Adequate treatment essential to stop TB across Europe – new ECDC/WHO report

​Over 1 000 patients are estimated to fall sick with tuberculosis (TB) every day across Europe – or more than 380 000 yearly – signalling that there is no room for complacency when it comes to TB prevention and control. Marking Word TB Day, the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe today released new surveillance data for 20111. The data show that while in general the number of TB cases has come down at a rate of 5% per year, countries in the eastern part of the Region bear 87% of the burden. These countries also recorded most of the 44 000 TB deaths in a year. The EU/EEA countries reported over 72 000 TB cases in 2011 which signifies a 4% decrease compared to 2010.

Commenting on the report’s findings, Tonio Borg, European Commissioner for Health and Consumer Policy, said: “I am pleased to see progress achieved in fighting tuberculosis across the European Union. I am concerned, however, with the critical situation in certain EU Member States, as well as the challenge posed by multi drug-resistant tuberculosis in countries which have previously been able to control the situation. The data point to notable health inequalities, with the vulnerable sector of society most affected. We need to reinforce our health systems so that all tuberculosis patients in the EU receive adequate treatment.”

ECDC Director Marc Sprenger points out: “Our primary aim is to further reduce TB transmission by timely diagnosis and adequate treatment of pulmonary TB. This is essential for TB elimination. But we should not forget about the patients with extrapulmonary TB, a form of TB that can affect any organ of the body making the diagnosis particularly challenging for both doctors and patients. This group is often neglected in TB control strategies. In 2011, more than 16 000 of all notified TB patients in the EU/EEA had extrapulmonary TB.”

“Improved diagnostic tools are helping to identify more TB cases, however, this means that health systems everywhere have to keep up the pace and provide all newly detected patients with full treatment. This is still suboptimal in the European Region where one in three patients does not get cured”, says Zsuzsanna Jakab, WHO Regional Director for Europe. “TB is curable if patients are treated free of charge, according to their own needs, and accompanied through the right therapy until they finish it completely. This means making health systems people-centred in the spirit of the new regional framework Health 2020.”

Adequate TB treatment essential

Adequate TB treatment will avert development of the drug-resistant forms of the disease like multi drugresistant TB (MDR TB) and extensively drug-resistant TB (XDR TB), which are growing into a public health emergency. 78 000 individuals are estimated to fall sick with M/XDR TB yearly in the WHO European Region where there are over half of the world’s countries with the highest percentage of M/XDR TB cases. In the EU/EEA, M/XDR TB is slightly decreasing but continues to be prevalent in TB patients especially in the three Baltic countries.

Less than 50% of patients detected with MDR TB are successfully treated. Treatment for M/XDR TB patients is much longer than treatment of regular TB, is hundreds of times more costly and gives more frequent and severe side effects. One untreated person with TB or M/XDR TB can infect 10-15 other individuals yearly and 10% of them develop the disease in their lifetime.

The current portfolio of TB drugs, diagnostics and vaccines is inadequate to treat TB and reach the elimination target globally by 2050. Few new drugs are in the pipeline with the potential to scale up the fight against TB. These drugs need to provide simpler, easily tolerable and less expensive therapies and reduce the treatment time from the current six months-2 years to less than two weeks.

Successful treatment is a target in the WHO Consolidated Action Plan on M/XDR TB

Diagnosing 85%, or 225 000, of the M/XDR TB patients and successfully treating at least 75% of them are key targets of the WHO Consolidated Action Plan on M/XDR TB that all European countries subscribed to in 2011. The plan highlights the importance of moving from hospital to ambulatory care to reduce the risk of hospital-acquired infections and the psychological burden. All this would translate in 120 000 lives and 12 billion US Dollars saved.

Extrapulmonary TB in the EU/EEA

From 2002 to 2011, the notification rates of extrapulmonary TB did not show a downward trend, whereas a decrease in pulmonary TB was recorded. As a result, the proportion of extrapulmonary TB patients increased from 16% in 2002 to 22% in 2011. The percentage of TB patients notified with extrapulmonary TB varied widely across the EU/EEA countries from as low as 4 to 67%. As symptoms of this form of TB may be diffuse or mimic other diseases, many doctors might not consider extrapulmonary TB, causing diagnostic delays or missed diagnoses.

Activities on World TB Day 2013

The WHO Regional Office for Europe launches a photo exhibition “Faces of Tuberculosis” on 20 March in Brussels, under the patronage of Glenis Willmott, Member of the European Parliament.

On 22 March, a joint ECDC-WHO Twitter chat on TB in the European Region will be held from 11:00 to 12:00 CET. Use the hashtag #TBchat

ECDC will launch a video documentary on extrapulmonary tuberculosison 19 March.

NOTES TO EDITORS

World TB Day is celebrated on 24 March each year around the world. The overall goal of the Day is to raise awareness about the burden of tuberculosis (TB) worldwide and the status of TB prevention and control efforts. 2013 is the second year of a two-year campaign for World TB Day, with the slogan “Stop TB in My Lifetime”.

The Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis (M/XDR TB) in the WHO European Region 2011–2015 aims to strengthen efforts to address the alarming problem of drug-resistant TB in the Region. The Plan has been prepared in Regionwide consultation with representatives of the 53 European Member States, experts, patients and communities suffering from the disease.

The WHO European Region comprises 53 countries, with a population of nearly 900 million people, of which around 508 million live in the EU/EEA (27 EU Member States plus Iceland, Liechtenstein and Norway).

(Extra)pulmonary TB

Tuberculosis (TB) most commonly affects the lungs (pulmonary TB), but it can affect virtually any organ. A case with TB in any other site than the lungs is considered an extrapulmonary TB (EPTB) case. EPTB, unlike pulmonary TB, is rarely infectious but contributes significantly to TB-related morbidity and can cause complications, lifelong sequelae and disabilities.