Tuberculosis surveillance and monitoring in Europe 2013: surveillance report

SURVEILLANCE REPORT Tuberculosis surveillance and monitoring in Europe 2013 www.ecdc.europa.eu www.euro.who.int

Tuberculosis surveillance and monitoring in Europe 2013 ii SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Suggested citation for full report: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2013. Stockholm: European Centre for Disease Prevention and Control, 2013. Tables and figures should be referenced: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2013. This report follows the European Union Interinstitutional Style Guide with regard to country names. The maps are reproduced with the permission of the WHO Regional Office for Europe. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authori- ties, or concerning the delimitation of its frontiers and boundaries. The WHO Regional Office for Europe is responsible for the accuracy of the translation of the Russian summary. © World Health Organization Cover picture © CDC/ Dr Ray Butler; Janice Carr ISBN 978-92-9193-447-8 ISSN 1977-3986 DOI 10.2900/77696 © European Centre for Disease Prevention and Control, 2013 Reproduction is authorised, provided the source is acknowledged. This report has been published jointly by the WHO Regional Office for Europe (WHO/Europe) and ECDC. WHO/Europe developed the descrip- tion of the European Region and validated the figures of the non-EU countries and ECDC developed the text for the EU/EEA countries and validated the EU/EEA figures. The report was coordinated by Vahur Hollo (ECDC) and Andrei Dadu (WHO/Europe). Contributing authors: Masoud Dara and Kristin Kremer (WHO/Europe), Marieke J. van der Werf, Csaba Ködmön and Phillip Zucs (ECDC). This report was sent for consultation and review to the TB disease- specific experts and focal points in the Member States. We would like to acknowledge the contribution and dedication of the experts in the Member States in reporting the data used for the produc- tion of this report. iii Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Contents Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1. Background and technical note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 1.1 Data reporting and analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 1.2 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2. Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1 The WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.2 European Union and European Economic Area countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 3. Commentary – Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4. Tables Summary table: Tuberculosis surveillance data by region, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 1: Estimates of the TB disease burden 2011, European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Table 2: Estimates of TB/HIV and MDR-TB 2011, European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Table 3: Tuberculosis cases, notification rates per 100 000 population and mean annual change in rates, European Region, 2007–2011 . . . . . . . . .38 Table 4: Tuberculosis cases and age-standardised rates per 100 000 population, European Region, 2007–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Table 5: New TB cases and relapses, notification rates per 100 000 population, European Region, 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Table 6: Tuberculosis cases by history of previous TB treatment, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Table 7: Tuberculosis cases by site of disease, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 8: New pulmonary tuberculosis cases by laboratory confirmation, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Table 9: Laboratory-confirmed tuberculosis cases by confirmation method, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 10: Classification of tuberculosis cases according to EU case definition, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 11: New TB cases by age group, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 12 Tuberculosis cases in children and adults, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 13: Tuberculosis cases by origin and sex ratio, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 14: Tuberculosis cases in children (<15 years old), by age group and origin, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Table 15: Laboratory practices and quality assurance for anti-TB drug susceptibility testing, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 16: Characteristics of anti-TB drug resistance surveillance of laboratory-confirmed cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Table 17: Multidrug-resistant TB among laboratory-confirmed TB cases by previous history of TB treatment, European Region, 2011 . . . . . . . . . . . . . 61 Table 18: Anti-TB drug resistance among new laboratory-confirmed pulmonary TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 Table 19: Anti-TB drug resistance among previously treated laboratory-confirmed pulmonary TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . 63 Table 20: Number and proportion of notified XDR-TB cases among MDR-TB cases with second-line drug susceptibility testing, European Region, 2009–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Table 21: Anti-TB drug resistance among all TB cases by origin, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Table 22: Tuberculosis cases with HIV infection, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 Table 23: Treatment outcome of new laboratory-confirmed pulmonary TB cases after 12 months, European Region, 2010 . . . . . . . . . . . . . . . . . . . . . . . . .69 Table 24: Treatment outcome of previously treated laboratory-confirmed pulmonary TB cases, European Region, 2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 25: Treatment outcome of all TB cases, European region, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 26: Treatment outcome of all MDR-TB cases after 24 months, European region, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Tables on specific topics in the 2013 report: TB in prisons and site of the disease Table A: TB in Prisons, European Region, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table B: Extrapulmonary TB cases, notification rates per 100 000 population and % of all TB, EU/EEA 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table C: All tuberculosis cases by site of disease, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Table D1: All tuberculosis cases by site of disease in children, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Table D2: All tuberculosis cases by site of disease in adults, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Table E: Extrapulmonary TB cases by laboratory confirmation and multidrug resistance, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85 Table F1: All TB cases by site and origin, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Table F2: All TB cases by site and origin, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 iv SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table F3: All TB cases by site and origin, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Table G: Treatment success for all TB cases by site of disease, EU/EEA, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92 Table H: Tuberculosis cases with HIV infection by site of disease, EU/EEA, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94 Trend tables Table I: All notified TB cases, rates per 100 000 population and mean annual change in rates, European Region, 1995–2011 . . . . . . . . . . . . . . . . . . . . . . .96 Table II: All laboratory confirmed tuberculosis cases, European Region, 1995–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table III: Tuberculosis cases in children (<15 years old), European Region, 1995–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table IV: Tuberculosis cases of foreign origin, EU/EEA, 1995–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Table V: MDR-TB notification among all laboratory confirmed TB cases, European Region, 2000–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Table VI: MDR-TB notification among all culture positive TB cases with available DST results, European Region, 2007–2011 . . . . . . . . . . . . . . . . . . . . . .116 Table VII: XDR-TB notification among all MDR-TB cases with second line drug sensitivity test results, European Region, 2006–2011 . . . . . . . . . . . .118 Table VIII: Tuberculosis cases with HIV infection, European Region, 2001–2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 Table IX: Treatment success of new laboratory-confirmed pulmonary TB cases, European Region, 2001–2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Table X: Treatment success of previously treated laboratory confirmed pulmonary TB cases, European Region, 2001–2010 . . . . . . . . . . . . . . . . . . . . . 128 Table XI: Treatment success of all MDR-TB cases, European Region, 2005–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 5. Maps & figures Figure A: Estimated TB incidence (per 100 000 population) and case detection rates (as a percentage), WHO European Region, 1990–2011 . . . . . 16 Figure B: Estimated TB incidence per 100 000 population, European Region, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Map 1a: Estimated TB mortality per 100 000 population, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Map 1b: Estimated TB prevalence per 100 000 population, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Map 1c: Estimated TB incidence per 100 000 population, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Map 2: TB notification rates per 100 000 population, European Region, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Map 3: TB notification rates, new and relapse cases per 100 000 population, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Map 4: Percentages of notified TB cases of foreign origin among all TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Map 5: Percentages of notified extrapulmonary TB cases among all TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Map 6: Percentages of smear positive pulmonary TB cases among new pulmonary TB, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Map 7: Percentage of TB cases confirmed by culture and smear among new pulmonary TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . .140 Map 8: Percentage of notified TB cases with multidrug resistance among new laboratory-confirmed pulmonary TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Map 9: Percentage of notified TB cases with multidrug resistance among previously treated laboratory-confirmed pulmonary TB cases, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Map 10: Percentage of notified TB cases with multidrug resistance among all TB cases with DST results, European Region, 2011 . . . . . . . . . . . . . . . 142 Map 11: Percentage of notified TB cases with extensive drug resistance among MDR-TB cases with second-line DST results, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Map 12: Percentage of HIV positive TB cases among all TB cases with known HIV status, European Region, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Map 13: Success rate of new laboratory-confirmed pulmonary TB cases, European Region, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Map 14: Success rate of previously treated laboratory-confirmed pulmonary TB cases, European Region, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Map 15: Success rate of all MDR-TB cases after 24 months, European Region, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Figure 1: TB estimated incidence and notification per 100 000 population, European Region, 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Figure 2: Estimated TB prevalence per 100 000 population, European Region, 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Figure 3: Estimated TB mortality per 100 000 population, European Region, 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Figure 4: Total TB notifications by previous treatment history and total TB case rates, Europe, 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Figure 5: Percentages of MDR among laboratory-confirmed TB cases, European Region, 2002–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Figure 6: Percentage of TB cases with HIV infection among TB cases with known HIV status, Europe, 2008–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Figure 7: Treatment outcome, new laboratory-confirmed pulmonary TB cases, Europe, 2001–2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Figure 8: Treatment outcome, previously treated laboratory-confirmed pulmonary TB cases, Europe, 2001–2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 Figure 9: Treatment outcome after 24 months of MDR-TB cases, Europe, 2007–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 6. Country profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155 7. Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT v AFB Acid-fast bacilli AIDS Acquired immunodeficiency syndrome CI Confidence interval CISID Centralized Information System for Infectious Diseases DOTS Directly Observed Treatment Short-Course (internationally recommended strategy for the control of tuberculosis) DRS Drug resistance surveillance DST Drug susceptibility testing ECDC European Centre for Disease Prevention and Control EEA European Economic Area EITUD European individual tuberculosis dataset EQA External quality assessment ERLN-TB European Reference Laboratory Network for TB EU European Union HIV Human immunodeficiency virus HPC High-priority countries ICD International Classification of Diseases ISO International Organization for Standardization MDB Mortality Database MDR Multidrug resistance MDR-TB Multidrug-resistant tuberculosis M/XDR-TB Multidrug and extensively drug-resistant tuberculosis MSM Men who have sex with men PR Prevalence ratio PWID People who inject drugs STAG-TB Strategic and Technical Advisory Group for Tuberculosis (STAG-TB), WHO TB Tuberculosis TESSy The European Surveillance System TME WHO Tuberculosis Monitoring and Evaluation platform TOM Treatment outcome monitoring UN United Nations WHO World Health Organization XDR Extensive drug resistance XDR-TB Extensively drug-resistant tuberculosis Abbreviations

1Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Summary 2SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Andorra Luxembourg Malta Monaco San Marino TESSy reporting countries (25) TME reporting countries (11) WHO high priority countries reporting to TESSy (5) WHO high priority countries reporting to TME (13) Map: Tuberculosis surveillance in Europe 2011a a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia. 3Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT This is fifth report launched jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe (WHO/Europe) following on from reports under the EuroTB project, established in 1996. The WHO European Region The 2015 Millennium Development Goal (MDG) target of halting the prevalence and death associated with tuber- culosis (TB) and reversing its incidence has been partially achieved in 2011, with TB incidence falling in the Region at a rate of about 5% per year between 2000 and 2011. Nevertheless, the prevalence of TB was estimated at 56 cases per 100 000 population (about 500 000 prevalent cases) in the Region and TB mortality was 4.9 deaths per 100 000 population (around 44 000 in total). It will therefore not be possible to reach the target of 50% reduction by 2015. The incidence of TB in the European Region varies among and within the countries, from a range of less than one TB case per 100 000 population to above 200 TB cases per 100 000 in others. The 53 countries of the WHO European Region account for around 4.4% of the world’s cases, representing an estimated 380 000 individuals with a new episode of TB (or relapse), or 42 cases per 100 000 population. Since 2005, TB notifications have decreased by almost one quarter, from 41 to 33 cases per 100 000 population. In 2011, the countries of the WHO European Region detected 295 968 new TB cases and relapses. When compared to the incidence for the Region, this indicates that 78% of the estimated cases were detected, making the Region’s surveillance system one of the most sensitive in the world. Among the 380 366 cases of all types and forms of TB, 71% (271 288) were identified as new cases in 2011. Of those 55% (123 525) were confirmed by sputum smear microscopy and/ or culture. The number of laboratory confirmations was higher in the western part of the Region than in the eastern countries (74% and 50.3% respectively). Overall, there were twice as many male cases reported as female cases, however a large variation was observed for male predominance in the gender distribution of TB cases, ranging from almost even distribution in some western countries (1.2:1) to around three times greater in others (2.9:1). In 2011, most of the new TB cases registered in the European Region were in the 25–44 years age group (41%). Over the last five years, region-wide trends in overall TB notification among children (age group 0–14 years) have decreased by 23%, from 8.7 to 6.7 cases per 100 000 population, accounting for 11 054 cases in 2011. However, the average percentage of patients within this age group in the Region has remained stable at around 6% over the same period. There were ten countries where under-fives accounted for more than half of the cases detected among children. In 2011, 12 751 TB cases with HIV co-infection (56.5%) were detected from the 22 500 estimated cases in the European Region. The estimated prevalence of HIV infection among TB patients was 6%.The fact that prevalence among all tested TB cases was very similar (6.2%) gives an indica- tion of the accuracy of TB-HIV surveillance in the Region. However, since HIV testing coverage is at 60%, the status was only known for 205 578 new and previous TB cases, 12 751 of which had an HIV co-infection. Given that so few countries report TB from correctional institutions it was difficult to calculate the extent to which prisons contribute to the regional TB burden. However, there were some countries in eastern Europe where TB cases in prisons exceeded 10% of the countrywide total of new TB cases, and in others the notification rate was close to or exceeded 1 000 cases per 100 000 prison population. In some low-incidence countries however, there was a higher risk of TB in prisons than in the general population. This was related to the higher rate of TB transmission there due to poor control measures and/or the concentration of vulnerable population sub-groups (such as immigrants from countries with a high TB incidence). In 2011, of an estimated 78 000 multidrug-resistant tuber- culosis (MDR-TB) cases in the European Region, 29 473 (38%) were detected. The prevalence of MDR among new TB cases in the Region amounted to 14% and 47.7% among previously treated cases. Testing coverage for resistance to second line drugs almost doubled compared to last year, however it is still at a very low level (9% of MDR-TB cases). Nevertheless, this allowed detection of 381 cases of extensively drug-resistant tuberculosis (XDR-TB), repre- senting 11% of the MDR-TB cases tested for second line drug susceptibility in the Region. New rapid methods to support TB diagnosis have recently been introduced in some countries within the Region. During the last five years, a gradual decrease in treatment success has been observed. Success rates are now down to 67.2%, 49.2% and 48.5% among new, previously treated and MDR-TB cases respectively. A decrease in the first two of the three cohorts is mostly related to an increase in the proportion of MDR-TB among them. In the third cohort it might be due to a rapid increase in the reporting coverage to nearly double that of last year (from almost 7 000 to over 12 000) and the lack of quality-assured administration of second-line drugs according to the most efficient regimens recommended by WHO. Given the above and the fact that the vast majority of the TB burden occurs in the 18 high-priority countries of the Executive Summary 4SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 European Region1 (87% of the TB incidence, 87% of the prevalence, 92% of the mortality caused by TB, 91% of TB/HIV co-infections, and 99% of the MDR-TB), the main efforts to combat and prevent TB in the Region need to be focused there. However, in western Europe and particularly in the large cities, the TB situation still needs continuous attention. In cooperation with national and international partners and civil society organisations, WHO Regional Office for Europe has been implementing a Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug- Resistant Tuberculosis and helping Member States to adopt evidence-based interventions in order to improve TB and multidrug- and extensively drug-resistant TB (M/XDR-TB) prevention and control. All countries with a high burden of MDR-TB, except the Russian Federation, have prepared and finalised their national MDR-TB action plans in line with the regional plan. In some countries the national plans are yet to be endorsed officially by the Ministries of Health. The WHO Regional Office for Europe has established the European Green Light Committee and the European Laboratory Initiative to help countries develop and/or adjust their national plans in response to the M/XDR-TB threat. This will help countries to reduce the proportion of MDR-TB cases among those previously treated by 20% detect 85% of estimated MDR-TB patients and successfully treat at least 75% of them. European Union and European Economic Area countries In 2011, 72 334 cases of TB were reported in 29 EU/EEA countries, which was 4% less than in 2010. The EU/EEA noti- fication rate was 14.2 per 100 000 population, continuing the long-term decreasing trend. In total, 80% of all notified TB cases were newly diag- nosed and 69% of all new pulmonary TB cases were culture-confirmed. Adult age groups were equally affected by TB while the notification rate in children under the age of 15 years was 4 per 100 0000, consistent with a slightly decreasing long- term trend. Overall, males were overrepresented by 80%. In total, 26% of all TB cases were of foreign origin, mostly residing in low-incidence countries. MDR-TB was reported for 5% of cases with drug suscepti- bility testing results (2% of new TB cases and 17% of previ- ously treated cases) and continues to be most prevalent in the three Baltic countries. The overall trend is slightly decreasing. Extensively drug-resistant TB (XDR-TB) was reported for 13% of 1 017 MDR-TB cases tested for second-line drug susceptibility. 1 The 18 high-priority countries (HPC) are: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. In all, 5% of TB cases with known HIV status were co-infected with the virus. Seventy-four percent of TB cases notified in 2010 and 32% of MDR-TB cases notified in 2009 had successfully completed their treatment. In total, 22% of all cases were notified with exclusively extrapulmonary TB (mostly lymphatic and pleural TB); 35% of them were confirmed by culture, 1% was multidrug- resistant and 82% were labelled treatment successes. Children and cases of foreign origin were at least twice as likely to be reported with extrapulmonary TB as adults and native cases, respectively. The distribution of clinical presentations in each of these two risk groups was distinctly different from the remaining cases. 5Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Представленный документ, является пятым докладом, изданный совместными усилиями Европейского центра по контролю и профилактике заболеваний (ЕЦКЗ) и Европейского регионального бюро ВОЗ (ЕРБ ВОЗ) вслед за ежегодными отчетами проекта EuroTB, учрежденным в 1996 г. в Европейском регионе ВОЗ. Европейский регион ВОЗ Цели развития тысячелетия (ЦРТ) - к 2015 г. вдвое сокра- тить показатели распространенности и смертности, ассоциированные с туберкулезом, и обратить вспять заболеваемость - были частично достигнуты. Темп заболеваемости ТБ в Регионе в период между 2000 и 2011 годами достиг 5% снижения в год. По расчетным данным, в 2011 г. показатель распространенности ТБ составил 56 случаев на 100 000 населения (всего около 500 000), а смертности 4,9 случаев на 100 000 населения (всего около 44 000), однако по прогнозам, пятиде- сятипроцентного сокращения смертности к 2015 г. достигнуть не удастся. Заболеваемость ТБ в Европейском регионе варьируется по странам и внутри стран в диапазоне от менее одного случая ТБ на 100 000 населения до свыше 200 случаев ТБ на 100 000 населения. На 53 страны Европейского региона ВОЗ приходится почти 4,4% всех случаев ТБ в мире, что по оценочным данным составляет около 380 тысяч больных с новыми эпизодами ТБ (или рецидивами) или 42 случая на 100 000 населения. С 2005 г. показатель регистрации ТБ сократился примерно на четверть – с 41 до 33 случаев на 100 000 населения. В 2011 г. в странах Европейского региона ВОЗ было выявлено 295 968 новых случаев и рецидивов ТБ. При сопоставлении с расчетной заболеваемостью в Регионе, эта цифра указывает на то, что выявляется в среднем 78% случаев, что делает систему эпиднадзора Европейского региона одной из наиболее эффективных в мире. В 2011 г среди 380 366 случаев всех типов и форм тубер- кулеза, 71% (271 288) был выявлен как новые случаи. Из них 55% (123 525) были подтверждены мазком мокроты и/или посевом. Лабораторная диагностика была более эффективной в западной, чем в восточной части Европейского региона, 74% и 50,3%, соответственно. В целом, было зарегистрировано в два раза больше случаев среди мужчин, чем среди женщин, однако в гендерном распределении случаев ТБ наблюдалось значительное варьирование в преобладании случаев заболевания среди мужчин – от почти ровного распреде- ления в некоторых западных странах (1,2:1) до примерно троекратного превышения в других (2,9:1). В 2011 г. чаще всего впервые выявленный туберкулез регистрировался у больных в возрастной группе 25–44 лет (41%). За последние пять лет наблюдаемае по всему Региону тенденция общей регистрации ТБ среди детей (возрастная группа 0–14 лет) характеризовалась сокра- щением на 23% - с 8,7 до 6,7 случаев на 100 000 насе- ления, что в 2011 г. составило 11 054 случаев. Однако средний процент больных этой возрастной группы в регионе оставался стабильным на уровне примерно 6% за тот же период времени. В десяти странах на возрастную группу младше 5 лет приходилось более половины случаев всего детского туберкулеза. В 2011 году из 22,5 тысяч расчетных случаев ТБ-ВИЧ в Европейском регионе выявили 12 751 случай ТБ с соче- танной инфекцией ВИЧ (56.5%). Расчетная распростра- ненность ВИЧ-инфекции среди больных ТБ составила 6%. Тот факт, что распространенность среди всех проте- стированных случаев ТБ (6,2%) была весьма сходной с расчетной, указывает на высокую специфичность системы эпиднадзора за ТБ-ВИЧ в Регионе. Однако в связи с тем, что охват тестированием на ВИЧ составляет лишь 60%, статус был известен лишь у 205 578 новых и ранее леченых случаев ТБ, из них 12 751 имели соче- танную ВИЧ-инфекцию. Поскольку лишь небольшое число стран сообщают о случаях ТБ в исправительных учреждениях, сложно рассчитать, до какой степени ситуация в пенитенци- арных учреждениях влияет на региональное бремя ТБ. Однако в некоторых странах Восточной Европы случаи ТБ в пенитенциарных учреждениях превышали 10% от всех новых случаев ТБ в целом по стране, а в других показатель регистрации был близок к 1000 случаев на 100 000 населения в местах лишения свободы или даже превышал это значение. Тем не менее, в некоторых странах с низкой заболеваемостью риск ТБ в местах лишения свободы был выше, чем среди населения в целом. Это было связано с более высоким показателем распространения ТБ в этих учреждениях вследствие неудовлетворительных мер контроля и/или концентрации уязвимых подгрупп населения (таких как мигранты из стран с высокой заболеваемостью ТБ). В 2011 г. из расчетных 78 тысяч случаев туберкулеза с множественной лекарственной устойчивостью (МЛУ-ТБ) в Европейском регионе было выявлено 29 473 (38%). Распространенность МЛУ-ТБ среди новых зарегистри- рованных случаев ТБ в Регионе составила 14% и среди ранее леченых случаев - 47,7%. Охват тестированием чувствительности к препаратам второго ряда вырос почти в два раза по сравнению с прошлым годом, однако он все еще находится на очень низком уровне (9% случаев МЛУ-ТБ). Тем не менее, это позволило выявить 381 случай туберкулеза с широкой лекарственной устой- чивостью (ШЛУ-ТБ), т.е. 11% случаев МЛУ-ТБ в Регионе, протестированных на чувствительность к препаратам Исполнительное резюме 6SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 второго ряда. Недавно в помощь диагностике ТБ в неко- торых странах Региона были внедрены быстрые методы. За последние пять лет наблюдалось постепенное снижение показателей успешного лечения, которые теперь сократились до 67,2%, 49,2% и 48,5% среди новых, ранее леченых и МЛУ-ТБ случаев, соответст- венно. Снижение показателя в первых двух из трех когорт связано, главным образом, с увеличением доли МЛУ-ТБ в этих когортах. В третьей когорте это может быть следствием быстрого увеличения охвата отчетно- стью – почти в два раза по сравнению с прошлым годом (почти с 7 до свыше 12 тысяч больных) и с недостатком препаратов второго ряда гарантированного качества для лечения в соответствии с наиболее эффективными схемами, рекомендованными ВОЗ. Принимая во внимание вышесказанное, а также тот факт, что большая часть бремени ТБ приходится на 18 стран высокого приоритета Европейского региона2 (87% заболеваемости ТБ, 87% распространенности, 92% смертности вследствие ТБ, 91% сочетанных инфекций ТБ/ВИЧ и 99% МЛУ-ТБ), основные усилия в борьбе с ТБ и профилактике этого заболевания в Регионе должны быть сосредоточены именно там. Однако в Западной Европе и, в особенности, в больших городах ситуация с ТБ требует постоянного внимания. В сотрудничестве с национальными и международными партнерами и организациями гражданского обще- ства Европейское региональное бюро ВОЗ реализует Комплексный план действий по профилактике и борьбе с туберкулезом с множественной и широкой лекарст- венной устойчивостью и помогает государствам-членам адаптировать доказательные меры вмешательства для совершенствования профилактики и контроля туберкулеза и туберкулеза с множественной и широкой лекарственной устойчивостью (М/ШЛУ-ТБ). Все страны с высоким бременем МЛУ-ТБ, за исключением Российской Федерации, подготовили и приняли окончательную редакцию своих национальных планов действий в отношении МЛУ-ТБ в соответствии с Региональным планом. В некоторых странах национальные планы еще должны быть официально одобрены Министерствами здравоохранения. Европейское региональное бюро ВОЗ учредило Европейский комитет зеленого света и Европейскую лабораторную инициативу для оказания помощи странам в разработке и/или корректировке их наци- ональных планов в ответ на угрозу М/ШЛУ-ТБ. Это поможет странам снизить долю случаев МЛУ-ТБ среди ранее леченных больных на 20%, выявлять 85% расчет- ного числа больных МЛУ-ТБ и успешно лечить, как минимум, 75% из них. 2 18 стран высокого приоритета (СВП): Азербайджан, Армения, Беларусь, Болгария, Грузия, Казахстан, Кыргызстан, Латвия, Литва, Республика Молдова, Румыния, Российская Федерация, Таджикистан, Туркменистан, Турция, Украина, Узбекистан и Эстония. Страны Европейского союза и Европейской экономической зоны В 2011 году 29 стран ЕС/ЕЭЗ сообщили о 72 334 случаях ТБ, что на 4% меньше, чем в 2010 г. Показатель реги- страции в ЕС/ЕЭЗ, продолжая многолетнюю тенденцию к снижению, составил 14,2 на 100 000 населения. В общей сложности, 80% всех зарегистрированных случаев ТБ были диагностированы впервые и 69% всех новых случаев легочного туберкулеза имели культу- ральное подтверждение. Туберкулез в равной степени затронул возрастные группы взрослых людей, а показатель регистрации у детей младше 15 лет составил 4 на 100 0000, с тенден- цией сопоставимой многолетней динамики у населения в целом. Мужчины составили 80% от всех случаев ТБ в странах ЕС. В целом 26% всех случаев ТБ имели иностранное проис- хождение и большинство из них проживали в странах с низкой заболеваемостью. МЛУ-ТБ был зарегистрирован у 5% случаев с результа- тами теста лекарственной чувствительности (2% новых случаев ТБ и 17% ранее леченых случаев), эта форма заболевания продолжает быть особенно распростра- ненной в трех странах Балтии. В целом отмечается тенденция к некоторому снижению. ШЛУ-ТБ был заре- гистрирован у 13% из 1 017 случаев МЛУ-ТБ, прошедших тестирование лекарственной чувствительности. Всего 5% случаев ТБ с известным статусом ВИЧ имели сочетанную инфекцию вирусом. Успешно закончили свое лечение 74% случаев ТБ, зарегистрированных в 2010 г., и 32% случаев МЛУ-ТБ, зарегистрированных в 2009 г. В общей сложности 22% всех случаев было зарегистри- ровано исключительно с внелегочным ТБ (в основном ТБ лимфатических узлов и плевры); 35% из них имели культуральное подтверждение, 1% - множественную лекарственную устойчивость и 82% были учтены как успех лечения. Вероятность регистрации внелегочного ТБ у детей и случаев иностранного происхождения была как минимум в два раза выше, чем у взрослых и случаев среди коренного населения, соответственно. Распределение клинических проявлений в каждой из этих двух групп риска заметно отличалось от остальных случаев. 7Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 1. Background and technical note

9Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Between 1996 and 2007, TB surveillance data from the European Region were collected and analysed annually under the ‘EuroTB’ project. Since 1 January 2008, ECDC and the WHO Regional Office for Europe (WHO/Europe) have jointly coordinated the collection and analysis of TB surveillance data in Europe, aiming to ensure data standardisation and high quality across the countries of the WHO European Region (except Liechtenstein, Monaco and San Marino). The underlying standards and definitions have been agreed by leading European experts [1]. This year’s report highlights two subsets of TB cases that tend to be neglected by routine surveillance: extrapul- monary TB cases (based on data from The European Surveillance System (TESSy)) and prisoners with TB (based on Tuberculosis Monitoring and Evaluation (TME) data). The data published in this report may vary from figures in national reports due to different reporting periods. The deadline for correcting and updating the data in the joint database used in this report was 31 October 2012. 1.1 Data reporting and analysis Designated experts within the national surveillance institutes submitted their TB surveillance and control programme management data for 2011 electronically to the ECDC–WHO/Europe Joint TB Information System via a common portal3. The TB surveillance data from the European Union and European Economic Area (EU/EEA) countries were redirected to The European Surveillance System (TESSy) platform hosted by ECDC (Annex 1). The surveillance data from the non-EU/EEA countries and the programme management data from the entire European Region were processed through WHO’s Tuberculosis Monitoring and Evaluation (TME) platform. A total of 29 EU/EEA Member States reported case-based data4. They were also asked to provide updates for 2008, 2009 and 2010 to allow for the exclusion of duplicate cases or those later found not to have TB, as well as for updates of treatment outcome variables. The remaining countries of the European Region reported aggregate data. The TESSy variable list for the 2012 data collec- tion (Annex 2) has undergone some minor changes to facilitate the reporting of molecular surveillance data: ‘IsolateID’ has replaced ‘StrainNumber’, and a new vari- able (‘ECDCIsolateID’) has been added. Reporting completeness (Annex 3) varied among coun- tries due to differences in national surveillance systems, 3 ECDC/WHO/Europe Joint Surveillance http://www.ecdcwhosurveillance.org/ 4 As Liechtenstein only provided TB data for five cases in 2007, it is not included in the commentary. legislation and TB case ascertainment. Although the quality and comparability of reported data have improved consid- erably in recent years, the reader is still cautioned against making direct comparisons across countries. For the calculation of notification rates, country population denominators by age group and gender were obtained from Eurostat5 for the EU and EEA countries and from United Nations statistics6 for all others. Overall notification rates were directly age-standardised using a 2000–2010 EU/EEA average as the standard population. Notification data were analysed by the main epidemiological (location, gender and age) and case management determi- nants (history of previous anti-TB treatment, localisation of disease, laboratory results and HIV serostatus). Where relevant, particularly for countries in the EU/EEA, analyses were stratified by origin of the case (native/foreign origin). Correlations were expressed as Spearman’s rank corre- lation coefficients and considered significant if p<0.05. Associations between variables were quantified as preva- lence ratios and their 95% confidence intervals, assuming an association if the confidence interval did not include 1. TB/HIV co-infection Belgium, Bulgaria, Czech Republic, Estonia, Iceland, Ireland, Luxembourg, Malta, Romania, Slovenia, Slovakia and Spain reported case-based HIV serostatus, while France, Latvia, the Netherlands and all non-EU/EEA coun- tries submitted this information in aggregate format via TME. Denmark, Finland, Hungary and Poland reported the number of HIV-infected TB cases, but not the denominator of known HIV test results, and were therefore excluded from the analysis. The number of cases with known HIV status was expressed as a percentage of all reported TB cases. To be considered complete HIV data must be available for >50% of all TB cases. Only EU/EEA countries reported TB/ HIV cases by site of disease (Table H). Drug resistance Since the reporting year 1998, the results of drug suscep- tibility testing (DST) from initial isolates of Mycobacterium tuberculosis have been collected for isoniazid, rifampicin, ethambutol and streptomycin. Data on second-line drug resistance for amikacin, kanamycin, capreomycin, cipro- floxacin and ofloxacin have been reported via TESSy since 2008 and via CISID/TME since 2009. In countries where DST results are linked to TB case notifications, case-based information on DST is collected (26 countries in 2011). When individual DST data are not available, data are collected in aggregate format in CISID/TME on the basis of previous 5 Available from: http://epp.eurostat.ec.europa.eu/portal/page/ portal/eurostat/home/ 6 Population by UN Population Division, World Population Prospects: The 2010 Revision, medium variant (2012). 1. Background and technical note 10 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 anti-TB treatment history. Information on the organisation and laboratory practices of anti-TB DST in the country is also collected using the TME module of the joint TB surveil- lance system. Drug resistance surveillance (DRS) methods vary across countries. Initial DST results may be collected routinely for all culture-positive TB cases notified, or only for cases included in specific surveys or diagnosed in/ referred to selected laboratories. Geographic coverage of DRS is partial in Azerbaijan, Italy, Kyrgyzstan, Spain, Tajikistan, Turkey, Turkmenistan and Uzbekistan. DRS data are considered as complete if: • they are collected nationwide and linked to TB case notification in countries using culture routinely (>50% culture confirmation); • DST results for isoniazid and rifampicin are available for >80% of culture-positive cases and; • External Quality Assessment (EQA) results show 95% or more confirmation by a supranational reference laboratory. Data were reported on DST for isoniazid, rifampicin, ethambutol and streptomycin at the start of treatment. Percentages of laboratory-confirmed drug-resistant cases were calculated using as a denominator those cases for which DST results were available for at least isoniazid and rifampicin. If the cases had DST results for ethambutol and streptomycin these were also shown. The results of DST for second-line drugs were analysed for MDR cases only. Treatment outcome monitoring (TOM) Since the reporting year 2002, treatment outcome data have been provided by EU/EEA countries through the submission of an updated dataset for cases notified one year prior to the year of reporting. The same applies to MDR treatment outcome for cases reported two years earlier. Thus, as part of the 2012 data call, outcome data were collected for TB cases notified in 2010, and MDR-TB cases reported in 2009. Non-EU/EEA countries have reported similar aggregated treatment outcome data for the past three years. This report includes a data analysis for outcome at 12 months and first-time outcome at 24 months after starting treatment. Case cohorts eligible for outcome analysis are expected to include all laboratory-confirmed pulmonary TB cases notified in the calendar year of interest, although the confirmation level varies, especially among the non-EU/ EEA countries. For countries reporting case-based data, the most recently updated information has been used for the purposes of this report. Hence, for these countries, the cohort is defined on the basis of the new dataset, updated following initial notification. This could result in denominators differing from the number of notified cases reported in the previous year’s report. For coun- tries reporting aggregate outcome data, completeness of cohorts is assessed by comparing the total number of cases included in TOM cohorts with those initially notified as pulmonary and culture or smear-positive, depending on the type of cohort. Geographical areas The 27 EU Member States and three EEA countries are presented separately in tables and in Chapter 2.2. These are: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom. The 24 remaining countries in the WHO European Region (non-EU/EEA) are: Albania, Andorra, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Croatia, Georgia, Israel, Kazakhstan, Kyrgyzstan, the former Yugoslav Republic of Macedonia, Moldova, Monaco, Montenegro, Russia, San Marino, Serbia, Switzerland, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. In order to highlight the 18 high-priority countries (HPC) [3] identified by WHO, their data are presented in italics and as subtotals alongside the subtotals for the EU/ EEA and non-EU/EEA Member States. The 18 HPC are: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. TB notifications from Greenland are footnoted in tables but are not included in the totals for the European Region. 1.2 Definitions TB case definition for surveillance Information from EU/EEA countries was collected to enable the classification of cases according to the case definition approved by the EU Member States and published by the European Commission [4]. It classifies cases as ‘possible’, ‘probable’ or ‘confirmed’. Possible cases meet clinical criteria only. Probable cases are defined by the additional detection of acid-fast bacilli (AFB) or M. tuberculosis nucleic acid or granulomata. Confirmed cases require a positive culture or detection of both AFB with microscopy and M. tuberculosis in nucleic acid amplification test. Data from the remaining countries of the European Region follow the WHO-recommended definition. This defines a ‘case of tuberculosis’ as a patient in whom TB has been confirmed by bacteriology or diagnosed by a clinician. A ‘definite case’ is defined as a patient with culture confirma- tion of Mycobacterium tuberculosis complex. In countries where culture is not routinely available, a patient with one sputum smear-positive for AFB (AFB+) is also considered a definite case. Cases discovered post-mortem, with gross pathological findings consistent with active TB that would have indi- cated anti-TB treatment had the patient been diagnosed before dying, also fit the clinical criteria and are included. 11 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Previous anti-TB treatment status Never treated (new case): a case never having previously received drug treatment for active TB, or having received anti-TB drugs for less than one month. Previously treated case (retreatment case): a case previ- ously diagnosed with TB having received treatment with anti-TB drugs (excluding preventive therapy) for at least one month. Previously treated cases were reported from 24 EU/EEA Member States. In the remaining five (Belgium, Denmark, Ireland, Norway and United Kingdom), information about previous treatment was not collected or incomplete and previous diagnosis was reported instead and used as a proxy for previous history. Relapse (Table 5): a case previously diagnosed with TB and then re-diagnosed as a definite (laboratory-confirmed) tuberculosis case after having been declared cured or having completed treatment (smear-negative pulmonary and extrapulmonary cases may also be relapses if supported by pathological or bacteriological evidence). Site of disease Pulmonary case: a case with TB affecting the lung paren- chyma, the tracheo-bronchial tree or the larynx are also included in pulmonary TB for cases reported to TESSy. Extrapulmonary case: a case with TB affecting any site other than pulmonary (see above). Pleural TB and intra- thoracic lymphatic TB by themselves are considered as extrapulmonary. Detailed information on further distri- bution of extrapulmonary cases was provided by 25 EU/ EEA countries. Notes on the definition • The above definitions are in accordance with the European Commission’s approved definitions for TB surveillance. • All possible, probable and confirmed cases are reported to the joint European surveillance database. For coun- tries with laboratory-based reporting where no clinical information is available, laboratory-confirmed cases should be reported. • Cases should be notified only once in a given 12-month period. However, a case should be reported again if the diagnosis of confirmed tuberculosis is made following completion of anti-TB treatment (relapse case), even if this occurs within 12 months of reporting the initial episode of disease. • Cases which have never been treated are commonly referred to as new cases, although this term should not be considered to indicate incidence in the strict epidemiological sense. • Among re-treated cases, relapses are included in notifica- tions from all countries, whereas cases re-treated after failure or default and chronic cases are not included. DST data have been analysed for laboratory-confirmed cases. Origin The geographic origin of a TB case is classified according to place of birth (born in the country/foreign origin) for Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and United Kingdom. The countries of Austria, Belgium, Poland, Greece, Hungary, Armenia, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Moldova. Montenegro, Russia, Serbia, Tajikistan, Ukraine and Uzbekistan use the classification of citizenship (citizen/ non-citizen). In Denmark, the birthplace of the parents is also used to classify origin (similarly, in the Netherlands the birthplace of parents is notified for case management purposes). The country of origin is included in case-based data. The term ‘native’ as used in this report refers to cases born in, or having citizenship (nationality) of the country of report. ‘Foreign origin’ refers to cases born in (or citizens of) a country different from the reporting country. Drug resistance Resistance among cases never treated: indicates primary drug resistance due to infection with resistant bacilli. Resistance among cases previously treated: usually indi- cates acquired drug resistance emerging during treatment as a consequence of selection of drug-resistant mutant bacilli. It can also result from exogenous re-infection with resistant bacilli. Multidrug resistance (MDR): resistance to at least isoniazid and rifampicin. Extensive drug resistance (XDR): resistance to (i) isoniazid and rifampicin (i.e. MDR), and (ii) resistance to a fluoroqui- nolone, and (iii) resistance to one or more of the following injectable drugs: amikacin, capreomycin, or kanamycin [5]. Treatment outcome Cohort All TB cases notified in the calendar year of interest, after exclusion of cases with final diagnosis other than TB or cases found to have been reported more than once. Note: MDR-TB cohort (2009): 24 month outcome was collected for MDR-TB cases notified in 2009. Period of observation Cases are observed until the first outcome up to a maximum of 12 months after the start of treatment. For multidrug- resistant cases in EU/EEA countries, treatment outcome after 24 months should be reported if treatment lasts longer than 12 months and the reported 12-month outcome is coded as ‘still on treatment’7. Non-EU/EEA countries evaluate treatment outcomes according to the WHO definition. 7 The degree of adherence to the 12-month limit is unknown, and a number of countries are known to exceed it. Outcome at 36 months is not included in the report. 12 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Treatment outcome categories In general, the outcome categories used are those recom- mended, with two additional categories: ‘still on treatment at 12 months’, and ‘unknown’ [6]. The categories are as follows: Cured: treatment completion and: • culture-negative samples taken at the end of treatment and on at least one previous occasion; or • in countries where sputum smear-positive cases are classified as definite (laboratory-confirmed), sputum microscopy negative for AFB at the end of treatment and on at least one previous occasion. Cured for MDR-TB: MDR-TB patient who has completed treatment according to programme protocol and has at least five consecutive negative cultures from samples collected at least 30 days apart during the final 12 months of treatment. Completed: treatment completed, but does not meet the criteria to be classified as cured or treatment failure. Failed: culture or sputum smear remaining positive or becoming positive again five months or later into the course of treatment. Patients found to be infected with an MDR strain at any point during that episode of treatment are also included in this definition, whether they were initially smear-negative or -positive. Failure for MDR-TB case: • Two or more of the five cultures recorded in the final 12 months of therapy are positive, or any one of the final three cultures is positive; or • a clinical decision has been made to terminate treatment early because of poor clinical or radiological response or adverse events. The latter failures can be indicated separately in order to perform a sub-analysis [6]. Died: death before cure or treatment completion, irrespec- tive of cause. Defaulted: • Treatment interrupted for two months or more, not resulting from a decision of the care provider; or • patient lost to follow-up for two months or more before the end of treatment, except if transferred. Transferred: patient referred to another clinical unit for treatment and information on outcome not available. Still on treatment8: • Patient still on treatment at 12 months without any other outcome during treatment; 8 Definition applicable to the EU/EEA countries only. or • patient reported as still on treatment at 12 months and still on treatment at 24 months without any other outcome. Unknown: information on outcome not available, for cases not known to have been transferred. In this report: • ‘Success’ refers to the combined treatment outcome categories cured and completed. • ‘Lost to follow-up’ is the combination of transferred and unknown for country profiles. 13 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2. Commentary

