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, 72 334 TB cases were reported in 2011. Notification rate 14.2 per 100 000 population (range 2.8 – 89.7). Figure 1: Country-specific TB notification rates, 2011 < 10 per 100 000 10 to 19 per 100 000 20 to 49 per 100 000 50 to 99 per 100 000 Not included or not reporting

TB notification rates in EU/EEA, 2007−2011 Overall in the EU/EEA, notification rates have steadily declined. 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. Figure 3: Country-specific proportion of all confirmed TB cases in 2011. < 60% 60 to 69% 70 to 79% ≥ 80% 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, 3 190 cases of TB in children were reported, accounting for 4.4% of all notified TB cases (range 0 – 11.1%) in the EU/EEA. Figure 4: Country-specific childhood TB notification rates among child population (0–14 years), 2011 < 2 per 100 000 child population 2 to 3.9 per 100 000 child population 4 to 9.9 per 100 000 child population ≥ 10 per 100 000 child population Not included or not reporting

Proportion of foreign origin among notified TB cases in EU/EEA, 2011 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, 2011 25 to 49% ≥ 75% 1 to 24% 50 to 74% < 1% Not included or not reporting

Proportion of notified extrapulmonary TB cases in EU/EEA, 2011 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, 2011 20 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. 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 2011. 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, 2011 69% of new pulmonary TB cases were culture-confirmed. The proportion varied widely across countries (range 0 – 98%). 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, 2011 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, 2011 2 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, 2011 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, 2011 2 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 100 000 population. 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, 2011 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, 2011 2 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, 2011 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, 2011 5 to 9% ≥ 20% 1 to 4% 10 to 19% < 1% Not included or not reporting Not included or not reporting *SLD ST – second line drug susceptibility testing result

Proportion of HIV positive TB cases among all TB cases with known HIV status in EU/EEA, 2011 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, 2011 2 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%). 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 2010. 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%). 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 2010. Seven EU/EEA Member States did not report stratified treatment outcome data

Treatment success rate for all notified pulmonary TB cases in EU/EEA The treatment success rate for all confirmed pulmonary TB cases notified in 2010 was 72.4% (range 0 – 88.9%). 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%). 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%). 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. Figure 22: Treatment outcome at 24 months for multidrug-resistant TB cases diagnosed in 2009, compared with cases diagnosed in 2007 and 2008