What We Do
Tuberculosis remains a common disease worldwide, even though it is rare in France. Its incidence has been declining over the past 30 years, though there was a slight increase in 2016 and 2017, followed by a decline in the years following the arrival of the COVID-19 pandemic in France. The challenge is therefore to quickly identify cases of active tuberculosis in order to limit the spread of the infection in the community.
In this context, Santé publique France’s missions are to monitor tuberculosis and promote its prevention through BCG vaccination.
Epidemiological Surveillance of Tuberculosis
Santé publique France is responsible for ensuring and coordinating tuberculosis surveillance in France. This surveillance is based on mandatory reporting and relies on a network of partners.
Monitoring incidence through mandatory reporting
Tuberculosis has been a notifiable disease (DO) since 1964. This involves reporting the disease at the time of diagnosis. Until 2022, reporting forms were submitted by reporting entities (clinicians and laboratory professionals) to the Regional Health Agency (ARS) in their region, which validated and entered the report in coordination with the Clat (Tuberculosis Control Centers), responsible for conducting case investigations. Until 2018, the electronic data files resulting from the ARS’s entry of the forms were transmitted once a year to Santé publique France in anonymized form. This system was modified following the introduction of electronic reporting (see box).
In 2003, mandatory reporting was expanded to include cases of tuberculosis infection (latent tuberculosis infection, or LTI) in children under 15 years of age. In 2021, the age limit was extended to those under 18. This reporting is done on the same form as for active tuberculosis cases. Starting in 2007, cases of active tuberculosis must be followed by a treatment outcome report. This must be submitted 12 months after the initial reporting date and is completed on a specific form.
With the transformation of the reporting process through the “e-DO tuberculosis” tool, reporting and notification will now be done simultaneously electronically via this tool.
e-DO Tuberculosis
In 2019, the surveillance system was replaced by an electronic reporting system. This project, known as “e-DO Tuberculosis,” was implemented in the ARS in July 2019. Since April 2022, the online reporting system has been available to reporters, who may, however, continue to use the “paper form” on a transitional basis. Since that date, the application has also been available to other surveillance stakeholders (ARS, CLAT, laboratories, etc.). Access to e-DO for all these surveillance stakeholders is provided via a secure, direct online connection. This new system is expected to simplify the reporting process and help improve the completeness and quality of data—particularly bacteriological data—due to the ability for laboratories and the National Reference Center for Mycobacteria and Mycobacterial Resistance to Antituberculosis Drugs (CNR-MyRMA) to report online. Numerous tools to help users get started with online reporting (tutorials, videos, brochures, FAQs) are available on the “e-DO” page of the Santé publique France website (under the “Support” tab).
Mandatory reporting forms for tuberculosis and treatment outcomes
Informing the public about the reporting of notifiable diseases
Assessing the Impact of Changes in BCG Vaccination Policy on Vaccination Coverage and Tuberculosis Incidence
Santé publique France is tasked with monitoring trends in BCG vaccination coverage among target population groups and the impact of changes in BCG vaccination policy on the epidemiology of tuberculosis. In July 2007, the mandatory BCG vaccination of children was replaced by a recommendation to vaccinate children most at risk of tuberculosis, particularly those born in, or with at least one parent born in, areas of high tuberculosis endemicity, and all children residing in the Île-de-France region or French Guiana. This recommendation has since been extended to Mayotte, which became a French department in 2011. BCG vaccination coverage is assessed using various tools. The impact on tuberculosis incidence focuses primarily on childhood tuberculosis and, in particular, on the incidence of severe forms, such as meningeal or miliary tuberculosis.
Tuberculosis Prevention Efforts
Santé publique France helps promote vaccination through various tools (website, promotional campaigns, brochures, etc.). We have created an informational website on the various vaccinations available in France to provide reliable, scientifically validated answers to questions the public and healthcare professionals may have on the subject.
A section dedicated to tuberculosis vaccination is available in two separate sections, one aimed at the general public and the other at healthcare professionals, to better support them in their practice:
In addition, Santé publique France produces prevention tools such as informational brochures for healthcare professionals as well as for the general public, along with a video adapted for people who are deaf or hard of hearing. These resources are available under the “Tools” tab
In relation to
Vaccination
thematic dossier
Contagious diseases most often affect children at a very young age. Because children are particularly vulnerable, they are a priority target for vaccination programs.
