Transcript Assessment of tuberculosis surveillance in Romania

Tuberculosis
Surveillance in Europe
EuroTB
update March 2008
WHO Collaborating Centre
About EuroTB, 1996-2007
EuroTB was set up in 1996 to develop and
coordinate a European network of national tuberculosis
surveillance institutions in the 53 countries of the WHO
European Region. The project was based at the Institut de
veille sanitaire (InVS) in France, and was financially
supported by the European Commission. The mission
statement of EuroTB was to improve the contribution of
surveillance to tuberculosis control in the European Region.
EuroTB promoted the standardisation of surveillance
methods. Its mainstay was the collection and validation of
national epidemiological information on tuberculosis,
including drug resistance and treatment outcome. The main
outputs were an annual report, scientific articles, oral
communications and data dissemination on www.eurotb.org.
Data presented here are the latest available at the end of
the project in December 2007.
WHO European Region, 2008
EUROPEAN UNION (EU) (dark blue)
Austria
Belgium
Bulgaria
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
WEST, non-EU (light blue)
Andorra
Iceland
Israel
Monaco
Norway
San Marino
Switzerland
EAST (orange)
Armenia
Azerbaijan
Belarus
Georgia
Kazakhstan
Kyrgyzstan
Moldova
Russian Federation
Tajikistan
Turkmenistan
Ukraine
Uzbekistan
BALKANS (yellow)
Albania
Bosnia & Herzegovina
Croatia
Macedonia, F.Y.R
Montenegro
Serbia
Turkey
Case-based reporting to EuroTB in 2007
Not included or not reporting to EuroTB
No case-based reporting (aggregate only)
Case-based notification data only
Case-based data, including drug resistance
Case-based data, including drug resistance and outcome*
*
*
Andorra
Malta
Monaco
San Marino
* No case-based data for drug resistance in Greece and Poland.
Outcome data in Greece started in report year 2006.
European definitions for TB surveillance (1)
Definite case*
A patient with culture-confirmed TB disease due to Mycobacterium
tuberculosis complex.
In countries where culture is not routine:
a patient with positive sputum smear
Other-than-
A patient with clinical and/or radiological signs compatible with TB
definite case*
and
clinician’s decision to treat with full treatment
Notifiable TB
All definite and other-than-definite TB cases notified in the calendar
case*
year of interest should be notified. Cases should only be counted
once in a given calendar year.
New case
A patient who has never had treatment for TB in the past or who has
taken anti-TB drugs for less than one month.
Retreated case
A patient previously treated for TB with combination chemotherapy for
4 weeks or more, excluding prophylactic therapy.
* In the new definitions proposed by the European Centre for Disease Prevention and Control, “definite” and
“other-than-definite” will be replaced by “possible” (based only on clinical criteria or post-mortem findings),
“probable” (if there is additional detection of acid-fast bacilli or granulomata or M.tb complex nucleic acid) or
“confirmed” (by culture, or nucleic acid+AFB). All three categories will be subject to reporting, as well as cases
reported only by laboratories without information on clinical criteria.
European definitions for TB surveillance (2)
Pulmonary case
A patient with TB of the lung parenchyma or the tracheobronchial tree (including larynx).
Extra-pulmonary case
A patient with TB of organs other than the lungs or the
tracheo-bronchial tree
Note: a patient with both pulmonary and extra-pulmonary TB is classified as pulmonary.
Primary drug resistance
Resistance to one or more anti-TB drugs at start of treatment
in a new TB case
Acquired drug
resistance
Resistance to one or more anti-TB drugs at start of treatment
in a retreated TB case
Multi-drug resistance
(MDR)
Resistance to at least isoniazid and rifampicin
Extensive drug
resistance (XDR)
MDR and
1)
resistance to a fluoroquinolone and
2)
resistance to one or more of the following injectable
drugs: amikacin, capreomycin, or kanamycin
European definitions for TB surveillance (3)
Treatment outcome categories (from 2001 cohorts)
Cured
Treatment completion and:
-culture becoming negative on samples taken at the end of treatment and
on at least one previous occasion, or
- sputum microscopy becoming negative for AFB at the end of treatment
and on at least one previous occasion
Completed
Treatment completion, not meeting the criteria to be classified as cure or
treatment failure
Died
Death before starting treatment or during treatment, irrespective of cause
(including post-mortem diagnosis)
Failed
Culture or sputum microscopy remaining positive or becoming positive
again at 5 months or later during treatment
Defaulted
Treatment interrupted for 2 consecutive months or more
Transferred
Patient referral to another clinical unit for treatment and information on
outcome not available / not obtained
Still on treatment
Patient still on treatment at 12 months and who did not meet any other
outcome during treatment, including patients with:
- treatment prolonged because of side effects / complications, initial
regimen planned for > 12 months
- initial treatment changed due to polyresistance (ie. resistance to at least
two first line drugs) on the isolate taken at the start of treatment
- information on the reasons for being still on treatment not available
Unknown
information on outcome not available
European definitions for TB surveillance (4)
Cohort analysis for treatment outcome monitoring (TOM)
Cohort
All definite pulmonary cases notified in one calendar
year and followed up for TOM. Cohorts in use for
TOM are either smear positive or culture positive
(depending on the country of report) and stratified by
treatment history - new, retreated and unknown.
