World Tuberculosis Day 2013
TB situation in 2011: Findings from the ECDC and
WHO/EURO joint TB surveillance report
ECDC TB Team
European Centre for Disease Prevention and Control
Stockholm, 24 March 2013
TB notification rates in EU/EEA, 2011
In the EU/EEA, 72 334 TB cases were reported in 2011.
Notification rate 14.2 per 100 000 population (range 2.8 – 89.7).
Figure 1: Country-specific TB notification rates, 2011
< 10 per 100 000
10 to 19 per 100 000
20 to 49 per 100 000
50 to 99 per 100 000
Not included or not
reporting
2
TB notification rates in EU/EEA, 2007−2011
Overall in the EU/EEA, notification rates have steadily declined.
Figure 2: Trend in TB notification rate in the EU/EEA 2007−2011
Notification rate per 100 000 population
20
15
16.8
16.5
15.8
14.9
14.2
10
5
2007
2008
2009
2010
2011
Year of reporting
3
Proportion of confirmed* TB cases in the
EU/EEA, 2011
Overall 61.3% (range 27.9 – 94.8%) of TB cases reported
in the EU/EEA were laboratory-confirmed.
Figure 3: Country-specific
proportion of all confirmed TB
cases in 2011.
< 60%
60 to 69%
70 to 79%
≥ 80%
Not included or
not reporting
*Confirmed by culture or both a positive sputum microscopy result and Mycobacterium tuberculosis nucleic acid identified in nucleic
acid amplification test.
4
TB notification rates in children <15 years
of age in EU/EEA, 2011
In 2011, 3 190 cases of TB in children were reported, accounting
for 4.4% of all notified TB cases (range 0 – 11.1%) in the EU/EEA.
Figure 4: Country-specific childhood TB
notification rates among child population
(0–14 years), 2011
< 2 per
100 000 child population
2 to 3.9 per
100 000 child population
4 to 9.9 per
100 000 child population
≥ 10 per
100 000 child population
Not included or not
reporting
5
Proportion of foreign origin among notified
TB cases in EU/EEA, 2011
In 2011, the overall proportion of TB cases of foreign origin in
the EU/EEA was 25.8% (range 0.3 – 89.4%).
Figure 5: Country-specific
proportion of foreign origin cases
among all notified TB cases,
EU/EEA, 2011
< 1%
1 to 24%
25 to 49%
50 to 74%
≥ 75%
Not included or
not reporting
6
Proportion of notified extrapulmonary TB
cases in EU/EEA, 2011
In 2011, the overall proportion of extrapulmonary TB cases in
the EU/EEA was 22.3% (range 3.9 – 66.7%).
Figure 6: Country-specific proportion
of extrapulmonary TB of all notified
TB cases, EU/EEA, 2011
< 5%
5 to 19%
20 to 29%
30 to 49%
≥ 50%
Not included or
not reporting
7
Extrapulmonary TB notification rates in
EU/EEA, 2002−2011
Extrapulmonary TB notification rates have remained stable in the last 10 years.
Figure 7: Trend in extrapulmonary TB notification rate in the EU/EEA, 2002−2011
Notification rate per 100 000 population
5
4
3
3.4
3.4
3.5
2003
2004
3.3
3.4
2005
2006
3.2
3.5
3.4
3.3
2008
2009
2010
3.2
2
1
0
2002
2007
2011
Year of reporting
8
Proportions of TB by site among all notified
TB cases in EU/EEA, 2002−2011
Percentage of extrapulmonary TB increased from 16.4% in 2002 to 22.4% in 2011.
Figure 8: Proportion of notified pulmonary and extrapulmonary TB cases in the
EU/EEA, 2002−2011
Number of cases
100000
Pulmonary TB
Extrapulmonary TB
90000
80000
70000
60000
50000
40000
30000
20000
10000
0
2002
2003
2004
2005
2006
Year of reporting
2007
2008
2009
2010
2011
9
Proportion of culture-confirmed new
pulmonary TB cases in EU/EEA, 2011
69% of new pulmonary TB cases were culture-confirmed.
The proportion varied widely across countries (range 0 – 98%).
Figure 9: Proportion of new pulmonary TB cases confirmed by culture, 2011
100
80
%
60
40
20
0
10
Proportion of notified TB cases with multi-drug
resistance among all confirmed TB cases in
EU/EEA, 2011
In 2011, the overall proportion of TB cases with multi-drug
resistance in the EU/EEA was 4.5% (range 0 – 29.8%).
Figure 10: Country-specific proportion
of multidrug resistance among all
confirmed TB cases,
EU/EEA, 2011
< 1%
1 to 1.9%
2 to 4.9%
5 to 9.9%
≥ 10%
Not included or
not reporting
11
Proportion of notified new TB cases with
multidrug resistance in EU/EEA, 2011
In 2011, the overall proportion of new TB cases with multidrug resistance in the EU/EEA was 2.4% (range 0 – 23.3%).
Figure 11: Country-specific
proportion of new TB cases with
multidrug resistance, EU/EEA,
2011
< 1%
1 to 1.9%
2 to 4.9%
5 to 9.9%
≥ 10%
Not included or
not reporting
12
Notification rates of new cases with
multidrug resistant TB in EU/EEA,
2007−2011
The notification rate of multidrug resistant TB have remained stable at around 0.3 per 100
000 population.
