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Tuberculosis surveillance and monitoring in Europe 2017
SURVEILLANCE REPORT
Origin of cases
TB cases of foreign origin represent 6.3% of all TB cases
notified Region-wide, 29.8% in EU/EEA countries and only
0.7% in non-EU/EEA countries (Table 10). In many countries
TB cases of foreign-origin represent a large majority:
Sweden (89.5%), Norway (88.7%), Iceland (85.7%), Israel
(83.2%), Cyprus (82.5%), Switzerland (75.9%), Netherlands
(72.1%) and Malta (75.0%).
TB in prisons
During 2015, 37 countries in the Region provided information
on TB case detection and treatment in prisons (Table
17). Overall, 13 845 (5.9%) of the new and relapse TB cases
in the Region were reported from prisons, 13 432 (97%)
of which were in the 18 high-priority countries. 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%. In the non-EU/EEA countries, the
notification rate in prisons was 1 194 new TB cases per
100 000 population, which is over seven times higher than
in the EU/EEA sub-region (159 per 100 000). The overall
notification rate for new TB cases in prisons in the WHO
European Region was 915 per 100 000 population. In six
countries the TB notification rate exceeded 1 000 cases per
100 000 detainees: Azerbaijan, Kazakhstan, Kyrgyzstan,
Moldova, Russia and Ukraine. The highest TB-related risks
in prison are calculated to be in Slovakia (37), Ukraine (28)
and Kyrgyzstan (26). Seven countries (Albania, Andorra,
Ireland, Luxemburg, Malta, Monaco and Slovenia) did not
report any cases of TB from their penitentiary systems.
Treatment outcome
The treatment success rate among 216 502 new TB cases
and relapses having started treatment in 2014 was 76.0%
(Table 19). The average rate for the 18 high-priority countries
was 77.2% cured and treatment completed. The treatment
success rate was slightly lower in the EU/EEA countries
than in non-EU/EEA countries (74.4% versus 76.5%). Only
14 countries achieved an 85% treatment success rate in this
treatment cohort. Another 12 countries were close to the
target, with success rates of 80–85%. Six countries had
treatment success rates below 60%, where no treatment
follow-up data were inversely correlated (Cyprus (28.2%),
Poland (26.8%), Spain (33.2%), Ireland (37.5%), Finland
(42.0%) and Denmark (44.3%).
In the 2014 yearly cohort of all clinically- and bacteriologically-confirmed
new TB and relapse cases, a total of
16 882 (7.8%) cases were reported to have died, 5.0% to
have been lost to follow-up and 4.7% to have had treatment
that failed. These unfavourable outcomes were lower in the
EU/EEA countries than in the rest of the Region, exemplified
by the proportion of patients with failed treatment: 0.7%
in the EU/EEA versus 5.9% in non-EU/EEA countries (Table
19). Countries reporting fatal outcomes in excess of 10%
were Slovenia (16.9%), Croatia (16.3%), Czech Republic
(14.1%), Estonia (12.2%), Moldova (11.4%), Hungary (11.2%),
Lithuania (10.9%), Finland (10.8%) and Ukraine (10.4%).
Countries reporting the highest failure rates were Ukraine
(8.5%) and Russia (8.4%). Commonly reported reasons
for poor treatment outcomes are HIV co-infection and a
significant level of drug use and alcoholism.
For 2014, the treatment success rate among the 9 493 child
TB cases was 88.0% (Table 20). The treatment success rate
was almost identical in the EU/EEA and the non-EU/EEA
countries (87.8% vs. 88.0%). Among child TB cases in the
Region 0.8% died, another 0.6% failed and 1.3% were lost
to follow-up.
Of 7 918 TB/HIV co-infected patients who started treatment
throughout the Region in 2014, only 3 278 (41.4%) had a
successful treatment outcome (Table 21). The reason for
the low success rate is frequent treatment failure (27.7%)
and death (21.1%); other treatment outcomes being lost
to follow up (7.2%) or unknown treatment outcome (1.9%).
In 2013, the treatment outcome was notified for 42 487 laboratory-confirmed
RR/MDR TB cases reported by 39 countries
(Table 22). For the whole Region the treatment success
rate was 51.4%, which is slightly higher than the 48.7%
treatment success rate reported for the 2012 RR/MDR TB
treatment cohort. The treatment success rate for RR/MDR TB
patients was higher in the non-EU/EEA countries than in
the EU/EEA countries (51.4% versus 41.1%). The countries
that performed best were the Netherlands (100%), Belgium
(83.3%), Serbia (78.9%), Austria and Sweden (75.0% each).
In the Region as a whole 12.9% of RR/MDR TB cases died,
15.5% failed and 12.4% were lost to follow-up.
Conclusion
TB continues to be a major public health challenge in
the WHO European Region. According to the latest estimates,
there were around 323 000 incident TB cases and
32 000 deaths in the Region in 2015, mostly in eastern and
central European countries. Overall, 85% of the annual
incidence TB cases and 91% of TB deaths are located in the
18 high-priority countries implementing the End TB Strategy
in the regional context of the WHO European Region.
In the last 10 years, the number of new TB cases has been
falling at an average rate of 5.4% per year. Nevertheless,
notification rates in countries where TB is a high-priority
remained almost eight times higher than those in the rest
of the Region.
The WHO European Region is the area most affected by
MDR TB in the entire world. Of the 10 countries in the world
with the highest burden of MDR TB, nine are in the Region.
In 2015, estimated percentages of MDR among new and
previously treated TB cases in the Region were 16% and
48% respectively, while reported percentages were 18.3%
and 47.4%, indicating that overall the MDR TB surveillance
system is working well within the Region.
Around 120 000 people in the Region are estimated to
be infected with RR/MDR TB every year. However, it is
important to note that over the last five years (2011–2015)
the capacity of countries’ health systems for early detection
of RR/MDR TB has increased substantially. In 2015,
42 826 cases (58%) of RR/MDR TB were detected out of an
estimated 74 000 for all notified TB cases. The shortfall
in detections could be attributed to the early-detection
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