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Eur Respir J. 2015 Apr;45(4):928-52. doi: 10.1183/09031936.00214014.

Towards tuberculosis elimination: an action framework for low-incidence countries.

Author information

1
Global TB Programme, World Health Organization, Geneva, Switzerland Both authors contributed equally.
2
WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy Both authors contributed equally.
3
TB Section, University College London and Public Health England, London, UK.
4
WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy.
5
KNCV Tuberculosis Foundation, The Hague, The Netherlands.
6
University Hospital Schleswig Holstein, Institute for Epidemiology, Kiel, Germany.
7
Global Health Borders Refugee and Onshore Services, Dept of Immigration and Border Protection, Sydney, Australia.
8
Global TB Programme, World Health Organization, Geneva, Switzerland.
9
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada.
10
National Institute for Infectious Diseases, Rome, Italy.
11
Research and Surveillance Group on TB, Leprosy and ARI, Epidemiology Board, Institute of Tropical Medicine "Pedro Kourí", Havana, Cuba.
12
Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.
13
TB Dept, National Institute for TB, Respiratory Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ružomberok, Slovakia.
14
Find and Treat, London, UK.
15
National TB Control Programme, Ministry of Health, Riyadh, Saudi Arabia.
16
European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
17
Swiss Lung Association, Bern, Switzerland.
18
WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.
19
Ministry of Health, Muscat, Oman.
20
Università degli Studi di Milano - Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy.
21
Belgian Lung and Tuberculosis Association, Brussels, Belgium.
22
Ministry of Health, Brasilia, Brazil.
23
Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy.
24
US Agency for International Development, Washington, DC, USA.
25
Unit of Infectious Diseases, Institution of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden.
26
University of Brescia, Brescia, Italy.
27
Ministry of Health, Jerusalem, Israel.
28
IRCCS San Raffaele Scientific Institute, Milan, Italy.
29
Advocates for Health International, San Diego, CA, USA.
30
TB and M/XDR-TB Control Programme, WHO Regional Office for Europe, Copenhagen, Denmark.
31
Norwegian Institute of Public Health, Oslo, Norway.
32
Médecins sans Frontières, Rome, Italy.
33
General Directorate of Health, Lisbon, Portugal.
34
Istituto Superiore di Sanita, Rome, Italy.
35
National Referral Centre for Mycobacteria, Athens Chest Hospital, Ministry of Health, Athens, Greece.
36
International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland.
37
WHO Regional Office for the Americas, Washington, DC, USA.
38
Dept of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
39
Finnish Lung Health Association, Helsinki, Finland Helsinki University Central Hospital, Division of Infectious Diseases, Helsinki, Finland.
40
Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare, Seoul, Republic of Korea.
41
International Organization for Migration, Geneva, Switzerland.
42
University of California, San Francisco, CA, USA American Thoracic Society (ATS), New York, NY, USA.
43
Stop TB and Leprosy Elimination, WHO Regional Office for the Western Pacific, Manila, Philippines.
44
Instituto de Salud Carlos III, Madrid, Spain.
45
HSE Health Protection Surveillance Centre, Dublin, Ireland.
46
Ministry for Health, Valletta, Malta.
47
Ministry of Health, Rome, Italy.
48
Pneumology Institute Marius Nasta, Bucharest, Romania.
49
Coimbra University Hospital, Coimbra, Portugal.
50
Statens Serum Institut (SSI), Copenhagen, Denmark.
51
Institut Jules Bordet (ULB), Brussels, Belgium.
52
Croatian National Institute of Public Health, Zagreb, Croatia.
53
Health Protection Scotland, Glasgow, UK.
54
Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
55
Asociacion Latinoamericana de Torax (ALAT) - Fundacion Neumologica Colombiana, Bogota, Colombia.
56
Ministry of Health, Labour and Welfare, Tokyo, Japan.
57
Finnish Lung Health Association, Helsinki, Finland.
58
Caritas Internationalis, Geneva, Switzerland.
59
Ministry of Health, Nicosia, Cyprus.
60
Fonds des Affections Respiratoires (FARES), Brussels, Belgium.

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.

PMID:
25792630
PMCID:
PMC4391660
DOI:
10.1183/09031936.00214014
[Indexed for MEDLINE]
Free PMC Article

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