New report: tuberculosis (TB) on the retreat in Europe, though concerns remain about drug-resistant strains and treatment failure

Stockholm, Copenhagen, 19 March 2012

To mark World TB Day, 24 March 2012, the European Centre for Disease Prevention and Control (ECDC) and WHO/Europe launch their joint report, “Tuberculosis surveillance and monitoring in Europe 2012”. For the first time, the report provides an overview of progress on TB control. It introduces monitoring frameworks for following up the Berlin Declaration on Tuberculosis and the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis (M/XDR-TB) in the WHO European Region 2011–2015, and presents the measures for 12 indicators linked to the follow-up of the Framework Action Plan to Fight Tuberculosis in the European Union (EU). In 2010, countries reported 309 648 new TB cases, a decline of 2.6% from 2009. This confirmed the general decrease in reported cases over the previous five years across the Region. The rising numbers of M/XDR-TB cases, however, pose a serious threat to work to eliminate TB, and highlight the importance of early detection and adequate treatment.

In 2010, the countries in the EU and European Economic Area (EEA) reported nearly 74 000 TB cases: around 7% less than in 2009. While MDR-TB notifications remained stable over the previous five years, the proportion of extensively drug-resistant cases within this group rose from 8.2% in 2009 to 13.2% in 2010, possibly owing to increased reporting. The new report analyses four epidemiological indicators that allow recent advances towards TB elimination to be measured: TB and MDR-TB notification rates, the ratio of cases in children to those in adults, and age distribution. It also assesses trends in eight strategic areas outlined in the EU Action Plan, in order to monitor the strengths and weaknesses of the TB control measures in EU/EEA countries.

For the events for urban TB control in Barcelona, Spain; Milan, Italy; London, United Kingdom; and Rotterdam, Netherlands on 22–23 March, ECDC Director Marc Sprenger stresses that: “Countries with low TB incidence – which means less than 20 per 100 000 population – face a particular challenge in taking the final step towards elimination of the disease, as TB often concentrates in big cities. In this setting, key populations – like people who inject drugs, homeless people and migrants – are disproportionally affected by TB. That is why we have to exchange best practices from across Europe: if services are not tailored to the needs of urban risk groups, there is a continuing risk of higher rates of TB in general and drug-resistant TB in particular.”

From 2005 to 2010, the WHO European Region observed a decline of 15.2% in TB notification rates. Unfortunately, the rates of treatment success also decreased in this period, to the dramatically low levels of 68.7% and 47.6% for new and previously treated patients, respectively. This was mainly owing to MDR-TB, whose prevalence in these patients was 13.7% and 48.7%, respectively.

“Our Region has the lowest TB treatment success rate and the highest M/XDR-TB rate in the world,” says Zsuzsanna Jakab, WHO Regional Director for Europe. “TB has not spared any country in our Region, but has hit hardest in the 18 high-priority countries, mainly in the eastern part of the Region [Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan]. This is something we must address as a matter of urgency. Special attention should be paid to timely diagnosis and adequate treatment of all types of the disease, with particular attention to vulnerable populations.”

The report shows that TB in children is still a great concern for the Region: in 2010, countries reported about 10 000 cases in people under 15 years. In addition, children represented more than 5% of all TB cases in 20 countries, and more than half of these cases were in children aged under 5 in 10 countries: Austria, Belgium, France, Greece, Israel, Italy, Latvia, Slovenia, Spain and Switzerland.

WHO/Europe set up a special project to prevent and combat M/XDR-TB. In close consultation with partners, it developed the five-year Consolidated Action Plan, which was endorsed by all 53 countries in the Region in 2011. The aim is to contain the spread of M/XDR-TB by achieving universal access to prevention, diagnosis and treatment services throughout the Region by 2015.

Background

World Tuberculosis Day is marked on 24 March each year to raise public awareness of the epidemic. Dr Robert Koch announced his discovery of the TB bacillus, paving the way for diagnosis and treatment, on 24 March 1882.

The WHO European Region comprises 53 countries plus Liechtenstein, with a population of nearly 900 million people; more than 504 million (56%) live in countries belonging to the EU or EEA (the 27 EU Member States plus Iceland, Liechtenstein and Norway).