EuroTB - Surveillance of tuberculosis in Europe

Background:

EuroTB was established in 1996 to improve the contribution of epidemiological surveillance to tuberculosis (TB) control in Europe. Until March 2008 when project activities finished, EuroTB coordinated the surveillance of TB in the 53 countries of the World Health Organisation's (WHO) European Region through contact points based in the national TB surveillance institutions which report standardised data annually to EuroTB. This work has now been handed over to the European Centre for Disease Prevention and Control (ECDC) and the WHO. The project was funded by the DG-SANCO of the European Commission and the Institut de veille sanitaire, France. Since 1998, a central component of the project was the surveillance for drug resistance (DRS) among TB strains reported in Europe, using both aggregated and case-based information. In 2005, a project was launched aimed to characterise European clusters of multi-drug resistant strains (MDR-TB) using epidemiological and molecular data, and run jointly between EuroTB and the National Institute of Public Health and the Environment (RIVM) of the Netherlands. Data from this network were used in 2006 to assess the frequency of extensively-resistant MDR-TB cases in reporting countries.

EuroTB data contributed to further characterise the foreign-born population as a risk group for TB incidence and for drug resistance in the European Union and other Western European countries. The broad geographic scope of EuroTB's surveillance enabled a better understanding of the epidemiological situation both within and outside the EU, including neighbouring countries of the former Soviet Union where the high incidence of TB and MDR-TB and the epidemics of HIV in certain countries, coupled with the lower available resources committed to TB control, represent a particular concern within the Region as a whole.

EuroTB was a Collaborating Centre of the WHO for the surveillance of tuberculosis. The implementation of a joint WHO/EuroTB data collection helped to improve the coordination of international surveillance and to avoid duplication of effort. EuroTB actively participated in developing consensus recommendations for TB surveillance in Europe and promoted standardisation of surveillance methods in Europe.

EuroTB has an informative website (including interactive access to surveillance data), and it published an annual surveillance report as well as periodical reports on the progress of the MDR-TB molecular surveillance project. In addition, staff from EuroTB regularly participated in scientific meetings and authored articles in peer-reviewed journals.

Problem:

Tuberculosis (TB) is a directly communicable condition and transmission most often occurs following the inhalation of droplets from a person with active TB. It is a serious disease which can lead to death, disability and chronicity. The likelihood of developing disease depends on host factors (HIV, immunity, general condition) and external factors (contact). The development of drug-resistant TB, including multi-drug resistant TB (MDR-TB), is largely a result of improper drug treatment. Once a TB patient develops resistant TB s/he can transmit the resistant TB to others.

These features make TB a cause of concern among the public and the public health professionals. TB has been in the limelight of late following outbreaks of infection linked to travel on long-haul international flights. Since 2006, reports of extensively resistant TB (XDR-TB) have made the headlines. With the re-emergence of TB as a public health challenge in the Western world in the early 1990s, the need for heightened surveillance for the condition also increased. In the West, risk of TB is higher in individuals originating from highly endemic areas, as well as marginalised individuals at higher risk of infection, disease or unfavourable outcome of TB.

In countries of the former socialist bloc, including those recently acceding to the EU, TB incidence is higher than the EU average. This is attributable to a number of factors, including the dismantlement of TB control facilities and the relative poverty in a number of countries following the reforms introduced in the wake of the economic upheavals after independence. Rates of multidrug resistant TB (MDR-TB) are high in the EU Baltic States and in other former countries of the Soviet Union bordering the enlarged EU. Enlargement and issues related to population mobility in the EU are likely to increase the opportunity for TB transmission.

Annual General Meeting of EuroTB - Vilnius, Lithuania (September 2006)

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