world tuberculosis day 2013 tb situation in 2011: findings from the ecdc and who/euro joint tb...
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World Tuberculosis Day 2013
TB situation in 2011: Findings from the ECDC and WHO/EURO joint TB surveillance report
ECDC TB TeamEuropean Centre for Disease Prevention and ControlStockholm, 24 March 2013
TB notification rates in EU/EEA, 2011In the EU/EEA, 72 334 TB cases were reported in 2011.Notification rate 14.2 per 100 000 population (range 2.8 – 89.7).
2
Not included or not reporting
50 to 99 per 100 000
20 to 49 per 100 000
10 to 19 per 100 000
< 10 per 100 000
Figure 1: Country-specific TB notification rates, 2011
TB notification rates in EU/EEA, 2007−2011 Overall in the EU/EEA, notification rates have steadily declined.
3
Figure 2: Trend in TB notification rate in the EU/EEA 2007−2011
2007 2008 2009 2010 20115
10
15
20
16.8 16.515.8
14.914.2
Year of reporting
Noti
fica
tion
rate
per
10
0 0
00
pop
ula
tion
Proportion of confirmed* TB cases in the EU/EEA, 2011Overall 61.3% (range 27.9 – 94.8%) of TB cases reported in the EU/EEA were laboratory-confirmed.
4
Figure 3: Country-specific proportion of all confirmed TB cases in 2011.
70 to 79%
≥ 80%
60 to 69%
< 60%
Not included or not reporting
*Confirmed by culture or both a positive sputum microscopy result and Mycobacterium tuberculosis nucleic acid identified in nucleic acid amplification test.
TB notification rates in children <15 years of age in EU/EEA, 2011In 2011, 3 190 cases of TB in children were reported, accounting for 4.4% of all notified TB cases (range 0 – 11.1%) in the EU/EEA.
5
Figure 4: Country-specific childhood TB notification rates among child population (0–14 years), 2011
Not included or not reporting
4 to 9.9 per 100 000 child population
2 to 3.9 per 100 000 child population
≥ 10 per 100 000 child population
< 2 per 100 000 child population
Proportion of foreign origin among notified TB cases in EU/EEA, 2011
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In 2011, the overall proportion of TB cases of foreign origin in the EU/EEA was 25.8% (range 0.3 – 89.4%).
Figure 5: Country-specific proportion of foreign origin cases among all notified TB cases, EU/EEA, 2011
25 to 49%
≥ 75%
1 to 24%
50 to 74%
< 1%
Not included or not reporting
Proportion of notified extrapulmonary TB cases in EU/EEA, 2011
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In 2011, the overall proportion of extrapulmonary TB cases in the EU/EEA was 22.3% (range 3.9 – 66.7%).
Figure 6: Country-specific proportion of extrapulmonary TB of all notified TB cases, EU/EEA, 2011
20 to 29%
≥ 50%
5 to 19%
30 to 49%
< 5%
Not included or not reporting
Extrapulmonary TB notification rates in EU/EEA, 2002−2011 Extrapulmonary TB notification rates have remained stable in the last 10 years.
8
Figure 7: Trend in extrapulmonary TB notification rate in the EU/EEA, 2002−2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
1
2
3
4
5
3.4 3.4 3.53.3 3.4 3.2
3.5 3.4 3.33.2
Year of reporting
Notifica
tion r
ate
per
100 0
00 p
opula
tion
Proportions of TB by site among all notified TB cases in EU/EEA, 2002−2011 Percentage of extrapulmonary TB increased from 16.4% in 2002 to 22.4% in 2011.
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Figure 8: Proportion of notified pulmonary and extrapulmonary TB cases in the EU/EEA, 2002−2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000 Pulmonary TB Extrapulmonary TB
Year of reporting
Number of cases
Proportion of culture-confirmed new pulmonary TB cases in EU/EEA, 201169% of new pulmonary TB cases were culture-confirmed. The proportion varied widely across countries (range 0 – 98%).
