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World Tuberculosis Day 2017 - Tuberculosis situation in the EU/EEA, 2015
1. World Tuberculosis Day 2017
Tuberculosis situation in the EU/EEA, 2015
Findings from the joint Tuberculosis surveillance and monitoring in
Europe, 2017 report by ECDC and WHO Regional Office for Europe
ECDC TB Team
European Centre for Disease Prevention and Control
Stockholm, 24 March 2017
2. TB notifications, EU/EEA, 2015
60 195 TB cases in 30 EU/EEA countries
Notification rate of 11.7 per 100 000
population (range 2.1–76.5)
2
Not reporting
20 to 49
10 to 19
5 to 9
≥ 50
Cases per
100 000 population
< 5
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
3. TB notifications, EU/EEA, 2006-2015
Steady decline between 2006 and 2015:
• number of TB cases decreased by 30%
• notification rate decreased by 37%
3
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
0
4
8
12
16
20
20 000
40 000
60 000
80 000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
TBcases/100000
TBcases
Year of reporting
TB cases Rate per 100 000 population
4. TB notification rate by sex and age group,
EU/EEA, 2015
4
0
5
10
15
20
25
0-4 5-14 15-24 25-44 45-64 ≥ 65
TBcases/100000
Age group
Male
Female
The highest notification rate was observed in the age group 25–44 years,
(14.4 per 100 000). Males were over-represented in all age groups except
children under 15 years.
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
5. TB notification rate by age group, EU/EEA,
2006–2015
5
Decreased by 2-5% annually in all age groups
1
10
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
TBcases/100000
Year of reporting
0-4 5-14 15-24 25-44 45-64 65+
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
6. TB in children under 15 years, EU/EEA, 2015
6
2 444 TB cases reported in children under 15 years
4.1% of all TB cases (range 0-21.1%)
3.0 notifications per 100 000 child population (range 0–21.3)
Not reporting
4 to 9.9
2 to 3.9
1 to 1.9
≥ 10
Cases per
100 000 children
< 1
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
7. Confirmed TB cases*, EU/EEA, 2015
7
* Confirmation by culture or by both sputum microscopy and
Mycobacterium tuberculosis nucleic acid amplification test
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
66.9% of TB cases were laboratory-confirmed
(range 42.9–91.5%)
Not reporting
≥ 80%
70 to 79%
60 to 69%
Proportion of confirmed
cases
< 60%
8. Previously treated TB cases, EU/EEA, 2015
8
Source: European Centre for Disease Prevention and Control/WHO Regional Office
for Europe. TB surveillance and monitoring in Europe, 2017
11.1% of reported cases had been previously
treated (range 0–21.7%)
Not reporting
≥ 15%
10 to 14.9%
5 to 9.9%
Proportion of previously
treated cases
< 5%
9. TB cases in persons of foreign origin,
EU/EEA, 2015
9
29.8% of TB cases occurred in persons of
foreign origin (range 0.2–89.5%)
Not reporting
50 to 74.9%
10 to 49.9%
1 to 9.9%
≥ 75%
Proportion of cases
< 1%
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
10. TB cases in persons of foreign origin,
EU/EEA, 2006–2015
10
0
2
4
6
8
10
0
5
10
15
20
25
30
35
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Cases/100000
Percentage
Year of reporting
Percentage of cases in persons of foreign origin
Rate per 100 000 of total population
Percentage of cases in persons of foreign origin increased from
17.6% in 2006 to 29.8% in 2015
Rate per 100 000 total population stable between 3.1 and 3.5
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
11. TB notification rates by origin, EU/EEA,
2010–2015
11
3.7% annual decline of notification rate in foreign population
7.0% annual decline of notification rate in native population
Source: Hollo V, Beauté J, Ködmön C, van der Werf MJ. TB notification rate decreases faster in residents of native origin
than in residents of foreign origin in the EU/EEA. (Eurosurveillance, March 2017).
1.0
10.0
100.0
2010 2011 2012 2013 2014 2015
cases/100000
Year of reporting
Rate per 100 000 in native population
Rate per 100 000 in foreign population
12. Extrapulmonary TB cases, EU/EEA, 2015
12
22.2% of TB cases had extrapulmonary TB
(range 2.8–46.4%)
Not reporting
≥ 30%
20 to 29.9%
10 to 19.9%
Proportion of
extrapulmonary cases
0 to 9.9%
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
13. Multidrug-resistant TB (MDR TB), EU/EEA,
2015
13
* DST – drug susceptibility results reported for at least isoniazid and rifampicinSource: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
4.1% of TB cases with DST* results were
multidrug-resistant (range 0–21.2%)
Not reporting
5 to 9.9%
2 to 4.9%
1 to 1.9%
≥ 10%
Proportion of cases
< 1%
14. MDR TB notification rate, EU/EEA, 2011–
2015
14
Rate was stable at 0.3 per 100 000 population between
2011 and 2015
0
0.1
0.2
0.3
0.4
0.5
2011 2012 2013 2014 2015
cases/100000
Year of reporting
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
15. Multidrug resistance among new
pulmonary TB cases, EU/EEA, 2015
15
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
2.2% of new pulmonary TB cases with DST* results
had MDR TB (range 0–13.5%)
* DST – drug susceptibility results reported for at least isoniazid and
rifampicin
Not reporting
5 to 9.9%
2 to 4.9%
1 to 1.9%
≥ 10%
Proportion of cases
< 1%
16. Multidrug resistance among previously
treated pulmonary TB cases, EU/EEA, 2015
16
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
