Epidemiological situation of tuberculosis and malaria in the Americas region

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The Americas region achieved the goal of reducing tuberculosis prevalence and mortality and increasing treatment coverage. Regarding malaria, among the main achievements are the increase of national funding, the decrease of estimated incidence of cases, the reduction of mortality rates and the elimination of the disease in three countries.

Epidemiological situation of tuberculosis in the Americas region

With regard to the state of the global tuberculosis epidemic, in 2015 the highest number of estimated cases happened in Asia (61%) and the WHO African region (26%). Percentages were lower in the Eastern Mediterranean region (7%), the European region (3%) and the Americas region (3%).

The Americas region achieved the reduction goal of 50% of prevalence, in addition to the goal of 50% reduction of mortality due to tuberculosis, whereas treatment coverage reached levels above 75%. In 2015, the total number of reported cases in the Americas region was 230.519 and the percentage of patients aware of their serology for HIV reached 82%. Estimated incidence (including HIV and TB) was 268.000 (250.000–287.000) and the estimated incidence of MDR/RR-TBC was 11.000 (10.000–12.000). In addition, in 2015 in the Americas, estimated figures show that 24.400 people died from tuberculosis (including TC/HIV), 31.700-contracted TBC/HIV and 50.000 people with tuberculosis are still undiagnosed.

Among the six WHO regions, in 2014 the major success in treatment rates was achieved in the Western Pacific region (92%) and in the Eastern Mediterranean region (91%). The lowest ones were (76%) in the Americas region – due to high levels of failure on follow-up and information – and in the European region – due to the high rates of treatment failure and death, influenced by the high frequency of MDR/RR-TBC.

There were significant differences in the Americas region, where the success of treatment for HIV positive patients with TB was of 56%, compared to 77% among HIV negative patients. In general, the proportion of MDR/RR-TC patients in the 2013 cohort that successfully completed treatment (cure or full treatment) was of 55%. The loss of follow-up was higher in the WHO Americas region (25%)

Worldwide, 87.236 children that began TBC preventive treatment in 2015 account for 7,1% ( range: 6,9-7,4% ) out of 1,2 million (range 1,18 million to 1,26 million) of children considered as eligible for treatment. High coverage levels were achieved in the WHO Americas region, with the estimate of 67% (range 63-71%).

Source: WHO Global Report on Tuberculosis.2016

Epidemiological situation of malaria in the Americas region

In the WHO Americas region, it is estimated that around 132 million people in 21 countries and territories have some risk to get malaria, with 21 million at high risk.

Plasmodium vivax is responsible for more than 70% of reported malaria cases in the region, although around 50% of the cases are due to Plasmodium falciparum in French Guyana, Colombia and Guyana; and basically 100% of cases in Dominican Republic and Haiti are due to Plasmodium falciparum.

The number of confirmed cases in the region decreased from 1,2 million in 2000 to 390.000 in 2014.

In 2015, 95% of cases in the region were located as follows: Brazil (24%), Bolivarian Republic of Venezuela (30%), Peru (19%), Colombia (10%), Haiti (9%) and Guyana (3%).

Between 2010 and 2015 there were favorable changes in the reduction of the estimated incidence rate higher than 40% in Belize, the Plurinational State of Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, El Salvador, French Guyana, Guyana, Haiti, Honduras, Mexico and Suriname. The estimated mortality rate was reduced between 20-40% in Colombia and 40% in Bolivia, Brazil, Dominican Republic, French Guyana, Guyana, Haiti, Honduras, Mexico and Suriname. It is worth noting that El Salvador, Belize and Suriname reported less than 200 malaria cases. These findings bring the possibility for the region to reach a 40% reduction on incidence of malaria cases and mortality by 2020, as required by the global technical strategy on malaria. Still of concern is the increase to more than 20% in the estimated incidence rate of malaria in Nicaragua, Peru, Bolivarian Republic of Venezuela and Panama, the estimated mortality rate increased in parallel (increase higher than 20%) in these countries, except for Panama which, as El Salvador, Ecuador and Belize reported zero mortality due to native cases in 2015.

Among the main achievements of the Americas region are:

funding increase for malaria from US$ 170 million to 201 million between 2010 and 2015, mainly with national sources;

a 31% decrease of estimated incidence of cases between 2010 and 2015;

a reduction of the mortality rate of 37% between 2010 and 2015;

the elimination in three countries that reached zero native cases since 2010.

Situation on the elimination of malaria in the Americas region

The Global Technical Strategy goal for Malaria is to eliminate malaria in at least 10 countries of the world by 2020, and an even more ambitious goal is to prevent the return of the disease in all the malaria-free countries.

Between 2000 and 2015, 17 countries have eliminated malaria (i.e. they have reduced to zero native cases in three years or more). In the Americas region, Argentina (2013), Paraguay (2014) and Costa Rica (2015) stand out. Among the countries that have eliminated malaria, WHO has certified six as malaria-free countries: the United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Kyrgyzstan (2016), Sri Lanka (2016). It is worth noting that the certification process is optional.

In progress towards the elimination of malaria, these 17 countries have reported a mean of 184 native cases five years before reaching zero cases (RI: 78 – 728), and a mean of 1.748 cases in ten years before reaching zero cases (RI: 423 – 5731). Even so, three countries (Cape Verde, El Salvador and Saudi Arabia) did not reach zero cases by 2015, despite having less than 500 native cases between 2000-2005. Belize, Dominican Republic, Ecuador, El Salvador and Mexico are in the pre-elimination phase. The remaining countries are in the control phase.

In 2015, 10 countries and territories reported less than 150 native cases, and other 9 countries reported between 150 and 1000 native cases. Therefore, from a positive perspective, it would seem possible to achieve the GTS goal by 2020 and eliminate malaria in 10 countries.

Malaria has not returned to any of the countries that eliminated this disease between 2000 and 2015.

Sources:
WHO Malaria Global Report 2015.
WHO Malaria Global Report 2016.