Η Φπκαηίσζε σο παγθόζκην πξόβιεκα Δρ Νικόλαος Γαλάνης Διεσθσντής Α Πνεσμονολογικού τμήματοςγπν «Γ. Παπανικολάοσ»
-Σν Μπθνβαθηεξίδην έρεη ζθνηώζεη πεξηζζόηεξνπο αλζξώπνπο απ νπνηνδήπνηε άιιν κηθξόβην ζε όιεο ηηο επνρέο -Δλδείμεηο όηη ππάξρεη ηνπιάρηζηνλ από ηελ επνρή ησλ Γεηλνζαύξσλ (πξηλ 160 εθαη. ρξόληα) -Βξέζεθε ζε κνύκηεο ζηελ Αίγππην (ε παιαηόηεξε πξηλ 1000) ζε ζθειεηό πξηλ 5000 ρξόληα) -Ο Αξηζηνηέιεο πεξηγξάθεη όηη ε λόζνο αλαπηύζζεηαη ζε αλζξώπνπο πνπ έξρνληαη ζε επαθή κε πάζρνληεο -Ήηαλ γλσζηή από ηελ αξραηόηεηα ζηελ Κίλα ηηο Ιλδίεο θαη ηε Χηιή
R. Koch 1843-1910 25 ρξνληα κεηά ηελ αλαθάιπςε ηνπ Μπθνβαθηεξηδίνπ ηεο θπκαηίσζεο από ηνλ Robert Koch, ζηηο 24 Μαξηίνπ 1882 Nέα απεηιή εμαηξεηηθα αλζεθηηθή θπκαηίσζε. Δίλαη ε επηζηήκε επαξθήο γηα λα αλαθόςεη ηελ επηδεκία;
Νέα περιζηαηικά & σποηροπές Φσμαηίωζης, 2004 Notified TB cases (new and relapse) per 100 000 population 0-24 25-49 50-99 100 or more No report Πηγή: WHO
Tα περιζζόηερα περιζηαηικά Tb καηά κεθαλήν εμθανίζονηαι ζηην Αθξηθή λόγω HIV/AIDS The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2002 per 100 000 population < 10 10 to 24 25 to 49 50 to 99 100 to 299 300 or more No Estimate
Επίπηωζη TB 1990/2005 1990 No estimate < 50 50-100 100-200 200-300 300 and more 2005 Stop TB Department
2003: Τα περιζζόηερα περιζηαηικά TB σπάρτοσν ζηην Ινδία και ηην Κίνα Europe 10% Number of cases < 1 000 1 000-9 999 10 000-99 999 100 000-999 999 1 000 000 or more No estimate Africa 21% Asia 59% The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2003 Global Tuberculosis Control. WHO Report 2005. WHO/HTM/TB/2005.349
20 εθαη.αζζελείο εηεζίσο TB- Global threaten 8,8 million new cases in 2003 1/3 Of the world s s population (22 billion) ) is infected with TB 88% in high burden countries (22) MDR TB in 109 countries 2 million death annually (98% in developing countries) 2005 I.P. Stoicescu (Bucharest, Romania) 1% αύμεζε αζζελώλ εηεζίσο
TB cases notified in EUR, 1980-2003 400.000 350.000 300.000 250.000 200.000 150.000 100.000 50.000 0 373 497 cases in 2002 360,741 cases in 2003 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Επίπηωζη Tb ζηην Εςπώπη 94/100.000 ζηα ζπλνξεύνληα θξάηε 54/100.000 ζηα 4 πξνζδεδεκέλα κέιε EU 30/100.000 ζηα 10 λέα κέιε EU 13/100.000 ζηνπο 15 EU TB incidence in European Union 54 %ooo 30 %ooo 13%ooo 94%ooo Overall TB incidence in EUROPE 50%ooo First fifteen UE countries Ten new members Four new accessing countries Countries bordering UE 2005 I.P. Stoicescu (Bucharest, Romania) 50/100.000 ζύλνιν Δπξώπεο