15 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2.1 The WHO European Region Key conclusions for the European Region • In 2011, the countries of the WHO European Region reported 295 968 new episodes (new and relapses) of TB (33 per 100 000 population) out of an estimated 380 000 (range 321–437 000), which would correspond to 42 cases per 100 000 population (range 36–49). More than 85% of them were in the 18 high priority countries (HPC) of the WHO European Region. • The Region maintained a relatively high case detec- tion rate for all cases: 78% (range 67–92%). • More than 44 000 (44–46 000) deaths were estimated to have been caused by TB in the Region (4.9 per 100 000 population) (range 4.7–5.3). Overall, 92% of deaths occurred in the 18 HPC. • The notification shows a 24% decrease compared to 2005, however there is a significant difference in TB notification rates among the countries, from 2 to 119 per 100 000 population. • In ten countries of the Region (all in EU/EEA), the under-fives accounted for more than half of the cases detected among children. • In 2011, there were 12 751 (56.5%) TB cases with HIV co-infection detected from the 22 500 (range 18–27 000) estimated in the WHO European Region. Estimated prevalence of HIV infection among incident TB patients was 6% (range 5.6–6.2%), with 3.6% of these cases occurring in the EU/EEA countries and 6.5% in the non-EU/EEA countries. Due to the low reporting coverage of HIV testing (60%), only 12 751 (6.2%) of the 205 578 new TB and previously treated cases were found to have HIV co-infections. Three countries reported higher rates of HIV positivity among TB patients: Ukraine (18.5%), Malta (16.7%) and Estonia (15%). • Of the 78 000 estimated MDR-TB cases in the Region, around 30 000 (38%) were detected in 2011. In all, 98% of them were reported by 18 HPC. The prevalence of MDR among new TB cases in the Region amounted to 14% and 47.7% among previously treated cases. Although testing coverage for XDR has almost doubled in the Region, it is still only at 9%, documenting that 11% of MDR-TB patients are XDR-TB. • Treatment success of new TB patients and previously treated patients is still very low (67.2% and 49.2% respectively). Over the last five years, a gradual decrease in treatment success has been noted in the Region. • The number of MDR-TB patients with reported treat- ment outcome almost doubled compared to last year (from nearly 7 000 to over 12 000), however the treat- ment success rate was lower among MDR-TB patients (56.3–48.5%) respectively and some Member States in western Europe still do not provide information on treatment outcome. • In response to the alarming problem of MDR-TB, all 53 Member States have fully endorsed the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region 2011–2015 and its accompanying Resolution EUR/RC61/R7 from the sixty-first session of the WHO Regional Committee for Europe in 2011. The Action Plan includes a set of activities for countries, WHO and partners in order to achieve universal access to prevention and treatment of M/XDR-TB. WHO is currently preparing a detailed report on progress with the implementation of the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in 2013. Tuberculosis burden estimates The 2015 Millennium Development Goal target of halting the prevalence and death associated with TB and reversing its incidence has been partially achieved, with TB incidence having fallen in the Region at a rate of around 5% per year between 2000 and 2011. TB prevalence was estimated at 56 (range 34–101) cases per 100 000 population in 2011 and the target for TB prevalence is on track to drop to 34 cases per 100 000 population in 2015. However, in 2011, TB mortality was 4.9 (range 4.7–5.3) deaths per 100 000 population and the Region will therefore not achieve the target of 50% reduction by 2015 compared to 1990 (4.4 per 100 000 population in 1990 and 8 per 100 000 popula- tion in 2000). The burden of TB in the European Region varies among and within the countries, from a range of less than one TB case per 100 000 population in some to over 200 TB cases per 100 000 in others. Even within each of the countries in western Europe, there are significant differences from one region to another, with TB rates above 100 per 100 000 population in some areas. The WHO European Region accounts for around 4.4% of the newly detected tuberculosis and relapse cases in the world [2]. This represents the emergence in the Region of an estimated 380 000 (range 321–437 000) individuals with a new episode of TB (new or relapse) during 2011. The incidence in the Region amounts to an estimated 42 (range 36–49) per 100 000 population (Table 1, Figure 1). In 2011, case detection rates increased to 78%. 2. Commentary 16 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Over 44 000 (44–46 000) deaths were attributed to TB, equivalent to 4.9 (range 4.7–5.3) per 100 000 population. The vast majority of TB cases occur in the 18 HPC9. These countries represent 87% of the TB incidence and 92% of the mortality caused by TB in the Region (Figure 2). Out of an estimated 78 000 MDR-TB cases in the European Region in 2011, around 30 000 (38%) were detected. A total of 98% of these were reported by the 18 HPC. In 2011, HIV infection was a contributory factor in 6% (5.6–6.2%) of the total incident (new and relapse) TB cases in the Region, representing 3.6% (3.2–4%) in the EU/EEA group of countries and 6.5% (6.2–6.7%) in the non-EU/EEA group of countries (Table 2). The countries with significantly high proportions of HIV are Ukraine (20%), Malta (17%), Estonia (15%) and Portugal (14%). Trends in notification In 2011, a total of over 380 000 TB cases were reported from 51 countries10 in the WHO European Region (42 per 100 000 population) (Table 3). This represents a 27% decrease on the 2007 rate (53.6 per 100 000), a 5.6% decrease on 2010 (43.6) and a 5.7% mean annual decrease for the period 2007–2011. However, during 2007–2008, there was an increase in notification of all types of TB in the Region, largely due to changes in the notification policy for TB patients in Kazakhstan and Russia. This policy meant that previously notified cases were included in the category of previously treated, thus artificially inflating the number of cases in Kazakhstan and Russia by counting them twice. Since 2009, none of the countries in the Region report prevalent TB cases in the overall notification. During the period 2005–2011, a 24% decline in notifica- tion rates was observed (around 295 968 new TB cases 9 The 18 countries are: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. 10 There are 53 countries in WHO European Region. San Marino and Turkmenistan did not report data in 2011. and relapses), decreasing from 41 to 33 cases per 100 000 population (Table 5). This trend reflects a true reduction in the spread of the disease, strongly influenced by the 24% decrease in notification rates in the Region’s 18 HPC (from 80 to 64 per 100 000 population) (Figure 4). Before 2004 there was a sustained plateau in the notification rate for new TB and relapses. Nevertheless, despite encouraging trends, the notification rate of new and relapse cases in the HPC remained twice as high as for the Region overall (64 compared with 33 cases per 100 000), and more than 5.3 times higher than the rate in the EU/EEA (12 cases per 100 000 population). The notification rate of new and relapse cases varies widely among countries, from two (Luxemburg) to 119 (Moldova) per 100 000 population (Table 5). It is noteworthy that some countries, including Luxemburg, have a considerably high (more than 25%) proportion of patients with unknown treatment history and, as a result, have reported less new and relapse cases. In addition to Moldova, there were three countries with notification rates above 100 per 100 000 population for new and relapse cases: Kyrgyzstan (103), Georgia (105) and Kazakhstan (113). After accounting for effect of age, when applying the stand- ardised notification rate only for new cases Tajikistan reaches the level of 111 per 100 000 population, versus the crude rate of 85, indicating that the relatively low notifica- tion rate in Tajikistan is due to the large child population, which shifts the crude rates towards lower values. In 2011, the number of countries with low notification of new and relapse cases (less than 20 cases per 100 000) [1] was 32. All of these 32 countries are in the western and central part of the Region and the majority of them are high-income countries11 which account for 16% of the notified burden in the Region. Nine countries reported new or relapse case rates of between 20 and 50 per 100 000 population: Turkey (20.4), Poland (20.8), Estonia (22.2), Portugal (22.7), Bulgaria (29.0), Bosnia and Herzegovina 11 High-income countries are those with a per capita gross national income of USD 12 476 or more in 2011, as defined by the World Bank (http://data.worldbank.org/about/country-classifications). Figure A: Estimated TB incidence (per 100 000 population) and case detection rates (as a percentage), WHO European Region, 1990–2011 0 20 40 60 80 100 20102008200620042002200019981996199419921990 Incidence Case detection rate Pe r 1 00 0 00 /P er ce nt ag e Global TB database, WHO (http://www.who.int/tb/country/data/download/en/index.html), accessed on 3 January 2013. 17 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT (36.2), Latvia (38.8), Armenia (40.7) and Belarus (49). Seven reported between 50 and 100 cases per 100 000 population: Uzbekistan (52), Lithuania (54), Azerbaijan (70), Ukraine (76), Russia (79), Romania (80) and Tajikistan (90). The 11 countries with new and relapse case notifications above 50 per 100 000 account for around 76% of the regional burden, with the largest contribution coming from Russia: 112 910 cases and 15% of the Region’s population (143 million). Due mainly to the revised case notification in Russia and Kazakhstan, the percentage of reported cases that had been previously treated decreased slightly, from 32% in 2007 to 29.8%12 in 2008, and to 26.7% in 2011 (Table 3). The percentage of previously treated cases in 2011 was 12.3% and 30.1% for the EU/EEA and non-EU/EEA respectively. There were 15 countries in which previously treated cases accounted for 15% or more of all TB cases: Azerbaijan (47.6%), Kazakhstan (45.1%), Russia (34.6%), Moldova (27.7%), Ukraine (26.9%), Andorra (25%), Romania (24.3%), Armenia (24.1%), Georgia (23.7%), Kyrgyzstan (22.3%), Estonia (22.3%), Belarus (21.0%), Lithuania (19.4%), Hungary (15.3%) and Macedonia (15.2%). Reasons for the high percentage of previous treatment among all cases include clinical failures and lack of programme manage- ment, possible re-infection and/or misclassification. TB cases with unknown treatment history were more often notified by countries in the western part of the Region. 12 European Centre for Disease Prevention and Control/WHO Regional Office for Europe: Tuberculosis Surveillance Report in Europe, 2008. Stockholm: ECDC, 2010. These included eight countries where more than 25% of TB cases identified had no previous treatment history: Luxemburg (53.8%), France (41.3%), Italy (39.8%), Austria (39.4%), Cyprus (37.0%), Belgium (26.8%), Ireland (27.8) and Switzerland (25.1%). Notification by site of disease In 2011, pulmonary localisation was notified in about 81% of the overall TB cases in the Region, a proportion similar to that observed over the last five years. In EU/ EEA countries a somewhat lower proportion of pulmonary localisation was seen (77%) than in non-EU/EEA coun- tries (82%). Data completeness on disease localisation in the Region increased significantly in 2011, with only 5% of unknown disease sites remaining. However, four non-EU/EEA and one EU/EEA country still need to improve their notification by disease localisation: Armenia (15.0% unknown disease sites), Georgia (14.3%), Ukraine (13.5%), Switzerland (9.3%) and Denmark (24.7%). Extrapulmonary TB was notified on average for 13% of all TB cases in the Region. However, seven countries reported more than 30% of their tuberculosis cases to have extrapulmonary localisation, and four countries had rates exceeding 40%: Iceland (66.7%), United Kingdom (48.1%), Netherlands (43.8%) and Norway (43.8%). Notification by laboratory confirmation Laboratory confirmation of TB diagnosis was reported for 123 525 (55.0%) of all 224 549 new pulmonary cases in the Region; 103 174 (45.9%) cases were confirmed by Figure B: Estimated TB incidence per 100 000 population, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 150 Not included or not reporting ≤ 10 11–20 101–150 51–100 21–50 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 18 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 culture and 20 351 (9.1%) by microscopy (Table 8). New rapid methods to support TB diagnosis have recently been introduced in some countries of the Region, and this year for the first time limited data was reported on cases in EU/EEA countries that were confirmed by microscopy and nucleic acid tests. Confirmation of TB diagnosis by culture among newly detected pulmonary TB cases was lower in non-EU/EEA countries (40.3%) than in EU/EEA countries (69.2%) (Table 8). Nine countries had more than 30% of new pulmonary cases that were sputum smear negative and culture-positive, underlining the need for the culture of smear negative isolates: Sweden (42.7%), Finland (38.7%), Latvia (38.4%), Czech Republic (38.4%), Slovenia (36.8%), Belgium (33.3%), Estonia (32.4%), Cyprus (32.0%) and Israel (31.0%). Notification by gender and age Although there were twice as many males reported as females among all TB cases (Table 3), a large variation was observed for male predominance in the gender distribution of TB cases. This ranged from an almost even distribution in Norway (1.2:1) to around three times greater in Armenia and Georgia (2.9:1 each). There were twelve other coun- tries where the female to male ratio among TB cases was greater than two: Albania, Belarus, Czech Republic, Estonia, Greece, Israel, Lithuania, Malta, Poland, Russia, Romania and Ukraine. This gender difference in TB case notifica- tion most likely reflects the over-representation of males in the various risk groups for TB, notably the homeless, prisoners, seasonal migrant workers and HIV-infected individuals among men who have sex with men (MSM) and people who inject drugs (PWID). In 2011, most (41%) of the newly detected TB cases in the European Region were in the 25–44 year age group (Table 11). This was also the most affected age group in both EU/EEA and non-EU/EEA countries, accounting for 35.4% and 39.9% of new TB notifications respectively. In eleven countries the oldest age group (65+ years) contained more than 25% of the new TB cases: Finland (49%), Bosnia and Herzegovina (35.4%), Serbia (31%), Croatia (30.9%), Slovenia (30.9%), Czech Republic (29.7%), Slovakia (29.1%), Germany (28.5%), Poland (26.1%), Greece (25.7%) and Hungary (25.5%). During 2007–2011, region-wide trends of overall TB noti- fication in children (age group 0–14 years) decreased by 23% in the Region from 8.7 to 6.7 cases per 100 000 population (Trends Table III). These trends were strongly influenced by the 23% decrease in TB notification among children observed in the 18 HPC (from 15.1 to 11.6 cases per 100 000 population). However, the average percentage of patients within this age group in the Region remained stable at around 6% over the same period (Table 11). In 14 of the Region’s countries children represented more than 5% of all TB cases. In ten countries youngsters under the age of five years accounted for more than half of the cases detected among children: Czech Republic (83%), Hungary (67%), Austria (63%), Slovakia (59%), Switzerland (58%) Belgium (57%), Spain (56%), France (54%), Germany (51%) and Slovenia (50%) (Table 11). Tuberculosis and HIV co-infection. Due to the limited information and HIV testing coverage still being reported by many countries, it is not possible to make comparisons between groups of countries, or to comment on temporal trends other than for single coun- tries. In 2011, many countries increased their HIV testing coverage compared to 2010, while a significant reduction was reported by Kyrgyzstan (from 100% to 2.4%) and Russia (from 100% to 49.8%), most probably due to the gaps in their recording/reporting system. Among those countries reporting representative HIV testing, three could docu- ment a significant overlap of the HIV and TB epidemics by exceeding 15% HIV prevalence among new and re-treatment TB cases (Table 22): Ukraine (18.5%), Malta (16.7%) and Estonia (15%). A number of other countries follow with more than 5% HIV prevalence: Latvia (9.4%), Spain (9.1%), France (7%), Netherlands (6.7%), Israel (6.3%), Moldova (5.7%), Belgium (5.2%) and Russia (5.2%). Of the EU/EEA countries that reported TB/HIV cases by site of TB disease, only 18% were extrapulmonary TB cases and the proportion of HIV testing was similar to that for pulmonary TB cases (51.1% vs. 58.2%). The rate of HIV infection was higher among the extrapulmonary TB cases tested than the pulmonary TB cases (6.1% vs. 3.9%). Notification by history of imprisonment There are still too few countries reporting complete quality data on TB detection in prisons (Table A). The most impor- tant information is missing from those countries that have high prison population rates13 such as Kazakhstan and Russia. Among those countries reporting complete data, three had TB cases in prisons exceeding 10% of the countrywide total of new TB cases: Georgia (20.8%), Slovakia (18.9%) and Israel (11%). The highest TB noti- fication rates in prisons were in Azerbaijan (1984 per 100 000 detainees), Lithuania (948 per 100 000 detainees), Tajikistan (886 per 100 000 detainees) and Slovakia (856 per 100 000 detainees). The highest relative risk of TB in prison is calculated for Slovakia (1445 RR) and Israel (57 RR). Given that so few countries report, it is difficult to calculate how much prisons contribute to the regional TB burden. Countries with high TB incidence and large prison populations are thought to contribute significantly. The high TB relative risk in prisons is not related to the level of TB incidence in the country but to the higher TB transmission there due to poor control measures and/or the concentration of vulnerable sub-groups of populations (such as immigrants from high TB incidence countries). Notification by patient origin TB cases of foreign origin represent 25.8% of the total TB cases (new and relapse) reported from EU/EEA countries and only 2.1% from non-EU/EEA countries (Table 13). TB cases of foreign origin represent a large majority in many countries: Israel (89.5%), Sweden (89.4%), Norway (87.8%), Malta (84.8%), Cyprus (83.3%), Luxemburg (80.8%), Iceland (77.8%), Switzerland (74%), the Netherlands (70.5%) and 13 Walmsley R. World prison population list (Ninth Edition). London: International Centre for Prison Studies, 2012. 19 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT United Kingdom (70.1%). This is also an indication that access to TB diagnosis in these countries is good and that they are committed to global efforts towards TB control. The smaller number of TB cases reported by origin (comparing Table 13 with Table 4) may diminish the TB epidemiological relevance of recent and past immigration, especially in some of the non-EU/EEA countries. Extrapulmonary TB was reported as higher among foreign-origin cases than among pulmonary TB cases in EU/EEA countries (37.8% vs. 16.5%) (Table F). EU/EEA countries also reported MDR-TB by origin (Table 21), showing higher rates of DST but lower rates of MDR-TB in foreign-origin than in native cases (67.7% vs. 45.7% and 3.4% vs. 5.4% respectively). This is probably the result of a more selective DST among native TB cases. Laboratory network performance Forty-five countries in the WHO European Region reported on their laboratory capacity. In total, these countries have 7 879 laboratories performing sputum smear micros- copy, 1 735 laboratories performing mycobacteriology cultures and 578 performing drug susceptibility testing (DST) (Table 15). The methods for rapid detection of TB and MDR-TB were the WHO recommended line probe assay (LPA) and, for the first time, the Xpert MTB/RIF assay. In all, 157 laboratories used the LPA and 104 used the Xpert MTB/RIF assay. Although the number of smear microscopy laboratories in non-EU/EEA countries is much higher than in the EU/EEA countries (6 547 vs. 1 332), the number of labo- ratories able to perform culture, DST and rapid diagnosis is much lower in non-EU/EEA countries (639 in non-EU/ EEA vs. 1 096 in EU/EEA countries for culture, 208 vs. 370 for DST, 39 vs. 118 for LPA, and 40 vs. 64 for Xpert MTB/ RIF, respectively). If we look at the number of laboratories in relation to the number of TB cases, the availability of microscopy is nearly equal in the EU/EEA and non-EU/ EEA. However, the limited availability of culture, DST and rapid diagnosis in non-EU/EEA countries becomes even more pronounced. Forty-three of the 45 countries reporting on their labora- tory network had established in-country external quality assurance (EQA) systems for smear microscopy and DST, and 42 participated in international EQA programmes for DST. Reporting on the results of the quality assurance was incomplete and also suggests that the performance of the laboratory network in some countries is poor and requires better coordination and monitoring at national level. International EQA shows good quality of DST at national reference laboratory level. All except three coun- tries scored over 95% of DST results correctly for isoniazid and rifampicin. Laboratory data from 19 countries in the EU/EEA and seven non-EU/EEA countries are based on defined criteria (national coverage of 100% or culture results available for 90% of all cases; 50% of all cases culture-positive, with DST results for 80% of culture-positive cases and EQA results matching for 95% or higher) (Table 16). Of the 380 474 cases registered in the countries of the Region, 40.8% (155 145) were confirmed by culture. This confirmation rate was slightly higher than in 2010 when it was 39.3%. The culture confirmation rate was much higher in EU/ EEA than in non-EU/EEA sub-regions (63.5 % vs. 35.4%). The percentage of positive cultures subjected to DST for first-line drugs decreased from 85.7% (131 007) in 2010 to 82.5% (127 936) in 2011 (Table 16). Multidrug-resistant tuberculosis notification In 2011, 49 countries in the Region reported on first-line anti-TB drug susceptibility test results, representing a slight decrease on 2010 when all countries reported data. In 2011, the prevalence of MDR-TB among 89 877 new TB cases tested for first-line DST in the Region was 13.2%, which is similar to the 2010 data (12.9%). While 14 countries reported 0 or less than 1% MDR among new TB cases, for six countries this rate was over 20% (Table 17). Except for the Baltic States, where MDR-TB among new cases varied from 11.1% in Lithuania to 22.9% in Estonia, the prevalence was 4% or lower in all EU/EEA countries. In the non-EU/EEA area, four countries had an MDR-TB prevalence ranging from 10–20% among new cases tested for first-line DST. Five countries had an even higher prevalence: Belarus (26%), Moldova (26.0%), Kazakhstan (30.3%), Uzbekistan (35.1%) and Tajikistan (44.7%). The data from Tajikistan and Uzbekistan are not representative for the whole country and therefore should be interpreted with care. The proportion of MDR-TB among 31 929 previously treated TB cases whose isolates were tested for first-line DST was 46.4%, comparable to the rate measured in 2010 (49.9%). Twelve countries had between 15% and 50% MDR-TB among previously treated cases tested for first line DST. In eight countries this rate was even higher: Kazakhstan (51.3%), Ukraine (51.7%), Russia (52.8%), Estonia (57.7%), Moldova (63.8%), Belarus (65.6%), Uzbekistan (72.4%) and Tajikistan (74.2%) (Table 17). However, due to the fact that data from some countries is not nationally representative, these data should be interpreted with care (Table 16). Over the past five years the MDR-TB notification rate among culture-positive cases with available DST results has been collected and trends have differed significantly by country (Trends Table VI). Overall, in the past five years the rate of MDR among tested cases was stable in the EU/EEA Region (4.5% in 2011). In the non-EU/EEA countries it increased from 20.3% in 2007 to 30.2% in 2011. When scaling up the rapid tests for MDR-TB detection, it should be noted that the percentage of isolates resistant to at least rifampicin but not to isoniazid is only 0.5% among new cases and 0.9% among previously treated cases (Tables 18 and 19). This underlines the strong correlation between rifampicin and MDR-TB in the Region and justifies the use of rifampicin as a marker for MDR-TB. XDR-TB notification In 2011, only 34 countries reported on second-line DST (21 EU/EEA and 13 non-EU/EEA countries, Table 20). Of the 3 448 MDR-TB cases subjected to second-line DST, 381 (11.0%) were extensively drug-resistant (XDR-TB). Compared to 2010, twice as many MDR-TB isolates were subjected to second-line DST in 2011. However, the prevalence of MDR in the Region was comparable to that for 2010. In EU/ EEA countries, where SLD testing was reasonably high (70.7% 20 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 of MDR-TB cases were tested for SLD), prevalence of XDR among MDR cases was 13.4%, which is slightly higher than the prevalence recorded in 2010 (12.6%). These percent- ages represent 136 and 114 cases, respectively. In contrast, the number of XDR-TB cases among MDR cases tested for second-line drugs reported from non-EU/EEA countries (where only 9.6% of notified MDR cases had an SLD DST result) decreased from 11.9% in 2010 to 10.0% in 2011. The XDR-TB prevalence varies widely from country to country (from 0 to 40%), however the small number of cases tested and probable selection bias dictates caution in interpreting these results. In Belarus, within the framework of a nation- wide anti-TB drug resistance survey in Minsk, SLD DST conducted among 107 MDR patients yielded 14.0% (15/107). Treatment outcome In 2010, the treatment success rate among 98 433 newly detected TB cases with laboratory-confirmed pulmonary disease was 67.2% (Table 23). This represents a further slight decrease on the treatment success rates recorded in previous years (68.7% for 2009, 69.7% for 2008, 70.7% for 2007 and 73.1% for the 2006 yearly cohorts) and may be explained by an increase in failures due to the growing MDR-TB burden and other unfavourable outcomes. The treat- ment success rate was higher in the EU/EEA countries than in non-EU/EEA countries (76.8% vs. 63.4%). Only eleven countries reached the target of 85% treatment success among newly detected cases with laboratory-confirmed TB. Another six were close to the target, with success rates between 80 and 85%. Four countries had treatment success rates below 60%. The lower overall success rate for the non-EU/EEA area was impacted mainly by Russia and Ukraine, which together represented 61% of cases in this sub-Region and reported treatment successes of 53.1% and 59.8% respectively. In the 2010 yearly cohort, a total of 8 321 (8.5%) new pulmonary laboratory-confirmed cases were reported to have died, 5.8% to have defaulted and 11.7% to have had treatment that failed. These unfavourable outcomes were lower in the EU/EEA countries than in the rest of the Region, exemplified by the proportion of patients with failed treatment – 1.6 % in EU/EEA versus 15.7% in non-EU/EEA countries (Table 23). Seven of the 12 countries with lethal outcomes in excess of 10% were in the EU/EEA countries. Six countries reported a treatment failure rate greater than 10%; Armenia (15.0%), Belarus (22.5%), Russia (23.1%), Ukraine (16.7%), Georgia (11.6%) and Tajikistan (10.7%). The high failure rates can largely be explained by the high MDR-TB prevalence in these countries. Kazakhstan reported a 26.9% treatment outcome for the category transferred or unknown. Because of the current definition of treatment outcomes, countries applying rapid diagnostic sensitivity tests are likely to report better outcomes, by placing new MDR cases directly into second-line treatment programmes, bypassing the new cases cohort. A revision of the case definition was recommended by the WHO’s Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) and is expected to be rolled out for implementation in the second quarter of 2013. Other reasons for poor treatment outcomes are the high rate of HIV co-infection, shortage of drug supplies and high rates of drug use and alcoholism in some countries [7–9]. Six non EU/EEA and nine EU/EEA countries have reported treatment default rates above five percent among new sputum smear positive pulmonary TB patients. High default rates in some Member States require further investigation to determine the reasons for treatment interruption and there should be appropriate intervention for patients in programmes. As expected, the treatment outcome among previously treated TB cases was lower than among newly detected cases. The treatment success rate among 56 234 laboratory- confirmed cases notified in 2010 with previously treated pulmonary disease was 49.2% (Table 24), a slight increase on the 48.0% recorded in 2009. As with the new TB cases, the success rate was higher in the EU/EEA countries than in non-EU/EEA countries (53.7% vs. 48.6%). Nine countries had a treatment success rate of 50% or lower among previ- ously treated TB cases. Eleven had a success rate above 70%, and six of these had a success rate of 80% or higher: Finland (85.7%), Slovakia (82.8%), Albania (90.0%), Bosnia and Herzegovina (95.0%), Israel (80.0%) and Montenegro (85.7%). These countries reported very few cases, except for Bosnia and Herzegovina which reported on the outcome of 101 cases. Out of all the previously treated cases in the Region with unsuccessful outcomes 10.4% died, 16.7% failed and another 10.3% defaulted. The treatment outcome of 12 110 MDR-TB cases, all repre- senting culture-confirmed MDR-TB cases notified in 2009, was reported by 34 countries (Table 26). For the whole Region the treatment success among MDR-TB cases was 48.5% and, in contrast to the other cohorts, the propor- tion of successfully treated MDR-TB cases was higher in the non-EU/EEA countries than in the EU/EEA countries (50.8% vs. 31.6%). The countries that performed best were: Kazakhstan (73.2%), Azerbaijan (74.0%), Israel (83.3%), United Kingdom (75.0) and Sweden (84.6%). In EU/EEA countries, 19.8% of MDR-TB cases died, 19.8% failed and 19.9% defaulted, while in non-EU/EEA countries 15.8% died, 8.6% failed and 12.4% defaulted. Conclusions and recommendations The 2015 Millennium Development Goal target of halting the prevalence and death associated with TB and reversing the incidence has been partially achieved, with TB inci- dence having fallen in the Region at a rate of about 5% per year between 2000 and 2011. The prevalence of TB was estimated at 56 (range 34–101) cases per 100 000 population in 2011 and the target for TB prevalence is on track to reach 34 cases per 100 000 population in 2015. However, in 2011, TB mortality was 4.9 (range 4.7–5.3) deaths per 100 000 population, meaning that the Region will not reach the target of 50% reduction by 2015 compared to 1990 (4.4 per 100 000 population in 1990 and 8.0 per 100 000 population in 2000). As in the previous year, tuberculosis surveillance reveals a mixed epidemiological picture among the Member States 21 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT of the WHO European Region. Member States in the east have much higher notification rates than the west. Although the Region accounts for only 4.4% of the world’s newly detected and relapsed TB cases, it reported about 300 000 new episodes of TB (33 per 100 000 population) out of an estimated 380 000 (range 321–437 000), which was 42 cases per 100 000 population (range 36–49). It also main- tained a high case detection rate of 78% (range 67–92%). This demonstrates that, on average, the countries of the Region have one of the most sensitive surveillance systems in the world. More than 44 000 (44–46 000) deaths were estimated to have been caused by TB in the Region (4.9 per 100 000 population) (range 4.7–5.3). TB notifications have been decreasing since 2005 from 41 to 33 cases per 100 000 population (295 968 new cases and relapses). Trends are confirmed by the fall in the registration of patients coming under the categories ‘previous treatment history’ and ‘laboratory-confirmed’ by smear or culture. Despite this encouraging trend, notification rates for newly- detected and relapsed TB cases in the 18 HPC remained almost eight times higher (64 per 100 00 population) than in the rest of the Region (8.8 per 100 000) and twice as high as the regional average (33 per 100 000 population). Unknown treatment history and undocumented localisa- tion of disease was more often reported by countries in the west of the Region. Similarly, the use of the standard definition also needs to be improved in some countries. Culture confirmation of newly detected pulmonary TB cases was extremely low among non-EU/EEA countries (40.3%) compared with EU/EEA countries (69.2%). Several countries had a significant proportion of sputum smear negative culture-positive patients, indicating challenges in assuring the quality of smear microscopy diagnosis and/ or adhering to the recommended diagnostic algorithm. New rapid methods for diagnosis of TB have recently been introduced in some countries within the Region, but data from these new tests have not been collected for 2011. During 2007–2011, region-wide trends of overall TB notifi- cation in children decreased by 23%, from 8.7 to 6.7 cases per 100 000 population, mainly driven by a 23% decrease in the 18 HPC (from 15.1 to 11.6 cases per 100 000 population). However, in the EU/EEA countries, this trend levelled off at around 4% during the same period. It is also alarming that over half of the children reported by 10 countries in the west of the Region were under five years of age. There is a need to ensure adequate and timely diagnosis and accurate recording and reporting of TB among children across the Region. The low proportion of TB in citizens of foreign origin in non-EU/EEA countries may be due to a lack of notification for this indicator in several countries. For a more accurate inter- pretation of the role of migration in spreading the disease based on routinely reported data, countries should initiate notification of patients using this criterion. When linked with the genotyping of mycobacterium strains this data will allow us to better understand molecular epidemiology and geographical spread across the Region and beyond. The majority of TB-HIV co-infected individuals (92%) were notified in the non-EU/EEA countries. The prevalence of HIV among TB cases in the Region increased from 3.6% in 2008 to 6.2% in 2011. Among countries reporting representative HIV testing, three could document a significant overlap of the HIV and TB epidemics by exceeding 15% HIV prevalence among new and re-treatment TB cases: Ukraine (18.5%), Malta (16.7%) and Estonia (15%). The increase in TB-HIV co-infection warrants a strengthening of collaborative TB/HIV activities. In 2011, the prevalence of MDR among new TB cases in the Region amounted to 14%, which is almost identical to the result for 2010 (13.7%). Except for the Baltic States, where MDR among new cases varied from 11.1% in Lithuania to 23.3% in Estonia, the percentage was under 3% in all EU/ EEA countries. In the non-EU/EEA sub-region, four countries had a prevalence of MDR among new cases ranging from 10–20%, and five countries had an even higher preva- lence: Moldova (26%), Belarus (26%), Kazakhstan (30.3%) Tajikistan (44.7%) and Uzbekistan (35.1%). The prevalence of MDR-TB among previously treated cases was 47.4% in 2011, comparable to the rate measured in 2010 (48.7%). Countries with more than 50% of previously treated cases that were tested for drug susceptibility and found to be infected with MDR-TB include: Armenia (53.6%), Belarus (65.6%), Estonia (58.8%), Kazakhstan (51.3%), Moldova (63.8%), Russia (52.8%), Tajikistan (74.2%), Ukraine (51.7%) and Uzbekistan (72.4%). The XDR-TB rate reported among MDR-TB cases was 11%, which is lower than 2010 (13%). Due to low testing coverage (only 3% and 9% of MDR cases respectively were subjected to second-line DST in 2010 and 2011 in the non EU/EEA region) or because data may be biased towards testing for more severe cases, it should not be considered representative. Over the last five years treatment success rates have continued to decrease, dropping to 67.2% for new cases and 49.2% for previously treated cases in 2011. Treatment success rates among newly detected pulmonary laboratory- confirmed TB and previously treated cases were higher in EU/EEA countries than in the rest of the Region – 76.8% vs. 63.4% and 51.1% vs. 48.6% respectively. In 2011, a total of 8 321 (8.5%) of new pulmonary laboratory- confirmed cases were reported to have died, 5.8% to have defaulted and 11.7% to have failed treatment. These rates were lower in the EU/EEA countries than outside the EU/ EEA area, exemplified by the proportion of patients that failed treatment: 1.6% in EU/EEA against 15.7% in non-EU/EEA countries. These high failures rates can be explained by the high MDR-TB prevalence in countries that account for the majority of the burden in the Region. The high default rates of patients in some Member States require investi- gation to determine the underlying factors and measures to address them. A lower treatment success rate was seen among MDR-TB patients from the 2009 cohort (48.5%) compared to 2008 (56.3%), however this may be due to the fact that the number 22 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 of MDR-TB cases with treatment outcomes reported almost doubled, from 6 920 to 12 110. Despite the decrease in TB notification, drug-resistant TB is becoming a major concern and there is an urgent need to address the root causes of its emergence and transmission. Shortcomings in health systems and social determinants of health in relation to TB should be addressed in every country. Early detection of TB, particularly drug resistant TB, and adequate treatment with patient-friendly services need to be ensured across the Region. Even in the EU/EEA countries the current treatment success of MDR-TB cohorts is very low (31.6%). In close consultation with the Member States, experts, patients and communities suffering from the disease, WHO Regional Office for Europe has devel- oped a Consolidated Action Plan to Prevent and Combat Multidrug and Extensively Drug-Resistant Tuberculosis 2011–201514. The Plan takes into account new diagnostic techniques, patient-centred models of care and tailored services for specific populations. All 53 Member States have fully endorsed the Consolidated Action Plan and the accompanying Resolution EUR/RC61/R7 from the sixty- first session of the WHO Regional Committee for Europe. It is important to join forces and ensure the Plan is being implemented. From 2013 onwards, the Joint ECDC-WHO/ Europe report and/or similar mechanism will be used to monitor progress on the implementation of the Action Plan and the Berlin Declaration15. To this end, specific monitoring frameworks have been developed for each of these two important regional commitments, as presented below. These frameworks complement one another and the ECDC Framework Action Plan to Fight Tuberculosis in the European Union16. 