17.2% (range 0–51.4%) of previously treated
pulmonary TB cases with DST* results had MDR TB
* DST – drug susceptibility results reported for at least isoniazid and
rifampicin
Not reporting
15 to 24.9%
5 to 14.9%
1 to 4.9%
≥ 25%
Proportion of cases
< 1%
17. Extensively drug-resistant TB (XDR TB),
EU/EEA, 2015
17
* DST – drug susceptibility test
19.7% of MDR TB cases with second line DST* were
extensively drug-resistant (range 0–30.0% and 13.0–
25.4% for countries reporting more than five cases)
Not reporting
15 to 24.9%
10 to 14.9%
1 to 9.9%
≥ 25%
Proportion of cases
< 1%
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
18. TB/HIV co-infection, EU/EEA, 2015
18
* Among countries reporting HIV status for at least 50% of
TB cases
4.6% of TB cases with known HIV status*
were HIV positive (range 0–17.4%)
Not reporting
≥ 15%
10 to 14.9%
1 to 9.9%
Proportion of confirmed
cases
< 1%
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
19. Treatment success of all TB cases notified
in 2014, EU/EEA, 2015
19
* Six EU/EEA Member States did not report treatment outcome dataSource: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
72.0% of all TB cases* had a successful treatment outcome after
12 months (range 43.3–88.9%)
0 10 20 30 40 50 60 70 80 90 100
EU/EEA
Finland
Denmark
Ireland
Spain
Poland
Cyprus
Germany
Croatia
Portugal
Hungary
Austria
Czech Republic
Slovenia
Lithuania
Belgium
United Kingdom
Latvia
Estonia
Norway
Romania
Netherlands
Bulgaria
Sweden
Slovakia
Iceland
Treatment success (%)
20. Treatment success of all notified TB cases,
2005–2014, EU/EEA
20
Proportion of successfully treated cases is stable (range 72–75%)
0%
20%
40%
60%
80%
100%
0
10 000
20 000
30 000
40 000
50 000
60 000
70 000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Year of notification
Totalnumber
Total number Total number of successfully treated cases Treatment success %
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
21. Treatment success, EU/EEA, 2015*
21
72.0% of all TB cases* had a successful treatment
outcome after 12 months (range 43.3–88.9%)
Not reporting
≥ 85%
60 to 84.9%
Proportion of treatment
success
< 60%
* Six EU/EEA Member States did not report treatment outcome dataSource: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
22. Treatment success in new confirmed TB
cases and relapses, started on treatment in
2014*, EU/EEA, 2015
22
* Cases started on second line treatment are excludedSource: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
74.4% of new confirmed cases and relapses had a successful
treatment outcome (range 44.8–88.9%)
0 10 20 30 40 50 60 70 80 90 100
EU/EEA
Finland
Denmark
Ireland
Spain
Poland
Cyprus
Germany
Croatia
Portugal
Hungary
Austria
Czech Republic
Slovenia
Lithuania
Belgium
United Kingdom
Latvia
Estonia
Norway
Romania
Netherlands
Bulgaria
Sweden
Slovakia
Iceland
Treatment success (%)
23. 23
* Six EU/EEA Member States did not report treatment outcome dataSource: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
74.4% of new confirmed TB cases and relapses had
a successful treatment outcome (range 44.8–88.9%)
Treatment success in new confirmed TB
cases and relapses notified in 2014*,
EU/EEA, 2015
Not reporting
≥ 85%
60 to 84.9%
Proportion of treatment
success
< 60%
24. Treatment success in MDR TB*, EU/EEA,
2015
24
40.4% of all MDR TB cases notified in 2013 were successfully
treated (range 0–93.8%)
0 10 20 30 40 50 60 70 80 90 100
EU/EEA
Slovakia
Poland
Ireland
Lithuania
Hungary
Romania
Germany
Bulgaria
Denmark
Portugal
United Kingdom
Estonia
Norway
Latvia
Sweden
Austria
Belgium
Netherlands
Treatment success (%)
* Croatia, Czech Republic, Iceland and Slovenia reported zero MDR TB cases in
2013
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
25. Treatment success in all cases with MDR
TB*, EU/EEA, 2015
25
* Croatia, Czech Republic, Iceland and Slovenia reported zero MDR TB cases in 2013,
nine Member States did not report treatment outcome data for MDR TB cases
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
40.4% of all MDR TB cases notified in 2013 was
successfully treated (range 0–93.8%)
Not reporting
≥ 70%
40 to 69.9%
Proportion of treatment
success
< 40%
26. Treatment outcomes of MDR TB cases
notified in 2011–2013, EU/EEA, 2015
26
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
Treatment success rates remained stable at 38-40% in the 2011,
2012 and 2013 cohorts
0
10
20
30
40
50
Success Died Failed Defaulted or
unknown
Still on treatment
Percentage
MDR TB cohort 2011 MDR TB cohort 2012 MDR TB cohort 2013
27. 27
Treatment success in XDR TB cases,
EU/EEA, 2015
27
* Cyprus, Ireland, Netherlands, Norway and Slovakia reported zero XDR TB cases in
2012. 13 countries did not report second line drug susceptibility testing results or
XDR TB treatment outcome data
Source: European Centre for Disease Prevention and Control/WHO Regional
Office for Europe. TB surveillance and monitoring in Europe, 2017
24.3% of the XDR TB cases notified in 2012 were treated
successfully (range 0–100%)
0 20 40 60 80 100 120
EU/EEA
Germany
Czech Republic
Lithuania
Romania
Bulgaria
Estonia
Austria
United Kingdom
Hungary
Latvia
Sweden
Portugal
Belgium
Treatment success (%)
Notas del editor
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72.0 of all TB cases were reported as successfully treated by 25 Member States
TOM results reported for 140 XDR TB cases notified in 2012