EUROPEAN UNION (EU) & WEST EU (dark blue) Austria Belgium Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Slovakia Slovenia Spain Sweden United Kingdom Non-EU (light blue) Andorra Iceland Israel Monaco Norway San Marino Switzerland CENTRE Albania Bosnia & Herzegovina Bulgaria Croatia Macedonia, F.Y.R Montenegro Romania Serbia Turkey EAST Armenia Azerbaijan Belarus Georgia Kazakhstan Kyrgyzstan Moldova, Republic of Russian Federation Tajikistan Turkmenistan Ukraine Uzbekistan TB notification, Europe, 2003 Region Cases Rate / 100,000 EU & West Rang e 64,434 14 2-82 Centre 60,957 49 18-142 East 290,39 5 Total 415,78 6 104 47-208 47 EuroTB
Χώξεο Αλαηνιηθήο Eπξώπεο «Η Φπκαηίσζε πξνζβάιιεη πεξηζζόηεξνπο ζήκεξα από όζνπο πξηλ 20 ρξόληα» - Η αύμεζε ηεο Tb είλαη ζπγθξίζηκε κε ηελ αληίζηνηρε ζηελ Αθξηθή ιόγσ ηνπ AIDS - Πεξηζζόηεξν από ηα ¾ ησλ πεξηζηαηηθώλ ηεο Δπξώπεο πξνέξρνληαη από ηελ Αλαηνιηθή - - Η ζπρλόηεηα δηπιαζηάζηεθε ηα ηειεπηαία 10 ρξόληα ιόγσ θνηλσληθννηθνλνκηθώλ πξνβιεκάησλ - Η λόζνο εκθαλίδεηαη θπξίσο ζε λένπο, θπιαθηζκέλνπο, αιθννιηθνύο θαη ζε άιιεο κεηνλεθηηθέο θνηλσληθέο νκάδεο - Οη Βαιηηθέο ρώξεο θαη ε Ρσζία έρνπλ ηα πςειόηεξα πνζνζηά MDR-Tb ζηνλ θόζκν, ζηηο ππόινηπεο αλαηνιηθέο άγλσζηνλ - Σαρεία αύμεζε HIV/AIDS ζηηο Λεπθνξσζία, Δζζνλία, Λεηνλία, Ληζνπαλία, Ρσζία θαη Οπθξαλία. WHO- DOTS Exp Plan to Stop TB 2002-2006
120 TB cases / 100,000 100 East 80 60 Centre* 40 20 EU & West 0 1996 1997 1998 1999 2000 2001 2002 2003 2004
Number of TB cases notified (country data Central and Eastern Europe 2003) Slovenia 275 Albania 543 Estonia 557 Greece 571 Macedonia FYROM 653 Slovakia 904 Czech Rep. 1101 Croatia 1356 Latvia 1686 Bosnia Herzegov 1740 Hungary 2507 Lithuania 2586 Bulgaria 3069 R. of Moldova 3619 Serbia and Montenegro 3895 Belarus 5106 Poland 9677 Turkey 18043 (2002) Romania 28335 Ukraine 37043 Russian Fed. 124041 Average EUROPE 39 o/oooo (47,2 Euro surveillance) Average Central and Eastern Europe 44.7 o/oooo WHO report 2005
TB notification rates, Balkans, 1996-2003 TB cases / 100,000 160 Romania 140 120 100 80 60 40 20 Bosnia & Herzegovina Bulgaria F.Y.R.Ο.Μ. Croatia Serbia & Montenegro* Turkey Albania Slovenia Greece 0 1996 1997 1998 1999 2000 2001 2002 2003 no data from Republika Srpska in 2003 * including Kosovo in 1996-1997 EuroTB
Proportion of TB cases with positive culture, 2004* % cases 100 80 EU & West Centre 60 40 20 0 * Excluding countries with <60 cases notified (Andorra, Cyprus, Iceland, Luxembourg, Malta, San Marino). No data for Monaco and Turkey ** Provisional data EuroTB
Laboratory confirmation of new pulmonary TB cases, 2001 Proportion of smear and/or culture confirmed new pulmonary cases < 50% 50-64% 65% Unknown
