Adequate treatment essential to stop tuberculosis across Europe – WHO/ECDC new report

Photo: SCANPIX

Over 1000 patients are estimated to fall sick with tuberculosis (TB) every day across Europe – or over 380 000 yearly – signalling that there is no room for complacency when it comes to TB prevention and control.

Marking World TB Day, the WHO Regional Office for Europe and ECDC today released new surveillance data for 2011. The data show that while overall the number of TB cases has come down at a rate of 5% per year, countries in the eastern part of the WHO European Region bear 87% of the burden. These countries also recorded most of the estimated 44 000 TB deaths in 2011. The European Union (EU)/European Economic Area (EEA) countries reported over 72 000 cases of TB, which signifies a 4% decrease compared to 2010.

“Improved diagnostic tools are helping to identify more TB cases, but this means that health systems everywhere have to keep up the pace and provide all newly detected patients with full treatment. This is still suboptimal in the European Region, where one in three TB patients does not get cured,” says Zsuzsanna Jakab, WHO Regional Director for Europe. “TB is curable if patients are treated free of charge, according to their own needs, and accompanied through the right therapy until they finish it completely. This means making health systems people-centred, in the spirit of the new regional policy framework, Health 2020.”

Commenting on the report’s findings, Tonio Borg, European Commissioner for Health and Consumer Policy, says: “I am pleased to see progress achieved in fighting TB across the EU. I am concerned however with the critical situation in certain EU Member States, as well as the challenge posed by multidrug-resistant TB in countries that have previously been able to control the situation. The data point to notable health inequalities, with the vulnerable sector of society most affected. We need to reinforce our health systems so that all TB patients in the EU receive adequate treatment.”

ECDC Director Marc Sprenger points out: “Our primary aim is to further reduce TB transmission by the timely diagnosis and adequate treatment of pulmonary TB. This is essential for TB elimination. But we should not forget about the patients with extrapulmonary TB, a form of TB that can affect any organ of the body, making the diagnosis particularly challenging for both doctors and patients. This group is often neglected in TB control strategies. In 2011, over 16 000 of all notified TB patients in the EU/EEA had extrapulmonary TB.”

Adequate TB treatment essential

Adequate TB treatment will avert development of the drug-resistant forms of the disease (multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB)), which are growing into a public health emergency. Some 78 000 individuals are estimated to fall sick with M/XDR-TB yearly in the European Region, where there are over half of the world’s countries with the highest percentage of M/XDR-TB cases. In the EU/EEA, M/XDR-TB is decreasing slightly but continues to be prevalent in TB patients especially in the three Baltic countries.

Fewer than 50% of patients with detected MDR-TB are successfully treated. Treatment for M/XDR-TB patients is much longer, is hundreds of times more costly and has more frequent and severe side effects than treatment of regular TB. One untreated TB or M/XDR-TB person can infect 10–15 other people yearly and 10% of these will develop the disease in their lifetime.

The current portfolio of TB drugs, diagnostics and vaccines is inadequate to treat TB and reach the elimination target globally by 2050. Few new drugs are in the pipeline with the potential to scale up the fight against TB. These drugs need to provide simpler, easily tolerated and less expensive therapies and reduce the treatment time from the current 6 months–2 years to less than two weeks.

Diagnosing 85% or 225 000 M/XDR-TB patients and treating at least 75% of them successfully are key targets of the WHO consolidated action plan on M/XDR-TB that all European countries subscribed to in 2011. The plan highlights the importance of moving from hospital to ambulatory care to reduce the risk of hospital-acquired infections and the psychological burden. All this would translate into 120 000 lives and US$ 12 billion saved.

From 2002 to 2011, the notification rates of extrapulmonary TB did not show a downward trend, whereas a decrease in pulmonary TB was recorded. As a result, the proportion of extrapulmonary TB patients increased from 16% in 2002 to 22% in 2011. The percentage of TB patients notified with extrapulmonary TB varied widely across the EU/EEA countries from as low as 4% to 67%. As symptoms of this form of TB may be diffuse or mimic other diseases, doctors may delay or miss diagnoses of extrapulmonary TB.