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Title page
Contents
Abbreviations 6
Summary 7
Executive summary 9
The WHO European Region 9
European Union and European Economic Area countries 9
Monitoring progress towards TB elimination 10
Резюме 11
Европеnскиn регион ВОЗ 11
Страны Европеnского союза и Европеnскоn экономическоn зоны 11
Мониторинг прогресса в направлении ликвидации туберкулеза 12
1. Main facts about TB 13
2. Technical note 17
2.1. Data reporting and analysis 19
2.2. Definitions 20
3. Commentary 23
3.1. The WHO European Region 25
3.2. European Union and European Economic Area countries 33
4. Commentary - Monitoring 37
4.1. WHO European Region 39
4.2. European Union and European Economic Area countries 45
5. Annexes 75
Annex 1: Tuberculosis surveillance system overview, 2016 76
Annex 2: List of variables for 2017 TB data collection 77
Annex 3: Reporting completeness of main variables used for the report 78
Annex 4: Reporting completeness into Global TB database, 2016 79
Annex 5: Laboratory network capacity, European Region, 2016 80
Annex 6: Monitoring framework for follow up of the TB Action Plan for the WHO European Region, 2016-2020 81
6. Tables 85
7. Trend tables 125
8. Country profiles 147
Albania 151
Andorra 152
Armenia 153
Austria 154
Azerbaijan 155
Belarus 156
Belgium 157
Bosnia and Herzegovina 158
Bulgaria 159
Croatia 160
Cyprus 161
Czech Republic 162
Denmark 163
Estonia 164
Finland 165
former Yugoslav Republic of Macedonia, the 166
France 167
Georgia 168
Germany 169
Greece 170
Hungary 171
Iceland 172
Ireland 173
Israel 174
Italy 175
Kazakhstan 176
Kyrgyzstan 177
Latvia 178
Lithuania 179
Luxembourg 180
Malta 181
Moldova 182
Montenegro 183
Netherlands 184
Norway 185
Poland 186
Portugal 187
Romania 188
Russia 189
Serbia 190
Slovakia 191
Slovenia 192
Spain 193
Sweden 194
Switzerland 195
Tajikistan 196
Turkey 197
Turkmenistan 198
Ukraine 199
United Kingdom 200
Uzbekistan 201
Table 1. Monitoring framework for follow up of the TB Action Plan for the WHO European Region, 2016-2020 54
Summary Table 1. Tuberculosis surveillance data by region, European Region, 2016 87
Table 1. Estimates of the TB disease burden, European Region 2016 88
Table 2. Estimates for TB/HIV co-infection and MDR TB, European Region, 2016 90
Table 3. Tuberculosis cases, notification rates per 100,000 population and mean annual change in rates, European Region, 2012-2016 92
Table 4. New TB cases and relapses, notification rates per 100,000 population and mean annual change in rates, European Region, 2012-2016 93
Table 5. Tuberculosis cases by history of previous TB treatment, European Region, 2016 94
Table 6. Tuberculosis cases by site of disease, European Region, 2016 95
Table 7. New and relapse pulmonary tuberculosis cases by diagnostic method, European Region, 2016 96
Table 7a. New and relapse tuberculosis cases by diagnostic method, European Region, 2016 97
Table 8. Tuberculosis cases according to EU case definition, EU/EEA, 2016 98
Table 9. New TB cases and relapses by age group and male-to-female ratio, European Region, 2016 100
Table 10. Tuberculosis cases by origin, European Region, 2016 102
Table 11. Drug resistance surveillance of pulmonary bacteriologically-confirmed tuberculosis cases, European Region, 2016 103
Table 12. Drug resistance surveillance of bacteriologically-confirmed pulmonary tuberculosis cases by previous TB treatment history, European Region, 2016 104
Table 13. Drug resistance in all laboratory-confirmed tuberculosis cases, EU/EEA, 2016 106
Table 14. XDR TB cases among all laboratory-confirmed MDR TB cases, European Region, 2016 107
Table 15. MDR and XDR TB cases enrolled in treatment, European Region, 2016 108
Table 16. New and relapse tuberculosis cases with HIV infection, European Region, 2016 109
Table 16a. All tuberculosis cases with HIV infection, EU/EEA, 2016 110
Table 17. Tuberculosis in prisons, European Region, 2016 111
Table 18. Treatment outcome for all TB cases notified in 2014, European Region, 2016 112
Table 19. Treatment outcome of new tuberculosis cases and relapses notified in 2014, European Region, 2016 113
