Information pack on tuberculosis (TB) in Europe

Exchange of views with ENVI on MDR tuberculosis

Dr Marc Sprenger, Director, ECDC21 March 2012, Brussels

TB notification rates, 2010

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In 2010, 73 996 TB cases were reported in the EU/EEA. The overall notification rate was 14.6 per 100 000 population.

Figure 1: Country-specific TB notification rates, 2010

51 – 100 per 100 000

21 – 50 per 100 000

101 – 150 per 100 000

11 to 20 per 100 000

10 per 100 000

> 150 per 100 000

Trend in TB notification rate in EU/EEA

A sustained decline in TB case notification rates was seen between 2006 and 2010.•22 Member States met the target of a mean five-year decline.•The overall decline is attributable to the high-incidence Member States.•It is essential to reinforce and maintain efforts to secure a continued decline.

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Figure 2: Trends in notification rate 2006−2010

Proportion of TB cases with notified MDR TB in EU/EEA, 2010

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In 2010, the overall proportion of TB cases with multi-drug resistance in the EU/EEA was 4.6%.

Figure 3: Country-specific proportion multidrug resistance among all notified TB cases with, EU/EEA, 2010

6 to 9.9%

2 to 5.9%

10 to 30%

1 to 1.9%

< 1%

> 30%

Not included or not reporting

Trend in MDR TB case notification rates, EU/EEA MDR-TB case notification rates remained stable between 2006 and 2010.•Seven countries met the target of a mean five-year decline. •This indicates strengthened and tailored TB control programmes in these countries.•The overall decline is attributable to that of the high-incidence Member States.

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Figure 4: Trends in MDR TB notification rates 2006−2010

Treatment success rate of new pulmonary TB cases, EU/EEA 2009The treatment success rate among new culture-confirmed pulmonary TB cases notified in 2009 was 79% (range: 29%–87%).

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Figure 5: Treatment success rate among previously untreated culture-confirmed pulmonary TB cases notified in 2009

* Five Member States did not report stratified treatment outcome monitoring (TOM) data for this analysis.

0

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0

Austria

Belgium

Bulgaria

Cyprus

Czech 

Republic

Denmark

Estonia

Finland

Germany

Hungary

Iceland

Ireland

Latvia

Lithuania

Malta

Netherlands

Norway

Poland

Portugal

Romania

Slovakia

Slovenia

Sweden

United 

Kingdom

EU/EEA

%

Treatment success rate of MDR TB cases, EU/EEA 2008The treatment success rate of all culture-confirmed MDR TB cases notified in 2008 was 30% (range: 0%–100.0%).

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Figure 6: Treatment success rate of all culture-confirmed MDR TB cases notified in 2008

* Denmark and Malta reported zero MDR TB cases in 2008. ** Nine Member States did not report stratified treatment outcome monitoring (TOM) data for this analysis.

0

10

20

30

40

50

60

70

80

90

100

Austria

Belgium

Bulga

ria

Cyprus

Czech 

Repu

blic

Estonia

Germ

any

Hungary

Ireland

Latvia

Netherland

s

Norw

ay

Polan

d

Romania

Slovakia

Sloven

ia

Swed

en

Unite

d Kingdo

m

EU/EEA

treatm

net success (%

)

TB cases reported in EU/EEA 2006−2010

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2006 2007 2008 2009 2010 Mean annual % change in rate, 2006-2010

