World Tuberculosis Day 2013 TB situation in 2011: Findings from the ECDC and WHO/EURO joint TB surveillance report ECDC TB Team European Centre for Disease Prevention and Control Stockholm, 24 March 2013

TB notification rates in EU/EEA, 2011 In the EU/EEA, TB cases were reported in Notification rate 14.2 per population (range 2.8 – 89.7). 2 Not included or not reporting 50 to 99 per to 49 per to 19 per < 10 per Figure 1: Country-specific TB notification rates, 2011

TB notification rates in EU/EEA, 2007−2011 Overall in the EU/EEA, notification rates have steadily declined. 3 Figure 2: Trend in TB notification rate in the EU/EEA 2007−2011

Proportion of confirmed* TB cases in the EU/EEA, 2011 Overall 61.3% (range 27.9 – 94.8%) of TB cases reported in the EU/EEA were laboratory-confirmed. 4 Figure 3: Country-specific proportion of all confirmed TB cases in to 79% ≥ 80% 60 to 69% < 60% Not included or not reporting *Confirmed by culture or both a positive sputum microscopy result and Mycobacterium tuberculosis nucleic acid identified in nucleic acid amplification test.

TB notification rates in children <15 years of age in EU/EEA, 2011 In 2011, cases of TB in children were reported, accounting for 4.4% of all notified TB cases (range 0 – 11.1%) in the EU/EEA. 5 Figure 4: Country-specific childhood TB notification rates among child population (0–14 years), 2011 Not included or not reporting 4 to 9.9 per child population 2 to 3.9 per child population ≥ 10 per child population < 2 per child population

Proportion of foreign origin among notified TB cases in EU/EEA, In 2011, the overall proportion of TB cases of foreign origin in the EU/EEA was 25.8% (range 0.3 – 89.4%). Figure 5: Country-specific proportion of foreign origin cases among all notified TB cases, EU/EEA, to 49% ≥ 75% 1 to 24% 50 to 74% < 1% Not included or not reporting

Proportion of notified extrapulmonary TB cases in EU/EEA, In 2011, the overall proportion of extrapulmonary TB cases in the EU/EEA was 22.3% (range 3.9 – 66.7%). Figure 6: Country-specific proportion of extrapulmonary TB of all notified TB cases, EU/EEA, to 29% ≥ 50% 5 to 19% 30 to 49% < 5% Not included or not reporting

Extrapulmonary TB notification rates in EU/EEA, 2002−2011 Extrapulmonary TB notification rates have remained stable in the last 10 years. 8 Figure 7: Trend in extrapulmonary TB notification rate in the EU/EEA, 2002−2011

Proportions of TB by site among all notified TB cases in EU/EEA, 2002−2011 Percentage of extrapulmonary TB increased from 16.4% in 2002 to 22.4% in Figure 8: Proportion of notified pulmonary and extrapulmonary TB cases in the EU/EEA, 2002−2011

Proportion of culture-confirmed new pulmonary TB cases in EU/EEA, % of new pulmonary TB cases were culture-confirmed. The proportion varied widely across countries (range 0 – 98%). 10 Figure 9: Proportion of new pulmonary TB cases confirmed by culture, 2011

Proportion of notified TB cases with multi-drug resistance among all confirmed TB cases in EU/EEA, In 2011, the overall proportion of TB cases with multi-drug resistance in the EU/EEA was 4.5% (range 0 – 29.8%). Figure 10: Country-specific proportion of multidrug resistance among all confirmed TB cases, EU/EEA, to 4.9% ≥ 10% 1 to 1.9% 5 to 9.9% < 1% Not included or not reporting

Proportion of notified new TB cases with multidrug resistance in EU/EEA, In 2011, the overall proportion of new TB cases with multi- drug resistance in the EU/EEA was 2.4% (range 0 – 23.3%). Figure 11: Country-specific proportion of new TB cases with multidrug resistance, EU/EEA, to 4.9% ≥ 10% 1 to 1.9% 5 to 9.9% < 1% Not included or not reporting

Notification rates of new cases with multidrug resistant TB in EU/EEA, 2007−2011 The notification rate of multidrug resistant TB have remained stable at around 0.3 per population. 13 Figure 12: Trends in multidrug resistant TB notification rate in the EU/EEA, 2007−2011

