Conclusion

Analysis of tuberculosis surveillance data for 2013 shows that the case notification rate has declined in Brittany since 2010, despite some regional variations. This rate is now closer to that of the rest of the country, whereas it was previously higher. In 2013, the reporting rate in Brittany was the 8th highest nationally, whereas it had previously been the 3rd highest.Broadly speaking, two types of tuberculosis coexist in Brittany: the form affecting people born in France tends to affect older individuals, is more often respiratory in nature, and is more frequently contagious, whereas the form affecting individuals born abroad is more often extrarespiratory than that of the native population, and respiratory cases are less frequently contagious. Geographically, tuberculosis among older native residents predominates in the Côtes d’Armor, Finistère, and Morbihan departments, whereas tuberculosis among young migrants predominates in Ille-et-Vilaine. The emergence of multidrug- and extensively drug-resistant forms, particularly in Eastern Europe and Central Asia, poses new challenges. Since 2010, the number of cases resistant to isoniazid and rifampicin has been increasing in Brittany and has drawn the attention of health authorities. The proportion of cases among children under 15 was less than 4%, which is equivalent to the national level. Furthermore, while meningeal forms did affect one child under 15, none affected children under 5. There is therefore no indication of particularly intense tuberculosis transmission in the Breton population. It is, however, important to continue ensuring that vaccination recommendations are properly followed. In fact, of the 8 children who developed tuberculosis, 6 should have been vaccinated, yet only 2 were. Despite the decline in the tuberculosis case rate, the Tuberculosis Surveillance System (LAT) must continue to play a vital role. Indeed, it is essential to identify and treat cases as early as possible and to limit the transmission of tuberculosis in the context of the emergence of multidrug-resistant forms.