Eurosurveillance - Volume 16, Issue 12, 24 March 2011

Efforts have been ongoing since 1996 to strengthen tuberculosis (TB) surveillance in Europe, starting with the launch of the EuroTB initiative. We present TB surveillance data for the Member States of the European Union (EU) and of the European Economic Area (EEA) for the latest reporting year (2009), highlighting key areas of epidemiological and programmatic focus. Despite a sustained decline of TB notifications at EU/EEA level, several aspects of TB control can still be improved.

Childhood tuberculosis (TB) has been neglected for decades as a key component of TB control. However, ensuring proper monitoring of childhood TB has recently been given renewed emphasis. A descriptive analysis of surveillance data was performed to assess burden and trends of paediatric TB in the European Union/European Economic Area (EU/EEA) between 2000 and 2009. From 2000 to 2009, 39,695 notified paediatric (defined as 0-14 years of age) TB cases were reported by the 27 EU countries plus Norway, Iceland and Liechtenstein. These paediatric cases accounted for 4.3% of all notified cases. However, across the EU/EEA Member States, paediatric case notification rates ranged from 29.6 per 100,000 to 0.3 per 100,000 for the latest reporting year, 2009. Overall, though, these rates dropped from 5.5 per 100,000 in 2000 to 4.2 per 100,000 in 2009. The EU/EEA average annual percent changes (AAPC) in paediatric notification rates decreased between 2000 and 2004 by 1.3% and between 2005 and 2009 by 2.4%, with an overall decrease between 2000 and 2009 of 2.8%. Of all paediatric cases reported from 2000 to 2009, only 16.9% were culture-confirmed, amongst which the overall treatment success was 80.5% for all culture-confirmed pulmonary paediatric TB cases. Childhood TB in the EU/EEA remains a public health issue. Due attention should be paid to assessing paediatric trends as they could provide an insight in recent transmission. Whilst the primary aim of further reducing TB rates among children is paramount, better rates of appropriate diagnosis should also be achieved, along with a further improvement of therapeutic success rates.

We report data on BCG vaccination coverage and paediatric tuberculosis (TB) incidence collected after the disappearance of the multipuncture device for BCG vaccination in January 2006 and the shift from universal to targeted vaccination in July 2007 in France. Vaccination coverage estimates in children for whom BCG is recommended allow assessing whether the recommendations are followed by doctors and/or accepted by the target population. In January and February 2006, BCG sales to the private sector in Île-de-France region were 74.2% and 41.3% of the ones for the same months the previous year. Total sales in 2006 amounted to 57.3% of those in 2005. Coverage decreased immediately after withdrawal of the multipuncture device, and remained generally insufficient in high risk children in the following years. However, the impact on paediatric TB incidence in 2008 seems very limited, although the duration of follow-up is still short. Training of doctors in intra-dermal vaccination and communication on the new vaccination policy should be strengthened.

The contribution of travel to high incidence countries and the impact of the discontinuation of universal Bacillus Calmette-Guérin (BCG) vaccination to the recent rise in tuberculosis (TB) in the United Kingdom remain unclear. An outbreak in a college presented an opportunity to assess these. A cohort of students answered a questionnaire assessing risk factors for TB. Participants were screened with an interferon gamma release assay (IGRA). Unadjusted and adjusted odds ratios (OR) were calculated using logistic regression. Among 2,284 students, 400 (17.5%) were diagnosed with TB infection. A higher risk was noted for travel to a high incidence area in the past two years (OR: 1.39; 95% confidence interval (CI): 1.04-1.89) and among those with the greatest exposure to the index case (OR: 3.94; 95% CI: 2.60-5.97). There was no association between BCG and risk of infection (OR: 1.05; 95% CI: 0.80-1.39). The lack of a protective effect by BCG on TB infection supports the discontinuation of universal vaccination. The association with foreign travel suggests the need to assess the cost-effectiveness of serial IGRA testing and treatment of positive persons among returning travellers.