Tuberculosis surveillance and monitoring in Europe 2014

Surveillance report
Publication series: Tuberculosis surveillance in Europe
Time period covered: 1 January - 31 December 2012

European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014. Stockholm: European Centre for Disease Prevention and Control, 2014.

​In 2012, 68 423 cases of tuberculosis (TB) were reported in 29 EU/EEA countries. This results in a notification rate of 13.5 per 100 000 population and constitutes a 6% decrease compared to 2011 (72 000 cases reported), confirming the average annual decline of 5% since 2008.

The sixth report launched jointly by ECDC and the WHO Regional Office for Europe indicates that, despite notable progress in the past decade, TB is still a public health concern in many countries across Europe. An assessment of progress towards TB elimination for the indicators defined in the report ‘Progressing towards TB elimination: A follow-up to the Framework Action Plan to Fight Tuberculosis in the European Union’ showed that none of the core indicators was achieved at EU/EEA level.

Executive summary

The surveillance data show that the majority of EU/EEA countries report sustained low levels of TB, which means fewer than 20 TB cases per 100 000 population. In 19 of them, the number of tuberculosis patients decreased. Rates were below 10 per 100 000 population in 18 countries and below 20 in 23 countries.

Overall, the EU/EEA countries have been – and still are – successful in the fight against TB and met the target of an average five-year decline. However, they have not yet met the set targets for successful treatment of the multidrug-resistant form of tuberculosis, MDR TB.

Only one in three MDR TB patients has a successful treatment 
In the EU/EEA, the treatment success rates of MDR TB patients have remained stable but at a very low level: only one in every three (34%) patients in the reporting EU/EEA countries finishes MDR TB treatment successfully. More than half die, fail treatment or default (stop taking treatment).
Merely 7 of the 21 countries reporting have maintained a mean five-year decline in MDR notification rates and the overall MDR TB treatment success rate remains far below the 70% target defined by the Framework Action Plan to Fight Tuberculosis in the European Union.
ECDC Director Marc Sprenger stressed: “If we are not able to diagnose and treat patients with multidrug-resistant tuberculosis early and successfully, this not only puts patients’ lives at risk but also paves the way for XDR TB. This is why it is essential to enable healthcare workers across Europe to fully support all MDR TB patients during the full course of treatment and make sure they finish it successfully.” MDR and XDR TB patients face much longer treatment, take more drugs, suffer from more side effects and treatment costs are five times higher compared to drug-susceptible TB. Only complete and successful tuberculosis treatment helps to prevent disease transmission and development of resistant strains that lead to the development of extensively drug-resistant TB (XDR TB), which is almost impossible to treat.

Improving treatment outcomes 
ECDC performed case studies on MDR treatment in four EU countries (Austria, Bulgaria, Spain, and United Kingdom). According to the “Healthcare system factors influencing treatment results of patients with multidrug-resistant tuberculosis” report, MDR TB needs to be diagnosed timely through increased uptake of rapid molecular testing to arrive at better treatment outcomes.
In addition, multidisciplinary decision-making on what treatment a patient should be prescribed and how the patient should be managed is advisable. The report highlights the importance of the interaction between the healthcare worker and the patient for successful MDR TB treatment and stresses that the patient’s social needs, such as housing, as well as their clinical needs, like co-management of substance dependencies and other co-morbidities should be taken into account.
Health systems in EU/EEA countries should be prepared to adequately diagnose and treat MDR TB or XDR TB and test all TB cases for drug susceptibility in a quality-assured laboratory. Early and rapid detection of all MDR TB cases as well as prompt and adequate treatment of drug-susceptible TB patients are essential in the path towards TB control and TB elimination in the EU/EEA.

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