Epidemiology of tuberculosis in WHO European Region and public health response.

PURPOSE: To provide an overview of the tuberculosis (TB) and multi-drug resistant tuberculosis (MDR-TB) in the WHO European Region and evolution of public health response with focus on extra-pulmonary tuberculosis and Pott's disease. METHODS: Authors reviewed regional strategic documents related to TB. The epidemiologic data were reviewed and analyzed. RESULTS: In the absence of associated pulmonary TB, Pott's disease is reported as extra-pulmonary TB (up to 47 % of all TB cases in some settings). Due to limitations of the surveillance system, the epidemiology of Pott's disease and its treatment success are unknown. The Stop TB Strategy and Consolidated Action Plan to Prevent and Combat M/XDR-TB provide comprehensive roadmaps to address all types of TB. CONCLUSIONS: There is a need to further analyze country data to document the extent of Pott's disease and develop specific guidelines for timely diagnosis and treatment of Pott's disease.

Influence of multidrug resistance on tuberculosis treatment outcomes with standardized regimens.

RATIONALE: Multidrug-resistant tuberculosis (TB) poses a major challenge to global TB control. We analyzed the association between estimated prevalence of initial or acquired MDR-TB, and treatment outcomes reported nationally. OBJECTIVES: We analyzed the estimated prevalence of initial or acquired MDR-TB and treatment outcomes reported nationally. METHODS: Countries were analyzed if multidrug resistance prevalence estimates were available, and if they reported outcomes for more than 250 cases treated using standardized regimens in 2003 and/or 2004. Data sources were the World Health Organization for treatment regimens, prevalence of initial multidrug resistance, and reported cases and treatment outcomes in 2003 and 2004; the Joint United Nations Programme on HIV/AIDS for HIV seroprevalence; and the World Bank for income per capita. The adjusted impact of initial multidrug resistance on initial and retreatment outcomes was estimated with weighted multivariate linear regression. MEASUREMENTS AND MAIN RESULTS: Among countries using one of two standardized initial regimens, failure rates averaged 5.0%, and relapse rates averaged 12.8% in the 20 countries where prevalence of initial multidrug resistance exceeded 3%, compared with an average of 1.6% (P < 0.0001) and 8.1% (P = 0.0002), respectively, in 83 countries where initial multidrug resistance prevalence was less than 3%. In 92 countries using one standardized retreatment regimen, failure rates were 2.7%, 3.8%, 6.2%, and 8.1% in quartiles of increasing prevalence of acquired multidrug resistance (P < 0.0001). When stratified by initial multidrug resistance prevalence, initial and retreatment outcomes in the 79 countries using the 6-month rifampin initial regimen were not significantly different from the 24 countries using the 2-month rifampin initial regimen. CONCLUSIONS: Currently recommended standardized TB initial and retreatment regimens should be reevaluated in countries where prevalence of initial multidrug resistance exceeds 3%, in view of poor treatment outcomes.

Brief guide on tuberculosis control for primary health care providers: for countries in the WHO European Region with a high and intermediate burden of tuberculosis

Tuberculosis is an increasingly serious problem in the WHO European region, particularly in the countries of eastern Europe, the Baltic States, and the Commonwealth of Independent States (CIS).Primary health care providers can play an important role in tuberculosis control through early detection of the disease, referral for treatment, and involvement in directly observed treatment. This guide has been written with the aim of developing the knowledge, awareness and skills of primary health care providers regarding tuberculosis and its prevention and control. The guide is not intended as a complete source of information on tuberculosis, but rather a summary of general principles regarding prevention, detection and treatment. The guide does not reflect specific national guidelines on TB control, and is intended to be used in conjunction with the appropriate national regulations. A reference card containing key information is included with this guide.

European framework to decrease the burden of TB/HIV

Tuberculosis in Europe is declining in countries in western and central Europe, but the burden is still high and increasing in eastern Europe. HIV/AIDS is increasing dramatically in eastern Europe. HIV-related tuberculosis (TB/HIV) morbidity and mortality are expected to accelerate significantly in the future. This framework aims to guide European countries in developing their national plan for reducing TB/HIV morbidity and mortality. It results from an extensive consultation process undertaken by the WHO Regional Office for Europe and by those responsible for HIV/AIDS and tuberculosis programmes and their partners. It builds on strategies developed globally and in Europe for tuberculosis control and for HIV/AIDS prevention and care. This framework sets out the rationale for effective collaboration between HIV/AIDS and tuberculosis national programmes. It identifies five strategic components (political commitment, collaborative prevention, intensified case-finding, coordinated treatment and strengthened surveillance) and eight key operations (central coordination, policy development, surveillance, training, supply management, service delivery, health promotion and research).

Европейская базовая стратегия снижения бремени ТБ/ВИЧ

Показатели распространенности туберкулеза и ВИЧ/СПИДа продолжают повышаться в странах Восточной Европы, в связи с чем ожидается также значительное повышение показателей заболеваемости и смертности от туберкулеза, связанного с ВИЧ-инфекцией (ТБ/ВИЧ). Цель настоящей концептуальной основы – помочь европейским странам разработать национальные планы снижения заболеваемости и смертности от ТБ/ВИЧ. В частности, в ней приводятся убедительные доводы в пользу эффективного сотрудничества между национальными программами борьбы с ВИЧ/СПИДом и программами борьбы с туберкулезом, и идентифицируются пять стратегических компонентов работы в этом направлении (политическая приверженность, профилактическая деятельность на основе партнерства, усиление работы по выявлению случаев заболевания, координация лечения, укрепление эпиднадзора) и восемь ключевых оперативных подходов (центральная координация, разработка политики, организация эпиднадзора, организация подготовки кадров, управление предложением, предоставление услуг, укрепление здоровья, проведение научных исследований).

The global tuberculosis situation. Progress and problems in the 20th century, prospects for the 21st century.

Mycobacterium tuberculosis has been identified in prehistoric remains of humans. Despite references to TB by Hippocrates and Galen, humankind had limited understanding of and few tools to defend itself against TB until the later 19th century. Subsequently, landmark advances in the 20th century provided the means to control and prevent this disease. At the same time, epidemiological developments and fundamental problems related to human behavior, socioeconomic conditions, and political circumstances continue to thwart efforts to diminish the burden of suffering and death caused by TB. This article reviewed some of these issues including the global failure of TB control in the late 20th century, the worldwide emergence of drug-resistant TB, the extensive spread of HIV infection and its impact on TB incidence; and changing health care and political environments. The obstacles to TB control remain and will remain challenges in the coming years. Still, recent developments in immunology, biochemistry, and molecular biology suggest that new knowledge and tools are just around the corner. These will enhance the ability to conquer this microbe by the end of the current century.