Period of
observation
Maximal duration of time from start of treatment or
registration for observing treatment outcome. This is
set at 12 months.
Tuberculosis notification rates (1)
World, 2006*
* Notified TB cases (new and relapse)
per 100 000 population
No report
0–24
25–49
50–99
100 or more
Source: WHO, 2008
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
 WHO 2006. All rights reserved
Tuberculosis notification rates (2)
WHO European Region, 2006
TB cases per 100 000 population
Not included
Not reporting to EuroTB
< 11
11 – 20
21 – 50
> 50
Andorra
Malta
Monaco
San Marino
Tuberculosis notification rates (3)
Trends by areas, 1996-2006
120
TB cases/100 000
100
East
80
European Region
60
Balkans
40
EU-27 & West
20
EU-15
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Tuberculosis notification rates (4)
Mean annual change in rate, 1998-2006*
% change in rate
10%
EU & West
Balkans
East
5%
0%
-5%
-10%
1998-2002
* Excluding Monaco, San Marino (EU & West)
2002-2006
Tuberculosis notification rates (5)
Pulmonary smear positive rates, 2006
40
Sputum smear positive
TB cases / 100 000
35
30
EU & West
25
20
Balkans
15
10
East
5
(1-68)
(6-15)
(27-117)
0
* Country range shown in brackets. Excluding countries with missing data (Monaco, San Marino) or using
the respiratory classification (Belarus, Bulgaria)
Percentage of TB cases of foreign origin, 2006
Not included or not reporting to EuroTB
0% – 4%
5% – 19%
20% – 49%
> 49%
Andorra
Malta
Monaco
San Marino
TB cases with positive culture, 2006*
Percentage of TB cases with positive culture
Not included or no culture data reported to EuroTB
< 40%
40% – 54%
55% – 74%
> 74%
Andorra
(28-100%)
Malta
(28-63%)
(4-36%)
Monaco
San Marino
* Data from 2005 for Ireland and Romania (culture results incomplete in 2006)
TB cases with primary MDR, 2006*
Percentage of new TB cases with MDR
Not included or not reporting to EuroTB
No nationwide data on drug resistance reported
0.0% – 0.9%
1.0% – 1.9%
2.0% – 5.9%
6.0% – 19.4%
*
*
*
*
*
Andorra
Malta
Monaco
San Marino
*
*
Showing only countries with nationwide data.
Data from 2004 for Poland and Romania and 2005 for Ireland.
Data representativeness unknown in countries marked with an asterisk.
Treatment outcome
New definite pulmonary cases, 2001-2005*
Success
Died
Failed or Still on treatment
Defaulted, Transferred or Unknown
100%
80%
60%
% cases
40%
20%
0%
2001 2002 2003 2004 2005
EU & West
2001 2002 2003 2004 2005
Balkans
2001 2002 2003 2004 2005
East
* Countries with representative outcome data. EU & West (culture positive): Andorra, Austria, Belgium, Czech
Rep, Denmark, Estonia, Germany, Hungary, Iceland, Ireland, Israel, Latvia, Lithuania, Malta, Netherlands,
Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden, United Kingdom. Balkans (smear positive):
Albania, Macedonia F.Y.R. East (smear positive): Kazakhstan, Kyrgyzstan
TB mortality rates, 2001-2006*
TB deaths per 100 000 population
Not included
No data or data incomplete
< 1.1
1.1 – 5.0
5.1 – 10.0
> 10.0
Andorra
Malta
Monaco
San Marino
* Source: WHO Mortality Database, October 2007. Data shown for latest available year.
Including only deaths from TB coded ICD-9 010-018 or ICD-10 A15-19.