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Lönnroth K, Migliori GB, Abubakar I, D'Ambrosio L, de Vries G, Diel R, Douglas P, Falzon D, Gaudreau MA, Goletti D, González Ochoa ER, LoBue P, Matteelli A, Njoo H, Solovic I, Story A, Tayeb T, van der Werf MJ, Weil D, Zellweger JP, Abdel Aziz M, Al Lawati MR, Aliberti S, Arrazola de Oñate W, Barreira D, Bhatia V, Blasi F, Bloom A, Bruchfeld J, Castelli F, Centis R, Chemtob D, Cirillo DM, Colorado A, Dadu A, Dahle UR, De Paoli L, Dias HM, Duarte R, Fattorini L, Gaga M, Getahun H, Glaziou P, Goguadze L, del Granado M, Haas W, Järvinen A, Kwon GY, Mosca D, Nahid P, Nishikiori N, Noguer I, O'Donnell J, Pace-Asciak A, Pompa MG, Popescu GG, Robalo Cordeiro C, Rønning K, Ruhwald M, Sculier JP, Simunović A, Smith-Palmer A, Sotgiu G, Sulis G, Torres-Duque CA, Umeki K, Uplekar M, van Weezenbeek C, Vasankari T, Vitillo RJ, Voniatis C, Wanlin M, Raviglione MC. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45:928-52. [PMID: 25792630 PMCID: PMC4391660 DOI: 10.1183/09031936.00214014] [Citation(s) in RCA: 530] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/02/2015] [Indexed: 12/31/2022]
Abstract
This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.
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Affiliation(s)
- Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Both authors contributed equally
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
- Both authors contributed equally
| | - Ibrahim Abubakar
- TB Section, University College London and Public Health England, London, UK
| | - Lia D'Ambrosio
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | - Roland Diel
- University Hospital Schleswig Holstein, Institute for Epidemiology, Kiel, Germany
| | - Paul Douglas
- Global Health Borders Refugee and Onshore Services, Dept of Immigration and Border Protection, Sydney, Australia
| | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Marc-Andre Gaudreau
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Delia Goletti
- National Institute for Infectious Diseases, Rome, Italy
| | - Edilberto R. González Ochoa
- Research and Surveillance Group on TB, Leprosy and ARI, Epidemiology Board, Institute of Tropical Medicine “Pedro Kourí”, Havana, Cuba
| | - Philip LoBue
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Howard Njoo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Ivan Solovic
- TB Dept, National Institute for TB, Respiratory Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ružomberok, Slovakia
| | | | - Tamara Tayeb
- National TB Control Programme, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Diana Weil
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Stefano Aliberti
- Università degli Studi di Milano – Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy
| | | | | | - Vineet Bhatia
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
| | - Amy Bloom
- US Agency for International Development, Washington, DC, USA
| | - Judith Bruchfeld
- Unit of Infectious Diseases, Institution of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | | | - Rosella Centis
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Andrei Dadu
- TB and M/XDR-TB Control Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ulf R. Dahle
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hannah M. Dias
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Mina Gaga
- National Referral Centre for Mycobacteria, Athens Chest Hospital, Ministry of Health, Athens, Greece
| | | | - Philippe Glaziou
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Lasha Goguadze
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Walter Haas
- Dept of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Asko Järvinen
- Finnish Lung Health Association, Helsinki, Finland
- Helsinki University Central Hospital, Division of Infectious Diseases, Helsinki, Finland
| | - Geun-Yong Kwon
- Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Payam Nahid
- University of California, San Francisco, CA, USA
- American Thoracic Society (ATS), New York, NY, USA
| | - Nobuyuki Nishikiori
- Stop TB and Leprosy Elimination, WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | - Joan O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Giorgia Sulis
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Carlos A. Torres-Duque
- Asociacion Latinoamericana de Torax (ALAT) - Fundacion Neumologica Colombiana, Bogota, Colombia
| | | | - Mukund Uplekar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Maryse Wanlin
- Fonds des Affections Respiratoires (FARES), Brussels, Belgium
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