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Figure 9: Proportion of new pulmonary TB cases confirmed by culture, 2011
EU/E
EA
Denm
ark
Slov
enia
Cypru
s
Swed
en
Nethe
rland
s
Esto
nia
Finla
nd
Norway
Malta
Belgi
umLa
tvia
Irela
nd
Germ
any
Czech
Rep
ublic
Portu
gal
Luxe
mbo
urg
Lithu
ania
Roman
ia
Spai
n
Austri
a
Unite
d Kin
gdom
Pola
nd
Bulga
ria
Greec
e
Slov
akia
Fran
ce
Hunga
ryIta
ly
Icela
nd0
20
40
60
80
100
%
Proportion of notified TB cases with multi-drug resistance among all confirmed TB cases in EU/EEA, 2011
11
In 2011, the overall proportion of TB cases with multi-drug resistance in the EU/EEA was 4.5% (range 0 – 29.8%).Figure 10: Country-specific proportion of multidrug resistance among all confirmed TB cases, EU/EEA, 2011
2 to 4.9%
≥ 10%
1 to 1.9%
5 to 9.9%
< 1%
Not included or not reporting
Proportion of notified new TB cases with multidrug resistance in EU/EEA, 2011
12
In 2011, the overall proportion of new TB cases with multi-drug resistance in the EU/EEA was 2.4% (range 0 – 23.3%).Figure 11: Country-specific proportion of new TB cases with multidrug resistance, EU/EEA, 2011
2 to 4.9%
≥ 10%
1 to 1.9%
5 to 9.9%
< 1%
Not included or not reporting
Notification rates of new cases with multidrug resistant TB in EU/EEA, 2007−2011The notification rate of multidrug resistant TB have remained stable at around 0.3 per 100 000 population.
13
Figure 12: Trends in multidrug resistant TB notification rate in the EU/EEA, 2007−2011
2007 2008 2009 2010 20110.0
0.1
0.2
0.3
0.4
0.33 0.350.33
0.30 0.30
Year of reporting
Notifica
tion r
ate
per
100 0
00
popula
tion
Proportion of notified previously treated TB cases with multidrug resistance in EU/EEA, 2011
14
In 2011, the overall proportion of previously treated TB cases with multidrug resistance in the EU/EEA was 16.8% (range 0 – 57.7%).Figure 13: Country-specific proportion of previously treated TB cases with multi-drug resistance, EU/EEA, 2011
2 to 4.9%
≥ 10%
1 to 1.9%
5 to 9.9%
< 1%
Not included or not reporting
Proportion of TB cases with extensive drug resistance among MDR-TB cases with SLD ST* reported in EU/EEA, 2011
15
In 2011, the proportion of extensive drug resistant cases among cases with multidrug resistance in EU/EEA was 13.4%(range 0 – 40.0%).Figure 14: Country-specific proportion of extensively drug resistant TB cases among TB cases with multi-drug resistance, EU/EEA, 2011
5 to 9%
≥ 20%
1 to 4%
10 to 19%
< 1%
*SLD ST – second line drug susceptibility testing result
Not included or not reporting
Not included or not reporting
Proportion of HIV positive TB cases among all TB cases with known HIV status in EU/EEA, 2011
16
In 2011, the overall proportion of HIV positive TB cases among TB cases with known HIV status in EU/EEA was 4.7% (range 0 – 40%).
Figure 15: Country-specific proportion of HIV positive TB cases among TB cases with known HIV status, EU/EEA, 2011
2 to 4.9%
≥ 10%
1 to 1.9%
5 to 9.9%
< 1%
Not included or not reporting
Treatment success rate for new pulmonary TB cases in EU/EEA*, 2010
The treatment success rate for new culture-confirmed pulmonary TB cases notified in 2010 was 76.8% (range: 0 – 91.4%).
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Figure 16: Treatment success rate for new culture-confirmed pulmonary TB cases notified in 2010
* Five EU/EEA Member States did not report treatment outcome data.
EU/E
EA
Austria
Belgiu
m
Bulgar
ia
Cypru
s
Czech
Rep
ublic
Denm
ark
Esto
nia
Finla
nd
Germ
any
Hungary
Iceland
Ireland
Latv
ia
Lithuan
ia
Luxe
mbou
rg
Malta
Nether
lands
Norway
Poland
Roman
ia
Slova
kia
Slove
nia
Spain
Sweden
United K
ingdom
0
20
40
60
80
100
Tre
atm
ent
succ
ess
(%
)
Treatment success rate for new pulmonary TB cases by year of reporting in EU/EEA, 2006−2010 The treatment success rate for new culture-confirmed pulmonary TB cases notified between 2006 and 2010 has slightly decreased from 79.5% in 2006 to 76.8% in 2010.