Proportion of notified previously treated TB cases with multidrug resistance in EU/EEA, In 2011, the overall proportion of previously treated TB cases with multidrug resistance in the EU/EEA was 16.8% (range 0 – 57.7%). Figure 13: Country-specific proportion of previously treated TB cases with multi-drug resistance, EU/EEA, to 4.9% ≥ 10% 1 to 1.9% 5 to 9.9% < 1% Not included or not reporting

Proportion of TB cases with extensive drug resistance among MDR-TB cases with SLD ST* reported in EU/EEA, In 2011, the proportion of extensive drug resistant cases among cases with multidrug resistance in EU/EEA was 13.4% (range 0 – 40.0%). Figure 14: Country-specific proportion of extensively drug resistant TB cases among TB cases with multi-drug resistance, EU/EEA, to 9% ≥ 20% 1 to 4% 10 to 19% < 1% *SLD ST – second line drug susceptibility testing result Not included or not reporting

Proportion of HIV positive TB cases among all TB cases with known HIV status in EU/EEA, In 2011, the overall proportion of HIV positive TB cases among TB cases with known HIV status in EU/EEA was 4.7% (range 0 – 40%). Figure 15: Country-specific proportion of HIV positive TB cases among TB cases with known HIV status, EU/EEA, to 4.9% ≥ 10% 1 to 1.9% 5 to 9.9% < 1% Not included or not reporting

Treatment success rate for new pulmonary TB cases in EU/EEA*, 2010 The treatment success rate for new culture-confirmed pulmonary TB cases notified in 2010 was 76.8% (range: 0 – 91.4%). 17 Figure 16: Treatment success rate for new culture-confirmed pulmonary TB cases notified in 2010 * Five EU/EEA Member States did not report treatment outcome data.

Treatment success rate for new pulmonary TB cases by year of reporting in EU/EEA, 2006−2010 The treatment success rate for new culture-confirmed pulmonary TB cases notified between 2006 and 2010 has slightly decreased from 79.5% in 2006 to 76.8% in Figure 17: Treatment success rate for new culture-confirmed pulmonary TB cases notified in 2006−2010

Treatment success rate for previously treated pulmonary TB cases in EU/EEA*, 2010 The treatment success rate for previously treated culture-confirmed pulmonary TB cases notified in 2010 was 53.7% (range 31.4 – 85.7%). 19 Figure 18: Treatment success rate for previously treated culture-confirmed pulmonary TB cases notified in 2010 * Iceland and Luxembourg reported zero previously treated TB cases in Seven EU/EEA Member States did not report stratified treatment outcome data

Treatment success rate for all notified pulmonary TB cases in EU/EEA*, 2010 The treatment success rate for all confirmed pulmonary TB cases notified in 2010 was 72.4% (range 0 – 88.9%). 20 Figure 19: Treatment success rate for all confirmed pulmonary TB cases notified in 2010 * Five EU/EEA Member States did not report treatment outcome data

Treatment success* rate for extrapulmonary TB cases in EU/EEA**, 2010 The treatment success rate for extrapulmonary TB cases notified in 2010 was 82.2% (range 21.1 – 100%). 21 Figure 20: Treatment success rate for extrapulmonary TB cases notified in 2010 *Treatment success of extrapulmonary TB consists of cases reported as completed full course of anti-tuberculosis treatment ** Seven Member States did not report stratified treatment outcome data

Treatment success rate for notified multidrug-resistant TB cases in EU/EEA*, 2009 The treatment success rate for all confirmed multidrug-resistant TB cases notified in 2009 was 31.6% (range 0 – 84.6%). 22 Figure 21: Treatment success rate for all confirmed multidrug-resistant TB cases notified in 2009 * Malta reported zero MDR TB cases in 2009, 11 Member States did not report treatment outcome data

Treatment outcome for multidrug-resistant TB cases notified in 2007−2009 Treatment outcomes for multidrug-resistant TB cases did not improve between the 2007 and 2009 cohort, EU/EEA. 23 Figure 22: Treatment outcome at 24 months for multidrug-resistant TB cases diagnosed in 2009, compared with cases diagnosed in 2007 and 2008