Notification rate per 100 000 population
Figure 12: Trends in multidrug resistant TB notification rate in the EU/EEA,
2007−2011
0.4
0.3
0.33
0.35
0.33
0.30
0.30
0.2
0.1
0.0
2007
2008
2009
2010
2011
Year of reporting
13
Proportion of notified previously treated TB
cases with multidrug resistance in EU/EEA,
2011
In 2011, the overall proportion of previously treated TB cases with
multidrug resistance in the EU/EEA was 16.8% (range 0 – 57.7%).
Figure 13: Country-specific
proportion of previously treated
TB cases with multi-drug
resistance, EU/EEA, 2011
< 1%
1 to 1.9%
2 to 4.9%
5 to 9.9%
≥ 10%
Not included or
not reporting
14
Proportion of TB cases with extensive drug resistance
among MDR-TB cases with SLD ST* reported
in EU/EEA, 2011
In 2011, the proportion of extensive drug resistant cases among
cases with multidrug resistance in EU/EEA was 13.4%
(range 0 – 40.0%).
Figure 14: Country-specific proportion of
extensively drug resistant TB cases among
TB cases with multi-drug
resistance, EU/EEA, 2011
< 1%
1 to 4%
5 to 9%
10 to 19%
Not
included
Not
includedoror
≥
20%
not
reporting
not reporting
*SLD ST – second line drug susceptibility testing result
15
Proportion of HIV positive TB cases among all TB
cases with known HIV status in EU/EEA, 2011
In 2011, the overall proportion of HIV positive TB cases among TB
cases with known HIV status in EU/EEA was 4.7%
(range 0 – 40%).
Figure 15: Country-specific
proportion of HIV positive TB
cases among TB cases with
known HIV status, EU/EEA,
2011
< 1%
1 to 1.9%
2 to 4.9%
5 to 9.9%
≥ 10%
Not included or
not reporting
16
Treatment success rate for new pulmonary
TB cases in EU/EEA*, 2010
The treatment success rate for new culture-confirmed pulmonary TB cases notified
in 2010 was 76.8% (range: 0 – 91.4%).
Figure 16: Treatment success rate for new culture-confirmed pulmonary TB cases
notified in 2010
Treatment success (%)
100
80
60
40
20
0
* Five EU/EEA Member States did not report treatment outcome data.
17
Treatment success rate for new
pulmonary TB cases by year of reporting
in EU/EEA, 2006−2010
The treatment success rate for new culture-confirmed pulmonary TB cases notified between
2006 and 2010 has slightly decreased from 79.5% in 2006 to 76.8% in 2010.
Figure 17: Treatment success rate for new culture-confirmed pulmonary TB cases
notified in 2006−2010
Treatment success (%)
100
80
79.5
79.2
79.5
78.9
76.8
2007
2008
2009
2010
60
40
20
0
2006
Year of reporting
18
Treatment success rate for previously
treated pulmonary TB cases in EU/EEA*,
2010
The treatment success rate for previously treated culture-confirmed pulmonary TB
cases notified in 2010 was 53.7% (range 31.4 – 85.7%).
Figure 18: Treatment success rate for previously treated culture-confirmed
pulmonary TB cases notified in 2010
100
Treatment success (%)
80
60
40
20
0
* Iceland and Luxembourg reported zero previously treated TB cases in 2010. Seven EU/EEA Member States did not
report stratified treatment outcome data
19
Treatment success rate for all notified
pulmonary TB cases in EU/EEA*, 2010
The treatment success rate for all confirmed pulmonary TB cases notified in 2010
was 72.4% (range 0 – 88.9%).
Figure 19: Treatment success rate for all confirmed pulmonary TB cases notified in
2010
Treatment success (%)
100
80
60
40
20
0
* Five EU/EEA Member States did not report treatment outcome data
20
Treatment success* rate for extrapulmonary
TB cases in EU/EEA**, 2010
The treatment success rate for extrapulmonary TB cases notified in 2010 was
82.2% (range 21.1 – 100%).
Figure 20: Treatment success rate for extrapulmonary TB cases notified in 2010
Treatment success (%)
100
80
60
40
20
0
*Treatment success of extrapulmonary TB consists of cases reported as completed full course of anti-tuberculosis treatment
** Seven Member States did not report stratified treatment outcome data
21
Treatment success rate for notified
multidrug-resistant TB cases in EU/EEA*,
2009
The treatment success rate for all confirmed multidrug-resistant TB cases notified in
2009 was 31.6% (range 0 – 84.6%).
Figure 21: Treatment success rate for all confirmed multidrug-resistant TB
cases notified in 2009
100
Treatment success (%)
80
60
40
20
0
* Malta reported zero MDR TB cases in 2009, 11 Member States did not report treatment outcome data
22
Treatment outcome for multidrug-resistant
TB cases notified in 2007−2009
Treatment outcomes for multidrug-resistant TB cases did not improve
between the 2007 and 2009 cohort, EU/EEA.
Figure 22: Treatment outcome at 24 months for multidrug-resistant TB
cases diagnosed in 2009, compared with cases diagnosed in 2007 and 2008
35
cohort 2009 (18 countries)
30
cohort 2008 (20 countries)
Percentage
25
cohort 2007 (15 countries)
20
15
10
5
0
Success
Died
Failed
Defaulted
Still on
treatment
Transferred or
unknown
23