Tuberculosis surveillance and monitoring in Europe 2021 –2019 data

European Union and European Economic Area countries

Epidemiology and treatment outcome

In 2019, 49 752 cases of TB were reported in 29 European Union and European Economic Area (EU/EEA) countries (Latvia and Liechtenstein did not report any case-based data), resulting in a notification rate of 9.6 per 100 000 population in the EU/EEA. The overall notification rate and the rates in most countries have been decreasing over the last five years.

Of all notified TB cases, 38 267 (76.9%) were newly diagnosed and 33 368 (67.1%) were confirmed by culture, or smear and nucleic acid amplification test. In 2019, adults aged between 25 and 64 years accounted for 65.3% of all new and relapse TB cases, while children under 15 years accounted for 4.1% of all new and relapse TB cases. Romania reported the highest notification rates among children, with 14.1 cases per 100 000 population aged between 0 and 4 years. In 2019, new and relapse TB cases were more frequently reported in males than females, with a male-to-female ratio of 1.8.

Approximately one third (34.5%) of TB cases reported in the EU/EEA in 2019 were of foreign origin, but this proportion was less than 25% in the countries with TB notification rates higher than 10 per 100 000 population (excluding Malta).

Of 24 812 cases with DST results, 834 (3.4%) had MDR-TB. The countries with the highest proportion of MDR-TB cases among cases with DST results (excluding France) were Estonia (21.3%) and Lithuania (17.0%). XDR-TB was reported for 21.9% of 584 MDR-TB cases tested for secondline drug susceptibility. The proportion of XDR-TB cases among pulmonary MDR-TB cases with results for secondline DST has remained between 20.0% and 25.0% since 2015. Lithuania and Romania reported 75.0% of the total XDR-TB cases in 2019.

The number of countries reporting data on HIV coinfection, which had peaked at 23 countries in 2016 and 2017, decreased to 21 in 2018 and again to 19 in 2019. Of the 16 088 TB cases with known HIV status, 502 (3.1%) were reported as HIV-positive.

TB in prisons remains poorly reported. For the 13 EU/EEA countries reporting data, the notification rate was 185 new and relapse TB cases per 100 000 prison population, and prisoners had a relative risk of 15.8 compared to the general population in the same countries.

Of all 42 811 TB cases notified in 2018 with a treatment outcome reported in 2019, 63.7% were treated successfully, 6.7% died and 0.8% experienced treatment failure. Of 937 MDR-TB cases notified in 2017 with a treatment outcome reported in 2019, 45.7% were treated successfully, 15.2% died and 11.0% experienced treatment failure. Treatment success was reported only for 34.9% of XDR-TB cases notified in 2016, while 26.2% of cases were reported to have died and 18.0% experienced treatment failure.

Conclusions

In 2019, 29 of 31 EU/EEA countries reported TB notification data. There was a further decline in the overall TB notification rate (9.6 per 100 000 population), continuing the trend observed since 2002. However, there is significant work ahead to achieve the United Nations Sustainable Development Goal 3 target notification rate at EU/EEA level of 2.4 per 100 000 population by 2030. Reassuringly, the number of reported MDR-TB and XDR-TB cases continued to decline in EU/EEA countries in 2019 and account for a very small proportion of all reported TB cases in 2019.

Across all cohorts, reported treatment success remains well below the WHO targets. Of all TB cases notified in 2018 with a treatment outcome reported in 2019, only 63.7% were treated successfully. Treatment success was lower for MDR-TB cases at 24 months (43.2%) and lower still among XDR-TB cases at 36 months (34.9%), while the proportion of deaths for these cohorts was 15.0% and 26.2%, respectively.

Across the EU/EEA, TB data continue to be incomplete for HIV coinfection, TB in prisons, and for treatment xi outcomes. In 2019, there were further declines in the number of countries reporting HIV status and treatment outcomes.