Surveillance of tuberculosis in Europe.

In 1995, countries of the WHO European Region approved WHO/IUATLD recommendations for the standardisation of tuberculosis in Europe including a common case definition, the notification of cases by both clinicians and laboratories, the computerisation of individual data and a common list of essential variables. Since 1996, the Euro TB programme started collecting data from European countries based on these recommendations. Data on tuberculosis cases, both definite (culture confirmed) and other cases, reported in 1995, 1996 and 1997 have been collected in the 51 countries of the WHO European Region. Close to 350,000 tuberculosis cases were reported each year, of which almost 2/3 were in countries of the former USSR. Most countries located in the eastern part of Europe, Portugal and Spain, reported 20 cases per 100,000 or over. Conversely, most countries situated in the western part of Europe, the Czech Republic and Israel, reported cases per 100,000. Notification rates were highest above 64 years of age in countries reporting cases per 100,000 and peaked in the 35-54 years old age group in other countries. Since 1995, notification rate declined or stabilised in most countries with cases per 100,000, but increased in several other countries, particularly in most republics of ex USSR. Tuberculosis surveillance systems are still heterogeneous among European countries. Regarding the case definition, a few countries notify only new cases, some countries notify only new and relapse cases and some also include other categories of recurrent cases in the notification. Only a few countries have a national reporting system of M. tuberculosis isolated which can be linked to clinical data. In 1997, 20 of the 51 countries had individual computerised data. The availability of essential variables differs between countries but is increasing over time. The standardisation and quality of epidemiological information on tuberculosis in Europe has clearly improved since the beginning of the Euro TB programme. It is hoped that this will help tuberculosis control efforts in the European Region.