6. Conclusion

The co-operation of countries of the WHO European Region in the feasibility study was excellent. Contacts were established in English or Russian with all but one of the 50 countries. Despite differences in reporting systems, data could be collected on tuberculosis cases notified in 1995 among 46 countries of the Region, based on the European consensus case definition. A total of 41 countries provided detailed information on the cases based on a minimum set of variables, and half of these countries provided individual computerised data.

The availability of information varied by country. It was excellent for age, sex and site of the disease, while the least documented epidemiological information was the geographic origin of the patient. The availability and completeness of bacteriological information (culture and sputum smear examination) varied across countries, probably reflecting both differences in the definition of a bacteriologically-confirmed case and differences in reporting systems, particularly with regard to the involvement of laboratories in the reporting.

Results showed large variations in notified incident tuberculosis in Europe. In 1995, incidence rates reported in eastern Europe were generally higher than those reported in western Europe. Tuberculosis was rarely reported in children and affected mainly adults. Countries with incidence rate of less than 20 cases per 100 000 reported a high proportion of patients in older ages, while tuberculosis affected proportionately more adolescents and young adults in the other countries. Tuberculosis affected almost twice as many males as females in the adult population, with however large between-country variations. The contribution of foreign patients originating from high incidence areas of the world was substantial in several countries of western Europe and modified the age and gender distribution of the cases. The vast majority of the cases were new episodes of tuberculosis in persons never diagnosed previously. Pulmonary tuberculosis represented around 80% of the reported cases, alone or in association with other sites. Bacteriological confirmation was reported in less than half of the cases, and 40% of the cases were reported as sputum smear positive, i.e. with a contagious form of the disease. These low proportions may reflect the unavailability of laboratory facilities in some areas, inappropriate diagnostic practices or underreporting of bacteriological information.

The surveillance of tuberculosis appears feasible in Europe. Improving the standardisation of definitions and the completeness of information will allow to improve the comparability of data and the analyses of time trends in the future.