14 Consolidated Action Plan to Prevent and Combat Multidrug and Extensively Drug-Resistant Tuberculosis in the WHO European Region http://www.euro.who.int/__data/assets/pdf_file/0014/152015/ e95786.pdf 15 The Berlin Declaration on Tuberculosis, WHO European Ministerial Forum, 22 October 2007 http://www.euro.who.int/__data/assets/ pdf_file/0008/68183/E90833.pdf 16 ECDC Framework Action Plan to Fight Tuberculosis in the European Union, Stockholm, February 2008 http://ecdc.europa.eu/en/ publications/publications/0803_spr_tb_action_plan.pdf 2.2 European Union and European Economic Area countries Data completeness As for TB cases notified in 2010, reporting of non-manda- tory variables in 2011 was complete or near-complete for classification, age, gender and most variables defining the origin of a case (Annex 3). Previous diagnosis and treatment were available for just over 90% of cases and previous treatment completion for 82%, with the latter being reported from four more countries than in 2010. The results of culture (78%) and microscopy (73%) were reported a little less frequently than in the previous year while the completeness of reporting for the causative pathogen decreased by ten percentage points to 42% in 2011. Drug susceptibility reporting improved throughout, involving an increased number of countries for several of the drugs under surveillance, reaching 13% for ciprofloxacin and 66% for kanamycin. Similar improvements were seen with the reporting of HIV status, which was provided by 16 countries for 26% of cases. Reporting of typing results remained limited to a maximum of 1% of cases from up to five countries. Compared with 2010, twelve-month and 24-month treatment outcomes were reported by one and three more countries, respectively. Twelve-month treatment outcome reporting completeness increased from 75% to 78% of TB cases, while 24-month treatment outcome decreased from 41% to 39% of MDR-TB cases. Time and place In 2011, 72 334 cases of TB were reported in 29 EU/EEA coun- tries, 4% less than in 2010 (Table 3). Romania accounted for 19 212 (27%) of all cases (rate: 89.7 per 100 000) and for 56% of the overall decrease from 2010. The EU/EEA notification rate in 2011 was 14.2 per 100 000 popula- tion, continuing the decreasing trend observed since the launch of European enhanced TB surveillance in 1996. Country-specific notification rates in 2011 differed more than 30-fold, ranging from 2.8 in Iceland to 89.7 in Romania. Rates were below 10 per 100 000 in 19 countries and below 20 in 22 countries. In most Member States, long-standing decreasing trends in TB notification rates continued in 2011 (Table 3) whereas in very few countries, such as Norway and the United Kingdom, long-term trends seemed to be slightly increasing. Classification and laboratory confirmation The distribution of cases was very similar to that for 2010: 57 659 (80%) of 72 334 TB cases reported in 2011 were newly diagnosed, 8 916 (12%) had been previously treated for TB and 5 759 (8%) had an unknown previous treatment status (Table 6). Country-specific proportions of new cases ranged from 42% in Luxembourg to 96% in Finland. The Member States with the lowest proportions of new cases had the 23 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT highest proportions of cases with unknown previous treat- ment status. Member States with higher TB notification rates had higher proportions of previously treated cases (Spearman’s rho=0.6; p=0.002). Laboratory confirmation was reported for 44 361 (61%) of 72 334 cases overall (Table 9) and culture confirmation for 30 265 (69%) of 43 731 new pulmonary cases (Table 8). All but 51 (0.1%) of the laboratory-confirmed cases were confirmed by culture or nucleic acid amplification test. Country-specific proportions of laboratory-confirmed cases ranged from 28% in Italy (provisional data) to 95% in Slovenia. Overall, the trend in case confirmation by culture, nucleic acid detection and sputum smear has been steadily increasing since 1995 (Table II). In most Member States this trend has also increased or remained stable, but in Denmark it decreased by 20 percentage points. According to the EU case definition, 44 361 (61%) of 72 334 TB cases reported in 2011 would be classified as confirmed, 5 246 (7%) as probable and 22 727 (31%) as possible (Table 10). Age and gender The male-to-female ratio notified in TB cases for 2011 was 1.8. Males were over-represented in all EU/EEA Member States but Iceland (Table 3). Among new TB cases, the age group most affected was that of adults aged 25–44 years (Table 11). However, although this age group and the next (45–64 years) accounted for 64% of all new cases, notification rates in the age groups of 15 years and above did not differ substantially from one other. Of all 72 274 TB cases notified in 2011 with known age, 3 190 (4%) were younger than 15 years, resulting in a noti- fication rate of 4 per 100 000 children, the same as in 2010 (Table 12). Romania, Spain and the United Kingdom accounted for 54% of this subset, while four of the five high-incidence countries had the highest age-specific notification rates. Overall, the trend in the paediatric TB notification rate has declined slightly during the past ten years from a peak of 5.7 in 2001 (Table III). However, some countries, such as Bulgaria, Finland and Italy, have seen increasing trends in recent years. Origin of cases Of the 72 334 TB cases notified in 2011, 51 191 (72%) were EU/EEA inhabitants (referred to as ‘native’), 18 646 (26%) were of foreign origin and 1 497 (2%) were of unknown origin (Table 13). Country-specific proportions of foreign-origin TB cases ranged from 0.3% in Romania to 89% in Sweden and were inversely correlated with countries’ TB notifica- tion rates (Spearman’s rho=-0.6; p=0.0005). Overall, the proportion of foreign-origin cases has been on the rise since 2001 (Table IV) which, in some countries has been due to a real increase, whereas in others, it is attributable to the sizeable drop in native cases (country profiles). Drug resistance Table 15 displays laboratory EQA participation and results by Member State. Of 45 955 laboratory-confirmed TB cases notified in 2011, 33 559 (73%) underwent isoniazid and rifampicin suscep- tibility testing. Twenty-one Member States tested at least 90% of their cases. Resistance to at least one anti-TB drug was reported for 4 289 (13%) of the cases tested overall (Table 16) and for 34–41% in Estonia, Latvia and Lithuania. MDR-TB was reported for 1 522 (5%) of 33 559 cases with drug susceptibility testing (DST) results: 629 (2%) of 25 810 new TB cases and 809 (17%) of 4 816 cases that had previ- ously received TB treatment (Table 17; for DST results among new and previously treated pulmonary cases, see Tables 18 and 19). As in previous years, MDR-TB was most frequently observed in the three Baltic countries, with 11–23% of all new cases affected. Among previously treated cases, MDR-TB was more widespread, reaching 29–58% in the Baltic States, but also affecting some low-incidence countries. Among culture-positive cases, the overall five- year-trend in MDR-TB proportion has decreased slightly, whereas country-specific trends have been increasing in some Member States such as Austria, Estonia, Finland and France (Table VI). In 2011, among cases with test results for drug resistance, MDR-TB was reported for 1 119 (5%) of 20 817 natives and 320 (3%) of 9 517 citizens of foreign-origin (Table 21). The MDR-TB risk in natives was 1.6 times the risk in foreigners (prevalence ratio [PR]=1.6; 95% confidence interval [CI]=1.4–1.8). Extensively drug-resistant TB was reported for 136 (13%) of 1 017 MDR-TB cases that had undergone second-line drug susceptibility testing (Table 20). Since 2006, no clear trend in XDR-TB notifications has been visible (Table VII). HIV co-infection With the exception of f ive countries only reporting HIV-positive cases, HIV status was reported for 21 530 (54%) of 40 188 TB cases from 16 countries (Table 22). Of 21 530 cases with known HIV status, 1 003 (5%) were reported as HIV-positive. In Member States with at least five HIV-co-infected TB cases, the proportion of such cases among TB cases with known HIV status was highest in Ireland, Malta and Estonia at 20%, 17% and 15% respec- tively. The trend in reporting HIV status increased from 2007 to 2010, levelling off in 2011, while no clear trend has been observed in the proportion of HIV-co-infected TB cases (Table VIII). Country-specific five-year trends in reported TB/HIV co-infection have been decreasing in the Czech Republic, the Netherlands and Spain, increasing in Latvia, and inconclusive in the remaining countries. Treatment outcome Of 8 916 previously treated TB cases notified in 2011, 4 979 (56%) had completed treatment; in 905 cases (10%), treat- ment had failed; 1 051 (12%) had defaulted and for 1 981 (22%), the outcome of previous incomplete treatment was unknown. 24 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Of 62 655 TB cases notified in 2010 with known treatment outcome, 46 545 (74%) had been treated successfully, 4 560 (7%) had died, 1 122 (2%) had experienced treatment failure, 3 877 (6%) had defaulted, 1 835 (3%) were still on treatment and 4 716 (8%) had been transferred or had an unknown outcome (Table 25). France, Greece, Italy and Portugal did not report treatment outcome. Country-specific TB notifica- tion rates were not correlated with treatment success or death during TB treatment. However, Member States with higher notification rates had higher proportions of failed (Spearman’s rho=0.4; p=0.03) and defaulted treatments (Spearman’s rho=0.6; p=0.0009). Of 27 777 new laboratory-confirmed pulmonary TB cases notified in 2010, 21 327 (77%) had been treated successfully, 1 841 (7%) had died, 438 (2%) had experienced treatment failure, 1 458 (5%) had defaulted, 714 (3%) were still on treatment and 1 999 (7%) had been transferred or had an unknown outcome (Table 23). In 23 Member States with no more than 25% unknown treatment outcome, treatment success ratios ranged from 65% (Austria and Denmark) to 91% (Norway). The overall treatment success ratio in new laboratory-confirmed pulmonary TB cases has been stable since 2002 (Table IX). Of the 6 481 previously treated TB cases notified in 2010, 3 495 (54%) had been treated successfully, 652 (10%) had died, 633 (10%) had experienced treatment failure, 991 (15%) had defaulted, 490 (8%) were still on treatment and 233 (4%) had been transferred or had an unknown outcome (Table 24). In 20 Member States with no more than 25% unknown treatment outcome, treatment success ratios ranged from 31% in Lithuania to 86% in Finland. Following an increase between 2004 and 2010, the overall treatment success ratio in previously treated TB cases dropped again in 2011 (Table X). Of 1 456 MDR-TB cases notified in 2009, 460 (32%) had been treated successfully, 288 (20%) had died, 289 (20%) had experienced treatment failure, 290 (20%) had defaulted, 94 (7%) were still on treatment and 30 (2%) had been transferred or had an unknown outcome (Table 26). In Member States with no more than 25% unknown treat- ment outcome, treatment success ratios ranged from 0 in the Czech Republic to 85% in Sweden. Member States with higher TB notification rates had higher MDR-TB failed treatment (Spearman’s rho=0.5; p=0.02) and case-fatality ratios (Spearman’s rho=0.5; p=0.04). Despite positive signals in some Member States, overall the 24-month MDR-TB treatment success ratio decreased steadily from 2005 to 2009 (Table XI). Special focus: extrapulmonary tuberculosis Of the 72 334 cases reported in 2011, 55 939 (77%) suffered from pulmonary TB, including 4 586 (6%) with additional extrapulmonary manifestations (Table 7). Purely extrapul- monary TB affected 16 116 (22%) of all notified cases. Country-specific proportions of extrapulmonary TB ranged from 4% in Hungary to 67% in Iceland while rates varied 1000-fold. The overall proportion increased from 2002 to 2009, remaining at 22% in 2010 and 2011 (Table B). The notification rate was stable at 3.2 to 3.5 per 100 000 over time. In 2011, of 16 116 purely extrapulmonary TB cases notified, 3 521 (22%) had lymphatic TB, 3 084 (19%) had pleural TB, and 3 320 (21%) suffered from TB at other extrapulmonary sites (Table C). No site was specified for all 6 191 (38%) extrapulmonary TB cases reported from Finland, Spain and the United Kingdom. In children under 15 years, extrapulmonary TB accounted for 1 347 (43%) of 3 145 cases with site information, and in adults aged 15 years and above it accounted for 14 761 (21%) of 68 851 cases. Children were twice as likely as adults to be reported with extrapulmonary TB (PR=2.0; 95%CI=1.9-2.1) (Table D). Compared with adults, children with extrapulmo- nary site-specified TB were twice as likely to be reported with lymphatic TB (PR=2.1; 95%CI=2.0-2.3) and had a 40% higher risk of meningitis (PR=1.4; 95%CI=1.04-2.0). However, they were 50% less likely to present with bone manifestations of TB (PR=0.5; 95%CI=0.4-0.8); 60% less likely to be reported with pleural TB (PR=0.4; 95%CI=0.3- 0.5); 70% less likely to be reported with gastrointestinal TB (PR=0.3; 95%CI=0.1-0.5); 80% less likely to be reported with disseminated TB (PR=0.2; 95%CI=0.1-0.6), had a 90% lower risk of spinal TB (PR=0.1; 95%CI=0.06-0.3) and a more than 90% lower risk of urogenital TB (PR=0.04; 95%CI=0.01-0.1). No significant difference between children and adults was found for other central nervous system manifestations of TB. Of 16 116 notified cases of extrapulmonary TB, 5 571 (35%) were confirmed by culture (Table E). In Member States with no more than 25% unknown culture results, 16–82% of extrapulmonary TB cases were culture-confirmed. Representing only 1% of cases, culture-confirmed MDR-TB was rare. In native cases, extrapulmonary TB accounted for 8 604 (17%) of 52 067 cases with site information, in cases of foreign origin 7 039 (38%) of 18 531 (Table F). The latter were over twice as likely to be notified with extrapulmonary TB (PR=2.3; 95%CI=2.2-2.4). Compared to native cases, cases of foreign origin with extrapulmonary site-specified were twice as likely to be reported with disseminated TB (PR=2.0; 95%CI=1.4-2.9); 80% more likely to be reported with lymphatic TB (PR=1.8; 95%CI=1.7-1.9); 60% more likely to be reported with gastrointestinal TB (PR=1.6; 95%CI=1.3-2.0) and had a 30% higher risk of bone TB (PR=1.3; 95%CI=1.1-1.5). However, they were 30% less likely to be notified with meningitis (PR=0.7; 95%CI=0.6-0.96); 50% less likely to present with urogenital TB (PR=0.5; 95%CI=0.4-0.7) and 60% less likely to be reported with pleural TB (PR=0.36; 95%CI=0.3-0.4). No significant differ- ences were found between the two strata for any of the remaining extrapulmonary sites. Of 13 366 extrapulmonary TB cases with treatment outcome information, 10 988 (82%) were treated successfully, compared to 35 317 (72%) of 48 789 of pulmonary TB cases (PR=1.13; 95%CI=1.12-1.14) (Table G). Among cases with extrapulmonary TB, the lowest treatment success ratios were found in those with disseminated TB, TB meningitis 25 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT and other CNS manifestations (53%, 63% and 68% respectively). Positive and negative HIV test results were reported for 3 097 (19%) of the 16 116 extrapulmonary TB cases, compared to 15 858 (28%) of 55 939 pulmonary TB cases (Table 6). Among extrapulmonary TB cases with known HIV status, 190 (6%) were reported as HIV-positive, whereas 614 (4%) were reported as HIV-positive among pulmonary TB cases (PR=1.4; 95% CI=1.2-1.7) (Table H). Conclusions for the EU/EEA This report highlights a number of positive developments in European TB epidemiology. Reporting completeness remains high for many variables and has improved for DST and HIV status compared to 2010. More countries have reported treatment outcome. Overall and in the vast majority of EU/EEA Member States, the TB notification rate continues to decrease, confirming the sustained effective- ness of national TB prevention and control programmes despite the economic crisis. At the same time, the propor- tion of culture-confirmed cases continues to increase, both overall and at Member State level, illustrating the success of the efforts invested in proper laboratory diagnosis of TB. Although displaying a wide range across countries, the rather even age distribution of TB notification rates at EU/ EEA level indicates that none of the adult age groups is at a markedly higher risk of developing symptomatic disease. At the same time, the low and continuously declining prevalence of paediatric TB suggests that recent transmis- sion does not contribute strongly to current TB dynamics. Although extrapulmonary TB never received much attention in the past, in 2011 it accounted for over 20 000 European cases of TB notified. Consequently, in this report it has been analysed in more depth. The huge differences between country-specific notification rates are probably partly explained by differing degrees of under-diagnosis and under-reporting of extrapulmonary TB. Real differences in disease prevalence could be partly due to differing distributions of children and citizens of foreign origin who were both found to be at least twice as likely to contract extrapulmonary TB as adults and persons of native origin. Clinical presentation of extrapulmonary TB also differed distinctly between children and adults and between natives and citizens of foreign origin. Children were reported to be more prone than adults to lymphatic TB and TB meningitis, but less likely to suffer from most of the other extrapul- monary manifestations. Cases of foreign origin were more likely than native cases to be reported with disseminated, lymphatic, gastrointestinal and bone TB, but less likely to present with TB meningitis, urogenital or pleural TB. Despite extrapulmonary TB being associated with HIV co-infection, the proportion of successful treatment was 10% higher for extrapulmonary than for pulmonary TB, perhaps partly due to the much lower prevalence of MDR in extrapulmonary cases. This report also reminds us of the persistent challenges associated with TB surveillance, prevention and control in Europe. For some Member States, collecting and reporting surveillance data to ECDC remains a formidable task: eight countries did not report any second-line DST results; 13 countries did not report complete HIV co-infection data; four countries provided no 12-month treatment outcome and 11 countries no 24-month outcomes. Lack of surveillance data hampers in-depth understanding of TB epidemiology, monitoring of TB programmes at national and European level, appropriate allocation of resources, and ultimately TB prevention and control itself. For high-incidence countries, reducing the TB burden is still an uphill struggle. In 2011, they were not only faced with notification rates up to 30 times higher than those in low-incidence countries, but also with higher propor- tions of previously treated cases, more drug and multidrug resistance and, to some extent, worse treatment outcomes. Although gradual progress in effective TB prevention and control is evident in the hardest-hit countries through consistently decreasing trends over time, there is still a considerable gap to close before all of Europe can truly envisage TB elimination. For many low-incidence countries, TB in citizens of foreign origin poses a growing problem. Migrants may import the disease after visiting their home countries where TB is endemic and refugees are more likely to contract TB in overcrowded detention camps. Cases of foreign origin are less prone to MDR, but at higher risk of extrapulmonary TB, possibly related to HIV co-infection. They may not neces- sarily fuel widespread community transmission of TB, but they tend to be harder to reach from a healthcare point of view and could eventually prove to be one of the major obstacles to TB elimination in low-incidence countries. Neither MDR nor XDR-TB trends seem to be increasing overall, but European XDR-TB surveillance in particular is still so patchy that no solid conclusions can be drawn. In the Baltic countries, but also among previously treated cases elsewhere, MDR-TB is still highly prevalent, and in some countries even on the rise, justifying the continued need for the utmost vigilance and antimicrobial stewardship. European surveillance of TB/HIV co-infection is still in its infancy and is severely hampered by the initial stigmati- sation of HIV and AIDS that has led to exceptionally rigid HIV data protection in many Member States, precluding any record linkage between TB and HIV surveillance data- bases. Given that Western society has grown much more tolerant over the past 30 years and that TB and HIV epide- miology influence one another and should therefore be analysed and interpreted in conjunction, the persistent over-cautiousness in this matter is anachronistic and detrimental to public health. A final challenge has only just begun to appear: the molec- ular surveillance of MDR-TB currently piloted in TESSy, which is expected to improve the very poor reporting of molecular typing data. In order to be useful, molecular TB surveillance requires improved population coverage, linkage between epidemiological and laboratory data at Member State level and thus close cooperation between experts from both fields. If successful, the collection, storage, analysis, interpretation and public health use of typing and epidemiological data will add an important new 26 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 response support dimension to European TB surveillance, enabling early detection and the monitoring and contain- ment of international outbreaks that might otherwise go unnoticed. ECDC and the EU/EEA Member States should vigorously tackle these challenges, even more so in the light of the austerity measures jeopardising national public health programmes all over Europe. The higher the quality of TB surveillance data, the clearer and more convincing the public health messages will be, making it more difficult to ignore the risks of down-prioritising TB elimination, both politically and economically. References 1. Broekmans JF, Migliori GB, Rieder HL et al. European framework for tuberculosis control and elimination in countries with a low inci- dence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J 2002;19:765–75. 2. World Health Organization. Global Tuberculosis Report 2012. Geneva: WHO, 2012. WHO/THM/TB/2012.6. Available from: http:// www.who.int/tb/publications/global_report/en/index.html 3. WHO Regional Offi ce for Europe. Plan to Stop TB in 18 High-priority Countries in the WHO European Region, 2007–2015. Copenhagen: WHO, 2007 4. European Union Commission. 2008/426/EC: Commission Decision of 28 April 2008 amending Decision 2002/253/EC laying down case defi nitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notifi ed under document number C(2008) 1589). OJ L 159, 18.06.2008, p. 46 5. World Health Organization. Guidelines for surveillance of drug resistance in tuberculosis (4th ed.). Geneva: WHO, 2009. WHO/CDS/ TB/2009.422 6. Falzon D, Scholten J, Infuso A. Tuberculosis outcome monitoring — Is it time to update European recommendations? Euro Surveill 2006;11(3):20–5 7. Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs, World Health Organization 2004, WHO/ HTM/TB/2004.344. 8. Gelmanova IY, Keshavjee S, Golubchikova VT, Berezina VI, Strelis AK, Yanova GV et al. Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance, Bulletin of the World Health Organization, Volume 85, Number 9, September 2007, 649-732 9. Shin SS, Pasechnikov AK, Gelmanova IY, Peremitin GG, Strelis AK, Mishustin S et al. Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia, Int J Tuberc Lung Dis. 2006 Apr;10(4):402-8. 10. Skrahina A, Hurevich H, Zalutskaya A, Sahalchyk E, Astrauko A, van Gemert W, et al. Alarming levels of drug-resistant tubercu- losis in Belarus: results of a survey in Minsk. Eur Respir J. 2012 June; 39(6): 1425–1431. Published online 2011 October 17. doi: 10.1183/09031936.00145411 27 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 3. Commentary – Monitoring

29 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Last year marked the production of the first TB monitoring report, providing an overview of progress on TB control in the WHO European Region and the EU/EEA. For the WHO European Region, two monitoring frameworks were developed by WHO’s Regional Office for Europe, aimed at monitoring the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region 2011–2015 [1], and the implementation of the 2007 Berlin Declaration on Tuberculosis [2]; confronting the overall TB health threat to the Region. In 2010, ECDC launched the epidemiological and strategic monitoring framework ‘Progressing towards TB elimination’ [3]. The feasibility of applying this moni- toring framework in the EU/EEA was first presented in 2011 [4]. The 2012 report [5] presented the first measurement of the indicators described in the monitoring framework ‘Progressing towards TB elimination’. This report also presented the monitoring framework for follow-up of the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region 2011–2015 and the Berlin Declaration Monitoring and Evaluation Framework. It was agreed to report on progress every other year, so the next monitoring results will be presented in 2014. More in-depth discussion and lists of indicators can be found in the 2012 report [5]. According to the Resolution of the WHO Regional Committee for Europe EUR/R61/R7 [6], the WHO Regional Director will report on progress in implementing the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region 2011–2015. The progress report will be presented at the 63rd session of the WHO Regional Committee for Europe in September 2013. For this WHO/Europe and its partners will prepare an overview of implementation progress in the 15 high-burden MDR-TB countries within the WHO European Region using quantitative data collected and presented in this report. The latest qualitative data on progress in implementing the Action Plan will be analysed at WHO’s Regional Office for Europe in collaboration with partners. References 1. The World Health Organization Regional Offi ce for Europe. Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis (M/XDR-TB) in the WHO European Region 2011–2015. Copenhagen: WHO/Europe, 12-15 Sep 2011. 2. The WHO European Ministerial Forum. The Berlin Declaration on Tuberculosis. Copenhagen: WHO/Europe, 22 October 2007. 3. European Centre for Disease Prevention and Control. Progressing towards TB elimination. A follow-up to the Framework Action Plan to Fight Tuberculosis in the European Union, 2010. 4. European Centre for Disease Prevention and Control/WHO Regional Offi ce for Europe. Tuberculosis surveillance in Europe 2009. Stockholm: ECDC, 2011. 5. European Centre for Disease Prevention and Control/WHO Regional Offi ce for Europe. Tuberculosis surveillance and monitoring in Europe 2012. Stockholm: ECDC, 2012. 6. The World Health Organization Regional Committee for Europe. Resolution EUR/RC61/R7. Multidrug- and extensively drug-resistant tuberculosis in the WHO European Region. Baku, Azerbaij an, 12–15 September 2011 3. Commentary – Monitoring

31 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 4. Tables

33 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Summary table: Tuberculosis surveillance data by region, European Region, 2011 Ta bl e s ho wi ng da ta by co un try Regiona EU/EEA Non-EU/EEA Total 18 High-Priority Countries (HPC) Nu mb er of re po rti ng co un tri es a Nu mb er of re po rti ng co un tri es a Nu mb er of re po rti ng co un tri es a Nu mb er of re po rti ng co un tri es a Total population (millions) - 29 507.8 24 392.3 53 899.4 18 388.7 Estimates of TB disease burden 2011b Estimated TB prevalence rate per 100 000 population 1 29 18.4 24 104.4 53 55.9 18 113.1 Estimated TB mortality rate per 100 000 population 1 29 0.9 23 10.1 52 4.9 18 10.5 Estimated TB incidence rate per 100 000 population 1 29 14.0 24 78.3 53 42.0 18 84.6 Estimated proportion of HIV-infection among incident TB cases (new and relapses) 2 29 3.6% 24 6.5% 53 6.0% 18 6.2% Estimated number of HIV-infection among TB incidence (new and replapses) 2 27 2 541 24 20 014 53 22 554 18 20 460 Estimated proportion of MDR-TB among notified TB cases (new and previously treated) 2 29 3.1% 24 24.1% 53 20.2% 18 22.8% Estimated number of MDR-TB cases 2011 2 29 2 913 24 98 128 53 101 040 18 100 355 Notifications of TB cases, 2011 Total number of TB cases 3 29 72 334 21 308 032 50 380 366 17 326 656 All TB cases per 100 000 population 3 29 14.2 21 78.1 50 42.2 17 84.0 Mean annual % change in overall notification rate (2007–2011) 3 29 -4.0% 21 -7.6% 50 -5.7% 17 -5.9% New TB cases and relapses per 100 000 population 5 29 12.1 21 58.3 50 32.8 17 64.3 Percentage of new cases among all TB cases 6 29 79.7% 80 70.2% 51 72.1% 17 70.4% Percentage of pulmonary TB among all TB cases 7 29 77.3% 21 82.4% 51 81.4% 17 82.8% Percentage of extrapulmonary TB among all TB cases 7 29 22.3% 21 11.1% 51 13.2% 17 11.3% Percentage of laboratory-confirmed cases among all TB cases 10 29 61.3% - - - - - - Percentage of laboratory-confirmed cases among new TB cases 8 29 74.6% 80 50.3% 51 55.0% 17 52.0% Sex ratio of all TB cases (male to female) 3 29 1.8 80 1.9 51 1.9 17 2.0 Multidrug resistance (MDR) and extensive drug resistance (XDR), 2011 Percentage of MDR-TB among all TB cases 16 29 4.5% 20 25.6% 49 19.0% 16 23.8% Mean annual % change in MDR-TB notification rate (2007–2011) VI 22 0.0% - 21.4% - 20.0% - 21.6% Percentage of XDR-TB among all MDR-TB cases with DST against SLDc 20 19 13.4% 12 10.1% 31 11.0% 12 11.2% TB-HIV coinfection, 2011 Percentage of all TB cases with known HIV status 22 16 53.6% 18 61.2% 34 60.3% 17 61.0% Percentage of HIV-positive cases among all TB cases with known HIV status 22 16 4.7% 18 6.4% 34 6.2% 17 6.2% Treatment outcome Treatment outcome of new laboratory-confirmed pulmonary cases reported in 2010d 23 24 89.6% Success (cure or treatment completion) 23 24 76.8% 18 63.4% 41 67.2% 16 65.7% Death 23 24 6.6% 18 9.2% 41 8.5% 16 8.7% Failure 23 24 1.6% 18 15.7% 41 11.7% 16 14.2% Default 23 24 5.3% 18 6.1% 41 5.8% 16 6.1% Still on treatment 23 24 2.6% 24 0.7% 5 0.4% Lost to follow-up (transferred, unknown) 23 24 7.2% 18 5.7% 41 6.1% 16 4.9% Treatment outcome of all laboratory-confirmed pulmonary MDR-TB cases reported in 2009e 26 22 87.3% Success (cure or treatment completion) 26 22 31.6% 16 50.8% 38 48.5% 15 48.3% Death 26 22 19.8% 16 15.8% 38 16.2% 15 16.4% Failure 26 22 19.8% 16 8.6% 38 9.9% 15 10.0% Default 26 22 19.9% 16 0.0% 38 0.8% 15 0.6% Still on treatment 26 22 6.5% 22 0.8% 5 0.6% Lost to follow-up (transfer, unknown) 26 22 2.4% 16 12.5% 38 11.3% 15 11.3% ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein HPC: 18 high priority countries to STOP TB in the WHO European Region: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan. a Number of countries with available data and included in the statistics. b WHO estimates, as published in report: Global tuberculosis control 2012 c SLD - Anti-TB second line drugs d Laboratory-confirmed means confirmed case by EU case definition for EU/EEA countries and smear and/or culture confirmation for non-EU/EEA countries e For non-EU/EEA countries this included MDR/TB cases enrolled for treatment 34 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 1: Estimates of the TB disease burden 2011, European Region Country Populationa Estimated number of deaths from TB (all forms, excluding HIV) Estimated prevalence of TB (all forms) Number per 100 000 Number per 100 000 Best Low High Best Low High Best Low High Best Low High EU/EEA Austria 8 413 429 33 33 33 0.4 0.4 0.4 390 160 720 4.6 1.9 8.6 Belgium 10 754 056 23 23 24 0.2 0.2 0.2 1 100 430 2 000 10.2 4.0 18.6 Bulgaria 7 446 135 190 190 190 2.5 2.5 2.6 3 300 1 300 6 300 44.3 17.5 84.6 Cyprus 1 116 564 1 1 2 0.1 0.1 0.1 57 22 110 5.1 2.0 9.9 Czech Republic 10 534 293 36 36 36 0.3 0.3 0.4 810 320 1 500 7.7 3.0 14.2 Denmark 5 572 594 14 13 14 0.3 0.2 0.3 450 180 850 8.1 3.2 15.3 Estonia 1 340 537 36 35 37 2.7 2.6 2.7 380 160 710 28.3 11.9 53.0 Finland 5 384 770 17 17 17 0.3 0.3 0.3 480 170 950 8.9 3.2 17.6 France 63 125 894 290 280 300 0.5 0.4 0.5 3 500 1 700 6 100 5.5 2.7 9.7 Germany 82 162 512 280 280 280 0.3 0.3 0.4 4 700 1 800 8 800 5.7 2.2 10.7 Greece 11 390 031 91 86 96 0.8 0.8 0.8 550 220 1 000 4.8 1.9 8.8 Hungary 9 966 116 81 81 81 0.8 0.8 0.8 2 300 890 4 300 23.1 8.9 43.1 Iceland 324 366 1 1 1 0.3 0.3 0.3 20 8 37 6.2 2.4 11.4 Ireland 4 525 802 20 20 20 0.5 0.5 0.5 420 170 790 9.3 3.8 17.5 Italy 60 788 694 350 340 360 0.6 0.6 0.6 2 100 860 4 000 3.5 1.4 6.6 Latvia 2 243 142 93 90 95 4.1 4.0 4.2 1 100 460 2 100 49.0 20.5 93.6 Lithuania 3 307 481 280 270 280 8.3 8.3 8.4 2 500 950 4 700 75.6 28.7 142.1 Luxembourg 515 941 0 0 0 0.0 0.0 0.0 3 1 6 0.7 0.3 1.2 Malta 417 855 1 1 1 0.3 0.3 0.3 44 16 85 10.5 3.8 20.3 Netherlands 16 664 746 35 34 36 0.2 0.2 0.2 1 400 560 2 700 8.4 3.4 16.2 Norway 4 924 848 7 7 7 0.2 0.1 0.2 380 150 710 7.7 3.0 14.4 Poland 38 298 949 790 750 820 2.1 2.0 2.1 11 000 4 400 21 000 28.7 11.5 54.8 Portugal 10 689 663 130 120 140 1.2 1.1 1.3 3 000 1 300 5 600 28.1 12.2 52.4 Romania 21 436 495 1 300 1 300 1 300 6.0 6.0 6.0 31 000 13 000 56 000 144.6 60.6 261.2 Slovakia 5 471 502 42 42 43 0.8 0.8 0.8 510 200 960 9.3 3.7 17.5 Slovenia 2 035 012 22 22 22 1.1 1.1 1.1 240 95 460 11.8 4.7 22.6 Spain 46 454 895 250 250 260 0.6 0.5 0.6 8 700 3 500 16 000 18.7 7.5 34.4 Sweden 9 440 747 17 17 17 0.2 0.2 0.2 810 320 1 500 8.6 3.4 15.9 United Kingdom 62 417 431 350 340 350 0.6 0.5 0.6 12 000 5 200 20 000 19.2 8.3 32.0 Subtotal EU/EEA 507 164 500 4 781 4 679 4 862 0.9 0.9 1.0 93 244 38 542 169 988 18.4 7.6 33.5 Non-EU/EEA Albania 3 215 988 7 5 9 0.2 0.2 0.3 460 130 1 000 14.3 4.0 31.1 Andorra 86 165 0 0 1 0.3 - 1.1 7 3 12 7.5 2.9 13.9 Armenia 3 100 236 270 220 330 8.8 7.2 11.0 2 400 1 100 4 300 77.4 35.5 138.7 Azerbaijan 9 306 023 340 240 440 3.6 2.6 4.8 16 000 7 700 28 000 171.9 82.7 300.9 Belarus 9 559 441 790 740 840 8.3 7.8 8.8 9 600 4 200 17 000 100.4 43.9 177.8 Bosnia and Herzegovina 3 752 228 250 240 270 6.8 6.4 7.2 2 500 1 000 4 500 66.6 26.7 119.9 Croatia 4 395 560 88 85 91 2.0 1.9 2.1 970 380 1 800 22.1 8.6 41.0 Georgia 4 329 026 160 140 190 3.7 3.2 4.3 6 900 2 800 13 000 159.4 64.7 300.3 Israel 7 562 194 15 14 15 0.2 0.2 0.2 530 210 1 000 7.0 2.8 13.2 Kazakhstan 16 206 750 2 200 2 000 2 500 14.0 12.0 15.0 27 000 11 000 51 000 166.6 67.9 314.7 Kyrgyzstan 5 392 580 670 590 760 12.0 11.0 14.0 9 400 3 900 17 000 174.3 72.3 315.2 Macedonia, the former Yugoslav Republic of 2 063 893 25 24 27 1.2 1.1 1.3 570 250 1 000 27.6 12.1 48.5 Moldova 3 544 864 600 550 640 17.0 16.0 18.0 8 300 3 800 15 000 234.1 107.2 423.1 Monaco 35 427 0 0 0 0.2 - 0.6 1 1 3 4.0 1.6 7.6 Montenegro 632 261 1 1 2 0.2 0.2 0.2 120 37 260 19.0 5.9 41.1 Russia 142 835 555 22 000 22 000 23 000 16.0 15.0 16.0 180 000 72 000 330 000 126.0 50.4 231.0 San Marino 31 735 0 0 0 - - - 1 0 1 1.8 0.7 3.5 Serbia 9 853 969 160 140 180 1.6 1.4 1.9 2 400 740 5 100 24.4 7.5 51.8 Switzerland 7 701 690 17 16 17 0.2 0.2 0.2 460 180 860 6.0 2.3 11.2 Tajikistan 6 976 958 1 100 760 1 500 16.0 11.0 22.0 24 000 12 000 41 000 344.0 172.0 587.6 Turkey 73 639 596 530 170 1 100 0.7 0.2 1.5 17 000 8 100 30 000 23.1 11.0 40.7 Turkmenistan 5 105 301 500 330 720 9.9 6.4 14.0 4 900 1 800 9 600 96.0 35.3 188.0 Ukraine 45 190 180 8 100 7 800 8 300 18.0 17.0 18.0 47 000 21 000 84 000 104.0 46.5 185.9 Uzbekistan 27 760 267 1 700 1 400 2 000 6.1 5.2 7.1 49 000 24 000 84 000 176.5 86.5 302.6 Subtotal non-EU/EEA 392 277 887 39 523 37 465 42 932 10.1 9.6 10.9 409 518 176 330 739 436 104.4 45.0 188.5 Total European Region 899 442 387 44 304 42 144 47 794 4.9 4.7 5.3 502 763 214 872 909 424 55.9 23.9 101.1 Subtotal 18 HPC 388 720 567 40 859 38 825 44 222 10.5 10.0 11.4 439 780 189 270 793 710 113.1 48.7 204.2 WHO European Region 18 TB High Priority Countries presented in italics. a Population estimate 2011 by UN Statistical database for all countries 35 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Estimated number of incident cases (all forms) Number per 100 000 Best Low High Best Low High 310 270 350 3.7 3.2 4.2 870 760 990 8.1 7.1 9.2 2 600 2 300 3 000 34.9 30.9 40.3 44 39 50 3.9 3.5 4.5 640 560 720 6.1 5.3 6.8 360 320 410 6.5 5.7 7.4 330 290 380 24.6 21.6 28.3 400 350 450 7.4 6.5 8.4 2 700 2 500 2 900 4.3 4.0 4.6 3 700 3 200 4 200 4.5 3.9 5.1 430 380 490 3.8 3.3 4.3 1 800 1 600 2 000 18.1 16.1 20.1 16 14 18 4.9 4.3 5.5 340 300 380 7.5 6.6 8.4 1 700 1 500 2 000 2.8 2.5 3.3 930 820 1 100 41.5 36.6 49.0 1 900 1 700 2 200 57.4 51.4 66.5 3 2 3 0.5 0.5 0.6 38 33 43 9.1 7.9 10.3 1 100 990 1 300 6.6 5.9 7.8 300 260 340 6.1 5.3 6.9 8 700 7 600 9 900 22.7 19.8 25.8 2 600 2 300 3 000 24.3 21.5 28.1 22 000 18 000 26 000 102.6 84.0 121.3 390 350 450 7.1 6.4 8.2 190 170 210 9.3 8.4 10.3 7 200 6 300 8 100 15.5 13.6 17.4 640 560 720 6.8 5.9 7.6 8 800 8 200 9 400 14.1 13.1 15.1 71 031 61 668 81 104 14.0 12.2 16.0 420 360 490 13.1 11.2 15.2 5 4 6 5.9 5.1 6.6 1 700 1 400 2 000 54.8 45.2 64.5 11 000 8 700 13 000 118.2 93.5 139.7 6 700 5 500 8 100 70.1 57.5 84.7 1 800 1 600 2 100 48.0 42.6 56.0 760 660 860 17.3 15.0 19.6 5 400 4 800 6 100 124.7 110.9 140.9 440 380 490 5.8 5.0 6.5 21 000 18 000 24 000 129.6 111.1 148.1 6 900 5 700 8 200 128.0 105.7 152.1 410 350 470 19.9 17.0 22.8 5 700 4 700 6 800 160.8 132.6 191.8 1 1 1 3.1 2.8 3.7 110 94 120 17.4 14.9 19.0 140 000 120 000 160 000 98.0 84.0 112.0 0 0 1 1.4 1.3 1.6 1 600 1 400 1 800 16.2 14.2 18.3 370 330 420 4.8 4.3 5.5 13 000 11 000 16 000 186.3 157.7 229.3 18 000 15 000 20 000 24.4 20.4 27.2 3 800 3 100 4 600 74.4 60.7 90.1 40 000 33 000 47 000 88.5 73.0 104.0 28 000 23 000 33 000 100.9 82.9 118.9 307 117 259 080 355 558 78.3 66.0 90.6 378 147 320 748 436 662 42.0 35.7 48.5 328 960 277 010 381 480 84.6 71.3 98.1 36 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 2: Estimates of TB/HIV and MDR-TB 2011, European Region Country Estimated HIV-infection among TB incidence (new and relapses) Estimated MDR-TB among notified new TB cases Number % Number % Best Low High Best Low High Best Low High Best Low High EU/EEA Austria 15 11 18 4.7 3.7 5.8 8 3 18 2.5 0.8 5.7 Belgium 40 29 52 4.6 3.5 5.8 8 3 16 1.5 0.6 3.1 Bulgaria 8 2 17 0.3 0.1 0.7 28 16 46 2.0 1.1 3.2 Cyprus 0 0 0 - - - 0 0 6 0.0 0.0 23.0 Czech Republic 3 2 5 0.5 0.3 0.7 10 4 20 2.0 0.8 4.1 Denmark 16 12 21 4.5 3.3 5.8 2 0 8 0.5 0.0 2.6 Estonia 50 36 66 15.0 11.0 19.0 56 43 72 23.0 17.0 29.0 Finland 5 4 7 1.3 0.9 1.8 5 1 12 2.2 0.6 5.5 France 220 180 280 8.3 6.6 10.0 9 5 15 0.5 0.2 0.8 Germany 76 54 100 2.1 1.5 2.7 69 33 130 2.5 1.2 4.5 Greece 10 7 13 2.2 1.6 2.9 3 0 19 0.9 0.0 4.7 Hungary 15 10 21 0.9 0.6 1.2 25 12 45 2.1 1.0 3.8 Iceland 1 0 1 3.4 2.6 4.3 0 0 2 0.0 0.0 60.0 Ireland 13 10 17 3.9 3.0 4.9 0 0 4 0.0 0.0 2.2 Italy 88 67 110 5.1 4.1 6.3 45 31 62 3.2 2.3 4.5 Latvia 83 66 100 8.9 7.4 11.0 89 70 110 13.0 10.0 16.0 Lithuania 17 11 25 0.9 0.6 1.2 170 140 200 13.0 11.0 15.0 Luxembourg 0 0 0 3.7 2.9 4.7 0 0 0 1.8 1.0 2.5 Malta 6 2 13 17.0 5.2 33.0 0 0 0 1.8 1.0 2.5 Netherlands 35 26 46 3.1 2.4 4.0 9 5 16 1.7 0.9 3.0 Norway 6 4 8 2.0 1.5 2.6 5 1 13 2.9 0.8 7.2 Poland 140 99 190 1.6 1.2 2.2 35 21 53 0.5 0.3 0.8 Portugal 370 290 460 14.0 12.0 17.0 21 11 36 1.2 0.6 2.1 Romania 350 240 490 1.6 1.2 2.2 340 220 500 2.8 1.8 4.2 Slovakia 0 0 0 - - - 4 0 13 1.4 0.2 4.8 Slovenia 1 1 1 0.4 0.3 0.6 0 0 5 0.0 0.0 3.0 Spain 660 560 760 9.1 8.3 10.0 10 1 35 0.2 0.0 0.8 Sweden 13 10 18 2.1 1.5 2.8 9 4 16 3.1 1.4 5.8 United Kingdom 300 220 380 3.4 2.6 4.2 54 42 70 1.3 1.0 1.7 Subtotal EU/EEA 2 541 1 952 3 219 3.6 3.2 4.0 1 013 667 1 543 1.8 1.2 2.7 Non-EU/EEA Albania 0 0 0 - - - 3 0 10 1.0 0.1 3.7 Andorra 0 0 0 - - - 0 0 2 0.0 0.0 60.0 Armenia 55 38 75 3.3 2.4 4.2 86 65 110 9.4 7.1 12.0 Azerbaijan 160 110 220 1.5 1.1 2.0 930 790 1 100 22.0 19.0 26.0 Belarus 250 180 340 3.8 3.0 4.7 1 200 1 100 1 300 32.0 30.0 35.0 Bosnia and Herzegovina 0 0 0 - - - 2 0 11 0.2 0.0 0.9 Croatia 5 3 7 0.6 0.4 0.9 1 0 5 0.2 0.0 0.9 Georgia 80 58 110 1.5 1.1 1.9 340 300 390 11.0 9.6 12.0 Israel 27 17 40 6.3 4.0 9.0 13 6 23 3.7 1.8 6.7 Kazakhstan 330 270 390 1.6 1.4 1.7 3 800 3 600 3 900 30.0 29.0 32.0 Kyrgyzstan 120 87 160 1.7 1.4 2.2 970 830 1 100 26.0 23.0 31.0 Macedonia, the former Yugoslav Republic of 0 0 0 - - - 0 0 7 0.0 0.0 2.8 Moldova 320 260 400 5.7 5.1 6.3 660 570 760 19.0 17.0 22.0 Monaco 0 0 0 - - - 0 0 0 1.8 1.0 2.5 Montenegro 0 0 0 - - - 2 0 8 1.8 0.0 9.4 Russia 9 300 7 400 11 000 6.7 5.7 7.7 19 000 17 000 21 000 20.0 18.0 22.0 San Marino 0 0 0 - - - 0 0 0 1.8 1.0 2.5 Serbia 11 5 22 7.1 3.1 13 8 2 21 0.5 0.1 1.3 Switzerland 19 14 24 5.1 4.0 6.2 1 0 5 0.3 0.0 1.8 Tajikistan 250 190 320 1.8 1.5 2.2 540 420 670 13.0 9.8 16.0 Turkey 27 15 44 0.2 0.1 0.2 83 10 300 0.9 0.1 3.3 Turkmenistan 0 0 0 - - - 0 0 0 3.8 1.0 9.5 Ukraine 8 100 6 700 9 600 20.0 20.0 21.0 4 400 3 800 5 100 16.0 14.0 18.0 Uzbekistan 960 780 1 200 3.4 3.2 3.7 2 400 1 800 3 000 23.0 18.0 29.0 Subtotal non-EU/EEA 20 014 16 127 23 952 6.5 6.2 6.7 34 438 30 294 38 821 16.1 14.2 18.2 Total European Region 22 554 18 079 27 171 6.0 5.6 6.2 35 451 30 960 40 364 13.1 11.4 14.9 Subtotal 18 HPC 20 460 16 443 24 557 6.2 5.9 6.4 35 092 30 774 39 658 15.4 13.5 17.5 ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. 37 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Estimated MDR-TB among notified previously treated TB cases Estimated MDR-TB among all notified TB cases Number % Number Best Low High Best Low High Best Low High 4 1 10 20.0 4.3 48.0 12 4 19 10 5 18 17.0 8.2 30.0 18 10 26 91 66 120 26.0 19.0 33.0 120 90 150 0 0 0 12.0 10.0 15.0 0 0 0 2 0 7 7.1 0.9 24.0 12 4 20 0 0 3 0.0 0.0 12.0 2 0 4 44 33 54 58.0 43.0 71.0 100 83 120 2 0 8 14.0 0.4 58.0 7 1 13 34 19 55 13.0 7.4 21.0 43 26 61 37 23 55 12.0 7.6 18.0 110 61 150 2 0 11 6.7 0.2 32.0 6 0 14 19 8 38 8.8 3.6 17.0 44 24 64 0 0 0 12.0 10.0 15.0 0 0 0 3 0 11 9.1 0.2 41.0 3 0 7 13 9 17 13.0 8.8 17.0 57 42 72 28 19 39 29.0 20.0 40.0 120 96 140 190 170 210 50.0 45.0 56.0 360 320 390 0 0 1 0.0 0.0 98.0 0 0 0 0 0 0 12.0 10.0 15.0 1 1 1 2 0 9 4.5 0.1 23.0 11 5 17 4 0 11 9.5 1.2 30.0 9 2 15 33 20 52 3.5 2.1 5.4 68 46 89 11 4 26 5.3 1.7 12.0 32 17 47 510 380 680 11.0 8.0 15.0 850 650 1 000 2 0 9 3.4 0.1 18.0 5 0 11 0 0 4 0.0 0.0 34.0 0 0 0 26 12 49 7.1 3.3 13.0 36 15 58 9 3 19 21.0 7.1 42.0 18 9 27 16 9 27 5.8 3.1 9.6 71 55 87 1 092 782 1 542 12.7 9.1 17.9 2 114 1 560 2 603 5 1 11 27.0 6.0 61.0 8 2 14 0 0 1 0.0 0.0 98.0 0 0 0 170 140 190 43.0 38.0 49.0 250 220 280 2 500 2 300 2 700 56.0 52.0 60.0 3 400 3 200 3 700 810 780 850 75.0 72.0 79.0 2 000 1 900 2 100 1 0 7 2.1 0.1 11.0 3 0 8 0 0 0 2.4 0.3 8.5 1 0 5 420 370 460 32.0 28.0 35.0 760 700 820 1 0 5 13.0 0.3 53.0 14 6 22 4 500 4 300 4 600 51.0 50.0 53.0 8 200 8 000 8 400 550 490 620 52.0 45.0 58.0 1 500 1 400 1 700 2 0 11 4.0 0.1 20.0 2 0 6 940 890 980 64.0 60.0 67.0 1 600 1 500 1 700 0 0 0 12.0 10.0 15.0 0 0 0 0 0 3 0.0 0.0 25.0 2 0 5 25 000 23 000 29 000 46.0 41.0 52.0 44 000 48 000 0 0 0 12.0 10.0 15.0 0 0 0 11 5 22 7.1 3.1 13 20 9 31 5 2 13 10.0 2.8 24.0 6 1 12 500 450 550 54.0 48.0 59.0 1 000 910 1 200 470 190 810 38.0 15.0 65.0 560 240 880 0 0 0 18.0 11.0 27.0 0 0 0 5 100 4 600 5 600 44.0 40.0 49.0 9 500 8 700 10 000 670 560 760 62.0 52.0 71.0 3 000 2 700 3 400 41 656 38 078 47 194 47.3 43.3 53.6 75 826 29 487 82 283 42 748 38 860 48 736 44.2 40.2 50.4 77 940 31 047 84 886 42 493 38 738 48 223 45.5 41.5 51.7 77 940 30 709 83 980 38 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 3: Tuberculosis cases, notification rates per 100 000 population and mean annual change in rates, European Region, 2007–2011 Country Trends in TB notification rate, 2007–2011 2007 2008 2009 2010 2011 M:F ratio 2011 Mean annual % change in rate, 2007–2011 N Rate N Rate N Rate N Rate N Rate EU/EEA Austria 0 10 20 874 10.6 817 9.8 696 8.3 691 8.3 687 8.2 1.6 -6.0 Belgium 0 10 20 1 020 9.6 990 9.3 994 9.2 1 086 10.0 1 044 9.5 1.8 -0.1 Bulgaria 0 25 50 3 038 39.6 3 150 41.2 2 910 38.3 2 649 35.0 2 407 32.1 2.0 -5.0 Cyprus 0 5 10 42 5.4 50 6.3 55 6.9 61 7.6 54 6.7 1.5 6.2 Czech Republic 0 5 10 846 8.2 864 8.3 694 6.6 669 6.4 600 5.7 2.5 -8.4 Denmarka 0 5 10 391 7.2 380 6.9 334 6.1 366 6.6 381 6.9 1.5 -0.8 Estonia 0 20 40 491 36.6 444 33.1 411 30.7 333 24.8 341 25.4 2.5 -8.4 Finland 0 5 10 348 6.6 344 6.5 417 7.8 325 6.1 325 6.0 1.3 -1.0 Franceb 0 5 10 5 574 8.8 5 758 9.0 5 276 8.2 5 116 7.9 4 942 7.6 1.5 -3.4 Germany 0 5 10 5 000 6.1 4 523 5.5 4 427 5.4 4 388 5.4 4 316 5.3 1.4 -3.4 Greece 0 5 10 639 5.7 664 5.9 589 5.2 487 4.3 489 4.3 2.4 -6.4 Hungary 0 10 20 1 685 16.7 1 619 16.1 1 407 14.0 1 741 17.4 1 445 14.5 1.9 -2.4 Iceland 0 5 10 14 4.6 6 1.9 9 2.8 22 6.9 9 2.8 0.3 19.1 Ireland 0 10 20 480 11.1 468 10.6 479 10.8 420 9.4 425 9.5 1.3 -3.8 Italyc 0 5 10 4 525 7.7 4 418 7.4 4 244 7.1 4 692 7.8 3 521 5.8 1.4 -5.8 Latvia 0 50 100 1 255 55.0 1 070 47.1 977 43.2 935 41.6 885 39.7 2.0 -7.7 Liechtenstein 0 10 20 5 14.2 - - - - - - - - - - Lithuania 0 50 100 2 408 71.1 2 250 66.8 2 081 62.1 1 938 58.2 1 904 58.7 2.3 -4.6 Luxembourg 0 5 10 39 8.2 28 5.8 27 5.5 29 5.8 26 5.1 1.4 -10.3 Malta 0 10 20 38 9.3 53 12.9 44 10.6 32 7.7 33 7.9 2.3 -1.0 Netherlands 0 5 10 998 6.1 1 015 6.2 1 158 7.0 1 065 6.4 1 007 6.0 1.3 0.1 Norway 0 5 10 302 6.5 313 6.6 358 7.5 336 6.9 361 7.3 1.2 3.5 Poland 0 20 40 8 614 22.6 8 080 21.2 8 236 21.6 7 509 19.7 8 478 22.2 2.1 -0.1 Portugal 0 20 40 3 139 29.6 3 002 28.3 2 871 27.0 2 626 24.7 2 540 23.9 2.0 -5.2 Romania 0 100 200 24 837 115.2 24 680 114.6 23 164 107.7 21 059 98.1 19 212 89.7 2.2 -6.0 Slovakia 0 10 20 682 12.6 633 11.7 506 9.3 439 8.1 399 7.3 1.7 -12.6 Slovenia 0 10 20 218 10.8 213 10.6 188 9.3 172 8.4 192 9.4 1.4 -3.2 Spain 0 10 20 7 768 17.5 8 216 18.1 7 592 16.6 7 239 15.7 6 762 14.7 1.6 -4.2 Sweden 0 5 10 482 5.3 546 5.9 617 6.7 668 7.2 586 6.2 1.5 4.7 United Kingdomd 0 10 20 8 329 13.7 8 606 14.1 8 917 14.5 8 483 13.7 8 963 14.3 1.3 1.2 Subtotal EU/EEA 0 10 20 84 081 16.8 83 200 16.5 79 678 15.8 75 576 14.9 72 334 14.2 1.8 -4.0 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. Note: For TB cases and case rates by country and year for the period 1995–2011 see http://ecdc.europa.eu/en/healthtopics/Tuberculosis/epidemiological_data/ Pages/tuberculosis_surveillance_Europe.aspx Note: The data published in this report might differ from figures in national reports due to reporting taking place at different times. The deadline for correcting and updating the data used in this report in the joint database was 31 October 2012. a Excluding Greenland (115 cases in 2011, see Chapter 1.1) b France Overseas territories have been included. Provisional data for 2011 from France. b Provisional data for 2011 from Italy. c Data before 2007 differ from those published in the UK due to a revision of the UK surveillance system. 39 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Country Trends in TB notification rate, 2007–2011 2007 2008 2009 2010 2011 M:F ratio 2011 Mean annual % change in rate, 2007–2011 N Rate N Rate N Rate N Rate N Rate Non-EU/EEA Albania 0 10 20 447 14.1 434 13.6 447 14.0 445 13.9 431 13.4 2.2 -1.2% Andorra 0 10 20 6 7.4 4 4.8 9 10.8 7 8.2 4 4.6 1.0 5.2% Armenia 0 50 100 2 129 69.3 2 125 69.0 2 006 65.0 1 780 57.6 1 582 51.0 2.9 -7.2% Azerbaijan 0 100 200 7 347 83.3 10 078 112.7 10 417 114.9 8 394 91.4 10 100 108.5 - 8.9% Belarus 0 50 100 5 756 59.2 5 483 56.6 5 511 57.2 5 554 57.9 5 118 53.5 2.7 -2.4% Bosnia and Herzegovina 0 50 100 2 400 63.5 1 736 46.0 1 772 47.0 1 390 37.0 1 385 36.9 1.3 -11.7% Croatia 0 20 40 982 22.2 980 22.2 855 19.4 695 15.8 619 14.1 1.4 -10.5% Georgia 0 100 200 5 912 133.9 5 836 132.8 5 978 136.7 5 796 133.2 5 533 127.8 2.9 -1.1% Israel 0 5 10 397 5.7 322 4.5 347 4.8 343 4.6 418 5.5 2.5 0.2% Kazakhstan 0 200 400 37 658 243.3 28 913 184.7 30 578 193.0 28 550 178.1 26 211 161.7 1.5 -9.1% Kyrgyzstan 0 100 200 6 707 130.5 7 127 136.9 6 358 120.6 6 295 118.0 6 666 123.6 1.3 -1.1% Macedonia, the former Yugoslav Republic of 0 20 40 563 27.5 483 23.5 473 23.0 420 20.4 362 17.5 1.4 -10.5% Moldova 0 100 200 6 367 173.4 5 838 160.6 5 591 155.2 5 447 152.5 5 341 150.7 - -3.4% Monaco 0 2 4 - - - - - - 1 2.8 - - - - Montenegro 0 20 40 159 25.3 133 21.1 120 19.0 114 18.1 112 17.7 1.4 -8.4% Russia 0 100 200 214 924 150.0 214 905 150.1 156 222 109.2 162 553 113.7 159 479 111.7 2.2 -6.2% San Marino - - - - - - - - - - - - Serbia 0 20 40 2 981 24.9 2 813 23.5 2 595 21.5 2 385 19.8 2 216 18.4 - -7.2% Serbia excluding UN Administered Province of Kosovod 0 10 20 1 020 10.4 1 091 11.1 970 9.8 1 501 15.2 1 341 13.6 - 10.0% UN Administered Province of Kosovod 0 50 100 1 961 92.2 1 722 80.0 1 625 74.5 884 40.1 875 41.1 - -16.3% Switzerland 0 5 10 472 6.3 516 6.8 554 7.3 548 7.2 578 7.5 1.4 4.6% Tajikistan 0 100 200 8 081 122.4 7 996 119.5 7 482 110.3 7 641 111.1 7 609 109.1 1.3 -2.8% Turkey 0 20 40 19 694 28.1 18 452 26.0 17 402 24.2 16 551 22.7 15 679 21.3 1.4 -6.7% Turkmenistan 0 50 100 3 698 76.1 3 909 79.5 3 157 63.4 3 230 64.1 - - - -4.9% Ukraine 0 50 100 40 643 87.8 37 832 82.3 38 901 85.1 36 409 80.1 42 676 94.4 2.2 2.3% Uzbekistan 0 50 100 23 390 88.2 21 194 79.0 21 453 79.1 20 330 74.1 15 913 57.3 1.4 -9.8% Subtotal non-EU/EEA 0 100 200 390 713 100.6 377 109 96.7 318 228 81.3 314 878 80.1 308 032 78.1 1.9 -5.9% Total European Region 0 50 100 474 794 53.6 460 309 51.7 397 906 44.5 390 454 43.6 380 366 42.2 1.9 -5.7% Subtotal 18 HPC 0 100 200 414 335 107.9 401 282 104.2 340 599 88.1 335 444 86.5 326 656 84.0 2.0 -5.9% d This designation is without prejudice to positions on status and is in line with UNSCR 1244 and the ICJ opinion on the Kosovo Declaration of Independance. 