After several years of decreasing incidence, 2013 saw a rise in the number of tuberculosis (TB) cases in Slovakia: 401 TB cases, including 6 fatalities, were reported to the National TB Register, which is an incidence of 7.41 cases per 100 000 people. Slovak experts from the National Institute of TB, Respiratory Diseases and Chest Surgery pointed to several factors influencing this increase during a World TB Day press conference on 24 March 2014.
The increase is caused in part by improvement in surveillance and case detection. Of all reported cases, 341 were newly diagnosed cases, and the rest were cases with recurrent TB. The highest incidence rate was recorded in the age group 0-4 and in higher age groups.
Pockets of higher incidence
According to the epidemiologic data, 5 outbreaks of TB were reported in the eastern part of the country. This region has the highest incidence rate at between 8.06 and 16.03 per 100 000 people. 26.43% of the total number of cases were among the Roma minority, which is considered to be the population at highest risk.
38 children aged 0-14 years, mainly from the socially disadvantaged groups, became ill with TB in 2013. This represents a substantial increase compared with previous years, and may be associated with active case detection resulting from recent changes in the bacille Calmette–Guérin (BCG) vaccination policy. Mandatory neonatal BCG vaccination was cancelled on 1 January 2012.
The increase in cases is also caused by growing migration, the experts explained, because the incidence rate in neighbouring countries Ukraine and Hungary is high (93/100 000 and 18/100 000, respectively). Moreover, many Slovaks work in the United Kingdom, where in some London neighbourhoods, for example, the incidence rate has reached 110 per 100 000 people. These workers and their families are at high risk for TB especially now that their children living in Slovakia are not being vaccinated.
Achievements and way forward for Slovakia
Exceeding the average treatment success rate of 77% in European Union Member States, 86.6% of TB patients in Slovakia were successfully treated in 2013. “Slovakia is a good example for other countries with lower treatment success rates. This percentage is a result of long-term effort of all those who participate in the process of TB prevention and treatment. Patients must be treated for 6 months and treatment must be directly observed," said the Slovak Chief TB expert Dr Ivan Solovic, who is also a WHO Temporary Advisor for TB.
Upon request of Slovakia’s Minister of Health, the WHO/Europe Tuberculosis and Multidrug- and Extensively Drug Resistant TB programme conducted an external review of the national TB control programme in February 2013, paying specific attention to childhood TB and interventions to move towards TB elimination.
One of the recommendations of the WHO experts was to define selection criteria identifying the subpopulation of children benefiting from pro-active interventions for diagnosis and treatment of TB including:
- close contacts of TB patients;
- persons who have immigrated from high-incidence settings;
- persons working or residing in congregate facilities having people who are at high risk for TB (prisons, refugee camps, mental institutes, homeless shelters, among others), taking into account other internationally recognized risk factors such as diabetes and immunosuppression.
- A second recommendation was to offer an opt-out, free of charge, provider-initiated BCG vaccination to children at risk for TB.
At present WHO Country Office is working closely with the Slovak Ministry of Health and its experts to provide assistance in these processes.
Source: WHO Europe