According to the latest report on tuberculosis (TB) surveillance and monitoring in Europe, jointly published by the European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO), a sharp drop of 24% in reported TB cases between 2019 and 2020 was probably exacerbated by the COVID-19 pandemic, which hindered detection and reporting.
TB remains one of the world’s deadliest infectious diseases, second only to COVID-19, and drug-resistant TB strains are still a major concern. In the fight against TB, urgent investment is critical, especially in the context of the ongoing pandemic.
The report finds that in 2020, over 33 000 TB cases were reported in the EU and EEA, and there were over 160,000 notifications of TB cases in the wider European Region. In contrast, 2019 saw around 47,500 cases reported in the EU and EEA, while in the European Region there were 216,000 new TB diagnoses. Although the rates in most countries have been decreasing over the last five years, the 24% drop in notifications of new and relapse TB cases between 2019 and 2020 represents a clear interruption of the downward trend.
The epidemic patterns and trends vary widely, with most EU and EEA countries approaching the low incidence level of below 10 per 100,000 population, but the European Region overall has nine of the 30 countries in the world with the highest multidrug-resistant tuberculosis (MDR-TB) burden.
In 2020, there were an estimated 21,000 TB deaths in the WHO European Region, the equivalent to 2.3 deaths per 100,000 population, with around 3,800 of these deaths occurring in the EU and EEA, which equates to 0.8 deaths per 100,000 population. For the first time in over two decades, the number of TB deaths increased because of a delay in, or lack of, diagnosis due to disruptions to services. This compromised the achievement of the End TB Strategy milestone to reduce the number of TB deaths by 35% in 2020.
In 2020, HIV prevalence in incident TB cases was estimated to be 12%. HIV-TB coinfection has remained unchanged since 2016, with one-in-six TB patients also infected with HIV. There were an estimated 29,000 HIV-positive TB cases in the European Region, while in the EU and EEA, there were 12,327 cases with known HIV status, 4.2% of which were reported as HIV-positive.
Of all cases notified in 2019 with a treatment outcome reported in 2020, 71.8% were treated successfully in the EU and EEA and 76.5% in the WHO European Region. Nevertheless, the treatment success rate in the region remains below the respective regional targets of 85% for new and relapse cases. Despite the efforts made and the availability of new drugs and treatment regimens, the burden in relation to MDR-TB or rifampicin-resistant TB (RR-TB) and TB and HIV remains considerable, underlining the need for more innovative approaches to the diagnosis and treatment of TB and MDR-TB or RR-TB. Rifampicin is the most potent anti-TB drug.
In the fight against TB, urgent investment in resources, support and care is vital, particularly in the context of the COVID-19 pandemic, which has jeopardized progress towards milestones in WHO’s End TB Strategy. See CN 56/1205 for a further report on this.
Sources: WHO, 24 March 2022 and ECDC, 24 March 2022