Table 20. Treatment outcome of new and relapse tuberculosis cases in children (0-14 years) notified in 2015, European Region, 2016 114
Table 21. Treatment outcome of HIV positive new and relapse tuberculosis cases notified in 2015, European Region, 2016 115
Table 22. Treatment outcome after 24 months of RR TB/MDR TB cases started on second-line treatment in 2014, European Region, 2016 116
Table 23. Treatment outcome after 24 months of laboratory-confirmed MDR TB cases notified in 2014, EU/EEA, 2016 117
Table 24. Treatment outcome after 24 months of XDR TB cases started on second-line treatment in 2014, European Region, 2016 118
Table 25. Treatment outcome after 36 months of XDR TB notified in 2013, EU/EEA, 2016 119
Table 26. Monitoring the WHO Europe Roadmap to Implement the Tuberculosis Action Plan for the WHO European Region, 2016-2020 120
7. Trend Tables 125
Table I. Estimated TB mortality per 100,000 population, European Region, 2007-2016 126
Table II. Estimated TB incidence per 100,000 population, European Region, 2007-2016 128
Table III. Tuberculosis cases in children under 15 years, European Region, 2012-2016 130
Table IV. Tuberculosis cases by origin, European Region, 2012-2016 132
Table V. MDR TB notification among new bacteriologically-confirmeda pulmonary TB cases with available DST results, European Region, 2012-2016 134
Table VI. MDR TB notification among previously treated bacteriologically-confirmed a pulmonary TB cases with available DST results, European Region, 2012-2016 135
Table VII. MDR TB notification among all bacteriologically confirmed a TB cases with available DST results, European Region, 2012-2016 136
Table VIII. XDR TB notification among pulmonary MDR TB cases with second-line drug sensitivity test results, European Region, 2012-2016 137
Table IX. Tuberculosis cases with HIV infection, European Region, 2012-2016 138
Table X. Treatment success after 12 months of new TB cases and relapses, European Region, 2011-2015 140
Table XI. Treatment success after 12 months of all TB cases, European Region, 2011-2015 141
Table XII. Treatment success after 24 months of RR/MDR TB cases started on treatment, European Region, 2010-2014 142
Table XIII. Treatment success after 24 months of XDR TB cases started on treatment, European Region, 2010-2014 143
Table XIV. Treatment success after 36 months of XDR TB cases notified in European Region, 2009-2013 144
Figure 3.1.1. Trend in TB notification rate per 100,000 between 2012 and 2016 in countries with under 20 cases per 100,000 (upper panel) and 20 cases and over per 100,000 (lower panel) in the WHO European Region 28
Figure 3.1.2. Percentages of MDR among laboratory-confirmed pulmonary TB cases, European Region, 2012-2016 30
Figure 3.1.3. Percentages of MDR among laboratory-confirmed pulmonary TB cases, EU/EEA, 2012- 2016 30
Figure 3.1.4. Percentages of MDR among laboratory-confirmed pulmonary TB cases, 18 high-priority countries, 2012-2016 30
Figure 3.2.1. TB notification rates per 100,000 population by year of reporting, EU/EEA, 1995-2016 32
Figure 4.1.1. Percentage of new and relapse TB patients notified in 2016 that were diagnosed using WHO recommended rapid tests in 18 high-priority countries and WHO European Region, 2016 40
Figure 4.1.2. First-line DST coverage among all bacteriologically confirmed TB cases (G1) by 18 high-priority countries and WHO European Region, 2016 40
Figure 4.1.3. RR TB case detection rate (G3) for 18 high-priority countries and WHO European Region, 2016 42
Figure 4.1.4/Figure 4.1.5. TB case detection rate (G3) for 18 high-priority countries and WHO European Region, 2016 42
Figure 4.1.5/Figure 4.1.4. Trend in new and relapse TB notification rate per 100,000 population for 18 high-priority countries and WHO European Region, 2012-2016 44
Figure 4.1.6. Trend of MDR percentage among new pulmonary TB cases for 18 high-priority countries and WHO European Region, 2012-2016 46
Figure 4.1.7. Trend in MDR percentage among previously treated pulmonary TB cases for 18 high-priority countries and WHO European Region, 2012-2016 48
