Co esponding au ho : Rohi G. Nugu wa
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Tube culosis: A global o e iew o he Si ua ion
Rohi G. Nugu wa 1, *, Neha L. Zod 1, Niki a V. Mahalle 1 and Ha igopal S. Sawa ka 2
1 Depa men o Pha macology, D . Rajend a Gode College o Pha macy, Am a a i-444602, Maha ash a (India).
2 Depa men o Pha maceu ical Chemis y, D . Rajend a Gode College o Pha macy, Am a a i-444602, Maha ash a, India.
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
Publica ion his o y: Recei ed on 03 Sep embe 2025; e ised on 11 Oc obe 2025; accep ed on 13 Oc obe 2025
A icle DOI: h ps://doi.o g/10.30574/gscbps.2025.33.1.0386
Abs ac
Tube culosis (TB) con inues o be a global heal h c isis, a ec ing o e 1.7 billion people wo ldwide by 1990—
app oxima ely one- hi d o he popula ion. This e iew aces pa e ns in p e alence, incidence, and mo ali y, d awing
a en ion o he une en p og ess ac oss egions. Sou h-Eas Asia and China accoun ed o mo e han hal o global TB
cases, while A ica epo ed he highes incidence a e, a e aging 220 cases pe 100,000 popula ion. HIV has eme ged
as a c i ical d i e , con ibu ing o nea ly 305,000 addi ional TB cases and signi ican ly aising mo ali y, pa icula ly in
sub-Saha an A ica. Despi e e ec i e sho -cou se chemo he apy and i s cos -e ec i eness, only abou 46% o cases
we e being de ec ed and ea ed globally a ha ime. Mo ali y emained high, wi h close o 3 million dea hs es ima ed
in 1990, concen a ed in Sou h-Eas Asia, China, and A ica. These indings e lec bo h medical and socio-economic
challenges- anging om po e y and unde nu i ion o gaps in heal h sys ems. The e iew emphasizes he u gen need
o imp o ed de ec ion, sus ained ea men adhe ence, in es men in accines and sho e egimens, and s a egies
ha add ess he social oo s o ulne abili y. Global elimina ion o TB will depend no only on medical inno a ion bu
also on poli ical will and coo dina ed in e na ional ac ion.
Keywo ds: Tube culosis; Global bu den; Mycobac e ium ube culosis; HIV co-in ec ion; D ug- esis an TB; Incidence;
Mo ali y; Public heal h; Epidemiology
1. In oduc ion
Tube culosis (TB) has long been a majo cause o illness and dea h a ound he wo ld. Ye , o many yea s, i was la gely
igno ed in bo h ich and poo coun ies. Recen ly, howe e , TB has s a ed o gain enewed a en ion, and e o s a e
being made o s eng hen con ol p og ams. This enewed ocus is mainly due o h ee easons[1,5]:
•HIV epidemic: TB cases ha e isen sha ply in coun ies wi h high HIV in ec ion a es.[1,3,10]
•E ec i e ea men : Sho -cou se chemo he apy has p o en o be highly e ec i e in cu ing TB.[4]
•Cos -e ec i eness: TB con ol is ecognized as one o he mos a o dable and e icien public heal h
measu es in de eloping na ions.[5]
This epo p o ides an upda e on he global TB si ua ion in 1990, and compa es i wi h ends since 1974. To explain
he scale and di ec ion o TB, se e al key measu es a e used—such as he ‘p e alence o TB in ec ion, case no i ica ion
a es, p edic ed incidence o disease, and TB- ela ed dea hs’. The in o ma ion comes om o icial epo s o TB cases
and dea hs submi ed o WHO, along wi h es ima es based on simple epidemiological models.[14]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
117
2. Me hods and Da a Sou ces:
2.1. Annual isk o in ec ion and p e alence o in ec ion
One o he mos impo an ways o measu e TB in a popula ion is by looking a he ‘annual isk o in ec ion- his means
