In the Western Pacific Region, TB remains a major public health problem. In 2005, there were an estimated 3.6 million prevalent cases of TB (206 per 100 000 population), of which almost 1.9 million were new cases (110 per 100 000 population). Three countries (China, the Philippines and Viet Nam) accounted for about 90% of the total estimated new cases in the Region.
The case detection rate in the Region in 2005 was 78% for new smear-positive cases and 63% for all forms of TB. In other words, the 671 719 notified new smear-positive cases represented 78% of the estimated 0.9 million new smear-positive cases, and the 1.3 million notified cases (all forms) represented 63% of the 1.9 million estimated cases (all forms). The case detection rate for new smear-positive cases in areas with directly observed treatment, short-course (DOTS) has been steadily increasing in the Region since 2002. The 111% increase in case detection in the Region from 2002 to 2005 is primarily due to a dramatic 196% increase in case detection in China.
In DOTS areas, the cure and treatment success rates were 87% and 91%, respectively, for the cohort of 566 237 new pulmonary smear-positive TB cases registered for treatment in 2004. Among the countries in the Region with a high burden of TB, only Papua New Guinea has a treatment success rate below the 85% regional target.
MDR-TB and TB-HIV co-infection are new challenges for TB control in the Region. Resistance to anti-TB drugs was found in all settings surveyed in the Region. Prevalence of MDR-TB in previously untreated cases varied widely across settings, ranging from 0% to 7.8%. TB associated with HIV infection is a growing concern in the Region, particularly in Papua New Guinea and Viet Nam, where estimated prevalence of HIV among TB patients is about 9.7% and 3%, respectively. The prevalence of HIV among TB cases is still high in Cambodia at 9.9%, but has shown a significant decline from 11.8% in 2003.
In the region overall, the global and regional targets of 70% case detection rate, 85% treatment success rate and region wide DOTS coverage were achieved by the end of 2005. Based on the experience in the Region, this substantial progress was a result of four major factors:
- strong leadership, both political and technical;
- government commitment;
- effective partnerships among national and international partners; and
- motivated and well-trained workforce of TB front-line health providers.
Gains made in these areas, and the achievement of the intermediate TB control targets, provide the Western Pacific Region with a strong foundation to take on the more challenging task of achieving the 2010 regional goal of reducing the TB prevalence and mortality by one half from 2000 level. To achieve this goal, the Region needs to accelerate the rate of decline in prevalence and mortality, currently about -4% to about -8%, by further improving the quality of DOTS implementation, and by addressing the current challenges of MDR-TB and HIV.