40 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 4: Tuberculosis cases and age-standardised rates per 100 000 population, European Region, 2007–2011 Country 2007 2008 2009 N Crude rate Standardised rate N Crude rate Standardised rate N Crude rate Standardised rate EU/EEA Austria 874 10.6 10.5 817 9.8 9.7 696 8.3 8.2 Belgium 1 020 9.6 9.8 990 9.3 9.4 994 9.2 9.4 Bulgaria 3 038 39.6 38.8 3 150 41.2 40.6 2 910 38.3 37.6 Cyprus 42 5.4 4.5 50 6.3 5.8 55 6.9 6.5 Czech Republic 846 8.2 8.3 864 8.3 8.3 694 6.6 6.7 Denmarkb 391 7.2 7.4 380 6.9 7.1 334 6.1 6.3 Estonia 491 36.6 36.9 444 33.1 33.4 411 30.7 30.9 Finland 348 6.6 6.5 344 6.5 6.4 417 7.8 7.7 France 5 574 8.8 8.9 5 758 9.0 9.1 5 276 8.2 8.3 Germany 5 000 6.1 5.9 4 523 5.5 5.3 4 427 5.4 5.2 Greece 639 5.7 5.5 664 5.9 5.8 589 5.2 5.1 Hungary 1 685 16.7 16.6 1 619 16.1 16.0 1 407 14.0 13.9 Iceland 14 4.6 4.7 6 1.9 1.7 9 2.8 2.7 Ireland 480 11.1 11.4 468 10.6 11.1 479 10.8 11.4 Italy 4 525 7.7 7.5 4 418 7.4 7.3 4 244 7.1 6.9 Latvia 1 255 55.0 55.2 1 070 47.1 47.2 977 43.2 42.9 Liechtenstein 5 14.2 - - - - - - - Lithuania 2 408 71.1 72.5 2 250 66.8 67.9 2 081 62.1 62.7 Luxembourg 39 8.2 8.3 28 5.8 5.8 27 5.5 5.4 Malta 38 9.3 9.5 53 12.9 13.1 44 10.6 10.3 Netherlands 998 6.1 6.3 1 015 6.2 6.4 1 158 7.0 7.3 Norway 302 6.5 6.7 313 6.6 6.8 358 7.5 7.8 Poland 8 614 22.6 23.5 8 080 21.2 21.9 8 236 21.6 22.2 Portugal 3 139 29.6 29.2 3 002 28.3 27.9 2 871 27.0 26.7 Romania 24 837 115.2 114.3 24 680 114.6 113.8 23 164 107.7 106.5 Slovakia 682 12.6 14.1 633 11.7 13.0 506 9.3 10.2 Slovenia 218 10.8 10.9 213 10.6 10.4 188 9.3 9.1 Spain 7 768 17.5 16.8 8 216 18.1 17.5 7 592 16.6 16.1 Sweden 482 5.3 5.4 546 5.9 6.2 617 6.7 6.9 United Kingdom 8 329 13.7 14.0 8 606 14.1 14.4 8 917 14.5 14.9 Total EU/EEA 84 081 16.8 16.7 83 200 16.5 16.4 79 678 15.8 15.7 Non-EU/EEA Albania 422 13.3 15.9 402 12.6 14.6 416 13.0 15.5 Andorra 5 6.1 7.2 4 4.8 4.8 7 8.4 8.0 Armenia 1 533 49.9 - 1 507 48.9 50.6 1 464 47.5 48.8 Azerbaijan 4 444 50.4 - 5 130 57.4 - 5 872 64.8 - Belarus 4 872 50.1 49.8 4 634 47.9 47.3 4 633 48.1 - Bosnia and Herzegovina 2 217 58.7 - 1 663 44.1 46.6 1 659 44.0 45.8 Croatia 884 20.0 - 944 21.4 20.6 793 18.0 17.5 Georgia 4 065 92.1 90.1 4 148 94.4 93.5 4 457 101.9 101.2 Israel 389 5.6 6.8 318 4.5 5.5 338 4.7 5.6 Kazakhstan 21 557 139.3 131.3 19 684 125.7 123.1 16 810 106.1 103.1 Kyrgyzstan 5 667 110.3 - 6 230 119.7 114.5 5 434 103.1 115.0 Macedonia, the former Yugoslav Republic of 494 24.1 25.0 427 20.8 21.3 417 20.3 20.6 Moldova 4 166 113.5 113.1 3 951 108.7 107.9 3 804 105.6 104.2 Monaco 0 0.0 0.0 0 0.0 0.0 0 0.0 0.0 Montenegro 137 21.8 23.0 123 19.5 20.7 108 17.1 18.1 Russia 118 367 82.6 82.1 120 835 84.4 81.8 117 227 81.9 79.1 San Marino 0 - - 0 - - 0 - - Serbia 2 667 27.1 - 2 526 25.7 - 1 740 17.7 18.3 Serbia excluding UN Administered Province of Kosovoc - - - - - - - - - UN Administered Province of Kosovoc - - - - - - - - - Switzerland 313 4.2 4.2 319 4.2 4.2 334 4.4 4.4 Tajikistan 6 078 92.0 112.0 6 150 91.9 114.5 5 864 86.4 108.4 Turkey 17 809 25.4 30.3 16 760 23.6 28.2 15 943 22.2 26.8 Turkmenistan 3 347 68.9 - 3 628 73.8 - 3 157 63.4 - Ukraine 34 891 75.4 - 35 739 77.7 76.4 33 424 73.1 71.6 Uzbekistan 18 773 70.8 91.1 15 971 59.6 80.8 16 569 61.1 80.5 Total non-EU/EEA 200 114 55.4 66.8 239 809 65.9 65.8 226 808 62.0 62.6 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. Note: For TB cases and case rates by country and year for the period 1995–2011, see http://ecdc.europa.eu/en/healthtopics/Tuberculosis/epidemiological_data/ Pages/epidemiological_data.aspx a The standard population based on the average of the EU Member States population by age group, 2000–2010 b Excluding Greenland (115 cases in 2011, see Chapter 1.1). c In accordance with the UN Security Council Resolution No. 1244 (1999).For EU/EEA countries all notified TB cases are presented and for non-EU/EEA countries only new cases notified in a particular year 41 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2010 2011 N Crude rate Standardised rate N Crude rate Standardised rate 691 8.3 8.2 687 8.2 8.1 1 086 10.0 10.2 1 044 9.5 9.7 2 649 35.0 34.5 2 407 32.1 31.4 61 7.6 6.8 54 6.7 6.5 669 6.4 6.4 600 5.7 5.7 366 6.6 6.9 381 6.9 7.1 333 24.8 25.0 341 25.4 25.5 325 6.1 6.0 325 6.0 5.8 5 116 7.9 8.1 4 942 7.6 7.7 4 388 5.4 5.2 4 316 5.3 5.0 487 4.3 4.2 489 4.3 4.2 1 741 17.4 17.1 1 445 14.5 14.1 22 6.9 7.2 9 2.8 2.8 420 9.4 9.9 425 9.5 10.0 4 692 7.8 7.7 3 521 5.8 5.8 935 41.6 41.4 885 39.7 39.4 - - - - - - 1 938 58.2 58.5 1 904 58.7 58.8 29 5.8 5.8 26 5.1 5.2 32 7.7 7.7 33 7.9 8.0 1 065 6.4 6.7 1 007 6.0 6.3 336 6.9 7.2 361 7.3 7.7 7 509 19.7 20.0 8 478 22.2 22.4 2 626 24.7 24.3 2 540 23.9 23.4 21 059 98.1 96.9 19 212 89.7 88.5 439 8.1 8.7 399 7.3 7.8 172 8.4 8.2 192 9.4 9.0 7 239 15.7 15.3 6 762 14.7 14.3 668 7.2 7.4 586 6.2 6.5 8 483 13.7 14.0 8 963 14.3 14.7 75 576 14.9 14.8 72 334 14.2 14.1 415 13.0 14.7 413 12.8 14.6 7 8.2 8.3 3 3.5 3.3 1 329 43.0 44.4 1 200 38.7 40.2 5 237 57.0 - 5 296 56.9 - 4 345 45.3 44.3 4 043 42.3 41.1 1 289 34.3 35.4 1 320 35.2 36.9 652 14.8 14.4 619 14.1 13.6 4 383 100.7 100.1 4 223 97.6 97.5 339 4.6 5.2 408 5.4 5.8 15 641 97.59541885 94.9 14 396 88.8 88.1 5 308 99.5 111.9 5 180 96.1 - 368 17.9 18.3 307 14.9 15.2 3 745 104.8 103.6 3 836 108.2 106.6 1 2.8 2.7 0 - - 102 16.2 17.2 100 15.8 16.2 109 904 76.9 69.2 104 320 73.0 70.4 0 - - 0 - - 2 178 22.1 - 1 205 12.2 12.7 - - - - - - - - 0.0 846 2.6 - 322 4.2 4.2 379 4.9 4.9 5 959 86.6 110.1 5 935 85.1 110.7 15 183 20.9 25.5 14 417 19.6 24.2 3 148 62.4 - 0 - - 31 295 68.9 - 31 188 69.0 - 15 734 57.3 76.2 13 995 50.4 68.2 185 026 57.6 56.1 171 119 52.3 47.4 42 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 5: New TB cases and relapses, notification rates per 100 000 population, European Region, 2002–2011a Country Trends in TB notification rate, 2002–2011a 2002 2003 2004 2005 2006 2007 N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA Austria 0 10 20 992 12.3 916 11.3 1 017 12.5 936 11.4 856 10.4 818 9.9 Belgium 0 5 10 952 9.2 695 6.7 860 8.3 851 8.1 825 7.8 819 7.7 Bulgaria 0 25 50 2 962 37.5 2 952 37.6 2 923 37.5 3 101 40.0 3 011 39.0 2 821 36.7 Cyprus 0 5 10 19 2.7 34 4.8 29 4.0 33 4.4 35 4.6 41 5.3 Czech Republic 0 10 20 1 156 11.3 1 110 10.9 1 027 10.1 886 8.7 872 8.5 770 7.5 Denmarkb 0 5 10 386 7.2 368 6.8 355 6.6 392 7.2 350 6.4 355 6.5 Estonia 0 25 50 621 45.6 559 41.2 540 40.0 480 35.6 426 31.7 457 34.0 Finland 0 5 10 476 9.2 412 7.9 329 6.3 354 6.8 281 5.3 333 6.3 France 0 5 10 4 314 7.0 4 292 6.9 4 523 7.3 4 443 7.1 4 193 6.6 3 871 6.1 Germany 0 5 10 5 062 6.1 4 985 6.0 5 149 6.2 4 825 5.8 4 469 5.4 4 185 5.1 Greece 0 5 10 281 2.6 552 5.0 600 5.4 583 5.3 567 5.1 530 4.7 Hungary 0 20 40 2 505 24.6 2 297 22.6 2 087 20.6 1 721 17.0 1 627 16.1 1 467 14.6 Iceland 0 5 10 8 2.8 5 1.7 12 4.1 10 3.4 13 4.3 12 3.9 Ireland 0 5 10 306 7.8 288 7.3 304 7.5 311 7.6 314 7.5 350 8.1 Italy 0 5 10 2 903 5.1 3 570 6.2 3 183 5.5 3 005 5.1 3 295 5.6 3 378 5.7 Latvia 0 50 100 1 803 76.9 1 686 72.3 1 571 67.7 1 404 60.9 1 285 56.0 1 226 53.7 Liechtenstein 0 10 20 - - - - - - - - - - 5 14.2 Lithuania 0 50 100 2 097 60.3 2 553 73.7 2 030 58.9 2 371 69.2 2 365 69.5 2 232 65.9 Luxembourg 0 10 20 31 7.0 53 11.8 31 6.8 36 7.8 33 7.0 0 0.0 Malta 0 10 20 24 6.1 6 1.5 19 4.8 24 6.0 30 7.4 37 9.1 Netherlands 0 5 10 1 191 7.4 1 101 6.8 1 128 6.9 1 071 6.6 980 6.0 947 5.8 Norway 0 5 10 207 4.6 246 5.4 240 5.2 238 5.2 223 4.8 224 4.8 Poland 0 20 40 9 212 24.1 8 901 23.3 8 337 21.8 8 586 22.5 7 980 20.9 8 033 21.1 Portugal 0 25 50 4 170 40.4 3 870 37.2 3 588 34.3 3 206 30.4 3 253 30.8 2 962 27.9 Romania 0 100 200 30 065 137.7 27 741 127.4 27 652 127.4 25 916 119.7 23 774 110.0 22 128 102.6 Slovakia 0 10 20 964 17.9 893 16.6 653 12.1 685 12.7 657 12.2 610 11.3 Slovenia 0 10 20 338 17.0 278 13.9 252 12.6 271 13.6 208 10.4 214 10.6 Spain 0 10 20 5 229 12.8 4 594 11.0 5 516 13.0 6 185 14.4 6 101 13.9 6 154 13.8 Sweden 0 5 10 371 4.2 385 4.3 429 4.8 531 5.9 476 5.3 446 4.9 United Kingdomc 0 10 20 5 290 8.9 5 135 8.6 5 308 8.9 6 015 10.0 6 270 10.4 5 987 9.9 Subtotal EU/EEA 0 10 20 83 935 17.1 80 477 16.4 79 692 16.1 78 470 15.8 74 769 15.0 71 412 14.3 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. Note: For TB cases and case rates by country and year for the period 1995–2011, see http://ecdc.europa.eu/en/healthtopics/Tuberculosis/epidemiological_data/ Pages/epidemiological_data.aspx a Cases with missing information on previous history of TB treatment are not included. For countries with no information on relapse, only new cases included. b Excluding Greenland (115 cases in 2011, see Chapter 1.1). c Data before 2007 differ from those published in the UK due to a revision of the UK surveillance system. 43 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 N Rate N Rate N Rate N Rate 737 8.9 438 5.2 360 4.3 401 4.8 787 7.4 787 7.3 790 7.3 705 6.4 2 945 38.5 2 657 34.9 2 413 31.9 2 173 29.0 18 2.3 43 5.4 33 4.1 31 3.9 806 7.8 632 6.0 620 5.9 569 5.4 331 6.0 292 5.3 331 6.0 359 6.5 400 29.8 358 26.7 289 21.6 297 22.2 328 6.2 403 7.6 312 5.8 312 5.8 3 328 5.2 2 873 4.5 2 752 4.3 2 639 4.1 3 773 4.6 3 757 4.6 3 627 4.4 3 577 4.4 535 4.8 466 4.1 354 3.1 452 4.0 1 433 14.3 1 265 12.6 1 543 15.4 1 278 12.8 5 1.6 8 2.5 22 6.9 8 2.5 360 8.2 364 8.2 327 7.3 280 6.2 3 409 5.7 2 540 4.2 2 751 4.6 2 018 3.3 1 048 46.1 948 41.9 915 40.7 866 38.8 - - - - - - - - 2 097 62.3 1 898 56.7 1 754 52.7 1 748 53.9 0 0.0 0 0.0 24 4.8 11 2.1 48 11.7 41 9.9 20 4.8 22 5.3 962 5.9 1 109 6.7 1 025 6.2 974 5.8 237 5.0 275 5.7 276 5.7 314 6.4 7 419 19.5 7 646 20.0 7 009 18.4 7 950 20.8 2 840 26.7 2 722 25.6 2 497 23.5 2 413 22.7 21 646 100.5 20 643 96.0 18 590 86.6 16 992 79.4 562 10.4 433 8.0 389 7.2 352 6.5 208 10.3 187 9.2 159 7.8 181 8.8 6 770 15.0 6 687 14.6 6 534 14.2 6 044 13.1 452 4.9 508 5.5 547 5.9 457 4.9 6 505 10.6 7 058 11.5 7 219 11.6 7 850 12.6 69 989 13.9 67 038 13.3 63 482 12.5 61 273 12.1 44 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Country Trends in TB notification rate, 2002–2011a 2002 2003 2004 2005 2006 2007 N Rate N Rate N Rate N Rate N Rate N Rate Non-EU/EEA Albania 0 10 20 594 19.2 543 17.5 547 17.5 506 16.1 469 14.9 438 13.8 Andorra 0 10 20 5 7.2 10 13.8 7 9.3 10 12.8 12 15.0 5 6.1 Armenia 0 50 100 1 433 46.8 1 538 50.3 1 660 54.2 2 206 72.0 1 767 57.6 1 682 54.7 Azerbaijan 0 50 100 5 142 62.1 3 840 45.8 5 404 63.7 6 034 70.3 5 705 65.6 5 521 62.6 Belarus 0 50 100 5 139 51.6 5 106 51.5 5 443 55.1 5 308 54.0 5 142 52.6 5 351 55.0 Bosnia and Herzegovina 0 50 100 1 691 44.8 1 740 46.0 2 353 62.2 2 111 55.8 1 778 47.0 2 373 62.8 Croatia 0 20 40 1 443 32.3 1 356 30.4 1 170 26.3 1 050 23.6 1 029 23.2 951 21.5 Georgia 0 100 200 4 490 97.1 4 212 92.2 4 011 88.7 4 501 100.5 4 554 102.5 4 310 97.6 Israel 0 5 10 466 7.5 472 7.4 456 7.0 371 5.6 340 5.0 396 5.7 Kazakhstan 0 100 200 27 546 184.9 27 069 181.0 26 349 175.0 25 512 168.2 23 796 155.4 24 752 159.9 Kyrgyzstan 0 100 200 6 613 132.2 6 172 123.2 6 104 121.6 6 329 125.5 6 174 121.4 6 098 118.7 Macedonia, the former Yugoslav Republic of 0 20 40 686 33.9 653 32.2 644 31.7 598 29.3 561 27.5 526 25.7 Moldova 0 100 200 3 769 95.0 3 619 92.9 4 806 125.6 5 141 136.5 4 990 134.3 4 857 132.3 Monaco 0 2 4 - - - - - - - - - - - - Montenegro 0 20 40 - - - - - - 156 24.9 167 26.6 147 23.4 Russia 0 50 100 128 873 88.6 124 041 85.6 121 426 84.1 127 930 88.9 124 689 86.9 127 338 88.9 San Marino 0 5 10 1 3.5 1 3.4 - - - - - - - - Serbia 0 20 40 - - - - - - 3 208 26.9 3 146 26.3 2 891 24.1 Serbia excluding UN Administered Province of Kosovod 0 20 40 - - - - - - 2 106 21.4 2 024 20.6 1 961 19.9 UN Administered Province of Kosovod 0 50 100 - - - - - - 1 102 53.8 1 122 53.4 930 43.7 Switzerland 0 5 10 438 6.0 401 5.5 407 5.5 381 5.1 341 4.6 313 4.2 Tajikistan 0 50 100 4 052 64.5 4 260 67.2 4 529 70.9 5 460 84.6 5 362 82.2 6 297 95.3 Turkey 0 20 40 18 043 27.6 17 923 27.0 17 543 26.1 19 744 29.4 19 629 28.4 18 878 27.0 Turkmenistan 0 50 100 3 671 79.8 3 771 81.1 3 382 72.0 3 191 67.2 3 223 67.1 3 428 70.6 Ukraine 0 50 100 40 175 83.6 37 043 77.8 38 403 81.2 39 608 84.4 41 265 88.6 37 517 81.1 Uzbekistan 0 50 100 20 588 81.5 20 700 81.2 20 289 78.9 21 513 82.9 23 900 91.2 19 779 74.6 Subtotal non-EU/EEA 0 50 100 274 858 71.1 264 470 68.4 264 933 68.4 280 868 73.3 278 039 72.2 273 848 70.9 Total European Region 0 25 50 358 793 41.1 344 947 39.5 344 625 39.3 359 338 40.8 352 808 40.0 345 260 39.0 Subtotal 18 HPC 0 50 100 307 082 80.4 294 785 77.2 294 065 76.9 305 749 79.9 301 057 78.6 294 672 76.7 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. Note: For TB cases and case rates by country and year for the period 1995–2011, see http://ecdc.europa.eu/en/healthtopics/Tuberculosis/epidemiological_data/ Pages/epidemiological_data.aspx d In accordance with the UN Security Council Resolution No. 1244 (1999). 45 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 N Rate N Rate N Rate N Rate 427 13.4 435 13.6 431 13.5 422 13.1 4 4.8 8 9.6 7 8.2 3 3.5 1 655 53.7 1 560 50.6 1 410 45.6 1 261 40.7 6 417 71.7 7 301 80.5 6 390 69.5 6 515 70.0 5 126 53.0 5 250 54.5 5 003 52.1 4 697 49.1 1 713 45.4 1 725 45.8 1 321 35.1 1 360 36.2 980 22.2 832 18.9 688 15.6 619 14.1 4 412 100.4 4 732 108.2 4 674 107.4 4 547 105.0 322 4.5 347 4.8 340 4.6 412 5.4 23 140 147.8 20 508 129.5 19 703 122.9 19 135 118.1 6 628 127.4 5 765 109.4 5 652 106.0 5 529 102.5 450 21.9 450 21.9 384 18.6 335 16.2 4 442 122.2 4 347 120.7 4 122 115.4 4 208 118.7 - - - - 1 2.8 - - 131 20.8 113 17.9 110 17.4 110 17.4 128 263 89.6 126 227 88.2 118 641 83.0 112 910 79.0 - - - - - - - - 2 714 22.6 2 526 21.0 2 326 19.3 2 171 19.2 1 722 17.5 1 625 16.5 1 442 14.6 1 296 14.7 992 46.1 901 41.3 884 40.1 875 50.3 319 4.2 334 4.4 322 4.2 379 4.9 6 396 95.6 6 125 90.3 6 297 91.5 6 290 90.2 17 600 24.8 16 757 23.3 15 879 21.8 15 054 20.4 3 757 76.4 3 157 63.4 3 230 64.1 - - 37 832 82.3 36 075 78.9 33 857 74.5 34 237 75.8 17 040 63.6 17 540 64.7 16 883 61.5 14 501 52.2 269 768 69.6 262 114 67.3 247 671 63.4 234 695 58.3 339 757 38.2 329 152 36.8 311 153 34.7 295 968 32.8 290 844 75.5 281 848 72.9 265 702 68.6 250 960 64.3 46 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 6: Tuberculosis cases by history of previous TB treatment, European Region, 2011 Country New Unknown previous TB history Previously treated total Previous treatment completed Previous treatment failed Previous treatment defaulted Other retreatment N (%)a N (%)a N (%)a N (%)b N (%)b N (%)b N (%)b N EU/EEA Austria 396 (57.6) 271 (39.4) 20 (2.9) 12 (60.0) 0 (0.0) 0 (0.0) 8 (40.0) 687 Belgiumc 705 (67.5) 280 (26.8) 59 (5.7) - (0.0) - (0.0) - (0.0) 59 (100.0) 1 044 Bulgaria 2 052 (85.3) - (0.0) 355 (14.7) 262 (73.8) 37 (10.4) 56 (15.8) 0 (0.0) 2 407 Cyprus 31 (57.4) 20 (37.0) 3 (5.6) 1 (33.3) 0 (0.0) 0 (0.0) 2 (66.7) 54 Czech Republic 569 (94.8) - (0.0) 31 (5.2) 0 (0.0) 0 (0.0) 0 (0.0) 31 (100.0) 600 Denmarkcd 359 (94.2) - (0.0) 22 (5.8) - (0.0) - (0.0) - (0.0) 22 (100.0) 381 Estonia 265 (77.7) - (0.0) 76 (22.3) 53 (69.7) 11 (14.5) 12 (15.8) 0 (0.0) 341 Finland 312 (96.0) - (0.0) 13 (4.0) 0 (0.0) 0 (0.0) 0 (0.0) 13 (100.0) 325 France 2 639 (53.4) 2 042 (41.3) 261 (5.3) 0 (0.0) 0 (0.0) 0 (0.0) 261 (100.0) 4 942 Germany 3 490 (80.9) 526 (12.2) 300 (7.0) 159 (53.0) 7 (2.3) 42 (14.0) 92 (30.7) 4 316 Greece 452 (92.4) 2 (0.4) 35 (7.2) 0 (0.0) 0 (0.0) 0 (0.0) 35 (100.0) 489 Hungary 1 223 (84.6) 1 (0.1) 221 (15.3) 153 (69.2) 0 (0.0) 56 (25.3) 12 (5.4) 1 445 Iceland 8 (88.9) 0 (0.0) 1 (11.1) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 9 Irelandc 280 (65.9) 118 (27.8) 27 (6.4) - (0.0) - (0.0) - (0.0) 27 (100.0) 425 Italy 2 018 (57.3) 1 403 (39.8) 100 (2.8) 0 (0.0) 0 (0.0) 0 (0.0) 100 (100.0) 3 521 Latvia 788 (89.0) 0 (0.0) 97 (11.0) 83 (85.6) 0 (0.0) 14 (14.4) 0 (0.0) 885 Liechtenstein - - - - - - - - - - - - - - - Lithuania 1 532 (80.5) 3 (0.2) 369 (19.4) 216 (58.5) 47 (12.7) 106 (28.7) 0 (0.0) 1 904 Luxembourg 11 (42.3) 14 (53.8) 1 (3.8) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 26 Malta 22 (66.7) 8 (24.2) 3 (9.1) 2 (66.7) 0 (0.0) 1 (33.3) 0 (0.0) 33 Netherlands 958 (95.1) 11 (1.1) 38 (3.8) 27 (71.1) 0 (0.0) 10 (26.3) 1 (2.6) 1 007 Norwayc 314 (87.0) 10 (2.8) 37 (10.2) - (0.0) - (0.0) - (0.0) 37 (100.0) 361 Poland 7 515 (88.6) 0 (0.0) 963 (11.4) 660 (68.5) 0 (0.0) 0 (0.0) 303 (31.5) 8 478 Portugal 2 325 (91.5) 0 (0.0) 215 (8.5) 147 (68.4) 2 (0.9) 23 (10.7) 43 (20.0) 2 540 Romania 14 543 (75.7) 0 (0.0) 4 669 (24.3) 3 139 (67.2) 801 (17.2) 729 (15.6) 0 (0.0) 19 212 Slovakia 323 (81.0) 26 (6.5) 50 (12.5) 48 (96.0) 0 (0.0) 0 (0.0) 2 (4.0) 399 Slovenia 181 (94.3) 0 (0.0) 11 (5.7) 9 (81.8) 0 (0.0) 1 (9.1) 1 (9.1) 192 Spain 6 044 (89.4) 348 (5.1) 370 (5.5) 0 (0.0) 0 (0.0) 0 (0.0) 370 (100.0) 6 762 Sweden 454 (77.5) 87 (14.8) 45 (7.7) 7 (15.6) 0 (0.0) 1 (2.2) 37 (82.2) 586 United Kingdomc 7 850 (87.6) 589 (6.6) 524 (5.8) - (0.0) - (0.0) - (0.0) 524 (100.0) 8 963 Subtotal EU/EEA 57 659 (79.7) 5 759 (8.0) 8 916 (12.3) 4 979 (55.8) 905 (10.2) 1 051 (11.8) 1 981 (22.2) 72 334 Non-EU/EEA Albania 413 (95.8) 0 0 18 (4.2) 9 (50.0) 0 (0.0) 0 (0.0) 9 (50.0) 431 Andorra 3 (75.0) 0 0 1 (25.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 4 Armenia 1 200 (75.9) 0 0 382 (24.1) 61 (16.0) 10 (2.6) 13 (3.4) 298 (78.0) 1 582 Azerbaijan 5 296 (54.0) 0 (0.0) 4 804 (47.6) 1 219 (25.4) 13 (0.3) 67 (1.4) 3 505 (73.0) 10 100 Belarus 4 043 (79.0) 0 0 1 075 (21.0) 654 (60.8) 228 (21.2) 26 (2.4) 167 (15.5) 5 118 Bosnia and Herzegovina 1 320 (95.3) 0 0 65 (4.7) 40 (61.5) 0 (0.0) 0 (0.0) 25 (38.5) 1 385 Croatia 619 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 619 Georgia 4 223 (76.3) 0 0 1 310 (23.7) 324 (24.7) 60 (4.6) 100 (7.6) 826 (63.1) 5 533 Israel 408 (97.6) 0 0 10 (2.4) 4 (40.0) 2 (20.0) 2 (20.0) 2 (20.0) 418 Kazakhstan 14 396 (54.9) 0 (0.0) 11 815 (45.1) 4 739 (40.1) 622 (5.3) 608 (5.1) 5 846 (49.5) 26 211 Kyrgyzstan 5 180 (77.7) 0 0 1 486 (22.3) 349 (23.5) 0 (0.0) 0 (0.0) 1 137 (76.5) 6 666 Macedonia, the former Yugoslav Republic of 307 (84.8) 0 0 55 (15.2) 28 (50.9) 0 (0.0) 0 (0.0) 27 (49.1) 362 Moldova 3 836 (71.8) 25 (0.5) 1 480 (27.7) 372 (25.1) 145 (9.8) 285 (19.3) 678 (45.8) 5 341 Monaco - - - - - - - - - - - - - - - Montenegro 100 (89.3) 0 0 12 (10.7) 10 (83.3) 0 (0.0) 2 (16.7) 0 (0.0) 112 Russia 104 320 (65.4) 0 0 55 159 (34.6) 8 590 (15.6) 9 879 (17.9) 2 745 (5.0) 33 945 (61.5) 159 479 San Marino - - - - - - - - - - - - - - - Serbia 2 051 (92.6) 3 (0.1) 162 (7.3) 120 (74.1) 6 (3.7) 9 (5.6) 27 (16.7) 2 216 Serbia excluding UN Administered Province of Kosovoe 1 205 (89.9) 3 (0.2) 133 (9.9) 91 (68.4) 6 (4.5) 9 (6.8) 27 (20.3) 1 341 UN Administered Province of Kosovoe 846 (96.7) 0 0 29 (3.3) 29 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 875 Switzerland 379 (65.6) 145 (25.1) 54 (9.3) 0 (0.0) 0 (0.0) 0 (0.0) 54 (100.0) 578 Tajikistan 5 935 (78.0) 745 (9.8) 929 (12.2) 355 (38.2) 198 (21.3) 67 (7.2) 309 (33.3) 7 609 Turkey 14 417 (92.0) 0 0 1 262 (8.0) 637 (50.5) 85 (6.7) 125 (9.9) 415 (32.9) 15 679 Turkmenistan - - - - - - - - - - - - - - - Ukraine 31 188 (73.1) 0 0 11 488 (26.9) 3 049 (26.5) 0 (0.0) 0 (0.0) 8 439 (73.5) 42 676 Uzbekistan 13 995 (87.9) 844 (5.3) 1 074 (6.7) 506 (47.1) 175 (16.3) 36 (3.4) 357 (33.2) 15 913 Subtotal non-EU/EEA 213 629 (69.4) 1 762 (0.6) 92 641 (30.1) 21 066 (22.7) 11 423 (12.3) 4 085 (4.4) 56 067 (60.5) 308 032 Total European Region 271 288 (71.3) 7 521 (2.0) 101 557 (26.7) 26 045 (25.6) 12 328 (12.1) 5 136 (5.1) 58 048 (57.2) 380 366 Subtotal 18 HPC 227 209 (69.6) 1 617 (0.5) 97 830 (29.9) 24 608 (25.2) 12 311 (12.6) 4 989 (5.1) 55 922 (57.2) 326 656 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Percentages among all TB cases. b Percentages among previously treated TB cases. c Distribution by previous diagnosis. d Excluding Greenland (see Chapter 1.1). e In accordance with the UN Security Council Resolution No. 1244 (1999). 47 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 7: Tuberculosis cases by site of disease, European Region, 2011 Country Pulmonary Extrapulmonary No site reported TotalPulmonary only Pulmonary + extrapulmonary Total pulmonary N (%) N (%) N (%) N (%) N (%) EU/EEA Austria 490 (71.3) 50 (7.3) 540 (78.6) 136 (19.8) 11 (1.6) 687 Belgium 645 (61.8) 102 (9.8) 747 (71.6) 297 (28.4) 0 (0.0) 1 044 Bulgaria 1 636 (68.0) 88 (3.7) 1 724 (71.6) 683 (28.4) 0 (0.0) 2 407 Cyprus 42 (77.8) 2 (3.7) 44 (81.5) 8 (14.8) 2 (3.7) 54 Czech Republic 493 (82.2) 29 (4.8) 522 (87.0) 78 (13.0) 0 (0.0) 600 Denmarka 232 (60.9) 8 (2.1) 240 (63.0) 47 (12.3) 94 (24.7) 381 Estonia 269 (78.9) 52 (15.2) 321 (94.1) 20 (5.9) 0 (0.0) 341 Finland 236 (72.6) 0 (0.0) 236 (72.6) 89 (27.4) 0 (0.0) 325 France 2 874 (58.2) 726 (14.7) 3 600 (72.8) 1 289 (26.1) 53 (1.1) 4 942 Germany 2 880 (66.7) 466 (10.8) 3 346 (77.5) 926 (21.5) 44 (1.0) 4 316 Greece 371 (75.9) 55 (11.2) 426 (87.1) 60 (12.3) 3 (0.6) 489 Hungary 1 357 (93.9) 32 (2.2) 1 389 (96.1) 56 (3.9) 0 (0.0) 1 445 Iceland 2 (22.2) 1 (11.1) 3 (33.3) 6 (66.7) 0 (0.0) 9 Ireland 263 (61.9) 30 (7.1) 293 (68.9) 121 (28.5) 11 (2.6) 425 Italy 2 349 (66.7) 233 (6.6) 2 582 (73.3) 939 (26.7) 0 (0.0) 3 521 Latvia 730 (82.5) 66 (7.5) 796 (89.9) 89 (10.1) 0 (0.0) 885 Liechtenstein - - - - - - - - - - - Lithuania 1 714 (90.0) 0 (0.0) 1 714 (90.0) 190 (10.0) 0 (0.0) 1 904 Luxembourg 21 (80.8) 1 (3.8) 22 (84.6) 4 (15.4) 0 (0.0) 26 Malta 17 (51.5) 5 (15.2) 22 (66.7) 11 (33.3) 0 (0.0) 33 Netherlands 431 (42.8) 132 (13.1) 563 (55.9) 441 (43.8) 3 (0.3) 1 007 Norway 146 (40.4) 54 (15.0) 200 (55.4) 158 (43.8) 3 (0.8) 361 Poland 7 828 (92.3) 51 (0.6) 7 879 (92.9) 599 (7.1) 0 (0.0) 8 478 Portugal 1 647 (64.8) 210 (8.3) 1 857 (73.1) 675 (26.6) 8 (0.3) 2 540 Romania 15 245 (79.4) 1 186 (6.2) 16 431 (85.5) 2 781 (14.5) 0 (0.0) 19 212 Slovakia 320 (80.2) 17 (4.3) 337 (84.5) 62 (15.5) 0 (0.0) 399 Slovenia 133 (69.3) 32 (16.7) 165 (85.9) 27 (14.1) 0 (0.0) 192 Spain 4 979 (73.6) 0 (0.0) 4 979 (73.6) 1 783 (26.4) 0 (0.0) 6 762 Sweden 298 (50.9) 60 (10.2) 358 (61.1) 228 (38.9) 0 (0.0) 586 United Kingdom 3 705 (41.3) 898 (10.0) 4 603 (51.4) 4 313 (48.1) 47 (0.5) 8 963 Subtotal EU/EEA 51 353 (71.0) 4 586 (6.3) 55 939 (77.3) 16 116 (22.3) 279 (0.4) 72 334 Non-EU/EEA Albania - - - - 294 (68.2) 128 (29.7) 9 (2.1) 431 Andorra - - - - 3 (75.0) 1 (25.0) 0 (0.0) 4 Armenia - - - - 1 056 (66.8) 289 (18.3) 237 (15.0) 1 582 Azerbaijan - - - - 8 938 (88.5) 1 131 (11.2) 31 (0.3) 10 100 Belarus - - - - 4 634 (90.5) 404 (7.9) 80 (1.6) 5 118 Bosnia and Herzegovina - - - - 1 259 (88.4) 166 (11.6) 0 (0.0) 1 425 Croatia - - - - 602 (88.7) 77 (11.3) 0 (0.0) 679 Georgia - - - - 3 676 (66.4) 1 065 (19.2) 792 (14.3) 5 533 Israel - - - - 351 (84.0) 67 (16.0) 0 (0.0) 418 Kazakhstan - - - - 23 806 (90.8) 2 405 (9.2) 0 (0.0) 26 211 Kyrgyzstan - - - - 4 835 (72.5) 1 613 (24.2) 218 (3.3) 6 666 Macedonia, the former Yugoslav Republic of - - - - 271 (74.9) 76 (21.0) 15 (4.1) 362 Moldova - - - - 4 876 (91.3) 460 (8.6) 5 (0.1) 5 341 Monaco - - - - - - - - - - - Montenegro - - - - 107 (89.9) 12 (10.1) 0 (0.0) 119 Russia - - - - 136 775 (85.8) 10 670 (6.7) 12 035 (7.5) 159 480 San Marino - - - - - - - - - - - Serbia - - - - 1 175 (53.0) 166 (7.5) 875 (39.5) 2 216 Serbia excluding UN Administered Province of Kosovob - - - - 1 175 (87.7) 166 (12.3) 0 (0.0) 1 341 UN Administered Province of Kosovob - - - - - - 875 - 875 Switzerland - - - - 359 (62.1) 165 (28.5) 54 (9.3) 578 Tajikistan - - - - 5 996 (78.8) 1 613 (21.2) 0 (0.0) 7 609 Turkey - - - - 9 909 (63.2) 5 770 (36.8) 0 (0.0) 15 679 Turkmenistan - - - - - - - - - - - Ukraine - - - - 33 165 (77.7) 3 737 (8.8) 5 774 (13.5) 42 676 Uzbekistan - - - - 11 824 (74.3) 4 089 (25.7) 0 (0.0) 15 913 Subotal non-EU/EEA - - - - 253 911 (82.4) 34 104 (11.1) 20 125 (6.5) 308 140 Total European Region - - - - 309 850 (81.4) 50 220 (13.2) 20 404 (5.4) 380 474 Subtotal 18 HPC - - - - 270 476 (82.8) 37 009 (11.3) 19 172 (5.9) 326 657 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). b In accordance with the UN Security Council Resolution No. 1244 (1999). 48 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 8: New pulmonary tuberculosis cases by laboratory confirmation, European Region, 2011 Country New pulmonary TB cases N (%)a Laboratory confirmed Culture positive N (%) Smear positive Smear negative Smear unknown TotalN (%)b N (%)b N (%)b N (%)b EU/EEA Austria 311 (57.6) 227 (73.0) 88 (28.3) 44 (14.1) 89 (28.6) 221 (71.1) Belgium 513 (68.7) 423 (82.5) 226 (44.1) 171 (33.3) 12 (2.3) 409 (79.7) Bulgaria 1 424 (82.6) 920 (64.6) 649 (45.6) 203 (14.3) 1 (0.1) 853 (59.9) Cyprus 25 (56.8) 22 (88.0) 11 (44.0) 8 (32.0) 3 (12.0) 22 (88.0) Czech Republic 495 (94.8) 378 (76.4) 186 (37.6) 190 (38.4) 0 (0.0) 376 (76.0) Denmarkd 224 (93.3) 219 (97.8) 124 (55.4) 58 (25.9) 37 (16.5) 219 (97.8) Estonia 247 (76.9) 203 (82.2) 122 (49.4) 80 (32.4) 0 (0.0) 202 (81.8) Finland 225 (95.3) 184 (81.8) 80 (35.6) 87 (38.7) 15 (6.7) 182 (80.9) France 1 922 (53.4) 1 437 (74.8) 409 (21.3) 494 (25.7) 37 (1.9) 940 (48.9) Germany 2 738 (81.8) 2 165 (79.1) 880 (32.1) 0 (0.0) 1 214 (44.3) 2 094 (76.5) Greece 392 (92.0) 313 (79.8) 154 (39.3) 58 (14.8) 19 (4.8) 231 (58.9) Hungary 1 170 (84.2) 556 (47.5) 208 (17.8) 248 (21.2) 48 (4.1) 504 (43.1) Iceland 3 (100.0) 1 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Ireland 195 (66.6) 156 (80.0) 83 (42.6) 37 (19.0) 34 (17.4) 154 (79.0) Italy 1 377 (53.3) 823 (59.8) 252 (18.3) 160 (11.6) 76 (5.5) 488 (35.4) Latvia 703 (88.3) 563 (80.1) 289 (41.1) 270 (38.4) 0 (0.0) 559 (79.5) Liechtenstein - - 0 - - - - - - - - - Lithuania 1 345 (78.5) 1 000 (74.3) 681 (50.6) 319 (23.7) 0 (0.0) 1 000 (74.3) Luxembourg 8 (36.4) 6 (75.0) 4 (50.0) 1 (12.5) 1 (12.5) 6 (75.0) Malta 15 (68.2) 12 (80.0) 7 (46.7) 3 (20.0) 2 (13.3) 12 (80.0) Netherlands 530 (94.1) 442 (83.4) 169 (31.9) 142 (26.8) 123 (23.2) 434 (81.9) Norway 174 (87.0) 143 (82.2) 37 (21.3) 50 (28.7) 53 (30.5) 140 (80.5) Poland 6 931 (88.0) 4 759 (68.7) 2 527 (36.5) 1 908 (27.5) 264 (3.8) 4 699 (67.8) Portugal 1 689 (91.0) 1 384 (81.9) 761 (45.1) 224 (13.3) 284 (16.8) 1 269 (75.1) Romania 11 914 (72.5) 9 294 (78.0) 6 775 (56.9) 1 908 (16.0) 0 (0.0) 8 683 (72.9) Slovakia 266 (78.9) 149 (56.0) 85 (32.0) 53 (19.9) 0 (0.0) 138 (51.9) Slovenia 155 (93.9) 151 (97.4) 82 (52.9) 57 (36.8) 12 (7.7) 151 (97.4) Spain 4 428 (88.9) 3 538 (79.9) 1 849 (41.8) 1 270 (28.7) 82 (1.9) 3 201 (72.3) Sweden 281 (78.5) 248 (88.3) 98 (34.9) 120 (42.7) 29 (10.3) 247 (87.9) United Kingdom 4 031 (87.6) 2 923 (72.5) 1 112 (27.6) 753 (18.7) 966 (24.0) 2 831 (70.2) Subtotal EU/EEA 43 731 (78.2) 32 639 (74.6) 17 948 (41.0) 8 916 (20.4) 3 401 (7.8) 30 265 (69.2) Non-EU/EEA Albania 285 (96.9) 209 (73.3) 151 (53.0) 29 (10.2) 0 (0.0) 180 (63.2) Andorra 3 (100.0) 1 (33.3) 1 (33.3) 0 (0.0) 0 (0.0) 1 (33.3) Armenia 911 (86.3) 437 (48.0) 313 (34.4) 108 (11.9) 0 (0.0) 421 (46.2) Azerbaijan 4 166 (46.6) 2 260 (54.2) 1 174 (28.2) 834 (20.0) 0 (0.0) 2 008 (48.2) Belarus 3 656 (78.9) 2 179 (59.6) 1 056 (28.9) 962 (26.3) 0 (0.0) 2 018 (55.2) Bosnia and Herzegovina 1 194 (94.8) 708 (59.3) 542 (45.4) 161 (13.5) 0 (0.0) 703 (58.9) Croatia 544 (90.4) 347 (63.8) 198 (36.4) 83 (15.3) 63 (11.6) 344 (63.2) Georgia 3 167 (86.2) 2 501 (79.0) 1 781 (56.2) 463 (14.6) 12 (0.4) 2 256 (71.2) Israel 342 (97.4) 241 (70.5) 131 (38.3) 106 (31.0) 0 (0.0) 237 (69.3) Kazakhstan 12 399 (52.1) 6 161 (49.7) 3 289 (26.5) 1 915 (15.4) 89 (0.7) 5 293 (42.7) Kyrgyzstan 3 662 (75.7) 1 537 (42.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Macedonia, the former Yugoslav Republic of 231 (85.2) 176 (76.2) 94 (40.7) 44 (19.0) 0 (0.0) 138 (59.7) Moldova 3 412 (70.0) 1 821 (53.4) 977 (28.6) 543 (15.9) 6 (0.2) 1 526 (44.7) Monaco - - 0 - - - - - - - - - Montenegro 88 (82.2) 56 (63.6) 48 (54.5) 8 (9.1) 0 (0.0) 56 (63.6) Russia 94 297 (68.9) 43 761 (46.4) 22 095 (23.4) 14 570 (15.5) 0 (0.0) 36 665 (38.9) San Marino - - 0 - - - - - - - - - Serbia 1 050 (89.4) 914 87 625 60 254 24 6 1 885 84 Serbia excluding UN Administered Province of Kosovoe 1 050 (89.4) 914 (87.0) 625 (59.5) 254 (24.2) 6 (0.6) 885 (84.3) UN Administered Province of Kosovoe - - 0 - - - - - - - - - Switzerland 260 (72.4) 224 (86.2) 86 (33.1) 28 (10.8) 106 (40.8) 220 (84.6) Tajikistan 4 322 (72.1) 2 174 (50.3) 0 0 (0.0) 0 (0.0) 0 (0.0) Turkey 8 852 (89.3) 6 398 (72.3) 3 638 (41.1) 1 071 (12.1) 400 (4.5) 5 109 (57.7) Turkmenistan - - 0 - - - - - - - - - Ukraine 27 821 (83.9) 13 715 (49.3) 13 715 (49.3) 0 (0.0) 0 (0.0) 13 715 (49.3) Uzbekistan 10 156 (85.9) 5 066 (49.9) 266 (2.6) 868 (8.5) 0 (0.0) 1 134 (11.2) Subtotal non-EU/EEA 180 818 (71.2) 90 886 (50.3) 50 180 (27.8) 22 047 (12.2) 682 (0.4) 72 909 (40.3) Total European Region 224 549 (72.5) 123 525 (55.0) 68 128 (30.3) 30 963 (13.8) 4 083 (1.8) 103 174 (45.9) Subtotal 18 HPC 192 454 (71.2) 99 990 (52.0) 56 820 (29.5) 24 114 (12.5) 508 (0.3) 81 442 (42.3) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Percentage among pulmonary TB cases. b Percentage among new pulmonary TB cases. c Percentage among all TB cases. d Excluding Greenland (see Chapter 1.1). e In accordance with the UN Security Council Resolution No. 1244 (1999). 49 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT New pulmonary TB cases All pulmonary TB cases All TB casesCulture negative/not done Smear positive Smear negative Smear unknown Total N (%)b N (%)b N (%)b N (%)b N (%)c N 6 (1.9) 25 (8.0) 59 (19.0) 90 (28.9) 540 (78.6) 687 14 (2.7) 70 (13.6) 20 (3.9) 104 (20.3) 747 (71.6) 1 044 67 (4.7) 443 (31.1) 61 (4.3) 571 (40.1) 1 724 (71.6) 2 407 0 (0.0) 3 (12.0) 0 (0.0) 3 (12.0) 44 (81.5) 54 2 (0.4) 117 (23.6) 0 (0.0) 119 (24.0) 522 (87.0) 600 0 (0.0) 3 (1.3) 2 (0.9) 5 (2.2) 240 (63.0) 381 1 (0.4) 38 (15.4) 6 (2.4) 45 (18.2) 321 (94.1) 341 2 (0.9) 34 (15.1) 7 (3.1) 43 (19.1) 236 (72.6) 325 497 (25.9) 411 (21.4) 74 (3.9) 982 (51.1) 3 600 (72.8) 4 942 71 (2.6) 0 (0.0) 573 (20.9) 644 (23.5) 3 346 (77.5) 4 316 82 (20.9) 42 (10.7) 37 (9.4) 161 (41.1) 426 (87.1) 489 52 (4.4) 445 (38.0) 169 (14.4) 666 (56.9) 1 389 (96.1) 1 445 1 (33.3) 1 (33.3) 1 (33.3) 3 (100.0) 3 (33.3) 9 2 (1.0) 16 (8.2) 23 (11.8) 41 (21.0) 293 (68.9) 425 335 (24.3) 222 (16.1) 332 (24.1) 889 (64.6) 2 582 (73.3) 3 521 4 (0.6) 130 (18.5) 10 (1.4) 144 (20.5) 796 (89.9) 885 - - - - - - - - - - - 0 (0.0) 345 (25.7) 0 (0.0) 345 (25.7) 1 714 (90.0) 1 904 0 (0.0) 1 (12.5) 1 (12.5) 2 (25.0) 22 (84.6) 26 0 (0.0) 0 (0.0) 3 (20.0) 3 (20.0) 22 (66.7) 33 8 (1.5) 42 (7.9) 46 (8.7) 96 (18.1) 563 (55.9) 1 007 3 (1.7) 1 (0.6) 30 (17.2) 34 (19.5) 200 (55.4) 361 60 (0.9) 1 983 (28.6) 189 (2.7) 2 232 (32.2) 7 879 (92.9) 8 478 115 (6.8) 82 (4.9) 223 (13.2) 420 (24.9) 1 857 (73.1) 2 540 611 (5.1) 2 499 (21.0) 121 (1.0) 3 231 (27.1) 16 431 (85.5) 19 212 11 (4.1) 117 (44.0) 0 (0.0) 128 (48.1) 337 (84.5) 399 0 (0.0) 1 (0.6) 3 (1.9) 4 (2.6) 165 (85.9) 192 337 (7.6) 644 (14.5) 246 (5.6) 1 227 (27.7) 4 979 (73.6) 6 762 1 (0.4) 23 (8.2) 10 (3.6) 34 (12.1) 358 (61.1) 586 92 (2.3) 402 (10.0) 706 (17.5) 1 200 (29.8) 4 603 (51.4) 8 963 2 374 (5.4) 8 140 (18.6) 2 952 (6.8) 13 466 (30.8) 55 939 (77.3) 72 334 29 (10.2) 69 (24.2) 7 (2.5) 105 (36.8) 294 (68.2) 431 0 (0.0) 1 (33.3) 1 (33.3) 2 (66.7) 3 (75.0) 4 16 (1.8) 474 (52.0) 0 (0.0) 490 (53.8) 1 056 (66.8) 1 582 252 (6.0) 1 906 (45.8) 0 (0.0) 2 158 (51.8) 8 938 (88.5) 10 100 161 (4.4) 1 442 (39.4) 35 (1.0) 1 638 (44.8) 4 634 (90.5) 5 118 5 (0.4) 485 (40.6) 1 (0.1) 491 (41.1) 1 259 (88.4) 1 425 3 (0.6) 72 (13.2) 125 (23.0) 200 (36.8) 602 (88.7) 679 245 (7.7) 631 (19.9) 35 (1.1) 911 (28.8) 3 676 (66.4) 5 533 4 (1.2) 42 (12.3) 59 (17.3) 105 (30.7) 351 (84.0) 418 868 (7.0) 6 177 (49.8) 61 (0.5) 7 106 (57.3) 23 806 (90.8) 26 211 1 537 (42.0) 2 125 (58.0) 0 (0.0) 3 662 (100.0) 4 835 (72.5) 6 666 38 (16.5) 51 (22.1) 4 (1.7) 93 (40.3) 271 (74.9) 362 295 (8.6) 1 428 (41.9) 163 (4.8) 1 886 (55.3) 4 876 (91.3) 5 341 - - - - - - - - - - 0 0 (0.0) 29 (33.0) 3 (3.4) 32 (36.4) 107 (89.9) 119 7 096 (7.5) 49 347 (52.3) 1 189 (1.3) 57 632 (61.1) 136 775 (85.8) 159 480 - - - - - - - - - - 0 29 3 118 11 18 2 165 16 1 175 88 29 (2.8) 118 (11.2) 18 (1.7) 165 (15.7) 1 175 (87.6) 1 341 - - - - - - - - - - - 4 (1.5) 0 (0.0) 36 (13.8) 40 (15.4) 359 (62.1) 578 2 174 (50.3) 2 148 (49.7) 0 (0.0) 4 322 (100.0) 5 996 (78.8) 7 609 1 289 (14.6) 1 301 (14.7) 1 153 (13.0) 3 743 (42.3) 9 909 (63.2) 15 679 - - - - - - - - - - 0 0 (0.0) 14 106 (50.7) 0 (0.0) 14 106 (50.7) 33 165 (77.7) 42 676 3 932 (38.7) 5 090 (50.1) 0 (0.0) 9 022 (88.8) 11 824 (74.3) 15 913 17 977 (9.9) 87 042 (48.1) 2 890 (1.6) 107 909 (59.7) 253 911 (82.6) 307 265 20 351 (9.1) 95 182 (42.4) 5 842 (2.6) 121 375 (54.1) 309 850 (81.6) 379 599 18 548 (9.6) 89 630 (46.6) 2 834 (1.5) 111 012 (57.7) 270 476 (82.8) 326 657 50 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 9: Laboratory-confirmed tuberculosis cases by confirmation method, EU/EEA, 2011 Country Smear-positive and nucleic- acid-test-positive onlya Culture-positive only Meeting both criteria All laboratory-confirmed cases All tuberculosis cases (N)N (%)b N (%)b N (%)b N (%)c Austria 3 (0.6) 384 (82.4) 79 (17.0) 466 (67.8) 687 Belgium 5 (0.6) 633 (79.4) 159 (19.9) 797 (76.3) 1 044 Bulgaria 0 (0.0) 1 070 (99.9) 1 (0.1) 1 071 (44.5) 2 407 Cyprus 0 (0.0) 44 (100.0) 0 (0.0) 44 (81.5) 54 Czech Republic 1 (0.2) 409 (96.0) 16 (3.8) 426 (71.0) 600 Denmarkd 0 (0.0) 182 (66.9) 90 (33.1) 272 (71.4) 381 Estonia 2 (0.8) 180 (68.2) 82 (31.1) 264 (77.4) 341 Finland 1 (0.4) 233 (92.5) 18 (7.1) 252 (77.5) 325 France 0 (0.0) 2 309 (100.0) 0 (0.0) 2 309 (46.7) 4 942 Germany 25 (0.8) 2 308 (75.2) 738 (24.0) 3 071 (71.2) 4 316 Greece 3 (1.1) 275 (98.9) 0 (0.0) 278 (56.9) 489 Hungary 0 (0.0) 597 (100.0) 0 (0.0) 597 (41.3) 1 445 Iceland 0 (0.0) 4 (100.0) 0 (0.0) 4 (44.4) 9 Ireland 1 (0.3) 272 (94.4) 15 (5.2) 288 (67.8) 425 Italye 0 (0.0) 982 (100.0) 0 (0.0) 982 (27.9) 3 521 Latvia 0 (0.0) 671 (100.0) 0 (0.0) 671 (75.8) 885 Liechtenstein - - - - - - - - - Lithuania 0 (0.0) 1 403 (100.0) 0 (0.0) 1 403 (73.7) 1 904 Luxembourg 0 (0.0) 19 (100.0) 0 (0.0) 19 (73.1) 26 Malta 0 (0.0) 24 (100.0) 0 (0.0) 24 (72.7) 33 Netherlands 6 (0.8) 583 (79.6) 143 (19.5) 732 (72.7) 1 007 Norway 0 (0.0) 224 (85.5) 38 (14.5) 262 (72.6) 361 Poland 0 (0.0) 5 581 (100.0) 0 (0.0) 5 581 (65.8) 8 478 Portugal 0 (0.0) 1 588 (100.0) 0 (0.0) 1 588 (62.5) 2 540 Romania 0 (0.0) 12 446 (100.0) 0 (0.0) 12 446 (64.8) 19 212 Slovakia 2 (1.1) 180 (95.7) 6 (3.2) 188 (47.1) 399 Slovenia 0 (0.0) 111 (61.0) 71 (39.0) 182 (94.8) 192 Spain 0 (0.0) 4 383 (100.0) 0 (0.0) 4 383 (64.8) 6 762 Sweden 1 (0.2) 381 (80.0) 94 (19.7) 476 (81.2) 586 United Kingdom 1 (0.0) 5 257 (99.5) 27 (0.5) 5 285 (59.0) 8 963 Total EU/EEA 51 (0.1) 42 733 (96.3) 1 577 (3.6) 44 361 (61.3) 72 334 WHO European Region 18 TB High Priority Countries presented in italics. a Only data on microscopy sputum smear results are collected in TESSy. b Percentage among all laboratory-confirmed TB cases. c Percentage among all TB cases. d Excluding Greenland (see Chapter 1.1). e Italy reported culture results only for cases with positive sputum smear. 51 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 10: Classification of tuberculosis cases according to EU case definition, EU/EEA, 2011 Country Confirmed Probable Possible All tuberculosis cases (N)N (%) N (%) N (%) Austria 466 (67.8) 72 (10.5) 149 (21.7) 687 Belgium 797 (76.3) 88 (8.4) 159 (15.2) 1 044 Bulgaria 1 071 (44.5) 187 (7.8) 1 149 (47.7) 2 407 Cyprus 44 (81.5) 1 (1.9) 9 (16.7) 54 Czech Republic 426 (71.0) 72 (12.0) 102 (17.0) 600 Denmarka 272 (71.4) 19 (5.0) 90 (23.6) 381 Estonia 264 (77.4) 17 (5.0) 60 (17.6) 341 Finland 252 (77.5) 25 (7.7) 48 (14.8) 325 France 2 309 (46.7) 922 (18.7) 1 711 (34.6) 4 942 Germany 3 071 (71.2) 301 (7.0) 944 (21.9) 4 316 Greece 278 (56.9) 96 (19.6) 115 (23.5) 489 Hungary 597 (41.3) 60 (4.2) 788 (54.5) 1 445 Iceland 4 (44.4) 1 (11.1) 4 (44.4) 9 Ireland 288 (67.8) 41 (9.6) 96 (22.6) 425 Italyb 982 (27.9) 540 (15.3) 1 999 (56.8) 3 521 Latvia 671 (75.8) 81 (9.2) 133 (15.0) 885 Liechtenstein - - - - - - - Lithuania 1 403 (73.7) 0 (0.0) 501 (26.3) 1 904 Luxembourg 19 (73.1) 0 (0.0) 7 (26.9) 26 Malta 24 (72.7) 0 (0.0) 9 (27.3) 33 Netherlands 732 (72.7) 80 (7.9) 195 (19.4) 1 007 Norway 262 (72.6) 19 (5.3) 80 (22.2) 361 Poland 5 581 (65.8) 73 (0.9) 2 824 (33.3) 8 478 Portugal 1 588 (62.5) 138 (5.4) 814 (32.0) 2 540 Romania 12 446 (64.8) 1 535 (8.0) 5 231 (27.2) 19 212 Slovakia 188 (47.1) 67 (16.8) 144 (36.1) 399 Slovenia 182 (94.8) 3 (1.6) 7 (3.6) 192 Spain 4 383 (64.8) 394 (5.8) 1 985 (29.4) 6 762 Sweden 476 (81.2) 27 (4.6) 83 (14.2) 586 United Kingdom 5 285 (59.0) 387 (4.3) 3 291 (36.7) 8 963 Total EU/EEA 44 361 (61.3) 5 246 (7.3) 22 727 (31.4) 72 334 WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). b Italy reported laboratory confirmation only for sputum smear positive cases. 52 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 11: New TB cases by age group, European Region, 2011 Country 0–4 5–14 15–24 25–44 45–64N (%) Rate N (%) Rate N (%) Rate N (%) Rate N (%) Rate EU/EEA Austria 12 (3.0) 3.1 7 (1.8) 0.8 54 (13.6) 5.3 134 (33.8) 5.7 105 (26.5) 4.6 Belgium 40 (5.7) 6.4 30 (4.3) 2.5 119 (16.9) 9.1 266 (37.7) 9.1 122 (17.3) 4.2 Bulgaria 58 (2.8) 15.5 115 (5.6) 17.4 194 (9.5) 21.8 637 (31.0) 29.3 656 (32.0) 31.7 Cyprus 0 (0.0) 0.0 0 (0.0) 0.0 5 (16.1) 4.2 19 (61.3) 7.8 1 (3.2) 0.5 Czech Republic 5 (0.9) 0.9 1 (0.2) 0.1 33 (5.8) 2.6 148 (26.0) 4.6 213 (37.4) 7.4 Denmarka 5 (1.4) 1.5 10 (2.8) 1.5 32 (8.9) 4.6 141 (39.3) 9.7 126 (35.1) 8.5 Estonia 0 (0.0) 0.0 1 (0.4) 0.8 18 (6.8) 10.0 117 (44.2) 31.0 93 (35.1) 26.7 Finland 3 (1.0) 1.0 8 (2.6) 1.4 24 (7.7) 3.6 54 (17.3) 4.0 70 (22.4) 4.6 France 82 (3.1) 2.0 70 (2.7) 0.9 320 (12.1) 4.0 977 (37.0) 5.8 622 (23.6) 3.6 Germany 83 (2.4) 2.4 80 (2.3) 1.1 283 (8.1) 3.1 1 053 (30.2) 4.9 997 (28.6) 4.3 Greece 15 (3.3) 2.6 21 (4.6) 2.0 62 (13.7) 5.3 146 (32.3) 4.3 88 (19.5) 3.0 Hungary 2 (0.2) 0.4 1 (0.1) 0.1 61 (5.0) 5.0 289 (23.6) 9.7 558 (45.6) 21.2 Iceland 0 (0.0) 0.0 1 (12.5) 2.3 1 (12.5) 2.1 4 (50.0) 4.5 1 (12.5) 1.3 Ireland 4 (1.4) 1.1 9 (3.2) 1.5 34 (12.1) 6.5 133 (47.5) 9.3 71 (25.4) 6.9 Italy 51 (2.5) 1.8 70 (3.5) 1.2 250 (12.4) 4.1 828 (41.0) 4.8 398 (19.7) 2.4 Latvia 25 (3.2) 22.4 36 (4.6) 18.5 78 (9.9) 25.2 331 (42.0) 51.7 252 (32.0) 43.0 Liechtenstein - - - - - - - - - - - - - - - Lithuania 26 (1.7) 15.6 62 (4.0) 19.3 116 (7.6) 24.4 533 (34.8) 59.4 557 (36.4) 65.7 Luxembourg 0 (0.0) 0.0 0 (0.0) 0.0 3 (27.3) 4.9 4 (36.4) 2.6 4 (36.4) 3.0 Malta 0 (0.0) 0.0 0 (0.0) 0.0 6 (27.3) 10.4 10 (45.5) 8.7 2 (9.1) 1.7 Netherlands 17 (1.8) 1.8 38 (4.0) 1.9 144 (15.0) 7.1 396 (41.3) 9.0 234 (24.4) 5.0 Norway 3 (1.0) 1.0 13 (4.1) 2.1 89 (28.3) 13.8 148 (47.1) 10.9 39 (12.4) 3.1 Poland 30 (0.4) 1.5 81 (1.1) 2.2 382 (5.1) 7.3 1 724 (22.9) 15.1 3 339 (44.4) 31.7 Portugal 18 (0.8) 3.5 25 (1.1) 2.3 233 (10.0) 20.0 838 (36.0) 26.6 767 (33.0) 27.6 Romania 298 (2.0) 27.4 462 (3.2) 21.3 2 455 (16.9) 82.1 5 137 (35.3) 76.2 4 119 (28.3) 78.1 Slovakia 10 (3.1) 3.5 7 (2.2) 1.3 29 (9.0) 3.8 63 (19.5) 3.7 120 (37.2) 8.2 Slovenia 2 (1.1) 1.9 2 (1.1) 1.1 6 (3.3) 2.6 64 (35.4) 10.6 51 (28.2) 8.7 Spain 295 (4.9) 11.9 229 (3.8) 5.1 635 (10.5) 13.4 2 401 (39.7) 16.1 1 339 (22.2) 11.5 Sweden 7 (1.5) 1.2 23 (5.1) 2.3 102 (22.5) 8.2 219 (48.2) 8.9 64 (14.1) 2.7 United Kingdom 132 (1.7) 3.4 255 (3.2) 3.6 1 221 (15.6) 14.9 3 628 (46.2) 21.3 1 610 (20.5) 10.1 Subtotal EU/EEA 1 223 (2.1) 4.5 1 657 (2.9) 3.2 6 989 (12.1) 11.5 20 442 (35.4) 14.3 16 618 (28.8) 12.2 Non-EU/EEA Albania 1 (0.2) 0.5 6 (1.5) 1.2 83 (20.1) 14.0 103 (24.9) 11.3 134 (32.4) 19.4 Andorra 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 2 (66.7) 7.2 1 (33.3) 4.6 Armenia 18 (1.5) 8.0 29 (2.4) 7.3 206 (17.2) 37.4 416 (34.7) 50.6 413 (34.4) 54.2 Azerbaijan 55 (1.0) 6.5 131 (2.5) 11.7 388 (7.3) 20.7 336 (6.3) 12.0 200 (3.8) 9.6 Belarus 10 (0.2) 1.9 16 (0.4) 1.7 373 (9.2) 28.0 1 755 (43.4) 61.3 1 506 (37.2) 57.3 Bosnia and Herzegovina 5 (0.4) 3.0 15 (1.1) 3.9 113 (8.3) 22.5 290 (21.3) 26.2 453 (33.3) 42.9 Croatia 3 (0.5) 1.4 10 (1.6) 2.3 48 (7.8) 9.1 132 (21.3) 10.9 235 (38.0) 19.0 Georgia 47 (1.1) 18.2 155 (3.7) 33.9 885 (21.0) 129.9 1 916 (45.4) 163.1 894 (21.2) 78.6 Israel 9 (2.2) 1.2 11 (2.7) 0.8 98 (24.0) 8.7 179 (43.9) 8.7 64 (15.7) 4.3 Kazakhstan 159 (1.1) 9.2 463 (3.2) 19.9 4 148 (28.8) 142.5 6 332 (44.0) 132.5 2 787 (19.4) 82.4 Kyrgyzstan - - - - - - 425 (8.2) 35.5 658 (12.7) 44.1 355 (6.9) 41.7 Macedonia, the former Yugoslav Republic of 5 (1.6) 4.5 28 (9.1) 11.4 55 (17.9) 17.8 79 (25.7) 12.6 86 (28.0) 16.5 Moldova 51 (1.3) 22.9 108 (2.8) 29.4 546 (14.2) 89.1 1 713 (44.7) 173.8 1 247 (32.5) 130.2 Monaco 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 Montenegro 1 (1.0) 2.6 2 (2.0) 2.4 14 (14.0) 15.6 32 (32.0) 17.9 38 (38.0) 23.3 Russia 1 214 (1.2) 14.7 2 331 (2.2) 17.2 13 382 (12.8) 69.1 53 200 (51.0) 122.8 28 845 (27.7) 72.1 San Marino 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 Serbia 6 (0.3) 0.7 7 (0.3) 0.4 146 (7.1) 8.4 366 (17.8) 11.3 483 (23.5) 16.5 Serbia excluding UN Administered Province of Kosovob 6 (0.5) 1.1 7 (0.6) 0.6 86 (7.1) 6.4 287 (23.8) 10.1 446 (37.0) 17.6 UN Administered Province of Kosovob 0 (0.0) 0.0 0 (0.0) 0.0 60 (7.1) 14.9 79 (9.3) 19.6 37 (4.4) 9.2 Switzerland 11 (2.9) 2.9 8 (2.1) 1.0 55 (14.5) 6.0 156 (41.2) 7.1 96 (25.3) 4.5 Tajikistan 136 (2.3) 15.4 433 (7.3) 26.0 1 801 (30.3) 110.9 2 178 (36.7) 128.0 1 013 (17.1) 117.4 Turkey 196 (1.4) 3.0 548 (3.8) 4.3 2 725 (18.9) 21.2 5 001 (34.7) 21.5 3 973 (27.6) 28.8 Turkmenistan 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 0.0 0.0 0 (0.0) 0.0 Ukraine 5 (0.0) 0.2 14 (0.0) 0.3 887 (2.8) 14.6 5 544 17.8 41.4 3 295 (10.6) 26.9 Uzbekistan 290 (2.1) 10.3 1 302 (9.3) 24.9 2 380 (17.0) 38.7 4 903 35.0 60.8 3 571 (25.5) 82.5 Subtotal non-EU/EEA 2 222 (1.0) 7.8 5 617 (2.6) 11 28 758 (13.5) 46.3 85 291 (39.9) 72.4 49 689 (23.3) 52.8 Total European Region 3 445 (1.3) 6.2 7 274 (2.7) 7 35 747 (13.2) 29.4 105 733 (39.0) 40.6 66 307 (24.4) 28.9 Subtotal 18 HPC 2 588 (1.1) 9.4 6 206 (2.7) 13 31 007 (13.6) 50.9 90 707 (39.9) 77.4 53 776 (23.7) 57.8 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). b In accordance with the UN Security Council Resolution No. 1244 (1999). 53 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT > 64 Unknown TotalN (%) Rate N (%) 84 (21.2) 5.7 0 (0.0) 396 128 (18.2) 6.9 0 (0.0) 705 392 (19.1) 29.4 0 (0.0) 2 052 6 (19.4) 5.7 0 (0.0) 31 169 (29.7) 10.3 0 (0.0) 569 45 (12.5) 4.8 0 (0.0) 359 36 (13.6) 15.8 0 (0.0) 265 153 (49.0) 16.3 0 (0.0) 312 567 (21.5) 5.2 1 (0.0) 2 639 993 (28.5) 5.9 1 (0.0) 3 490 116 (25.7) 5.3 4 (0.9) 452 312 (25.5) 18.7 0 (0.0) 1 223 1 (12.5) 2.6 0 (0.0) 8 29 (10.4) 5.6 0 (0.0) 280 411 (20.4) 3.3 10 (0.5) 2 018 66 (8.4) 17.0 0 (0.0) 788 - - - - - - 238 (15.5) 44.4 0 (0.0) 1 532 0 (0.0) 0.0 0 (0.0) 11 4 (18.2) 6.2 0 (0.0) 22 129 (13.5) 5.0 0 (0.0) 958 22 (7.0) 3.0 0 (0.0) 314 1 959 (26.1) 37.8 0 (0.0) 7 515 436 (18.8) 22.6 8 (0.3) 2 325 2 072 (14.2) 64.6 0 (0.0) 14 543 94 (29.1) 14.0 0 (0.0) 323 56 (30.9) 16.5 0 (0.0) 181 1 137 (18.8) 14.4 8 (0.1) 6 044 39 (8.6) 2.2 0 (0.0) 454 1 004 (12.8) 9.7 0 (0.0) 7 850 10 698 (18.6) 12.1 32 (0.1) 57 659 86 (20.8) 27.2 0 (0.0) 413 0 (0.0) 0.0 0 (0.0) 3 118 (9.8) 34.6 0 (0.0) 1 200 20 (0.4) 3.4 4 166 (78.7) 5 296 383 (9.5) 29.6 0 (0.0) 4 043 482 (35.4) 90.5 2 (0.1) 1 320 191 (30.9) 25.0 0 (0.0) 619 326 (7.7) 52.5 0 (0.0) 4 223 47 (11.5) 5.9 0 (0.0) 408 507 (3.5) 46.5 0 (0.0) 14 396 80 (1.5) 34.2 3 662 (70.7) 5 180 54 (17.6) 21.8 0 (0.0) 307 171 (4.5) 42.9 0 (0.0) 3 836 0 (0.0) 0.0 0 (0.0) 0 13 (13.0) 16.3 0 (0.0) 100 5 348 (5.1) 29.2 0 (0.0) 104 320 0 (0.0) 0.0 0 (0.0) 0 413 (20.1) 26.8 630 (30.7) 2 051 373 (31.0) 26.3 0 (0.0) 1 205 40 (4.7) 32.7 630 (74.5) 846 53 (14.0) 4.0 0 (0.0) 379 374 (6.3) 156.5 0 (0.0) 5 935 1 974 (13.7) 44.1 0 (0.0) 14 417 0 (0.0) 0.0 0 757 (2.4) 10.9 20 686 (66.3) 31 188 1 549 (11.1) 129.4 0 (0.0) 13 995 12 946 (6.1) 31.1 29 146 (13.6) 213 629 23 644 (8.7) 18.1 29 178 (10.8) 271 288 14 411 (6.3) 35 28 514 (12.5) 227 209

