ABSTRACT
To estimate trends in tuberculosis (TB) notification rates by geographical origin, we retrieved surveillance data from 2010 to 2015 for 29 European Union and European Economic Area countries. The TB notification rate decreased at an annual rate of 5.3%. The decrease in notification rate was higher in native residents (7.0%) than in those of foreign origin (3.7%). Targeted screening and facilitated access to care and treatment could help prevent and control TB in migrants.
Subject(s)
Disease Notification/statistics & numerical data , Emigrants and Immigrants/statistics & numerical data , European Union , Tuberculosis/epidemiology , Disease Notification/methods , Europe/epidemiology , Female , Humans , Incidence , Population SurveillanceSubject(s)
Antitubercular Agents , Tuberculosis, Multidrug-Resistant , Europe , Humans , Mycobacterium tuberculosisABSTRACT
The European Union and European Economic Area (EU/EEA) tuberculosis (TB) surveillance system collects detailed information on resistance to TB drugs. Using this information, we provide an overview of the current TB drug resistance situation and trends in the EU/EEA by performing a descriptive analysis, including analysis of treatment outcomes, of the TB cases reported between January 2007 and December 2012. The percentages of TB cases with different drug resistance patterns have been stable with about 90% of the new laboratory-confirmed cases pan-susceptible, 6% monodrug-resistant, 2% polydrug-resistant, 2% multidrug drug-resistant (MDR) TB - excluding extensively drugresistant (XDR) TB -, and 0.2% XDR-TB. In previously treated laboratory-confirmed TB cases, the percentage with MDR-TB excluding XDR-TB declined until 2010 to 16% and remained stable thereafter. During the study period, the percentages of cases with monodrug- and polydrug-resistant TB remained constant at about 8% and 2% whereas the percentage of XDR-TB cases increased slightly to 2.6%. Treatment outcome results for all cases have been stable with overall 77.9% of the pan-susceptible cases, 69.6% of the monoresistant cases, 68.2% of the polyresistant cases, 32.2% of the MDR-TB cases (excluding XDR-TB), and 19.1% of the XDR-TB cases treated successfully. The treatment success rate target for new pulmonary culture-positive MDR-TB cases of 70% has not been reached. In addition, drug resistance surveillance can be improved by more complete reporting of drug susceptibility results and treatment outcome.
Subject(s)
Antitubercular Agents/therapeutic use , European Union , Sentinel Surveillance , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Europe/epidemiology , Female , Health Care Surveys , Humans , Infant , Infant, Newborn , Laboratories/organization & administration , Male , Microbial Sensitivity Tests/methods , Middle Aged , Population Surveillance , Treatment Outcome , Tuberculosis/epidemiology , Tuberculosis, Multidrug-Resistant/epidemiology , Young AdultABSTRACT
Tuberculosis (TB) is decreasing in the European Union/European Economic Area (EU/EEA), but remains a significant public health problem. Although pulmonary TB accounts for the majority of the cases and is the main transmissible form of the disease, extrapulmonary TB also contributes to the burden of disease and does not receive specific attention in international control strategies. We performed a descriptive analysis to assess the burden and trends of extrapulmonary TB in EU/EEA countries. During 200211, 167,652 cases of extrapulmonary TB were reported by the 30 Member States. Extrapulmonary TB accounted for 19.3% of all notified cases, ranging from 5.8% to 44.4% among the Member States. Overall, TB notification rates decreased in 200211 due to a decrease in pulmonary TB. Notification rates of extrapulmonary TB remained stable at 3.4 per 100,000 in 2002 and 3.2 per 100,000 in 2011. Thus the proportion of extrapulmonary TB increased from 16.4% in 2002 to 22.4% in 2011. Of all extrapulmonary TB cases reported during 200211, 37.9% were foreign-born or citizens of another country, 33.7% were culture-confirmed, and the overall treatment success was 81.4%. A significant percentage of notified TB cases are extrapulmonary, and in contrast to pulmonary TB, extrapulmonary TB rates are not decreasing.
Subject(s)
Disease Notification/statistics & numerical data , European Union/statistics & numerical data , Tuberculosis, Pulmonary/epidemiology , Cost of Illness , Emigrants and Immigrants , Europe/epidemiology , HIV Infections/diagnosis , HIV Infections/epidemiology , Humans , Incidence , Outcome and Process Assessment, Health Care/statistics & numerical data , Population Surveillance , Treatment Outcome , Tuberculosis, Pulmonary/pathology , Tuberculosis, Pulmonary/prevention & control , Tuberculosis, Pulmonary/transmission , United Kingdom/epidemiologyABSTRACT
The 2012 combined tuberculosis (TB) surveillance and monitoring report for the European Union and European Economic Area identifies a mean annual decline in TB notification rate by 4.4% from 2006 to 2010. Culture confirmation for new pulmonary cases and drug susceptibility testing have increased to 65.6% and 70.8%, but remain under their targets of 80% and 100%, respectively. Reporting of treatment outcome and coinfection with human immunodeficiency virus also remain suboptimal. Strengthened control practices are needed to allow progress towards TB elimination.
