Towards tuberculosis elimination: an action framework for low-incidence countries.
Migliori, Giovanni Battista
de Vries, Gerard
González Ochoa, Edilberto R
van der Werf, Marieke J
Abdel Aziz, Mohamed
Al Lawati, Mohamed R M
Arrazola de Oñate, Wouter
Cirillo, Daniela M
Dahle, Ulf R
De Paoli, Laura
Dias, Hannah M
Del Granado, Mirtha
Pompa, Maria G
Popescu, Gilda G
Robalo Cordeiro, Carlos
Torres-Duque, Carlos A
van Weezenbeek, Catharina
Vitillo, Robert J
Raviglione, Mario C
Affiliation1Global TB Programme, World Health Organization, Geneva, Switzerland Both authors contributed equally. 2WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy Both authors contributed equally. 3TB Section, University College London and Public Health England, London, UK. 4WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy. 5KNCV Tuberculosis Foundation, The Hague, The Netherlands. 6University Hospital Schleswig Holstein, Institute for Epidemiology, Kiel, Germany. 7Global Health Borders Refugee and Onshore Services, Dept of Immigration and Border Protection, Sydney, Australia. 8Global TB Programme, World Health Organization, Geneva, Switzerland. 9Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada. 10National Institute for Infectious Diseases, Rome, Italy. 11Research and Surveillance Group on TB, Leprosy and ARI, Epidemiology Board, Institute of Tropical Medicine "Pedro Kourí", Havana, Cuba. 12Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA. 13TB Dept, National Institute for TB, Respiratory Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ružomberok, Slovakia. 14Find and Treat, London, UK. 15National TB Control Programme, Ministry of Health, Riyadh, Saudi Arabia. 16European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. 17Swiss Lung Association, Bern, Switzerland. 18WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt. 19Ministry of Health, Muscat, Oman. 20Università degli Studi di Milano - Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy. 21Belgian Lung and Tuberculosis Association, Brussels, Belgium. 22Ministry of Health, Brasilia, Brazil. 23Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy. 24US Agency for International Development, Washington, DC, USA. 25Unit of Infectious Diseases, Institution of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden. 26University of Brescia, Brescia, Italy. 27Ministry of Health, Jerusalem, Israel. 28IRCCS San Raffaele Scientific Institute, Milan, Italy. 29Advocates for Health International, San Diego, CA, USA. 30TB and M/XDR-TB Control Programme, WHO Regional Office for Europe, Copenhagen, Denmark. 31Norwegian Institute of Public Health, Oslo, Norway. 32Médecins sans Frontières, Rome, Italy. 33General Directorate of Health, Lisbon, Portugal. 34Istituto Superiore di Sanita, Rome, Italy. 35National Referral Centre for Mycobacteria, Athens Chest Hospital, Ministry of Health, Athens, Greece. 36International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland. 37WHO Regional Office for the Americas, Washington, DC, USA. 38Dept of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. 39Finnish Lung Health Association, Helsinki, Finland Helsinki University Central Hospital, Division of Infectious Diseases, Helsinki, Finland. 40Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare, Seoul, Republic of Korea. 41International Organization for Migration, Geneva, Switzerland. 42University of California, San Francisco, CA, USA American Thoracic Society (ATS), New York, NY, USA. 43Stop TB and Leprosy Elimination, WHO Regional Office for the Western Pacific, Manila, Philippines. 44Instituto de Salud Carlos III, Madrid, Spain. 45HSE Health Protection Surveillance Centre, Dublin, Ireland. 46Ministry for Health, Valletta, Malta. 47Ministry of Health, Rome, Italy. 48Pneumology Institute Marius Nasta, Bucharest, Romania. 49Coimbra University Hospital, Coimbra, Portugal. 50Statens Serum Institut (SSI), Copenhagen, Denmark. 51Institut Jules Bordet (ULB), Brussels, Belgium. 52Croatian National Institute of Public Health, Zagreb, Croatia. 53Health Protection Scotland, Glasgow, UK. 54Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy. 55Asociacion Latinoamericana de Torax (ALAT) - Fundacion Neumologica Colombiana, Bogota, Colombia. 56Ministry of Health, Labour and Welfare, Tokyo, Japan. 57Finnish Lung Health Association, Helsinki, Finland. 58Caritas Internationalis, Geneva, Switzerland. 59Ministry of Health, Nicosia, Cyprus. 60Fonds des Affections Respiratoires (FARES), Brussels, Belgium.
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CitationTowards tuberculosis elimination: an action framework for low-incidence countries. 2015, 45 (4):928-52 Eur. Respir. J.
JournalThe European respiratory journal
AbstractThis 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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