ABSTRACT
Germany is a low-incidence country for tuberculosis, but there is no time for complacency. With an annual incidence of 10 per 100,000 population the City of Munich counts twice as many cases of tuberculosis compared to the national average. Reasons for the concentration of tuberculosis in big cities include the high proportion of migrants from countries with high prevalence of tuberculosis and from socioeconomically disadvantaged populations. Munich's population is growing fast and is expected to exceed 1.5 million in the near future. Migrants looking for employment now come predominantly from Romania, Bulgaria and Poland. The proportion of foreign born patients with tuberculosis increased over the last ten years from 49 to 80 %. Asylum seekers and migrants need special attention from the public tuberculosis services. The proportion of tuberculosis patients with social problems increased from 37 to 55 % over the last 6 years. Demands for medical and social support have increased and the case management is increasingly complex. In 2011 the ambulatory treatment of 6 immigrants was supervised by the public health services in Munich. Increasingly, uninsured patients from southeastern states of the European Union need medical treatment. In Europe the overall number of tuberculosis cases is decreasing. The proportion of multidrug-resistant (MDR) tuberculosis in Eastern Europe is alarming. 15 of worldwide 27 countries with the highest MDR load are located in the European Region. In Munich the number of MDR cases is still low at 1-4 cases each year. But duration, cost and side effects of therapy are strong barriers to treatment success. All patients have the right to get adequate diagnostic work-up and effective treatment no matter in which country they reside. To realize this request with cross-border control and care, is a big challenge to the public health service in a global perspective.
