Although the epidemiological picture within the EU/EEA is generally favourable, there is no room for complacency. A similar favourable epidemiological situation was described in several countries decades ago, resulting in a decrease in awareness and the reduction of resources and services for TB prevention and control. Consequently, there was a re-emergence of the disease fuelled by the HIV epidemic, the development of multi-drug and extensively drug resistant TB (M/XDR TB), and the aggregation of burden among vulnerable populations.
To master the basics of TB prevention and control the TB programme at the ECDC is working in a multi-disciplinary approach aimed at maintaining and strengthening the capacity of health systems, TB control commitment of the EU/EEA countries, TB awareness, TB diagnosis, TB treatment and standards of TB care.
- EU action plan and monitoring framework
- Country visits.
- World TB Day activities.
- Guidance in managing contacts to M/XDR-TB cases
- Development of Standards for TB case management in the EU
- Assembling evidence on rational use of TB drugs
EU action plan and monitoring framework
As tools and resources to the ECDC TB programme, as well as to EU/EEA countries, the ECDC developed and launched the Framework action plan to fight TB in the EU and the monitoring framework, Progressing towards TB elimination: A follow-up to the action plan to fight TB in the EU.
The Framework action plan to fight TB in the EU/EEA describes four principles that are key to securing TB prevention and control in the EU/EEA. Cross-cutting these four principles are eight strategic areas aimed at guiding the ECDC as well as Member States in TB control priorities.
Progressing towards TB elimination: A follow-up to the action plan to fight TB in the EU/EEA was launched in November 2010, to provide EU/EEA countries as well as the ECDC with a monitoring framework to assess the progress towards the elimination of TB. The framework presents four epidemiological and eight operational indicators, all of which relate to the eight strategic areas of the Action Plan. The ECDC TB programme aims to use this resource in its own work as a tool to assess and measure the impact of efforts, as well as to identify new needs and challenges, on TB prevention and control in the EU/EEA.
ECDC conducts country visits jointly with the WHO Regional Office for Europe, upon formal requests by the Member state’s Ministry of Health or corresponding competent body. The country visit aims to, jointly with representatives of the national TB programme, identify strengths and challenges in the national programmes based on the TB burden of that specific country. Based on our observations we produce a comprehensive report which is shared with the country.
If you are a national TB programme manager and would like to request a country visit, please approach your country’s Ministry of Health, or contact the ECDC TB programme that can help in facilitating the process of a formal request.
World TB Day activities
World TB Day, on March 24th each year, commemorates the day in 1882 when Dr Robert Koch announced that he had discovered the causative agent of tuberculosis, Mycobacterium tuberculosis. It is a day on which the eyes of the public are focused on TB, and ECDC engages in activities aimed to increase the awareness around TB. Each year we have a different theme for our concerted activities and these are produced in the format of a TB Spotlight.
Guidance in managing contacts to M/XDR-TB cases
The management of contacts to multi-drug and extensively drug resistant TB (M/XDR-TB) cases should be considered as a key intervention in preventing the emergence of further resistant cases. Contact tracing remains a common active case-finding measure within the EU, and public health offices within EU/EEA countries are often faced with the dilemma of how to manage contacts to resistant cases.
In alignment with the ECDC procedures for developing guidance, we are in the process to provide the EU/EEA countries with guidance on the management of persons exposed to M/XDR-TB cases. This worked is based on providing the scientific background to the issue and consolidate expert opinions in addition to identifying gaps for future research including operational research.
Development of Standards for TB case management in the EU/EEA
Findings from an ECDC-funded project; a survey on the management of MDR TB cases in the EU/EEA (read more in the TBNET/ECDC publication), indicated that mismanagement of TB cases in general is a current challenge in the EU/EEA. Sub-optimal adherence to diagnostic-, treatment- and infection control-practices were observed and recorded in the reference centre survey, an observation that is further highlighted in the literature. The mismanagement of TB cases poses a threat to TB elimination as it increases the risk of TB transmission as well as the emergence of drug resistance.
In response to this, in 2011, the TB programme will be engaging in developing EU standards of TB care. The aim is to develop standards for TB care tailored to the EU setting and that are in line with accepted international principles and guidance, as published in the International standards for TB care and the Patients’ Charter for TB care.
Assembling evidence on rational use of TB drugs
Drug resistant TB is recognized as a threat within the EU/EEA and prevention of TB drug resistance is key to ensure progress towards elimination. The TB drug pipeline has, after decades of neglect, finally thickened with several new agents currently under clinical development for either the treatment of drug susceptible TB or for MDR-TB treatment. It is vital out of a public health perspective to assure that the new drugs are introduced and used in a rational way. The ultimate goal is to ensure the longevity of all new TB drugs, a cornerstone in the prevention and control of TB. ECDC has therefore identified the need to assess the public health risks entailed with introducing new drugs and regimens for TB.