epidemiology of tuberculosis in europe...2014/09/22 · epidemiology of tuberculosis in europe...
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Epidemiology of tuberculosis in Europe
Marieke J. van der Werf European Centre for Disease Prevention and Control
Amsterdam, 22 September 2014
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Tuberculosis surveillance in the EU
Aim: To provide a complete and reliable overview of the TB situation to identify strengths and remaining challenges in TB control and to guide actions to eventually eliminate TB
European Tuberculosis Surveillance Network
• Started in 1996
• Covers 53 countries of the WHO Europe Region
• Currently coordinated by WHO/Europe and ECDC
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Surveillance system • Annual submission of TB surveillance data to WHO/Europe and ECDC
• Validation and analyses of data by WHO/Europe and ECDC
• Publication of report ‘Tuberculosis surveillance and monitoring in Europe’ around World TB Day (24th of March)
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Nat. institutes
Disease experts
General public
AF members
MB members
WHO
EMCDDA
EFSA
Others
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The European Surveillance System
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Surveillance information collected at EU level – Case based
• Age
• Gender
• Foreign/National
• HIV status
• Type of TB
- Pulmonary TB/extrapulmonary TB
- New/previously treated
• Laboratory diagnostic tests
- Smear microscopy
- Culture
- Nucleic acid amplification
• Drug sensitivity test results
• Treatment outcome
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TB notifications in EU/EEA, 2012
In 2012, 68 423 TB cases were reported in the EU/EEA. The notification rate was 13.5 per 100 000 population (range 3.4–85.2).
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Not included or not reporting
> 100 per 100 000
21 to 50 per 100 000
11 to 20 per 100 000
=< 10 per 100 000
51 to 100 per 100 000
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TB notifications in WHO European Region, 2012
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TB notification rates in EU/EEA, 2008−2012 Overall in the EU/EEA, notification rates have steadily declined.
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2008 2009 2010 2011 2012
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EU/EEA
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TB notification rates in WHO European Region, 2008-2012 In the WHO European Region notification rates are declining.
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0
20
40
60
80
100
120
2008 2009 2010 2011 2012
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EU/EEA Non EU/EEA WHO European Region
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TB in children (<15 years of age)
9
Not included or not reporting
4 to 9.9 per 100 000 child population
2 to 3.9 per 100 000 child population
≥ 10 per 100 000 child population
< 2 per 100 000 child population
In 2012, 2 845 TB cases in children were reported,
accounting for 4.2% (range 0–7.8%) of all notified TB cases
in the EU/EEA.
Notification rate
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TB cases of foreign origin, EU/EEA
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In 2012, the overall proportion of TB cases of foreign origin in the EU/EEA was 26.8% (range 0.2–85.4%).
25 to 49.9%
≥ 75%
1 to 24.9%
50 to 74.9%
< 1%
Not included or not reporting
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TB cases of foreign origin, WHO European Region
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TB/HIV co-infection
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In 2012, the overall proportion HIV positive among TB cases with known HIV status in EU/EEA was 5.5% (range 0–16.5%).
5 to 9.9%
2 to 4.9%
≥ 10%
< 1%
Not included or not reporting
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Extrapulmonary TB cases
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In 2012, the overall proportion of extrapulmonary TB cases in the EU/EEA was 23.0% (range 2.9–48.6%).
20 to 29.9%
≥ 40%
10 to 19.9%
30 to 39.9%
< 10%
Not included or not reporting
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Extrapulmonary TB risk factors, 2002-2011*
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Pulmonary TB Extrapulmonary TB
Site unknown Total
Sex N=642,871 N=167,652 N=3,696 N=868,726
Female 32.5% 46.4% 45.3% 35.3%
Male 67.4% 53.4% 53.6% 64.5%
Unknown 0.1% 0.2% 1.1% 0.1%
Age groups N=642,871 N=167,652 N=3,696 N=868,726
0-14 3.1% 7.7% 20.4% 4.1%
15-24 10.6% 13.4% 8.5% 11.1%
25-44 35.9% 36.7% 26.3% 36.1%
45-64 32.1% 22.6% 21.4% 30.2%
>=65 18.0% 19.5% 20.6% 18.3%
Unknown 0.2% 0.2% 2.8% 0.2%
Origin N=614,199 N=156,957 N=2,744 N=773,900
Foreign 17.7% 37.9% 31.0% 21.8%
Native 79.7% 58.6% 43.7% 75.3%
Unknown 2.6% 3.4% 25.4% 2.8%
* Sandgren et al., Eurosurveillance 2013
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Resistance pattern among new and previously treated TB cases*
0
5
10
15
20
25
30
35
40
2007 2008 2009 2010 2011 2012
%
0
5
10
15
20
25
30
35
40
2007 2008 2009 2010 2011 2012
%
0
5
10
15
20
25
30
35
40
2007 2008 2009 2010 2011 2012
%
Monoresistance
Polyresistancenon MDR TB
MDR TB, notXDR TB
XDR TB
Any resistance
New cases Previously treated cases 0
5
10
