World Tuberculosis Day 2014

The TB situation in 2012: Findings from the joint TB surveillance and monitoring report by ECDC and the WHO Regional Office for Europe

ECDC TB TeamEuropean Centre for Disease Prevention and ControlStockholm, 24 March 2014

TB notifications by countryIn 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

50 to 99 per 100 000

20 to 49 per 100 000

10 to 19 per 100 000

< 10 per 100 000

Figure 1: TB notification rate per 100 000 population by country, EU/EEA, 2012

EU definition: Confirmed TB cases*

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Figure 2: Percentage of laboratory-confirmed TB cases by country, EU/EEA, 2012

70 to 79%

≥ 80%

60 to 69%

< 60%

Not included or not reporting

* Confirmed by culture or by both a positive sputum microscopy result and Mycobacterium tuberculosis nucleic acid identified in nucleic acid amplification test.

Overall, 61.9% (range 21.5–91.4%) of TB cases reported in the EU/EEA were laboratory confirmed.

TB in children

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Figure 3: TB notification rate in children under 15 years of age per 100 000 child population, by country, EU/EEA, 2012

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% of all notified TB cases (range 0–7.8%) in the EU/EEA.

TB cases of foreign origin

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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%).Figure 4: Percentage of TB cases of foreign origin by country, EU/EEA, 2012

25 to 49.9%

≥ 75%

1 to 24.9%

50 to 74.9%

< 1%

Not included or not reporting

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%).Figure 5: Percentage of extrapulmonary TB cases by country, EU/EEA, 2012

20 to 29.9%

≥ 40%

10 to 19.9%

30 to 39.9%

< 10%

Not included or not reporting

Extrapulmonary TB notification over timeExtrapulmonary TB notification rates have remained stable in the last 10 years.

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Figure 6: Extrapulmonary TB notification rate per 100 000 population by year, EU/EEA, 2003−2012

2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

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2

3

4

Year of reporting

Notifica

tion r

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per

100 0

00 p

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tion

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%).

Figure 7: Percentage of multidrug resistance among all confirmed TB cases by country, EU/EEA, 2012

2 to 4.9%

≥ 10%

1 to 1.9%

5 to 9.9%

< 1%

Not included or not reporting

Multidrug-resistance among new pulmonary TB cases

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Figure 8: Percentage of new pulmonary TB cases with multidrug resistance by country, EU/EEA, 2012

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%).

Multidrug-resistance among previously treated pulmonary TB cases

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In 2012, the overall proportion of previously treated pulmonary TB cases with multidrug resistance in the EU/EEA was 18.8% (range 0–50.0%).

Figure 9: Percentage of previously treated pulmonary TB cases with multidrug resistance by country, EU/EEA, 2012

10 to 19.9%

≥ 20%

1 to 9.9%

< 1%

Not included or not reporting

Extensively drug-resistant TB

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In 2012, the proportion of extensively drug-resistant TB cases among multidrug-resistant cases in EU/EEA was 13.7% (range 0–50.0%).

Figure 10: Percentage of extensively drug-resistant TB cases among multidrug-resistant TB cases tested for second-line drug susceptibility, by country, EU/EEA, 2012

10 to 19.9%

1 to 9.9%

≥20%

< 1%

Not included or not reporting

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%).

Figure 11: Percentage of HIV-positive cases among TB cases with known HIV status, by country, EU/EEA, 2012

5 to 9.9%

2 to 4.9%

≥ 10%

< 1%

Not included or not reporting

Treatment success in new pulmonary TB cases over timeThe treatment success rate in new culture-confirmed pulmonary TB cases notified between 2007 and 2011 has slightly decreased from 79.2% in 2007 to 76.5% in 2011.

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Figure 12: 12-month treatment success rate in new culture-confirmed pulmonary TB cases by year of initial case reporting, EU/EEA, 2007–2011

2007 2008 2009 2010 20110

20

40

60

80

100

79.2 79.4 79.0 77.0 76.5

Year of initial reporting

Tre

atm

ent s

ucce

ss (

%)

Treatment success in new pulmonary TB casesTreatment success rate for culture-confirmed new pulmonary TB cases notified in 2011 was 76.5% (range: 0–91.3%).