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Figure 17: Treatment success rate for new culture-confirmed pulmonary TB cases notified in 2006−2010
2006 2007 2008 2009 20100
20
40
60
80
100
79.5 79.2 79.5 78.9 76.8
Year of reporting
Tre
atm
ent s
ucce
ss (
%)
Treatment success rate for previously treated pulmonary TB cases in EU/EEA*, 2010The treatment success rate for previously treated culture-confirmed pulmonary TB cases notified in 2010 was 53.7% (range 31.4 – 85.7%).
19
Figure 18: Treatment success rate for previously treated culture-confirmed pulmonary TB cases notified in 2010
* Iceland and Luxembourg reported zero previously treated TB cases in 2010. Seven EU/EEA Member States did not report stratified treatment outcome data
0
20
40
60
80
100
Tre
atm
ent
succ
ess
(%
)
Treatment success rate for all notified pulmonary TB cases in EU/EEA*, 2010The treatment success rate for all confirmed pulmonary TB cases notified in 2010 was 72.4% (range 0 – 88.9%).
20
Figure 19: Treatment success rate for all confirmed pulmonary TB cases notified in 2010
* Five EU/EEA Member States did not report treatment outcome data
EU/E
EA
Austri
a
Belgi
um
Bulga
ria
Cypru
s
Czech
Rep
ublic
Denm
ark
Esto
nia
Finla
nd
Germ
any
Hunga
ry
Icela
nd
Irela
nd
Latv
ia
Lithu
ania
Luxe
mbo
urg
Malta
Nethe
rland
s
Norway
Pola
nd
Roman
ia
Slov
akia
Slov
enia
Spai
n
Swed
en
Unite
d Kin
gdom
0
20
40
60
80
100
Tre
atm
en
t su
ccess
(%
)
Treatment success* rate for extrapulmonary TB cases in EU/EEA**, 2010The treatment success rate for extrapulmonary TB cases notified in 2010 was 82.2% (range 21.1 – 100%).
21
Figure 20: Treatment success rate for extrapulmonary TB cases notified in 2010
*Treatment success of extrapulmonary TB consists of cases reported as completed full course of anti-tuberculosis treatment** Seven Member States did not report stratified treatment outcome data
EU/E
EA
Austria
Belgiu
m
Bulgar
ia
Cypru
s
Czech
Rep
ublic
Denm
ark
Esto
nia
Germ
any
Hungary
Iceland
Ireland
Latv
ia
Lithuan
ia
Malta
Nether
lands
Norway
Poland
Roman
ia
Slova
kia
Slove
nia
Spain
Sweden
United K
ingdom
0
20
40
60
80
100
Tre
atm
ent
succ
ess
(%
)
Treatment success rate for notified multidrug-resistant TB cases in EU/EEA*, 2009The treatment success rate for all confirmed multidrug-resistant TB cases notified in 2009 was 31.6% (range 0 – 84.6%).
22
Figure 21: Treatment success rate for all confirmed multidrug-resistant TB cases notified in 2009
* Malta reported zero MDR TB cases in 2009, 11 Member States did not report treatment outcome data
EU/E
EA
Austria
Belgiu
m
Bulgar
ia
Czech
Rep
ublic
Denm
ark
Esto
nia
Germ
any
Hungary
Latv
ia
Lithuan
ia
Nether
lands
Norway
Poland
Roman
ia
Slova
kia
Sweden
United K
in...
0
20
40
60
80
100
Tre
atm
ent
succ
ess
(%
)
Treatment outcome for multidrug-resistant TB cases notified in 2007−2009Treatment outcomes for multidrug-resistant TB cases did not improve between the 2007 and 2009 cohort, EU/EEA.
23
Figure 22: Treatment outcome at 24 months for multidrug-resistant TB cases diagnosed in 2009, compared with cases diagnosed in 2007 and 2008
Success Died Failed Defaulted Still on treatment
Transferred or unknown
0
5
10
15
20
25
30
35
cohort 2009 (18 countries)
cohort 2008 (20 countries)
cohort 2007 (15 countries)
Perc
enta
ge