Epidemiology of tuberculosis in Europe

The regular decline in tuberculosis (TB) notification rates observed in several industrialized countries over the past two decades has levelled off or reversed in recent years. The aim of the present study is to review the epidemiological situation in Europe (updated to 1996), focusing on the annual risk of TB infection, mortality, notifications and age distribution of new smear-positive cases. Epidemiological data were obtained from national statistical reports produced by the Ministry of Health, the Global Tuberculosis Programme and Monitoring Project of the World Health Organization and the Euro TB Report on the feasibility study of Surveillance of Tuberculosis in Europe. The increasingly high mortality rates notified by the Baltic States, Romania, the Russian Federation and the countries previously belonging to the USSR and a few countries of the former Yugoslavia have been attributed to late patient detection and low cure rates, compounded, in some cases, with a lack of first-line drugs, resulting in the use of suboptimal regimens. In addition, higher death rates than in the general population have been described in risk groups, including prisoners and exprisoners, alcohol addicts and the unemployed. The analysis of notification rates and trends in Europe indicates that a stabilization in the number of notified cases or even a new decline had been achieved where efficient TB control programmes had been established or revitalized (e.g. in the majority of Western European and in several Central European countries).