Figure 4.1.8. Proportion of TB patients hospitalised for first-line and second-line TB treatment (E3) for 18 high-priority countries and WHO European Region, 2016 50
Figure 4.1.9. Absolute number of RR/MDR TB cases detected (orange lines) compared with those reported to have been enrolled on second line treatment (blue lines) 2010-2016 in each of the 18 high-priority... 52
Figure 4.1.10. Trend in treatment success rate for new and relapsed TB cases enrolled into treatment 2012-2015 in each of the high-priority countries and totally for 18 high-priority countries and WHO European Region, 2012-2016 56
Figure 4.1.11. Trend in treatment success rate among MDR TB cohort enrolled in treatment between 2010 and 2014 in each of the 18 high-priority countries, and as a total for the 18 high-priority countries and WHO European Region, 2010-2014 57
Figure 4.1.12. Trend in TB mortality rate for the 18 high-priority countries and WHO European Region, 2010-2016 58
Figure 4.1.13. Percentage of cases detected against the estimated number of incident TB/HIV co-infected cases for 18 high-priority countries and WHO European Region, 2016 59
Figure 4.1.14. HIV testing coverage among new and relapse TB patients for the 18 high-priority countries and WHO European Region, 2016 59
Figure 4.1.15. Percentage of HIV co-infection among new and relapse TB cases for the 18 high-priority countries and WHO European Region, 2012-2016 60
Figure 4.1.16. Number of HIV cases detected and number enrolled in ART for the 18 high-priority countries, 2011-2016 61
Figure 4.1.17. LTBI treatment coverage for the 18 high-priority countries and WHO European Region, 2016 62
Figure 4.1.18. Contact investigation coverage for the 18 high-priority countries and WHO European Region, 2016 62
Figure 4.1.19. LTBI treatment coverage of childhood TB contacts aged under five years for the 18 high-priority countries and WHO European Region 63
Figure 4.1.20. Treatment success of new and relapse TB cases among prisoners for the 18 high-priority countries and WHO European Region, 2015 63
Figure 4.2.1. Indicator 1.A.1. Coverage of population at risk with systematic screening for active TB and LTBI (only TB contacts evaluated), 2016 64
Figure 4.2.2. Indicator 1.B.1. Percentage of TB patients diagnosed using WHO-recommended rapid tests, 2016 64
Figure 4.2.3. Indicator 1.B.2. First-line DST coverage among all bacteriologically confirmed TB patients, 2016 65
Figure 4.2.4. Indicator 1.B.3. RR/MDR TB case detection rate, 2016 65
Figure 4.2.5. Indicator 1.B.4. TB notification rate per 100 000 population (E1), 2016 66
Figure 4.2.6. Indicator 1.B.5. TB case detection rate, 2016 66
Figure 4.2.7. Indicator 1.B.6. Percentage of RR/MDR TB among new TB patients (E2), 2014 and 2016 67
Figure 4.2.8. Indicator 1.B.7. Percentage of RR/MDR TB among previously treated TB patients, 2016 67
Figure 4.2.9. Indicator 1.C.1. Percentage of hospitalisation for new TB patients, 2016 (E3) 68
Figure 4.2.10. Indicator 1.C.2. Percentage of detected RR/MDR TB enrolled in treatment, 2016 (G3) (E4) 68
Figure 4.2.11. Indicator 1.C.3. TB treatment success, 2016 (G2) 69
Figure 4.2.12. Indicator 1.C.4. TB treatment success rate among the RR/MDR TB cohort, 2016 (G4), (E4) 69
Figure 4.2.13. Indicator 1.C.5. TB mortality rate, 2016 (ICD A15-19) 70
Figure 4.2.14. Indicator 1.D.1. Percentage of detected cases out of estimated incident TB/HIV co-infected cases, 2016 70
Figure 4.2.15. Indicator 1.D.2. HIV testing coverage, 2016 (G9) (E7) 71
Figure 4.2.16. Indicator 1.D.3. Percentage of HIV among all TB cases, 2016 71
Figure 4.2.17. Indicator 1.D.4. Percentage of TB/HIV patients enrolled in ART, 2016 72
Figure 4.2.18. Indicator 1.E.1. Contact investigation coverage (G2) (E7) 72
Figure 4.2.19. Indicator 1.E.2. Contact-tracing coverage for children under five years (G2) (E7) 73
Figure 4.2.20. Treatment success of new and relapse TB cases among prisoners 73
Maps
Map 1. TB notification rates of new TB cases and relapses per 100,000 population, European Region, 2016 26
Map 2. Percentage of notified TB cases with multidrug resistance among new pulmonary laboratory confirmed TB cases, European Region, 2016 26
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