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The EuroTB programme
for the surveillance of tuberculosis in Europe was set up in
1996 to collect, analyse and disseminate data on tuberculosis
cases notified in the WHO European Region. The programme is
managed jointly by the European Centre for the Epidemiological
Monitoring of AIDS (CESES) in Saint-Maurice, France, and the
Royal Netherlands Tuberculosis Association (KNCV) in The Hague,
The Netherlands. Information is collected yearly on cases notified
in each country, based on consensus recommendations including
common definitions and a common set of variables.
In 1996, 315 892 cases
of tuberculosis were notified in 50 countries of the WHO European
Region. The notification rate was :
- lower than 20 per 100 000 in 21 countries
("low incidence countries"), all situated in the
western part of Europe except for the Czech Republic and
Israel;
- 20 cases per 100 000 or over in 29
countries ("high incidence countries") located
in the eastern part of Europe except for Portugal and Spain.
Between 1995 and 1996,
the notification rate decreased in 18 countries, remained stable
in five and increased in 24. The rate increased by more than
10% in 12 countries, including eight republics of the former
USSR which reported over 50 cases per 100 000 in 1996.
In 1996, the age and
sex specific tuberculosis notification rates varied across
countries. The notification rates were highest in patients
aged 65 or over in "low incidence countries" and
in those aged 35-54 years in other countries. The rates were
similar in males and females until the age of 15, but were
higher in males in all age groups thereafter, with greater
sex differences in "high incidence countries".
Patients of foreign
origin accounted for more than 30% of the cases in 11 of the
23 countries providing information on geographic origin.
The median proportion
of cases with a positive culture was 54% in the 18 countries
reporting this information. In the 31 countries reporting sputum
smear results, the median proportion of smear positive cases
was 40% among pulmonary cases.
The results of this
two-year surveillance show improvements in availability and
completeness of data and provide a contrasting picture of the
epidemiological situation of tuberculosis in Europe. Notification
rates declined or stabilised in most "low incidence countries",
but increased in many "high incidence countries",
mostly located in the eastern part of Europe, confirming the
changes observed in the late 1980s and early 1990s.
Several factors may
have contributed to the recent increases in tuberculosis notifications;
in particular, impoverishment of population subgroups and inadequacies
or deterioration of tuberculosis control. Transient increases
have been observed in several western European countries related
to migration from countries with higher incidence of tuberculosis.
The impact of HIV infection has been limited to a few countries
but could be substantial in the future in some other countries
with rapidly emerging HIV epidemics.
The heterogeneous epidemiological
trends observed in Europe as well as recent reports of high
prevalence of multi-drug resistance in some areas justify the
continuation of the surveillance of tuberculosis in Europe
including the monitoring of drug resistance and treatment outcome. |
