Adequate treatment essential to stop tuberculosis across Europe – WHO/ECDC new report

Marking World TB Day, the WHO Regional Office for Europe and ECDC today released new surveillance data for 2011 (1). The data show that while overall the number of TB cases has come down at a rate of 5% per year, countries in the eastern part of the WHO European Region bear 87% of the burden. These countries also recorded most of the estimated 44 000 TB deaths in 2011. The European Union (EU)/European Economic Area (EEA) countries reported over 72 000 cases of TB, which signifies a 4% decrease compared to 2010.

"Improved diagnostic tools are helping to identify more TB cases, but this means that health systems everywhere have to keep up the pace and provide all newly detected patients with full treatment. This is still suboptimal in the European Region, where one in three TB patients does not get cured," says Zsuzsanna Jakab, WHO Regional Director for Europe. "TB is curable if patients are treated free of charge, according to their own needs, and accompanied through the right therapy until they finish it completely. This means making health systems people-centred, in the spirit of the new regional policy framework, Health 2020."

Commenting on the report's findings, Tonio Borg, European Commissioner for Health and Consumer Policy, says: "I am pleased to see progress achieved in fighting TB across the EU. I am concerned however with the critical situation in certain EU Member States, as well as the challenge posed by multidrug-resistant TB in countries that have previously been able to control the situation. The data point to notable health inequalities, with the vulnerable sector of society most affected. We need to reinforce our health systems so that all TB patients in the EU receive adequate treatment."

ECDC Director Marc Sprenger points out: "Our primary aim is to further reduce TB transmission by the timely diagnosis and adequate treatment of pulmonary TB. This is essential for TB elimination. But we should not forget about the patients with extrapulmonary TB, a form of TB that can affect any organ of the body, making the diagnosis particularly challenging for both doctors and patients. This group is often neglected in TB control strategies. In 2011, over 16 000 of all notified TB patients in the EU/EEA had extrapulmonary TB."

Adequate TB treatment essential

Adequate TB treatment will avert development of the drug-resistant forms of the disease (multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB)), which are growing into a public health emergency. Some 78 000 individuals are estimated to fall sick with M/XDR-TB yearly in the European Region, where there are over half of the world's countries with the highest percentage of M/XDR-TB cases. In the EU/EEA, M/XDR-TB is decreasing slightly but continues to be prevalent in TB patients especially in the three Baltic countries.

Fewer than 50% of patients with detected MDR-TB are successfully treated. Treatment for M/XDR-TB patients is much longer, is hundreds of times more costly and has more frequent and severe side effects than treatment of regular TB. One untreated TB or M/XDR-TB person can infect 10–15 other people yearly and 10% of these will develop the disease in their lifetime.

The current portfolio of TB drugs, diagnostics and vaccines is inadequate to treat TB and reach the elimination target globally by 2050. Few new drugs are in the pipeline with the potential to scale up the fight against TB. These drugs need to provide simpler, easily tolerated and less expensive therapies and reduce the treatment time from the current 6 months–2 years to less than two weeks.

Successful treatment targeted in WHO consolidated action plan on M/XDR-TB

Diagnosing 85% or 225 000 M/XDR-TB patients and treating at least 75% of them successfully are key targets of the WHO consolidated action plan on M/XDR-TB that all European countries subscribed to in 2011. The plan highlights the importance of moving from hospital to ambulatory care to reduce the risk of hospital-acquired infections and the psychological burden. All this would translate into 120 000 lives and US$ 12 billion saved.

Focus on extrapulmonary TB in the EU/EEA

From 2002 to 2011, the notification rates of extrapulmonary TB did not show a downward trend, whereas a decrease in pulmonary TB was recorded. As a result, the proportion of extrapulmonary TB patients increased from 16% in 2002 to 22% in 2011. The percentage of TB patients notified with extrapulmonary TB varied widely across the EU/EEA countries from as low as 4% to 67%. As symptoms of this form of TB may be diffuse or mimic other diseases, doctors may delay or miss diagnoses of extrapulmonary TB.

Activities on World TB Day 2013

The WHO Regional Office for Europe launches a photo exhibition "Faces of Tuberculosis" on 20 March in Brussels, Belgium under the patronage of Glenis Willmott, Member of the European Parliament.

On 22 March, a joint WHO/ECDC twitter chat on TB in the European Region will be held from 11:00 to 12:00 CET. Use the hashtag #TBchat.

ECDC will launch a video documentary on extrapulmonary TB on 19 March.

Notes to editors

• World TB Day is celebrated on 24 March each year around the world. The overall goal of the Day is to raise awareness about the burden of TB worldwide and the status of TB prevention and control efforts. 2013 is the second year of a two-year campaign for World TB Day, with the slogan "Stop TB in My Lifetime".

• The WHO Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region 2011–2015 aims to strengthen efforts to address the alarming problem of drug-resistant TB in the Region. The Plan was developed in a Region-wide consultation with representatives of the 53 WHO European Member States, experts, patients and communities suffering from the disease.

• TB most commonly affects the lungs (pulmonary TB), but it can affect virtually any organ (extrapulmonary TB). A case with TB in any other site than the lungs is considered an extrapulmonary TB (EPTB) case. EPTB, unlike pulmonary TB, is rarely infectious but contributes significantly to TB-related morbidity and can cause complications, lifelong sequelae and disabilities.

• The WHO European Region comprises 53 countries, with a population of nearly 900 million people, of which around 508 million live in the EU/EEA (27 EU Member States plus Iceland, Liechtenstein and Norway).

The WHO Regional Office for Europe's web site offers further information:

• Tuberculosis surveillance and monitoring in Europe 2013. Stockholm, ECDC, 2013
• Fact sheet: Figures talk: tuberculosis (TB) in the WHO European Region
• Global tuberculosis report 2012. Geneva, WHO, 2012
• Tuberculosis. Country work [web site]. Copenhagen, WHO Regional Office for Europe, 2011
• Roadmap to prevent and combat drug-resistant tuberculosis. Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis (M/XDR-TB) in the WHO European Region 2011–2015. Copenhagen WHO Regional Office for Europe, 2011
• Tuberculosis [web site]. Copenhagen, WHO Regional Office for Europe, 2013
• WHO Europe and the European Parliament mark World TB Day 2013

ECDC resources include:

• Tuberculosis surveillance and monitoring in Europe 2013. Stockholm, ECDC, 2013
• ECDC/WHO TB Surveillance and Monitoring Report 2013 Slide presentation - main findings
• Patient stories: a video documentary on extrapulmonary TB. Stockholm, ECDC, 2013
• Framework Action Plan to fight tuberculosis in the European Union. Stockholm, ECDC, 2008
• Progressing towards TB elimination. Stockholm, ECDC, 2010
• Articles on extrapulmonary TB in the EU/EEA. Eurosurveillance (as of 21 March 2013)
• European Union Standards for Tuberculosis Care. European Respiratory Journal, 2012, 39:807–819

(1) ECDC, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2013. Stockholm, ECDC, 2013.

ECDC press release

Source: WHO Europe