Problems to control TB in eastern Europe and consequences in low incidence countries

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Tuberculosis (TB) notification rates, previously declining in industrialized nations, have plateaued or increased in the USA and Europe.
• A significant divergence is observed between Central/Eastern and Western European countries regarding TB trends.
• Central and Eastern European nations, particularly former USSR states, show stagnant or rising TB rates since the 1990s.

Purpose of the Study:

• To analyze the key factors contributing to the worsening TB control in Eastern Europe.
• To examine the implications of this situation for Western European countries.
• To propose potential strategies for improved TB management in the region.

Main Methods:

• Evaluation of age-specific TB notification rates across European sub-regions.
• Analysis of socio-economic factors, health system weaknesses, and specific risk groups influencing TB control.
• Review of consequences, including the spread of drug resistance and multidrug-resistant TB (MDRTB).

Main Results:

• Eastern Europe exhibits a TB pattern affecting younger populations, indicating rampant community transmission.
• Major challenges include socio-economic crises, weak health systems, the HIV pandemic, MDRTB, and inadequate control in prisons.
• Sub-optimal TB control facilitates the exportation of TB cases and drug resistance, including MDRTB, to Western Europe via immigration.

Conclusions:

• Effective TB control is achievable, as demonstrated by successful outcomes in the Czech Republic, Slovakia, and Slovenia.
• A comprehensive health system reform, emphasizing cost-effective interventions, is essential, especially in former USSR countries.
• Prompt international action is required to manage MDRTB as an emergency, fostering collaboration between donor and recipient nations.