he chance ha a heal hy, unin ec ed pe son will ge in ec ed wi h ‘Mycobac e ium ube culosis wi hin one yea . This
measu e is especially use ul in coun ies whe e TB is common, because i helps es ima e how many new TB cases may
appea in he u u e.[6]
To calcula e his, esea che s used da a om ‘ ube culin skin es su eys’ ha ha e been collec ed since 1975. These
su eys gi e in o ma ion abou TB in ec ion a di e en ages. A model was hen applied ha conside ed h ee main
ac o s:[6]
• The annual isk o in ec ion,[6]
• How his isk has been changing o e ime, and [6]
• The age s uc u e o he popula ion By combining hese ac o s, hey we e able o es ima e TB in ec ion
a es in di e en egions and age g oups.[6]
Fo people wi h ‘bo h TB and HIV, es ima es we e made by applying he TB in ec ion a es in he 15–49 yea age g oup’
( he age g oup mos a ec ed by HIV) o popula ions whe e HIV in ec ion is common.[10]
3. Case No i ica ions
Since 1974, he Expanded P og amme on Immuniza ion (EPI)has been egula ly collec ing da a on TB cases. These
epo s a e sen by coun ies o WHO egional o ices, and he in o ma ion is upda ed and published wice a yea . [14]
Fo his analysis, unusual numbe s (ou lie s) we e emo ed. Ou lie s we e de ined as cases whe e he numbe epo ed
in one yea was ei he h ee imes highe o one- hi d lowe han he numbe s epo ed in he yea s jus be o e and
a e . These sha p jumps o d ops usually e lec changes in epo ing sys ems o TB p og ams, no ac ual changes in
he disease i sel .[14,11,12]
Popula ion igu es used as denomina o s came om Wo ld Bank p ojec ions, wi h EPI supplying da a o smalle
coun ies.[9]
• Fo each coun y, esea che s calcula ed:[14,11,12]
• The 10-yea a e age numbe o TB cases (1980–1989), and[14,11,12]
• The highes annual numbe o TB cases epo ed du ing he same pe iod.[14,11,12]
• To look a longe - e m (secula ) ends, hey examined 5-yea a e ages o he highes annual numbe s wi hin
hose in e als.[14,11,12]
Fo egional igu es, he o al numbe o cases epo ed by all coun ies in a egion was added up. Then, he egional
no i ica ion a e was calcula ed by di iding his numbe by he popula ion o ha egion (excluding coun ies ha did
no epo any da a).[14,1]
3.1. Expec ed Incidence
To es ima e how many new TB cases occu each yea , calcula ions we e done sepa a ely o each coun y and hen
combined a he egional le el.[7,8]
These calcula ions we e based on wo main obse a ions:[7,8]
• In coun ies whe e TB is e y common, o e e y 1% annual isk o in ec ion, he e a e abou 39–59 cases o
smea -posi i e pulmona y TB pe 100,000 people.[7]
• Fo each smea -posi i e case, he e a e abou 1.22 addi ional cases o ei he smea -nega i e o ex a-
pulmona y TB.[7]
Using hese ela ionships, he expec ed numbe o TB cases was calcula ed wi h di e en annual isks o in ec ion o
di e en egions:[7,8]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
118
• A ica: 1.5% o 2.5%[7,8]
• Cen al & Sou h Ame ica + Eas e n Medi e anean: 0.5% o 1.5%[7,8]
• Sou h-Eas Asia & Wes e n Paci ic: 1% o 2.25%[7,8]
On op o his, HIV- ela ed TB was es ima ed. Fo people in ec ed wi h bo h HIV and TB, i was assumed ha abou 10%
would de elop ac i e TB disease each yea .[7,8]
3.2. Co e age
Co e age (also called he case de ec ion a io) means he p opo ion o people wi h ac i e TB who a e ac ually
diagnosed, ea ed, and o icially epo ed. In p ac ice, his is es ima ed by compa ing he numbe o epo ed TB cases
wi h he numbe o expec ed cases, and exp essing i as a pe cen age.
