World Tuberculosis Day 2014 The TB situation in 2012: Findings from the joint TB surveillance and monitoring report by ECDC and the WHO Regional Office for Europe ECDC TB Team European Centre for Disease Prevention and Control Stockholm, 24 March 2014

Monitoring Four epidemiological indicators Eight core indicators 2

Epidemiological indicators 3

Indicator 1: Trends in case notification rate 2008−2012 Target: Mean declining trend over the previous five years Status 2012: 21 countries met the target 4 Figure 1: Trend in TB notification rate, EU/EEA, 2008−2012

Indicator 2: Trends in multidrug-resistant TB case notification rate Target: Mean declining trend in MDR TB over the previous five years Status 2012: 7 countries met the target 5 Figure 2: Multidrug-resistant TB notification rate per by year, EU/EEA, 2008−2012

Indicator 3: Trends in child-to-adult notification ratio Target: Mean declining 10-year trend in child-to-adult notification ratio Status 2012: Three countries reported a declining trend 6 Figure 3: Child-to-adult TB notification ratio, EU/EEA, 2003−2012

Indicator 4: Trends in mean age of TB cases Target: Increasing 10-year trend Status 2012: Twelve countries met the target 7 Figure 4: Trend in mean age of TB cases, EU/EEA, 2003−2012

Core indicators 8

Indicator 1 and 2: Availability of national TB control plan and implementation guidelines 9 13 countries have a national TB control plan 11 countries have a plan and guidelines for implementation Information not available or country not reporting National TB control plan not available National TB control plan available with implementation guidelines National TB control plan available Figure 5: Availability of a national TB control plan and implementation guidelines, EU/EEA, 2012

Indicator 3: Percentage of national TB reference laboratories achieving adequate performance in the external quality assessment (EQA) scheme 10 * Results for 2012 report obtained from European Reference Laboratory Network for Tuberculosis (ERLN-TB) for smear microscopy, culture, and drug susceptibility testing for first- and second-line TB drugs. No country-specific data are available. Target: 100% of national TB reference laboratories achieving ≥ 80% performance (smear, culture, first- and second-line drug susceptibility testing). Status 2012*: Nineteen laboratories participated in the EQA for all four diagnostic methods and 18 (95%) laboratories achieved a performance of ≥ 80% for all four methods.

Indicator 4: Availability of a strategy for introducing and implementing new tools for TB control 11 Target: All Member States (100%) have a strategy within the national TB programme supporting the introduction and implementation of new tools for TB control. Status 2012: Seven countries have a strategy in place. Figure 6: Availability of a strategy for introducing and implementing new tools for TB control, by country, EU/EEA, 2012 Information not available or country not reporting Strategy for new tools for TB control not available Strategy for new tools for TB control available

Indicator 5: Percentage of new pulmonary TB cases confirmed by culture Target: 80% of new pulmonary TB cases are culture confirmed. Status 2012: 69.8% of new pulmonary TB cases were culture confirmed, 11 countries met the target. 12 Figure 7: Percentage of new pulmonary TB cases confirmed by culture by country, EU/EEA, 2012

Indicator 5: Percentage of new pulmonary TB cases tested by DST for first-line drugs 13 Figure 8: Percentage of new pulmonary TB cases tested for susceptibility to first line drugs, by country, EU/EEA, to 84.9% 100% < 50% 85 to 99.9% Not included or not reporting Target: 100% of TB cases tested for susceptibility to first-line drugs (isoniazid and rifampicin) among new pulmonary TB cases. Status 2012: For 77.6% of culture-confirmed TB cases, DST results for first line drugs were reported; seven countries met the 100% target.

Target: All Member States (100%) report treatment outcome monitoring to ECDC. Status 2012: 26 EU/EEA Member States reported treatment outcome for new culture-confirmed pulmonary TB cases notified in Indicator 6: Percentage of Member States reporting treatment success rate 14 Figure 9: Treatment outcome reporting for new pulmonary TB cases notified in 2011, by country, EU/EEA, 2012 Treatment outcome not reported Treatment outcome reported

Indicator 7: Treatment success rate Target: Treatment success rate of at least 85% for new pulmonary culture-confirmed TB cases. Status 2012: Treatment success rate for EU/EEA was 76.5% (range: 0–91.3%), target met by three countries. 15 Figure 10: Treatment success rate in culture-confirmed new pulmonary TB cases notified in 2011, by country, EU/EEA, 2012 * Iceland and Malta reported zero new TB cases in Three EU/EEA Member States did not report treatment outcome data

Target: Treatment success of 70% of new pulmonary culture-positive MDR TB cases Status 2012: Success rate in EU/EEA was 47.6% (range 0–100.0%), target met by 4 countries Figure 11: 24-month treatment success rate in new pulmonary culture positive multidrug-resistant TB cases notified in 2010, by country, EU/EEA, 2012 Indicator 7: Treatment success rate new pulmonary culture positive MDR TB cases* 16 * Cyprus, Iceland, Malta, Slovakia and Slovenia reported zero MDR TB cases in 2010, seven Member States did not report stratified treatment outcome data

Indicator 8: Percentage of TB patients for whom HIV status is known 17 Figure 12: Percentage of TB cases with HIV status reported, by country, EU/EEA, to 74.9% 100% < 50% 75 to 99.9% Not included or not reporting Target: HIV status is known for 100% of notified TB cases. Status 2012: 16 countries (60.6%) reported HIV test results, one country met the 100% target.