Reported laboratory confirmation (smear and/or culture) of new, pulmonary TB cases, 2002 Proportion of cases with lab confirmation < 50% 50-64% > 65% 2005 I.P. Stoicescu (Bucharest, Romania)
TB cases among foreigners 2002 (%) Πεξηζηαηηθά Tb% ηνπ ζπλόινπ ζε αιινδαπνύο ζηελ Δπξώπε ην 2002 80 Foreign-born make a large and growing contribution to TB in Europe Source: Euro TB 70 60 50 40 30 20 10 0 Finland Portugal Greece Ireland Austria Italy Germany France Luxembourg Belgium UK Netherlands Denmark Sweden Norway
Ειζαγόμενη TB,ηόπορ πποέλεςζηρ αζθενών EU & West, 2003 (N=15,678)* Centre & East 21% Africa 38% America & Oceania 5% EU & West 5% Asia 25% Other / Unknown 6% * Foreign = born outside or not citizen of the country of report; excluding countries without data (Israel, Monaco, Poland, Spain), and Scotland. EuroTB
MDR-TB prevalence in new cases: 1994-2003 MDR-TB is rampant in the former Soviet Union and China Lithuania Tomsk Ivanovo Estonia (Russia) (Russia) 9.4 13.7 12.2 9 9.3 14.2 14.2 13.2 Latvia Kazakhstan Uzbekistan Domenican Rep 6.6 Ivory Coast 5.3 14.2 Israel 5 Iran Henan 10.4 (China) Liaoning 7.8 (China) 4.9 Ecuador 3.1 Ref: DRS Report #3 (in press) World Health Organization
Multi-drug resistance (MDR), new cases, 2003 16 % MDR 14 12 10 8 6 4 2 0 Culture & DST routine; complete, nationwide data Other data survey, 2001-2004 * excluding Scotland
Εξαιπεηικά Ανθεκηική TB Extensively Drug Resistance TB
Directly Observed Therapy / Short-course Απεπζείαο Δπηηεξνύκελε Βξαρεία Θεξαπεία
Number of countries Global DOTS Expansion 1990-2003 Total number of countries 211 200 180 182 150 100 DOTS 98 104 122 126 147 155 50 73 0 10 15 19 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Years Stop TB Department
CASE DETECTION 80 70 Θεραπεύοντας την TB - DOTS ανά τον κόσμο 60 50 40 30 20 10 16% 18% 22% 18 16 24% 22 28% 24 32% 28 32 37% 37 45% 45 0 1994 1996 1998 2000 2002 2004
Μέρξη ην 2005, 70% ησλ παζρόλησλ λα δηαγλσζζνύλ θαη 85% λα ζεξαπεπηνύλ Μέρξη ην 2010 ζα πξέπεη ην θνξηίν ηεο λόζνπ λα κεησζεί θαηά 50% ζε ζρέζε κε ην 2000 (Αλαζεσξήζεθε γηα ην 201 ην πξόγξακκα Stop TB 2006-2015). Σν 2050 ε επίπησζε ηεο λόζνπ λα είλαη θάησ από 1 αλά εθαηνκκύξην θαηνίθνπο
Percent of deaths 14 12 10 8 6 4 2 0 Ischaemic heart Cerebrovascular Major causes of death in 2030? WHO October 2005 HIV/AIDS COPD Lower resp inf Diabetes Lung cancer 8ε αηηία ζαλάηνπ ην 2030 TB Road accidents Perinatal
Η Φπκαηίσζε πξνιακβάλεηαη θαη ζεξαπεύεηαη Χξεκαηνδόηεζε ηελ παγθόζκηα πξνζπάζεηα γηα λα εμαιεηθζεί Eπένδςζε Επεύνα Δπάζε Η Φςμαηίωζη οποςδήποηε είναι, είναι πανηού