Fo 1990, he analysis wo ked like his:[1,8]
The highes , a e age, and lowes expec ed numbe s o TB cases o each coun y we e calcula ed by applying he
no i ica ion a es om 1980–1989 o he 1990 popula ion.[14,1]
These igu es we e hen compa ed wi h he p edic ed numbe o TB cases in 1990, which allowed esea che s o
es ima e a ange o co e age alues ( om low o high) o each coun y.[1,8]
3.3. Mo ali y
People usually die om ube culosis when he disease is no diagnosed in ime o when ea men does no wo k—
ei he because pa ien s do no comple e hei medicines p ope ly o because he TB bac e ia a e d ug- esis an . To
measu e TB dea hs, dea h ce i ica es a e used o see bo h he o al numbe o dea hs and how many o hem we e
caused by TB. Fo his analysis, mo ali y da a om 62 coun ies we e aken om he Wo ld Heal h S a is ics Annual
1988 and 1990.[11,12]
The expec ed numbe o TB dea hs in 1990 was calcula ed wi h he ollowing assump ions:
• Un ea ed TB cases: Abou 50% we e expec ed o die.[11,12]
• T ea ed TB cases: In mos de eloping coun ies, cu e a es a e a ound 50–60%, so he a e age a ali y among
epo ed cases was assumed o be 15%.[11,12]
• Al hough dea hs a e usually highe among smea -posi i e pa ien s han smea -nega i e ones, bo h g oups we e
assumed o ha e he same a ali y a e, since smea -posi i e cases a e mo e likely o be iden i ied and ea ed
in de eloping coun ies.[11,12]
• To es ima e mo ali y, esea che s looked a he p opo ion o pa ien s ea ed, using bo h he a e age and high
co e age es ima es. This ga e a low es ima e and a high es ima e o TB dea hs.[11,12]
Fo TB dea hs linked o HIV in ec ion, wo di e en calcula ions we e made:[11,12]
• Lowe es ima e: assumed HIV-posi i e and HIV-nega i e TB pa ien s had he same a ali y a e and ea men
co e age.[11,12]
• Highe es ima e: assumed ha 50% o all HIV-posi i e TB pa ien s would die, no ma e i hey we e ea ed o
no .[11,12]
Finally, coun ies we e g ouped by WHO egions (Eu ope, Eas e n Medi e anean, A ica, and Sou h-Eas Asia). Bu
some adjus men s we e made:[11,12]
China was kep sepa a e because no no i ica ion da a was a ailable.[11,12]
Japan, Aus alia, New Zealand, Canada, and he USA we e also placed in a sepa a e g oup because hey a e indus ialized
coun ies wi h e y low TB le els.[11,12]
As a esul , he “Ame ican Region” and “Wes e n Paci ic Region” in his analysis do no exac ly ma ch he o icial WHO
de ini ions.[11,12]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
119
4. Resul s – P e alence o Tube culosis In ec ion :
In 1990, abou one- hi d o he global popula ion—a ound 1.7 billion people—we e in ec ed wi h Mycobac e ium
ube culosis.[1]
The Wes e n Paci ic Region had he highes in ec ion a e, wi h 44% o people in ec ed.[1]
The Eas e n Medi e anean Region had he lowes , a 19%.[1]
Mos in ec ed people li ed in:[1]
• Sou h-Eas Asia (25%)[1]
• China (22%)[1]
• Eu ope and i e majo indus ialized coun ies (22%)[1]
4.1.1. Age dis ibu ion o in ec ion:
Looking a age pa e ns shows impo an di e ences:[1]
• In Wes e n Eu ope, abou 28%o people we e in ec ed, bu 80% o hem we e olde han 50 yea s.[1]
• In sub-Saha an A ica, abou 34%we e in ec ed, bu 77% we e younge han 50 yea s.[1]
• In A ica, Sou h-Eas Asia, and he Wes e n Paci ic, mo e han hal o adul s aged 15 yea s and abo e
we e in ec ed (54%, 52%, and 62%, espec i ely).[1]
4.2. Dual in ec ion wi h TB and HIV:[1,10]
In 1990, mo e han 3 million people wo ldwide we e in ec ed wi h bo h TB and HIV.[1]
A ica had he la ges sha e, wi h abou 2.4 million people (78% o he o al), because HIV le els a e e y high he e and
abou 48% o adul s aged 15–49 al eady had TB in ec ion.[10]