55 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 12 Tuberculosis cases in children and adults, European Region, 2011 Country Age < 15 Age ≥ 15N (%)a Rate N (%) a Rate EU/EEA Austria 24 (3.5) 1.9 663 (96.5) 9.2 Belgium 85 (8.1) 4.6 959 (91.9) 10.6 Bulgaria 176 (7.3) 17.0 2 231 (92.7) 34.5 Cyprus 0 (0.0) 0.0 54 (100.0) 8.1 Czech Republic 6 (1.0) 0.4 594 (99.0) 6.6 Denmarkb 16 (4.2) 1.6 365 (95.8) 8.0 Estonia 1 (0.3) 0.5 340 (99.7) 30.0 Finland 11 (3.4) 1.2 314 (96.6) 7.0 France 255 (5.2) 2.1 4 685 (94.8) 8.8 Germany 179 (4.1) 1.6 4 134 (95.8) 5.8 Greece 38 (7.8) 2.3 447 (91.4) 4.6 Hungary 4 (0.3) 0.3 1 441 (99.7) 16.9 Iceland 1 (11.1) 1.5 8 (88.9) 3.2 Ireland 20 (4.7) 2.0 404 (95.1) 11.5 Italy 209 (5.9) 2.5 3 281 (93.2) 6.3 Latvia 61 (6.9) 19.9 824 (93.1) 42.8 Liechtenstein - - - - - - Lithuania 88 (4.6) 18.0 1 816 (95.4) 65.9 Luxembourg 1 (3.8) 1.1 25 (96.2) 5.9 Malta 0 (0.0) 0.0 33 (100.0) 9.3 Netherlands 56 (5.6) 1.9 951 (94.4) 6.9 Norway 17 (4.7) 1.8 344 (95.3) 8.6 Poland 111 (1.3) 1.9 8 367 (98.7) 25.8 Portugal 44 (1.7) 2.7 2 487 (97.9) 27.5 Romania 776 (4.0) 23.9 18 436 (96.0) 101.2 Slovakia 17 (4.3) 2.0 382 (95.7) 8.3 Slovenia 4 (2.1) 1.4 188 (97.9) 10.7 Spain 541 (8.0) 7.8 6 211 (91.9) 15.8 Sweden 36 (6.1) 2.3 550 (93.9) 7.0 United Kingdom 413 (4.6) 3.8 8 550 (95.4) 16.6 Subtotal EU/EEA 3 190 (4.4) 4.0 69 084 (95.5) 16.1 Non-EU/EEA Albania 7 (1.6) 1.0 424 (98.4) 16.9 Andorra 0 (0.0) 0.0 4 (100.0) 5.5 Armenia 51 (3.2) 8.2 1 531 (96.8) 61.8 Azerbaijan 0 - - 0 - - Belarus 27 (0.5) 1.9 4 720 (92.2) 58.2 Bosnia and Herzegovina 17 (1.2) 3.1 1 406 (101.5) 44.0 Croatia 13 (2.1) 2.0 666 (107.6) 17.8 Georgia 206 (3.7) 28.8 5 327 (96.3) 147.4 Israel 20 (4.8) 1.0 403 (96.4) 7.3 Kazakhstan 659 (2.9) 16.3 22 417 (97.1) 184.3 Kyrgyzstan 504 (8.1) 31.1 4 739 (75.8) 125.6 Macedonia, the former Yugoslav Republic of 33 (9.1) 9.2 330 (91.2) 19.3 Moldova 0 - - 0 - - Monaco 0 - - 0 - - Montenegro 3 (2.7) 2.5 116 (103.6) 22.7 Russia 3 545 (2.2) 16.2 100 842 (63.2) 83.4 San Marino 0 - - 0 - - Serbia 50 (2.3) 2.3 2 137 (96.4) 22.6 Serbia excluding UN Administered Province of Kosovoc 13 (1.0) 0.8 1 328 (99.0) 16.3 UN Administered Province of Kosovoc 37 (4.2) 7.5 809 (92.5) 60.8 Switzerland 26 (4.5) 2.2 556 (96.2) 8.5 Tajikistan 569 (7.5) 22.3 5 366 (70.5) 121.2 Turkey 761 (4.9) 4.0 14 918 (95.1) 27.4 Turkmenistan 0 - - 0 - - Ukraine 520 (1.2) 8.0 30 139 (70.6) 77.9 Uzbekistan 1 751 (11.0) 21.8 14 165 (89.0) 71.8 Subtotal non-EU/EEA 8 762 (2.9) 11.2 210 206 (69.1) 66.6 Total European Region 11 952 (3.2) 7.6 279 290 (75.2) 37.6 Subtotal 18 HPC 9 695 (3.0) 12.8 227 811 (70.6) 72.8 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Percentages calculation based on all cases with age notified. b Excluding Greenland (see Chapter 1.1). c In accordance with the UN Security Council Resolution No. 1244 (1999). 56 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 13: Tuberculosis cases by origin and sex ratio, European Region, 2011 Country Criterion Native Foreign Male Female Gender unknown Total (%) Sex ratio (M:F) Male Female Gender unknown Total (%) Sex ratio (M:F) EU/EEA Austria citizenship 223 131 0 354 (51.5) 1.7 194 132 0 326 (47.5) 1.5 Belgium citizenship 323 177 0 500 (47.9) 1.8 346 198 0 544 (52.1) 1.7 Bulgaria birthplace 1 601 797 0 2 398 (99.6) 2.0 7 2 0 9 (0.4) 3.5 Cyprus birthplace 6 3 0 9 (16.7) 2.0 26 19 0 45 (83.3) 1.4 Czech Republic birthplace 337 151 0 488 (81.3) 2.2 92 20 0 112 (18.7) 4.6 Denmarka,b birthplace 102 44 0 146 (38.3) 2.3 129 106 0 235 (61.7) 1.2 Estonia birthplace 214 79 0 293 (85.9) 2.7 29 19 0 48 (14.1) 1.5 Finland birthplace 123 89 0 212 (65.2) 1.4 37 42 0 79 (24.3) 0.9 France birthplace 1 228 868 12 2 108 (42.7) 1.4 1 513 926 17 2 456 (49.7) 1.6 Germany birthplace 1 312 787 1 2 100 (48.8) 1.7 1 125 892 8 2 025 (46.8) 1.3 Greece citizenship 185 87 1 273 (55.6) 2.1 156 57 3 216 (44.4) 2.6 Hungary citizenship 928 490 0 1 418 (98.1) 1.9 21 6 0 27 (1.9) 3.5 Iceland birthplace 1 1 0 2 (22.2) 1.0 1 6 0 7 (77.8) 0.2 Ireland birthplace 114 75 0 189 (44.5) 1.5 95 84 0 179 (42.1) 1.1 Italy birthplace 895 682 1 1 578 (44.7) 1.3 992 685 0 1 677 (47.7) 1.4 Latvia birthplace 544 273 0 817 (92.3) 2.0 43 16 0 59 (6.7) 2.7 Liechtenstein - - - - - - - Lithuania birthplace 1 296 564 0 1 860 (97.7) 2.3 39 5 0 44 (2.3) 7.8 Luxembourg birthplace 4 1 0 5 (19.2) 4.0 11 10 0 21 (80.8) 1.1 Malta birthplace 3 2 0 5 (15.2) 1.5 20 8 0 28 (84.8) 2.5 Netherlands birthplace 179 113 0 292 (29.0) 1.6 386 324 0 710 (70.5) 1.2 Norway birthplace 33 11 0 44 (12.2) 3.0 163 154 0 317 (87.8) 1.1 Poland citizenship 5 683 2 757 0 8 440 (99.6) 2.1 31 7 0 38 (0.4) 4.4 Portugal birthplace 1 448 703 0 2 151 (84.6) 2.1 254 131 0 385 (15.3) 1.9 Romania birthplace 13 123 6 039 0 19 162 (99.7) 2.2 30 20 0 50 (0.3) 1.5 Slovakia birthplace 249 147 0 396 (99.2) 1.7 2 1 0 3 (0.8) 2.0 Slovenia birthplace 70 65 0 135 (70.3) 1.1 41 16 0 57 (29.7) 2.6 Spain birthplace 2 841 1 673 14 4 528 (67.0) 1.7 1 270 865 3 2 138 (31.6) 1.5 Sweden birthplace 38 24 0 62 (10.6) 1.6 311 213 0 524 (89.4) 1.5 United Kingdom birthplace 1 274 934 18 2 226 (24.8) 1.4 3 584 2 688 15 6 287 (70.1) 1.3 Subtotal EU/EEA 34 377 17 767 47 52 191 (72.2) 1.9 10 948 7 652 46 18 646 (25.8) 1.4 Non-EU/EEA Albania citizenship 295 136 0 431 (100.0) 2.2 0 0 0 0 (0.0) - Andorra citizenship 2 2 0 4 (100.0) 1.0 0 0 0 0 (0.0) - Armenia citizenship 1 167 406 0 1 573 (99.4) 2.9 0 0 0 0 (0.0) - Azerbaijan citizenship - - - - - - - - - - - - Belarus citizenship 3 469 1 278 0 4 747 (100.0) 2.7 0 0 0 0 (0.0) - Bosnia and Herzegovina citizenship 807 618 0 1 425 (100.0) 1.3 0 0 0 0 (0.0) - Croatia birthplace 194 134 0 328 (48.3) 1.4 35 40 0 75 (11.0) 0.9 Georgia citizenship 4 118 1 415 0 5 533 (100.0) 2.9 0 0 0 0 (0.0) - Israel birthplace 28 16 0 44 (10.5) 1.8 270 104 0 374 (89.5) 2.6 Kazakhstan citizenship 13 815 9 261 0 23 076 (100.0) 1.5 0 0 0 0 (0.0) - Kyrgyzstan birthplace 2 969 2 274 0 5 243 (100.0) 1.3 0 0 0 0 (0.0) - Macedonia, the former Yugoslav Republic of birthplace 206 141 0 347 (95.9) 1.5 8 7 0 15 (4.1) 1.1 Moldova citizenship - - - - - - - - - - - - Monaco birthplace - - - - - - - - - - - - Montenegro citizenship 70 49 0 119 (100.0) 1.4 0 0 0 0 (0.0) - Russia citizenship 69 693 31 806 0 101 499 (97.3) 2.2 2 156 665 0 2 821 (2.7) 3.2 San Marino - - - - - - - - - - - - Serbia 1 237 944 - 2 181 (99.7) 1.3 2 4 - 6 (0.3) 0.5 Serbia excluding UN Administered Province of Kosovoc citizenship 801 534 0 1 335 (99.6) 1.5 2 4 0 6 (0.4) 0.5 UN Administered Province of Kosovoc birthplace 436 410 0 846 (100.0) 1.1 0 0 0 0 (0.0) - Switzerland birthplace 79 48 0 127 (22.0) 1.6 250 178 0 428 (74.0) 1.4 Tajikistan birthplace 3 347 2 588 0 5 935 (100.0) 1.3 0 0 0 0 (0.0) - Turkey birthplace 9 083 6 394 0 15 477 (98.7) 1.4 99 103 0 202 (1.3) 1.0 Turkmenistan citizenship - - - - - - - - - - - - Ukraine citizenship - - - - - - - - - - - - Uzbekistan birthplace 9 170 6 700 0 15 870 (99.7) 1.4 10 14 0 24 (0.2) 0.7 Subtotal non-EU/EEA 119 749 64 210 - 183 959 (97.7) 1.9 2 830 1 115 - 3 945 (2.1) 2.5 Total European Region 154 126 81 977 47 236 150 (90.6) 1.9 13 778 8 767 46 22 591 (8.7) 1.6 Subtotal 18 HPC 133 609 69 874 - 203 483 (98.4) 1.9 2 413 844 - 3 257 (1.6) 2.9 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a By birthplace of parents for Danish-born cases under 26 years of age. b Excluding Greenland (see Chapter 1.1). c In accordance with the UN Security Council Resolution No. 1244 (1999). 57 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Unknown Total Male Female Gender unknown Total (%) Sex ratio (M:F) Male Female Gender unknown Total Sex ratio (M:F) 5 2 0 7 (1.0) 2.5 422 265 0 687 1.6 0 (0.0) - 669 375 0 1 044 1.8 0 (0.0) - 1 608 799 0 2 407 2.0 0 (0.0) - 32 22 0 54 1.5 0 (0.0) - 429 171 0 600 2.5 0 (0.0) - 231 150 0 381 1.5 0 (0.0) - 243 98 0 341 2.5 25 9 0 34 (10.5) 2.8 185 140 0 325 1.3 223 154 1 378 (7.6) 1.4 2 964 1 948 30 4 942 1.5 111 80 0 191 (4.4) 1.4 2 548 1 759 9 4 316 1.5 0 (0.0) - 341 144 4 489 2.3 0 (0.0) - 949 496 0 1 445 1.9 0 (0.0) - 2 7 0 9 0.3 35 22 0 57 (13.4) 1.6 244 181 0 425 1.3 155 111 0 266 (7.5) 1.4 2 042 1 478 1 3 521 1.4 7 2 0 9 (1.0) 3.5 594 291 0 885 2.0 - - - 0 0 0 0 - 0 (0.0) - 1 335 569 0 1 904 2.3 0 (0.0) - 15 11 0 26 1.4 0 (0.0) - 23 10 0 33 2.3 4 1 0 5 (0.5) 4.0 569 438 0 1 007 1.3 0 (0.0) - 196 165 0 361 1.2 0 (0.0) - 5 714 2 764 0 8 478 2.1 2 2 0 4 (0.2) 1.0 1 704 836 0 2 540 2.0 0 (0.0) - 13 153 6 059 0 19 212 2.2 0 (0.0) - 251 148 0 399 1.7 0 (0.0) - 111 81 0 192 1.4 61 34 1 96 (1.4) 1.8 4 172 2 572 18 6 762 1.6 0 (0.0) - 349 237 0 586 1.5 254 189 7 450 (5.0) 1.3 5 112 3 811 40 8 963 1.3 882 606 9 1 497 (2.1) 1.5 46 207 26 025 102 72 334 1.8 0 0 0 0 (0.0) - 295 136 0 431 2.2 0 0 0 0 (0.0) - 2 2 0 4 1.0 8 1 0 9 (0.6) 8.0 1 175 407 0 1 582 2.9 - - - - - - - - - - - 0 0 0 0 (0.0) - 3 469 1 278 0 4 747 2.7 0 0 0 0 (0.0) - 807 618 0 1 425 1.3 163 113 0 276 (40.6) 1.4 392 287 0 679 1.4 0 0 0 0 (0.0) - 4 118 1 415 0 5 533 2.9 0 0 0 0 (0.0) - 298 120 0 418 2.5 0 0 0 0 (0.0) - 13 815 9 261 0 23 076 1.5 0 0 0 0 (0.0) - 2 969 2 274 0 5 243 1.3 0 0 0 0 (0.0) - 214 148 0 362 1.4 - - - - - - - - - - - - - - - - - - - - - - 0 0 0 0 (0.0) - 70 49 0 119 1.4 0 0 0 0 (0.0) - 71 849 32 471 0 104 320 2.2 - - - - - - - - - - - - 0 - - - - 1 239 948 - 2 187 1.3 0 0 0 0 (0.0) - 803 538 0 1 341 1.5 0 0 0 0 (0.0) - 436 410 0 846 1.1 13 10 0 23 (4.0) 1.3 342 236 0 578 1.4 0 0 0 0 (0.0) - 3 347 2 588 0 5 935 1.3 0 0 0 0 (0.0) - 9 182 6 497 0 15 679 1.4 - - - - - - - - - - - - - - - - - - - - - - 15 4 0 19 (0.1) 3.8 9 195 6 718 0 15 913 1.4 199 128 - 327 (0.2) 2.2 122 778 65 453 - 188 231 1.9 1 081 734 9 1 824 (0.7) 2.2 168 985 91 478 102 260 565 1.8 30 7 - 37 (0.0) 2.2 136 052 70 725 - 206 777 1.9 58 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 14: Tuberculosis cases in children (<15 years old), by age group and origin, EU/EEA, 2011 Country Native Foreign origin Unknown Total children 0–4 5–14 0–4 5–14 0–4 5–14 0–4 5–14 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Austria 5 (71.4) 2 (28.6) 10 (58.8) 7 (41.2) 0 (0.0) 0 (0.0) 15 (62.5) 9 (37.5) Belgium 29 (54.7) 24 (45.3) 19 (59.4) 13 (40.6) 0 (0.0) 0 (0.0) 48 (56.5) 37 (43.5) Bulgaria 59 (33.5) 117 (66.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 59 (33.5) 117 (66.5) Cyprus 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) - (0.0) 0 (0.0) Czech Republic 5 (83.3) 1 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (83.3) 1 (16.7) Denmarka,b 5 (41.7) 7 (58.3) 0 (0.0) 4 (100.0) 0 (0.0) 0 (0.0) 5 (31.3) 11 (68.8) Estonia 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) - (0.0) 1 (100.0) Finland 3 (50.0) 3 (50.0) 0 (0.0) 4 (100.0) 0 (0.0) 1 (100.0) 3 (27.3) 8 (72.7) France 101 (63.5) 58 (36.5) 20 (23.0) 67 (77.0) 4 (44.4) 5 (55.6) 125 (49.0) 130 (51.0) Germany 70 (59.3) 48 (40.7) 17 (34.0) 33 (66.0) 5 (45.5) 6 (54.5) 92 (51.4) 87 (48.6) Greece 9 (39.1) 14 (60.9) 7 (46.7) 8 (53.3) 0 (0.0) 0 (0.0) 16 (42.1) 22 (57.9) Hungary 3 (75.0) 1 (25.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (75.0) 1 (25.0) Iceland 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) - (0.0) 1 (100.0) Ireland 5 (41.7) 7 (58.3) 0 (0.0) 7 (100.0) 0 (0.0) 1 (100.0) 5 (25.0) 15 (75.0) Italy 73 (55.3) 59 (44.7) 19 (26.8) 52 (73.2) 2 (33.3) 4 (66.7) 94 (45.0) 115 (55.0) Latvia 24 (40.0) 36 (60.0) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 25 (41.0) 36 (59.0) Liechtenstein - - - - - - - - - - - - - - - - Lithuania 26 (29.9) 61 (70.1) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 26 (29.5) 62 (70.5) Luxembourg 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) - (0.0) 1 (100.0) Malta 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) - (0.0) 0 (0.0) Netherlands 12 (40.0) 18 (60.0) 5 (20.0) 20 (80.0) 0 (0.0) 1 (100.0) 17 (30.4) 39 (69.6) Norway 1 (50.0) 1 (50.0) 3 (20.0) 12 (80.0) 0 (0.0) 0 (0.0) 4 (23.5) 13 (76.5) Poland 30 (27.3) 80 (72.7) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 30 (27.0) 81 (73.0) Portugal 17 (47.2) 19 (52.8) 1 (12.5) 7 (87.5) 0 (0.0) 0 (0.0) 18 (40.9) 26 (59.1) Romania 299 (38.8) 472 (61.2) 4 (80.0) 1 (20.0) 0 (0.0) 0 (0.0) 303 (39.0) 473 (61.0) Slovakia 10 (58.8) 7 (41.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 10 (58.8) 7 (41.2) Slovenia 2 (66.7) 1 (33.3) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 2 (50.0) 2 (50.0) Spain 267 (63.0) 157 (37.0) 31 (28.4) 78 (71.6) 3 (37.5) 5 (62.5) 301 (55.6) 240 (44.4) Sweden 3 (37.5) 5 (62.5) 4 (14.3) 24 (85.7) 0 (0.0) 0 (0.0) 7 (19.4) 29 (80.6) United Kingdom 116 (44.6) 144 (55.4) 18 (12.9) 121 (87.1) 6 (42.9) 8 (57.1) 140 (33.9) 273 (66.1) Total EU/EEA 1 174 (46.6) 1 344 (53.4) 159 (25.6) 462 (74.4) 20 (39.2) 31 (60.8) 1 353 (42.4) 1 837 (57.6) WHO European Region 18 TB High Priority Countries presented in italics. a By birthplace of parents for Danish-born cases under 26 years of age. b Excluding Greenland (see Chapter 1.1). 59 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 15: Laboratory practices and quality assurance for anti-TB drug susceptibility testing, European Region, 2011 Country Labs performing External quality assurance External quality assurance for DST Smear microscopy Culture National a International M icr os co py (N ) Cu ltu re ( N) DS T (N ) Lin e P ro be A ss ay (N ) Xp er t M TB /R IF (N ) Ye ar b La bo ra to rie s wi th ac ce pt ab le pe rfo rm an ce (N ) Ye ar c La bo ra to rie s wi th ac ce pt ab le pe rfo rm an ce (N ) EQ A av ail ab le at na tio na l l ev el No . l ab s EQ A av ail ab le at in te rn at io na l le ve l Ye ar d % agreement of results for: Iso ni az id Ri fa mp ici n EU/EEA Austria - - - - - - - - - - - - - - - Belgium 115 114 15 8 6 2011 3 2011 3 Yes 14 Yes 2011 100 100 Bulgaria 34 33 13 3 0 2011 34 2011 29 Yes 3 Yes 2011 100 100 Cyprus - - - - - - - - - - - - - - - Czech Republic 48 48 17 17 - 2011 37 2011 37 Yes 15 Yes 2011 100 100 Denmark 10 1 1 1 - 2010 - 2010 1 No - Yes 2010 100 100 Estonia 5 2 2 2 2 2011 5 2011 2 Yes 1 Yes 2011 100 100 Finland 21 11 1 5 3 2011 - 2011 - Yes - Yes 2011 100 100 France 235 230 70 21 20 2011 - 2011 - Yes 34 Yes 2011 100 100 Germany 254 189 84 - - - - - - - - Yes 2011 100 100 Greece - - - - - - - - - - - - - - Hungary 13 13 7 2 2 2011 9 2011 5 Yes 2 Yes 2011 100 100 Iceland 1 1 1 1 0 2011 1 2011 1 - - - - - - Ireland 13 13 3 3 2 2011 13 2011 13 Yes 2 Yes 2011 100 100 Italy - - - - - - - - - - - - - - - Latvia 16 4 1 1 1 2011 16 2011 4 - - Yes 2011 97 100 Liechtenstein - - - - - - - - - - - - - - - Lithuania 13 6 6 1 5 2011 4 2011 6 Yes 3 Yes 2011 90 90 Luxembourg 1 1 1 1 1 2011 1 2011 1 - - Yes 2011 100 100 Malta 1 1 0 0 - 2011 1 - - - - - - - - Netherlands 42 37 4 1 2 2011 - 2011 - - - Yes 2010 100 100 Norway 18 10 3 4 0 2011 18 2011 10 Yes 2 Yes 2011 100 100 Poland 85 85 47 11 3 2011 85 2011 85 Yes 46 Yes 2011 100 100 Portugal 88 88 22 18 - 2010 34 2010 - Yes 11 Yes 2010 100 100 Romania 113 70 43 0 0 2011 90 2011 38 Yes 2 Yes 2011 100 100 Slovakia 5 5 2 0 0 2011 4 2011 4 Yes 1 Yes 2010 90 95 Slovenia 3 3 1 1 1 2011 3 2011 2 - - Yes 2011 100 100 Spain - - - - - - - - - - - Yes 2011 100 100 Sweden 5 5 5 5 0 2011 5 2011 4 Yes 4 Yes 2011 100 100 United Kingdom 193 126 21 12 16 2011 192 2011 126 Yes 20 Yes 2011 - - Subtotal EU/EEA 1 332 1 096 370 118 64 2010-11 555 2010-11 371 16 160 23 2010-11 99.0 99.3 Non-EU/EEA Albania 17 1 1 1 0 2011 17 2011 0 Yes 1 Yes 2010 100 100 Andorra 8 8 8 0 - - - - - No - - - Armenia 30 1 1 1 0 2011 29 2011 1 Yes 1 Yes 2011 100 100 Azerbaijan 72 6 2 2 2 2011 1 2011 0 Yes 2 Yes - - - Belarus 196 41 20 1 0 2011 177 2011 41 Yes 20 Yes 2011 100 100 Bosnia and Herzegovina 15 13 4 3 0 2011 15 2011 13 Yes 4 Yes 2011 100 100 Croatia 14 14 6 1 1 - - Yes 0 Yes 2011 100 100 Georgia 29 2 1 1 1 2011 29 2011 2 Yes 1 Yes 2010 97 100 Israel 19 19 2 1 1 2011 17 2011 17 Yes 2 Yes 2011 100 100 Kazakhstan 466 100 22 10 0 2011 466 2011 100 Yes 22 Yes 2011 95 95 Kyrgyzstan 122 4 3 0 0 - - Yes - Yes 2011 97 - Macedonia, the former Yugoslav Republic of 8 5 1 0 0 2011 8 2011 5 Yes 1 Yes 2010 100 100 Moldova 59 4 4 3 - 2011 28 2011 4 Yes 4 Yes 2011 100 100 Monaco 0 0 0 0 - 2011 - 2011 - - 0 - - - - Montenegro 1 1 1 0 0 2011 1 2011 1 Yes 1 Yes 2011 100 100 Russia 3746 117 0 0 - 2011 828 2011 88 Yes 0 - - - - San Marino 0 0 0 0 - 2011 - 2011 - - - - - - - Serbia 43 31 6 1 1 2011 38 2011 0 Yes 3 Yes 2011 100 100 Serbia excluding UN Administered Province of Kosovof 31 29 4 1 0 2011 26 2011 0 Yes 2 Yes 2011 100 100 UN Administered Province of Kosovof 12 2 2 0 1 2011 12 2011 0 - 1 - 2010 100 100 Switzerland 42 24 10 0 14 2011 40 2011 24 Yes 7 Yes 2011 - - Tajikistan 92 3 1 2 2 2011 45 2011 1 Yes 1 Yes 2011 93 89 Turkey 389 156 71 9 18 - - Yes 0 Yes 2011 100 100 Turkmenistan - - - - - - - - - - - - - Ukraine 859 82 42 0 0 - - Yes 23 Yes 2010 100 100 Uzbekistan 320 7 2 3 0 2011 296 2011 5 Yes 2 Yes 2011 100 100 Subtotal Non-EU/EEA 6 547 639 208 39 40 2011 2 035 2011 302 22 95 19 2010- 2011 99.0 93.6 Total European Region 7 879 1 735 578 157 104 2010-11 2 590 2010-11 673 38 255 42 2010-11 96.5 94.2 Subtotal 18 HPC 6 561 638 234 39 31 2011 2 048 2011 321 16 85 16 2010-11 97.9 91.6 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a For countries with more than one DST laboratory; national reference laboratory not included as these laboratories report to the International EQA result. b Year of participation in external quality assurance for smear microscopy c Year of participation in external quality assurance for isolation of M. Tuberculosis complex by culture d Year of participation in external quality assurance for DST for first line anti TB drugs e Excluding Greenland (see Chapter 1.1). f In accordance with the UN Security Council Resolution No. 1244 (1999). 60 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 16: Characteristics of anti-TB drug resistance surveillance of laboratory-confirmed cases, European Region, 2011 Country Source of data Coverage Laboratory-confirmed TB casesa DST results (Isoniazid and Rifampicin) MDR cases Cases resistant to any anti-TB drugb Reporting completenessc N (%) N (%) N (%) N (%) EU/EEA Austria TESSy national 466 (67.8) 450 (96.6) 19 (4.2) 58 (12.9) Y Belgium TESSy national 797 (76.3) 754 (94.6) 15 (2.0) 57 (7.6) Y Bulgaria TESSy national 1,071 (44.5) 733 (68.4) 55 (7.5) 124 (16.9) N Cyprus TESSy national 44 (81.5) 40 (90.9) 1 (2.5) 4 (10.0) Y Czech Republic TESSy national 426 (71.0) 408 (95.8) 7 (1.7) 28 (6.9) Y Denmarkd TESSy national 272 (71.4) 271 (99.6) 3 (1.1) 13 (4.8) Y Estonia TESSy national 264 (77.4) 262 (99.2) 78 (29.8) 108 (41.2) Y Finland TESSy national 252 (77.5) 245 (97.2) 5 (2.0) 17 (6.9) Y France NRL-TMEe national 2,309 (46.7) 1,568 (67.9) 40 (2.6) 117 (7.5) N Germany TESSy national 3,071 (71.2) 2,821 (91.9) 56 (2.0) 287 (10.2) Y Greece TESSy national 278 (56.9) 159 (57.2) 5 (3.1) 31 (19.5) N Hungary TESSy national 597 (41.3) 479 (80.2) 7 (1.5) 41 (8.6) N Iceland TESSy national 4 (44.4) 4 (100.0) 0 (0.0) 0 (0.0) N Ireland TESSy national 288 (67.8) 239 (83.0) 3 (1.3) 20 (8.4) Y Italyf NRL-TMEe partial national 2,576 (73.2) 2,542 (98.7) 81 (3.2) 386 (15.2) N Latvia TESSy national 671 (75.8) 644 (96.0) 95 (14.8) 218 (33.9) Y Liechtenstein - - - - - - - - - - - Lithuania TESSy national 1,403 (73.7) 1,403 (100.0) 296 (21.1) 516 (36.8) Y Luxembourg TESSy national 19 (73.1) 19 (100.0) 2 (10.5) 4 (21.1) Y Malta TESSy national 24 (72.7) 22 (91.7) 0 (0.0) 3 (13.6) Y Netherlands TESSy national 732 (72.7) 726 (99.2) 15 (2.1) 85 (11.7) Y Norway TESSy national 262 (72.6) 257 (98.1) 4 (1.6) 33 (12.8) Y Poland TESSy national 5,581 (65.8) 4,993 (89.5) 41 (0.8) 280 (5.6) Y Portugal TESSy national 1,588 (62.5) 1,252 (78.8) 22 (1.8) 194 (15.5) N Romania TESSy national 12,446 (64.8) 6,026 (48.4) 530 (8.8) 944 (15.7) N Slovakia TESSy national 188 (47.1) 185 (98.4) 3 (1.6) 12 (6.5) N Slovenia TESSy national 182 (94.8) 182 (100.0) 0 (0.0) 7 (3.8) Y Spain NRL-TMEe partial national 4,383 (64.8) 1,273 (29.0) 41 (3.2) 112 (8.8) N Sweden TESSy national 476 (81.2) 475 (99.8) 17 (3.6) 66 (13.9) Y United Kingdom TESSy national 5,285 (59.0) 5,127 (97.0) 81 (1.6) 524 (10.2) Y Subtotal EU/EEA 45,955 (63.5) 33,559 (73.0) 1,522 (4.5) 4,289 (12.8) 19 Non-EU/EEA Albania NRL-TME national 205 (47.6) 205 (100.0) 5 (2.4) - - N Andorra NRL-TME national 3 (75.0) 2 (66.7) 0 (0.0) - - N Armenia NRL-TME national 529 (33.4) 529 (100.0) 79 (14.9) - - N Azerbaijan NRL-TME partial national 2,176 (21.5) 720 (33.1) 90 (12.5) - - N Belarus NRL-TME national 3,137 (61.3) 3,032 (96.7) 1,594 (52.6) - - Y Bosnia and Herzegovina NRL-TME national 745 (52.3) 745 (100.0) 5 (0.7) - - Y Croatia NRL-TME national 393 (57.9) 393 (100.0) 2 (0.5) - - Y Georgia NRL-TME national 2,955 (53.4) 2,872 (97.2) 453 (15.8) - - Y Israel NRL-TME national 284 (67.9) 284 (100.0) 11 (3.9) - - Y Kazakhstan NRL-TME national 11,555 (44.1) 11,555 (100.0) 4,575 (39.6) - - N Kyrgyzstan NRL-TME partial national - - - - - - - - N Macedonia, the former Yugoslav Republic of NRL-TME national 155 (42.8) 155 (100.0) 1 (0.6) - - N Moldova NRL-TME national 2,561 (47.9) 2,385 (93.1) 1,001 (42.0) - - N Monaco - - 0 - 0 - 0 - - - - Montenegro NRL-TME national 72 (60.5) 72 (100.0) 1 (1.4) - - Y Russia NRL-TME national 51,924 (32.6) 47,627 (91.7) 13,785 (28.9) - - N San Marino - - 0 - 0 - 0 - - - - Serbia - partial national 1,025 (76.4) 966 (94.2) 9 (0.9) - - N Serbia excluding UN Administered Province of Kosovog NRL-TME national 1,025 (76.4) 966 (94.2) 9 (0.9) - - Y UN Administered Province of Kosovog - national 0 - 0 - 0 - - - N Switzerland NRL-TME national 487 (84.3) 454 (93.2) 8 (1.8) - - Y Tajikistan NRL-TME partial national 1,623 (21.3) 576 (35.5) 380 (66.0) - - N Turkey NRL-TME partial national 4,828 (30.8) 4,823 (99.9) 262 (5.4) - - N Turkmenistan NRL-TME partial national - - - - - - - - - Ukraine NRL-TME national 20,103 (47.1) 14,765 (73.4) 4,305 (29.2) - - N Uzbekistan NRL-TME partial national 4,430 (27.8) 2,217 (50.0) 1,385 (62.5) - - N Subtotal non-EU/EEA 109,190 (35.4) 94,377 (86.4) 27,951 (25.6) 0 - 0 Total European Region 155,145 (40.8) 127,936 (82.5) 29,473 (19.0) 0 - 19 Subtotal 18 HPC 121,676 (37.2) 100,169 (82.3) 28,963 (23.8) 0 - 0 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Lab-confirmed cases consists culture positive or nucleic acid amplification and sputum smear positive cases for EU/EEA countries. Only culture positive cases for non-EU countries. b Any resistance to isoniazid, rifampicin, ethambutol or streptomycin expressed as a percentage of cases with DST results available at least for isoniazid and rifampicin. No routine testing for ethambutol and streptomycin in all countries. c Data considered complete when national coverage 100% or culture results available for 90% of all cases, and 50% of all cases culture-positive, 75% of them with DST results and EQA results accurate in 95% of samples for reported year. d Excluding Greenland (see Chapter 1.1). e NRL: National reference laboratory; TME: WHO Tuberculosis Monitoring and Evaluation Database. f Data from Italy reported from NRL; data may differ from data shown elsewhere in this report. g In accordance with the UN Security Council Resolution No. 1244 (1999). 61 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 17: Multidrug-resistant TB among laboratory-confirmed TB cases by previous history of TB treatment, European Region, 2011 Country New Previously treated Previous treatment unknown All TB cases reporteda Cases with DST results Multidrug-resistant Cases with DST results Multidrug-resistant Cases with DST results Multidrug-resistant Cases with DST results Multidrug-resistant N (%) N (%) N (%) N (%) EU/EEA Austria 257 9 (3.5) 11 2 (18.2) 182 8 (4.4) 450 19 (4.2) Belgiuma 524 7 (1.3) 35 4 (11.4) 195 4 (2.1) 754 15 (2.0) Bulgaria 588 18 (3.1) 145 37 (25.5) 0 0 - 733 55 (7.5) Cyprus 25 1 (4.0) 2 0 (0.0) 13 0 (0.0) 40 1 (2.5) Czech Republic 392 6 (1.5) 16 1 (6.3) 0 0 - 408 7 (1.7) Denmarka,b 257 3 (1.2) 14 0 (0.0) 0 0 - 271 3 (1.1) Estonia 210 48 (22.9) 52 30 (57.7) 0 0 - 262 78 (29.8) Finland 237 5 (2.1) 8 0 (0.0) 0 0 - 245 5 (2.0) France 1 232 25 (2.0) 110 9 (8.2) 226 6 (2.7) 1 568 40 (2.6) Germany 2 367 28 (1.2) 146 18 (12.3) 308 10 (3.2) 2 821 56 (2.0) Greece 148 3 (2.0) 11 2 (18.2) 0 0 - 159 5 (3.1) Hungary 411 2 (0.5) 68 5 (7.4) 0 0 - 479 7 (1.5) Iceland 4 0 (0.0) 0 0 - 0 0 - 4 0 (0.0) Irelanda 176 0 (0.0) 15 1 (6.7) 48 2 (4.2) 239 3 (1.3) Italy 760 30 (3.9) 441 24 (5.4) 1 341 27 (2.0) 2 542 81 (3.2) Latvia 562 71 (12.6) 82 24 (29.3) 0 0 - 644 95 (14.8) Liechtenstein - - - - - - - - - - - - Lithuania 1 031 114 (11.1) 369 180 (48.8) 3 2 (66.7) 1 403 296 (21.1) Luxembourg 7 0 (0.0) 1 0 (0.0) 11 2 (18.2) 19 2 (10.5) Malta 17 0 (0.0) 0 0 - 5 0 (0.0) 22 0 (0.0) Netherlands 695 12 (1.7) 22 1 (4.5) 9 2 (22.2) 726 15 (2.1) Norwaya 229 3 (1.3) 22 0 (0.0) 6 1 (16.7) 257 4 (1.6) Poland 4 416 23 (0.5) 577 18 (3.1) 0 0 - 4 993 41 (0.8) Portugal 1 155 17 (1.5) 97 5 (5.2) 0 0 - 1 252 22 (1.8) Romania 3 855 117 (3.0) 2 171 413 (19.0) 0 0 - 6 026 530 (8.8) Slovakia 147 2 (1.4) 29 1 (3.4) 9 0 (0.0) 185 3 (1.6) Slovenia 171 0 (0.0) 11 0 (0.0) 0 0 - 182 0 (0.0) Spain 1 013 15 (1.5) 96 16 (16.7) 164 10 (6.1) 1 273 41 (3.2) Sweden 375 9 (2.4) 31 5 (16.1) 69 3 (4.3) 475 17 (3.6) United Kingdoma 4 549 61 (1.3) 234 13 (5.6) 344 7 (2.0) 5 127 81 (1.6) Subtotal EU/EEA 25 810 629 (2.4) 4 816 809 (16.8) 2 933 84 (2.9) 33 559 1 522 (4.5) Non-EU/EEA Albania 194 2 (1.0) 11 3 (27.3) 0 0 - 205 5 (2.4) Andorra 1 0 (0.0) 1 0 (0.0) 0 0 - 2 0 (0.0) Armenia 439 66 (15.0) 90 13 (14.4) 0 0 - 529 79 (14.9) Azerbaijan 569 55 (9.7) 151 35 (23.2) 0 0 - 720 90 (12.5) Belarus 2 084 542 (26.0) 948 622 (65.6) 0 430 3 032 1 594 (52.6) Bosnia and Herzegovina 704 1 (0.1) 41 4 (9.8) 0 0 - 745 5 (0.7) Croatia 353 1 (0.3) 40 1 (2.5) 0 0 - 393 2 (0.5) Georgia 2 197 239 (10.9) 675 214 (31.7) 0 0 - 2 872 453 (15.8) Israel 275 10 (3.6) 9 1 (11.1) 0 0 - 284 11 (3.9) Kazakhstan 5 293 1 604 (30.3) 4 790 2 456 (51.3) 1 472 515 (35.0) 11 555 4 575 (39.6) Kyrgyzstan - - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 130 0 (0.0) 25 1 (4.0) 0 0 - 155 1 (0.6) Moldova 1 379 359 (26.0) 1 006 642 (63.8) 0 0 - 2 385 1 001 (42.0) Monaco - - - - - - - - - - - - Montenegro 57 1 (1.8) 13 0 (0.0) 2 0 (0.0) 72 1 (1.4) Russia 34 007 6 596 (19.4) 13 620 7 189 (52.8) 0 0 (0.0) 47 627 13 785 (28.9) San Marino - - - - - - - - - - - - Serbia 863 3 (0.3) 100 6 (6.0) 3 0 - 966 9 (0.9) Serbia excluding UN Administered Province of Kosovoc 863 3 (0.3) 100 6 (6.0) 3 0 - 966 9 (0.9) UN Administered Province of Kosovoc - - - - - - - - - - - - Switzerland 304 1 (0.3) 40 4 (10.0) 110 3 (2.7) 454 8 (1.8) Tajikistan 161 72 (44.7) 415 308 (74.2) 0 0 - 576 380 (66.0) Turkey 4 221 116 (2.7) 602 146 (24.3) 0 0 - 4 823 262 (5.4) Turkmenistan - - - - - - - - - - - - Ukraine 10 352 1 367 (13.2) 4 413 2 283 (51.7) 0 655 - 14 765 4 305 (29.2) Uzbekistan 484 170 (35.1) 123 89 (72.4) 1 610 1 126 (69.9) 2 217 1 385 (62.5) Subtotal non-EU/EEA 64 067 11 205 (17.5) 27 113 14 017 (51.7) 3 197 2 729 (85.4) 94 377 27 951 (29.6) Total European Region 89 877 11 834 (13.2) 31 929 14 826 (46.4) 6 130 2 813 (45.9) 127 936 29 473 (23.0) Subtotal 18 HPC 67 432 11 554 (17.1) 29 652 14 681 (49.5) 3 085 2 728 (88.4) 100 169 28 963 (28.9) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. DST: Drug Susceptibility Testing; NRL: National Reference Laboratory a Cases classified according to previous TB treatment history. From Belgium, Denmark, Ireland, Norway and United Kingdom previous diagnosis was reported instead and used as a proxy for previous treatment. b Excluding Greenland (see Chapter 1.1). c In accordance with the UN Security Council Resolution No. 1244 (1999). 62 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 18: Anti-TB drug resistance among new laboratory-confirmed pulmonary TB cases, European Region, 2011a Country Cases resistant to at leastb: New laboratory- confirmed pulmonary TB cases New pulmonary TB casesCases with DST results Isoniazid Rifampicin Isoniazid and rifampicin (multidrug resistant) N (%)c N (%)d N (%)d N (%)d N (%)e N EU/EEA Austria 214 (96.0) 21 (9.8) 10 (4.7) 8 (3.7) 223 (71.7) 311 Belgium 397 (95.9) 21 (5.3) 5 (1.3) 4 (1.0) 414 (80.7) 513 Bulgaria 579 (67.9) 42 (7.3) 23 (4.0) 17 (2.9) 853 (59.9) 1 424 Cyprus 21 (95.5) 0 (0.0) 0 (0.0) 0 (0.0) 22 (88.0) 25 Czech Republic 365 (96.8) 11 (3.0) 11 (3.0) 6 (1.6) 377 (76.2) 495 Denmarkf 218 (99.5) 9 (4.1) 2 (0.9) 2 (0.9) 219 (97.8) 224 Estonia 202 (100.0) 63 (31.2) 48 (23.8) 47 (23.3) 202 (81.8) 247 Finland 176 (96.2) 14 (8.0) 5 (2.8) 5 (2.8) 183 (81.3) 225 France - - - - - - - - - - - Germany 1 961 (92.9) 128 (6.5) 30 (1.5) 26 (1.3) 2 111 (77.1) 2 738 Greece 139 (59.4) 17 (12.2) 4 (2.9) 3 (2.2) 234 (59.7) 392 Hungary 407 (80.8) 22 (5.4) 2 (0.5) 2 (0.5) 504 (43.1) 1 170 Iceland 0 - 0 - 0 - 0 - 0 (0.0) 3 Ireland 135 (87.1) 4 (3.0) 0 (0.0) 0 (0.0) 155 (79.5) 195 Italy - - - - - - - - - - - Latvia 543 (97.1) 155 (28.5) 70 (12.9) 69 (12.7) 559 (79.5) 703 Liechtenstein - - - - - - - - - - - Lithuania 1 000 (100.0) 231 (23.1) 116 (11.6) 111 (11.1) 1 000 (74.3) 1 345 Luxembourg 6 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (75.0) 8 Malta 11 (91.7) 0 (0.0) 0 (0.0) 0 (0.0) 12 (80.0) 15 Netherlands 434 (98.9) 40 (9.2) 9 (2.1) 9 (2.1) 439 (82.8) 530 Norway 136 (97.1) 11 (8.1) 2 (1.5) 2 (1.5) 140 (80.5) 174 Poland 4 210 (89.6) 139 (3.3) 28 (0.7) 23 (0.5) 4 699 (67.8) 6 931 Portugal 1 018 (80.2) 71 (7.0) 15 (1.5) 14 (1.4) 1 269 (75.1) 1 689 Romania 3 855 (44.4) 275 (7.1) 145 (3.8) 117 (3.0) 8 683 (72.9) 11 914 Slovakia 138 (98.6) 5 (3.6) 3 (2.2) 2 (1.4) 140 (52.6) 266 Slovenia 151 (100.0) 1 (0.7) 0 (0.0) 0 (0.0) 151 (97.4) 155 Spain - - - - - - - - - - - Sweden 247 (99.6) 30 (12.1) 6 (2.4) 5 (2.0) 248 (88.3) 281 United Kingdom 2 751 (97.1) 188 (6.8) 39 (1.4) 35 (1.3) 2 832 (70.3) 4 031 Subtotal EU/EEA 19 314 (75.2) 1 498 (7.8) 573 (3.0) 507 (2.6) 25 675 (71.3) 36 004 Non-EU/EEA Albania 194 (100.0) 21 (10.8) 8 (4.1) 2 (1.0) 194 (68.1) 285 Andorra 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (66.7) 3 Armenia 439 (100.0) 139 (31.7) 76 (17.3) 66 (15.0) 439 (48.2) 911 Azerbaijan 569 (28.3) 114 (20.0) 59 (10.4) 55 (9.7) 2 009 (48.2) 4 166 Belarus 2 084 (95.6) 627 (30.1) 568 (27.3) 542 (26.0) 2 179 (59.6) 3 656 Bosnia and Herzegovina 704 (100.0) 2 (0.3) 1 (0.1) 1 (0.1) 704 (59.0) 1 194 Croatia 353 (100.0) 11 (3.1) 2 (0.6) 1 (0.3) 353 (64.9) 544 Georgia 2 197 (97.3) 513 (23.4) 262 (11.9) 239 (10.9) 2 257 (71.3) 3 167 Israel 275 (100.0) 25 (9.1) 10 (3.6) 10 (3.6) 275 (80.4) 342 Kazakhstan 5 293 (100.0) 1 714 (32.4) 1 629 (30.8) 1 604 (30.3) 5 293 (42.7) 12 399 Kyrgyzstan - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 130 (100.0) 5 (3.8) 3 (2.3) 0 (0.0) 130 (56.3) 231 Moldova 1 379 (92.5) 503 (36.5) 374 (27.1) 359 (26.0) 1 491 (43.7) 3 412 Monaco - - - - - - - - - - - Montenegro 57 (100.0) 2 (3.5) 1 (1.8) 1 (1.8) 57 (64.8) 88 Russia 34 007 (92.8) 6 596 (19.4) 6 596 (19.4) 6 596 (19.4) 36 665 (38.9) 94 297 San Marino - - - - - - - - - - - Serbia 863 (94.1) 17 (2.0) 3 (0.3) 3 (0.3) 917 (87.3) 1 050 Serbia excluding UN Administered Province of Kosovog 863 (94.1) 17 (2.0) 3 (0.3) 3 (0.3) 917 (87.3) 1 050 UN Administered Province of Kosovog - - - - - - - - - - - Switzerland 304 (95.0) 15 (4.9) 3 (1.0) 1 (0.3) 320 (123.1) 260 Tajikistan 161 (15.9) 86 (53.4) 81 (50.3) 72 (44.7) 1 010 (23.4) 4 322 Turkey 4 221 (99.9) 474 (11.2) 157 (3.7) 116 (2.7) 4 226 (47.7) 8 852 Turkmenistan - - - - - - - - - - - Ukraine 10 352 (75.5) 1 658 (16.0) 1 498 (14.5) 1 367 (13.2) 13 715 (49.3) 27 821 Uzbekistan 484 (42.6) 285 (58.9) 174 (36.0) 170 (35.1) 1 135 (11.2) 10 156 Subtotal non-EU/EEA 64 067 (87.3) 12 807 (20.0) 11 505 (18.0) 11 205 (17.5) 73 371 (41.4) 177 156 Total European Region 83 381 (84.2) 14 305 (17.2) 12 078 (14.5) 11 712 (14.0) 99 046 (46.5) 213 160 Subtotal 18 HPC 67 365 (82.4) 13 475 (20.0) 11 876 (17.6) 11 547 (17.1) 81 716 (43.3) 188 792 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. DST: Drug Susceptibility Testing a Cases classified according to previous TB treatment history. From Belgium, Denmark, Ireland, Norway and United Kingdom previous diagnosis was reported instead and used as a proxy for previous treatment. b Any resistance to isoniazid, rifampicin; expressed as a percentage of cases with DST results available at least for isoniazid and rifampicin. c Percentage among new laboratory-confirmed pulomonary TB cases. d Percentage among new laboratory-confirmed pulmonaryTB cases with DST results. e Percentage among new pulmonary TB cases with DST results. f Excluding Greenland (see Chapter 1.1). g In accordance with the UN Security Council Resolution No. 1244 (1999). 63 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 19: Anti-TB drug resistance among previously treated laboratory-confirmed pulmonary TB cases, European Region, 2011a Country Cases resistant to at leastb: Previously treated laboratory-confirmed pulmonary TB cases Total previously treated pulmonary TB cases Cases with DST results Isoniazid Rifampicin Isoniazid and rifampicin(multidrug resistant) N (%)c N (%)d N (%)d N (%)d N (%)e N EU/EEA Austria 9 (81.8) 3 (33.3) 2 (22.2) 2 (22.2) 11 (64.7) 17 Belgium 31 (93.9) 5 (16.1) 4 (12.9) 4 (12.9) 33 (71.7) 46 Bulgaria 145 (76.3) 55 (37.9) 41 (28.3) 37 (25.5) 190 (63.3) 300 Cyprus 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (66.7) 3 Czech Republic 15 (83.3) 1 (6.7) 2 (13.3) 1 (6.7) 18 (66.7) 27 Denmarkf 12 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 12 (75.0) 16 Estonia 51 (96.2) 33 (64.7) 30 (58.8) 30 (58.8) 53 (71.6) 74 Finland 6 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (54.5) 11 France 0 (0.0) 0 - 0 - 0 - 105 (50.5) 208 Germany 124 (91.9) 23 (18.5) 19 (15.3) 16 (12.9) 135 (56.5) 239 Greece 11 (57.9) 3 (27.3) 2 (18.2) 2 (18.2) 19 (57.6) 33 Hungary 68 (79.1) 8 (11.8) 6 (8.8) 5 (7.4) 86 (39.4) 218 Iceland 0 - 0 - 0 - 0 - 0 - 0 Ireland 14 (93.3) 3 (21.4) 1 (7.1) 1 (7.1) 15 (71.4) 21 Italy 0 (0.0) 0 - 0 - 0 - 31 (39.2) 79 Latvia 80 (88.9) 40 (50.0) 23 (28.8) 23 (28.8) 90 (96.8) 93 Liechtenstein - - - - - - - - - - - Lithuania 366 (100.0) 206 (56.3) 184 (50.3) 179 (48.9) 366 (100.0) 366 Luxembourg 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 1 Malta 0 - 0 - 0 - 0 - 0 (0.0) 2 Netherlands 17 (94.4) 1 (5.9) 1 (5.9) 1 (5.9) 18 (75.0) 24 Norway 16 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 16 (72.7) 22 Poland 570 (90.8) 44 (7.7) 21 (3.7) 18 (3.2) 628 (66.2) 948 Portugal 88 (75.9) 12 (13.6) 5 (5.7) 4 (4.5) 116 (69.0) 168 Romania 2 171 (57.7) 592 (27.3) 452 (20.8) 413 (19.0) 3 763 (83.3) 4 517 Slovakia 29 (100.0) 4 (13.8) 1 (3.4) 1 (3.4) 29 (60.4) 48 Slovenia 10 (100.0) 1 (10.0) 0 (0.0) 0 (0.0) 10 (100.0) 10 Spain 0 (0.0) 0 - 0 - 0 - 220 (74.6) 295 Sweden 21 (100.0) 6 (28.6) 5 (23.8) 5 (23.8) 21 (67.7) 31 United Kingdom 165 (95.4) 22 (13.3) 12 7 11 (6.7) 173 (61.8) 280 Subtotal EU/EEA 4 022 (65.2) 1 062 (26.4) 811 (20.2) 753 (18.7) 6 167 (76.2) 8 097 Non-EU/EEA Albania 11 (100.0) 6 (54.5) 3 (27.3) 3 (27.3) 11 (122.2) 9 Andorra 0 - 0 - 0 - 0 - 0 - 0 Armenia 90 (100.0) 25 (27.8) 18 (20.0) 13 (14.4) 90 (62.1) 145 Azerbaijan 151 (90.4) 64 (42.4) 41 (27.2) 35 (23.2) 167 (7.9) 2 124 Belarus 948 (99.0) 656 (69.2) 639 (67.4) 622 (65.6) 958 (98.0) 978 Bosnia and Herzegovina 41 (100.0) 5 (12.2) 4 (9.8) 4 (9.8) 41 (63.1) 65 Croatia 40 (100.0) 3 (7.5) 2 (5.0) 1 (2.5) 40 (69.0) 58 Georgia 675 (96.7) 297 (44.0) 223 (33.0) 214 (31.7) 698 (53.3) 1 310 Israel 9 (100.0) 2 (22.2) 2 (22.2) 1 (11.1) 9 (100.0) 9 Kazakhstan 4 790 (100.0) 2 564 (53.5) 2 486 (51.9) 2 456 (51.3) 4 790 (56.9) 8 417 Kyrgyzstan - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 25 (100.0) 2 (8.0) 4 (16.0) 1 (4.0) 25 (62.5) 40 Moldova 1 006 (94.0) 711 (70.7) 652 (64.8) 642 (63.8) 1 070 (74.4) 1 439 Monaco - - - - - - - - - - - Montenegro 13 (100.0) 0 (0.0) 1 (7.7) 0 (0.0) 13 (68.4) 19 Russia 13 620 (89.3) 7 189 (52.8) 7 189 (52.8) 7 189 (52.8) 15 259 (35.9) 42 478 San Marino Serbia 100 (95.2) 7 (7.0) 6 (6.0) 6 (6.0) 105 (86.1) 122 Serbia excluding UN Administered Province of Kosovog 100 (95.2) 7 (7.0) 6 (6.0) 6 (6.0) 105 (86.1) 122 UN Administered Province of Kosovog - - - - - - - - - - - Switzerland 40 (88.9) 7 (17.5) 4 (10.0) 4 (10.0) 45 (83.3) 54 Tajikistan 415 (67.7) 319 (76.9) 314 (75.7) 308 (74.2) 613 (95.8) 640 Turkey 602 (100.0) 186 (30.9) 168 (27.9) 146 (24.3) 602 (57.0) 1 057 Turkmenistan - - - - - - - - - - - Ukraine 4 413 (69.1) 2 406 (54.5) 2 377 (53.9) 2 283 (51.7) 6 388 (55.6) 11 488 Uzbekistan 123 (27.0) 113 (91.9) 99 (80.5) 89 (72.4) 455 (46.6) 977 Subtotal non-EU/EEA 27 112 (86.4) 14 562 (53.7) 14 232 (52.5) 14 017 (51.7) 31 379 (43.9) 71 438 Total European Region 31 134 (82.9) 15 624 (50.2) 15 043 (48.3) 14 770 (47.4) 37 546 (47.2) 79 535 Subtotal 18 HPC 29 646 (83.4) 15 456 (52.1) 14 936 (50.4) 14 679 (49.5) 35 552 (46.5) 76 403 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. DST: Drug Susceptibility Testing a Cases classified according to previous TB treatment history. From Belgium, Denmark, Ireland, Norway and United Kingdom previous diagnosis was reported instead and used as a proxy for previous treatment. b Any resistance to isoniazid, rifampicin; expressed as a percentage of cases with DST results available at least for isoniazid and rifampicin. c Percentage among previously treated laboratory-confirmed pulomonary TB cases. d Percentage among previously treated laboratory-confirmed pulmonary TB cases with DST results. e Percentage among previously treated pulmonary TB cases with DST results. f Excluding Greenland (see Chapter 1.1). g In accordance with the UN Security Council Resolution No. 1244 (1999). 64 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 20: Number and proportion of notified XDR-TB cases among MDR-TB cases with second-line drug susceptibility testing, European Region, 2009–2011 Country 2009 2010 Total laboratory- confirmed with FLD DST (N)a Total MDR-TB Total MDR with SLD DST (N) Total XDR-TB Total laboratory- confirmed with FLD DST (N)a Total MDR-TB Total MDR with SLD DST (N) Total XDR-TB N (%) N (%) N (%) N (%) EU/EEA Austria 436 23 (5.3) 21 2 (9.5) 474 16 (3.4) 16 1 (6.3) Belgium 760 10 (1.3) 10 3 (30.0) 822 19 (2.3) 19 2 (10.5) Bulgaria 845 43 (5.1) 24 1 (4.2) 968 56 (5.8) 35 1 (2.9) Cyprus 31 4 (12.9) 2 0 (0.0) - - - - - - Czech Republic 452 8 (1.8) 7 1 (14.3) 419 9 (2.1) 4 1 (25.0) Denmarkb 241 2 (0.8) 2 0 (0.0) 283 2 (0.7) 2 0 (0.0) Estonia 304 85 (28.0) 79 8 (10.1) 262 65 (24.8) 61 10 (16.4) Finland - - - - - - - - - - - - France - - - - - - - - - - - - Germany - - - - - - - - - - - - Greece 169 12 (7.1) 11 2 93 2 (2.2) 2 0 (0.0) Hungary - - - - - - 570 19 (3.3) 18 2 (11.1) Iceland - - - - - - - - - - - - Ireland - - - - - - - - - - - - Italy 2 511 82 (3.3) 32 1 (3.1) 2 597 87 (3.4) 10 0 (0.0) Latvia 752 131 (17.4) 130 16 (12.3) 716 88 (12.3) 87 13 (14.9) Liechtenstein - - - - - - - - - - - - Lithuania 1 478 322 (21.8) 4 4 (100.0) 1 363 310 (22.7) 310 50 (16.1) Luxembourg - - - - - - - - - - - - Malta - - - - - - 16 1 (6.3) 1 0 (0.0) Netherlands - - - - - - - - - - - - Norway 283 8 (2.8) 4 0 (0.0) 275 8 (2.9) 8 0 (0.0) Poland 3 858 21 (0.5) 5 1 (20.0) 3 706 30 (0.8) 12 1 (8.3) Portugal - - - - - - - - - - - - Romania 6 266 624 (10.0) 217 26 (12.0) 6 129 574 (9.4) 215 27 (12.6) Slovakia 235 1 (0.4) 1 0 (0.0) 234 1 (0.4) 1 0 (0.0) Slovenia - - - - - - - - - - - - Spain 1 750 56 (3.2) - 5 - 1 416 49 (3.5) 49 3 (6.1) Sweden 515 13 (2.5) 13 0 (0.0) - - - - - - United Kingdom 4 955 60 (1.2) 52 1 (1.9) 4 603 60 (1.3) 57 3 (5.3) Subtotal EU/EEA 25 841 1 505 (5.8) 614 71 (11.6) 24 946 1 396 (5.6) 907 114 (12.6) Non-EU/EEA Albania 128 0 (0.0) - - - 205 2 (1.0) 2 0 (0.0) Andorra 3 0 (0.0) - - - - - - - - Armenia 680 156 (22.9) - - - 691 177 (25.6) 177 21 (11.9) Azerbaijan 0 0 - - - - - - - - - - Belarus 3 985 1 342 (33.7) - - - - - - - - - Bosnia and Herzegovina 920 2 (0.2) - - - - - - - - - Croatia 517 7 (1.4) - - - - - - - - Georgia 2 372 369 (15.6) 306 32 (10.5) 2 545 359 (14.1) 313 30 (9.6) Israel 266 6 (2.3) 6 0 (0.0) 247 12 (4.9) 12 1 (8.3) Kazakhstan 9 578 3 644 (38.0) 282 216 (76.6) - - - 0 - - Kyrgyzstan 1 930 785 (40.7) - - - 941 489 (52.0) 32 32 (100.0) Macedonia, the former Yugoslav Republic of 219 1 (0.5) 0 0 - 181 7 (3.9) 5 1 (20.0) Moldova 2 413 1 069 (44.3) 0 0 - - - - - - - Monaco 0 0 0 0 - - - - - - - Montenegro 89 1 (1.1) 1 0 (0.0) - - - - - - Russia 58 716 14 686 (25.0) - - - - - - - - - San Marino - - - - - - 0 0 - - - Serbia - - - - - - - - - - - - Serbia excluding UN Administered Province of Kosovoc - - - - - - - - - - - - UN Administered Province of Kosovoc - - - - - - - - - - - - Switzerland 453 5 (1.1) - - - 454 9 (2.0) 9 0 (0.0) Tajikistan 1 413 319 (22.6) 52 11 (21.2) - - - - - Turkey 4 313 222 (5.1) 0 0 4 957 250 (5.0) 5 3 (60.0) Turkmenistan 275 39 (14.2) 0 0 - - - - - Ukraine 18 355 3 482 (19.0) 0 0 - - - - - Uzbekistan 1 303 654 (50.2) 58 13 (22.4) 4 025 1 023 (25.4) 364 16 (4.4) Subtotal non-EU/EEA 107 928 26 789 (24.8) 705 272 (38.6) 14 246 2 328 (16.3) 919 104 (11.3) Total European Region 133 769 28 294 (21.2) 1 319 343 (26.0) 39 192 3 724 (9.5) 1 826 218 (11.9) Subtotal 18 HPC 114 978 27 972 (24.3) 1 152 327 (28.4) 22 597 3 391 (15.0) 1 599 203 (12.7) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region TB High Priority Countries presented in italics. FLD DST - drug susceptibility testing for first line TB drugs, SLD DST - drug susceptibility testing for second line TB drugs. a Includes only countries reporting second-line anti-TB drug susceptibility testing. b Excluding Greenland (see Chapter 1.1). c In accordance with the UN Security Council Resolution No. 1244 (1999). 65 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2011 Total laboratory- confirmed with FLD DST (N)a Total MDR-TB Total MDR with SLD DST (N) Total XDR-TB N (%) N (%) 450 19 (4.2) 19 6 (31.6) 754 15 (2.0) 15 3 (20.0) 733 55 (7.5) 46 0 (0.0) 40 1 (2.5) 1 0 (0.0) 408 7 (1.7) 5 2 (40.0) 271 3 (1.1) 2 0 (0.0) 262 78 (29.8) 75 14 (18.7) - - - - - - - - - - - - 2 821 56 (2.0) 2 0 (0.0) 159 5 (3.1) 5 2 (40.0) 479 7 (1.5) 5 0 (0.0) - - - - - - 239 3 (1.3) 1 0 (0.0) 2 542 81 (3.2) 50 6 (12.0) 644 95 (14.8) 95 12 (12.6) - - - - - - 1 403 296 (21.1) 295 53 (18.0) - - - - - - - - - - - - - - - - - - 257 4 (1.6) 4 0 (0.0) 4 993 41 (0.8) 9 1 (11.1) - - - - - - 6 026 530 (8.8) 248 30 (12.1) 185 3 (1.6) 3 0 (0.0) - - - - - - 1 273 41 (3.2) 41 1 (2.4) 475 17 (3.6) 17 0 (0.0) 5 127 81 (1.6) 79 6 (7.6) 29 541 1 438 (4.9) 1 017 136 (13.4) - - - - - - - - - - - - 529 79 (14.9) 79 0 (0.0) 720 90 (12.5) 84 3 (3.6) - - - - - - 745 5 (0.7) 5 0 (0.0) - - - - - - 2 872 453 (15.8) 440 28 (6.4) 284 11 (3.9) 11 0 (0.0) 11 555 4 575 (39.6) 825 187 (22.7) - - - - - - - - - - - - - - - - - - - - - - - 72 1 (1.4) 1 0 (0.0) - - - - - - - - - - - - 966 9 (1.0) 9 2 (22.2) 966 9 (0.9) 9 2 (22.2) - - - - - 454 8 (1.8) 8 0 (0.0) 576 380 (66.0) 122 12 (9.8) 4 823 262 (5.4) 13 1 (7.7) - - - - - - - - - - - - 2 217 1 385 (62.5) 834 12 (1.4) 25 813 7 258 (28.1) 2 431 245 (10.1) 55 354 8 696 (15.7) 3 448 381 (11.0) 32 360 8 278 (25.6) 3 156 352 (11.2) 66 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 21: Anti-TB drug resistance among all TB cases by origin, EU/EEA, 2011a Country Criterion Native All native TB cases (N) Cases with DST results (N) Cases resistant to at least: Isoniazid Rifampicin Isoniazid and rifampicin(multidrug resistant) N (%)b N (%)c N (%)c N (%)c Austria citizenship 354 232 (65.5) 11 (4.7) 2 (0.9) 0 (0.0) Belgium citizenship 500 345 (69.0) 15 (4.3) 0 (0.0) 0 (0.0) Bulgaria birthplace 2 398 732 (30.5) 98 (13.4) 65 (8.9) 55 (7.5) Cyprus birthplace 9 7 (77.8) 0 (0.0) 0 (0.0) 0 (0.0) Czech Republic birthplace 488 327 (67.0) 2 (0.6) 7 (2.1) 2 (0.6) Denmarkf birthplace 146 104 (71.2) 2 (1.9) 0 (0.0) 0 (0.0) Estonia birthplace 293 231 (78.8) 86 (37.2) 71 (30.7) 70 (30.3) Finland birthplace 212 151 (71.2) 6 (4.0) 2 (1.3) 2 (1.3) France birthplace - - - - - - - - - Germany birthplace 2 100 1 367 (65.1) 43 (3.1) 12 (0.9) 8 (0.6) Greece citizenship 273 69 (25.3) 4 (5.8) 1 (1.4) 0 (0.0) Hungary citizenship 1 418 469 (33.1) 29 (6.2) 7 (1.5) 6 (1.3) Iceland birthplace 2 0 (0.0) 0 - 0 - 0 - Ireland birthplace 189 101 (53.4) 3 (3.0) 0 (0.0) 0 (0.0) Italy birthplace 1 578 899 (57.0) 55 (6.1) 19 (2.1) 13 (1.4) Latvia birthplace 817 599 (73.3) 188 (31.4) 90 (15.0) 89 (14.9) Liechtenstein - - - - - - - - - - Lithuania birthplace 1 860 1 369 (73.6) 431 (31.5) 296 (21.6) 286 (20.9) Luxembourg birthplace 5 4 (80.0) 0 (0.0) 0 (0.0) 0 (0.0) Malta birthplace 5 3 (60.0) 0 (0.0) 0 (0.0) 0 (0.0) Netherlands birthplace 292 192 (65.8) 10 (5.2) 0 (0.0) 0 (0.0) Norway birthplace 44 22 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) Poland citizenship 8 440 4 967 (58.9) 183 (3.7) 48 (1.0) 40 (0.8) Portugal birthplace 2 151 1 068 (49.7) 82 (7.7) 14 (1.3) 12 (1.1) Romania birthplace 19 162 6 019 (31.4) 866 (14.4) 596 (9.9) 529 (8.8) Slovakia birthplace 396 184 (46.5) 9 (4.9) 4 (2.2) 3 (1.6) Slovenia birthplace 135 125 (92.6) 1 (0.8) 0 (0.0) 0 (0.0) Spain birthplace - - - - - - - - - Sweden birthplace 62 44 (71.0) 6 (13.6) 0 (0.0) 0 (0.0) United Kingdom birthplace 2 226 1 187 (53.3) 72 (6.1) 6 (0.5) 4 (0.3) Total EU/EEA 45 555 20 817 (45.7) 2 202 (10.6) 1 240 (6.0) 1 119 (5.4) WHO European Region TB High Priority Countries presented in italics. DST: Drug Susceptibility Testing a Cases with unknown origin are not included. b Percentage among all native TB cases. c Percentage among all native TB cases with DST results. d Percentage among all foreign-origin TB cases. e Percentage among all foreign-origin TB cases with DST results. f Excluding Greenland (see Chapter 1.1). 67 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Foreign-origin All foreign TB cases (N) Cases with DST results (N) Cases resistant to at least: Isoniazid Rifampicin Isoniazid and rifampicin (multidrug resistant) N (%)d N (%)d N (%)e N (%)e 326 213 (65.3) 37 (17.4) 19 (8.9) 19 (8.9) 544 409 (75.2) 35 (8.6) 17 (4.2) 15 (3.7) 9 1 (11.1) 0 (0.0) 0 (0.0) 0 (0.0) 45 33 (73.3) 3 (9.1) 1 (3.0) 1 (3.0) 112 81 (72.3) 10 (12.3) 6 (7.4) 5 (6.2) 235 167 (71.1) 11 (6.6) 3 (1.8) 3 (1.8) 48 31 (64.6) 11 (35.5) 8 (25.8) 8 (25.8) 79 68 (86.1) 9 (13.2) 3 (4.4) 3 (4.4) - - - - - - - - - 2 025 1 404 (69.3) 158 (11.3) 51 (3.6) 48 (3.4) 216 90 (41.7) 16 (17.8) 5 (5.6) 5 (5.6) 27 10 (37.0) 1 (10.0) 1 (10.0) 1 (10.0) 7 4 (57.1) 0 (0.0) 0 (0.0) 0 (0.0) 179 119 (66.5) 10 (8.4) 2 (1.7) 2 (1.7) 1 677 1 612 (96.1) 189 (11.7) 79 (4.9) 68 (4.2) 59 45 (76.3) 15 (33.3) 6 (13.3) 6 (13.3) - - - - - - - - - 44 34 (77.3) 15 (44.1) 10 (29.4) 10 (29.4) 21 15 (71.4) 3 (20.0) 2 (13.3) 2 (13.3) 28 19 (67.9) 1 (5.3) 0 (0.0) 0 (0.0) 710 532 (74.9) 51 (9.6) 16 (3.0) 15 (2.8) 317 235 (74.1) 20 (8.5) 4 (1.7) 4 (1.7) 38 26 (68.4) 2 (7.7) 1 (3.8) 1 (3.8) 385 184 (47.8) 16 (8.7) 10 (5.4) 10 (5.4) 50 7 (14.0) 1 (14.3) 1 (14.3) 1 (14.3) 3 1 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) 57 57 (100.0) 2 (3.5) 0 (0.0) 0 (0.0) - - - - - - - - - 524 431 (82.3) 53 (12.3) 19 (4.4) 17 (3.9) 6 287 3 689 (58.7) 295 (8.0) 82 (2.2) 76 (2.1) 14 052 9 517 (67.7) 964 (10.1) 346 (3.6) 320 (3.4) 68 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 22: Tuberculosis cases with HIV infection, European Region, 2011 Country All TB cases (N) Cases with known HIV status HIV positive N (%) N (%)a EU/EEA Austria - - - - - Belgium 1 044 845 (80.9) 44 (5.2) Bulgaria 2 407 1 698 (70.5) 5 (0.3) Cyprusb - - - - - Czech Republic 600 153 (25.5) 4 (2.6) Denmarkb,c - - - - - Estonia 341 313 (91.8) 47 (15.0) Finlandc - - - - - France 4 942 1 354 (27.4) 95 (7.0) Germany - - - - - Greece - - - - - Hungaryb - - - - - Iceland 9 8 (88.9) 0 (0.0) Ireland 425 94 (22.1) 19 (20.2) Italy - - - - - Latvia 885 752 (85.0) 71 (9.4) Liechtenstein - - - - - Lithuania 1 904 1 352 (71.0) 22 (1.6) Luxembourg 26 5 (19.2) 2 (40.0) Malta 33 30 (90.9) 5 (16.7) Netherlands 1 007 460 (45.7) 31 (6.7) Norway - - - - - Polandb - - - - - Portugal - - - - - Romania 19 212 9 383 (48.8) 243 (2.6) Slovakia 399 395 (99.0) 0 (0.0) Slovenia 192 147 (76.6) 0 (0.0) Spain 6 762 4 541 (67.2) 415 (9.1) Sweden - - - - - United Kingdom - - - - - Subtotal EU/EEA 40 188 21 530 (53.6) 1 003 (4.7) Non-EU/EEA Albania 431 170 (39.4) 2 (1.2) Andorra - - - - - Armenia 1 582 1 499 (94.8) 49 (3.3) Azerbaijan 9 805 6 179 (63.0) 76 (1.2) Belarus 5 118 4 747 (92.8) 217 (4.6) Bosnia and Herzegovina - - - - - Croatia - - - - - Georgia 5 533 2 550 (46.1) 50 (2.0) Israel 418 384 (91.9) 24 (6.3) Kazakhstan 26 211 22 480 (85.8) 352 (1.6) Kyrgyzstan 6 666 153 (2.3) 0 (0.0) Macedonia, the former Yugoslav Republic of 362 45 (12.4) 0 (0.0) Moldova 5 341 5 017 (93.9) 285 (5.7) Monaco 0 0 - 0 - Montenegro 112 92 (82.1) 0 (0.0) Russia 159 479 79 494 (49.8) 4 104 (5.2) San Marino - - - - - Serbia 1 341 67 (5.0) 6 (9.0) Serbia excluding UN Administered Province of Kosovod 1 341 67 (5.0) 6 (9.0) UN Administered Province of Kosovod - - - - - Switzerland - - - - - Tajikistan 7 609 6 241 (82.0) 115 (1.8) Turkey 15 679 7 241 (46.2) 29 (0.4) Turkmenistan - - - - - Ukraine 42 676 31 776 (74.5) 5 893 (18.5) Uzbekistan 15 913 15 913 (100.0) 546 (3.4) Subtotal non-EU/EEA 304 571 184 048 (60.4) 11 748 (6.4) Total European Region 344 759 205 578 (59.6) 12 751 (6.2) Subtotal 18 HPC 326 656 196 788 (60.2) 12 104 (6.2) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region TB High Priority Countries presented in italics. Case-based reporting of HIV-coinfection highlighted. a % of HIV-positive cases were calculated if total cases tested for HIV was provided. b Cyprus, Denmark, Finland, Hungary and Poland reported HIV positive cases, but not the number of tested cases for HIV and are therefore excluded from the current analysis. c Excluding Greenland (see Chapter 1.1). d In accordance with the UN Security Council Resolution No. 1244 (1999). 69 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 23: Treatment outcome of new laboratory-confirmed pulmonary TB cases after 12 months, European Region, 2010 Country Cases notified in 2010 Success Died Failed Defaulted Still on treatment Transferred or unknown N (%) N (%) N (%) N (%) N (%) N (%) EU/EEAa Austria 206 133 (64.6) 13 (6.3) 0 (0.0) 13 (6.3) 31 (15.0) 16 (7.8) Belgium 474 357 (75.3) 33 (7.0) 0 (0.0) 53 (11.2) 16 (3.4) 15 (3.2) Bulgaria 946 816 (86.3) 75 (7.9) 15 (1.6) 29 (3.1) 10 (1.1) 1 (0.1) Cyprus 20 5 (25.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 15 (75.0) Czech Republic 361 249 (69.0) 61 (16.9) 0 (0.0) 24 (6.6) 14 (3.9) 13 (3.6) Denmarkb,c 218 141 (64.7) 23 (10.6) 5 (2.3) 1 (0.5) 7 (3.2) 41 (18.8) Estonia 192 129 (67.2) 20 (10.4) 3 (1.6) 7 (3.6) 33 (17.2) 0 (0.0) Finland 185 138 (74.6) 16 (8.6) 0 (0.0) 4 (2.2) 10 (5.4) 17 (9.2) France - - - - - - - - - - - - - Germany 2 090 1 600 (76.6) 256 (12.2) 3 (0.1) 33 (1.6) 54 (2.6) 144 (6.9) Greece - - - - - - - - - - - - - Hungary 515 355 (68.9) 64 (12.4) 0 (0.0) 51 (9.9) 27 (5.2) 18 (3.5) Iceland 16 14 (87.5) 1 (6.3) 0 (0.0) 0 (0.0) 0 (0.0) 1 (6.3) Irelandb 164 119 (72.6) 12 (7.3) 0 (0.0) 2 (1.2) 2 (1.2) 29 (17.7) Italy - - - - - - - - - - - - - Latvia 596 451 (75.7) 47 (7.9) 3 (0.5) 37 (6.2) 58 (9.7) 0 (0.0) Liechtenstein - - - - - - - - - - - - - Lithuania 959 656 (68.4) 107 (11.2) 13 (1.4) 104 (10.8) 75 (7.8) 4 (0.4) Luxembourg 14 0 (0.0) 1 (7.1) 0 (0.0) 0 (0.0) 0 (0.0) 13 (92.9) Malta 5 4 (80.