15
20
25
30
35
40
2007 2008 2009 2010 2011 2012
%
Monoresistance
Polyresistancenon MDR TB
MDR TB, notXDR TB
XDR TB
Any resistance
* Van der Werf et al. Eurosurveillance 2014
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Characteristics of TB cases by drug resistance pattern, EU/EEA, 2012 (1)
Pan-susceptible
(%)
Monoresistant (%)
Polyresistant non-MDR TB
(%)
MDR TB not XDR TB (%)
XDR TB (%)
Total (%)
Gender
Female 32.9 32.5 33.5 25.6 21.9 32.6
Male 67.1 67.5 66.3 74.4 78.1 67.4
Unknown 0 0 0.2 0 0 0
Age groups
0 – 14 1.5 2.1 1.3 1.1 0 1.5
15 – 24 11.1 12.7 11.9 9.4 7.0 11.1
25 – 44 37.7 41.6 45.8 43.6 48.4 38.4
45 – 64 32.4 32.8 32.4 38.7 36.7 32.7
≥65 17.3 10.8 8.6 7.3 7.8 16.3
Origin
Foreign 28.1 34.6 32.4 18.7 12.5 28.1
Native 70.5 64.1 66.3 81.1 87.5 70.6
Unknown 1.4 1.3 1.3 0.2 0 1.3
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Characteristics of TB cases by drug resistance pattern, EU/EEA, 2012 (2)
Pan-susceptible
(%)
Monoresistant (%)
Polyresistant non-MDR TB
(%)
MDR TB not XDR TB (%)
XDR TB (%)
Total (%)
Previous TB
No 84.1 78.2 80.1 43.7 19.5 81.6
Yes 11.9 18.0 15.3 53.1 77.3 14.4
Unknown 4 3.9 4.7 3.1 3.1 4
HIV status
HIV tested 26.6 28.5 32.2 52.7 65.6 28.1
HIV infected 4.4 8.7 8.7 10.4 13.1 5.3
Unknown 73.4 71.5 67.8 47.3 34.4 71.9
Site of disease
Pulmonary 84.5 83.0 85.8 95.3 99.2 85
Extra-pulmonary 15.3 17.0 14.0 4.7 0.8 14.8
Unknown 0.2 0 0.2 0.1 0 0.2
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Multidrug-resistant TB
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In 2012, the overall proportion of TB cases with multi-drug resistance in the EU/EEA was 4.6% (range 0–25.5%).
2 to 4.9%
≥ 10%
1 to 1.9%
5 to 9.9%
< 1%
Not included or not reporting
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Multidrug-resistance among new pulmonary TB cases
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2 to 4.9%
1 to 1.9%
≥ 5%
< 1%
Not included or not reporting
In 2012, the overall percentage of new pulmonary TB cases with multidrug resistance in the EU/EEA was 2.6% (range 0–20.5%).
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MDR TB in new TB cases, WHO European Region
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Trends in MDR TB case notification rate
In EU/EEA, mean declining trend in MDR TB In non EU/EEA, increasing trend in MDR TB
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0
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2008 2009 2010 2011 2012
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tifi
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EU/EEA non EU/EEA WHO European Region
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Extensively drug-resistant TB
22
In 2012, the proportion of extensively drug-resistant TB cases among multidrug-resistant cases in EU/EEA was 13.7% (range 0–50.0%).
10 to 19.9%
1 to 9.9%
≥20%
< 1%
Not included or not reporting
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Treatment success in new pulmonary TB cases
Treatment success rate for culture-confirmed new pulmonary TB cases notified in 2011 was 76.5% (range: 58.3–91.3%).
23 * Iceland and Malta reported zero new TB cases in 2011. Three EU/EEA Member States did not report treatment
outcome data
0
20
40
60
80
100
Tre
atm
ent
succ
ess
(%
)
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Treatment success in previously treated pulmonary TB cases
The treatment success rate for previously treated culture-confirmed pulmonary TB cases notified in 2011 was 55.2% (range 25.0–100.0%).
24 * Iceland and Malta reported zero previously treated TB cases in 2011. Three EU/EEA Member States did not report treatment
outcome data stratified by treatment history
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20
40
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%
Tre
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succ
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Treatment success rate in multidrug-resistant TB*
The treatment success rate for all multidrug-resistant TB cases notified in 2010 was 33.6% (range 0–100.0%).
25 * Slovenia reported zero MDR TB cases in 2010, 9 Member States did not report treatment outcome data for MDR TB cases
0
20
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Treatment outcome in multidrug-resistant TB over time Treatment outcomes for multidrug-resistant TB cases improved slightly between the 2008 and 2010 cohort, EU/EEA.
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0
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Success Died Failed Defaulted Still on treatment Transferred orunknown
cohort 2008
cohort 2009
cohort 2010
Tre
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Treatment success in extensively drug-resistant TB*
The treatment success rate in extensively drug-resistant TB cases notified in 2009 was 25.0% (range 0–66.7%).
27 * Cyprus, Denmark, Iceland, Malta, Slovakia, Slovenia and Sweden reported zero XDR TB cases in 2009, 12 countries did not
report Secondline drug resistance testing results or stratified treatment outcome data
0
20
40
60
80
EU/EEA Austria Belgium Bulgaria Czech
Republic
Estonia Latvia Lithuania Norway Poland Romania United
Kingdom
Tre
atm
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succ
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Contact the ECDC TB Programme
http://ecdc.europa.eu