Subject(s)
Disease Notification/statistics & numerical data , Population Surveillance , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/prevention & control , Age Distribution , Antitubercular Agents/therapeutic use , Drug Resistance, Bacterial , Europe/epidemiology , European Union/statistics & numerical data , Female , HIV Infections/epidemiology , Humans , Male , Opportunistic Infections/epidemiology , Treatment Outcome , Tuberculosis, Pulmonary/drug therapyABSTRACT
The 2012 combined tuberculosis (TB) surveillance and monitoring report for the European Union and European Economic Area identifies a mean annual decline in TB notification rate by 4.4% from 2006 to 2010. Culture confirmation for new pulmonary cases and drug susceptibility testing have increased to 65.6% and 70.8%, but remain under their targets of 80% and 100%, respectively. Reporting of treatment outcome and coinfection with human immunodeficiency virus also remain suboptimal. Strengthened control practices are needed to allow progress towards TB elimination.
ABSTRACT
In order to ensure the availability of resources for tuberculosis (TB) and HIV management and control, it is imperative that countries monitor and plan for co-infection in order to identify, treat and prevent TB-HIV co-infection, thereby reducing TB burden and increasing the years of healthy life of people living with HIV. A systematic review was undertaken to determine the burden of TB-HIV infection in the European Union (EU) and European Economic Area (EEA). Data on the burden of HIV infection in TB patients and risk factors for TB-HIV co-infection in the EU/EEA were extracted from studies that collected information in 1996 and later, regardless of the year of initiation of data collection, and a narrative synthesis presented. The proportion of HIV-co-infected TB patients varied from 0 to 15%. Western and eastern countries had higher levels and increasing trends of infection over time compared with central EU/EEA countries. Groups at higher risk of TB-HIV co-infection were males, young adults, foreign-born persons, the homeless, injecting drug users and prisoners. Further research is needed into the burden and associated risk factors of co-infection in Europe, to help plan effective control measures. Increased HIV testing of TB patients and targeted and informed strategies for control and prevention could help curb the co-infection epidemic.
Subject(s)
Coinfection/epidemiology , HIV Infections/epidemiology , Population Surveillance , Tuberculosis, Pulmonary/epidemiology , Drug Users/statistics & numerical data , Emigrants and Immigrants/statistics & numerical data , European Union/statistics & numerical data , Female , Ill-Housed Persons/statistics & numerical data , Humans , Incidence , Male , Prevalence , Prisoners/statistics & numerical data , Sex FactorsABSTRACT
Information on the burden of tuberculosis (TB)-HIV co-infection is critical for the planning and evaluation of TB-HIV control and treatment strategies. This study assessed current practices in countries of the European Union (EU) and European Economic Area (EEA) for monitoring HIV co-infection in TB surveillance systems, countries' current co-infection burden and associated clinical practice. An online survey was distributed to all national TB surveillance nominated European Centre for Disease Prevention and Control contact points in the EU/EEA. We received 25 responses from 30 countries (83% response rate). Patients' HIV status was collected in 18 out of the 25 TB surveillance systems, usually via clinician reporting (16 out of 18 surveillance systems). Although most countries recommended routine testing of TB patients for HIV, the proportion actually tested varied from 5% to 90%. The burden of HIV co-infection was found to be elevated in countries with higher levels of HIV testing and higher prevalence of HIV. We suggest that TB-HIV co-infection be monitored in all EU/EEA countries to facilitate the planning and evaluation of TB-HIV control strategies. Strengthening collaboration between TB and HIV clinicians and surveillance departments, and consideration of patient confidentiality restraints would be advantageous. The level of HIV testing in TB patients is low despite national recommendations and testing should be further promoted and monitored.
