world tuberculosis day 2015 the tb situation in 2013: findings from the joint tb surveillance and...
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World Tuberculosis Day 2015
The TB situation in 2013: 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 2015
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TB notifications by countryIn 2013, 64 844 TB cases were reported in the EU/EEA.The notification rate was 12.7 per 100 000 population (range 3.4–83.5).
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Figure 1: TB notification rate per 100 000 population by country, EU/EEA, 2013
Not included or not reporting
20 to 49 per 100 000
10 to 19 per 100 000
5 to 9 per 100 000
< 5 per 100 000
≥ 50 per 100 000
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TB notification rate over timeThe TB notification rate has decreased from 19.3 per 100 000 population in 2004 to 12.7 in 2013.
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Figure 2: TB notification rate per 100 000 population in EU/EEA 2004−2013
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
5
10
15
20
25
Year of reporting
case
s/100 0
00
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EU definition: confirmed TB cases*
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Figure 3: Percentage of laboratory-confirmed TB cases by country, EU/EEA, 2013
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.
In 2013, 62.1% (range 21.4–94.3%) of TB cases reported in the EU/EEA were laboratory confirmed.
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Previously treated TB cases
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In 2013, the proportion of all previously treated TB cases in the EU/EEA was 11.7% (range 0.0–23.0%).
Figure 4: Percentage of previously treated TB cases by country, EU/EEA, 2013
Not included or not reporting
10 to 14.9%
≥ 15%
5 to 9.9%
< 5%
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TB in children
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Figure 5: TB notification rate in children under 15 years of age per 100 000 child population, by country, EU/EEA, 2013
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 2013, 2 655 TB cases in children were reported, accounting for 4.1% of all notified TB cases (range 0–9.5%) in the EU/EEA.
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TB cases of foreign origin
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In 2013, the proportion of TB cases of foreign origin in the EU/EEA was 28.0% (range 0.3–94.7%).Figure 6: Percentage of TB cases of foreign origin by country, EU/EEA, 2013
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 over time
The percentage of foreign TB cases increased from 18.2% in 2004 to 28.0% in 2013. The notification rate of foreign-origin TB cases has remained stable since 2004 (between 3.4 and 3.8 per 100 000 population).
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Figure 7: Percentage of TB cases with foreign origin, EU/EEA, 2004−2013
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
5
10
15
20
25
30
Year of reporting
Perc
enta
ge
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Extrapulmonary TB cases
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In 2013, the proportion of extrapulmonary TB cases in the EU/EEA was 22.3% (range 4.7–63.6%).
Figure 8: Percentage of extrapulmonary TB cases by country, EU/EEA, 2013
20 to 29.9%
≥ 40%
10 to 19.9%
30 to 39.9%
< 10%
Not included or not reporting
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Multidrug-resistant TB among all TB cases
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In 2013, the proportion of TB cases with multidrug-resistance in the EU/EEA was 4.1% (range 0–22.7%). Figure 9: Percentage of MDR TB among all confirmed TB cases by country, EU/EEA, 2013
2 to 4.9%
≥ 10%
1 to 1.9%
5 to 9.9%
< 1%
Not included or not reporting
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Multidrug-resistant TB case notification rate over timeThe rate of notified MDR TB cases has remained stable over the past five years at 0.3 per 100 000 population.
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Figure 10: MDR TB notification rate per 100 000 population in EU/EEA 2009−2013
2009 2010 2011 2012 20130.0
0.1
0.2
0.3
0.4
0.5
Year of reporting
case
s/100 0
00
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Multidrug-resistance among new pulmonary TB cases
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Figure 11: Percentage of new pulmonary TB cases with MDR TB by country, EU/EEA, 2013
2 to 4.9%
1 to 1.9%
≥ 5%
< 1%
Not included or not reporting
In 2013, the percentage of new pulmonary TB cases with multidrug-resistance in the EU/EEA was 2.6% (range 0–17.3%).
