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World Tuberculosis Day 2017
Tuberculosis situation in the EU/EEA, 2015Findings from the joint Tuberculosis surveillance and monitoring in Europe, 2017 report by ECDC and WHO Regional Office for Europe ECDC TB TeamEuropean Centre for Disease Prevention and ControlStockholm, 24 March 2017
TB notifications, EU/EEA, 201560 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 4910 to 195 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
TB notifications, EU/EEA, 2006-2015Steady decline between 2006 and 2015:• number of TB cases decreased by
30% • notification rate decreased by 37%
3Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. TB surveillance and monitoring in Europe, 2017
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
20 000
40 000
60 000
80 000
0
4
8
12
16
20TB cases Rate per 100 000 population
Year of reporting
TB c
ases
TB c
ases
/100
000
TB notification rate by sex and age group, EU/EEA, 2015
4
0-4 5-14 15-24 25-44 45-64 ≥ 650
5
10
15
20
25
MaleFemale
Age group
TB c
ases
/100
000
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
TB notification rate by age group, EU/EEA, 2006–2015
5
Decreased by 2-5% annually in all age groups
2006 2007 2008 2009 2010 2011 2012 2013 2014 20151
10
1000-4 5-14 15-24 25-44 45-64 65+
Year of reporting
TB c
ases
/100
000
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
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 9.92 to 3.91 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
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%
Previously treated TB cases, EU/EEA, 2015
8Source: 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%
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
TB cases in persons of foreign origin, EU/EEA, 2006–2015
10
2006 2007 2008 2009 2010 2011 2012 2013 2014 201505
101520253035
0
2
4
6
8
10Percentage of cases in persons of foreign originRate per 100 000 of total population
Year of reporting
Perc
enta
ge
Case
s/10
0 00
0
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
TB notification rates by origin, EU/EEA, 2010–2015
11
3.7% annual decline of notification rate in foreign population7.0% 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. (Submitted to Eurosurveillance. 2017; Publication pending).
2010 2011 2012 2013 2014 20151.0
10.0
100.0Rate per 100 000 in native populationRate per 100 000 in foreign population
Year of reporting
case
s/10
0 00
0
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
Multidrug-resistant TB (MDR TB), EU/EEA, 2015
13* DST – drug susceptibility results reported for at least isoniazid and rifampicin
Source: 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%
MDR TB notification rate, EU/EEA, 2011– 2015
14
Rate was stable at 0.3 per 100 000 population between 2011 and 2015
2011 2012 2013 2014 20150
0.1
0.2
0.3
0.4
0.5
Year of reporting
case
s/100
000
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
Multidrug resistance among new pulmonary TB cases, EU/EEA, 2015
15Source: 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%
Multidrug resistance among previously treated pulmonary TB cases, EU/EEA, 2015
16Source: 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%
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
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
Treatment success of all TB cases notified in 2014, EU/EEA, 2015
19* Six EU/EEA Member States did not report treatment outcome data
Source: 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%)
EU/EEAFinland
DenmarkaIreland
SpainPolandCyprus
GermanyLithuania
EstoniaPortugal
CroatiaHungary
AustriaCzech Republic
SloveniaLatvia
BelgiumRomania
United KingdomNorway
BulgariaNetherlands
SwedenSlovakiaIceland
0 10 20 30 40 50 60 70 80 90 100
Treatment success (%)
Treatment success of all notified TB cases, 2005–2014, EU/EEA
20
Proportion of successfully treated cases is stable (range 72–75%)
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 0
10 000
20 000
30 000
40 000
50 000
60 000
70 000
0%
20%
40%
60%
80%
100%
Total number Total number of successfully treated casesTreatment success %
Tota
l num
ber
Year of notificationSource: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017
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
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%)
EU/EEAFinland
DenmarkIreland
SpainPolandCyprus
GermanyCroatia
PortugalHungary
AustriaCzech Republic
SloveniaLithuaniaBelgium
United KingdomLatvia
EstoniaNorway
RomaniaNetherlands
BulgariaSwedenSlovakia
Iceland
0 10 20 30 40 50 60 70 80 90 100Treatment success (%)
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%
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%)
EU/EEASlovakia
PolandIreland
LithuaniaHungaryRomaniaGermanyBulgaria
DenmarkPortugal
United KingdomEstoniaNorway
LatviaSwedenAustria
BelgiumNetherlands
0 10 20 30 40 50 60 70 80 90 100
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
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%
Treatment outcomes of MDR TB cases notified in 2011–2013, EU/EEA, 2015
26Source: 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
Success Died Failed Defaulted or unknown
Still on treatment
0
10
20
30
40
50
MDR TB cohort 2011 MDR TB cohort 2012 MDR TB cohort 2013
Perc
enta
ge
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%)
EU/EEAGermany
Czech RepublicLithuaniaRomaniaBulgariaEstoniaAustria
United KingdomHungary
LatviaSwedenPortugalBelgium
0 20 40 60 80 100 120Treatment success (%)