German Perspective on TB Prevention and Control in the SDG Era - Nita Perumal, RKI High-level event on the occasion of World Tuberculosis Day ...
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German Perspective on TB Prevention and Control in the SDG Era Nita Perumal, RKI High-level event on the occasion of World Tuberculosis Day, 20th 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 24th, 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
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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.
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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
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TB Epidemiology in Germany, 2002-2017
All Cases Children only
2017: 5,486 2017: 238
2016: 5,949 2016: 228
2015: 5,834 2015: 192
20/03/2018 7
TB Treatment Outcomes in Germany, 2016
90%
WHO Goal
81%
Germany
20/03/2018 8Reaching the End TB Strategy’s Pre-Elimination Goals 20/03/2018 9
What is Germany currently doing nationally?
• Diagnosis, • Contact tracing • Electronic, case-
treatment, and • Targeted screening based mandatory
care in accordance reporting
with TB standards
of care
Case Active case-
Surveillance
Management finding
• Evidence-based, • TB patients and • National TB
current guidelines their families meeting organized
• Expert advice for • General every year for
complicated cases population World TB Day
Technical
Information Exchange
Guidance
20/03/2018 10What are Germany’s priorities?
Think TB! Molecular Surveillance United Effort
Increasing awareness Using the latest Considerably greater
and expertise among technologies, establish and intensified collective
medical professionals nationwide integrated efforts to improve TB
and other care givers to molecular surveillance surveillance and control
decrease diagnostic to detect spread of TB and eventually reach the
delay, secure adequate early and conduct goal of elimination.
treatment, and prevent systematic drug
further disease. resistance surveillance.
Source: CDC. Think TB Poster. Cole et al. Nature. 1998 Jun 11;393(6685):537-44. Source: Pixabay
20/03/2018 11Priorities 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 12Germany 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 13Conclusion
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 co-
operation of many, if possible of all,
medical men, shoulder to shoulder
with the State and the whole
population.
- An address on the fight against tuberculosis in
the light of the experience that has been gained in
© Foto RKI
the successful combat of other infectious
diseases. Robert Koch. London, 1901
20/03/2018 14Thank you
© Foto RKI
TB-Team: Nita Perumal, Barbara Hauer, Bonita Brodhun, Stefan Kröger, Tanja Charles
Unit Head: Walter Haas
20/03/2018 15You can also read