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Figure 13: Treatment success rate in culture-confirmed new pulmonary TB cases notified in 2011, by country, EU/EEA, 2012

* Iceland and Malta reported zero new TB cases in 2011. Three EU/EEA Member States did not report treatment outcome data

EU/E

EA

Austria

Belgiu

m

Bulgar

ia

Cypru

s

Czech

Rep

ublic

Denm

ark

Esto

nia

Finla

nd

Germ

any

Hungary

Ireland

Latv

ia

Lithuan

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Malta

Nether

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Norway

Poland

Portu

gal

Roman

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Slova

kia

Slove

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Spain

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United K

ingdom

0

20

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t su

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(%

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Treatment success in previously treated pulmonary TB casesThe treatment success rate for previously treated culture-confirmed pulmonary TB cases notified in 2011 was 55.2% (range 25.0–100.0%).

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Figure 14: Treatment success rate in previously treated culture-confirmed pulmonary TB cases notified in 2011, by country, EU/EEA

* 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

Subt

otal

EU/E

EA

Austri

a

Belgi

um

Bulga

ria

Cypru

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Czech

Rep

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Denm

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Esto

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Finla

nd

Germ

any

Hunga

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Irela

nd

Latv

ia

Lithu

ania

Nethe

rland

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Norway

Pola

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Portu

gal

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ia

Slov

akia

Slov

enia

Spai

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Unite

d Kin

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0

20

40

60

80

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%

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succ

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(%

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Treatment success rate in confirmed pulmonary TB cases*The treatment success rate for all confirmed pulmonary TB cases notified in 2011 was 72.4% (range 0–90.4%).

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Figure 15: Treatment success rate in laboratory confirmed pulmonary TB cases notified in 2011, by country, EU/EEA, 2012

* Four EU/EEA Member States did not report treatment outcome data

EU/E

EA

Austria

Belgiu

m

Bulgar

ia

Cypru

s

Czech

Rep

ublic

Denm

ark

Esto

nia

Finla

nd

Germ

any

Hungary

Ireland

Latv

ia

Lithuan

ia

Luxe

mbou

rg

Malta

Nether

lands

Norway

Poland

Portu

gal

Roman

ia

Slova

kia

Slove

nia

Spain

Sweden

United K

in...

0

20

40

60

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Treatment success rate in extrapulmonary TB*The treatment success rate in extrapulmonary TB cases notified in 2011 was 82.2% (range 59.0–100%).

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Figure 16: Treatment success rate in extrapulmonary TB cases notified in 2011, by country, EU/EEA, 2012

* Five Member States did not report stratified treatment outcome data

EU/E

EA

Austria

Belgiu

m

Bulgar

ia

Cypru

s

Czech

Rep

ublic

Denm

ark

Esto

nia

Germ

any

Hungary

Iceland

Ireland

Latv

ia

Lithuan

ia

Malta

Nether

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Norway

Poland

Portu

gal

Roman

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Slova

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in...

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20

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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%).

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Figure 17: 24-month treatment success rate in multidrug-resistant TB cases notified in 2010, by country, EU/EEA, 2012

* Slovenia reported zero MDR TB cases in 2010, 9 Member States did not report treatment outcome data for MDR TB cases

EU/E

EA

Austri

a

Belgi

um

Bulga

ria

Czech

Rep

ublic

Denm

ark

Esto

nia

Germ

any

Hunga

ry

Irela

nd

Latv

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Lith

uani

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Mal

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Treatment outcome in multidrug-resistant TB over timeTreatment outcomes for multidrug-resistant TB cases improved slightly between the 2008 and 2010 cohort, EU/EEA.

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Figure 18: 24-month treatment outcome in multidrug-resistant TB cases notified from 2008 to 2010, by year of initial case reporting, EU/EEA, 2012

Success Died Failed Defaulted Still on treatment

Transferred or unknown

0

10

20

30

40

cohort 2008

cohort 2009

cohort 2010

Tre

atm

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succ

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(%

)

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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%).

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Figure 19: 36-month treatment success rate in extensively drug-resistant TB cases notified in 2009, by country, EU/EEA, 2012

* Cyprus, Denmark, Iceland, Malta, Slovakia, Slovenia and Sweden reported zero XDR TB cases in 2009, 12 countries did not report SLD DST results or stratified treatment outcome data

EU/EEA Austria Belgium Bulgaria Czech Republic

Estonia Latvia Lithuania Norway Poland Romania United Kingdom

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20

40

60

80

Treatm

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succ

ess

(%

)