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (20.0) Netherlands 470 365 (77.7) 31 (6.6) 0 (0.0) 19 (4.0) 18 (3.8) 37 (7.9) Norwayb 139 127 (91.4) 4 (2.9) 1 (0.7) 0 (0.0) 5 (3.6) 2 (1.4) Poland 3 998 2 631 (65.8) 242 (6.1) 10 (0.3) 354 (8.9) 15 (0.4) 746 (18.7) Portugal - - - - - - - - - - - - - Romania 9 445 7 916 (83.8) 441 (4.7) 379 (4.0) 538 (5.7) 171 (1.8) 0 (0.0) Slovakia 177 149 (84.2) 22 (12.4) 0 (0.0) 5 (2.8) 0 (0.0) 1 (0.6) Slovenia 121 104 (86.0) 12 (9.9) 0 (0.0) 1 (0.8) 2 (1.7) 2 (1.7) Spain 3 574 2 516 (70.4) 211 (5.9) 5 (0.1) 27 (0.8) 31 (0.9) 784 (21.9) Sweden 289 246 (85.1) 14 (4.8) 1 (0.3) 2 (0.7) 17 (5.9) 9 (3.1) United Kingdomb 2 603 2 106 (80.9) 135 (5.2) 0 (0.0) 154 (5.9) 118 (4.5) 90 (3.5) Subtotal EU/EEA 27 777 21 327 (76.8) 1 841 (6.6) 438 (1.6) 1 458 (5.3) 714 (2.6) 1 999 (7.2) Non-EU/EEAd Albania 145 132 (91.0) 4 (2.8) 0 (0.0) 4 (2.8) - - 5 (3.4) Andorra - - - - - - - - - - - - - Armenia 339 243 (71.7) 15 (4.4) 51 (15.0) 27 (8.0) - - 3 (0.9) Azerbaijan 1 919 1 470 (76.6) 64 (3.3) 86 (4.5) 188 (9.8) - - 111 (5.8) Belarus 2 184 1 447 (66.3) 183 (8.4) 491 (22.5) 12 (0.5) - - 51 (2.3) Bosnia and Herzegovina 441 434 (98.4) 5 (1.1) 1 (0.2) 1 (0.2) - - 0 (0.0) Croatia 181 136 (75.1) 25 (13.8) 0 (0.0) 7 (3.9) - - 13 (7.2) Georgia 2 500 1 908 (76.3) 70 (2.8) 289 (11.6) 173 (6.9) - - 60 (2.4) Israel 99 75 (75.8) 11 (11.1) 0 (0.0) 0 (0.0) - - 13 (13.1) Kazakhstan 4 919 2 995 (60.9) 158 (3.2) 329 (6.7) 116 (2.4) - - 1 321 (26.9) Kyrgyzstan - - - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 143 128 (89.5) 6 (4.2) 4 (2.8) 3 (2.1) - - 2 (1.4) Moldova 1 267 724 (57.1) 145 (11.4) 67 (5.3) 166 (13.1) - - 165 (13.0) Monaco - - - - - - - - - - - - - Montenegro 39 34 (87.2) 2 (5.1) 0 (0.0) 1 (2.6) - - 2 (5.1) Russia 30 123 15 984 (53.1) 3 531 (11.7) 6 970 (23.1) 2 131 (7.1) - - 1 507 (5.0) San Marino - - - - - - - - - - - - - Serbia 702 602 (85.8) 48 (6.8) 7 (1.0) 31 (4.4) - - 14 (2.0) Serbia excluding UN Administered Province of Kosovoe 702 602 (85.8) 48 (6.8) 7 (1.0) 31 (4.4) - - 14 (2.0) UN Administered Province of Kosovoe - - - - - - - - - - - - - Switzerland - - - - - - - - - - - - - Tajikistan 2 290 1 834 (80.1) 111 (4.8) 246 (10.7) 72 (3.1) - - 27 (1.2) Turkey 5 375 4 905 (91.3) 165 (3.1) 40 (0.7) 136 (2.5) - - 129 (2.4) Turkmenistan - - - - - - - - - - - - - Ukraine 13 279 7 935 (59.8) 1 665 (12.5) 2 212 (16.7) 1 009 (7.6) - - 458 (3.4) Uzbekistan 4 711 3 819 (81.1) 272 (5.8) 276 (5.9) 215 (4.6) - - 129 (2.7) Subtotal non-EU/EEA 70 656 44 805 (63.4) 6 480 (9.2) 11 069 (15.7) 4 292 (6.1) - - 4 010 (5.7) Total European Region 98 433 66 132 (67.2) 8 321 (8.5) 11 507 (11.7) 5 750 (5.8) 714 (0.7) 6 009 (6.1) Subtotal 18 HPC 81 044 53 232 (65.7) 7 069 (8.7) 11 470 (14.2) 4 960 (6.1) 347 (0.4) 3 966 (4.9) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a For EU/EEA countries: new pulmonary confirmed cases. b Not previously diagnosed cases. c Excluding Greenland (see Chapter 1.1). d For non-EU/EEA countries: new pulmonary smear-positive (and/or culture-positive) cases. e In accordance with the UN Security Council Resolution No. 1244 (1999). 70 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 24: Treatment outcome of previously treated laboratory-confirmed pulmonary TB cases, European Region, 2010 Country Cases notified in 2010 Success Died Failed Defaulted Still on treatment Transferred or unknown N (%) N (%) N (%) N (%) N (%) N (%) EU/EEAa Austria 15 9 (60.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (33.3) 1 (6.7) Belgiumb 51 32 (62.7) 3 (5.9) 0 (0.0) 5 (9.8) 8 (15.7) 3 (5.9) Bulgaria 196 101 (51.5) 29 (14.8) 19 (9.7) 29 (14.8) 16 (8.2) 2 (1.0) Cyprus 0 0 - 0 - 0 - 0 - 0 - 0 - Czech Republic 30 20 (66.7) 5 (16.7) 0 (0.0) 0 (0.0) 3 (10.0) 2 (6.7) Denmarkb,c 26 16 (61.5) 4 (15.4) 1 (3.8) 0 (0.0) 0 (0.0) 5 (19.2) Estonia 60 24 (40.0) 5 (8.3) 2 (3.3) 7 (11.7) 22 (36.7) 0 (0.0) Finland 7 6 (85.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (14.3) France - - - - - - - - - - - - - Germany 185 131 (70.8) 28 (15.1) 1 (0.5) 9 (4.9) 5 (2.7) 11 (5.9) Greece - - - - - - - - - - - - - Hungary 87 43 (49.4) 9 (10.3) 0 (0.0) 17 (19.5) 12 (13.8) 6 (6.9) Iceland 0 0 - 0 - 0 - 0 - 0 - 0 - Irelandb 18 11 (61.1) 3 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 4 (22.2) Italy - - - - - - - - - - - - - Latvia 106 65 (61.3) 7 (6.6) 0 (0.0) 12 (11.3) 22 (20.8) 0 (0.0) Liechtenstein - - - - - - - - - - - - - Lithuania 360 113 (31.4) 64 (17.8) 13 (3.6) 80 (22.2) 89 (24.7) 1 (0.3) Luxembourg 0 0 - 0 - 0 - 0 - 0 - 0 - Malta 2 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) Netherlands 26 15 (57.7) 4 (15.4) 0 (0.0) 1 (3.8) 2 (7.7) 4 (15.4) Norwayb 22 14 (63.6) 4 (18.2) 1 (4.5) 0 (0.0) 2 (9.1) 1 (4.5) Poland 587 350 (59.6) 43 (7.3) 2 (0.3) 66 (11.2) 12 (2.0) 114 (19.4) Portugal - - - - - - - - - - - - - Romania 4 228 2 236 (52.9) 397 (9.4) 594 (14.0) 741 (17.5) 260 (6.1) 0 (0.0) Slovakia 29 24 (82.8) 4 (13.8) 0 (0.0) 0 (0.0) 1 (3.4) 0 (0.0) Slovenia 11 7 (63.6) 4 (36.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Spain 224 128 (57.1) 19 (8.5) 0 (0.0) 6 (2.7) 7 (3.1) 64 (28.6) Sweden 24 15 (62.5) 0 (0.0) 0 (0.0) 0 (0.0) 6 (25.0) 3 (12.5) United Kingdomb 187 121 (64.7) 20 (10.7) 0 (0.0) 18 (9.6) 18 (9.6) 10 (5.3) Subtotal EU/EEA 6 481 3 482 (53.7) 652 (10.1) 633 (9.8) 991 (15.3) 490 (7.6) 233 (3.6) Non-EU/EEAd Albania 30 27 (90.0) 1 (3.3) 0 (0.0) 2 (6.7) - - 0 (0.0) Andorra - - - - - - - - - - - - - Armenia 451 302 (67.0) 27 (6.0) 46 (10.2) 58 (12.9) - - 18 (4.0) Azerbaijan 4 194 2 626 (62.6) 135 (3.2) 186 (4.4) 611 (14.6) - - 636 (15.2) Belarus 792 379 (47.9) 82 (10.4) 282 (35.6) 9 (1.1) - - 40 (5.1) Bosnia and Herzegovina 101 96 (95.0) 2 (2.0) 1 (1.0) 1 (1.0) - - 1 (1.0) Croatia 37 28 (75.7) 5 (13.5) 0 (0.0) 1 (2.7) - - 3 (8.1) Georgia 1 421 879 (61.9) 73 (5.1) 248 (17.5) 163 (11.5) - - 58 (4.1) Israel 5 4 (80.0) 1 (20.0) 0 (0.0) 0 (0.0) - - 0 (0.0) Kazakhstan 8 734 4 119 (47.2) 764 (8.7) 389 (4.5) 422 (4.8) - - 3 040 (34.8) Kyrgyzstan - - - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 52 34 (65.4) 9 (17.3) 2 (3.8) 6 (11.5) - - 1 (1.9) Moldova 1 702 545 (32.0) 241 (14.2) 90 (5.3) 288 (16.9) - - 538 (31.6) Monaco - - - - - - - - - - - - - Montenegro 14 12 (85.7) 0 (0.0) 0 (0.0) 0 (0.0) - - 2 (14.3) Russia 14 609 4 984 (34.1) 1 751 (12.0) 4 884 (33.4) 1 703 (11.7) - - 1 287 (8.8) San Marino - - - - - - - - - - - - - Serbia 172 129 (75.0) 17 (9.9) 1 (0.6) 18 (10.5) - - 7 (4.1) Serbia excluding UN Administered Province of Kosovoe 172 129 (75.0) 17 (9.9) 1 (0.6) 18 (10.5) - - 7 (4.1) UN Administered Province of Kosovoe - - - - - - - - - - - - - Switzerland - - - - - - - - - - - - - Tajikistan 1 732 1 243 (71.8) 189 (10.9) 198 (11.4) 77 (4.4) - - 25 (1.4) Turkey 1 368 940 (68.7) 72 (5.3) 29 (2.1) 101 (7.4) - - 226 (16.5) Turkmenistan - - - - - - - - - - - - - Ukraine 9 812 4 540 (46.3) 1 388 (14.1) 2 242 (22.8) 1 003 (10.2) - - 639 (6.5) Uzbekistan 4 527 3 284 (72.5) 459 (10.1) 225 (5.0) 387 (8.5) - - 172 (3.8) Subtotal non-EU/EEA 49 753 24 171 (48.6) 5 216 (10.5) 8 823 (17.7) 4 850 (9.7) - - 6 693 (13.5) Total European Region 56 234 27 653 (49.2) 5 868 (10.4) 9 456 (16.8) 5 841 (10.4) 409 (0.7) 6 926 (12.3) Subtotal 18 HPC 54 292 26 380 (48.6) 5 683 (10.5) 9 447 (17.4) 5 691 (10.5) 409 (0.8) 6 682 (12.3) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Previously treated pulmonary confirmed cases for EU/EEA countries. b Previously diagnosed cases. c Excluding Greenland (see Chapter 1.1). d For non-EU/EEA countries: new pulmonary smear-positive (and/or culture-positive) cases. e In accordance with the UN Security Council Resolution No. 1244 (1999). 71 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table 25: Treatment outcome of all TB cases, European region, 2010 Country Cases notified in 2010 Success Died Failed Defaulted Still on treatment Transferred or unknown N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austria 691 423 (61.2) 61 (8.8) 0 (0.0) 41 (5.9) 96 (13.9) 70 (10.1) Belgium 1 086 820 (75.5) 64 (5.9) 0 (0.0) 124 (11.4) 34 (3.1) 44 (4.1) Bulgaria 2 649 2 231 (84.2) 239 (9.0) 37 (1.4) 109 (4.1) 27 (1.0) 6 (0.2) Cyprus 61 13 (21.3) 0 (0.0) 0 (0.0) 1 (1.6) 0 (0.0) 47 (77.0) Czech Republic 669 486 (72.6) 104 (15.5) 0 (0.0) 36 (5.4) 18 (2.7) 25 (3.7) Denmarka 366 242 (66.1) 31 (8.5) 9 (2.5) 1 (0.3) 15 (4.1) 68 (18.6) Estonia 333 198 (59.5) 40 (12.0) 6 (1.8) 25 (7.5) 64 (19.2) 0 (0.0) Finland 325 146 (44.9) 17 (5.2) 0 (0.0) 4 (1.2) 10 (3.1) 148 (45.5) France - - - - - - - - - - - - - Germany 4 388 3 262 (74.3) 503 (11.5) 6 (0.1) 139 (3.2) 105 (2.4) 373 (8.5) Greece - - - - - - - - - - - - - Hungary 1 741 1 254 (72.0) 218 (12.5) 0 (0.0) 161 (9.2) 66 (3.8) 42 (2.4) Iceland 22 20 (90.9) 1 (4.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (4.5) Ireland 420 304 (72.4) 27 (6.4) 0 (0.0) 7 (1.7) 2 (0.5) 80 (19.0) Italy - - - - - - - - - - - - - Latvia 935 711 (76.0) 78 (8.3) 3 (0.3) 61 (6.5) 81 (8.7) 1 (0.1) Liechtenstein - - - - - - - - - - - - - Lithuania 1 938 1 280 (66.0) 214 (11.0) 29 (1.5) 240 (12.4) 170 (8.8) 5 (0.3) Luxembourg 29 0 (0.0) 1 (3.4) 0 (0.0) 0 (0.0) 0 (0.0) 28 (96.6) Malta 32 19 (59.4) 1 (3.1) 0 (0.0) 2 (6.3) 0 (0.0) 10 (31.3) Netherlands 1 065 869 (81.6) 54 (5.1) 0 (0.0) 41 (3.8) 31 (2.9) 70 (6.6) Norway 336 288 (85.7) 15 (4.5) 6 (1.8) 0 (0.0) 18 (5.4) 9 (2.7) Poland 7 509 4 976 (66.3) 426 (5.7) 12 (0.2) 653 (8.7) 31 (0.4) 1 411 (18.8) Portugal - - - - - - - - - - - - - Romania 21 059 16 232 (77.1) 1 519 (7.2) 1 002 (4.8) 1 653 (7.8) 653 (3.1) 0 (0.0) Slovakia 439 384 (87.5) 44 (10.0) 1 (0.2) 7 (1.6) 1 (0.2) 2 (0.5) Slovenia 172 139 (80.8) 27 (15.7) 0 (0.0) 2 (1.2) 2 (1.2) 2 (1.2) Spain 7 239 4 861 (67.2) 420 (5.8) 9 (0.1) 75 (1.0) 60 (0.8) 1 814 (25.1) Sweden 668 567 (84.9) 25 (3.7) 2 (0.3) 6 (0.9) 31 (4.6) 37 (5.5) United Kingdom 8 483 6 820 (80.4) 431 (5.1) 0 (0.0) 489 (5.8) 320 (3.8) 423 (5.0) Subtotal EU/EEA 62 655 46 545 (74.3) 4 560 (7.3) 1 122 (1.8) 3 877 (6.2) 1 835 (2.9) 4 716 (7.5) Non-EU/EEA Albania 445 398 (89.4) 10 (2.2) 0 (0.0) 29 (6.5) - - 8 (1.8) Andorra 7 6 (85.7) 0 (0.0) 0 (0.0) 0 (0.0) - - 1 (14.3) Armenia 1 780 1 389 (78.0) 76 (4.3) 118 (6.6) 148 (8.3) - - 49 (2.8) Azerbaijan 8 652 5 878 (67.9) 380 (4.4) 435 (5.0) 1 154 (13.3) - - 805 (9.3) Belarus 5 091 3 735 (73.4) 385 (7.6) 780 (15.3) 30 (0.6) - - 161 (3.2) Bosnia and Herzegovina 1 071 1 051 (98.1) 10 (0.9) 3 (0.3) 4 (0.4) - - 3 (0.3) Croatia 263 199 (75.7) 37 (14.1) 0 (0.0) 9 (3.4) - - 18 (6.8) Georgia 5 807 4 360 (75.1) 181 (3.1) 577 (9.9) 491 (8.5) - - 198 (3.4) Israel 346 292 (84.4) 22 (6.4) 0 (0.0) 8 (2.3) - - 24 (6.9) Kazakhstan 22 183 14 388 (64.9) 1 045 (4.7) 927 (4.2) 684 (3.1) - - 5 139 (23.2) Kyrgyzstan - - - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 420 347 (82.6) 38 (9.0) 6 (1.4) 23 (5.5) - - 6 (1.4) Moldova 5 447 3 064 (56.3) 607 (11.1) 211 (3.9) 633 (11.6) - - 932 (17.1) Monaco - - - - - - - - - - - - - Montenegro 116 101 (87.1) 5 (4.3) 0 (0.0) 3 (2.6) - - 7 (6.0) Russia 108 604 67 384 (62.0) 8 170 (7.5) 17 801 (16.4) 8 118 (7.5) - - 7 131 (6.6) San Marino - - - - - - - - - - - - - Serbia 1 515 1 291 (85.2) 100 (6.6) 11 (0.7) 80 (5.3) - - 33 (2.2) Serbia excluding UN Administered Province of Kosovob 1 515 1 291 (85.2) 100 (6.6) 11 (0.7) 80 (5.3) - - 33 (2.2) UN Administered Province of Kosovob - - - - - - - - - - - - - Switzerland - - - - - - - - - - - - - Tajikistan 7 691 6 377 (82.9) 429 (5.6) 495 (6.4) 251 (3.3) - - 139 (1.8) Turkey 16 551 14 513 (87.7) 505 (3.1) 88 (0.5) 446 (2.7) - - 999 (6.0) Turkmenistan - - - - - - - - - - - - - Ukraine 40 299 25 583 (63.5) 4 256 (10.6) 5 474 (13.6) 2 991 (7.4) - - 1 995 (5.0) Uzbekistan 20 261 16 822 (83.0) 1 088 (5.4) 577 (2.8) 1 153 (5.7) - - 621 (3.1) Subtotal non-EU/EEA 246 549 167 178 (67.8) 17 344 (7.0) 27 503 (11.2) 16 255 (6.6) - - 18 269 (7.4) Total European Region 309 204 213 723 (69.1) 21 904 (7.1) 28 625 (9.3) 20 132 (6.5) 1 835 (0.6) 22 985 (7.4) Subtotal 18 HPC 269 280 184 145 (68.4) 19 212 (7.1) 28 560 (10.6) 18 187 (6.8) 995 (0.4) 18 181 (6.8) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). b In accordance with the UN Security Council Resolution No. 1244 (1999). 72 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table 26: Treatment outcome of all MDR-TB cases after 24 months, European region, 2009 Country Total number of MDR cases Success Died Failed Defaulted Still on treatment Transferred or unknown N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austria 23 10 (43.5) 1 (4.3) 0 (0.0) 8 (34.8) 4 (17.4) 0 (0.0) Belgium 10 4 (40.0) 1 (10.0) 0 (0.0) 2 (20.0) 3 (30.0) 0 (0.0) Bulgaria 43 8 (18.6) 18 (41.9) 5 (11.6) 5 (11.6) 5 (11.6) 2 (4.7) Cyprus - - - - - - - - - - - - - Czech Republic 8 0 (0.0) 1 (12.5) 0 (0.0) 4 (50.0) 1 (12.5) 2 (25.0) Denmarka 2 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Estonia 85 35 (41.2) 18 (21.2) 5 (5.9) 9 (10.6) 15 (17.6) 3 (3.5) Finland - - - - - - - - - - - - - France - - - - - - - - - - - - - Germany 62 38 (61.3) 4 (6.5) 1 (1.6) 4 (6.5) 6 (9.7) 9 (14.5) Greece - - - - - - - - - - - - - Hungary 18 3 (16.7) 3 (16.7) 9 (50.0) 2 (11.1) 1 (5.6) 0 (0.0) Iceland - - - - - - - - - - - - - Ireland - - - - - - - - - - - - - Italy - - - - - - - - - - - - - Latvia 131 77 (58.8) 25 (19.1) 6 (4.6) 19 (14.5) 3 (2.3) 1 (0.8) Liechtenstein - - - - - - - - - - - - - Lithuania 322 97 (30.1) 93 (28.9) 31 (9.6) 98 (30.4) 2 (0.6) 1 (0.3) Luxembourg - - - - - - - - - - - - - Malta 0 0 - 0 - 0 - 0 - 0 - 0 - Netherlands 20 12 (60.0) 0 (0.0) 0 (0.0) 4 (20.0) 1 (5.0) 3 (15.0) Norway 8 5 (62.5) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 2 (25.0) Poland 21 12 (57.1) 4 (19.0) 2 (9.5) 1 (4.8) 1 (4.8) 1 (4.8) Portugal - - - - - - - - - - - - - Romania 624 102 (16.3) 118 (18.9) 228 (36.5) 126 (20.2) 50 (8.0) 0 (0.0) Slovakia 1 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 - Slovenia - - - - - - - - - - - - - Spain - - - - - - - - - - - - - Sweden 13 11 (84.6) 0 (0.0) 1 (7.7) 1 (7.7) 0 (0.0) 0 (0.0) United Kingdom 60 45 (75.0) 0 (0.0) 0 (0.0) 7 (11.7) 2 (3.3) 6 (10.0) Subtotal EU/EEA 1 451 460 (31.6) 288 (19.8) 289 (19.8) 290 (19.9) 94 (6.5) 30 (2.4) Non-EU/EEA Albania - - - - - - - - - - - - - Andorra - - - - - - - - - - - - - Armenia 134 69 (51.5) 10 (7.5) 19 (14.2) 31 (23.1) - - 5 (3.7) Azerbaijan 100 74 (74.0) 8 (8.0) 12 (12.0) 6 (6.0) - - 0 (0.0) Belarus 1 422 572 (40.2) 214 (15.0) 156 (11.0) 175 (12.3) - - 305 (21.4) Bosnia and Herzegovina 1 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) - - 0 (0.0) Croatia 2 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) - - 1 (50.0) Georgia 503 270 (53.7) 38 (7.6) 30 (6.0) 141 (28.0) - - 24 (4.8) Israel 6 5 (83.3) 0 (0.0) 0 (0.0) 0 (0.0) - - 1 (16.7) Kazakhstan 3 897 2 851 (73.2) 254 (6.5) 279 (7.2) 207 (5.3) - - 306 (7.9) Kyrgyzstan 545 193 (35.4) 53 (9.7) 48 (8.8) 208 (38.2) - - 43 (7.9) Macedonia, the former Yugoslav Republic of 1 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) - - 0 (0.0) Moldova - - - - - - - - - - - - - Monaco - - - - - - - - - - - - - Montenegro 1 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Russia - - - - - - - - - - - - - San Marino - - - - - - - - - - - - - Serbia 10 6 (60.0) 3 (30.0) 1 (10.0) 0 (0.0) - - 0 (0.0) Serbia excluding UN Administered Province of Kosovob 10 6 (60.0) 3 (30.0) 1 (10.0) 0 (0.0) - - 0 (0.0) UN Administered Province of Kosovob - - - - - - - - - - - - - Switzerland - - - - - - - - - - - - - Tajikistan 52 37 (71.2) 7 (13.5) 6 (11.5) 2 (3.8) - - 0 (0.0) Turkey 222 147 (66.2) 19 (8.6) 4 (1.8) 12 (5.4) - - 40 (18.0) Turkmenistan - - - - - - - - - - - - - Ukraine 3 299 906 (27.5) 1 030 (31.2) 307 (9.3) 458 (13.9) - - 598 (18.1) Uzbekistan 464 285 (61.4) 43 (9.3) 50 (10.8) 76 (16.4) - - 10 (2.2) Subtotal non-EU/EEA 10 659 5 418 (50.8) 1 679 (15.8) 912 (8.6) 1 317 (12.4) - - 1 333 (12.5) Total European Region 12 110 5 878 (48.5) 1 967 (16.2) 1 201 (9.9) 1 607 (13.3) 94 (0.8) 1 363 (11.3) Subtotal 18 HPC 11 843 5 723 (48.3) 1 948 (16.4) 1 186 (10.0) 1 573 (13.3) 75 (0.6) 1 338 (11.3) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). b In accordance with the UN Security Council Resolution No. 1244 (1999). 73 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Tables on specifi c topics in the 2013 report: TB in prisons and site of the disease

75 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table A: TB in Prisons, European Region, 2010 Country Prison population (N) New TB cases (all forms) notified in prisons Proportion of new TB cases in prisons out of the country totala TB relative risk in prisons (RR)N Rate EU/EEA Austria - - - - - Belgium 18 188 15 82.5 2.1% 12.5 Bulgaria 9 322 42 450.5 2.0% 16.5 Cyprus - - - - - Czech Republic 21 900 38 173.5 6.7% 32.0 Denmark - - - - - Estonia - 14 - 5.3% - Finland - - - - - France 61473 - - - - Germany - - - - - Greece - - - - - Hungary - - - - - Iceland 157 - - - - Ireland 13 758 - - - - Italy - - - - - Latvia 10 383 56 539.3 7.1% 15.4 Liechtenstein - - - - - Lithuania 8 856 84 948.5 5.5% 20.6 Luxembourg 600 - - - - Malta - - - - - Netherlands 33 054 21 63.5 2.2% 11.0 Norway - - - - Poland 80 522 179 222.3 2.4% 11.3 Portugal - - - - Romania 27 559 122 442.7 0.8% 6.5 Slovakia 7 126 61 856.0 18.9% 144.8 Slovenia - - - - - Spain - - - - - Sweden - - - - - United Kingdom - - - - - Subtotal EU/EEAb 216 910 618 284.9 2.1% 11.4 Non-EU/EEA Albania 6 000 4 66.7 1.0% 5.2 Andorra 0 0 - - - Armenia 4 314 28 649.0 2.3% 16.7 Azerbaijan 16 478 327 1984.5 6.2% 34.4 Belarus 33 003 146 442.4 3.6% 10.5 Bosnia and Herzegovina - - - - - Croatia - - - - - Georgia 23 684 879 3711.4 20.8% 38.2 Israel 14 239 45 316.0 11.0% 57.5 Kazakhstan - - - - - Kyrgyzstan - - - - - Macedonia, the former Yugoslav Republic of - - - - - Moldova 22 000 159 722.7 4.1% 6.7 Monaco - - - - - Montenegro 1 500 0 - - - Russia - - - - - San Marino - - - - - Serbia - - - - - Serbia excluding UN Administered Province of Kosovoc - - - - - UN Administered Province of Kosovoc - - - - - Switzerland - - - - - Tajikistan 10 500 93 885.7 1.6% 10.3 Turkey 120 814 111 91.9 0.8% 4.6 Turkmenistan - - - - - Ukraine 147 272 388 263.5 1.2% 3.8 Uzbekistan - - - - - Subtotal non-EU/EEA 399 804 2 180 545.3 3.1% 12.7 Total European Region 631 229 2 798 443.3 2.8% 12.5 Subtotal 18 HPC 434 185 2 435 560.8 2.7% 11.9 ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a The proportion is related to all new TB cases reported by country. b In the calculation of summary results only countries reporting complete data are included. c In accordance with Security Council Resolution 1244(1999) 76 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table B: Extrapulmonary TB cases, notification rates per 100 000 population and % of all TB, EU/EEA 2002–2011 Country 2002 2003 2004 2005 2006 To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB N (%) Rate N (%) Rate N (%) Rate N (%) Rate N (%) Rate Austria 1 074 212 (19.7) 2.6 990 163 (16.5) 2.0 1 075 180 (16.7) 2.2 998 188 (18.8) 2.3 906 145 (16.0) 1.8 Belgium 1 294 316 (24.4) 3.1 1 117 280 (25.1) 2.7 1 198 319 (26.6) 3.1 1 107 306 (27.6) 2.9 1 117 350 (31.3) 3.3 Bulgaria 3 335 393 (11.8) 5.0 3 263 424 (13.0) 5.4 3 232 345 (10.7) 4.4 3 302 376 (11.4) 4.8 3 232 327 (10.1) 4.2 Cyprus 20 6 (30.0) 0.9 35 6 (17.1) 0.8 30 3 (10.0) 0.4 37 13 (35.1) 1.7 37 6 (16.2) 0.8 Czech Republic 1 200 283 (23.6) 2.8 1 162 250 (21.5) 2.5 1 057 233 (22.0) 2.3 984 155 (15.8) 1.5 951 159 (16.7) 1.6 Denmarka 419 111 (26.5) 2.1 393 107 (27.2) 2.0 385 96 (24.9) 1.8 428 131 (30.6) 2.4 387 106 (27.4) 2.0 Estonia 713 85 (11.9) 6.2 623 66 (10.6) 4.9 594 62 (10.4) 4.6 518 51 (9.8) 3.8 460 36 (7.8) 2.7 Finland 477 177 (37.1) 3.4 415 122 (29.4) 2.3 336 103 (30.7) 2.0 372 99 (26.6) 1.9 297 85 (28.6) 1.6 France 6 322 1 598 (25.3) 2.6 6 098 1 553 (25.5) 2.5 5 578 1 445 (25.9) 2.3 5 368 1 421 (26.5) 2.3 5 323 1 300 (24.4) 2.1 Germany 7 701 1 437 (18.7) 1.7 7 166 1 390 (19.4) 1.7 6 542 1 299 (19.9) 1.6 6 020 1 368 (22.7) 1.7 5 378 1 168 (21.7) 1.4 Greece 582 78 (13.4) 0.7 620 87 (14.0) 0.8 774 86 (11.1) 0.8 769 116 (15.1) 1.0 681 91 (13.4) 0.8 Hungary 2 838 207 (7.3) 2.0 2 582 179 (6.9) 1.8 2 340 140 (6.0) 1.4 1 964 126 (6.4) 1.2 1 859 92 (4.9) 0.9 Iceland 8 2 (25.0) 0.7 5 2 (40.0) 0.7 12 7 (58.3) 2.4 11 6 (54.5) 2.0 13 6 (46.2) 2.0 Ireland 408 93 (22.8) 2.4 407 102 (25.1) 2.6 432 118 (27.3) 2.9 450 130 (28.9) 3.2 463 125 (27.0) 3.0 Italy 4 212 991 (23.5) 1.7 4 518 1 159 (25.7) 2.0 4 220 1 193 (28.3) 2.1 4 212 1 031 (24.5) 1.8 4 503 1 167 (25.9) 2.0 Latvia 1 855 231 (12.5) 9.8 1 726 183 (10.6) 7.8 1 610 205 (12.7) 8.8 1 443 148 (10.3) 6.4 1 328 124 (9.3) 5.4 Liechtenstein - - - - - - - - - - - - - - - - - - - - Lithuania 2 844 493 (17.3) 14.2 2 821 429 (15.2) 12.4 2 514 389 (15.5) 11.3 2 574 363 (14.1) 10.6 2 559 320 (12.5) 9.4 Luxembourg 32 4 (12.5) 1 54 3 (5.6) 1 31 2 (6.5) 0 37 3 (8.1) 1 33 1 (3.0) 0 Malta 24 5 (20.8) 1.3 7 3 (42.9) 0.8 19 5 (26.3) 1.3 25 6 (24.0) 1.5 30 6 (20.0) 1.5 Netherlands 1 401 501 (35.8) 3.1 1 321 453 (34.3) 2.8 1 344 547 (40.7) 3.4 1 128 470 (41.7) 2.9 1 031 403 (39.1) 2.5 Norway 251 98 (39.0) 2.2 337 125 (37.1) 2.7 302 102 (33.8) 2.2 288 106 (36.8) 2.3 290 104 (35.9) 2.2 Poland 10 475 1 031 (9.8) 2.7 10 124 913 (9.0) 2.4 9 493 802 (8.4) 2.1 9 269 820 (8.8) 2.1 8 587 708 (8.2) 1.9 Portugal 4 501 1 192 (26.5) 11.5 4 148 1 124 (27.1) 10.8 3 854 984 (25.5) 9.4 3 558 0 (0.0) 0.0 3 456 773 (22.4) 7.3 Romania 33 595 3 699 (11.0) 16.9 31 039 4 080 (13.1) 18.7 31 034 4 027 (13.0) 18.5 29 288 3 757 (12.8) 17.3 26 600 3 756 (14.1) 17.4 Slovakia 1 053 209 (19.8) 3.9 983 206 (21.0) 3.8 705 141 (20.0) 2.6 760 141 (18.6) 2.6 730 133 (18.2) 2.5 Slovenia 350 55 (15.7) 2.8 293 44 (15.0) 2.2 263 51 (19.4) 2.6 278 33 (11.9) 1.7 215 41 (19.1) 2.0 Spain 7 626 133 (1.7) 0.3 7 467 137 (1.8) 0.3 7 766 1 006 (13.0) 2.4 7 820 979 (12.5) 2.3 8 029 1 430 (17.8) 3.3 Sweden 407 146 (35.9) 1.6 408 152 (37.3) 1.7 461 149 (32.3) 1.7 559 207 (37.0) 2.3 497 178 (35.8) 2.0 United Kingdom 7 330 2 903 (39.6) 4.9 7 266 2 983 (41.1) 5.0 7 650 3 193 (41.7) 5.3 8 349 3 683 (44.1) 6.1 8 363 3 707 (44.3) 6.1 Total EU/EEA 102 347 16 689 (16.3) 3.4 97 388 16 725 (17.2) 3.4 94 851 17 232 (18.2) 3.5 91 916 16 233 (17.7) 3.3 87 355 16 847 (19.3) 3.4 ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). 77 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2007 2008 2009 2010 2011 To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB To ta l T B ca se s no tif ie d ( N) Extrapulmonary TB N (%) Rate N (%) Rate N (%) Rate N (%) Rate N (%) Rate 874 144 (16.5) 1.7 817 137 (16.8) 1.6 696 121 (17.4) 1.4 691 133 (19.2) 1.6 687 136 (19.8) 1.6 1 020 281 (27.5) 2.7 990 271 (27.4) 2.5 994 274 (27.6) 2.5 1 086 303 (27.9) 2.8 1 044 297 (28.4) 2.7 3 038 298 (9.8) 3.9 3 150 743 (23.6) 9.7 2 910 787 (27.0) 10.3 2 649 798 (30.1) 10.6 2 407 683 (28.4) 9.1 42 6 (14.3) 0.8 50 8 (16.0) 1.0 55 19 (34.5) 2.4 61 19 (31.1) 2.4 54 8 (14.8) 1.0 846 124 (14.7) 1.2 864 131 (15.2) 1.3 694 106 (15.3) 1.0 669 97 (14.5) 0.9 600 78 (13.0) 0.7 391 91 (23.3) 1.7 380 95 (25.0) 1.7 334 70 (21.0) 1.3 366 44 (12.0) 0.8 381 47 (12.3) 0.8 491 34 (6.9) 2.5 444 34 (7.7) 2.5 411 22 (5.4) 1.6 333 21 (6.3) 1.6 341 20 (5.9) 1.5 348 111 (31.9) 2.1 344 125 (36.3) 2.4 417 118 (28.3) 2.2 325 92 (28.3) 1.7 325 89 (27.4) 1.7 5 574 1 356 (24.3) 2.1 5 758 1 603 (27.8) 2.5 5 276 1 395 (26.4) 2.2 5 116 1 361 (26.6) 2.1 4 942 1 289 (26.1) 2.0 5 000 1 043 (20.9) 1.3 4 523 995 (22.0) 1.2 4 427 933 (21.1) 1.1 4 388 979 (22.3) 1.2 4 316 926 (21.5) 1.1 639 86 (13.5) 0.8 664 86 (13.0) 0.8 589 84 (14.3) 0.7 487 69 (14.2) 0.6 489 60 (12.3) 0.5 1 685 100 (5.9) 1.0 1 619 86 (5.3) 0.9 1 407 71 (5.0) 0.7 1 741 74 (4.3) 0.7 1 445 56 (3.9) 0.6 14 5 (35.7) 1.6 6 3 (50.0) 1.0 9 2 (22.2) 0.6 22 4 (18.2) 1.3 9 6 (66.7) 1.9 480 131 (27.3) 3.0 468 130 (27.8) 3.0 479 164 (34.2) 3.7 420 150 (35.7) 3.4 425 121 (28.5) 2.7 4 525 1 091 (24.1) 1.8 4 418 1 131 (25.6) 1.9 4 244 1 156 (27.2) 1.9 4 692 1 316 (28.0) 2.2 3 521 939 (26.7) 1.5 1 255 141 (11.2) 6.2 1 070 120 (11.2) 5.3 977 89 (9.1) 3.9 935 88 (9.4) 3.9 885 89 (10.1) 4.0 - - - - - - - - - - - - - - - - - - - - 2 408 280 (11.6) 8.3 2 250 266 (11.8) 7.9 2 081 236 (11.3) 7.0 1 938 225 (11.6) 6.8 1 904 190 (10.0) 5.9 39 3 (7.7) 1 - - - - 27 2 (7.4) 0 29 6 (20.7) 1 26 4 (15.4) 1 38 11 (28.9) 2.7 53 13 (24.5) 3.2 44 18 (40.9) 4.4 32 13 (40.6) 3.1 33 11 (33.3) 2.6 998 402 (40.3) 2.5 1 015 417 (41.1) 2.5 1 158 517 (44.6) 3.1 1 065 475 (44.6) 2.9 1 007 441 (43.8) 2.6 302 123 (40.7) 2.6 313 128 (40.9) 2.7 358 132 (36.9) 2.8 336 137 (40.8) 2.8 361 158 (43.8) 3.2 8 614 628 (7.3) 1.6 8 080 597 (7.4) 1.6 8 236 582 (7.1) 1.5 7 509 517 (6.9) 1.4 8 478 599 (7.1) 1.6 3 139 728 (23.2) 6.9 3 002 753 (25.1) 7.1 2 871 763 (26.6) 7.2 2 626 727 (27.7) 6.8 2 540 675 (26.6) 6.3 24 837 3 351 (13.5) 15.5 24 680 3 310 (13.4) 15.4 23 164 3 351 (14.5) 15.6 21 059 3 058 (14.5) 14.2 19 212 2 781 (14.5) 13.0 682 134 (19.6) 2.5 633 111 (17.5) 2.1 506 92 (18.2) 1.7 439 67 (15.3) 1.2 399 62 (15.5) 1.1 218 38 (17.4) 1.9 213 33 (15.5) 1.6 188 26 (13.8) 1.3 172 30 (17.4) 1.5 192 27 (14.1) 1.3 7 768 1 501 (19.3) 3.4 8 216 1 901 (23.1) 4.2 7 592 1 814 (23.9) 4.0 7 239 1 933 (26.7) 4.2 6 762 1 783 (26.4) 3.9 482 180 (37.3) 2.0 546 236 (43.2) 2.6 617 264 (42.8) 2.9 668 252 (37.7) 2.7 586 228 (38.9) 2.4 8 329 3 777 (45.3) 6.2 8 606 3 921 (45.6) 6.4 8 917 4 082 (45.8) 6.6 8 483 3 949 (46.6) 6.4 8 963 4 313 (48.1) 6.9 84 076 16 198 (19.3) 3.2 83 172 17 384 (20.9) 3.5 79 678 17 290 (21.7) 3.4 75 576 16 937 (22.4) 3.3 72 334 16 116 (22.3) 3.2 78 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table C: All tuberculosis cases by site of disease, EU/EEA, 2011 Country Total TB cases notified (N) Pulmonary TB Extrapulmonary Extrapulmonary TB Lymphatic Pleural Urogenital Bone N (%)b N (%)b N (%)c N (%)c N (%)c N (%)c Austria 687 540 (78.6) 136 (19.8) 65 (47.8) 20 (14.7) 16 (11.8) 8 (5.9) Belgium 1 044 747 (71.6) 297 (28.4) 150 (50.5) 72 (24.2) 14 (4.7) 11 (3.7) Bulgaria 2 407 1 724 (71.6) 683 (28.4) 273 (40.0) 216 (31.6) 29 (4.2) 17 (2.5) Cyprus 54 44 (81.5) 8 (14.8) 5 (62.5) 2 (25.0) 0 (0.0) 0 (0.0) Czech Republic 600 522 (87.0) 78 (13.0) 34 (43.6) 16 (20.5) 6 (7.7) 2 (2.6) Denmarkd 381 240 (63.0) 47 (12.3) 31 (66.0) 6 (12.8) 4 (8.5) 0 (0.0) Estonia 341 321 (94.1) 20 (5.9) 5 (25.0) 6 (30.0) 2 (10.0) 2 (10.0) Finland 325 236 (72.6) 89 (27.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) France 4 942 3 600 (72.8) 1 289 (26.1) 577 (44.8) 229 (17.8) 47 (3.6) 116 (9.0) Germany 4 316 3 346 (77.5) 926 (21.5) 431 (46.5) 147 (15.9) 90 (9.7) 67 (7.2) Greece 489 426 (87.1) 60 (12.3) 22 (36.7) 8 (13.3) 3 (5.0) 1 (1.7) Hungary 1 445 1 389 (96.1) 56 (3.9) 6 (10.7) 9 (16.1) 11 (19.6) 13 (23.2) Iceland 9 3 (33.3) 6 (66.7) 3 (50.0) 1 (16.7) 0 (0.0) 0 (0.0) Ireland 425 293 (68.9) 121 (28.5) 46 (38.0) 24 (19.8) 5 (4.1) 6 (5.0) Italy 3 521 2 582 (73.3) 939 (26.7) 385 (41.0) 111 (11.8) 79 (8.4) 33 (3.5) Latvia 885 796 (89.9) 89 (10.1) 47 (52.8) 26 (29.2) 5 (5.6) 0 (0.0) Liechtenstein - - - - - - - - - - - - - Lithuania 1 904 1 714 (90.0) 190 (10.0) 51 (26.8) 58 (30.5) 17 (8.9) 20 (10.5) Luxembourg 26 22 (84.6) 4 (15.4) 4 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Malta 33 22 (66.7) 11 (33.3) 6 (54.5) 1 (9.1) 1 (9.1) 0 (0.0) Netherlands 1 007 563 (55.9) 441 (43.8) 225 (51.0) 64 (14.5) 19 (4.3) 11 (2.5) Norway 361 200 (55.4) 158 (43.8) 87 (55.1) 16 (10.1) 5 (3.2) 15 (9.5) Poland 8 478 7 879 (92.9) 599 (7.1) 149 (24.9) 214 (35.7) 68 (11.4) 40 (6.7) Portugal 2 540 1 857 (73.1) 675 (26.6) 215 (31.9) 188 (27.9) 48 (7.1) 11 (1.6) Romania 19 212 16 431 (85.5) 2 781 (14.5) 535 (19.2) 1 606 (57.7) 117 (4.2) 89 (3.2) Slovakia 399 337 (84.5) 62 (15.5) 20 (32.3) 18 (29.0) 7 (11.3) 0 (0.0) Slovenia 192 165 (85.9) 27 (14.1) 10 (37.0) 11 (40.7) 1 (3.7) 1 (3.7) Spain 6 762 4 979 (73.6) 1 783 (26.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Sweden 586 358 (61.1) 228 (38.9) 139 (61.0) 15 (6.6) 2 (0.9) 11 (4.8) United Kingdom 8 963 4 603 (51.4) 4 313 (48.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total EU/EEA 72 334 55 939 (77.3) 16 116 (22.3) 3 521 (21.8) 3 084 (19.1) 596 (3.7) 474 (2.9) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a CNS - central nervous system. b Percentages among all notified TB cases. c Percentages among extrapulmonary cases. d Excluding Greenland (see Chapter 1.1). 79 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Extrapulmonary TB UnknownSpinal Gastrointestinal Meningitis Disseminated CNSa/other Other extrapulmonary Extrapulmonary no site specified N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)b 3 (2.2) 8 (5.9) 1 (0.7) 2 (1.5) 2 (1.5) 11 (8.1) 0 (0.0) 11 (1.6) 18 (6.1) 8 (2.7) 7 (2.4) 3 (1.0) 1 (0.3) 13 (4.4) 0 (0.0) 0 (0.0) 21 (3.1) 12 (1.8) 5 (0.7) 4 (0.6) 3 (0.4) 103 (15.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 2 (3.7) 6 (7.7) 0 (0.0) 0 (0.0) 0 (0.0) 2 (2.6) 12 (15.4) 0 (0.0) 0 (0.0) 0 (0.0) 2 (4.3) 0 (0.0) 1 (2.1) 0 (0.0) 3 (6.4) 0 (0.0) 94 (24.7) 4 (20.0) 0 (0.0) 1 (5.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 89 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 46 (3.6) 26 (2.0) 0 (0.0) 248 (19.2) 0 (0.0) 53 (1.1) 34 (3.7) 43 (4.6) 22 (2.4) 13 (1.4) 9 (1.0) 70 (7.6) 0 (0.0) 44 (1.0) 2 (3.3) 4 (6.7) 2 (3.3) 7 (11.7) 1 (1.7) 10 (16.7) 0 (0.0) 3 (0.6) 0 (0.0) 0 (0.0) 2 (3.6) 0 (0.0) 0 (0.0) 15 (26.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 1 (16.7) 0 (0.0) 0 (0.0) 5 (4.1) 4 (3.3) 3 (2.5) 1 (0.8) 0 (0.0) 21 (17.4) 6 (5.0) 11 (2.6) 72 (7.7) 56 (6.0) 14 (1.5) 18 (1.9) 14 (1.5) 157 (16.7) 0 (0.0) 0 (0.0) 4 (4.5) 1 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 6 (6.7) 0 (0.0) 0 (0.0) - - - - - - - - - - - - - - - - 0 (0.0) 2 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 42 (22.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (9.1) 0 (0.0) 1 (9.1) 0 (0.0) 0 (0.0) 1 (9.1) 0 (0.0) 0 (0.0) 26 (5.9) 33 (7.5) 3 (0.7) 0 (0.0) 7 (1.6) 53 (12.0) 0 (0.0) 3 (0.3) 12 (7.6) 0 (0.0) 3 (1.9) 2 (1.3) 2 (1.3) 16 (10.1) 0 (0.0) 3 (0.8) 35 (5.8) 12 (2.0) 10 (1.7) 16 (2.7) 2 (0.3) 53 (8.8) 0 (0.0) 0 (0.0) 36 (5.3) 30 (4.4) 16 (2.4) 32 (4.7) 9 (1.3) 90 (13.3) 0 (0.0) 8 (0.3) 129 (4.6) 65 (2.3) 129 (4.6) 0 (0.0) 3 (0.1) 108 (3.9) 0 (0.0) 0 (0.0) 13 (21.0) 1 (1.6) 0 (0.0) 0 (0.0) 0 (0.0) 3 (4.8) 0 (0.0) 0 (0.0) 1 (3.7) 3 (11.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 783 (100.0) 0 (0.0) 19 (8.3) 20 (8.8) 5 (2.2) 0 (0.0) 3 (1.3) 14 (6.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 313 (100.0) 47 (0.5) 441 (2.7) 304 (1.9) 270 (1.7) 125 (0.8) 59 (0.4) 1 051 (6.5) 6 191 (38.4) 279 (0.4) 80 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table D1: All tuberculosis cases by site of disease in children, EU/EEA, 2011 Country Total TB cases notified (N) Pulmonary TB Extrapulmonary Extrapulmonary TB Lymphatic Pleural Urogenital Bone N (%)b N (%)b N (%)c N (%)c N (%)c N (%)c Austria 24 21 (87.5) 3 (12.5) 1 (33.3) 0 (0.0) 0 (0.0) 1 (33.3) Belgium 85 60 (70.6) 25 (29.4) 19 (76.0) 2 (8.0) 0 (0.0) 0 (0.0) Bulgaria 176 16 (9.1) 160 (90.9) 158 (98.8) 1 (0.6) 0 (0.0) 0 (0.0) Cyprus 0 0 - 0 - 0 - 0 - 0 - 0 - Czech Republic 6 5 (83.3) 1 (16.7) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Denmarkd 16 8 (50.0) 3 (18.8) 1 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) Estonia 1 1 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Finland 11 9 (81.8) 2 (18.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) France 255 140 (54.9) 95 (37.3) 55 (57.9) 2 (2.1) 1 (1.1) 8 (8.4) Germany 179 142 (79.3) 32 (17.9) 18 (56.3) 0 (0.0) 0 (0.0) 7 (21.9) Greece 38 32 (84.2) 3 (7.9) 1 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) Hungary 4 4 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Iceland 1 1 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Ireland 20 11 (55.0) 9 (45.0) 5 (55.6) 1 (11.1) 0 (0.0) 0 (0.0) Italy 209 169 (80.9) 40 (19.1) 21 (52.5) 5 (12.5) 0 (0.0) 3 (7.5) Latvia 61 25 (41.0) 36 (59.0) 32 (88.9) 4 (11.1) 0 (0.0) 0 (0.0) Liechtenstein 88 7 (8.0) 81 (92.0) 40 (49.4) 3 (3.7) 0 (0.0) 1 (1.2) Lithuania - - - - - - - - - - - - - Luxembourg 1 1 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Malta 0 0 - 0 - 0 - 0 - 0 - 0 - Netherlands 56 22 (39.3) 34 (60.7) 29 (85.3) 2 (5.9) 0 (0.0) 1 (2.9) Norway 17 9 (52.9) 8 (47.1) 4 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) Poland 111 60 (54.1) 51 (45.9) 40 (78.4) 6 (11.8) 1 (2.0) 1 (2.0) Portugal 44 29 (65.9) 15 (34.1) 4 (26.7) 6 (40.0) 0 (0.0) 0 (0.0) Romania 776 317 (40.9) 459 (59.1) 286 (62.3) 113 (24.6) 1 (0.2) 6 (1.3) Slovakia 17 11 (64.7) 6 (35.3) 4 (66.7) 1 (16.7) 0 (0.0) 0 (0.0) Slovenia 4 2 (50.0) 2 (50.0) 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Spain 541 417 (77.1) 124 (22.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Sweden 36 28 (77.8) 8 (22.2) 4 (50.0) 1 (12.5) 0 (0.0) 0 (0.0) United Kingdom 413 251 (60.8) 150 (36.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total EU/EEA 3 190 1 798 (56.4) 1 347 (42.2) 725 (53.8) 147 (10.9) 3 (0.2) 28 (2.1) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a CNS - central nervous system. b Percentages among all notified TB cases. c Percentages among extrapulmonary cases. d Excluding Greenland (see Chapter 1.1). 81 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Extrapulmonary TB UnknownSpinal Gastrointestinal Meningitis Disseminated CNSa/other Other extrapulmonary Extrapulmonary no site specified N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)b 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (4.0) 2 (8.0) 0 (0.0) 0 (0.0) 1 (4.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (33.3) 0 (0.0) 1 (33.3) 0 (0.0) 5 (31.3) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (3.2) 0 (0.0) 0 (0.0) 26 (27.4) 0 (0.0) 20 (7.8) 1 (3.1) 0 (0.0) 2 (6.3) 0 (0.0) 0 (0.0) 4 (12.5) 0 (0.0) 5 (2.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (66.7) 0 (0.0) 3 (7.9) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (11.1) 2 (22.2) 0 (0.0) 0 (0.0) 1 (2.5) 0 (0.0) 1 (2.5) 2 (5.0) 7 (17.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 37 (45.7) 0 (0.0) 0 (0.0) - - - - - - - - - - - - - - - - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 3 (37.5) 0 (0.0) 0 (0.0) 1 (2.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (3.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (6.7) 1 (6.7) 0 (0.0) 0 (0.0) 3 (20.0) 0 (0.0) 0 (0.0) 4 (0.9) 5 (1.1) 31 (6.8) 0 (0.0) 0 (0.0) 13 (2.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 124 (100.0) 0 (0.0) 1 (12.5) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 150 (100.0) 12 (2.9) 7 (0.5) 9 (0.7) 40 (3.0) 3 (0.2) 3 (0.2) 104 7.7 278 (20.6) 45 (1.4) 82 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table D2: All tuberculosis cases by site of disease in adults, EU/EEA, 2011 Country Total TB cases notified (N) Pulmonary TB Extrapulmonary Extrapulmonary TB Lymphatic Pleural Urogenital Bone N (%)b N (%)b N (%)c N (%)c N (%)c N (%)c Austria 663 519 (78.3) 133 (20.1) 64 (48.1) 20 (15.0) 16 (12.0) 7 (5.3) Belgium 959 687 (71.6) 272 (28.4) 131 (48.2) 70 (25.7) 14 (5.1) 11 (4.0) Bulgaria 2 231 1 708 (76.6) 523 (23.4) 115 (22.0) 215 (41.1) 29 (5.5) 17 (3.3) Cyprus 54 44 (81.5) 8 (14.8) 5 (62.5) 2 (25.0) 0 (0.0) 0 (0.0) Czech Republic 594 517 (87.0) 77 (13.0) 33 (42.9) 16 (20.8) 6 (7.8) 2 (2.6) Denmarkd 365 232 (63.6) 44 (12.1) 30 (68.2) 6 (13.6) 4 (9.1) 0 (0.0) Estonia 340 320 (94.1) 20 (5.9) 5 (25.0) 6 (30.0) 2 (10.0) 2 (10.0) Finland 314 227 (72.3) 87 (27.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) France 4 685 3 459 (73.8) 1 193 (25.5) 522 (43.8) 227 (19.0) 46 (3.9) 108 (9.1) Germany 4 134 3 204 (77.5) 892 (21.6) 413 (46.3) 145 (16.3) 90 (10.1) 60 (6.7) Greece 447 390 (87.2) 57 (12.8) 21 (36.8) 8 (14.0) 3 (5.3) 1 (1.8) Hungary 1 441 1 385 (96.1) 56 (3.9) 6 (10.7) 9 (16.1) 11 (19.6) 13 (23.2) Iceland 8 2 (25.0) 6 (75.0) 3 (50.0) 1 (16.7) 0 (0.0) 0 (0.0) Ireland 404 281 (69.6) 112 (27.7) 41 (36.6) 23 (20.5) 5 (4.5) 6 (5.4) Italy 3 281 2 383 (72.6) 898 (27.4) 364 (40.5) 105 (11.7) 79 (8.8) 30 (3.3) Latvia 824 771 (93.6) 53 (6.4) 15 (28.3) 22 (41.5) 5 (9.4) 0 (0.0) Liechtenstein - - - - - - - - - - - - - Lithuania 1 816 1 707 (94.0) 109 (6.0) 11 (10.1) 55 (50.5) 17 (15.6) 19 (17.4) Luxembourg 25 21 (84.0) 4 (16.0) 4 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Malta 33 22 (66.7) 11 (33.3) 6 (54.5) 1 (9.1) 1 (9.1) 0 (0.0) Netherlands 951 541 (56.9) 407 (42.8) 196 (48.2) 62 (15.2) 19 (4.7) 10 (2.5) Norway 344 191 (55.5) 150 (43.6) 83 (55.3) 16 (10.7) 5 (3.3) 15 (10.0) Poland 8 367 7 819 (93.5) 548 (6.5) 109 (19.9) 208 (38.0) 67 (12.2) 39 (7.1) Portugal 2 487 1 822 (73.3) 657 (26.4) 211 (32.1) 180 (27.4) 48 (7.3) 11 (1.7) Romania 18 436 16 114 (87.4) 2 322 (12.6) 249 (10.7) 1 493 (64.3) 116 (5.0) 83 (3.6) Slovakia 382 326 (85.3) 56 (14.7) 16 (28.6) 17 (30.4) 7 (12.5) 0 (0.0) Slovenia 188 163 (86.7) 25 (13.3) 8 (32.0) 11 (44.0) 1 (4.0) 1 (4.0) Spain 6 211 4 553 (73.3) 1 658 (26.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Sweden 550 330 (60.0) 220 (40.0) 135 (61.4) 14 (6.4) 2 (0.9) 11 (5.0) United Kingdom 8 550 4 352 (50.9) 4 163 (48.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total EU/EEA 69 084 54 090 (78.3) 14 761 (21.4) 2 796 18.9 2 932 (19.9) 593 (4.0) 446 (3.0) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a CNS - central nervous system. b Percentages among all notified TB cases. c Percentages among extrapulmonary cases. d Excluding Greenland (see Chapter 1.1). 83 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Extrapulmonary TB UnknownSpinal Gastrointestinal Meningitis Disseminated CNSa/other Other extrapulmonary Extrapulmonary no site specified N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)b 3 (2.3) 8 (6.0) 1 (0.8) 2 (1.5) 1 (0.8) 11 (8.3) 0 (0.0) 11 (1.7) 18 (6.6) 7 (2.6) 5 (1.8) 3 (1.1) 1 (0.4) 12 (4.4) 0 (0.0) 0 (0.0) 21 (4.0) 12 (2.3) 4 (0.8) 4 (0.8) 3 (0.6) 103 (19.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 2 (3.7) 6 (7.8) 0 (0.0) 0 (0.0) 0 (0.0) 2 (2.6) 12 (15.6) 0 (0.0) 0 (0.0) 0 (0.0) 2 (4.5) 0 (0.0) 0 (0.0) 0 (0.0) 2 (4.5) 0 (0.0) 89 (24.4) 4 (20.0) 0 (0.0) 1 (5.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 87 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 42 (3.5) 26 (2.2) 0 (0.0) 222 (18.6) 0 (0.0) 33 (0.7) 33 (3.7) 43 (4.8) 20 (2.2) 13 (1.5) 9 (1.0) 66 (7.4) 0 (0.0) 38 (0.9) 2 (3.5) 4 (7.0) 2 (3.5) 7 (12.3) 1 (1.8) 8 (14.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (3.6) 0 (0.0) 0 (0.0) 15 (26.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 1 (16.7) 0 (0.0) 0 (0.0) 5 (4.5) 4 (3.6) 3 (2.7) 1 (0.9) 0 (0.0) 20 (17.9) 4 (3.6) 11 (2.7) 72 (8.0) 55 (6.1) 14 (1.6) 17 (1.9) 12 (1.3) 150 (16.7) 0 (0.0) 0 (0.0) 4 (7.5) 1 (1.9) 0 (0.0) 0 (0.0) 0 (0.0) 6 (11.3) 0 (0.0) 0 (0.0) - - - - - - - - - - - - - - - - 0 (0.0) 2 (1.8) 0 (0.0) 0 (0.0) 0 (0.0) 5 (4.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (9.1) 0 (0.0) 1 (9.1) 0 (0.0) 0 (0.0) 1 (9.1) 0 (0.0) 0 (0.0) 26 (6.4) 33 (8.1) 3 (0.7) 0 (0.0) 7 (1.7) 51 (12.5) 0 (0.0) 3 (0.3) 12 (8.0) 0 (0.0) 3 (2.0) 1 (0.7) 2 (1.3) 13 (8.7) 0 (0.0) 3 (0.9) 34 (6.2) 12 (2.2) 10 (1.8) 16 (2.9) 2 (0.4) 51 (9.3) 0 (0.0) 0 (0.0) 35 (5.3) 29 (4.4) 15 (2.3) 32 (4.9) 9 (1.4) 87 (13.2) 0 (0.0) 8 (0.3) 125 (5.4) 60 (2.6) 98 (4.2) 0 (0.0) 3 (0.1) 95 (4.1) 0 (0.0) 0 (0.0) 13 (23.2) 1 (1.8) 0 (0.0) 0 (0.0) 0 (0.0) 2 (3.6) 0 (0.0) 0 (0.0) 1 (4.0) 3 (12.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 658 (100.0) 0 (0.0) 18 (8.2) 19 (8.6) 5 (2.3) 0 (0.0) 3 (1.4) 13 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 163 (100.0) 35 (0.4) 433 (2.9) 295 (2.0) 229 (1.6) 122 (0.8) 56 (0.4) 947 (6.4) 5 912 (40.1) 233 (0.3)

85 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table E: Extrapulmonary TB cases by laboratory confirmation and multidrug resistance, EU/EEA, 2011 Country Total (N) Culture positive Culture negative Culture unknown/ not available MDR-TB N (%) N (%) N (%) N (%)a Austria 136 74 (54.4) 35 (25.7) 27 (19.9) 1 (1.4) Belgium 297 205 (69.0) 55 (18.5) 37 (12.5) 3 (1.5) Bulgaria 683 28 (4.1) 295 (43.2) 360 (52.7) 1 (3.6) Cyprus 8 6 (75.0) 0 (0.0) 2 (25.0) 1 (16.7) Czech Republic 78 31 (39.7) 40 (51.3) 7 (9.0) 0 (0.0) Denmarkb 47 38 (80.9) 8 (17.0) 1 (2.1) 1 (2.6) Estonia 20 9 (45.0) 9 (45.0) 2 (10.0) 1 (11.1) Finland 89 63 (70.8) 0 (0.0) 26 (29.2) 0 (0.0) France 1 289 504 (39.1) 162 (12.6) 623 (48.3) 0 (0.0) Germany 926 542 (58.5) 180 (19.4) 204 (22.0) 5 (0.9) Greece 60 24 (40.0) 2 (3.3) 34 (56.7) 0 (0.0) Hungary 56 7 (12.5) 22 (39.3) 27 (48.2) 0 (0.0) Iceland 6 4 (66.7) 1 (16.7) 1 (16.7) 0 (0.0) Ireland 121 62 (51.2) 15 (12.4) 44 (36.4) 0 (0.0) Italy 939 13 (1.4) 250 (26.6) 676 (72.0) 0 (0.0) Latvia 89 22 (24.7) 67 (75.3) 0 (0.0) 3 (13.6) Liechtenstein - - - - - - - - - Lithuania 190 34 (17.9) 156 (82.1) 0 (0.0) 4 (11.8) Luxembourg 4 2 (50.0) 1 (25.0) 1 (25.0) 0 (0.0) Malta 11 9 (81.8) 1 (9.1) 1 (9.1) 0 (0.0) Netherlands 441 267 (60.5) 69 (15.6) 105 (23.8) 3 (1.1) Norway 158 103 (65.2) 6 (3.8) 49 (31.0) 1 (1.0) Poland 599 254 (42.4) 255 (42.6) 90 (15.0) 0 (0.0) Portugal 675 203 (30.1) 63 (9.3) 409 (60.6) 4 (2.0) Romania 2 781 0 (0.0) 0 (0.0) 2 781 (100.0) 0 - Slovakia 62 10 (16.1) 37 (59.7) 15 (24.2) 0 (0.0) Slovenia 27 21 (77.8) 4 (14.8) 2 (7.4) 0 (0.0) Spain 1 783 799 (44.8) 523 (29.3) 461 (25.9) 0 (0.0) Sweden 228 170 (74.6) 35 (15.4) 23 (10.1) 6 (3.5) United Kingdom 4 313 2 067 (47.9) 0 (0.0) 2 246 (52.1) 29 (1.4) Total EU/EEA 16 116 5 571 (34.6) 2 291 (14.2) 8 254 (51.2) 63 (1.1) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a Percentage of MDR-TB culture-positive extrapulmonary cases, with available DST results. b Excluding Greenland (see Chapter 1.1). 86 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table F1: All TB cases by site and origin, EU/EEA, 2011 Country Total TB cases notified (N) Native Pulmonary TB Extrapulmonary Lymphatic Pleural Urogenital Bone N (%)b N (%)b N (%)c N (%)c N (%)c N (%)c Austria 354 270 (76.3) 77 (21.8) 31 (40.3) 14 (18.2) 12 (15.6) 2 (2.6) Belgium 500 366 (73.2) 134 (26.8) 60 (44.8) 41 (30.6) 12 (9.0) 6 (4.5) Bulgaria 2 398 1 717 (71.6) 681 (28.4) 272 (39.9) 216 (31.7) 29 (4.3) 17 (2.5) Cyprus 9 7 (77.8) 2 (22.2) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) Czech Republic 488 425 (87.1) 63 (12.9) 26 (41.3) 13 (20.6) 5 (7.9) 1 (1.6) Denmarkd 146 96 (65.8) 11 (7.5) 4 (36.4) 4 (36.4) 2 (18.2) 0 (0.0) Estonia 293 278 (94.9) 15 (5.1) 4 (26.7) 4 (26.7) 2 (13.3) 2 (13.3) Finland 212 162 (76.4) 50 (23.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) France 2 108 1 620 (76.9) 465 (22.1) 185 (39.8) 90 (19.4) 20 (4.3) 50 (10.8) Germany 2 100 1 735 (82.6) 353 (16.8) 116 (32.9) 73 (20.7) 53 (15.0) 27 (7.6) Greece 273 241 (88.3) 30 (11.0) 10 (33.3) 5 (16.7) 2 (6.7) 1 (3.3) Hungary 1 418 1 363 (96.1) 55 (3.9) 6 (10.9) 8 (14.5) 11 (20.0) 13 (23.6) Iceland 2 2 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Ireland 189 142 (75.1) 42 (22.2) 10 (23.8) 15 (35.7) 4 (9.5) 2 (4.8) Italy 1 578 1 151 (72.9) 427 (27.1) 138 (32.3) 61 (14.3) 57 (13.3) 15 (3.5) Latvia 817 735 (90.0) 82 (10.0) 45 (54.9) 22 (26.8) 5 (6.1) 0 (0.0) Liechtenstein - - - - - - - - - - - - - Lithuania 1 860 1 673 (89.9) 187 (10.1) 49 (26.2) 57 (30.5) 17 (9.1) 20 (10.7) Luxembourg 5 5 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Malta 5 2 (40.0) 3 (60.0) 0 (0.0) 0 (0.0) 1 (33.3) 0 (0.0) Netherlands 292 200 (68.5) 91 (31.2) 43 (47.3) 22 (24.2) 5 (5.5) 2 (2.2) Norway 44 32 (72.7) 12 (27.3) 4 (33.3) 3 (25.0) 0 (0.0) 1 (8.3) Poland 8 440 7 845 (93.0) 595 (7.0) 147 (24.7) 213 (35.8) 68 (11.4) 39 (6.6) Portugal 2 151 1 598 (74.3) 545 (25.3) 174 (31.9) 148 (27.2) 44 (8.1) 8 (1.5) Romania 19 162 16 390 (85.5) 2 772 (14.5) 528 (19.0) 1 605 (57.9) 116 (4.2) 89 (3.2) Slovakia 396 335 (84.6) 61 (15.4) 19 (31.1) 18 (29.5) 7 (11.5) 0 (0.0) Slovenia 135 116 (85.9) 19 (14.1) 7 (36.8) 7 (36.8) 1 (5.3) 1 (5.3) Spain 4 528 3 363 (74.3) 1 165 (25.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Sweden 62 44 (71.0) 18 (29.0) 6 (33.3) 5 (27.8) 0 (0.0) 1 (5.6) United Kingdom 2 226 1 550 (69.6) 649 (29.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total EU/EEA 52 191 43 463 (83.3) 8 604 (16.5) 1 885 (21.9) 2 644 (30.7) 473 (5.5) 297 (3.5) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a CNS - central nervous system. b Percentages among all notified TB cases. c Percentages among extrapulmonary cases. d Excluding Greenland (see Chapter 1.1). 87 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Native Site unknownSpinal Gastrointestinal Meningitis Disseminated CNSa/other Other extrapulmonary Extrapulmonary no site specified N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)b 1 (1.3) 4 (5.2) 1 (1.3) 2 (2.6) 2 (2.6) 8 (10.4) 0 (0.0) 7 (2.0) 2 (1.5) 3 (2.2) 2 (1.5) 0 (0.0) 1 (0.7) 7 (5.2) 0 (0.0) 0 (0.0) 21 (3.1) 12 (1.8) 5 (0.7) 4 (0.6) 3 (0.4) 102 (15.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 0 (0.0) 0 (0.0) 6 (9.5) 0 (0.0) 0 (0.0) 0 (0.0) 2 (3.2) 10 (15.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (9.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 39 (26.7) 2 (13.3) 0 (0.0) 1 (6.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 50 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 16 (3.4) 9 (1.9) 0 (0.0) 95 (20.4) 0 (0.0) 23 (1.1) 8 (2.3) 13 (3.7) 14 (4.0) 6 (1.7) 6 (1.7) 37 (10.5) 0 (0.0) 12 (0.6) 1 (3.3) 3 (10.0) 0 (0.0) 4 (13.3) 1 (3.3) 3 (10.0) 0 (0.0) 2 (0.7) 0 (0.0) 0 (0.0) 2 (3.6) 0 (0.0) 0 (0.0) 15 (27.3) 0 (0.0) 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 1 (2.4) 1 (2.4) 3 (7.1) 0 (0.0) 0 (0.0) 6 (14.3) 0 (0.0) 5 (2.6) 28 (6.6) 21 (4.9) 5 (1.2) 9 (2.1) 6 (1.4) 87 (20.4) 0 (0.0) 0 (0.0) 4 (4.9) 1 (1.2) 0 (0.0) 0 (0.0) 0 (0.0) 5 (6.1) 0 (0.0) 0 (0.0) - - - - - - - - - - - - - - - - 0 (0.0) 2 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 42 (22.5) 0 (0.0) 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 1 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (33.3) 0 (0.0) 0 (0.0) 1 (1.1) 2 (2.2) 2 (2.2) 0 (0.0) 1 (1.1) 13 (14.3) 0 (0.0) 1 (0.3) 2 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (8.3) 1 (8.3) 0 (0.0) 0 (0.0) 35 (5.9) 12 (2.0) 10 (1.7) 16 (2.7) 2 (0.3) 53 (8.9) 0 (0.0) 0 (0.0) 30 (5.5) 28 (5.1) 13 (2.4) 15 (2.8) 9 (1.7) 76 (13.9) 0 (0.0) 8 (0.4) 129 (4.7) 65 (2.3) 129 (4.7) 0 (0.0) 3 (0.1) 108 (3.9) 0 (0.0) 0 (0.0) 13 (21.3) 1 (1.6) 0 (0.0) 0 (0.0) 0 (0.0) 3 (4.9) 0 (0.0) 0 (0.0) 0 (0.0) 3 (15.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 165 (100.0) 0 (0.0) 0 (0.0) 3 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 3 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 649 (100.0) 27 (1.2) 285 (3.3) 175 (2.0) 203 (2.4) 65 (0.8) 37 (0.4) 676 (7.9) 1 864 (21.7) 124 0.2 88 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table F2: All TB cases by site and origin, EU/EEA, 2011 Country Total TB cases notified (N) Foreign origin Pulmonary TB Extrapulmonary Lymphatic Pleural Urogenital Bone N (%)b N (%)b N (%)c N (%)c N (%)c N (%)c Austria 326 264 (81.0) 58 (17.8) 33 (56.9) 6 (10.3) 4 (6.9) 6 (10.3) Belgium 544 381 (70.0) 163 (30.0) 90 (55.2) 31 (19.0) 2 (1.2) 5 (3.1) Bulgaria 9 7 (77.8) 2 (22.2) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) Cyprus 45 37 (82.2) 6 (13.3) 4 (66.7) 2 (33.3) 0 (0.0) 0 (0.0) Czech Republic 112 97 (86.6) 15 (13.4) 8 (53.3) 3 (20.0) 1 (6.7) 1 (6.7) Denmarkd 235 144 (61.3) 36 (15.3) 27 (75.0) 2 (5.6) 2 (5.6) 0 (0.0) Estonia 48 43 (89.6) 5 (10.4) 1 (20.0) 2 (40.0) 0 (0.0) 0 (0.0) Finland 79 48 (60.8) 31 (39.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) France 2 456 1 711 (69.7) 728 (29.6) 341 (46.8) 121 (16.6) 24 (3.3) 60 (8.2) Germany 2 025 1 481 (73.1) 528 (26.1) 294 (55.7) 71 (13.4) 30 (5.7) 37 (7.0) Greece 216 185 (85.6) 30 (13.9) 12 (40.0) 3 (10.0) 1 (3.3) 0 (0.0) Hungary 27 26 (96.3) 1 (3.7) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) Iceland 7 1 (14.3) 6 (85.7) 3 (50.0) 1 (16.7) 0 (0.0) 0 (0.0) Ireland 179 110 (61.5) 66 (36.9) 29 (43.9) 8 (12.1) 0 (0.0) 4 (6.1) Italy 1 677 1 230 (73.3) 447 (26.7) 221 (49.4) 50 (11.2) 22 (4.9) 16 (3.6) Latvia 59 52 (88.1) 7 (11.9) 2 (28.6) 4 (57.1) 0 (0.0) 0 (0.0) Liechtenstein - - - - - - - - - - - - - Lithuania 44 41 (93.2) 3 (6.8) 2 (66.7) 1 (33.3) 0 (0.0) 0 (0.0) Luxembourg 21 17 (81.0) 4 (19.0) 4 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Malta 28 20 (71.4) 8 (28.6) 6 (75.0) 1 (12.5) 0 (0.0) 0 (0.0) Netherlands 710 362 (51.0) 347 (48.9) 180 (51.9) 42 (12.1) 14 (4.0) 9 (2.6) Norway 317 168 (53.0) 146 (46.1) 83 (56.8) 13 (8.9) 5 (3.4) 14 (9.6) Poland 38 34 (89.5) 4 (10.5) 2 (50.0) 1 (25.0) 0 (0.0) 1 (25.0) Portugal 385 255 (66.2) 130 (33.8) 41 (31.5) 40 (30.8) 4 (3.1) 3 (2.3) Romania 50 41 (82.0) 9 (18.0) 7 (77.8) 1 (11.1) 1 (11.1) 0 (0.0) Slovakia 3 2 (66.7) 1 (33.3) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Slovenia 57 49 (86.0) 8 (14.0) 3 (37.5) 4 (50.0) 0 (0.0) 0 (0.0) Spain 2 138 1 560 (73.0) 578 (27.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Sweden 524 314 (59.9) 210 (40.1) 133 (63.3) 10 (4.8) 2 (1.0) 10 (4.8) United Kingdom 6 287 2 812 (44.7) 3 462 (55.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total EU/EEA 18 646 11 492 (61.6) 7 039 (37.8) 1 528 (21.7) 418 (5.9) 112 (1.6) 166 (2.4) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a CNS - central nervous system. b Percentages among all notified TB cases. c Percentages among extrapulmonary cases. d Excluding Greenland (see Chapter 1.1). 