UNIFORM REPORTING OF TUBERCULOSIS IN EUROPE

Hans L. Rieder

International Union Against Tuberculosis and Lung Disease, Paris, France

A consensus conference held in Wolfheze, Netherlands, among participants from the 51 countries of Europe agreed on uniform reporting criteria for cases of tuberculosis in Europe (Eur Resp J 1996;9:1097-1104). The consensus statement called for a uniform case definition, notifications based on mandatory reporting for both laboratories and physicians, and a preference for individual (as opposed to aggregate) case notifications. With the financial support of the European Union, a project was launched to collect tuberculosis notification data in a coordinating center which has now published the results for three consecutive years. In the most recent report on cases notified in 1997, all but two of the 51 countries participated in the reporting according to the guidelines. Nineteen reported individual data and 30 provided aggregate data, the former group slowly increasing over the three-year period. Notification rates ranged from 0 (in Monaco and San Marino) to 154 per 100,000 population (in Georgia) with a median of 154 per 100,000 population. In general, notification rates tended to decrease compared to 1995 in those countries with the lowest rates, and to increase in countries with rates of 50 per 100,000 and above. Particularly in Western Europe, the proportion of cases identified among the foreign-born plays an increasing role with currently four countries in which the proportion of these exceeds now 50 per cent of the total.

This project demonstrates that both a political and technical will exists in Europe to gather forces for improved surveillance; the data have become comparable between countries for the first time in the history of tuberculosis surveillance in Europe; an increasing number of countries is moving towards electronic caption of data on individual cases. While EuropeÕs tuberculosis surveillance system still lags more than a decade behind that of North America, the current results have been achieved in a remarkably short period of time, particularly considering the large cultural, economic and political differences between the countries of Europe. They also suggest that the path chosen needs to be pursued and strengthened further.