Country Number Rate Number Rate Number Rate Number Rate Number Rate

Austria 906 11.0 874 10.6 817 9.8 698 8.4 688 8.2 -6.8%

Belgium 1,117 10.6 1,020 9.6 990 9.3 994 9.2 1,115 10.3 -0.5%

Bulgaria 3,232 41.9 3,038 39.6 3,150 41.2 2,910 38.3 2,649 35.0 -4.2%

Cyprus 37 4.8 42 5.4 50 6.3 55 6.9 61 7.6 12.0%

Czech Rep. 951 9.3 846 8.2 864 8.3 695 6.6 678 6.5 -8.3%

Denmark(a) 387 7.1 391 7.2 376 6.9 337 6.1 359 6.5 -2.1%

Estonia 460 34.2 491 36.6 444 33.1 411 30.7 329 24.5 -7.5%

Finland 297 5.7 348 6.6 344 6.5 417 7.8 327 6.1 3.4%

France 5,323 8.4 5,574 8.8 5,758 9.0 5,276 8.2 5,116 7.9 -1.4%

Germany 5,378 6.5 5,000 6.1 4,519 5.5 4,419 5.4 4,330 5.3 -5.0%

Greece 681 6.1 645 5.8 670 6.0 594 5.3 489 4.3 -8.0%

Hungary 1,859 18.4 1,685 16.7 1,619 16.1 1,407 14.0 1,741 17.4 -0.5%

Iceland 13 4.3 14 4.6 6 1.9 9 2.8 22 6.9 35.2%

Ireland 463 11.0 480 11.1 468 10.6 479 10.8 427 9.6 -3.3%

Italy 4,503 7.7 4,525 7.7 4,418 7.4 4,244 7.1 3,249 5.4 -7.9%

Latvia 1,328 57.9 1,255 55.0 1,070 47.1 978 43.2 934 41.5 -7.9%

Lithuania 2,559 75.2 2,408 71.1 2,250 66.8 2,081 62.1 1,938 58.2 -6.2%

Luxembourg 33 7.0 39 8.2 28 5.8 27 5.5 29 5.8 -3.2%

Malta 30 7.4 38 9.3 53 12.9 44 10.6 32 7.7 4.8%

Netherlands 1,031 6.3 998 6.1 1,015 6.2 1,157 7.0 1,073 6.5 0.9%

Norway 290 6.2 302 6.5 313 6.6 358 7.5 339 7.0 3.0%

Poland 8,587 22.5 8,614 22.6 8,080 21.2 8,236 21.6 7,509 19.7 -3.2%

Portugal 3,456 32.7 3,139 29.6 3,002 28.3 2,871 27.0 2,626 24.7 -6.8%

Romania 26,600 123.1 24,837 115.2 24,680 114.6 23,164 107.7 21,078 98.2 -5.4%

Slovakia 730 13.5 682 12.6 633 11.7 506 9.3 439 8.1 -11.9%

Slovenia 215 10.7 218 10.8 213 10.6 188 9.3 172 8.4 -5.8%

Spain 8,029 18.3 7,768 17.5 8,216 18.1 7,592 16.6 7,089 15.4 -4.1%

Sweden 497 5.5 482 5.3 546 5.9 617 6.7 675 7.2 7.3%

UK 8,363 13.8 8,329 13.7 8,606 14.1 8,917 14.5 8,483 13.7 -0.2%Total EU/EEA

countries 87 355 17.5 84 082 16.8 83 198 16.5 79 681 15.8 73 996 14.6 -4.4%

ECDC’s framework action plan to fight tuberculosis in the EU

Strategic areas1. TB control commitment, TB

awareness and capacity of health systems

2. Surveillance3. Laboratory services4. Prompt and quality TB care

for all5. MDR- and XDR-TB6. TB/HIV co-infection7. New tools for TB control8. Build partnership and

collaboration with countries

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Principles1.Ensure prompt and quality TB care for all2.Strengthen capacity of health systems3.Develop and assess new tools and approaches4.Build partnerships and collaboration with countries and stakeholders

Impact of the economic crisis on TB in the EU:Lessons from history?

New York City financial crisis in 1975: major health cuts

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• Department of Health cut by 20%

• Workforce cut by 28%• 7 of 20 district health

centres closed• 6 of 14 chest clinics

(responsible for TB diagnosis) closed

• City TB hospital closed.

• Budget cut of 17% for Health and Hospitals Corporation

Source Freudenberg et al. American Journal of Public Health, March 2006, Vol 96, No. 3

Impact on TB, AIDS and homicide in New York City 1970s−2002

12Source Freudenberg et al. American Journal of Public Health, March 2006, Vol 96, No. 3

Long-term cost of upsurge in TB in New York City• A cost-of-illness study assessing the excess

medical expenditures due to the reduction in spending of the city of New York after the fiscal crisis in 1975 showed that the cuts resulted in about 10,000 excess TB cases (on a total of 47,000) between 1979 and 1999.

• The excess TB cases incurred nearly US$ 500 million in direct medical costs.

13Source Freudenberg et al. American Journal of Public Health, March 2006, Vol 96, No. 3

Read more about ECDC’s TB programme:http://ecdc.europa.eu/en/activities/diseaseprogrammes/programme_tuberculosis/Pages/index.aspx