In 2003, 415,786 cases of tuberculosis (TB) were notified in the 52 countries of the WHO European Region. The overall notifi cation rate was 47.2 cases per 100,000, with diverging levels and trends across three geographic areas. European Union (EU) and West : In the 25 countries of the EU, and in Andorra, Iceland, Israel, Monaco, Norway, San Marino and Switzerland (West), 64,434 TB cases were notifi ed in 2003, an overall notifi cation rate of 13.6 cases per 100,000, being highest in the Baltic States (47-82). Of all cases, 23% were over 64 years, 63% were men and at least 31% were of foreign origin. Seventy-seven percent of the cases had pulmonary TB, of which 43% had positive sputum smear. Culture was positive in 55% of cases but results were not available in 22%. Notifi cation rates were higher in the population of foreign origin (57; peaking at 25- 34 years) than in nationals (5; peaking over 64 years). Between 1997 and 2003, rates decreased by 20%, but less in young adults (-5%) than in the other age-groups (-26%). Numbers of cases decreased less in persons of foreign origin (-2%) than in nationals (-34%). HIV prevalence among TB cases (19 countries) was below 0.5% in five new EU countries, increased to 2-3% in Estonia and Latvia, and was highest in Portugal (16%) and Spain (10%). Among 9,827 AIDS cases reported in 2003, 2,273 (23%) had TB as initial AIDS-indicative disease, representing 3% of notifi ed TB cases. Multi-drug resistance (MDR) remained more frequent in the Baltic States (combined MDR: 19%) than in 15 other countries (2%; range: 0-6%), where MDR was present in 15% of cases from the former Soviet Union. In 23 countries with complete outcome data (2002), success was reported in 74% of new definite pulmonary cases, death in 7% and default or unknown outcome in 14%. Success ratio decreased with increasing age. In the EU & West, TB morbidity concentrates in the population of foreign origin, the elderly and in HIV-infected individuals. Surveillance and control should target these risk groups. Centre : In the Centre, 60,597 cases were notifi ed in 2003 with incomplete data from Bosnia & Herzegovina. Rates (49 cases per 100,000 overall) were much higher in Romania (142) than in Albania, Bulgaria, Croatia, F.Y.R. of Macedonia, Romania, Serbia & Montenegro and Turkey (18 to 41). Age-specific rates peaked in the age group 45-54 years in Romania (226) and Bulgaria (54), and over 64 years in the other countries (61) (no data for Turkey). Pulmonary cases represented 81% of cases and half of them had positive sputum smear. Culture confi rmation was not available for Serbia & Montenegro and Turkey and was reported in over 50% of cases in Bosnia & Herzegovina, Croatia and in Romania (2002). Since 1999, TB notifi cation rates decreased only in Albania, Croatia and Turkey. The number of new AIDS cases remained low in 2003 (N=469). AIDS indicative diseases were missing for 52% of AIDS cases, and 15% had TB, representing 0.1% of total TB cases. Drug resistance data from Croatia and Bosnia & Herzegovina indicated low levels of drug resistance. Success ratios among new cases (2002) were higher than 78% in all fi ve countries with complete cohorts. The lack of decrease in notifi cation rates in countries with highest prevalence and the scarcity of data on culture and drug resistance call for strengthened TB control programmes. East : In 2003, Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Rep. of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan reported 290,395 TB cases (104 cases per 100,000), of which 52% from the Russian Federation. Age specifi c rates (6 countries) peaked in the age group 25-34 years (208), indicating high levels of recent transmission. Positive sputum smear was reported in 39% of pulmonary cases. Culture results were rarely reported. Between 1999 and 2003, notification rates increased by 4.5% yearly, partly due to increased completeness of reporting. Of 2,097 AIDS cases notifi ed in 2003 (89% from Ukraine; no data from the Russian Federation), 59% had TB as AIDS indicative disease, representing 2.7% of total TB cases in Ukraine and 0.6% or less in the other countries. Data on drug resistance in recent years suggest high levels of MDR in most countries. Seven of the 10 countries providing outcome data for 2002 reported 7-11% failures among new smear positive cases, probably refl ecting high prevalence of primary MDR. While the high levels of TB morbidity and MDR in the East are a major public health concern for the whole European Region, surveillance data remain incomplete and of limited use to TB control programmes. (R.A.)
Année de publication : 2005
Pages : 123 p.