In Eu ope and he i e indus ialized coun ies, o e 1.5 million people had HIV, bu TB in ec ion was ela i ely low
among 15–49 yea olds. As a esul , dual TB/HIV in ec ion was a e in hese coun ies-making up less han 6% o he
wo ld’s o al dual in ec ions.[10]
Table 1 Wo ldwide p e alence o ube culosis in ec ion, 1990 [1]
Region
P e alence (%)
Numbe In ec ed
(Millions)
Pe cen age o o al
A ica
33.8
171
9.9
Ame ica
25.9
117
6.8
Eas e n Medi e anean
19.4
52
3.0
Sou h-Eas Asia
34.3
426
24.7
Wes e n Paci ic
43.8
195
11.3
China
33.7
379
22.0
Eu ope and o he s
31.6
382
22.2
All Regions
32.8
1722
100
All o he na ions in he WHO Region a e included. [1]
Consis s o all na ions in he Ame ican WHO Region excluding he Uni ed S a es and Canada. [1]
All na ions in he Wes e n Paci ic WHO Region a e included wi h he excep ion o China Japan Aus alia and New
Zealand. New Zealand. [1]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
120
Re e s o he USA, Canada, Japan, Aus alia, and New Zealand.[1]
4.3. Tube culosis No i ica ions
Coun y epo s[11,12,14,1]
Ou o 194 coun ies and s a es lis ed in he WHO’s EPI da abase, 8 coun ies (abou 4%)ha e no epo ed any TB cases
since 1974. These include:[14]
• A ica (3 coun ies, 6%): Como os, Namibia, S . Helena[1,11,12,14]
• Ame icas (1 coun y, 2%): Ne he lands An illes[1,11,12,14]
• Sou h-Eas Asia (1 coun y, 9%): Democ a ic People’s Republic o Ko ea[1,11,12,14]
• Wes e n Paci ic (1 coun y, 3%): China[1,11,12,14]
• Eu ope (2 coun ies, 6%): Albania and San Ma ino[1,11,12,14]
No i ica ions: Looking a epo s om 1980 o 1989, he a e age numbe o TB cases epo ed wo ldwide each yea
was abou 2.5 million. A ound 40%o hese we e om Sou h-Eas Asia. The emaining cases we e sp ead almos e enly
ac oss he o he i e egions (each con ibu ing abou 8–14%).[1,11,12,14]
4.4. Case no i ica ion a es:[14,1]
Lowes in indus ialized coun ies abou 50 pe 100,000 people in A ica and La in Ame ica. The highes annual a was
s ill modes -abou 56 pe 100,000 in La in Ame ica. [1,11,12,14]
Figu e 1 P e alence o ube culosis in ec ion, by age, in opical and sou he n A ica, 1990
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
121
Figu e 2 P e alence o ube culosis in ec ion, by age, in Wes e n Eu ope 1990.[1]
Table 2 Wo ldwide p e alence o ube culosis and HIV in ec ion in 15-49 yea s – olds , 1990.[10]
Region
HIV
In ec ed(x1000)
P e alence o TB
in ec ion
HIV/TB in ec ed
No.(x1000)
%
A ica
1500
48
2375
77.8
Ame ica
1000
30
301
9.9
Eas e n Medi e anean
30
23
7
0.2
Sou h-Eas Asia, Wes e n Paci ic
and China
500
40
200
6.6
Eu ope and o he s
1500
11
170
5.6
All Region
8030
34
3053
100.0
• This g oup co e s e e y coun y in he WHO Region.[1,11,12,14]
• This g oup includes all coun ies in he Ame icas, bu no he USA o Canada.[1,11,12,14]
• This g oup includes coun ies in he Wes e n Paci ic Region, bu no China, Japan, Aus alia, o New
Zealand.[1,11,12,14]
• This g oup only co e s he USA, Canada, Japan, Aus alia, and New Zealand.[1,11,12,14]
4.5. T ends in ube culosis no i ica ions
Be ween 1974 and 1989, ube culosis (TB) case epo s showed di e en ends ac oss he wo ld.[14,1]
F om 1974–79, abou 2 million cases we e epo ed ( om 178 coun ies). In he nex pe iod, 1980–84, his numbe
ose o 2.4 million ( om 180 coun ies). Howe e , in 1985–89, i ell sligh ly o 2.2 million ( om 164 coun ies).[14,1]
The same gene al pa e n was seen when looking a TB a es pe 100,000 people.[14,1]
Bu he s o y was no he same e e ywhe e:.[14,1]
In Eu ope and o he indus ialized coun ies, TB cases kep going down o e he 15 yea s. The sudden ise in 1985–89
was mos ly because he USSR s a ed epo ing i s cases o he WHO in 1988.[14,1]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