89 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Foreign origin Site unknownSpinal Gastrointestinal Meningitis Disseminated CNSa/other Other extrapulmonary Extrapulmonary no site specified N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)b 2 (3.4) 4 (6.9) 0 (0.0) 0 (0.0) 0 (0.0) 3 (5.2) 0 (0.0) 4 (1.2) 16 (9.8) 5 (3.1) 5 (3.1) 3 (1.8) 0 (0.0) 6 (3.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (4.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (13.3) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.8) 0 (0.0) 1 (2.8) 0 (0.0) 3 (8.3) 0 (0.0) 55 (23.4) 2 (40.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 31 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 29 (4.0) 17 (2.3) 0 (0.0) 136 (18.7) 0 (0.0) 17 (0.7) 25 (4.7) 27 (5.1) 7 (1.3) 7 (1.3) 3 (0.6) 27 (5.1) 0 (0.0) 16 (0.8) 1 (3.3) 1 (3.3) 2 (6.7) 3 (10.0) 0 (0.0) 7 (23.3) 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 1 (16.7) 0 (0.0) 0 (0.0) 4 (6.1) 3 (4.5) 0 (0.0) 1 (1.5) 0 (0.0) 13 (19.7) 4 (6.1) 3 (1.7) 40 (8.9) 31 (6.9) 9 (2.0) 7 (1.6) 8 (1.8) 43 (9.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (14.3) 0 (0.0) 0 (0.0) - - - - - - - - - - - - - - - - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 25 (7.2) 31 (8.9) 1 (0.3) 0 (0.0) 6 (1.7) 39 (11.2) 0 (0.0) 1 (0.1) 10 (6.8) 0 (0.0) 3 (2.1) 2 (1.4) 1 (0.7) 15 (10.3) 0 (0.0) 3 (0.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (4.6) 2 (1.5) 3 (2.3) 17 (13.1) 0 (0.0) 14 (10.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 578 (100.0) 0 (0.0) 19 (9.0) 17 (8.1) 5 (2.4) 0 (0.0) 3 (1.4) 11 (5.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 462 (100.0) 13 (0.2) 151 (2.1) 122 (1.7) 65 (0.9) 58 (0.8) 22 (0.3) 322 (4.6) 4 075 (57.9) 115 (0.6) 90 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table F3: All TB cases by site and origin, EU/EEA, 2011 Country Total TB cases notified (N) Unknown origin Pulmonary TB Extrapulmonary Lymphatic Pleural Urogenital Bone N (%)b N (%)b N (%)c N (%)c N (%)c N (%)c Austria 7 6 (85.7) 1 (14.3) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) Belgium 0 0 - 0 - 0 - 0 - 0 - 0 - Bulgaria 0 0 - 0 - 0 - 0 - 0 - 0 - Cyprus 0 0 - 0 - 0 - 0 - 0 - 0 - Czech Republic 0 0 - 0 - 0 - 0 - 0 - 0 - Denmarkd 0 0 - 0 - 0 - 0 - 0 - 0 - Estonia 0 0 - 0 - 0 - 0 - 0 - 0 - Finland 34 26 (76.5) 8 (23.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) France 378 269 (71.2) 96 (25.4) 51 (53.1) 18 (18.8) 3 (3.1) 6 (6.3) Germany 191 130 (68.1) 45 (23.6) 21 (46.7) 3 (6.7) 7 (15.6) 3 (6.7) Greece 0 0 - 0 - 0 - 0 - 0 - 0 - Hungary 0 0 - 0 - 0 - 0 - 0 - 0 - Iceland 0 0 - 0 - 0 - 0 - 0 - 0 - Ireland 57 41 (71.9) 13 (22.8) 7 (53.8) 1 (7.7) 1 (7.7) 0 (0.0) Italy 266 201 (75.6) 65 (24.4) 26 (40.0) 0 (0.0) 0 (0.0) 2 (3.1) Latvia 9 9 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Liechtenstein - - - - - - - - - - - - - Lithuania 0 0 - 0 - 0 - 0 - 0 - 0 - Luxembourg 0 0 - 0 - 0 - 0 - 0 - 0 - Malta 0 0 - 0 - 0 - 0 - 0 - 0 - Netherlands 5 1 (20.0) 3 (60.0) 2 (66.7) 0 (0.0) 0 (0.0) 0 (0.0) Norway 0 0 - 0 - 0 - 0 - 0 - 0 - Poland 0 0 - 0 - 0 - 0 - 0 - 0 - Portugal 4 4 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - Romania 0 0 - 0 - 0 - 0 - 0 - 0 - Slovakia 0 0 - 0 - 0 - 0 - 0 - 0 - Slovenia 0 0 - 0 - 0 - 0 - 0 - 0 - Spain 96 56 (58.3) 40 (41.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Sweden 0 0 - 0 - 0 - 0 - 0 - 0 - United Kingdom 450 241 (53.6) 202 (44.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total EU/EEA 1 497 984 (65.7) 473 (31.6) 108 (22.8) 22 (4.7) 11 (2.3) 11 (2.3) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a CNS - central nervous system. b Percentages among all notified TB cases. c Percentages among extrapulmonary cases. d Excluding Greenland (see Chapter 1.1). 91 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Unknown origin Site unknownSpinal Gastrointestinal Meningitis Disseminated CNSa/other Other extrapulmonary Extrapulmonary no site specified N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)c N (%)b 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 8 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.0) 0 (0.0) 0 (0.0) 17 (17.7) 0 (0.0) 13 (3.4) 1 (2.2) 3 (6.7) 1 (2.2) 0 (0.0) 0 (0.0) 6 (13.3) 0 (0.0) 16 (8.4) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (15.4) 2 (15.4) 3 (5.3) 4 (6.2) 4 (6.2) 0 (0.0) 2 (3.1) 0 (0.0) 27 (41.5) 0 (0.0) 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) - - - - - - - - - - - - - - - - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (33.3) 0 (0.0) 1 (20.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 40 (100.0) 0 (0.0) 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 202 (100.0) 7 (1.6) 5 (1.1) 7 (1.5) 2 (0.4) 2 (0.4) 0 (0.0) 53 (11.2) 252 (53.3) 40 2.7 92 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table G: Treatment success for all TB cases by site of disease, EU/EEA, 2010 Country To ta l e xt ra pu lm on ar y (N ) Treatment success Extrapulmonary TB by site Ly mp ha tic (N ) Treatment success Pl eu ra l ( N) Treatment success Ur og en ita l ( N) Treatment success Bo ne (N ) Treatment success Sp in al (N ) Treatment success N (%) N (%) N (%) N (%) N (%) N (%) Austria 133 85 (63.9) 76 54 (71.1) 15 10 (66.7) 5 4 (80.0) 6 2 (33.3) 4 1 (25.0) Belgium 303 244 (80.5) 174 143 (82.2) 41 36 (87.8) 18 17 (94.4) 10 5 (50.0) 17 15 (88.2) Bulgaria 798 738 (92.5) 305 296 (97.0) 238 212 (89.1) 20 20 (100.0) 23 21 (91.3) 25 20 (80.0) Cyprus 19 4 (21.1) 9 1 (11.1) 4 2 (50.0) 2 1 (50.0) 0 0 (0.0) 1 0 (0.0) Czech Republic 97 79 (81.4) 30 23 (76.7) 32 25 (78.1) 5 5 (100.0) 9 7 (77.8) 8 7 (87.5) Denmarka 44 31 (70.5) 18 13 (72.2) 6 4 (66.7) 3 3 (100.0) 1 1 (100.0) 6 4 (66.7) Estonia 21 13 (61.9) 5 3 (60.0) 7 5 (71.4) 5 4 (80.0) 1 1 (100.0) 2 0 (0.0) Finland - - - - - - - - - - - - - - - - - - France - - - - - - - - - - - - - - - - - - Germany 979 752 (76.8) 459 369 (80.4) 157 120 (76.4) 83 74 (89.2) 66 47 (71.2) 37 28 (75.7) Greece - - - - - - - - - - - - - - - - - - Hungary 74 62 (83.8) 6 5 (83.3) 32 27 (84.4) 5 4 (80.0) 15 11 (73.3) 0 0 (0.0) Iceland 4 4 (100.0) 2 2 (100.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) Ireland 150 117 (78.0) 61 52 (85.2) 24 18 (75.0) 4 2 (50.0) 8 6 (75.0) 5 2 (40.0) Italy - - - - - - - - - - - - - - - - - - Latvia 88 80 (90.9) 43 41 (95.3) 30 26 (86.7) 7 7 (100.0) 4 2 (50.0) 1 1 (100.0) Liechtenstein - - - - - - - - - - - - - - - - - - Lithuania 225 209 (92.9) 87 82 (94.3) 69 63 (91.3) 20 19 (95.0) 21 18 (85.7) 0 0 (0.0) Luxembourg - - - - - - - - - - - - - - - - - - Malta 13 8 (61.5) 9 6 (66.7) 1 0 (0.0) 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) Netherlands 475 406 (85.5) 237 213 (89.9) 54 47 (87.0) 22 17 (77.3) 26 23 (88.5) 33 30 (90.9) Norway 137 117 (85.4) 80 73 (91.3) 10 9 (90.0) 2 1 (50.0) 7 5 (71.4) 7 6 (85.7) Poland 517 386 (74.7) 120 94 (78.3) 199 144 (72.4) 69 54 (78.3) 42 27 (64.3) 24 21 (87.5) Portugal - - - - - - - - - - - - - - - - - - Romania 3 058 2 734 (89.4) 566 518 (91.5) 1 792 1 661 (92.7) 114 96 (84.2) 88 70 (79.5) 146 108 (74.0) Slovakia 67 62 (92.5) 12 11 (91.7) 21 19 (90.5) 12 12 (100.0) 3 3 (100.0) 12 11 (91.7) Slovenia 30 23 (76.7) 8 7 (87.5) 16 11 (68.8) 2 2 (100.0) 0 0 (0.0) 1 0 (0.0) Spain 1 933 1 312 (67.9) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) Sweden 252 218 (86.5) 141 129 (91.5) 26 19 (73.1) 9 9 (100.0) 15 12 (80.0) 15 11 (73.3) United Kingdom 3 949 3 304 (83.7) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) Total EU/EEA 13 366 10 988 (82.2) 2 448 2 135 (87.2) 2 774 2 458 (88.6) 407 351 (86.2) 346 262 (75.7) 344 265 (77.0) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland (see Chapter 1.1). 93 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Extrapulmonary TB by site Ga st ro -in te st in al (N ) Treatment success M en in gi tis (N ) Treatment success Di ss em in at ed (N ) Treatment success CN S/ ot he r ( N) Treatment success Ot he r ex tra pu lm on ar y ( N) Treatment success Ex tra pu lm on ar y n o sit e s pe cif ie d ( N) Treatment success N (%) N (%) N (%) N (%) N (%) N (%) 10 6 (60.0) 1 0 (0.0) 5 1 (20.0) 4 2 (50.0) 7 5 (71.4) 0 0 (0.0) 7 5 (71.4) 8 6 (75.0) 3 1 (33.3) 1 1 (100.0) 24 15 (62.5) 0 0 (0.0) 11 10 (90.9) 6 6 (100.0) 8 6 (75.0) 0 0 (0.0) 162 147 (90.7) 0 0 (0.0) 1 0 (0.0) 1 0 (0.0) 0 0 (0.0) 1 0 (0.0) 0 0 (0.0) 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) 0 0 (0.0) 1 1 (100.0) 11 10 (90.9) 0 0 (0.0) 1 0 (0.0) 2 1 (50.0) 1 1 (100.0) 1 0 (0.0) 5 4 (80.0) 0 0 (0.0) 0 0 (0.0) 1 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 42 30 (71.4) 23 10 (43.5) 17 9 (52.9) 11 6 (54.5) 84 59 (70.2) 0 0 (0.0) - - - - - - - - - - - - - - - - - - 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) 0 0 (0.0) 15 14 (93.3) 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) 0 0 (0.0) 8 2 (25.0) 1 1 (100.0) 4 2 (50.0) 35 32 (91.4) 0 0 (0.0) - - - - - - - - - - - - - - - - - - 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) 0 0 (0.0) 2 2 (100.0) 0 0 (0.0) - - - - - - - - - - - - - - - - - - 3 2 (66.7) 2 2 (100.0) 0 0 (0.0) 0 0 (0.0) 23 23 (100.0) 0 0 (0.0) - - - - - - - - - - - - - - - - - - 2 1 (50.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 30 21 (70.0) 8 1 (12.5) 0 0 (0.0) 11 8 (72.7) 54 46 (85.2) 0 0 (0.0) 0 0 (0.0) 2 1 (50.0) 4 2 (50.0) 2 2 (100.0) 23 18 (78.3) 0 0 (0.0) 13 8 (61.5) 5 3 (60.0) 4 2 (50.0) 4 3 (75.0) 37 30 (81.1) 0 0 (0.0) - - - - - - - - - - - - - - - - - - 78 63 (80.8) 128 91 (71.1) 0 0 (0.0) 4 3 (75.0) 142 124 (87.3) 0 0 (0.0) 2 1 (50.0) 0 0 (0.0) 1 1 (100.0) 0 0 (0.0) 4 4 (100.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 3 3 (100.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 1 933 1 312 (67.9) 19 17 (89.5) 5 2 (40.0) 3 1 (33.3) 6 6 (100.0) 13 12 (92.3) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) 3 949 3 304 (83.7) 221 166 (75.1) 202 127 (62.9) 47 25 (53.2) 50 34 (68.0) 645 549 (85.1) 5 882 4 616 (78.5) 94 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table H: Tuberculosis cases with HIV infection by site of disease, EU/EEA, 2011 Country Pulmonary Extrapulmonary Total (N)a Cases with known HIV status HIV positive Total (N)a Cases with known HIV status HIV positive N (%) N (%) N (%) N (%) Austria - - - - - - - - - - Belgium 747 592 (79.3) 34 (5.7) 297 253 (85.2) 10 (4.0) Bulgaria 1 724 1 408 (81.7) 4 (0.3) 683 290 (42.5) 1 (0.3) Cyprus - - - - - - - - - - Czech Republic 522 136 (26.1) 3 (2.2) 78 17 (21.8) 1 (5.9) Denmarkb - - - - - - - - - - Estonia 321 296 (92.2) 45 (15.2) 20 17 (85.0) 2 (11.8) Finland - - - - - - - - - - France - - - - - - - - - - Germany - - - - - - - - - - Greece - - - - - - - - - - Hungary - - - - - - - - - - Iceland 3 2 (66.7) 0 (0.0) 3 2 (66.7) 0 (0.0) Ireland 293 63 (21.5) 16 (25.4) 121 31 (25.6) 3 (9.7) Italy - - - - - - - - - - Latvia - - - - - - - - - - Liechtenstein - - - - - - - - - - Lithuania 1 714 1 286 (75.0) 21 (1.6) 190 66 (34.7) 1 (1.5) Luxembourg - - - - - - - - - - Malta 22 21 (95.5) 5 (23.8) 11 9 (81.8) 0 (0.0) Netherlands - - - - - - - - - - Norway - - - - - - - - - - Poland - - - - - - - - - - Portugal - - - - - - - - - - Romania 16 431 8 188 (49.8) 191 (2.3) 2 781 1 195 (43.0) 52 (4.4) Slovakia 337 336 (99.7) 0 (0.0) 62 59 (95.2) 0 (0.0) Slovenia 165 132 (80.0) 0 (0.0) 27 15 (55.6) 0 (0.0) Spain 4 979 3 398 (68.2) 295 (8.7) 1 783 1 143 (64.1) 120 (10.5) Sweden - - - - - - - - - - United Kingdom - - - - - - - - - - Subtotal EU/EEA 27 258 15 858 (58.2) 614 (3.9) 6 056 3 097 (51.1) 190 (6.1) ‘European Region’ comprises the 53 countries of the WHO European Region. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding cases from countries not reporting positive and negative HIV status b Excluding Greenland (see Chapter 1.1). 95 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Trend tables 96 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table I: All notified TB cases, rates per 100 000 population and mean annual change in rates, European Region, 1995–2011 Country Trend in rate, 1995–2011 1995 1996 1997 1998 1999 2000 2001 N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA Austria 0 10 20 1 479 18.6 1 488 19 1 396 17.5 1 316 16.5 1 245 15.6 1 225 15.3 1 075 13.4 Belgium 0 10 20 1 380 13.6 1 352 13 1 263 12.4 1 203 11.8 1 270 12.4 1 313 12.8 1 321 12.9 Bulgaria 0 25 50 3 245 38.5 3 109 37 3 437 41.2 4 117 49.7 3 530 42.9 3 349 40.9 3 862 47.4 Cyprus 0 5 10 36 5.6 24 4 47 7.1 45 6.7 39 5.7 33 4.8 40 5.7 Czech Republic 0 10 20 1 851 17.9 1 936 19 1 834 17.8 1 805 17.5 1 631 15.9 1 442 14.0 1 350 13.1 Denmarka 0 10 20 448 8.6 484 9.2 554 10.5 529 10.0 536 10.1 548 10.3 511 9.6 Estonia 0 50 100 608 42.0 683 47.9 744 52.9 818 58.7 754 54.7 791 57.7 812 59.4 Finland 0 10 20 654 12.8 635 12.4 557 10.9 612 11.9 594 11.5 546 10.6 501 9.7 France 0 10 20 8 723 14.7 7 656 12.9 6 832 11.4 6 651 11.1 6 674 11.1 6 714 11.1 6 465 10.6 Germany 0 10 20 12 198 15.0 11 814 14.4 11 163 13.6 10 440 12.7 9 974 12.2 9 064 11.0 7 539 9.2 Greece 0 10 20 939 8.9 945 8.9 767 7.1 1 152 10.7 952 8.8 703 6.4 617 5.6 Hungary 0 25 50 4 339 42.0 4 278 41.4 4 240 41.2 3 999 38.9 3 914 38.2 3 598 35.2 3 150 30.9 Iceland 0 5 10 12 4.5 11 4.1 10 3.7 17 6.2 12 4.4 13 4.7 13 4.6 Ireland 0 10 20 458 12.7 434 12.0 416 11.4 424 11.5 469 12.6 403 10.7 406 10.6 Italy 0 5 10 5 225 9.2 5 152 9.1 5 176 9.1 4 795 8.4 4 429 7.8 4 759 8.4 4 505 7.9 Latvia 0 50 100 1 541 61.6 1 761 71.3 2 003 81.9 2 182 90.1 1 968 82.0 2 063 86.6 2 082 88.1 Liechtenstein 0 10 20 - - - - - - - - - - - - - - Lithuania 0 50 100 2 362 64.8 2 608 72.1 2 926 81.5 3 016 84.7 2 903 82.1 2 981 84.9 2 989 85.7 Luxembourg 0 10 20 32 7.9 36 8.7 38 9.1 44 10.4 42 9.8 44 10.1 32 7.3 Malta 0 10 20 10 2.7 29 7.8 11 2.9 16 4.2 22 5.8 18 4.7 16 4.1 Netherlands 0 10 20 1 619 10.5 1 678 10.8 1 486 9.5 1 341 8.6 1 535 9.7 1 404 8.9 1 436 9.0 Norway 0 5 10 236 5.4 217 5.0 205 4.7 244 5.5 273 6.1 237 5.3 288 6.4 Poland 0 25 50 15 959 41.4 15 358 39.8 13 967 36.1 13 302 34.4 12 179 31.5 11 477 29.7 10 672 27.9 Portugal 0 50 100 5 577 55.7 5 248 52.3 5 112 50.8 5 260 52.0 5 160 50.8 4 494 44.1 4 399 42.9 Romania 0 100 200 23 271 102.5 24 113 106.4 23 903 105.9 25 758 114.3 26 870 119.5 27 667 123.2 30 440 135.7 Slovakia 0 25 50 1 537 28.7 1 499 27.9 1 298 24.1 1 282 23.8 1 218 22.6 1 111 20.6 1 076 20.0 Slovenia 0 25 50 525 26.4 563 28.3 481 24.2 449 22.6 438 22.1 380 19.1 371 18.6 Spain 0 25 50 8 764 22.3 8 331 21.1 9 347 23.6 9 111 23.0 8 393 21.1 8 395 21.0 7 453 18.4 Sweden 0 5 10 564 6.4 493 5.6 456 5.2 446 5.0 493 5.6 458 5.2 428 4.8 United Kingdom 0 10 20 6 161 10.6 6 240 10.7 6 355 10.9 5 719 9.8 5 701 9.7 6 724 11.4 6 864 11.6 Subtotal EU/EEA 0 15 30 109 753 22.7 108 175 22.3 106 024 21.9 106 093 21.8 103 218 21.2 101 954 20.9 100 713 20.6 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. Note: The data published in this report might differ from figures in national reports due to different times of reporting. The deadline for correcting and updating the data used in this report in the joint database was 31 October 2012. a Excluding Greenland data (see Chapter 1.1). 97 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 M ea n a nn ua l % ch an ge in ra te , 1 99 5– 20 11 Sl op e o f t re nd lin e 19 95 –2 01 1N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate 1 074 13.3 990 12.2 1 075 13.2 998 12.2 906 11.0 874 10.6 817 9.8 696 8.3 691 8.3 687 8.2 -4.9% -0.69 1 294 12.6 1 117 10.8 1 198 11.5 1 107 10.6 1 117 10.6 1 020 9.6 990 9.3 994 9.2 1 086 10.0 1 044 9.5 -2.0% -0.27 3 335 42.3 3 263 41.6 3 232 41.4 3 302 42.5 3 232 41.9 3 038 39.6 3 150 41.2 2 910 38.3 2 649 35.0 2 407 32.1 -0.7% -0.36 20 2.8 35 4.9 30 4.1 37 4.9 37 4.8 42 5.4 50 6.3 55 6.9 61 7.6 54 6.7 6.4% 0.08 1 200 11.8 1 162 11.4 1 057 10.4 984 9.6 951 9.3 846 8.2 864 8.3 694 6.6 669 6.4 600 5.7 -6.7% -0.86 419 7.8 393 7.3 385 7.1 428 7.9 387 7.1 391 7.2 380 6.9 334 6.1 366 6.6 381 6.9 -1.0% -0.24 713 52.4 623 45.9 594 44.0 518 38.4 460 34.2 491 36.6 444 33.1 411 30.7 333 24.8 341 25.4 -2.6% -1.83 477 9.2 415 8.0 336 6.4 372 7.1 297 5.7 348 6.6 344 6.5 417 7.8 325 6.1 325 6.0 -3.8% -0.46 6 322 10.3 6 098 9.9 5 578 9.0 5 368 8.6 5 323 8.4 5 574 8.8 5 758 9.0 5 276 8.2 5 116 7.9 4 942 7.6 -3.9% -0.35 7 701 9.3 7 166 8.7 6 542 7.9 6 020 7.3 5 378 6.5 5 000 6.1 4 523 5.5 4 427 5.4 4 388 5.4 4 316 5.3 -6.2% -0.66 582 5.3 620 5.6 774 7.0 769 6.9 681 6.1 639 5.7 664 5.9 589 5.2 487 4.3 489 4.3 -2.9% -0.27 2 838 27.9 2 582 25.5 2 340 23.1 1 964 19.5 1 859 18.4 1 685 16.7 1 619 16.1 1 407 14.0 1 741 17.4 1 445 14.5 -6.0% -2.03 8 2.8 5 1.7 12 4.1 11 3.7 13 4.3 14 4.6 6 1.9 9 2.8 22 6.9 9 2.8 10.9% -0.05 408 10.5 407 10.3 432 10.7 450 10.9 463 11.0 480 11.1 468 10.6 479 10.8 420 9.4 425 9.5 -1.6% -0.14 4 212 7.4 4 518 7.9 4 220 7.3 4 212 7.2 4 503 7.7 4 525 7.7 4 418 7.4 4 244 7.1 4 692 7.8 3 521 5.8 -2.5% -0.14 1 855 79.1 1 726 74.0 1 610 69.4 1 443 62.6 1 328 57.9 1 255 55.0 1 070 47.1 977 43.2 935 41.6 885 39.7 -2.3% -2.66 - - - - - - - - - - 5 14.2 - - - - - - - - - - 2 844 81.8 2 821 81.5 2 514 73.0 2 574 75.1 2 559 75.2 2 408 71.1 2 250 66.8 2 081 62.1 1 938 58.2 1 904 58.7 -0.4% -1.12 32 7.2 54 12.0 31 6.8 37 8.0 33 7.0 39 8.2 28 5.8 27 5.5 29 5.8 26 5.1 0.1% -0.25 24 6.1 7 1.8 19 4.8 25 6.2 30 7.4 38 9.3 53 12.9 44 10.6 32 7.7 33 7.9 24.6% 0.38 1 401 8.7 1 321 8.2 1 344 8.3 1 128 6.9 1 031 6.3 998 6.1 1 015 6.2 1 158 7.0 1 065 6.4 1 007 6.0 -3.1% -0.29 251 5.5 337 7.4 302 6.6 288 6.3 290 6.2 302 6.5 313 6.6 358 7.5 336 6.9 361 7.3 2.7% 0.14 10 475 27.4 10 124 26.5 9 493 24.9 9 269 24.3 8 587 22.5 8 614 22.6 8 080 21.2 8 236 21.6 7 509 19.7 8 478 22.2 -3.7% -1.26 4 501 43.6 4 148 39.9 3 854 36.8 3 558 33.8 3 456 32.7 3 139 29.6 3 002 28.3 2 871 27.0 2 626 24.7 2 540 23.9 -5.1% -2.09 33 595 153.9 31 039 142.6 31 034 142.9 29 288 135.2 26 600 123.1 24 837 115.2 24 680 114.6 23 164 107.7 21 059 98.1 19 212 89.7 -0.6% -0.43 1 053 19.6 983 18.3 705 13.1 760 14.1 730 13.5 682 12.6 633 11.7 506 9.3 439 8.1 399 7.3 -7.8% -1.32 350 17.6 293 14.7 263 13.2 278 13.9 215 10.7 218 10.8 213 10.6 188 9.3 172 8.4 192 9.4 -5.8% -1.25 7 626 18.6 7 467 17.9 7 766 18.3 7 820 18.2 8 029 18.3 7 768 17.5 8 216 18.1 7 592 16.6 7 239 15.7 6 762 14.7 -2.4% -0.46 407 4.6 408 4.6 461 5.1 559 6.2 497 5.5 482 5.3 546 5.9 617 6.7 668 7.2 586 6.2 0.4% 0.06 7 330 12.4 7 266 12.2 7 650 12.8 8 349 13.9 8 363 13.8 8 329 13.7 8 606 14.1 8 917 14.5 8 483 13.7 8 963 14.3 2.1% 0.30 102 347 20.9 97 388 19.8 94 851 19.2 91 916 18.5 87 355 17.5 84 081 16.8 83 200 16.5 79 678 15.8 75 576 14.9 72 334 14.2 -2.9% -0.53 98 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Country Trend in rate, 1995–2011 1995 1996 1997 1998 1999 2000 2001 N Rate N Rate N Rate N Rate N Rate N Rate N Rate Non-EU/EEA Albania 0 15 30 641 20.4 738 23.7 655 21.2 694 22.5 743 24.2 612 19.9 555 18.0 Andorra 0 25 50 0 - 17 26.1 23 35.4 8 12.5 10 15.6 12 18.6 10 15.1 Armenia 0 50 100 1 000 31.0 928 29.3 1 051 33.5 1 381 44.4 1 510 48.9 1 355 44.0 1 389 45.3 Azerbaijan 0 100 200 1 429 18.4 2 480 31.6 4 635 58.6 4 672 58.6 4 690 58.3 5 187 64.0 4 898 59.8 Belarus 0 50 100 4 854 47.2 5 598 54.6 5 832 57.2 6 150 60.5 7 339 72.6 6 799 67.6 2 341 23.4 Bosnia and Herzegovina 0 50 100 2 132 64.0 2 220 67.2 2 695 80.1 2 785 80.0 2 955 82.1 2 500 67.7 2 469 65.9 Croatia 0 25 50 2 114 45.3 2 174 46.7 2 054 44.4 2 118 46.2 1 765 38.9 - - 1 376 30.7 Georgia 0 100 200 1 625 32.1 3 522 70.5 8 446 171.5 5 098 104.8 5 837 121.5 4 819 101.5 4 006 85.5 Israel 0 10 20 0 0.0 369 6.7 422 7.5 643 11.2 522 8.9 537 8.9 512 8.4 Kazakhstan 0 200 400 11 310 71.0 13 944 88.7 17 060 110.2 20 623 135.1 24 979 165.6 27 875 186.4 26 224 176.0 Kyrgyzstan 0 100 200 3 393 73.9 4 093 87.9 5 346 112.8 3 214 66.6 6 376 130.2 6 463 130.4 - - Macedonia, the former Yugoslav Republic of 0 25 50 786 40.0 724 36.7 693 34.9 620 31.1 591 29.5 641 31.9 648 32.1 Moldova 0 100 200 2 925 67.4 2 922 67.8 2 908 68.1 2 625 62.2 2 711 65.1 2 935 71.5 3 608 89.3 Monaco 0 5 10 - - - - - - - - 3 8.6 - - - - Montenegro 0 25 50 - - - - - - - - - - - - - - Russia 0 100 200 84 980 57.1 111 075 74.8 121 765 82.2 121 434 82.2 134 360 91.2 153 155 104.4 132 477 90.6 San Marino 0 3 6 - - - - 1 3.8 - - - - 1 3.7 - - Serbia 0 25 50 - - - - - - - - - - - - - - Serbia excluding UN Administered Province of Kosovob 0 25 50 - - - - - - - - - - - - - - UN Administered Province of Kosovob 0 50 100 - - - - - - - - - - - - - - Switzerland 0 10 20 831 11.8 764 10.8 747 10.5 749 10.5 789 11.1 640 8.9 617 8.6 Tajikistan 0 100 200 2 029 35.1 1 647 28.1 1 858 31.3 2 448 40.6 - - 2 779 45.0 3 508 56.3 Turkey 0 25 50 22 981 39.0 20 212 33.8 20 778 34.2 22 509 36.5 22 088 35.2 18 038 28.3 4 444 6.9 Turkmenistan 0 100 200 1 939 46.3 2 072 48.6 3 357 77.4 3 839 87.3 4 092 92.0 5 932 131.8 3 948 86.7 Ukraine 0 100 200 21 459 42.0 23 414 46.1 27 204 54.0 31 318 62.8 32 879 66.6 32 945 67.4 3 150 6.5 Uzbekistan 0 100 200 9 866 43.0 11 919 51.1 12 954 54.5 14 558 60.3 15 318 62.6 16 074 64.9 7 095 28.3 Subtotal non-EU/EEA 0 50 100 176 294 46.6 210 832 55.5 240 484 63.2 247 486 64.9 269 557 70.6 289 299 75.7 203 573 53.2 Total European Region 0 50 100 286 047 33.2 319 007 37.0 346 508 40.1 353 579 40.8 372 775 43.0 391 253 45.1 304 286 35.0 Subtotal 18 HPC 0 100 200 200 817 52.7 236 100 61.8 266 207 69.7 275 760 72.2 298 204 78.0 321 207 84.0 237 571 62.2 b In accordance with the UN Security Council Resolution No. 1244 (1999). 99 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 M ea n a nn ua l % ch an ge in ra te , 1 99 5– 20 11 Sl op e o f t re nd lin e 19 95 –2 01 1N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate 594 19.2 561 18.1 581 18.6 540 17.2 502 15.9 447 14.1 434 13.6 447 14.0 445 13.9 431 13.4 -2.2% -0.65 5 7.2 11 15.2 7 9.3 10 12.8 13 16.3 6 7.4 4 4.8 9 10.8 7 8.2 4 4.6 3.1% -0.77 1 433 46.8 1 570 51.3 1 701 55.5 2 322 75.7 2 155 70.2 2 129 69.3 2 125 69.0 2 006 65.0 1 780 57.6 1 582 51.0 4.0% 2.21 5 142 62.1 3 931 46.9 6 501 76.7 7 920 92.2 7 498 86.2 7 347 83.3 10 078 112.7 10 417 114.9 8 394 91.4 10 100 108.5 15.5% 4.89 - - 5 963 60.1 6 490 65.7 6 357 64.7 6 065 62.0 5 756 59.2 5 483 56.6 5 511 57.2 5 554 57.9 5 118 53.5 -9.1% 0.32 1 691 44.8 1 780 47.1 2 382 63.0 2 160 57.1 1 800 47.6 2 400 63.5 1 736 46.0 1 772 47.0 1 390 37.0 1 385 36.9 -1.6% -2.28 1 443 32.3 1 494 33.5 1 297 29.1 1 144 25.8 1 135 25.6 982 22.2 980 22.2 855 19.4 695 15.8 619 14.1 -12.3% -1.81 4 490 97.1 5 993 131.1 5 967 132.0 6 448 144.0 6 311 142.0 5 912 133.9 5 836 132.8 5 978 136.7 5 796 133.2 5 533 127.8 15.9% 3.58 466 7.5 472 7.4 456 7.0 372 5.6 340 5.0 397 5.7 322 4.5 347 4.8 343 4.6 418 5.5 0.1% -0.12 27 546 184.9 44 868 299.9 39 380 261.6 40 429 266.5 38 556 251.8 37 658 243.3 28 913 184.7 30 578 193.0 28 550 178.1 26 211 161.7 7.0% 7.01 6 613 132.2 8 670 173.1 6 591 131.3 6 765 134.2 6 656 130.9 6 707 130.5 7 127 136.9 6 358 120.6 6 295 118.0 6 666 123.6 7.4% 2.95 686 33.9 697 34.4 680 33.4 658 32.3 627 30.7 563 27.5 483 23.5 473 23.0 420 20.4 362 17.5 -4.8% -1.02 1 146 28.9 6 241 160.2 6 008 157.0 6 278 166.7 6 118 164.7 6 367 173.4 5 838 160.6 5 591 155.2 5 447 152.5 5 341 150.7 25.8% 8.01 - - - - - - - - - - - - - - - - 1 2.8 - - - -0.04 - - - - - - 170 27.1 171 27.3 159 25.3 133 21.1 120 19.0 114 18.1 112 17.7 -6.7% 1.78 128 873 88.6 152 244 105.1 152 438 105.6 154 379 107.3 152 265 106.1 214 924 150.0 214 905 150.1 156 222 109.2 162 553 113.7 159 479 111.7 5.4% 3.68 1 3.5 1 3.4 - - - - - - - - - - - - - - - - - -0.09 - - - - - - 3 468 35.2 3 272 33.3 2 981 24.9 2 813 23.5 2 595 21.6 2 385 19.9 2 216 18.5 -7.2% -1.64 - - - - - - 3 468 35.2 3 272 33.3 1 020 10.4 1 091 11.1 970 9.8 1 501 15.2 1 341 13.6 -9.9% -1.05 - - - - - - - - - - 1 961 92.2 1 722 80.0 1 625 74.5 884 41.6 875 41.1 -16.3 -14.06 671 9.2 630 8.6 602 8.2 563 7.6 519 6.9 472 6.3 516 6.8 554 7.3 548 7.2 578 7.5 -2.5% -0.31 687 10.9 4 883 77.1 5 122 80.1 7 526 116.6 6 671 102.2 8 081 122.4 7 996 119.5 7 482 110.3 7 641 111.1 7 609 109.1 34.4% 7.09 - - 6 032 9.1 8 444 12.6 21 303 31.3 20 526 29.7 19 694 28.1 18 452 26.0 17 402 24.2 16 551 22.7 15 679 21.3 3.3% -0.72 3 671 79.8 4 759 102.4 4 182 89.0 3 291 69.3 3 369 70.2 3 698 76.1 3 909 79.5 3 157 63.4 3 230 64.1 0 -1.8% -1.62 - - 53 444 112.2 - - - - 41 265 88.6 40 643 87.8 37 832 82.3 38 901 85.1 36 409 80.1 42 676 94.4 -2.9% 2.64 20 588 81.5 26 172 102.7 25 714 100.0 28 891 111.3 25 310 96.6 23 390 88.3 21 194 79.0 21 453 79.1 20 330 74.1 15 913 57.3 9.3% 2.20 205 746 79.4 330 416 88.6 274 543 81.7 300 994 89.3 331 144 86.0 390 713 100.6 377 109 97.2 318 228 81.3 314 878 80.1 308 032 78.1 4.6% 2.25 308 093 35.3 427 804 48.9 369 394 44.5 392 910 47.2 418 499 47.4 474 789 53.6 460 309 51.7 397 906 44.5 390 454 43.6 380 366 40.8 2.1% 0.66 242 531 97.6 364 242 95.3 307 522 91.8 329 034 98.0 356 944 93.1 414 335 107.9 401 282 104.2 340 599 88.1 335 444 86.5 326 656 84.0 5.2% 2.20 100 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table II: All laboratory confirmed tuberculosis cases, European Region, 1995–2011 Country Trend in percentage, 1995–2011 1995 1996 1997 1998 1999 2000 2001 N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s EU/EEA Austria 0 50 100 945 (63.9) 910 (61.2) 853 (61.1) 864 (65.7) 852 (68.4) 802 (65.5) 696 (64.7) Belgium 0 50 100 742 (53.8) 731 (54.1) 641 (50.8) 813 (67.6) 926 (72.9) 969 (73.8) 958 (72.5) Bulgaria 0 50 100 - - - - - - - - - - 1 408 (42.0) 1 323 (34.3) Cyprus 0 50 100 - - - - - - - - - - - - - - Czech Republic 0 50 100 - - 1 002 (51.8) 907 (49.5) 951 (52.7) 830 (50.9) 875 (60.7) 854 (63.3) Denmarka 0 50 100 406 (90.6) 427 (88.2) 459 (82.9) 445 (84.1) 428 (79.9) 430 (78.5) 383 (75.0) Estonia 0 50 100 181 (29.8) 440 (64.4) 595 (80.0) 536 (65.5) 528 (70.0) 541 (68.4) 591 (72.8) Finland 0 50 100 477 (72.9) 513 (80.8) 447 (80.3) 499 (81.5) 511 (86.0) 460 (84.2) 419 (83.6) France 0 50 100 - - 1 563 (20.4) 1 576 (23.1) 1 631 (24.5) 1 683 (25.2) 1 756 (26.2) 1 744 (27.0) Germany 0 50 100 - - - - - - - - - - - - 4 670 (61.9) Greece 0 50 100 - - - - - - - - 396 (41.6) 287 (40.8) 268 (43.4) Hungary 0 50 100 - - - - - - - - 1 206 (30.8) 912 (25.3) 940 (29.8) Iceland 0 50 100 9 (75.0) 6 (54.5) 9 (90.0) 11 (64.7) 8 (66.7) 9 (69.2) 12 (92.3) Ireland 0 50 100 - - - - - - 243 (57.3) 260 (55.4) 229 (56.8) 149 (36.7) Italy 0 50 100 1 860 (35.6) 2 111 (41.0) 2 193 (42.4) 2 261 (47.2) 2 164 (48.9) 1 778 (37.4) 1 616 (35.9) Latvia 0 50 100 - - - - - - - - - - 1 298 (62.9) 1 288 (61.9) Liechtenstein 0 50 100 - - - - - - - - - - - - - - Lithuania 0 50 100 - - - - - - - - - - 1 556 (52.2) 1 771 (59.3) Luxembourg 0 50 100 24 (75.0) 22 (61.1) 6 (15.8) 44 (100.0) 42 (100.0) 44 (100.0) 32 (100.0) Malta 0 50 100 4 (40.0) 9 (31.0) 2 (18.2) 4 (25.0) 13 (59.1) 10 (55.6) 10 (62.5) Netherlands 0 50 100 808 (49.9) 1 225 (73.0) 1 049 (70.6) 692 (51.6) 943 (61.4) 863 (61.5) 915 (63.7) Norway 0 50 100 150 (63.6) 149 (68.7) 139 (67.8) 176 (72.1) 186 (68.1) 170 (71.7) 220 (76.4) Poland 0 50 100 - - - - - - - - 6 700 (55.0) 6 377 (55.6) 5 965 (55.9) Portugal 0 50 100 - - - - - - - - - - 2 281 (50.8) 2 290 (52.1) Romania 0 50 100 8 582 (36.9) 5 630 (23.3) 13 726 (57.4) 13 158 (51.1) 13 495 (50.2) 13 708 (49.5) 13 816 (45.4) Slovakia 0 50 100 - - 811 (54.1) 748 (57.6) 737 (57.5) 645 (53.0) 596 (53.6) 575 (53.4) Slovenia 0 50 100 307 (58.5) 423 (75.1) 356 (74.0) 346 (77.1) 350 (79.9) 324 (85.3) 308 (83.0) Spain 0 50 100 - - - - - - - - - - 3 436 (40.9) 2 693 (36.1) Sweden 0 50 100 460 (81.6) 417 (84.6) 380 (83.3) 368 (82.5) 412 (83.6) 371 (81.0) 359 (83.9) United Kingdom 0 50 100 - - - - - - 3 104 (54.3) 2 904 (50.9) 3 231 (48.1) 3 551 (51.7) Subtotal EU/EEA 0 50 100 14 955 (32.1) 16 389 (34.1) 24 086 (52.1) 26 883 (50.3) 35 482 (49.8) 44 721 (48.2) 48 416 (44.1) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 101 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s 703 (65.5) 636 (64.2) 675 (62.8) 654 (65.5) 569 (62.8) 541 (61.9) 488 (59.7) 445 (63.9) 480 (69.5) 466 (67.8) 1 014 (78.4) 868 (77.7) 937 (78.2) 834 (75.3) 884 (79.1) 800 (78.4) 810 (81.8) 802 (80.7) 854 (78.6) 797 (76.3) 1 626 (48.8) 1 377 (42.2) 1 283 (39.7) 1 254 (38.0) 1 360 (42.1) 1 385 (45.6) 1 360 (43.2) 1 281 (44.0) 1 174 (44.3) 1 071 (44.5) 13 (65.0) 23 (65.7) 19 (63.3) 19 (51.4) 23 (62.2) 33 (78.6) 36 (72.0) 41 (74.5) 59 (96.7) 44 (81.5) 758 (63.2) 756 (65.1) 666 (63.0) 644 (65.4) 621 (65.3) 557 (65.8) 560 (64.8) 477 (68.7) 434 (64.9) 426 (71.0) 311 (74.2) 299 (76.1) 291 (75.6) 328 (76.6) 301 (77.8) 293 (74.9) 291 (76.6) 242 (72.5) 287 (78.4) 272 (71.4) 534 (74.9) 466 (74.8) 452 (76.1) 389 (75.1) 352 (76.5) 385 (78.4) 348 (78.4) 308 (74.9) 264 (79.3) 264 (77.4) 395 (82.8) 351 (84.6) 293 (87.2) 326 (87.6) 272 (91.6) 252 (72.4) 249 (72.4) 307 (73.6) 255 (78.5) 252 (77.5) 1 725 (27.3) 2 394 (39.3) 2 570 (46.1) 2 412 (44.9) 2 412 (45.3) 2 535 (45.5) 2 532 (44.0) 2 427 (46.0) 2 386 (46.6) 2 309 (46.7) 4 966 (64.5) 4 704 (65.6) 4 362 (66.7) 4 142 (68.8) 3 814 (70.9) 3 503 (70.1) 3 194 (70.6) 3 208 (72.5) 3 108 (70.8) 3 071 (71.2) 271 (46.6) 229 (36.9) 206 (26.6) 214 (27.8) 210 (30.8) 210 (32.9) 248 (37.3) 303 (51.4) 189 (38.8) 278 (56.9) 959 (33.8) 929 (36.0) 990 (42.3) 777 (39.6) 832 (44.8) 772 (45.8) 760 (46.9) 706 (50.2) 623 (35.8) 597 (41.3) 6 (75.0) 4 (80.0) 8 (66.7) 8 (72.7) 12 (92.3) 11 (78.6) 5 (83.3) 8 (88.9) 19 (86.4) 4 (44.4) 253 (62.0) 261 (64.1) 279 (64.6) 283 (62.9) 316 (68.3) 315 (65.6) 312 (66.7) 341 (71.2) 281 (66.9) 288 (67.8) 1 600 (38.0) 2 554 (56.5) 1 954 (46.3) 1 662 (39.5) 1 735 (38.5) 1 840 (40.7) 1 529 (34.6) 1 381 (32.5) 1 651 (35.2) 982 (27.9) 1 296 (69.9) 1 263 (73.2) 1 157 (71.9) 1 109 (76.9) 995 (74.9) 994 (79.2) 838 (78.3) 773 (79.1) 733 (78.4) 671 (75.8) - - - - - - - - - - 5 (100.0) - - - - - - - - 1 544 (54.3) 1 680 (59.6) 1 598 (63.6) 1 739 (67.6) 1 787 (69.8) 1 686 (70.0) 1 616 (71.8) 1 478 (71.0) 1 363 (70.3) 1 403 (73.7) 32 (100.0) 54 (100.0) 31 (100.0) 37 (100.0) 33 (100.0) 26 (66.7) 0 (0.0) 27 (100.0) 20 (69.0) 19 (73.1) 14 (58.3) 3 (42.9) 8 (42.1) 11 (44.0) 15 (50.0) 19 (50.0) 25 (47.2) 20 (45.5) 16 (50.0) 24 (72.7) 768 (54.8) 756 (57.2) 759 (56.5) 852 (75.5) 755 (73.2) 721 (72.2) 745 (73.4) 760 (65.6) 787 (73.9) 732 (72.7) 192 (76.5) 273 (81.0) 246 (81.5) 214 (74.3) 225 (77.6) 245 (81.1) 226 (72.2) 287 (80.2) 276 (82.1) 262 (72.6) 5 663 (54.1) 5 553 (54.8) 5 049 (53.2) 5 399 (58.2) 5 229 (60.9) 5 410 (62.8) 5 093 (63.0) 5 223 (63.4) 4 756 (63.3) 5 581 (65.8) 2 571 (57.1) 2 296 (55.4) 2 317 (60.1) 2 193 (61.6) 2 234 (64.6) 2 076 (66.1) 2 085 (69.5) 1 981 (69.0) 1 605 (61.1) 1 588 (62.5) 18 547 (55.2) 17 012 (54.8) 18 605 (60.0) 18 483 (63.1) 16 844 (63.3) 16 189 (65.2) 14 741 (59.7) 15 243 (65.8) 13 673 (64.9) 12 446 (64.8) 504 (47.9) 406 (41.3) 357 (50.6) 357 (47.0) 401 (54.9) 397 (58.2) 383 (60.5) 235 (46.4) 234 (53.3) 188 (47.1) 292 (83.4) 259 (88.4) 231 (87.8) 245 (88.1) 184 (85.6) 189 (86.7) 201 (94.4) 179 (95.2) 155 (90.1) 182 (94.8) 3 837 (50.3) 3 572 (47.8) 3 457 (44.5) 3 686 (47.1) 3 651 (45.5) 3 950 (50.8) 4 493 (54.7) 4 095 (53.9) 4 890 (67.6) 4 383 (64.8) 353 (86.7) 349 (85.5) 370 (80.3) 444 (79.4) 397 (79.9) 365 (75.7) 436 (79.9) 515 (83.5) 524 (78.4) 476 (81.2) 4 025 (54.9) 4 163 (57.3) 4 501 (58.8) 4 849 (58.1) 4 963 (59.3) 4 775 (57.3) 4 852 (56.4) 5 035 (56.5) 4 909 (57.9) 5 285 (59.0) 54 772 (53.5) 53 490 (54.9) 53 671 (56.6) 53 564 (58.3) 51 426 (58.9) 50 479 (60.0) 48 456 (58.2) 48 128 (60.4) 46 005 (60.9) 44 361 (61.3) 102 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Country Trend in percentage, 1995–2011 1995 1996 1997 1998 1999 2000 2001 N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s Non-EU/EEA Albania 0 50 100 - - - - - - - - - - - - - - Andorra 0 50 100 - - - - - - - - - - - - - - Armenia 0 50 100 - - - - - - - - - - - - - - Azerbaijan 0 50 100 - - - - - - - - - - - - - - Belarus 0 50 100 - - - - - - - - - - - - - - Bosnia and Herzegovina 0 50 100 - - - - - - - - - - - - - - Croatia 0 50 100 - - - - - - - - - - - - - - Georgia 0 50 100 - - - - - - - - - - - - - - Israel 0 50 100 - - - - - - - - - - - - - - Kazakhstan 0 50 100 - - - - - - - - - - - - - - Kyrgyzstan 0 50 100 - - - - - - - - - - - - - - Macedonia, the former Yugoslav Republic of 0 50 100 - - - - - - - - - - - - - - Moldova 0 50 100 - - - - - - - - - - - - - - Monaco 0 50 100 - - - - - - - - - - - - - - Montenegro 0 50 100 - - - - - - - - - - - - - - Russia 0 50 100 - - - - - - - - - - - - - - San Marino - - - - - - - - - - - - - - Serbia 0 50 100 - - - - - - - - - - - - - - Serbia excluding UN Administered Province of Kosovob 0 50 100 - - - - - - - - - - - - - - UN Administered Province of Kosovob - - - - - - - - - - - - - - Switzerland 0 50 100 - - - - - - - - - - - - - - Tajikistan 0 50 100 - - - - - - - - - - - - - - Turkey 0 50 100 - - - - - - - - - - - - - - Turkmenistan 0 50 100 - - - - - - - - - - - - - - Ukraine 0 50 100 - - - - - - - - - - - - - - Uzbekistan 0 50 100 - - - - - - - - - - - - - - Subtotal non-EU/EEA 0 50 100 - - - - - - - - - - - - - - Total European Region 0 50 100 - - - - - - - - - - - - - - Subtotal 18 HPC 0 50 100 - - - - - - - - - - - - - - b In accordance with the UN Security Council Resolution No. 1244 (1999). 103 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s - - - - - - - - 197 (39.2) 179 (40.0) - - 209 (46.8) 205 (46.1) 205 (47.6) - - - - - - - - 8 (61.5) 3 (50.0) 3 (75.0) 3 (33.3) 4 (57.1) 3 (75.0) - - - - - - - - 580 (26.9) 497 (23.3) 599 (28.2) 680 (33.9) 691 (38.8) 529 (33.4) - - - - - - - - 1 454 (19.4) 1 356 (18.5) - - - - 2 957 (35.2) 2 176 (22.2) - - - - - - - - 2 086 (34.4) 1 988 (34.5) 1 934 (35.3) 2 188 (39.7) 3 783 (68.1) 3 137 (61.3) - - - - - - - - 993 (55.2) 1 266 (52.8) 757 (43.6) 920 (51.9) 647 (46.5) 745 (53.8) - - - - - - - - 583 (51.4) 575 (58.6) 440 (44.9) 517 (60.5) 492 (70.8) 393 (63.5) - - - - - - - - 1 831 (29.0) 1 979 (33.5) 2 194 (37.6) 2 584 (43.2) 2 724 (47.0) 2 955 (53.4) - - - - - - - - 206 (60.6) 242 (61.0) 178 (55.3) 266 (76.7) 247 (72.0) 284 (67.9) - - - - - - - - 7 227 (18.7) 7 184 (19.1) - - 9 774 (32.0) 11 571 (40.5) 11 555 (50.1) - - - - - - - - 1 833 (27.5) 1 720 (25.6) - - 1 930 (30.4) 941 (14.9) - - - - - - - - - - 212 (33.8) 247 (43.9) 178 (36.9) 238 (50.3) 187 (44.5) 155 (42.8) - - - - - - - - 1 679 (27.4) 1 940 (30.5) 2 161 (37.0) 2 416 (43.2) 2 609 (47.9) 2 561 (47.9) - - - - - - - - - - - - - - - - 1 (100.0) - - - - - - - - - - 101 (59.1) 76 (47.8) 74 (55.6) 89 (74.2) 74 (64.9) 72 (64.3) - - - - - - - - 46 491 (30.5) 50 262 (23.4) 50 168 (23.3) 68 963 (44.1) 54 208 (33.3) 51 924 (32.6) - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 271 (38.8) 1 397 (46.9) 1 316 (46.8) - - 1 122 (47.0) 1 025 (76.4) - - - - - - - - 1 271 (38.8) 1 397 (46.9) 1 316 (46.8) - - 1 122 (47.0) 1 025 (76.4) - - - - - - - - - - - - - - - - - - - - - - - - - - - - 308 (59.3) 331 (70.1) 185 (35.9) 470 (84.8) 469 (85.6) 487 (84.3) - - - - - - - - 2 051 (30.7) 2 228 - - - 1 413 (18.9) 648 (8.5) 1 623 (21.3) - - - - - - - - 9 142 (44.5) 8 741 (44.4) 8 178 (44.3) 5 835 (33.5) 4 965 (30.0) 4 828 (30.8) - - - - - - - - 1 155 (34.3) - - 1 331 (34.0) 275 (8.7) 169 (5.2) - - - - - - - - - 14 206 (34.4) 11 028 (27.1) 14 866 (39.3) 19 035 (48.9) 14 876 (40.9) 20 103 (47.1) - - - - - - - - 7 211 (28.5) 6 326 (27.0) 5 117 (24.1) 2 579 (12.0) 4 167 (20.5) 4 430 (27.8) - - - - - - - - 100 825 (30.4) 99 565 (26.0) 89 679 (24.4) 120 384 (39.4) 107 757 (34.2) 109 190 (35.4) - - - - - - - - 152 251 (36.4) 150 039 (31.6) 138 135 (30.0) 168 512 (42.3) 153 762 (39.4) 153 551 (40.4) - - - - - - - - 118 284 (33.1) 115 888 (28.0) 105 451 (26.3) 136 755 (40.2) 121 516 (36.2) 121 676 (37.2) 104 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table III: Tuberculosis cases in children (<15 years old), European Region, 1995–2011 Table IIIa: 1995–2001 Country Trend in percentage, 1995–2011 1995 1996 1997 1998 N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate EU/EEA Austria 0 5 10 55 (3.7) 3.9 51 (3.4) 3.6 63 (4.5) 4.5 47 (3.6) 3.4 Belgium 0 5 10 87 (6.3) 4.8 69 (5.1) 3.8 67 (5.3) 3.7 78 (6.5) 4.3 Bulgaria 0 5 10 - - - - - - - - - - - - Cyprus 0 5 10 - - - - - - - - - - - - Czech Republic 0 2 4 65 (3.5) 3.3 38 (2.0) 2.0 20 (1.1) 1.1 34 (1.9) 1.9 Denmarka 0 5 10 28 (6.3) 3.1 40 (8.3) 4.3 52 (9.4) 5.5 48 (9.1) 5.0 Estonia 0 2 4 18 (3.0) 6.0 18 (2.6) 6.2 28 (3.8) 10.0 10 (1.2) 3.7 Finland 0 2 4 6 (0.9) 0.6 5 (0.8) 0.5 5 (0.9) 0.5 6 (1.0) 0.6 France 0 5 10 426 (4.9) 3.6 383 (5.0) 3.3 308 (4.5) 2.7 333 (5.0) 2.9 Germany 0 5 10 514 (4.2) 3.9 578 (4.9) 4.4 480 (4.3) 3.6 490 (4.7) 3.7 Greece 0 5 10 - - - - - - - - - 105 (9.1) 5.9 Hungary 0 1 2 - - - 16 (0.4) 0.9 17 (0.4) 0.9 22 (0.6) 1.2 Iceland 0 10 20 - - - 1 (9.1) 1.5 0 (0.0) 0.0 1 (5.9) 1.5 Ireland 0 5 10 - - - - - - - - - 25 (5.9) 3.0 Italy 0 5 10 196 (3.8) 2.3 174 (3.4) 2.1 154 (3.0) 1.9 147 (3.1) 1.8 Latvia 0 5 10 63 (4.1) 12.1 86 (4.9) 17.0 90 (4.5) 18.4 126 (5.8) 26.8 Liechtenstein 0 1 2 - - - - - - - - - - - - Lithuania 0 5 10 121 (5.1) 15.2 128 (4.9) 16.4 147 (5.0) 19.2 170 (5.6) 22.7 Luxembourg 0 5 10 1 (3.1) 1.3 1 (2.8) 1.3 2 (5.3) 2.6 0 (0.0) 0.0 Malta 0 10 20 1 (10.0) 1.2 3 (10.3) 3.8 1 (9.1) 1.2 1 (6.3) 1.2 Netherlands 0 5 10 93 (5.7) 3.3 98 (5.8) 3.4 91 (6.1) 3.2 81 (6.0) 2.8 Norway 0 5 10 15 (6.4) 1.8 19 (8.8) 2.2 20 (9.8) 2.3 14 (5.7) 1.6 Poland 0 1 2 218 (1.4) 2.4 181 (1.2) 2.1 161 (1.2) 1.9 123 (0.9) 1.5 Portugal 0 5 10 287 (5.1) 16.0 220 (4.2) 12.5 219 (4.3) 12.7 223 (4.2) 13.1 Romania 0 5 10 975 (4.2) 20.6 1 195 (5.0) 26.1 1 127 (4.7) 25.4 1 461 (5.7) 33.7 Slovakia 0 3 6 67 (4.4) 5.5 46 (3.1) 3.8 27 (2.1) 2.3 40 (3.1) 3.5 Slovenia 0 3 6 8 (1.5) 2.2 6 (1.1) 1.7 5 (1.0) 1.4 6 (1.3) 1.8 Spain 0 5 10 - - - - - - - - - 491 (5.4) 8.0 Sweden 0 5 10 30 (5.3) 1.8 26 (5.3) 1.6 30 (6.6) 1.8 20 (4.5) 1.2 United Kingdom 0 5 10 426 (6.9) 3.8 410 (6.6) 3.6 481 (7.6) 4.3 371 (6.5) 3.3 Subtotal EU/EEA 0 3 6 3 700 (4.0) 4.9 3 792 (4.0) 4.9 3 595 (3.9) 4.7 4 473 (4.4) 5.3 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 105 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 1999 2000 2001 N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate 50 (4.0) 3.6 72 (5.9) 5.2 66 (6.1) 4.9 63 (5.0) 3.5 69 (5.3) 3.8 76 (5.8) 4.2 - - - 148 (4.4) 11.4 166 (4.3) 13.1 - - - - - - - - - 17 (1.0) 1.0 21 (1.5) 1.2 12 (0.9) 0.7 46 (8.6) 4.8 42 (7.7) 4.3 49 (9.6) 4.9 14 (1.9) 5.4 18 (2.3) 7.2 15 (1.8) 6.2 2 (0.3) 0.2 3 (0.5) 0.3 6 (1.2) 0.6 311 (4.7) 2.7 305 (4.5) 2.6 278 (4.3) 2.4 425 (4.3) 3.3 446 (4.9) 3.5 300 (4.0) 2.3 27 (2.8) 1.6 24 (3.4) 1.4 45 (7.3) 2.7 23 (0.6) 1.3 10 (0.3) 0.6 11 (0.3) 0.7 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 39 (8.3) 4.7 17 (4.2) 2.1 16 (3.9) 1.9 151 (3.4) 1.8 148 (3.1) 1.8 152 (3.4) 1.9 - - - 145 (7.0) 33.9 158 (7.6) 38.6 - - - - - - - - - - - - 124 (4.2) 17.5 124 (4.1) 18.1 3 (7.1) 3.7 4 (9.1) 4.9 0 (0.0) 0.0 0 (0.0) 0.0 2 (11.1) 2.6 0 (0.0) 0.0 103 (6.7) 3.5 88 (6.3) 3.0 65 (4.5) 2.2 25 (9.2) 2.8 18 (7.6) 2.0 24 (8.3) 2.7 108 (0.9) 1.4 103 (0.9) 1.4 124 (1.2) 1.7 171 (3.3) 10.2 115 (2.6) 6.9 117 (2.7) 7.1 1 336 (5.0) 31.3 1 729 (6.2) 41.6 1 911 (6.3) 47.2 21 (1.7) 1.9 15 (1.4) 1.4 22 (2.0) 2.1 10 (2.3) 3.0 9 (2.4) 2.8 13 (3.5) 4.1 628 (7.5) 10.4 526 (6.3) 8.8 493 (6.6) 8.3 11 (2.2) 0.7 22 (4.8) 1.3 13 (3.0) 0.8 377 (6.6) 3.3 385 (5.7) 3.4 469 (6.8) 4.2 3 961 (4.2) 4.8 4 608 (4.5) 5.5 4 725 (4.7) 5.7 106 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Country Trend in percentage, 1995–2011 1995 1996 1997 1998 N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate Non-EU/EEA Albania 0 5 10 - - - - - - 1 (0.2) 0.1 3 (0.4) 0.3 Andorra - - - - - - - - - - - - Armenia 0 3 6 2 (0.2) 0.2 2 (0.2) 0.2 5 (0.5) 0.6 3 (0.2) 0.4 Azerbaijan 0 2 4 - - - 5 (0.2) 0.2 - - - - - - Belarus 0 1 2 - - - - - - - - - - - - Bosnia and Herzegovina 0 1 2 - - - 5 (0.2) 0.7 16 (0.6) 2.3 4 (0.1) 0.6 Croatia 0 2 4 16 (0.8) 1.8 - - - 25 (1.2) 3.0 33 (1.6) 4.1 Georgia 0 3 6 4 (0.2) 0.3 5 (0.1) 0.4 0 (0.0) 0.0 8 (0.2) 0.7 Israel 0 5 10 - - - 3 (0.8) 0.2 7 (1.7) 0.4 2 (0.3) 0.1 Kazakhstan 0 3 6 - - - - - - 69 (0.4) 1.5 96 (0.5) 2.2 Kyrgyzstan 0 5 10 4 (0.1) 0.2 12 (0.3) 0.7 5 (0.1) 0.3 7 (0.2) 0.4 Macedonia, the former Yugoslav Republic of 0 10 20 4 (0.5) 0.8 8 (1.1) 1.7 2 (0.3) 0.4 8 (1.3) 1.7 Moldova 0 2 4 2 (0.1) 0.2 2 (0.1) 0.2 0 (0.0) 0.0 4 (0.2) 0.4 Monaco - - - - - - - - - - - Montenegro 0 2 4 - - - - - - - - - - - - Russia 0 2 4 - - - - - - - - - 2 (0.0) 0.0 San Marino - - - - - - - - - - - - Serbia 0 1 2 - - - - - - - - - - - - Serbia excluding UN Administered Province of Kosovob 0 1 2 - - - - - - - - - - - - UN Administered Province of Kosovob - - - - - - - - - - - - Switzerland 0 2 4 1 (0.1) 0.1 1 (0.1) 0.1 0 (0.0) 0.0 1 (0.1) 0.1 Tajikistan 0 5 10 0 (0.0) 0.0 9 (0.5) 0.4 15 (0.8) 0.6 11 (0.4) 0.4 Turkey 0 5 10 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 Turkmenistan 0 1 2 3 (0.2) 0.2 2 (0.1) 0.1 2 (0.1) 0.1 2 (0.1) 0.1 Ukraine 0 1 2 31 (0.1) 0.3 22 (0.1) 0.2 34 (0.1) 0.4 60 (0.2) 0.6 Uzbekistan 0 10 20 0 (0.0) 0.0 7 (0.1) 0.1 0 (0.0) 0.0 0 (0.0) 0.0 Subtotal non-EU/EEA 0 3 6 67 (0.2) 0.3 83 (0.1) 0.2 181 (0.3) 0.7 244 (0.3) 0.9 Total European Region 0 2 4 3 767 (1.3) 2.0 3 875 (1.2) 2.1 3 776 (1.1) 2.1 4 717 (1.4) 2.6 Subtotal 18 HPC 0 2 4 1 223 (0.6) 1.3 1 493 (0.6) 1.6 1 522 (0.6) 1.6 1 960 (0.7) 2.1 b In accordance with the UN Security Council Resolution No. 1244 (1999). 107 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 1999 2000 2001 N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate 0 (0.0) 0.0 5 (0.8) 0.5 4 (0.7) 0.4 - - - - - - - - - 10 (0.7) 1.2 3 (0.2) 0.4 3 (0.2) 0.4 - - - - - - 5 (0.1) 0.2 - - - - - - 6 (0.3) 0.3 8 (0.3) 1.1 8 (0.3) 1.1 13 (0.5) 1.8 3 (0.2) 0.4 - - - 2 (0.1) 0.3 8 (0.1) 0.7 5 (0.1) 0.5 6 (0.1) 0.6 47 (9.0) 2.8 52 (9.7) 3.1 32 (6.3) 1.9 94 (0.4) 2.2 120 (0.4) 2.9 126 (0.5) 3.1 13 (0.2) 0.7 10 (0.2) 0.6 0 (0.0) 0.0 2 (0.3) 0.4 6 (0.9) 1.3 2 (0.3) 0.5 4 (0.1) 0.4 3 (0.1) 0.3 7 (0.2) 0.8 - - - - - - - - - - - - - - - - - - 50 (0.0) 0.2 2 (0.0) 0.0 63 (0.0) 0.2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14 (1.8) 1.1 10 (1.6) 0.8 12 (1.9) 1.0 - - - 0 (0.0) 0.0 8 (0.2) 0.3 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 7 (0.2) 0.4 35 (0.6) 2.1 4 (0.1) 0.2 36 (0.1) 0.4 62 (0.2) 0.7 27 (0.9) 0.3 15 (0.1) 0.2 17 (0.1) 0.2 28 (0.4) 0.3 311 (0.4) 1.3 338 (0.1) 0.6 348 (0.2) 0.5 4 272 (1.2) 2.4 4 946 (1.3) 2.9 5 073 (1.7) 3.0 1 587 (0.5) 1.8 2 421 (0.8) 2.7 2 657 (1.1) 3.1 108 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table IIIb: 2002–2011 Country 2002 2003 2004 2005 2006 N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate EU/EEA Austria 38 (3.5) 2.8 46 (4.6) 3.4 53 (4.9) 4.0 42 (4.2) 3.2 61 (6.7) 4.6 Belgium 72 (5.6) 4.0 70 (6.3) 3.9 70 (5.8) 3.9 73 (6.6) 4.1 63 (5.6) 3.5 Bulgaria 146 (4.4) 12.4 183 (5.6) 16.0 199 (6.2) 18.0 180 (5.5) 16.8 197 (6.1) 18.8 Cyprus 1 (5.0) 0.7 0 (0.0) 0.0 0 (0.0) 0.0 3 (8.1) 2.1 3 (8.1) 2.1 Czech Republic 7 (0.6) 0.4 11 (0.9) 0.7 7 (0.7) 0.5 5 (0.5) 0.3 4 (0.4) 0.3 Denmarka 34 (8.1) 3.4 33 (8.4) 3.3 28 (7.3) 2.8 39 (9.1) 3.8 26 (6.7) 2.6 Estonia 3 (0.4) 1.3 4 (0.6) 1.8 2 (0.3) 0.9 1 (0.2) 0.5 8 (1.7) 4.0 Finland 6 (1.3) 0.6 4 (1.0) 0.4 5 (1.5) 0.5 5 (1.3) 0.5 1 (0.3) 0.1 France 277 (4.4) 2.4 311 (5.1) 2.7 330 (5.9) 2.8 299 (5.6) 2.6 298 (5.6) 2.5 Germany 346 (4.5) 2.7 287 (4.0) 2.3 264 (4.0) 2.2 228 (3.8) 1.9 192 (3.6) 1.6 Greece 43 (7.4) 2.6 18 (2.9) 1.1 58 (7.5) 3.6 62 (8.1) 3.9 45 (6.6) 2.8 Hungary 12 (0.4) 0.7 9 (0.3) 0.6 9 (0.4) 0.6 5 (0.3) 0.3 9 (0.5) 0.6 Iceland 1 (12.5) 1.5 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 Ireland 18 (4.4) 2.2 24 (5.9) 2.9 10 (2.3) 1.2 28 (6.2) 3.3 21 (4.5) 2.4 Italy 141 (3.3) 1.7 180 (4.0) 2.2 197 (4.7) 2.4 191 (4.5) 2.3 170 (3.8) 2.1 Latvia 112 (6.0) 28.7 110 (6.4) 29.5 110 (6.8) 30.9 68 (4.7) 19.9 84 (6.3) 25.6 Liechtenstein - - - - - - - - - - - - - - - Lithuania 142 (5.0) 21.5 131 (4.6) 20.7 119 (4.7) 19.5 90 (3.5) 15.4 106 (4.1) 18.9 Luxembourg 1 (3.1) 1.2 1 (1.9) 1.2 0 (0.0) 0.0 1 (2.7) 1.2 0 (0.0) 0.0 Malta 0 (0.0) 0.0 1 (14.3) 1.3 0 (0.0) 0.0 0 (0.0) 0.0 1 (3.3) 1.4 Netherlands 72 (5.1) 2.4 59 (4.5) 2.0 76 (5.7) 2.5 55 (4.9) 1.8 51 (4.9) 1.7 Norway 11 (4.4) 1.2 18 (5.3) 2.0 23 (7.6) 2.5 18 (6.3) 2.0 23 (7.9) 2.5 Poland 119 (1.1) 1.7 100 (1.0) 1.5 120 (1.3) 1.8 99 (1.1) 1.6 69 (0.8) 1.1 Portugal 110 (2.4) 6.7 84 (2.0) 5.1 75 (1.9) 4.5 86 (2.4) 5.2 94 (2.7) 5.7 Romania 1 809 (5.4) 46.9 1 569 (5.1) 42.3 1 413 (4.6) 39.6 1 105 (3.8) 32.2 1 055 (4.0) 31.4 Slovakia 20 (1.9) 2.0 20 (2.0) 2.1 19 (2.7) 2.0 22 (2.9) 2.4 23 (3.2) 2.6 Slovenia 11 (3.1) 3.6 9 (3.1) 3.0 5 (1.9) 1.7 7 (2.5) 2.4 8 (3.7) 2.8 Spain 486 (6.4) 8.2 479 (6.4) 7.9 511 (6.6) 8.3 498 (6.4) 8.0 544 (6.8) 8.6 Sweden 18 (4.4) 1.1 17 (4.2) 1.1 20 (4.3) 1.3 37 (6.6) 2.3 29 (5.8) 1.9 United Kingdom 434 (5.9) 3.9 356 (4.9) 3.2 447 (5.8) 4.1 451 (5.4) 4.2 386 (4.6) 3.6 Subtotal EU/EEA 4 490 (4.4) 5.4 4 134 (4.2) 5.1 4 170 (4.4) 5.2 3 698 (4.0) 4.6 3 571 (4.1) 4.5 Non-EU/EEA Albania 2 (0.3) 0.2 2 (0.4) 0.2 7 (1.2) 0.8 0 (0.0) 0.0 42 (8.4) 5.3 Andorra - - - - - - - - - - - - - - - Armenia 3 (0.2) 0.4 14 (0.9) 2.0 3 (0.2) 0.4 6 (0.3) 0.9 92 (4.3) 13.9 Azerbaijan 11 (0.2) 0.5 4 (0.1) 0.2 16 (0.2) 0.7 167 (2.1) 7.9 217 (2.9) 10.5 Belarus - - - - - - 1 (0.0) 0.1 0 (0.0) 0.0 61 (1.0) 4.1 Bosnia and Herzegovina 3 (0.2) 0.4 8 (0.4) 1.2 6 (0.3) 0.9 3 (0.1) 0.5 24 (1.3) 4.0 Croatia 1 (0.1) 0.1 1 (0.1) 0.1 4 (0.3) 0.6 2 (0.2) 0.3 28 (2.5) 4.0 Georgia 6 (0.1) 0.6 2 (0.0) 0.2 6 (0.1) 0.7 4 (0.1) 0.5 347 (5.5) 43.4 Israel 30 (6.4) 1.7 24 (5.1) 1.4 25 (5.5) 1.4 29 (7.8) 1.6 30 (8.8) 1.6 Kazakhstan 101 (0.4) 2.6 - - - 86 (0.2) 2.3 77 (0.2) 2.1 - - - Kyrgyzstan 0 (0.0) 0.0 0 (0.0) 0.0 14 (0.2) 0.9 16 (0.2) 1.0 16 (0.2) 1.0 Macedonia, the former Yugoslav Republic of 5 (0.7) 1.2 1 (0.1) 0.2 2 (0.3) 0.5 4 (0.6) 1.0 78 (12.4) 19.7 Moldova 16 (1.4) 1.8 2 (0.0) 0.2 19 (0.3) 2.5 5 (0.1) 0.7 - - - Monaco - - - - - - - - - - - - - - - Montenegro - - - - - - - - - 0 (0.0) 0.0 1 (0.6) 0.8 Russia 0 (0.0) 0.0 0 (0.0) 0.0 63 (0.0) 0.3 0 (0.0) 0.0 - - - San Marino - - - - - - - - - - - - - - - Serbia 9 (0.3) 0.5 28 (0.9) 1.6 Serbia excluding UN Administered Province of Kosovob - - - - - - - - - 9 (0.3) 0.5 28 (0.9) 1.6 UN Administered Province of Kosovob - - - - - - - - - - - - - - - Switzerland 20 (3.0) 1.6 20 (3.2) 1.6 10 (1.7) 0.8 17 (3.0) 1.4 15 (2.9) 1.3 Tajikistan 13 (1.9) 0.5 0 (0.0) 0.0 18 (0.4) 0.7 34 (0.5) 1.3 - - - Turkey 0 #DIV/0! 0.0 0 (0.0) 0.0 2 (0.0) 0.0 83 (0.4) 0.4 1 113 (5.4) 5.8 Turkmenistan 5 (0.1) 0.3 8 (0.2) 0.5 2 (0.0) 0.1 5 (0.2) 0.3 38 (1.1) 2.5 Ukraine 0 #DIV/0! 0.0 39 (0.1) 0.5 0 - 0.0 0 - 0.0 463 (1.1) 6.9 Uzbekistan 28 (0.1) 0.3 38 (0.1) 0.4 54 (0.2) 0.6 65 (0.2) 0.8 2 833 (11.2) 33.5 Subtotal non-EU/EEA 244 (0.3) 0.9 163 (0.2) 0.6 338 (0.1) 0.5 526 (0.4) 1.1 5 426 (4.3) 10.8 Total European Region 4 734 (1.6) 2.8 4 297 (1.0) 2.6 4 508 (1.2) 2.8 4 224 (1.1) 2.7 8 997 (2.1) 5.7 Subtotal 18 HPC 2 395 (1.0) 2.9 2 104 (0.6) 2.6 2 127 (0.7) 2.7 1 906 (0.6) 2.5 6 630 (1.9) 8.7 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). b In accordance with the UN Security Council Resolution No. 1244 (1999). 