In 2004, 414,163 cases of tuberculosis (TB) were notified in the WHO European Region. The overall notification rate was 47 cases per 100,000, with diverging rates and trends across the different parts of the Region. In the 25 countries of the EU, and in Andorra, Iceland, Israel, Norway, San Marino and Switzerland (West, no data from Monaco), 60,266 TB cases were notified in 2004, an overall notification rate of 12.6 per 100,000, being highest in the Baltic States (44-73). Of all cases, 23% were over 64 years, 63% were men and at least 29% were of foreign origin. Seventy seven percent of the cases had pulmonary TB, of which 42% were sputum smear positive. Culture was positive in 55% of cases but results were not available in 22%. Notification rates were higher in the population of foreign origin (57; peaking at 25-34 years) than in nationals (5; peaking over 64 years). Between 1998 and 2004, rates decreased by 24%, but less in young adults (-3%) than in the older age-groups (-31%). Numbers of cases decreased less in persons of foreign origin (-2%) than in nationals (-38%). HIV prevalence among TB cases (20 countries) was below 0.4% in five countries, but increased progressively to 3-4% in Estonia and Latvia in 2004, and was highest in Portugal (16%). Among 9,924 AIDS cases reported in 2004, 2,311 (23%) had TB as initial AIDS-indicative disease, representing 3% of all notified TB cases that year. Multi-drug resistance (MDR) remained more frequent in the Baltic States (combined MDR: 19%) than in 17 other countries (2%; range: 0-5%), where MDR was common (16%) in cases from the former Soviet Union. In 23 countries with complete outcome data (2003), success was reported in 77% of new definite pulmonary cases, death in 7% while 11% were lost to follow up. Success ratio decreased with increasing age and was higher in extra-pulmonary cases. 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. In the Centre, 62,609 cases were notified in 2004. Rates (50.7 per 100,000 overall) were much higher in Romania (146) than in Albania, Bosnia & Herzegovina, Bulgaria, Croatia, F.Y.R. of Macedonia, Serbia & Montenegro and Turkey (19 to 61). Age-specific rates peaked in the age group 45-64 years in Romania (201) and Bulgaria (50), and in cases aged > 64 years in the other countries (no data for Turkey). Pulmonary cases represented 87% of notifications of which half were sputum smear positive. Culture confirmation was not available for Turkey and was reported in over 50% of cases in Bosnia & Herzegovina, Croatia and in Romania (2003). Since 2000, TB notification rates decreased only in Albania, Croatia and Serbia & Montenegro. AIDS incidence remained low in 2004 (N=370). AIDS indicative diseases were missing for 66% of AIDS cases, and 7% had TB, representing less than 0.1% of total TB cases. Drug resistance data from all countries (no data available for Turkey) indicated low levels of drug resistance except in Bulgaria and Romania (combined MDR: 5-6%). Success ratios among new cases (2003) were higher than 80% in four countries with complete cohorts. The lack of decrease in notification rates in countries with highest prevalence and the scarcity of data on culture and drug resistance call for stren thened TB co g ntrol programmes. In 2004, Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Rep. of Moldova, Russian Federation, Ta Turkmenistan, Ukraine and Uzbekistan reported 291,288 TB jikistan, cases (104.7 per 100,000), of which 52% from the Russian Federation. Age specific rates (5 countries) peaked in the age group 25-34 years (240), indicating high levels of recent transmission. Positive sputum smear was reported in 31% of pulmonary cases. Culture results were reported by five countries for a small proportion of cases (8% culture positive; country range 4-35%). Between 2000 and 2004, notification rates increased by 3.6% yearly, partly due to increased completeness of reporting. Of 2,902 AIDS cases notified in 2004 (88% from Ukraine; no data from Kyrgyzstan, the Russian Federation and Uzbekistan), 54% had TB as AIDS indicative disease, representing 3.6% of total TB cases in Ukraine and less than 0.8% in the other countries. Data on drug resistance in recent years suggest high levels of MDR in most countries. Six of the 10 countries reporting outcomes for 2003 notifications had complete data and reported 10% failures (range 3-14%) among new smear positive cases, probably reflecting 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 : 2006
Pages : 115 p.