Tuberculosis Elimination at Stake

Ahead of World TB Day, a new guidance paper and surveillance report on tuberculosis (TB) in Europe urge for immediate diagnostic screening and care of the most vulnerable populations, including refugees and migrants, and the poor and marginalized.

Data released in a new report by European Center for Disease Prevention and Control (ECDC; Stockholm, Sweden) and World Health Organization (WHO) show that an estimated 340,000 Europeans developed TB in 2014, corresponding to a rate of 3.7 cases per 1 million population. With new TB cases decreasing by 4.3% on average between 2010 and 2014, the WHO European Region has met the Millennium Development Goal target of reversing the incidence of TB by 2015. However, high rates of multidrug-resistant (MDR) TB and TB affecting vulnerable populations (e.g., homeless, drug and alcohol abusers, and migrants from countries with high rates of TB) continue to challenge TB elimination (defined as < 1 case TB disease per 1 million population per year).

The WHO European Region comprises 53 countries with a population of nearly 900 million people, of which around 508 million live in the EU/EEA (European Union/European Economic Area: 28 EU Member States plus Iceland, Liechtenstein, and Norway).

"One quarter of all 480,000 patients sick with MDR TB globally were in the European Region in 2014. This alarmingly high number is a major challenge for TB control", said Dr. Zsuzsanna Jakab, WHO Regional Director for Europe, "The most vulnerable groups [...] are at greater risk of developing MDR TB. Because of their living conditions, TB is often diagnosed late, and it is harder for them to complete a treatment course. If we really want to eliminate TB from Europe, no one must be left behind."

"Social circumstances or lifestyles may make it more difficult for some people to recognize the symptoms of TB, access healthcare services, follow a treatment, or attend regular healthcare appointments. We need to think about tailored interventions for such vulnerable people, which can include outreach teams or directly observed treatment," said ECDC acting director Dr Andrea Ammon, “If TB is not successfully tackled in vulnerable groups, it will not be eliminated."

There is no systematic association between migration and transmission of tuberculosis. The risk of being infected or developing TB disease depends on several factors including TB rates in country of origin. New TB cases in some origin countries (e.g., Syria) are lower than the European Region average. In addition, as TB is not easily transmissible and contacts are limited, there is a low risk that migrants transmit the disease to the resident population.

Universal health coverage should be ensured for refugees and migrants, both documented and undocumented. The European Region is the only one in the world with a consensus document on the minimum package of cross-border TB control and care interventions, including access to medical services irrespective of a migrant's registration status. TB screening must never be used as a reason to reject a refugee or a migrant. The recently published Systematic screening for active tuberculosis: an operational guide provides guidance on how to target and tailor TB screening to detect active disease and provide immediate treatment in populations most at risk.

Related Links:
European Center for Disease Prevention and Control