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Multidrug-resistance among previously treated pulmonary TB cases
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In 2013, the proportion of previously treated pulmonary TB cases with multidrug-resistance in the EU/EEA was 17.0% (range 0–100.0%).Figure 12: Percentage of previously treated pulmonary TB cases with MDR TB by country, EU/EEA, 2013
10 to 19.9%
≥ 20%
1 to 9.9%
< 1%
Not included or not reporting
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Extensively drug-resistant TB (XDR TB)
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In 2013, the proportion of extensively drug-resistant TB cases among multidrug-resistant cases in the EU/EEA was 17.5% (range 0–100.0% and 4.2–36.4% for countries reporting more than one case).Figure 13: Percentage of XDR TB cases among MDR TB cases tested for second-line drug susceptibility, by country, EU/EEA, 2013
20 to 29.9%
10 to 19.9%
≥30%
< 10%
Not included or not reporting
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TB/HIV co-infection
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In 2013, the proportion HIV positive among TB cases with known HIV status in EU/EEA was 4.9% (range 0–22.6%).
Figure 14: Percentage of HIV-positive cases among TB cases with known HIV status, by country, EU/EEA, 2013
5 to 9.9%
1 to 4.9%
≥10%
< 1%
Not included or not reporting
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Treatment success after 12 months in all TB cases*The treatment success rate for all TB cases notified in 2012 was 73.5% (range: 10.3–87.8%) and has remained stable over the past five years.
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Figure 15: Treatment success rate of TB cases notified in 2012, by country, EU/EEA, 2013
* Four EU/EEA Member States did not report treatment outcome data
EU/EEACroatia
MaltaCyprusFinlandEstoniaIrelandPoland
DenmarkAustria
LithuaniaHungary
SpainGermany
Czech RepublicBelgiumPortugal
LatviaNorway
United KingdomRomaniaSweden
SloveniaIceland
NetherlandsBulgariaSlovakia
0 10 20 30 40 50 60 70 80 90 100
Treatment success (%)
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Treatment success in new confirmed pulmonary TB cases and relapses started on treatment in 2012*The treatment success rate for confirmed new pulmonary TB cases and relapses notified in 2012 was 77.1% (range: 9.3–90.0%).
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Figure 16: Treatment success rate in confirmed new pulmonary TB cases and relapses started on treatment in 2012, by country, EU/EEA, 2013
* Cases started on second line treatment are excluded
EU/EEACroatia
MaltaCyprusFinlandPolandIreland
DenmarkSpain
HungaryAustria
GermanyPortugal
Czech RepublicBelgiumNorway
United KingdomEstoniaSweden
RomaniaNetherlands
SloveniaBulgaria
LatviaSlovakia
Iceland
0 20 40 60 80 100Treatment success (%)
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Treatment success rate in multidrug-resistant TB*The treatment success rate for all multidrug-resistant TB cases notified in 2011 was 37.8% (range 0–75.0%).
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Figure 17: 24-month treatment success rate in multidrug-resistant TB cases notified in 2011, by country, EU/EEA, 2013
* Malta and Slovenia reported zero MDR TB cases in 2012, 9 Member States did not report treatment outcome data for MDR TB cases
EU/EEADenmarkRomania
Czech RepublicIreland
SlovakiaPoland
LithuaniaHungary
United KingdomEstonia
PortugalGermany
LatviaBulgaria
NetherlandsAustria
SwedenBelgiumNorway
0 20 40 60 80
Treatment success (%)
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Treatment outcome in multidrug-resistant TB over timeThe treatment outcomes for multidrug-resistant TB cases improved slightly between the 2009 and 2011 cohort, EU/EEA.
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Figure 18: 24-month treatment outcome in multidrug-resistant TB cases notified from 2009 to 2011, by year of initial case reporting, EU/EEA
Success Died Failed Defaulted or unknown
Still on treatment0
10
20
30
40
MDR TB cohort 2009 MDR TB cohort 2010 MDR TB cohort 2011
Tre
atm
en
t ou
tcom
e (
%)
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Treatment success in extensively drug-resistant TB*The treatment success rate in extensively drug-resistant TB cases notified in 2010 was 25.9% (range 0–100.0%).
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Figure 19: 36-month treatment success rate in extensively drug-resistant TB cases notified in 2010, by country, EU/EEA, 2013
* Cyprus, Denmark, Italy, Norway, Slovakia and Slovenia reported zero XDR TB cases in 2010, 12 countries did not report SLD DST results or XDR TB treatment outcome data
EU/E
EA
Hunga
ry
Lith
uani
a
Roman
ia
Esto
nia
Unite
d Ki
ngdo
m
Latv
ia
Portu
gal
Austri
a
Belgi
um
Bulga
ria
Czech
Rep
ublic
Pola
nd0
20
40
60
80
100
Tre
atm
en
t su
cce
ss (
%)