Subject(s)
Coinfection/epidemiology , HIV Infections/epidemiology , Mass Screening/methods , Population Surveillance/methods , Tuberculosis, Pulmonary/epidemiology , Adolescent , Europe/epidemiology , European Union/statistics & numerical data , Female , Humans , Incidence , Male , PrevalenceABSTRACT
Childhood tuberculosis (TB) has been neglected for decades as a key component of TB control. However, ensuring proper monitoring of childhood TB has recently been given renewed emphasis. A descriptive analysis of surveillance data was performed to assess burden and trends of paediatric TB in the European Union/European Economic Area (EU/EEA) between 2000 and 2009. From 2000 to 2009, 39,695 notified paediatric (defined as 014 years of age) TB cases were reported by the 27 EU countries plus Norway, Iceland and Liechtenstein. These paediatric cases accounted for 4.3% of all notified cases. However, across the EU/EEA Member States, paediatric case notification rates ranged from 29.6 per 100,000 to 0.3 per 100,000 for the latest reporting year, 2009. Overall,though, these rates dropped from 5.5 per 100,000 in 2000 to 4.2 per 100,000 in 2009. The EU/EEA average annual percent changes (AAPC) in paediatric notification rates decreased between 2000 and 2004 by 1.3%and between 2005 and 2009 by 2.4%, with an overall decrease between 2000 and 2009 of 2.8%. Of all paediatric cases reported from 2000 to 2009, only 16.9%were culture-confirmed, amongst which the overall treatment success was 80.5% for all culture-confirmed pulmonary paediatric TB cases. Childhood TB in the EU/EEA remains a public health issue. Due attention should be paid to assessing paediatric trends as they could provide an insight in recent transmission. Whilst the primary aim of further reducing TB rates among children is paramount, better rates of appropriate diagnosis should also be achieved, along with a further improvement of therapeutic success rates.
Subject(s)
Disease Outbreaks/statistics & numerical data , Risk Assessment/methods , Tuberculosis/epidemiology , Adolescent , Child , Child, Preschool , Europe/epidemiology , European Union , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Population Surveillance , Risk FactorsSubject(s)
Disease Notification/statistics & numerical data , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Population Surveillance/methods , Tuberculosis/epidemiology , Tuberculosis/prevention & control , Europe/epidemiology , European Union , Humans , Incidence , Mandatory Reporting , Portugal/epidemiology , Risk Assessment/methods , Risk Factors , Tuberculosis/diagnosisABSTRACT
BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone. DESIGN: Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy. RESULTS: Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment. CONCLUSIONS: Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.
Subject(s)
Antitubercular Agents/administration & dosage , Bacteriological Techniques , Directly Observed Therapy , Drug Monitoring/methods , Drug Resistance, Multiple, Bacterial , Mycobacterium tuberculosis/drug effects , Tuberculosis, Multidrug-Resistant/drug therapy , Drug Administration Schedule , Estonia , Female , Humans , Latvia , Male , Microbial Sensitivity Tests , Microscopy , Mycobacterium tuberculosis/isolation & purification , Peru , Philippines , Pilot Projects , Retrospective Studies , Russia , Sputum/microbiology , Time Factors , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/microbiologyABSTRACT
An analysis of surveillance data was performed to assess treatment outcomes of patients belonging to selected calendar year cohorts. Twenty-two countries in the European Union (EU) and European Economic Area (EEA) reported treatment outcome monitoring data for culture-confirmed pulmonary tuberculosis (TB) cases reported in 2007. The overall treatment success rate was 73.8% for all culture-confirmed pulmonary cases and 79.5% for new culture-confirmed pulmonary cases. For the cohort of new culture-confirmed TB cases, only three countries achieved the target of 85% success rate. This underachievement appears to be a result of relative high defaulting and unknown outcome information. Case fatality remains high particularly among cases of national origin. This factor appears attributable to advanced age of the national cohort. Treatment outcomes for multidrug-resistant tuberculosis were reported by 15 countries, with a range of 19.8% to 100% treatment success at 24 months. The data underline the urgent need for strengthening treatment outcome monitoring in the EU and EEA in order to ensure an effective programme implementation and case management that will ultimately contribute to TB elimination.
Subject(s)
Case Management/standards , European Union , Outcome Assessment, Health Care , Tuberculosis/drug therapy , Europe/epidemiology , Humans , Outcome Assessment, Health Care/statistics & numerical data , Outcome Assessment, Health Care/trends , Population Surveillance , Quality Assurance, Health Care , Tuberculosis/epidemiologyABSTRACT
Since 2008, the European Centre for Disease Prevention and Control has been collecting data from the European Union (EU) and European Economic Area (EEA) on resistance to first- and second-line drugs against tuberculosis (TB). In 2008, the proportion of multidrug-resistant tuberculosis (MDR TB) was 6.0% of the total case load for 25 countries reporting data. Extensively drug-resistant (XDR TB) reporting has increased since 2007 and was observed in 7.3% of the MDR TB cases in 13 reporting countries. MDR TB remains a threat and XDR TB is now established within the EU/EEA borders.
Subject(s)
European Union , Extensively Drug-Resistant Tuberculosis/epidemiology , Antitubercular Agents/pharmacology , Antitubercular Agents/therapeutic use , Europe/epidemiology , Extensively Drug-Resistant Tuberculosis/drug therapy , Humans , Population SurveillanceABSTRACT
Since 1 January 2008, the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization Regional Office for Europe (WHO/Europe) jointly coordinate the tuberculosis (TB) surveillance activities in Europe. The data collected provides an opportunity for a comprehensive analysis of the TB situation. We aimed at analysing the EU and EEA/EFTA data to identify general TB trends and to provoke some discussion regarding the challenges and needs for monitoring the epidemic.