum smear-positive tuberculosis cases. Case notifications represent only a fraction of the true number of cases in a country because the coverage by effective NTP may be incomplete. The estimated case detection rate is defined as: Case detection rate (%) = Annual new smear-positive notifications (country) Estimated annual new smear-positive incidence (country)

DOTS detection rate refers to case detection under DOTS: DOTS detection rate (%) = Annual new smear-positive notifications under DOTS Estimated annual new smear-positive incidence (country)

The case detection rate and DOTS detection rate are identical when a country has a 100% DOTS enrolment rate. Updated estimated incidence for 2003 used in this report was provided by WHO. Population with access to DOTS: The country’s population that lives 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 types) (%) = DOTS enrolment rate (new SS+) (%) = Annual notifications of all types under DOTS Total annual notifications of all types Annual notification of new SS+ under DOTS Total annual notifications of new SS+

Tuberculosis Control in the Western Pacific Region: 2006 Report

ANNEXES

ANNEX 2. Formulas for estimating tuberculosis incidence, prevalence and deaths Formulas 1. I = T/d and Is= Ts/ds Definitions N = Population I = Incidence of TB (number of new cases of TB per year 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) l = 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 6. IRR = ma+ra+/ma-ra-= (Ia+/Na+)/(Ia-/Na-) t = Proportion of TB patients who die from TB (case fatality rate [CFR]) m = Prevalence of infection with MTB 7. Ia+/Ia = IRR(Na+/Na)/[1+(Na+/Na)(IRR-1)] 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) 8. 9. Ia* = Ia+-Ia-Na+/NaDa* = Da+-f - (I+-Ia*) n = Other age groups (<15 or >49), assumed HIV-uninfected + = HIV-positive - = HIV-negative * = Attributable to HIV infection

2. 3. 4.

P = tl and Ps= tsls Is/N = lk D = fl and Ds= fls

I = Ia++Ia-+In or I = ma+ra+Na++ma-ra-Na-+mnrnNn

Source: Corbett EL et al. The Growing Burden of Tuberculosis. Global Trends and Interactions with the HIV Epidemic. Archives Internal Medicine, 2003, 163(9): 1009-1021.

Tuberculosis Control in the Western Pacific Region: 2006 Report

ANNEXES

ANNEX 3. Statistical methods Rates of change per year in the time series were assessed by estimating the slope of the logtransformed rates against time. The statistical analysis was carried out using the R language,9 available at no charge off the Internet.10

Ihaka R and Gentleman R. A language for data analysis and graphics. Journal of Computational and Graphical Statistics, 1996, 5(3): 299–314. 10 The R Project for Statistical Computing (http://www.r-project.org).

Tuberculosis Control in the Western Pacific Region: 2006 Report

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Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Publications

Дата принятия 31 декабря 2006 г.

Источник Всемирная организация здравоохранения