German Perspective on TB Prevention and Control in the SDG Era Nita Perumal, RKI High-level event on the occasion of World Tuberculosis Day, 20 th March 2018
Tuberculosis - one of the oldest diseases in the history of mankind Visiting the poor Source: Illustration von Karl Giradet aus La Magasin Pittoresque, Paris, 1844. Capital and Labour Source: Karikatur aus der englischen Zeitschrift Punch, 1843. 20/03/2018 2
Robert Koch discovered Mycobacterium tuberculosis on March 24 th, 1882 Source: Wikimedia Commons. Robert Koch in seinem Laboratorium. Source: Title page of Robert Koch's publication in the "Berliner Klinischen Wochenschrift" on April 10th, 1882, following his lecture on March 24th, 1882, titled "The aetiology of tuberculosis". 20/03/2018 3
DIAGNOSTIC Progress: TB is now relatively easy to diagnose Source: Wikimedia Commons. GeneXpert Source: CDC/George P. Kubica (1979). CDC-PHIL ID #5789. http://phil.cdc.gov/ Source: Carl Mydans (1935). Library of Congress Prints and Photographs LC-DIG-fsa-8a00473 20/03/2018 4
THERAPEUTIC Progress: TB can be cured a large majority of the time when the right combination of medications is made available and the full course is taken by the patient Source: Pixabay Source: Artificial pneuothorax at Stannington Sanatorium. Wellcome Images. Source: Children in a TB sanatorium. The Finnish Museum of Photography. Wikimedia Commons. 20/03/2018 5
Surveillance is key TB mortality in Prussia, 1875 1910 Deaths per 10,000 population Dramatic fall in TB mortality, even during Robert Koch s time Improved living conditions and nutrition through social and economic advancements Source: Robert Koch, Epidemiologie der Tuberkulose; Vortrag an der Akademie der Wissenschaften zu Berlin am 7. April 1910 20/03/2018 6
TB Epidemiology in Germany, 2002-2017 All Cases 2017: 5,486 2016: 5,949 2015: 5,834 Children only 2017: 238 2016: 228 2015: 192 20/03/2018 7
TB Treatment Outcomes in Germany, 2016 90% WHO Goal 81% Germany 20/03/2018 8
Reaching the End TB Strategy s Pre-Elimination Goals 20/03/2018 9
What is Germany currently doing nationally? Diagnosis, treatment, and care in accordance with TB standards of care Case Management Contact tracing Targeted screening Active casefinding Electronic, casebased mandatory reporting Surveillance Evidence-based, current guidelines Expert advice for complicated cases TB patients and their families General population National TB meeting organized every year for World TB Day Technical Guidance Information Exchange 20/03/2018 10
What are Germany s priorities? Think TB! Increasing awareness and expertise among medical professionals and other care givers to decrease diagnostic delay, secure adequate treatment, and prevent further disease. Molecular Surveillance Using the latest technologies, establish nationwide integrated molecular surveillance to detect spread of TB early and conduct systematic drug resistance surveillance. United Effort Considerably greater and intensified collective efforts to improve TB surveillance and control and eventually reach the goal of elimination. Source: CDC. Think TB Poster. Cole et al. Nature. 1998 Jun 11;393(6685):537-44. Source: Pixabay 20/03/2018 11
Priorities for a global improvement in the TB situation Development of new diagnostic methods and therapeutic agents, as well as a vaccine, necessary for worldwide TB control and elimination However, crucial to keep in mind the following : Barrier-free access to medical services that conform to international standards of care Optimal and best practice usage of recommended tools and measures Integrated and coordinated patient-centered approach Surveillance, including treatment outcome monitoring and resistance monitoring 20/03/2018 12
Germany stands behind the goal of eliminating TB Germany recognizes and is cognizant of the global TB situation and the urgent need for action for its improvement. We have shown this through support and co-writing of the Berlin Declaration in 2007 support for the inclusion of TB within the theme of antimicrobial resistance, which was one of the priorities during Germany s G20 presidency in 2017 participation in StopTB Partnership Board Meetings support for the Moscow Declaration following the Health Ministers conference in 2017 support and preparation for the UNGA high-level meetings, such as the upcoming meeting in New York in 2018, etc. It is urgent to use the current momentum to accelerate the TB elimination efforts! 20/03/2018 13
Conclusion We do well, but could do even better. But the strength of a small number of medical men was inadequate to the conflict with a disease so deeply rooted in our habits and customs. Such a conflict requires the cooperation of many, if possible of all, medical men, shoulder to shoulder with the State and the whole population. Foto RKI - An address on the fight against tuberculosis in the light of the experience that has been gained in the successful combat of other infectious diseases. Robert Koch. London, 1901 20/03/2018 14
Thank you Foto RKI TB-Team: Nita Perumal, Barbara Hauer, Bonita Brodhun, Stefan Kröger, Tanja Charles Unit Head: Walter Haas 20/03/2018 15