122
In he Eas e n Medi e anean Region and Eu ope/indus ialized coun ies, TB d opped in bo h numbe o cases and
in ec ion a es.[14,1]
In A ica and Sou h-Eas Asia, TB inc eased in bo h o al cases and in ec ion a es.[14,1]
In Cen al/Sou h Ame ica and he Wes e n Paci ic, in ec ion a es wen down, bu he o al numbe o cases s ill wen
up—likely because popula ions g ew as e han he all in in ec ion a es.[14,1]
Looking a he bigge pic u e:[14,1]
O e 15 yea s, TB a es dec eased in 101 coun ies bu inc eased in 59 coun ies (abou 1.7 dec eases o e e y 1
inc ease).[14,1]
I Eu ope and he indus ialized coun ies a e le ou , he a io is close o 1.2 dec eases o e e y 1 inc ease, sugges ing
ha he global TB si ua ion had no signi ican ly imp o ed in hose yea s.[14,1]
Table 3 Mean and highes numbe o ube culosis cases epo ed annually in he wo ld, 1980-89[14,1]
Region
Mean
Highes
Cases
Ra e pe 100 000
Cases
Ra e pe 100 000
A ica
234 863
51
317 841
69
Ame icas
200 607
49
225 815
55
Eas e n
Medi e anean
361 722
111
602 874
182
Sou h-Eas Asia
974 861
84
1 223 172
105
Wes e n Paci ic
334 205
168
432 846
218
Eu ope
288 465
34
336 301
40
O he s
900 84
21
105 876
25
All Regions
2 484 817
51
3 244 727
68
• Co e s e e y coun y ha belongs o he WHO Region.[14,1]
• Re e s o all he coun ies in he Ame icas, bu lea es ou he USA and Canada.[14,1]
• Re e s o he Wes e n Paci ic Region coun ies, bu does no include China, Japan, Aus alia, o New
Zealand.[14,1]
• Speci ically includes only he USA, Canada, Japan, Aus alia, and New Zealand.[14,1]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
123
Table 4 T ends in he a e age numbe o ube culosis cases no i ied in he wo ld ,1974-89[14,1]
Region
1974-1979
1990-1984
1985-1989
Case
s
Ra e pe
100 000
popula io
n
Coun ie
s
epo ing
(%)
Case
s
Ra e pe
100 000
popula io
n
Coun ie
s
epo ing
(%)
Case
s
Ra e pe
100 000
popula io
n
Coun ie
s
epo ing
(%)
A ica
187
084
65
42(91)
230
063
57
43(93)
210
695
57
32(70)
Ame icas
172
220
52
44(94)
203
345
54
44(94)
173
654
42
41(87)
Eas e n
Medi e anea
n
274
643
108
23(96)
427
832
143
23(96)
224
302
67
22(92)
Sou h-Eas
Asia
696
931
73
10(91)
943
140
87
10(91)
1
023
850
85
10(91)
Wes e n
Paci ic
288
885
174
26(81)
337
907
183
27(84)
304
238
154
26(81)
Sub o al
1
617
763
78
145(92)
2
142
287
90
147(94)
1
936
739
72
131(83)
Eu ope
279
905
54
28(88)
179
941
34
28(88)
273
166
33
28(88)
O he s
132
701
35
5(100)
96
617
25
5(100)
82
224
20
5(100)
All Regions
2
032
369
63
178(95)
2
418
845
68
180(93)
2
239
694
58
164(85)
4.6. Impac o HIV on no i ica ion a es
In A ica, 13 coun ies wi h a high numbe o HIV cases (such as Bu undi, Congo, E hiopia, Kenya, Malawi, Mozambique,
Rwanda, Tanzania, Uganda, Zambia, Zimbabwe, Cô e d’I oi e, and Zai e) we e compa ed wi h o he coun ies in he
egion. Upda ed in o ma ion came om a WHO su ey in 1989 and da a collec ed h ough TB p og ams suppo ed by
he In e na ional Union Agains Tube culosis and Lung Disease.[1,10]
• O e he las 15 yea s, a clea di e ence was seen:[1,10]
• In coun ies wi hou a majo HIV epidemic, he a e age numbe o TB cases pe 100,000 people wen
down— om 60 (1974–79) o 59 (1980–84) o 47 (1985–89).[14]
• In coun ies hi ha d by HIV, TB cases ac ually wen up— om 51 (1974–79) o 56 (1980–84) o 64
(1985–89).[1,10]
• This shows ha HIV had a majo ole in pushing TB a es highe in hose coun ies.[1,10]
4.7. Incidence o ube culosis
4.7.1. Tube culosis cases in 1990 [1,8]
• I was es ima ed ha abou 8 million people de eloped ube culosis wo ldwide in 1990. [1,8]
• The la ges sha e was in Sou h-Eas Asia wi h abou 2.47 million cases (31%) [1,8].
