What Is Tuberculosis Surveillance in the European Union Telling Us?

BACKGROUND: Today's European Union (EU) encompasses countries with diverse patterns of tuberculosis epidemiology. METHODS: We explored national tuberculosis data for 1999-2003 reported to the EuroTB surveillance network. We analyzed only complete, representative data for drug resistance (from 15 countries) and treatment outcomes (from 19 countries). RESULTS: Between 1999 and 2003, overall tuberculosis notification rates in the 25 EU countries decreased by 4% each year, down to 14 cases per 100,000 population in 2003, but Italy and the United Kingdom registered increases because of tuberculosis in immigrants. In 2003, EU countries reported 62,743 tuberculosis cases; of these, 76% were in persons who were previously untreated, 22% were in persons >64 years old, and 30% were in foreigners (the percentage in individual countries ranged from 2% to 75%). In Estonia, Latvia, and Lithuania, resistance to isoniazid and rifampicin occurred in 15%-23% of cases in which resistance testing was performed, but it was uncommon elsewhere (median resistance, 1%). Among previously untreated culture-positive patients with pulmonary tuberculosis, 76% had successful outcome (the percentage in individual countries ranged from 54% to 100%); among these patients, the probability of successful outcome diminished with advancing age. Of 9414 patients with AIDS reported in the EU, 2207 (23%) had tuberculosis as the initial defining illness, representing 3% of all tuberculosis cases notified that year (the percentage in individual countries ranged from 0% to 10%). The prevalence of HIV infection among patients with tuberculosis was highest in Portugal (16.1%) and Spain (9.6%), but it increased in Estonia (from 0.1% to 2.9%) and in Latvia (from 0.5% to 2.3%) between 1999 and 2003. CONCLUSIONS: Surveillance data would be more comparable if more countries reported exhaustive and representative data. Drug resistance is low in most EU countries other than former Soviet states. HIV infection and tuberculosis comorbidity is important in certain countries. Prevention and control of tuberculosis in the EU should target groups at higher risk of infection or death, including foreigners and the elderly population.