[Tuberculosis in Poland and the world at the beginning of the third millennium]

Tuberculosis has been a major public health problem in Poland for many decades.

The aim of this investigation was to evaluated incidence, prevalence and mortality from TB in Poland in 1998 and to examine trends of TB incidence.

Individual date on tuberculosis cases reported to National TB Register and date of prevalence and mortality from TB were analysed.

The paper presents the epidemiological situation of TB in Poland in 1998. The year of 1998 was the fifth consecutive year of decline at TB incidence after previous years (1991-1993) of increase. In 1998 there were 13,302 newly registered TB cases, of which 1,476 were relapses. The incidence was 34.4 per 100,000 population, (30.6 were the new cases and 3.8 relapses). Relapses represented 11.1% of all new registered cases. The incidence in 1998 was 4.7% lower than in 1997, but the rate of decline was smaller than in previous year (9.3%). Among the total number of newly registered cases there were 7,501 cases (19.4 per 100,000) bacteriologically confirmed, of which 4,090 cases were sputum smear positive. The proportion of bacteriologically culture positive cases was 56.4% and of sputum smear positive -30.7% which is rather low, but similar to previous years. In view of sufficient network of laboratory services this low proportion of bacteriological confirmation of diagnosis may indicate low quality of bacteriological examinations. In 96.2% of cases the diagnosis was respiratory tuberculosis. Low proportion (3.8%) of non respiratory tuberculosis, which continuous for many years, may indicate inadequacies in diagnosis and registration of this form of disease. The incidence of tuberculosis increases with age, from 1.5 in children up to 67.3 among 65 and older. The proportion of cases in the age group 20-44 years is still high (38.1%). The incidence in men (47.4) is two times higher than in women (22.1), and in rural population higher than in urban--35.6 and 33.7 respectively. The prevalence of tuberculosis at the end of 1998 was 39.5 (15,284 cases), of which 56.2% were bacteriologically confirmed cases (8,593 cases). In the latter group there were 256 cases bacteriologically positive for longer than one year, and 541 cases resistant to at least 1 drug. The proportion of resistant cases (6.3%) is similar to previous years and does not seem to influence the overall effectiveness of chemotherapy.

In recent years incidence of TB in Poland decreased. The incidence of tuberculosis in Poland was about 2 times higher than the average for E.U. countries, but lower than in other Eastern European countries. The distance between Poland and countries with lowest incidence is estimated at 25-30 years.