• China had a ound 2.13 million cases (27%) [1,8]
• The A ican Region epo ed abou 1.16 million cases (15%) [1,8]
• When looking a how common TB was compa ed o he size o he popula ion: [1,8]
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 116-128
124
• The highes incidence was in A ica wi h abou 220 cases pe 100,000 people. [1,8]
• The lowes incidence was in he Ame icas wi h a ound 120 pe 100,000 people. [1,8]
• In Eu ope and o he indus ialized coun ies, using he a e age a e om 1980–89 (31 pe 100,000),
abou 392,000 cases we e expec ed in 1990. [1,8]
4.7.2. E ec o HIV on TB cases
• HIV g ea ly in luenced TB numbe s because people in ec ed wi h bo h HIV and TB a e mo e likely o
de elop ac i e disease. In 1990, he es ima ed ex a TB cases caused by HIV we e: [1,10]
• 238,000 in A ica[1,10]
• 30,000 in Cen al and Sou h Ame ica[1,10]
• 20,000 in Sou h-Eas Asia and he Wes e n Paci ic[1,10]
• 17,000 in Eu ope and indus ialized coun ies[1,10]
Globally, HIV added abou 305,000 TB cases in 1990, which was a ound 4% o all cases. While his may look small
wo ldwide, in A ica i had a huge e ec — aising TB incidence om 220 o 265 cases pe 100,000, which is abou a 20%
inc ease.[1]
Table 5 Cases o ube culosis expec ed in he wo ld in 1990[1,8]
Region
Cases
Ra e pe 100 000
Popula ion
Pe cen age o all cases
A ica
1 160 000
220
15
Ame icas
534 000
120
7
Eas e n Medi e anean
594 000
155
7
Sou h-Eas Asia
2 470 000
194
31
Wes e n Paci ic
420 000
191
5
China
2 127 000
191
27
Eu ope and o he s
392 000
31
5
HIV- ela ed
305 000
6
4
All Regions
8 002 000
152
100
The annual isk o TB in ec ion was es ima ed a 1.5–2.5% in A ica, 0.5–1.5% in he Ame icas and Eas e n
Medi e anean, and 1–2.25% in Sou h-Eas Asia and he Wes e n Paci ic.[1,10]
WHO Region no es:[1,10]
• Includes all coun ies in he WHO Region.[1,10]
• Fo he Ame icas, his includes all coun ies excep he USA and Canada.[1,10]
• Fo he Wes e n Paci ic, his includes all coun ies excep China, Japan, Aus alia, and New
Zealand.[1,10]
• The “ i e indus ialized coun ies” a e he USA, Canada, Japan, Aus alia, and New Zealand.[1,10]
HIV- ela ed TB cases by egion:[1,10]
• A ica: 238,000 cases (78%)[1,10]
• La in Ame ica: 30,000 cases (10%)[1,10]
• Eu ope + i e indus ialized coun ies: 17,000 cases (6%)[1,10]
• Eas e n Medi e anean: 693 cases (0.2%)[1,10]
• Sou h-Eas Asia + Wes e n Paci ic: 20,000 cases (6%)[1,10]
