Tuberculosis rates falling across Europe – but drug resistance remains a threat

New tuberculosis (TB) infections have fallen by 4.3% annually over the last decade in Europe, the fastest decline anywhere in the world. But even though this progress is remarkable, hard-to-treat TB threatens to stop it in its tracks.

According to the Tuberculosis surveillance and monitoring in Europe 2018 report released on Monday (19 March), there were 297,000 TB cases reported across the 52 countries in the WHO European region, and 26,000 deaths.

While the region accounts for just 3% of the total global burden of TB, it makes up 20% of all multi-drug resistant TB (MDR-TB) incidence, and nine out of the 30 countries with the highest MDR-TB are in the WHO European region.

Since 2012, the rates of notified MDR-TB have remained unchanged, with data revealing that one in four MDR-TB cases are not detected across Europe. While there have been improvements in the numbers of people diagnosed - increasing from 33% in 2011 to 73% in 2016 – it falls short of the regional target of reaching 85%.

The overall TB burden is greatest in the east of the region where TB incidence was five times higher than the average in the European Union and European Economic Community.

In terms of absolute numbers, Russia had the largest number of people with TB in 2016 at 94,000, followed by the Ukraine (39,000), Romania (15,000) and Kazakhstan (12,000). In terms of numbers relative to population, Kyrgyzstan had the highest incident rate at 145 per 100,000 population, followed by Moldova (101 per 100,000) and Georgia (92 per 100,000).

Thankfully, rates of new TB infections are declining in many of these countries and at a far higher rate than the global decline of 1.9%. The highest annual rates of decline in the WHO European Region between 2007 and 2017 were in Kazakhstan (-9.4%), Estonia (-8.6%) and Tajikistan (-7.4%). Across the region, TB deaths have fallen two-fold from the decade previous, with these improvements accelerating in the last two years.

TB remains the leading cause of death for people living with HIV, and the region has seen an ‘unprecedented increase’ in HIV prevalence in incident TB cases from 3% to 12% - higher than both the global average and trend. TB/HIV co-infection has increased from 13,000 to 34,000, representing a 260% increase during the period from 2007 to 2016. The report stated that this increase was driven by the "spread and dynamic of the HIV epidemic in the Region."

In a press release, Dr Zsuzsanna Jakab, WHO Regional Director for Europe said: “It is not enough to ‘walk’ towards ending TB, as this way we would arrive too late for too many people. We need to ‘leap forward’ and invest now for individual benefits and societal returns. The Tuberculosis action plan for the WHO European Region 2016–2020 shows that bold actions will save over 3 million lives and US$ 48 billion in 5 years in the Region.”

She contined, “We need to revamp political commitment at all levels to achieve tangible and immediate results that change and save the lives of all those people suffering from TB today and ensure a TB-free world for our children tomorrow."