1. Tuberculosis in the EU: An ECDC perspective World TB day European Parliament 22 March 2007 Zsuzsanna Jakab ECDC Director

2. Public health Socio-economical Scientific Regional The issues...

3. Regional gradient in TB cases, Europe 2005 Not included No data 0 – 10 11 – 20 21 – 50 >50 EU-27 19/100,000 Balkan states 29/100,000 FSU 110/100,000 Cases per 100,000 population Source: EuroTB

4. TB trends in Europe, 1995-2005 Cases per 100,000 population Source: EuroTB

5. Migration patterns change the epidemiology of TB

6. No data 0 % – 4 % 5 % – 19 % 20 % – 49 % >49 % Percentage cases foreign origin TB cases of foreign origin, Europe 2005 9 % FSU 34 % Asia 33 % Africa 8 % Balkans 19% EU cases of foreign origin Source: EuroTB

7. TB/HIV co infection in the EU, 2000-2005* * countries with >50 TB cases/year and with data for > two years Percentage cases with HIV Source: EuroTB Portugal Estonia Latvia Spain United Kingdom

8. TB in vulnerable populations in a low incidence country Highest rate in Europe (KAZ) 217 EU 14 104 FSU PrisonsEld. 74+ Foreign males City aver. Inner city Country average Data 2003, Sources: BES. Agencia Salut Publica Barcelona. Dirección General IIPP

9. Vaccine does not reduce transmission New drugs and diagnostic methods needed Drug resistance (MDR and XDR) an obstacle for successful treatment Operational research needed Scientific issue

10. Multi drug resistance (MDR), EU 2005 Percentage per tested cases * Countries with incomplete data Source: EuroTB

11. TB challenges for the EU TB PATTERNCHALLENGES Low incidence EU, 20 countries Move towards elimination TB increasingly rare Vulnerable groups Containing outbreaks Maintain awareness and expertise Moderate to high incidence EU, 7 countries Population-level control HIV Drug resistance (MDR, XDR) High incidence neighbouring countries Collaboration with neighbouring countries

12. ECDC strategies for TB in 2007 Further strengthen surveillance Strengthen laboratory capacity Develop scientific guidance Analyse national action plans with countries to further sterngthen them Develop European Action Plan at request of Commissioner Kyprianou

13. Conclusions TB remains an issue of concern for all countries Strategies to be developed according to the epidemiological situation Pursue effective partnership Progress towards elimination only achievable if the global burden of TB decreases

14. ecdc.europa.eu Thank you! Zsuzsanna Jakab Director, ECDC info@ecdc.eu.int