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Tuberculosis surveillance and monitoring in Europe 2017
SURVEILLANCE REPORT
pulmonary TB cases increased from 18.3% in 2011 to 22.9%
in 2015. At the same time, despite an impressive decline
in incident TB cases per capita, the notification rate for
MDR TB increased from 3.0 to 3.9 per 100 000 population.
Of the 9 165 MDR TB cases subjected to second-line DST,
2 149 (23%) were XDR-TB, which represents an increase
of five percentage points on the previous year. This rapid
change at Regional level is related to the fact that Ukraine
began reporting second line DST data to the WHO’s TB database
for the first time, together with a sharp increase in
the XDR-TB notification rate in Belarus from 29% in 2014
to 36% in 2015.
In 2015 41 188 were enrolled into MDR TB treatment
programmes, which was a significant increase from 34 215
in 2011.
Compared to 2011, access to XDR-TB treatment had
increased significantly among the reporting countries, with
an overall XDR-TB treatment coverage of 98.6% at Regional
level, compared to 44.0% in 2011. Between 2011 and 2015,
the number patients with XDR-TB enrolled in compassionate
treatment with new drugs regiments increased from
170 to 2 700 respectively.
In the reporting countries, of the 206 096 new and relapse
TB patients notified 181 995 were screened for HIV (88.3%).
A total of 16 380 TB cases were detected with HIV-positive
status, which is 9.0% of those tested. This is significantly
higher than the 5.5% with HIV-positive status recorded in
2011, indicating that the absolute number of TB/HIV cases
continues to increase in the Region from 11 652 to 16 380
between 2011–2015. The Regional trend is influenced by
a sharp increase in TB/HIV co-infection in the countries of
eastern Europe, mostly impacted by an increase in Russia
and Ukraine, although in EU/EEA countries the TB/HIV
co-infection rate is decreasing.
In 2015, reporting of anti-retroviral therapy (ART) reporting
was low, only 22 countries in the Region provided information
on anti-retroviral therapy (ART) enrolment of TB cases
with HIV-positive status, or 9 230 (56.3%) of all 16 380 HIV
co-infected TB cases. Out of them 5 818 (64%) had received
ART. This is higher than in 2014 (59.1%), but far below the
WHO target of universal ART coverage.
Overall, 5.9% of the new and relapse TB cases reported
in the Region were from prisons. In EU/EEA countries the
proportion of TB cases in prisons represented only 1.6%
of the country total; in non-EU countries the proportion
was 6.8%. The overall notification rate for new TB cases
and relapses in prisons in the WHO European Region was
915 per 100 000 inmates, 24 times higher than in the general
population.
Treatment monitoring
The treatment success rate among the 243 058 new TB cases
and relapses having started treatment in 2014 was 76%.
For the entire Region the treatment success rate among
MDR TB cases enrolled into treatment in 2013 was 51%,
which is higher than 46% MDR TB treatment success rate
reported in 2011. While all MDR TB patients have now
universal access to second-line drugs treatment, the rate
of successful treatment among them is far below the 75%
target.
Regional response
The new global End TB Strategy 2016–2035, which was
aligned to the UN’s Sustainable Development Goals (SGD)
2030 and endorsed by the 67th session of the World Health
Assembly, has been adapted for the WHO European Region.
A new Roadmap to implement the TB Action Plan for the WHO
European Region 2016–2020 was subsequently endorsed
at the 65th session of the WHO Regional Committee in
Vilnius, Lithuania on 14–17 September 2015.
TB Action Plan 2016–2020 incorporates the lessons learned
in implementing the Consolidated Action Plan to Prevent
and Combat Multidrug- and Extensively Drug-Resistant
Tuberculosis in the WHO European Region 2011–2015, and
is in line with WHO’s European health policy framework,
Health 2020, and other key Regional health strategies and
policies. TB Action Plan sets a Regional goal of preventing
further spread of drug-susceptible and drug-resistant TB
by achieving universal access to prevention, diagnosis
and treatment in all Member States of the Region which, in
turn, will contribute to the End TB Strategy aim of ending
the TB epidemic. Under the TB Action Plan, targets to be
achieved by 2020 are: a 35% reduction in TB deaths, a
25% reduction in TB incidence rates and a 75% treatment
success rate among MDR TB patients.
As stipulated in the TB Action Plan, there is a need to scaleup
rapid diagnosis, and ensure efficient and adequate
treatment for all. To this end, uptake and rational use of
new diagnostic tests, new medicines and shorter treatment
regimens shall be pursued, with a more people-centred
approach to care. Along with existing tools, innovative
approaches are required and research into new tools, such
as a more efficient vaccine, and intersectoral, innovative
approaches to address inequalities in health systems.
European Union and European
Economic Area countries
Epidemiology
In 2015, 60 195 cases of TB were reported in 30 EU/EEA
countries. In a majority of countries, the notification rates
have fallen steadily during the period 2011−2015 continuing
a long-term decreasing trend. Nevertheless, annual rates
of decline are still too small to envisage TB elimination in
European low-incidence countries by 2050.
Of all notified TB cases, 73.2% were newly diagnosed
and 79.5% of new pulmonary TB cases were confirmed
by culture, smear or nucleic acid amplification test. Thirty
per cent of all TB cases were of foreign origin, mostly
residing in low-incidence countries. Of 60 168 TB cases
reported with information on age, 39 463 (65.6%) were
between 25 and 64 years old. The highest notification
rate was observed in the 25–44 years of age group at
14.4 per 100 000. Children under 15 years of age accounted
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