109 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2007 2008 2009 2010 2011 N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate N % am on g a ll TB ca se s Rate 25 (2.9) 1.9 39 (4.8) 3.1 18 (2.6) 1.4 25 (3.6) 2.0 24 (3.5) 1.9 67 (6.6) 3.7 52 (5.3) 2.9 64 (6.4) 3.5 71 (6.5) 3.9 85 (8.1) 4.6 196 (6.5) 19.0 227 (7.2) 22.2 210 (7.2) 20.6 217 (8.2) 21.1 176 (7.3) 17.0 1 (2.4) 0.7 3 (6.0) 2.2 2 (3.6) 1.5 2 (3.3) 1.5 0 (0.0) 0.0 4 (0.5) 0.3 4 (0.5) 0.3 7 (1.0) 0.5 3 (0.4) 0.2 6 (1.0) 0.4 27 (6.9) 2.7 22 (5.8) 2.2 22 (6.6) 2.2 21 (5.7) 2.1 16 (4.2) 1.6 1 (0.2) 0.5 2 (0.5) 1.0 3 (0.7) 1.5 6 (1.8) 3.0 1 (0.3) 0.5 4 (1.1) 0.4 4 (1.2) 0.4 7 (1.7) 0.8 6 (1.8) 0.7 11 (3.4) 1.2 331 (5.9) 2.8 292 (5.1) 2.5 253 (4.8) 2.1 232 (4.5) 1.9 255 (5.2) 2.1 180 (3.6) 1.6 124 (2.7) 1.1 146 (3.3) 1.3 160 (3.6) 1.5 179 (4.1) 1.6 35 (5.5) 2.2 37 (5.6) 2.3 36 (6.1) 2.2 33 (6.8) 2.0 38 (7.8) 2.3 7 (0.4) 0.5 4 (0.2) 0.3 5 (0.4) 0.3 11 (0.6) 0.7 4 (0.3) 0.3 0 (0.0) 0.0 0 (0.0) 0.0 1 (11.1) 1.5 0 (0.0) 0.0 1 (11.1) 1.5 41 (8.5) 4.7 15 (3.2) 1.7 18 (3.8) 1.9 21 (5.0) 2.2 20 (4.7) 2.0 154 (3.4) 1.9 229 (5.2) 2.7 184 (4.3) 2.2 282 (6.0) 3.3 209 (5.9) 2.5 57 (4.5) 17.9 48 (4.5) 15.4 40 (4.1) 12.9 46 (4.9) 14.9 61 (6.9) 19.9 0 (0.0) 0.0 - - - - - - - - - - - - 85 (3.5) 15.8 100 (4.4) 19.3 74 (3.6) 14.7 92 (4.7) 18.4 88 (4.6) 18.0 2 (5.1) 2.3 0 (0.0) 0.0 1 (3.7) 1.1 1 (3.4) 1.1 1 (3.8) 1.1 2 (5.3) 2.9 0 (0.0) 0.0 1 (2.3) 1.5 0 (0.0) 0.0 0 (0.0) 0.0 49 (4.9) 1.7 50 (4.9) 1.7 58 (5.0) 2.0 34 (3.2) 1.2 56 (5.6) 1.9 19 (6.3) 2.1 23 (7.3) 2.5 14 (3.9) 1.5 13 (3.9) 1.4 17 (4.7) 1.8 74 (0.9) 1.2 76 (0.9) 1.3 99 (1.2) 1.7 62 (0.8) 1.1 111 (1.3) 1.9 71 (2.3) 4.3 65 (2.2) 4.0 78 (2.7) 4.8 52 (2.0) 3.2 44 (1.7) 2.7 1 007 (4.1) 30.3 924 (3.7) 28.2 965 (4.2) 29.6 823 (3.9) 25.3 776 (4.0) 23.9 16 (2.3) 1.8 14 (2.2) 1.6 11 (2.2) 1.3 11 (2.5) 1.3 17 (4.3) 2.0 6 (2.8) 2.1 3 (1.4) 1.1 6 (3.2) 2.1 3 (1.7) 1.0 4 (2.1) 1.4 477 (6.1) 7.4 600 (7.3) 9.1 537 (7.1) 7.9 484 (6.7) 7.0 541 (8.0) 7.8 36 (7.5) 2.3 27 (4.9) 1.8 31 (5.0) 2.0 47 (7.0) 3.0 36 (6.1) 2.3 490 (5.9) 4.6 497 (5.8) 4.6 428 (4.8) 4.0 386 (4.6) 3.6 413 (4.6) 3.8 3 464 (4.1) 4.4 3 481 (4.2) 4.4 3 319 (4.2) 4.2 3 144 (4.2) 4.0 3 190 (4.4) 4.0 27 (6.0) 3.5 19 (4.4) 2.5 17 (3.8) 2.3 18 (4.0) 2.5 7 (1.6) 1.0 - - - - - - - - - - - - - - - 41 (1.9) 6.3 85 (4.0) 13.4 65 (3.2) 10.4 59 (3.3) 9.5 47 (3.0) 7.5 - - - - - - 271 (2.6) 14.0 244 (2.9) 12.7 186 (1.9) 9.5 31 (0.5) 2.1 38 (0.7) 2.6 11 (0.2) 0.8 31 (0.6) 2.2 26 (0.5) 1.8 - - - 17 (1.0) 2.9 14 (0.8) 2.4 13 (0.9) 2.3 20 (1.4) 3.6 - - - 27 (2.8) 4.0 25 (2.9) 3.7 18 (2.6) 2.7 13 (2.1) 2.0 306 (5.2) 39.6 267 (4.6) 35.6 281 (4.7) 38.4 249 (4.3) 34.5 202 (3.7) 28.3 27 (6.8) 1.4 14 (4.3) 0.7 10 (2.9) 0.5 19 (5.5) 0.9 20 (4.8) 1.0 1 884 (5.0) 50.7 981 (3.4) 26.0 818 (2.7) 21.3 733 (2.6) 18.7 622 (2.7) 15.4 14 (0.2) 0.9 630 (8.8) 39.9 541 (8.5) 34.0 531 (8.4) 33.1 - - - 55 (9.8) 14.2 40 (8.3) 10.6 31 (6.6) 8.4 33 (7.9) 9.1 33 (9.1) 9.2 176 (2.8) 27.2 160 (2.7) 25.6 161 (2.9) 26.5 137 (2.5) 23.0 159 (3.0) 26.9 - - - - - - - - - - - - - - - 2 (1.3) 1.6 1 (0.8) 0.8 2 (1.7) 1.6 3 (2.6) 2.5 3 (2.7) 2.5 3 422 (1.6) 16.2 3 203 (1.5) 15.2 3 111 (2.0) 14.6 831 (0.5) 3.9 3 545 (2.2) 16.2 - - - - - - - - - - - - - - - 28 (0.9) 1.6 24 (0.9) 1.4 25 (1.0) 1.4 19 (0.8) 1.1 19 (0.9) 0.8 28 (0.9) 1.6 24 (0.9) 1.4 25 (1.0) 1.4 19 (0.8) 1.1 19 (0.9) 0.8 - - - - - - - - - - - - - - - 15 (3.2) 1.3 11 (2.1) 0.9 16 (2.9) 1.4 12 (2.2) 1.0 19 (3.3) 1.6 585 (7.2) 23.0 547 (6.8) 21.5 456 (6.1) 17.9 491 (6.4) 19.3 569 (7.5) 22.3 952 (4.8) 4.9 949 (5.1) 4.9 940 (5.4) 4.9 879 (5.3) 4.6 744 (4.7) 3.9 8 (0.2) 0.5 7 (0.2) 0.5 5 (0.2) 0.3 3 (0.1) 0.2 - - - 21 (0.1) 0.3 581 (1.5) 8.9 580 (1.5) 9.0 302 (0.8) 4.7 19 (0.0) 0.3 2 583 (11.0) 31.0 2 008 (9.5) 24.4 2 263 (10.5) 27.8 1 878 (9.2) 23.3 1 592 (10.0) 19.8 10 177 (2.7) 13.7 9 609 (2.6) 12.8 9 643 (3.0) 12.5 6 503 (2.1) 7.6 7 839 (2.6) 9.0 13 641 (2.9) 8.7 13 090 (2.8) 8.4 12 962 (3.3) 8.3 9 647 (2.5) 6.2 11 029 (2.9) 6.7 11 369 (2.7) 15.1 10 757 (2.7) 14.3 10 795 (3.2) 14.3 7 552 (2.3) 10.0 8 813 (2.7) 11.6 110 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table IV: Tuberculosis cases of foreign origin, EU/EEA, 1995–2011 Country Trend in percentage, 1995–2011 1995 1996 1997 1998 1999 2000 2001 N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s Austria 0 25 50 358 (24.2) 350 (23.5) 346 (24.8) 293 (22.3) 319 (25.6) 335 (27.3) 271 (25.2) Belgium 0 50 100 455 (33.0) 435 (32.2) 414 (32.8) 427 (35.5) 454 (35.7) 508 (38.7) 604 (45.7) Bulgaria 0 1 2 - - - - - - - - - - - - 0 (0.0) Cyprus 0 50 100 - - - - - - - - - - - - 25 (62.5) Czech Republic 0 20 40 17 (0.9) 0 (0.0) 108 (5.9) 110 (6.1) 135 (8.3) 143 (9.9) 193 (14.3) Denmarka 0 50 100 246 (54.9) 283 (58.5) 380 (68.6) 344 (65.0) 371 (69.2) 350 (63.9) 334 (65.4) Estonia 0 20 40 0 (0.0) 2 (0.3) 28 (3.8) 114 (13.9) 167 (22.1) 183 (23.1) 182 (22.4) Finland 0 20 40 38 (5.8) 41 (6.5) 46 (8.3) 58 (9.5) 47 (7.9) 47 (8.6) 66 (13.2) France 0 25 50 2 417 (27.7) 1 845 (24.1) 1 613 (23.6) 1 607 (24.2) 1 932 (28.9) 2 193 (32.7) 2 305 (35.7) Germany 0 25 50 3 532 (29.0) 3 474 (29.4) 3 427 (30.7) 3 291 (31.5) 3 305 (33.1) 3 047 (33.6) 2 741 (36.4) Greece 0 50 100 - - - - - - 126 (10.9) 116 (12.2) 68 (9.7) 104 (16.9) Hungary 0 2 4 0 (0.0) 42 (1.0) 44 (1.0) 10 (0.3) 64 (1.6) 56 (1.6) 57 (1.8) Iceland 0 50 100 1 (8.3) 4 (36.4) 2 (20.0) 8 (47.1) 8 (66.7) 5 (38.5) 7 (53.8) Ireland 0 25 50 - - - - - - 35 (8.3) 65 (13.9) 49 (12.2) 65 (16.0) Italy 0 25 50 525 (10.0) 572 (11.1) 691 (13.4) 797 (16.6) 961 (21.7) 1 201 (25.2) 1 391 (30.9) Latvia 0 5 10 - - - - 85 (4.2) 61 (2.8) - - 147 (7.1) 122 (5.9) Liechtenstein 0 20 40 - - - - - - - - - - - - - - Lithuania 0 5 10 - - - - 157 (5.4) 231 (7.7) - - 160 (5.4) 174 (5.8) Luxembourg 0 50 100 16 (50.0) 0 (0.0) 17 (44.7) 25 (56.8) 28 (66.7) 21 (47.7) 9 (28.1) Malta 0 50 100 4 (40.0) 10 (34.5) 3 (27.3) 4 (25.0) 7 (31.8) 5 (27.8) 3 (18.8) Netherlands 0 50 100 913 (56.4) 833 (49.6) 817 (55.0) 805 (60.0) 898 (58.5) 879 (62.6) 881 (61.4) Norway 0 50 100 97 (41.1) 102 (47.0) 110 (53.7) 129 (52.9) 180 (65.9) 167 (70.5) 206 (71.5) Poland 0 1 2 - - - - - - - - - - - - 0 (0.0) Portugal 0 10 20 - - - - - - - - 325 (6.3) 434 (9.7) 491 (11.2) Romania 0 1 2 6 (0.0) - - 15 (0.1) 0 (0.0) 2 (0.0) 0 (0.0) 4 (0.0) Slovakia 0 2 4 4 (0.3) 2 (0.1) 0 (0.0) 1 (0.1) 4 (0.3) 8 (0.7) 13 (1.2) Slovenia 0 20 40 111 (21.1) 106 (18.8) 101 (21.0) 81 (18.0) 103 (23.5) 94 (24.7) 84 (22.6) Spain 0 20 40 - - - - - - 94 (1.0) 151 (1.8) 451 (5.4) 412 (5.5) Sweden 0 50 100 315 (55.9) 291 (59.0) 300 (65.8) 269 (60.3) 319 (64.7) 305 (66.6) 286 (66.8) United Kingdom 0 50 100 - - - - - - 2 987 (52.2) 2 959 (51.9) 3 458 (51.4) 3 588 (52.3) Total EU/EEA 0 20 40 9 055 (14.0) 8 392 (21.0) 8 704 (13.1) 11 907 (14.3) 12 920 (15.6) 14 314 (16.4) 14 618 (14.5) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 111 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s N % am on g a ll TB ca se s 305 (28.4) 343 (34.6) 447 (41.6) 436 (43.7) 335 (37.0) 319 (36.5) 299 (36.6) 230 (33.0) 300 (43.4) 326 (47.5) 657 (50.8) 605 (54.2) 634 (52.9) 571 (51.6) 574 (51.4) 482 (47.3) 473 (47.8) 485 (48.8) 594 (54.7) 544 (52.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (0.2) 6 (0.2) 8 (0.3) 2 (0.1) 9 (0.4) 7 (35.0) 22 (62.9) 23 (76.7) 25 (67.6) 28 (75.7) 31 (73.8) 44 (88.0) 46 (83.6) 50 (82.0) 45 (83.3) 164 (13.7) 126 (10.8) 149 (14.1) 129 (13.1) 130 (13.7) 151 (17.8) 185 (21.4) 135 (19.5) 117 (17.5) 112 (18.7) 265 (63.2) 235 (59.8) 237 (61.6) 252 (58.9) 225 (58.1) 242 (61.9) 227 (59.7) 202 (60.5) 220 (60.1) 235 (61.7) 140 (19.6) 130 (20.9) 138 (23.2) 83 (16.0) 73 (15.9) 80 (16.3) 83 (18.7) 79 (19.2) 61 (18.3) 48 (14.1) 49 (10.3) 51 (12.3) 42 (12.5) 54 (14.5) 53 (17.8) 74 (21.3) 54 (15.7) 125 (30.0) 107 (32.9) 79 (24.3) 2 564 (40.6) 2 572 (42.2) 2 526 (45.3) 2 422 (45.1) 2 310 (43.4) 2 498 (44.8) 2 587 (44.9) 2 427 (46.0) 2 469 (48.3) 2 456 (49.7) 2 991 (38.8) 3 014 (42.1) 2 884 (44.1) 2 633 (43.7) 2 248 (41.8) 2 100 (42.0) 1 936 (42.8) 1 941 (43.8) 2 014 (45.9) 2 025 (46.9) 111 (19.1) 155 (25.0) 180 (23.3) 219 (59.3) - - 212 (33.2) 249 (37.5) 255 (43.3) 231 (47.4) 216 (44.2) 47 (1.7) 51 (2.0) 44 (1.9) 62 (3.2) 41 (2.2) 48 (2.8) 47 (2.9) 32 (2.3) 21 (1.2) 27 (1.9) 3 (37.5) 3 (60.0) 8 (66.7) 7 (63.6) 9 (69.2) 9 (64.3) 4 (66.7) 5 (55.6) 16 (72.7) 7 (77.8) 123 (30.1) 89 (21.9) 129 (29.9) 152 (33.8) 160 (34.6) 192 (40.0) 203 (43.4) 206 (43.0) 171 (40.7) 179 (42.1) 1 293 (30.7) 1 459 (32.3) 1 664 (39.4) 1 854 (44.0) 2 108 (46.8) 1 960 (43.3) 2 026 (45.9) 2 052 (48.4) 2 284 (48.7) 1 677 (47.6) 115 (6.2) 93 (5.4) 119 (7.4) 84 (5.8) 69 (5.2) 66 (5.3) 56 (5.2) 60 (6.1) 62 (6.6) 59 (6.7) - - - - - - - - - - 1 (20.0) - - - - - - - - 133 (4.7) 128 (4.5) 87 (3.5) 90 (3.5) 74 (2.9) 76 (3.2) 49 (2.2) 61 (2.9) 47 (2.4) 44 (2.3) 13 (40.6) 36 (66.7) 25 (80.6) 25 (67.6) 20 (60.6) 24 (61.5) 0 (0.0) 16 (59.3) 17 (58.6) 21 (80.8) 9 (37.5) 4 (57.1) 12 (63.2) 17 (68.0) 17 (56.7) 24 (63.2) 42 (79.2) 34 (77.3) 25 (78.1) 28 (84.8) 854 (61.0) 749 (56.7) 721 (53.6) 758 (67.2) 659 (63.9) 626 (62.7) 708 (69.8) 842 (72.7) 787 (73.9) 710 (70.5) 191 (76.1) 267 (79.2) 239 (79.1) 225 (78.1) 235 (81.0) 239 (79.1) 261 (83.4) 323 (90.2) 289 (86.0) 317 (87.8) 0 (0.0) 0 (0.0) 0 (0.0) 17 (0.2) 47 (0.5) 55 (0.6) 53 (0.7) 53 (0.6) 46 (0.6) 38 (0.4) 567 (12.6) 503 (12.1) 455 (11.8) 0 (0.0) 398 (11.5) 423 (13.5) 443 (14.8) 441 (15.4) 425 (16.2) 385 (15.2) 7 (0.0) 0 (0.0) 2 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 35 (0.2) 50 (0.2) 50 (0.3) 12 (1.1) 16 (1.6) 15 (2.1) 27 (3.6) 11 (1.5) 12 (1.8) 9 (1.4) 7 (1.4) 8 (1.8) 3 (0.8) 77 (22.0) 43 (14.7) 54 (20.5) 48 (17.3) 34 (15.8) 38 (17.4) 56 (26.3) 55 (29.3) 41 (23.8) 57 (29.7) 444 (5.8) 603 (8.1) 787 (10.1) 1 448 (18.5) 1 552 (19.3) 2 029 (26.1) 2 495 (30.4) 2 330 (30.7) 2 383 (32.9) 2 138 (31.6) 293 (72.0) 305 (74.8) 343 (74.4) 410 (73.3) 357 (71.8) 374 (77.6) 442 (81.0) 507 (82.2) 572 (85.6) 524 (89.4) 4 294 (58.6) 4 538 (62.5) 4 825 (63.1) 5 445 (65.2) 5 455 (65.2) 5 481 (65.8) 5 819 (67.6) 5 996 (67.2) 5 816 (68.6) 6 287 (70.1) 15 728 (17.1) 16 140 (18.5) 16 789 (19.7) 17 493 (19.9) 17 222 (19.9) 17 871 (21.3) 18 856 (22.7) 18 988 (23.8) 19 225 (25.4) 18 646 (25.8) 112 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table V: MDR-TB notification among all laboratory confirmed TB cases, European Region, 2000–2011 Country Trend in percentage, 2000–2011 2000 2001 2002 2003 2004 2005 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austria 0 5 10 5 (0.7) 5 (0.8) 3 (0.4) 12 (2.0) 19 (3.0) 13 (2.1) Belgium 0 2 4 11 (1.1) 18 (2.4) 21 (2.6) 9 (1.1) 12 (1.4) 11 (1.5) Bulgaria 0 5 10 - - - - - - 44 (3.2) 47 (3.7) 47 (3.7) Cyprus 0 20 40 - - - - 1 (33.3) 0 (0.0) 0 (0.0) 1 (5.9) Czech Republic 0 2 4 9 (1.4) 9 (1.3) 10 (2.0) 2 (0.3) 6 (1.2) 13 (2.2) Denmarka 0 1 2 - . - . 1 (0.3) 0 (0.0) 0 (0.0) 5 (1.5) Estonia 0 20 40 103 (19.5) 158 (27.2) 138 (25.9) 106 (22.8) 90 (19.9) 78 (20.2) Finland 0 2 4 2 (0.5) 4 (1.1) 3 (0.9) 3 (0.9) 0 (0.0) 2 (0.6) France 0 2 4 15 (0.8) 15 (0.8) 23 (1.3) 25 (1.2) 26 (1.3) 24 (1.1) Germany 0 2 4 - - 105 (2.7) 89 (2.0) 91 (2.1) 98 (2.5) 103 (2.7) Greece 0 5 10 - - - - 22 (8.1) 22 (9.6) 16 (7.8) 12 (5.6) Hungary 0 3 6 7 (2.2) 13 (2.9) 17 (3.1) 20 (3.8) 11 (2.2) 17 (4.1) Iceland 0 20 40 0 (0.0) 0 (0.0) 0 (0.0) 1 (25.0) 0 (0.0) 0 (0.0) Ireland 0 2 4 3 (1.4) 1 (1.0) 0 (0.0) 1 (0.4) 2 (0.8) 3 (1.1) Italy 0 5 10 35 (2.0) 38 (2.4) 33 (2.1) 42 (1.6) 24 (1.2) 22 (1.4) Latvia 0 10 20 150 (11.6) 150 (11.6) 226 (18.2) 174 (14.6) 195 (17.7) 161 (15.3) Liechtenstein 0 1 2 - - - - - - - - - - - - Lithuania 0 20 40 156 (10.0) 266 (15.0) 297 (19.2) 312 (22.3) 318 (20.0) 338 (19.4) Luxembourg 0 5 10 - - - - - - 1 (1.9) 1 (3.2) 0 (0.0) Malta 0 10 20 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Netherlands 0 2 4 8 (0.9) 8 (1.6) 2 (0.3) 8 (1.3) 3 (0.4) 8 (0.9) Norway 0 2 4 3 (1.8) 5 (2.3) 7 (3.6) 3 (1.1) 4 (1.6) 3 (1.4) Poland 0 1 2 - - 92 (1.5) - - - - 51 (1.0) 46 (1.2) Portugal 0 2 4 30 (3.0) 31 (2.7) 34 (2.2) 23 (1.7) 35 (2.3) 31 (1.9) Romania 0 10 20 165 (4.1) 198 (6.5) 0 . 585 (18.4) 810 (17.5) 849 (17.1) Slovakia 0 2 4 7 (1.2) 6 (1.0) 3 (0.6) 6 (1.5) 1 (0.3) 8 (2.6) Slovenia 0 1 2 0 (0.0) 3 (1.0) 2 (0.7) 1 (0.4) 0 (0.0) 1 (0.4) Spain 0 2 4 - - 51 (1.9) 31 (0.8) 47 (1.3) 59 (1.7) 80 (2.2) Sweden 0 2 4 5 (1.4) 4 (1.1) 4 (1.1) 7 (2.0) 6 (1.6) 4 (0.9) United Kingdom 0 1 2 28 (0.9) 25 (0.7) 34 (0.9) 52 (1.3) 47 (1.1) 40 (0.8) Subtotal EU/EEA 0 5 10 742 (3.6) 1 205 (3.7) 1 001 (4.0) 1 597 (5.3) 1 881 (5.1) 1 920 (5.2) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 113 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2006 2007 2008 2009 2010 2011 N (%) N (%) N (%) N (%) N (%) N (%) 10 (1.9) 9 (1.8) 15 (3.1) 23 (5.3) 16 (3.4) 19 (4.2) 18 (2.2) 14 (1.9) 21 (2.7) 10 (1.3) 19 (2.3) 15 (2.0) 53 (3.9) 76 (7.5) 31 (3.3) 43 (5.1) 56 (5.8) 55 (7.5) 0 (0.0) 3 (10.3) 1 (2.8) 4 (12.9) 0 (0.0) 1 (2.5) 12 (2.1) 8 (1.5) 11 (2.1) 8 (1.8) 9 (2.1) 7 (1.7) 3 (1.0) 2 (0.7) 0 (0.0) 2 (0.8) 2 (0.7) 3 (1.1) 55 (15.6) 82 (21.4) 73 (21.0) 85 (28.0) 65 (24.8) 78 (29.8) 2 (0.7) 2 (0.8) 1 (0.4) 6 (2.0) 6 (2.4) 5 (2.0) 30 (1.3) 20 (0.8) 27 (1.1) 30 (1.2) 23 (1.0) 40 (2.6) 82 (2.3) 66 (2.0) 49 (1.6) 62 (2.1) 52 (1.8) 56 (2.0) 13 (6.2) 14 (2.2) - - 12 (7.1) 2 (2.2) 5 (3.1) 14 (2.6) 12 (2.6) 13 (2.8) 18 (4.0) 19 (3.3) 7 (1.5) 0 (0.0) 1 (9.1) 1 (20.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (1.4) 7 (2.4) 2 (0.7) 1 (0.3) 2 (0.7) 3 (1.3) 28 (1.8) 56 (3.0) 71 (4.6) 82 (5.9) 87 (3.5) 81 (3.1) 142 (14.7) 99 (10.1) 128 (15.5) 131 (17.4) 88 (12.3) 95 (14.8) - - 0 (0.0) - - - - - - - - 332 (18.6) 314 (18.6) 276 (17.1) 322 (21.8) 310 (22.7) 296 (21.1) 0 (0.0) 0 (0.0) - - 0 (0.0) 0 (0.0) 2 (10.5) 2 (14.3) 1 (5.3) 0 (0.0) 0 (0.0) 1 (6.3) 0 (0.0) 6 (0.8) 6 (0.8) 15 (2.0) 20 (2.6) 11 (1.4) 15 (2.1) 3 (1.3) 3 (1.2) 4 (1.8) 8 (2.8) 8 (2.9) 4 (1.6) 32 (0.9) 22 (0.6) 19 (0.5) 21 (0.5) 30 (0.8) 41 (0.8) 22 (1.3) 34 (2.0) 32 (1.8) 24 (1.4) 19 (1.6) 22 (1.8) 673 (14.8) 673 (17.6) 792 (14.3) 624 (10.0) 574 (9.4) 530 (8.8) 7 (1.7) 7 (1.8) 4 (1.0) 1 (0.4) 1 (0.4) 3 (1.6) 1 (0.5) 0 (0.0) 2 (1.0) 1 (0.6) 0 (0.0) 0 (0.0) 50 (1.4) 59 (1.5) 76 (1.7) 56 (1.4) 49 (1.2) 41 (3.2) 3 (0.8) 15 (4.1) 11 (2.6) 13 (2.5) 18 (3.4) 17 (3.6) 51 (1.0) 56 (1.2) 53 (1.1) 60 (1.2) 60 (1.3) 81 (1.6) 1 648 (4.6) 1 661 (4.7) 1 728 (4.8) 1 667 (4.6) 1 527 (4.2) 1 522 (4.5) 114 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Country Trend in percentage, 2000–2011 2000 2001 2002 2003 2004 2005 N (%) N (%) N (%) N (%) N (%) N (%) Non-EU/EEA Albania 0 2 4 - - - - - - - - - - 1 (0.6) Andorra - - - - - - - - - - - - Armenia 0 20 40 - - - - - - - - 157 (24.8) 162 (21.4) Azerbaijan 0 50 100 - - - - - - - - 17 - 800 (97.7) Belarus 0 50 100 - - - - - - - - 340 (11.0) - - Bosnia and Herzegovina 0 1 2 5 (0.4) 2 (0.2) 4 (0.4) 2 (0.2) 10 (0.9) 11 (1.0) Croatia 0 1 2 2 (0.2) 5 (0.6) 6 (0.7) 8 (1.0) 3 (0.4) 6 (0.9) Georgia 0 10 20 - - - - - - - - - - 195 (14.8) Israel 0 10 20 44 (10.7) 23 (6.3) 16 (4.5) 20 (5.6) 14 (4.4) 16 (6.0) Kazakhstan 0 20 40 - - - - - - - - 4 828 (28.0) - - Kyrgyzstan 0 50 100 - - - - - - - - 259 (27.5) 989 (100.0) Macedonia, the former Yugoslav Republic of 0 3 6 - - - - - - - - 2 (1.4) 4 (3.2) Moldova 0 25 50 - - - - - - - - - - 338 (28.5) Monaco - - - - - - - - - - - - Montenegro 0 2 4 - - - - - - - - - - 2 (2.0) Russia 0 20 40 - - - - - - - - - - - - San Marino - - - - - - - - - - - - Serbia 0 1 2 - - - - - - - - - - 9 (0.7) Serbia excluding UN Administered Province of Kosovob 0 1 2 - - - - - - - - - - 9 (0.7) UN Administered Province of Kosovob - - - - - - - - - - - - Switzerland 0 2 4 1 (0.3) 7 (1.4) 11 (2.1) 12 (2.5) 5 (1.1) 5 (1.1) Tajikistan 0 50 100 - - - - - - - - - - - - Turkey 0 5 10 - - - - - - - - - - 191 (5.1) Turkmenistan 0 20 40 - - - - - - - - - - - - Ukraine 0 20 40 - - - - - - - - - - - - Uzbekistan 0 50 100 - - - - - - - - 9 (1.3) 86 (19.8) Subtotal non-EU/EEA 0 20 40 52 (1.8) 37 (1.2) 37 (1.3) 42 (1.5) 5 644 (22.0) 2 815 (21.0) Total European Region 0 20 40 794 (4.5) 1 242 (5.0) 1 038 (4.5) 1 639 (7.4) 7 525 (14.8) 4 735 (10.8) Subtotal 18 HPC 0 20 40 574 (22.1) 772 (24.7) 661 (21.2) 1 221 (40.0) 7 070 (25.4) 4 234 (25.7) b In accordance with the UN Security Council Resolution No. 1244 (1999). 115 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2006 2007 2008 2009 2010 2011 N (%) N (%) N (%) N (%) N (%) N (%) 1 (0.7) 3 (1.6) 2 (0.9) 0 - 2 (1.0) 5 (2.4) - - - - - - - - - - - - 215 (24.7) 125 (19.5) 128 (21.1) 156 (22.9) 177 (38.5) 79 (14.9) 398 (51.5) 196 (41.7) - - - - 552 (31.3) 90 (12.5) 651 (20.9) 870 (26.2) 923 (28.5) 1 342 (33.7) 1 576 (41.7) 1 594 (52.6) 7 (0.6) 8 (0.6) 12 (1.4) 2 (0.2) 2 (0.3) 5 (0.7) 3 (0.4) 7 (1.0) 4 7 (1.4) - - 2 (0.5) 266 (14.1) 269 (14.0) 481 (20.0) 369 (15.6) 359 (14.1) 453 (15.8) 19 (7.9) 14 (4.9) 13 (5.7) 6 (2.3) 12 (4.9) 11 (3.9) 4 117 (26.2) 5 568 (35.9) 3 676 (34.1) 3 644 (38.0) 4 033 (34.9) 4 575 (39.6) 336 (30.1) 322 (26.4) 269 (33.3) 785 (40.7) 489 (100.0) - - 6 (3.7) 9 (4.7) 2 (1.4) 1 (0.5) 7 (3.9) 1 (0.6) 1 204 (41.8) 896 (39.9) 1 048 (43.0) 1 069 (44.3) 1 082 (42.9) 1 001 (42.0) - - - - - - - - - - - - 2 (1.9) 2 (2.3) 0 - 1 (1.1) 0 - 1 (1.4) - - 5 297 (15.0) 6 960 (16.3) 14 686 (25.0) 12 387 (25.1) 13 785 (28.9) - - - - - - - - - - - - 10 (0.9) 25 (1.9) 16 (1.5) - - 12 (1.3) 9 (0.9) 10 (0.9) 25 (1.9) 16 (1.5) - - 12 (1.3) 9 (0.9) - - - - - - - - - - - - 4 (0.9) 8 (2.7) 5 (1.2) - - 9 (2.0) 8 (1.8) - - - - - - 319 (22.6) 266 (69.5) 380 (66.0) 249 (5.2) 240 (4.9) 263 (5.3) 222 (5.1) 250 (5.0) 262 (5.4) 16 (15.5) - - - - 39 (14.2) 38 (26.4) - - - - - - - - 3 482 (19.0) 5 336 (38.0) 4 305 (29.2) 83 (28.1) 484 (57.1) 342 (46.0) 654 (50.2) 1 023 (25.4) 1 385 (62.5) 7 587 (21.3) 14 343 (20.3) 14 144 (19.8) 26 784 (24.8) 27 612 (28.0) 27 951 (25.6) 9 235 (15.9) 16 004 (16.1) 15 872 (15.4) 28 451 (21.1) 29 139 (22.5) 29 473 (19.0) 8 790 (24.4) 15 511 (20.7) 15 390 (19.8) 27 972 (24.8) 28 661 (27.4) 28 963 (23.8) 116 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table VI: MDR-TB notification among all culture positive TB cases with available DST results, European Region, 2007–2011 Country Trend in percentage, 2007–2011 2007 2008 2009 2010 2011 M ea n a nn ua l % ch an ge in ra te , 2 00 7– 20 11 N (%) Rate N (%) Rate N (%) Rate N (%) Rate N (%) Rate EU/EEA Austria 0 5 10 9 (1.8) 0.1 15 (3.1) 0.2 23 (5.3) 0.3 16 (3.4) 0.2 19 (4.2) 0.2 26.6% Belgium 0 2 4 14 (1.9) 0.1 21 (2.7) 0.2 10 (1.3) 0.1 19 (2.3) 0.2 15 (2.0) 0.1 15.7% Bulgaria 0 5 10 76 (7.5) 1.0 31 (3.3) 0.4 43 (5.1) 0.6 56 (5.8) 0.7 55 (7.5) 0.7 2.6% Cyprus 0 10 20 3 (10.3) 0.4 1 (2.8) 0.1 4 (12.9) 0.5 0 (0.0) 0.0 1 (2.5) 0.1 - Czech Republic 0 2 4 8 (1.5) 0.1 11 (2.1) 0.1 8 (1.8) 0.1 9 (2.1) 0.1 7 (1.7) 0.1 -0.5% Denmarka 0 1 2 2 (0.7) 0.0 0 (0.0) 0.0 2 (0.8) 0.0 2 (0.7) 0.0 3 (1.1) 0.1 - Estonia 0 25 50 82 (21.4) 6.1 73 (21.0) 5.4 85 (28.0) 6.3 65 (24.8) 4.9 78 (29.8) 5.8 0.5% Finland 0 2 4 2 (0.8) 0.0 1 (0.4) 0.0 6 (2.0) 0.1 6 (2.4) 0.1 5 (2.0) 0.1 107.3% France 0 2 4 20 (1.3) 0.0 27 (1.7) 0.0 30 (1.2) 0.0 23 (1.6) 0.0 40 (2.6) 0.1 23.5% Germany 0 2 4 66 (2.0) 0.1 49 (1.6) 0.1 62 (2.1) 0.1 52 (1.8) 0.1 56 (2.0) 0.1 -1.7% Greece 0 5 10 14 (2.6) 0.1 - - - 12 (7.1) 0.1 2 (2.2) 0.0 5 (3.1) 0.0 - Hungary 0 2 4 12 (2.6) 0.1 13 (2.8) 0.1 18 (4.0) 0.2 19 (3.3) 0.2 7 (1.5) 0.1 -2.5% Iceland 0 10 20 1 (9.1) 0.3 1 (20.0) 0.3 0 (0.0) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 - Ireland 0 2 4 7 (2.4) 0.2 2 (0.7) 0.0 1 (0.3) 0.0 2 (0.7) 0.0 3 (1.3) 0.1 6.6% Italy 0 2 4 56 (3.3) 0.1 71 (3.7) 0.1 82 (3.3) 0.1 87 (3.4) 0.1 81 (3.2) 0.1 9.7% Latvia 0 10 20 99 (10.1) 4.3 128 (15.5) 5.6 131 (17.4) 5.8 88 (12.3) 3.9 95 (14.8) 4.3 2.3% Liechtenstein 0 1 2 0 (0.0) 0.0 - - - - - - - - - - - - - Lithuania 0 20 40 314 (18.6) 9.3 276 (17.1) 8.2 322 (21.8) 9.6 310 (22.7) 9.3 296 (21.1) 9.1 0.1% Luxembourg 0 10 20 0 (0.0) 0.0 - - - 0 (0.0) 0.0 0 (0.0) 0.0 2 (10.5) 0.4 - Malta 0 5 10 1 (5.3) 0.2 0 (0.0) 0.0 0 (0.0) 0.0 1 (6.3) 0.2 0 (0.0) 0.0 - Netherlands 0 2 4 6 (0.8) 0.0 15 (2.0) 0.1 20 (2.6) 0.1 11 (1.4) 0.1 15 (2.1) 0.1 43.1% Norway 0 2 4 3 (1.2) 0.1 4 (1.8) 0.1 8 (2.8) 0.2 8 (2.9) 0.2 4 (1.6) 0.1 19.3% Poland 0 1 2 22 (0.6) 0.1 19 (0.5) 0.0 21 (0.5) 0.1 30 (0.8) 0.1 41 (0.8) 0.1 19.0% Portugal 0 1 2 34 (2.0) 0.3 32 (1.8) 0.3 24 (1.4) 0.2 19 (1.6) 0.2 22 (1.8) 0.2 -9.1% Romania 0 10 20 673 (17.6) 3.1 792 (14.3) 3.7 624 (10.0) 2.9 574 (9.4) 2.7 530 (8.8) 2.5 -4.6% Slovakia 0 1 2 7 (1.8) 0.1 4 (1.0) 0.1 1 (0.4) 0.0 1 (0.4) 0.0 3 (1.6) 0.1 20.3% Slovenia 0 1 2 0 (0.0) 0.0 2 (1.0) 0.1 1 (0.6) 0.0 0 (0.0) 0.0 0 (0.0) 0.0 - Spain 0 3 6 59 (4.3) 0.1 76 (4.7) 0.2 56 (3.2) 0.1 49 (3.5) 0.1 41 (3.2) 0.1 -7.5% Sweden 0 3 6 15 (4.1) 0.2 11 (2.6) 0.1 13 (2.5) 0.1 18 (3.4) 0.2 17 (3.6) 0.2 5.2% United Kingdom 0 1 2 56 (1.2) 0.1 53 (1.1) 0.1 60 (1.2) 0.1 60 (1.3) 0.1 81 (1.6) 0.1 9.9% Subtotal EU/EEA 0 3 6 1 661 (5.2) 0.3 1 728 (5.3) 0.4 1 667 (4.8) 0.3 1 527 (4.7) 0.3 1 522 (4.5) 0.3 0.0% ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 117 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Country Trend in percentage, 2007–2011 2007 2008 2009 2010 2011 M ea n a nn ua l % ch an ge in ra te , 2 00 7– 20 11 N (%) Rate N (%) Rate N (%) Rate N (%) Rate N (%) Rate Non-EU/EEA Albania 0 2 4 3 (1.6) 0.1 2 (0.9) 0.1 0 (0.0) - 2 (1.0) 0.1 5 (2.4) 0.2 - Andorra 0 1 2 - - - - - - - - - - - - - - - - Armenia 0 20 40 125 (19.5) 4.1 128 (21.1) 4.2 156 (22.9) 5.1 68 (14.8) 2.2 79 (14.9) 2.5 -4.2% Azerbaijan 0 25 50 196 (41.7) 2.2 - - - - - - 552 (31.3) 6.0 90 (12.5) 1.0 - Belarus 0 50 100 870 (26.2) 8.9 923 (28.5) 9.5 1 342 (33.7) 13.9 1 576 (41.7) 16.4 1 594 (52.6) 16.7 18.0% Bosnia and Herzegovina 0 1 2 8 (0.6) 0.2 12 (1.4) 0.3 2 (0.2) 0.1 2 (0.3) 0.1 5 (0.7) 0.1 29.4% Croatia 0 1 2 7 (1.0) 0.2 4 0.1 7 (1.4) 0.2 - - - 2 (0.5) 0.0 - Georgia 0 10 20 269 (14.0) 6.1 481 (20.0) 10.9 369 (15.6) 8.4 359 (14.1) 8.2 453 (15.8) 10.5 20.4% Israel 0 3 6 14 (4.9) 0.2 13 (5.7) 0.2 6 (2.3) 0.1 12 (4.9) 0.2 11 (3.9) 0.1 5.3% Kazakhstan 0 25 50 5 568 (35.9) 36.0 3 676 (34.1) 23.5 3 644 (38.0) 23.0 4 033 (34.9) 25.2 4 575 (39.6) 28.2 -3.8% Kyrgyzstan 0 50 100 322 (26.4) 6.3 269 (33.3) 5.2 785 (40.7) 14.9 489 (100.0) 9.2 - - - 8.0% Macedonia, the former Yugoslav Republic of 0 3 6 9 (4.7) 0.4 2 (1.4) 0.1 1 (0.5) 0.0 7 (3.9) 0.3 1 (0.6) 0.0 96.3% Moldova 0 25 50 896 (39.9) 24.4 1 048 (43.0) 28.8 1 069 (44.3) 29.7 1 082 (42.9) 30.3 1 001 (42.0) 28.2 4.1% Monaco - - - - - - - - - - - - - - - - Montenegro 0 2 4 2 (2.3) 0.3 - - - 1 (1.1) 0.2 - - - 1 (1.4) 0.2 - Russia 0 25 50 5 297 (15.0) 3.7 6 960 (16.3) 4.9 14 686 (25.0) 10.3 12 387 (25.1) 8.7 13 785 (28.9) 9.7 34.6% San Marino - - - - - - - - - - - - - - - - Serbia 0 1 2 25 (1.9) 0.3 16 (1.5) 0.2 - - - 12 (1.3) 0.1 9 (0.9) 0.1 Serbia excluding UN Administered Province of Kosovob 0 1 2 25 (1.9) 0.3 16 (1.5) 0.2 - - - 12 (1.3) 0.1 9 (0.9) 0.1 - UN Administered Province of Kosovob - - - - - - - - - - - - - - - - Switzerland 0 2 4 8 (2.7) 0.1 5 (1.2) 0.1 - - - 9 (2.0) 0.1 8 (1.8) 0.1 - Tajikistan 0 50 100 - - - - - - 319 (22.6) 4.7 266 (69.5) 3.9 380 (66.0) 5.4 11.5% Turkey 0 3 6 240 (4.9) 0.3 263 (5.3) 0.4 222 (5.1) 0.3 250 (5.0) 0.3 262 (5.4) 0.4 1.6% Turkmenistan 0 25 50 - - - - - - 39 (14.2) 0.8 38 (26.4) 0.8 - - - 22.6% Ukraine 0 25 50 - - - - - - 3 482 (19.0) 7.6 5 336 (38.0) 11.7 4 305 (29.2) 9.5 11.8% Uzbekistan 0 50 100 484 (57.1) 1.8 342 (46.0) 1.3 654 (50.2) 2.4 1 023 (25.4) 3.7 1 385 (62.5) 5.0 36.8% Subtotal non-EU/EEA 0 20 40 14 343 (20.3) 3.7 14 144 (19.8) 3.6 26 784 (24.8) 6.9 27 503 (27.9) 7.0 27 951 (25.6) 7.1 22.6% Total European Region 0 20 40 16 004 (16.1) 1.8 15 872 (15.4) 1.8 28 451 (21.1) 3.2 29 030 (22.4) 3.2 29 473 (19.0) 3.3 20.0% Subtotal 18 HPC 0 20 40 15 511 (20.7) 4.0 15 390 (19.8) 4.0 27 972 (24.8) 7.2 28 552 (27.3) 7.4 28 963 (23.8) 7.5 20.8% b In accordance with the UN Security Council Resolution No. 1244 (1999). 118 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table VII: XDR-TB notification among all MDR-TB cases with second line drug sensitivity test results, European Region, 2006–2011a Country Trend in percentage, 2006–2011 2006 2007 2008 2009 2010 2011 Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austria 0 20 40 - - - - - - 13 4 (30.8) 21 2 (9.5) 16 1 (6.3) 19 6 (31.6) Belgium 0 20 40 18 2 (11.1) 14 1 (7.1) 21 2 (9.5) 10 3 (30.0) 19 2 (10.5) 15 3 (20.0) Bulgaria 0 10 20 - - - 42 6 (14.3) 27 1 (3.7) 24 1 (4.2) 35 1 (2.9) 46 0 (0.0) Cyprus 0 1 2 - - - 2 0 (0.0) 1 0 (0.0) 2 0 (0.0) 0 0 (0.0) 1 0 (0.0) Czech Republic 0 50 100 4 3 (75.0) 4 0 (0.0) 10 1 (10.0) 7 1 (14.3) 4 1 (25.0) 5 2 (40.0) Denmarkb 0 1 2 - - - 2 0 (0.0) 0 0 (0.0) 2 0 (0.0) 2 0 (0.0) 2 0 (0.0) Estonia 0 10 20 52 5 (9.6) 82 14 (17.1) 69 6 (8.7) 79 8 (10.1) 61 10 (16.4) 75 14 (18.7) Finland - - - - - - - - - - - - - - - - - - France - - - - - - - - - - - - - - - - - - Germany 0 1 2 - - - - - - - - - - - - - - - 2 0 (0.0) Greece 0 20 40 - - - - - - - - - 11 2 (18.2) 2 0 (0.0) 5 2 (40.0) Hungary 0 10 20 - - - - - - - - - - - - 18 2 (11.1) 5 0 (0.0) Iceland 0 1 2 - - - 1 0 (0.0) 1 0 (0.0) 0 0 (0.0) 0 0 (0.0) 0 0 (0.0) Ireland 0 1 2 - - - - - - - - - - - - - - - 1 0 (0.0) Italy 0 10 20 - - - - - - 71 0 (0.0) 32 1 (3.1) 10 0 (0.0) 50 6 (12.0) Latvia 0 10 20 - - - 95 6 (6.3) 127 19 (15.0) 130 16 (12.3) 87 13 (14.9) 95 12 (12.6) Liechtenstein - - - - - - - - - - - - - - - - - - Lithuania 0 50 100 - - - - - - - - - 4 4 (100.0) 310 50 (16.1) 295 53 (18.0) Luxembourg - - - - - - - - - - - - - - - - - - Malta 0 1 2 - - - 1 0 (0.0) 0 0 (0.0) 0 0 (0.0) 1 0 (0.0) 0 0 (0.0) Netherlands - - - - - - - - - - - - - - - - - - Norway 0 1 2 - - - - - - - - - 4 0 (0.0) 8 0 (0.0) 4 0 (0.0) Poland 0 50 100 - - - - - - 4 3 (75.0) 5 1 (20.0) 12 1 (8.3) 9 1 (11.1) Portugal - - - - - - - - - - - - - - - - - - Romania 0 50 100 1 1 (100.0) 48 48 (100.0) 78 53 (67.9) 217 26 (12.0) 215 27 (12.6) 248 30 (12.1) Slovakia 0 1 2 - - - 5 0 (0.0) 4 0 (0.0) 1 0 (0.0) 1 0 (0.0) 3 0 (0.0) Slovenia - - - - - - - - - - - - - - - - - - Spain 0 5 10 - - - - - - 73 3 (4.1) 56 5 (8.9) 49 3 (6.1) 41 1 (2.4) Sweden 0 5 10 - - - 14 1 (7.1) 10 1 (10.0) 13 0 (0.0) 0 0 (0.0) 17 0 (0.0) United Kingdom 0 5 10 - - - - - - - - - 52 1 (1.9) 57 3 (5.3) 79 6 (7.6) Subtotal EU/EEA 0 20 40 75 11 (14.7) 310 76 (24.5) 509 93 (18.3) 670 71 (10.6) 907 114 (12.6) 1 017 136 (13.4) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Includes countries reporting second-line anti-TB drug susceptibility testing. b Excluding Greenland data (see Chapter 1.1). 119 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Country Trend in percentage, 2006–2011 2006 2007 2008 2009 2010 2011 Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB Total MDR TB with SLD DST XDR-TB N (%) N (%) N (%) N (%) N (%) N (%) Non-EU/EEA Albania 0 1 2 - - - - - - - - - - - - 2 0 (0.0) - - - Andorra - - - - - - - - - - - - - - - - - - Armenia 0 10 20 - - - 125 10 (8.0) 0 10 - - - 177 21 (11.9) 79 0 (0.0) Azerbaijan 0 2 4 - - - - - - - - - - - - - - - 84 3 (3.6) Belarus - - - - - - - - - - - - - - - - - - Bosnia and Herzegovina 0 1 2 - - - - - - - - - - - - - - - 5 0 (0.0) Croatia 0 1 2 - - - 7 0 (0.0) - - - - - - - - - - - - Georgia 0 10 20 - - - 140 13 (9.3) - - - 306 32 (10.5) 313 30 (9.6) 440 28 (6.4) Israel 0 5 10 19 0 (0.0) 14 0 (0.0) 13 1 (7.7) 6 0 (0.0) 12 1 (8.3) 11 0 (0.0) Kazakhstan 0 50 100 - - - - - - - - - 282 216 (76.6) 0 0 825 187 (22.7) Kyrgyzstan 0 50 100 - - - - - - - - - - - - 32 32 (100.0) - - - Macedonia, the former Yugoslav Republic of 0 10 20 - - - - - - - - - - - - 5 1 (20.0) - - - Moldova 0 5 10 47 3 (6.4) 319 0 (0.0) - - - - - - - - - - - - Monaco - - - - - - - - - - - - - - - - - - Montenegro 0 1 2 - - - 2 0 (0.0) - - - 1 0 (0.0) - - - 1 0 (0.0) Russia - - - - - - - - - - - - - - - - - - San Marino - - - - - - - - - - - - - - - - - - Serbia 0 20 40 9 2 (22.2) Serbia excluding UN Administered Province of Kosovoc 0 20 40 - - - - - - - - - - - - - - - 9 2 (22.2) UN Administered Province of Kosovoc - - - - - - - - - - - - - - - - - - Switzerland 0 1 2 - - - 8 0 (0.0) 5 0 (0.0) - - - 9 0 (0.0) 8 0 (0.0) Tajikistan 0 20 40 - - - - - - - - - 52 11 (21.2) - - - 122 12 (9.8) Turkey 0 50 100 - - - - - - - - - - - - 5 3 (60.0) 13 1 (7.7) Turkmenistan - - - - - - - - - - - - - - - - - - Ukraine - - - - - - - - - - - - - - - - - - Uzbekistan 0 25 50 - - - 19 9 (47.4) 45 8 (17.8) 58 13 (22.4) 364 16 (4.4) 834 12 (1.4) Subtotal non-EU/EEA 0 50 100 66 3 (4.5) 634 32 (64.7) 63 19 (30.2) 705 272 (36.8) 919 104 (11.3) 2 431 245 (10.1) Total European Region 0 20 40 141 14 (9.9) 944 108 (11.4) 572 112 (19.6) 1 375 343 (25.0) 1 826 218 (11.9) 3 448 381 (11.0) Subtotal 18 HPC 0 20 40 100 9 (9.0) 870 106 (12.2) 346 97 (28.0) 1 152 327 (28.4) 1 599 203 (12.7) 3 156 352 (11.2) c In accordance with the UN Security Council Resolution No. 1244 (1999).

121 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Table VIII: Tuberculosis cases with HIV infection, European Region, 2001–2011 Table VIIIa: 2001–2006a Country 2001 2002 2003 2004 2005 2006 TB cases HIV positive TB cases HIV positive TB cases HIV positive TB cases HIV positive TB cases HIV positive TB cases HIV positive N (%)b N (%)b N (%)b N (%)b N (%)b N (%)b EU/EEA Austria - - - - - - - - - - - - - - - - - - Belgium 1 321 60 (4.5) 1 294 51 (3.9) 1 117 70 (6.3) 1 198 55 (4.6) 1 107 52 (4.7) 1 117 55 (4.9) Bulgaria - - - - - - - - - 3 232 10 (0.3) 3 302 0 (0.0) 3 232 6 (0.2) Cyprus - - - - - - - - - - - - - - - 37 0 (0.0) Czech Republic 1 350 2 (0.1) 1 200 0 (0.0) 1 162 5 (0.4) - - - - - - 951 4 (0.4) Denmarkc 511 11 (2.2) 419 0 (0.0) 393 11 (2.8) 385 7 (1.8) 428 9 (2.1) 387 11 (2.8) Estonia 812 7 (0.9) 713 20 (2.8) 623 18 (2.9) 594 26 (4.4) 518 33 (6.4) 460 41 (8.9) Finland - - - - - - - - - - - - 372 3 (0.8) 297 6 (2.0) France 6 465 364 (5.6) - - - - - - - - - - - - - - - Germany - - - - - - - - - - - - - - - - - - Greece - - - - - - - - - - - - - - - - - - Hungary - - - - - - - - - - - - - - - - - - Iceland 13 0 (0.0) 8 1 (12.5) 5 1 (20.0) 12 1 (8.3) 11 1 (9.1) 13 2 (15.4) Ireland 406 7 (1.7) 408 19 (4.7) 407 2 (0.5) 432 13 (3.0) 450 11 (2.4) 463 7 (1.5) Italy - - - - - - - - - 4 220 11 (0.3) 4 212 - - 4 503 - - Latvia 2 082 27 (1.3) 1 855 25 (1.3) 1 726 40 (2.3) 1 610 40 (2.5) 1 443 51 (3.5) 1 328 45 (3.4) Liechtenstein - - - - - - - - - - - - - - - - - - Lithuania 2 989 3 (0.1) 2 844 1 (0.0) 2 821 0 (0.0) 2 514 8 (0.3) 2 574 7 (0.3) 2 559 13 (0.5) Luxembourg - - - - - - - - - - - - - - - - - - Malta 16 0 (0.0) 24 0 (0.0) 7 1 (14.3) 19 1 (5.3) 25 0 (0.0) 30 2 (6.7) Netherlands 1 436 67 (4.7) 1 401 62 (4.4) 1 321 65 (4.9) 1 344 46 (3.4) 1 128 61 (5.4) 1 031 41 (4.0) Norway - - - - - - - - - - - - - - - - - - Poland - - - - - - - - - - - - - - - - - - Portugal 4 399 680 (15.5) 4 501 727 (16.2) 4 148 669 (16.1) 3 854 607 (15.7) 3 558 546 (15.3) 3 456 474 (13.7) Romania - - - - - - 31 039 161 (0.5) 31 034 144 (0.5) 29 288 160 (0.5) 26 600 60 (0.2) Slovakia 1 076 0 (0.0) 1 053 0 (0.0) 983 1 (0.1) 705 0 (0.0) 760 1 (0.1) 730 0 (0.0) Slovenia 371 2 (0.5) 350 1 (0.3) 293 1 (0.3) 263 3 (1.1) 278 0 (0.0) 215 1 (0.5) Spain 7 453 599 (8.0) 7 626 926 (12.1) 7 467 714 (9.6) 7 766 436 (5.6) 7 820 394 (5.0) 8 029 354 (4.4) Sweden - - - - - - - - - - - - - - - - - - United Kingdom 6 864 314 (4.6) 7 330 459 (6.3) 7 266 548 (7.5) 7 650 663 (8.7) 8 349 679 (8.1) 8 363 640 (7.7) Subtotal EU/EEA 37 551 2 143 (5.7) 31 026 2 292 (7.4) 60 778 2 307 (3.8) 62 600 2 059 (3.3) 53 051 2 008 (3.8) 50 935 1 762 (3.5) Non-EU/EEA Albania 555 0 (0.0) 594 0 (0.0) 561 0 (0.0) 581 0 (0.0) 540 1 (0.2) 502 3 (0.6) Andorra 10 0 (0.0) 5 0 (0.0) 11 0 (0.0) 7 0 (0.0) 10 0 (0.0) 13 0 (0.0) Armenia 1 389 0 (0.0) 1 433 0 (0.0) 1 570 0 (0.0) 1 701 6 (0.4) 2 322 6 (0.3) 2 155 25 (1.2) Azerbaijan 4 898 0 (0.0) 5 142 0 (0.0) 3 931 0 (0.0) 6 501 0 (0.0) 7 920 0 (0.0) 7 498 0 (0.0) Belarus 2 341 0 (0.0) 0 0 - 5 963 0 (0.0) 6 490 77 (1.2) 6 357 139 (2.2) 6 065 0 (0.0) Bosnia and Herzegovina 2 469 0 (0.0) 1 691 0 (0.0) 1 780 0 (0.0) 2 382 0 (0.0) 2 160 0 (0.0) 1 800 0 (0.0) Croatia 1 376 0 (0.0) 1 443 0 (0.0) 1 494 0 (0.0) 1 297 0 (0.0) 1 144 0 (0.0) 1 135 0 (0.0) Georgia 4 006 0 (0.0) 4 490 0 (0.0) 5 993 0 (0.0) 5 967 9 (0.2) 6 448 13 (0.2) 6 311 17 (0.3) Israel 512 27 (5.3) 466 25 (5.4) 472 37 (7.8) 456 12 (2.6) 372 17 (4.6) 340 12 (3.5) Kazakhstan 26 224 0 (0.0) 27 546 0 (0.0) 44 868 0 (0.0) 39 380 0 (0.0) 40 429 183 (0.5) 38 556 234 (0.6) Kyrgyzstan 298 0 (0.0) 6 613 0 (0.0) 8 670 0 (0.0) 6 591 0 (0.0) 6 765 0 (0.0) 6 656 0 (0.0) Macedonia, the former Yugoslav Republic of 648 0 (0.0) 686 0 (0.0) 697 0 (0.0) 680 0 (0.0) 658 2 (0.3) 627 0 (0.0) Moldova 3 608 0 (0.0) 1 146 0 (0.0) 6 241 0 (0.0) 6 008 0 (0.0) 6 278 9 (0.1) 6 118 20 (0.3) Monaco 0 - - 0 - - 0 0 - 0 0 - 0 - - 0 - - Montenegro 0 - - 0 - - 0 0 - 0 - - 170 0 (0.0) 171 1 (0.6) Russia 132 477 0 (0.0) 128 873 0 (0.0) 152 244 0 (0.0) 152 438 4 506 (3.0) 154 379 3 533 (2.3) 152 265 1 979 (1.3) San Marino 0 - - 1 0 (0.0) 1 0 (0.0) 0 - - 0 - - 0 - - Serbia 3 468 3 (0.1) 3 272 5 (0.2) Serbia excluding UN Administered Province of Kosovod - - - 0 - - 0 0 - 0 - - 3 468 3 (0.1) 3 272 5 (0.2) UN Administered Province of Kosovod - - - 0 0 - 0 0 - 0 - - 0 Switzerland 617 0 (0.0) 671 0 (0.0) 630 0 (0.0) 602 0 (0.0) 563 0 (0.0) 519 0 (0.0) Tajikistan 3 508 0 (0.0) 687 0 (0.0) 4 883 0 (0.0) 5 122 0 (0.0) 7 526 1 (0.0) 6 671 3 (0.0) Turkey 4 444 0 (0.0) 0 0 - 6 032 0 (0.0) 8 444 0 (0.0) 21 303 0 (0.0) 20 526 0 (0.0) Turkmenistan 3 948 0 (0.0) 3 671 0 (0.0) 4 759 0 (0.0) 4 182 0 (0.0) 3 291 0 (0.0) 3 369 0 (0.0) Ukraine 3 150 0 (0.0) 0 942 - 53 444 0 (0.0) 0 - - 0 1 526 41 265 1 987 (4.8) Uzbekistan 7 095 0 (0.0) 20 588 0 (0.0) 26 172 0 (0.0) 25 714 138 (0.5) 28 891 147 (0.5) 25 310 238 (0.9) Subtotal non-EU/EEA 203 573 27 (0.0) 205 746 967 (0.5) 330 416 37 (0.0) 274 543 4 748 (1.7) 300 994 5 580 (1.9) 331 144 4 524 (1.4) Total European Region 241 124 2 170 (1.7) 236 772 3 259 (2.8) 391 194 2 344 (2.8) 338 230 6 807 (2.8) 354 045 7 588 (2.8) 382 079 6 286 (2.8) Subtotal 18 HPC 237 571 37 (0.0) 242 531 988 (0.4) 364 242 219 (0.1) 307 522 4 964 (1.6) 329 034 5 808 (1.8) 356 944 4 668 (1.3) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a HIV prevalence may be underestimated due to incomplete HIV testing and/or reporting of HIV serostatus. b Totals and percentages calculated from all registered TB cases with reported HIV test results. c Excluding Greenland data (see Chapter 1.1). d In accordance with the UN Security Council Resolution No. 1244 (1999). 122 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table VIIIb: 2007–2011a Country 2007 2008 2009 All TB cases (N) Cases with known HIV status HIV positive All TB cases (N) Cases with known HIV status HIV positive All TB cases (N) Cases with known HIV status HIV positive N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austria - - - - - - - - - - - - - - - Belgium 1 020 871 (85.4) 52 (6.0) 990 913 (92.2) 56 (6.1) 994 930 (93.6) 43 (4.6) Bulgaria 3 038 199 (6.6) 0 (0.0) 3 150 520 (16.5) 0 (0.0) 2 910 1 155 (39.7) 1 (0.1) Cyprus 42 42 (100.0) 0 (0.0) 50 36 (72.0) 2 (5.6) 55 - - - - Czech Republic 846 161 (19.0) 7 (4.3) 864 174 (20.1) 7 (4.0) 694 160 (23.1) 6 (3.8) Denmarkc 391 158 (40.4) 13 (8.2) 380 - - - - 334 207 (62.0) 9 (4.3) Estonia 491 450 (91.6) 52 (11.6) 444 400 (90.1) 44 (11.0) 411 379 (92.2) 40 (10.6) Finland 348 8 (2.3) 8 - 344 5 (1.5) 5 (100.0) 417 6 (1.4) 6 - France - - - - - - - - - - - - - - - Germany - - - - - - - - - - - - - - - Greece - - - - - - - - - - - - - - - Hungary - - - - - - - - - - - - - - - Iceland - - - - - - - - - - 9 7 (77.8) 0 (0.0) Ireland 480 51 (10.6) 16 (31.4) 468 54 (11.5) 15 (27.8) 479 136 (28.4) 11 (8.1) Italy 4 525 - - - - 4 418 - - - - - - - - - Latvia 1 255 1 066 (84.9) 56 (5.3) 1 070 910 (85.0) 72 (7.9) 977 830 (85.0) 73 (8.8) Liechtenstein - - - - - - - - - - - - - - - Lithuania 2 408 13 (0.5) 13 - 2 250 - - 21 - 2 081 - - 14 - Luxembourg - - - - - - - - - - - - - - - Malta 38 - - - - 53 45 (84.9) 5 (11.1) 44 38 (86.4) 4 (10.5) Netherlands 998 205 (20.5) 32 (15.6) 1 015 261 (25.7) 37 (14.2) 1 158 380 (32.8) 42 (11.1) Norway - - - - - - - - - - - - - - - Poland 8 587 33 (0.4) - - 8 080 35 (0.4) - - 8 236 27 (0.3) 27 - Portugal 3 139 2 664 (84.9) 467 (17.5) 3 002 2 350 (78.3) 438 (18.6) 2 871 2 455 (85.5) 392 (16.0) Romania 24 837 6 367 (25.6) 178 (2.8) 24 680 6 149 (24.9) 202 (3.3) 23 164 6 443 (27.8) 214 (3.3) Slovakia 682 682 (100.0) 0 (0.0) 633 633 (100.0) 0 (0.0) 506 500 (98.8) 1 (0.2) Slovenia 218 98 (45.0) 0 (0.0) 213 130 (61.0) 0 (0.0) 188 132 (70.2) 0 (0.0) Spain 7 768 3 969 (51.1) 548 (13.8) 8 216 3 937 (47.9) 507 (12.9) 7 592 3 599 (47.4) 425 (11.8) Sweden - - - - - - - - - - - - - - - United Kingdom 8 329 526 (6.3) 526 - 8 606 553 (6.4) 553 - - - - - - Subtotal EU/EEA 54 140 17 563 (32.4) 1 421 (8.1) 37 817 16 512 (43.7) 860 (5.2) 35 328 17 351 (49.1) 799 (4.6) Non-EU/EEA Albania 447 37 (8.3) 1 (2.7) 434 177 (40.8) 4 (2.3) 447 211 (47.2) 6 (2.8) Andorra 6 0 (0.0) 0 - 4 0 (0.0) 0 - 9 0 (0.0) 0 - Armenia 2 129 335 (15.7) 8 (2.4) 2 125 335 (15.8) 12 (3.6) 2 006 521 (26.0) 17 (3.3) Azerbaijan 7 347 0 (0.0) 31 - 10 078 5 945 (59.0) 0 (0.0) 10 417 0 (0.0) 0 - Belarus 5 756 5 756 (100.0) 152 (2.6) 5 483 5 227 (95.3) 156 (3.0) 5 511 5 227 (94.8) 190 (3.6) Bosnia and Herzegovina 2 400 0 (0.0) 0 - 1 736 0 (0.0) 0 - 1 772 0 (0.0) 0 - Croatia 982 0 (0.0) 3 - 980 0 (0.0) 0 - 855 0 (0.0) 0 - Georgia 5 912 842 (14.2) 32 (3.8) 5 836 1 482 (25.4) 20 (1.3) 5 978 1 289 (21.6) 33 (2.6) Israel 397 397 (100.0) 16 (4.0) 322 283 (87.9) 12 (4.2) 347 288 (83.0) 22 (7.6) Kazakhstan 37 658 24 532 (65.1) 213 (0.9) 28 913 28 237 (97.7) 238 (0.8) 30 578 29 597 (96.8) 325 (1.1) Kyrgyzstan 6 707 0 (0.0) 0 - 7 127 6 508 (91.3) 117 (1.8) 6 358 6 358 (100.0) 88 (1.4) Macedonia, the former Yugoslav Republic of 563 97 (17.2) 1 (1.0) 483 99 (20.5) 2 (2.0) 473 43 (9.1) 0 (0.0) Moldova 6 367 5 123 (80.5) 194 (3.8) 5 838 5 171 (88.6) 260 (5.0) 5 591 5 107 (91.3) 260 (5.1) Monaco 0 - - 0 - 0 0 - 0 - 0 0 - 0 - Montenegro 159 32 (20.1) 0 (0.0) 133 73 (54.9) 0 (0.0) 120 91 (75.8) 0 (0.0) Russia 214 924 218 866 (101.8) 4 828 (2.2) 214 905 214 905 (100.0) 5 892 (2.7) 156 222 156 222 (100.0) 7 064 (4.5) San Marino 0 0 - 0 - 0 0 - 0 - 0 0 - 0 - Serbia 2 981 9 (0.3) 9 (100.0) 2 813 5 (0.2) 5 (100.0) 2 595 5 (0.2) 5 (100.0) Serbia excluding UN Administered Province of Kosovod 2 981 9 (0.3) 9 (100.0) 2 813 5 (0.2) 5 (100.0) 2 595 5 (0.2) 5 (100.0) UN Administered Province of Kosovod 0 - 0 - 0 0 - 0 - 0 0 - 0 - Switzerland 472 0 (0.0) 0 - 516 0 (0.0) 0 - 554 0 (0.0) 0 - Tajikistan 8 081 2 763 (34.2) 43 (1.6) 7 996 3 949 (49.4) 48 (1.2) 7 482 3 714 (49.6) 49 (1.3) Turkey 19 694 0 (0.0) 0 - 18 452 0 (0.0) 0 - 17 402 1 (0.0) 1 (100.0) Turkmenistan 3 698 0 (0.0) 0 - 3 909 0 (0.0) 0 - 3 157 0 (0.0) 0 - Ukraine 40 643 34 300 (84.4) 2 345 (6.8) 37 832 35 739 (94.5) 3 375 (9.4) 38 901 33 424 (85.9) 3 771 (11.3) Uzbekistan 23 390 31 682 (135.5) 371 (1.2) 21 194 21 194 (100.0) 256 (1.2) 21 453 21 453 (100.0) 357 (1.7) Subtotal non-EU/EEA 390 713 324 771 (83.1) 8 247 (2.5) 377 109 329 329 (87.3) 10 397 (3.2) 318 228 263 551 (82.8) 12 188 (4.6) Total European Region 474 794 342 334 (72.1) 10 215 (3.0) 460 309 346 434 (75.3) 12 361 (3.6) 397 906 280 935 (70.6) 13 498 (4.8) Subtotal 18 HPC 414 335 332 294 (80.2) 8 516 (2.6) 401 282 336 671 (83.9) 10 713 (3.2) 340 599 271 720 (79.8) 12 497 (4.6) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a HIV prevalence may be underestimated due to incomplete HIV testing and/or reporting of HIV serostatus. b Totals and percentages calculated from all registered TB cases with reported HIV test results. c Excluding Greenland data (see Chapter 1.1). d In accordance with the UN Security Council Resolution No. 1244 (1999). 123 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2010 2011 All TB cases (N) Cases with known HIV status HIV positive All TB cases (N) Cases with known HIV status HIV positive N (%) N (%) N (%) N (%) - - - - - - - - - - 1 086 943 (86.8) 62 (6.6) 1 044 845 (80.9) 44 (5.2) 2 649 1 773 (66.9) 2 (0.1) 2 407 1 698 (70.5) 5 (0.3) - - - - - 54 1 (1.9) 1 - 669 176 (26.3) 5 (2.8) 600 153 (25.5) 4 (2.6) 366 9 (2.5) 9 - 381 9 (2.4) 9 - 333 298 (89.5) 34 (11.4) 341 313 (91.8) 47 (15.0) 325 4 (1.2) 4 - 325 3 (0.9) 3 - 5 116 1 233 (24.1) 121 (9.8) 4 942 1 354 (27.4) 95 (7.0) - - - - - - - - - - - - - - - - - - - - - - - - - 1 445 1 (0.1) 1 - 22 21 (95.5) 1 (4.8) 9 8 (88.9) 0 (0.0) 420 98 (23.3) 15 (15.3) 425 94 (22.1) 19 (20.2) - - - - - - - - - - 935 748 (80.0) 69 (9.2) 885 752 (85.0) 71 (9.4) - - - - - - - - - - 1 938 912 (47.1) 20 (2.2) 1 904 1 352 (71.0) 22 (1.6) 29 29 (100.0) 0 (0.0) 26 5 (19.2) 2 (40.0) 32 26 (81.3) 3 (11.5) 33 30 (90.9) 5 (16.7) 1 065 370 (34.7) 47 (12.7) 1 007 460 (45.7) 31 (6.7) - - - - - - - - - - 7 509 22 (0.3) 22 - 8 478 26 (0.3) 26 - 2 626 1 720 (65.5) 229 (13.3) - - - - - 21 059 7 833 (37.2) 241 (3.1) 19 212 9 383 (48.8) 243 (2.6) 439 430 (97.9) 1 (0.2) 399 395 (99.0) 0 (0.0) 172 131 (76.2) 1 (0.8) 192 147 (76.6) 0 (0.0) 7 239 4 909 (67.8) 456 (9.3) 6 762 4 541 (67.2) 415 (9.1) - - - - - - - - - - 8 483 378 (4.5) 378 - - - - - - 37 525 21 659 (57.7) 1 316 (6.1) 40 188 21 530 (53.6) 1 003 (4.7) 445 186 (41.8) 0 (0.0) 431 170 (39.4) 2 (1.2) 7 0 (0.0) 0 - - - - - - 1 780 1 242 (69.8) 17 (1.4) 1 582 1 499 (94.8) 49 (3.3) 8 394 0 (0.0) 0 - 10 100 6 179 (61.2) 76 (1.2) 5 554 5 153 (92.8) 190 (3.7) 5 118 4 747 (92.8) 217 (4.6) 1 390 0 (0.0) 0 - 1 385 0 (0.0) 0 - 695 0 (0.0) 1 - 619 0 (0.0) 4 - 5 796 1 841 (31.8) 35 (1.9) 5 533 2 550 (46.1) 50 (2.0) 343 308 (89.8) 13 (4.2) 418 384 (91.9) 24 (6.3) 28 550 23 854 (83.6) 333 (1.4) 26 211 22 480 (85.8) 352 (1.6) 6 295 6 295 (100.0) 183 (2.9) 6 254 153 (2.4) 0 (0.0) 420 39 (9.3) 0 (0.0) 362 45 (12.4) 0 (0.0) 5 447 5 192 (95.3) 308 (5.9) 5 341 5 017 (93.9) 285 (5.7) 1 0 (0.0) - - - - - - - 114 84 (73.7) 1 (1.2) 112 92 (82.1) 0 (0.0) 162 553 162 553 (100.0) 8 653 (5.3) 159 479 79 494 (49.8) 4 104 (5.2) 0 0 - 0 - 0 0 - 0 - 2 385 16 (0.7) 12 (75.0) 2 216 67 (3.0) 6 (9.0) 2 385 16 (0.7) 12 (75.0) 1 341 67 (5.0) 6 (9.0) 0 0 - 0 - 875 - - - - 548 0 (0.0) 0 - 578 - - - - 7 641 4 049 (53.0) 100 (2.5) 7 609 6 241 (82.0) 115 (1.8) 16 551 581 (3.5) 14 (2.4) 15 679 7 241 (46.2) 29 (0.4) 3 230 3 230 (100.0) 0 (0.0) 0 0 - 0 - 36 409 34 621 (95.1) 5 752 (16.6) 42 676 31 776 (74.5) 5 893 (18.5) 20 330 20 330 (100.0) 427 (2.1) 15 913 15 913 (100.0) 546 (3.4) 314 878 269 574 (85.6) 16 039 (5.9) 304 571 184 048 (60.4) 11 748 (6.4) 390 454 291 683 (74.7) 17 761 (6.1) 344 759 205 578 (59.6) 12 751 (6.2) 335 444 280 551 (83.6) 16 380 (5.8) 326 656 196 788 (60.2) 12 104 (6.2) 124 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table IX: Treatment success of new laboratory-confirmed pulmonary TB cases, European Region, 2001–2010 Country Trend in percentage, 2001–2010 2001 2002 2003 2004 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) EU/EEA Austria 0 50 100 553 449 (81.2) 555 438 (78.9) 514 397 (77.2) 552 422 (76.4) Belgium 0 50 100 534 336 (62.9) 617 402 (65.2) 437 313 (71.6) 520 380 (73.1) Bulgaria 0 50 100 - - - - - - 1 260 1 145 (90.9) - - - Cyprus 0 50 100 - - - 11 9 (81.8) 21 17 (81.0) 17 6 (35.3) Czech Republic 0 50 100 704 487 (69.2) 609 420 (69.0) 620 465 (75.0) 550 381 (69.3) Denmarka 0 50 100 196 173 (88.3) 217 169 (77.9) 213 179 (84.0) 201 171 (85.1) Estonia 0 50 100 351 238 (67.8) 346 235 (67.9) 332 231 (69.6) 336 239 (71.1) Finland 0 50 100 - - - - - - - - - - - - France - - - - - - - - - - - - Germany 0 50 100 2 589 1 718 (66.4) 2 659 1 879 (70.7) 2 665 1 951 (73.2) 2 790 1 973 (70.7) Greece - - - - - - - - - - - - Hungary 0 50 100 732 392 (53.6) 734 433 (59.0) 709 384 (54.2) 787 438 (55.7) Iceland 0 50 100 7 6 (85.7) 5 5 (100.0) 2 2 (100.0) 4 3 (75.0) Ireland 0 50 100 129 76 (58.9) 161 121 (75.2) 152 107 (70.4) 162 124 (76.5) Italy - - - - - - - - - - - - Latvia 0 50 100 1 004 769 (76.6) 943 742 (78.7) 963 749 (77.8) 857 643 (75.0) Liechtenstein 0 50 100 - - - - - - - - - - - - Lithuania 0 50 100 1 142 844 (73.9) 1 001 738 (73.7) 1 099 836 (76.1) 1 092 814 (74.5) Luxembourg - - - - - - - - - - - - Malta 0 50 100 9 8 (88.9) 12 11 (91.7) 2 2 (100.0) 5 5 (100.0) Netherlands 0 50 100 601 519 (86.4) 444 383 (86.3) 441 379 (85.9) 436 368 (84.4) Norway 0 50 100 145 124 (85.5) 97 81 (83.5) 119 102 (85.7) 132 113 (85.6) Poland 0 50 100 4 905 3 734 (76.1) 4 594 3 476 (75.7) 4 578 3 646 (79.6) 4 246 3 358 (79.1) Portugal 0 50 100 2 024 1 626 (80.3) 2 114 1 794 (84.9) 1 838 1 539 (83.7) 1 870 1 603 (85.7) Romania 0 50 100 10 960 7 779 (71.0) 13 116 10 363 (79.0) 12 272 10 079 (82.1) 12 937 10 622 (82.1) Slovakia 0 50 100 413 356 (86.2) 364 302 (83.0) 318 280 (88.1) 273 237 (86.8) Slovenia 0 50 100 250 198 (79.2) 231 188 (81.4) 207 173 (83.6) 169 150 (88.8) Spain 0 50 100 - - - - - - ` - - - - - Sweden 0 50 100 220 143 (65.0) 208 166 (79.8) 208 174 (83.7) 238 146 (61.3) United Kingdom 0 50 100 1 807 1 197 (66.2) 2 043 1 435 (70.2) 2 009 1 423 (70.8) 2 165 1 569 (72.5) Subtotal EU/EEA 0 50 100 29 275 21 172 (72.3) 31 081 23 790 (76.5) 30 979 24 573 (79.3) 30 339 23 765 (78.3) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 125 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2005 2006 2007 2008 2009 2010 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) N (%) N (%) 511 389 (76.1) 468 322 (68.8) 430 165 (38.4) 381 263 (69.0) 226 155 (68.6) 206 133 (64.6) 505 351 (69.5) 479 346 (72.2) 501 342 (68.3) 506 380 (75.1) 486 371 (76.3) 474 357 (75.3) - - - - - - 1 233 972 (78.8) 1 193 1 012 (84.8) 1 056 897 (84.9) 946 816 (86.3) 17 11 (64.7) 20 16 (80.0) 28 - - 10 7 (70.0) 28 8 (28.6) 20 5 (25.0) 538 375 (69.7) 528 368 (69.7) 459 331 (72.1) 468 319 (68.2) 402 271 (67.4) 361 249 (69.0) - - - 201 168 (83.6) 214 173 (80.8) 204 155 (76.0) 172 130 (75.6) 218 141 (64.7) 295 211 (71.5) 272 193 (71.0) 302 186 (61.6) 257 156 (60.7) 239 141 (59.0) 192 129 (67.2) - - - - - - 181 130 (71.8) 170 123 (72.4) 227 154 (67.8) 185 138 (74.6) - - - - - - - - - - - - - - - - - - 2 665 1 882 (70.6) 2 558 1 950 (76.2) 2 447 1 876 (76.7) 2 178 1 705 (78.3) 2 250 1 732 (77.0) 2 090 1 600 (76.6) - - - - - - - - - - - - - - - - - - 607 306 (50.4) 687 342 (49.8) 612 311 (50.8) 602 317 (52.7) 597 341 (57.1) 515 355 (68.9) 5 5 (100.0) 6 4 (66.7) 7 6 (85.7) 1 0 (0.0) 4 3 (75.0) 16 14 (87.5) 158 117 (74.1) 182 119 (65.4) 181 127 (70.2) 202 156 (77.2) 189 128 (67.7) 164 119 (72.6) - - - - - - - - - - - - - - - - - - 849 649 (76.4) 776 594 (76.5) 772 634 (82.1) 641 484 (75.5) 592 443 (74.8) 596 451 (75.7) - - - - - - 4 0 (0.0) - - - - - - - - - 1 248 951 (76.2) 1 293 988 (76.4) 1 209 860 (71.1) 1 211 870 (71.8) 1 033 740 (71.6) 959 656 (68.4) - - - - - - - - - - - - - - - - - - 9 8 (88.9) 11 11 (100.0) 12 9 (75.0) 13 12 (92.3) 10 8 (80.0) 5 4 (80.0) 535 442 (82.6) 493 402 (81.5) 460 380 (82.6) 461 370 (80.3) 454 365 (80.4) 470 365 (77.7) 113 103 (91.2) 111 96 (86.5) 114 103 (90.4) 105 88 (83.8) 146 124 (84.9) 139 127 (91.4) 4 514 3 483 (77.2) 4 321 3 286 (76.0) 4 510 3 449 (76.5) 4 228 3 128 (74.0) 4 391 2 957 (67.3) 3 998 2 631 (65.8) - - - 1 825 1 593 (87.3) 1 694 1 467 (86.6) 1 669 1 468 (88.0) 1 565 1 318 (84.2) - - - 12 650 10 676 (84.4) 11 688 10 026 (85.8) 11 247 9 532 (84.8) 10 085 8 504 (84.3) 10 737 9 165 (85.4) 9 445 7 916 (83.8) 263 237 (90.1) 288 238 (82.6) 295 258 (87.5) 269 234 (87.0) 174 143 (82.2) 177 149 (84.2) 197 158 (80.2) 145 125 (86.2) 150 123 (82.0) 159 127 (79.9) 149 130 (87.2) 121 104 (86.0) - - - - - - - - - - - - - - - 3 574 2 516 (70.4) 276 192 (69.6) 249 0 (0.0) 237 193 (81.4) 222 196 (88.3) 255 221 (86.7) 289 246 (85.1) 2 260 1 674 (74.1) 2 438 1 887 (77.4) 2 239 1 756 (78.4) 2 312 1 828 (79.1) 2 569 2 119 (82.5) 2 603 2 106 (80.9) 28 215 22 220 (78.8) 29 039 23 074 (79.5) 29 538 23 383 (79.2) 27 547 21 902 (79.5) 27 951 22 064 (78.9) 27 763 21 327 (76.8) 126 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 b In accordance with the UN Security Council Resolution No. 1244 (1999). Country Trend in percentage, 2001–2010 2001 2002 2003 2004 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) Non-EU/EEA Albania 0 50 100 171 156 (91.2) 225 189 (84.0) 212 186 (87.7) 201 150 (74.6) Andorra 0 50 100 1 1 (100.0) 3 3 (100.0) 6 6 (100.0) 3 3 (100.0) Armenia 0 50 100 284 257 (90.5) 295 233 (79.0) 406 312 (76.8) 461 325 (70.5) Azerbaijan 0 50 100 1 421 1 093 (76.9) 1 149 950 (82.7) 1 889 1 321 (69.9) 2 249 1 251 (55.6) Belarus 0 50 100 - - - - - - 2 236 1 630 (72.9) 2 284 1 699 (74.4) Bosnia and Herzegovina 0 50 100 539 529 (98.1) 526 499 (94.9) 272 255 (93.8) 1 025 1 007 (98.2) Croatia 0 50 100 0 0 - 204 143 (70.1) 438 168 (38.4) 423 193 (45.6) Georgia 0 50 100 1 014 679 (67.0) 987 643 (65.1) 989 657 (66.4) 1 301 880 (67.6) Israel 0 50 100 313 265 (84.7) 278 238 (85.6) 276 228 (82.6) 248 206 (83.1) Kazakhstan 0 50 100 8 894 6 922 (77.8) 9 185 7 137 (77.7) 8 660 6 452 (74.5) 7 927 5 743 (72.4) Kyrgyzstan 0 50 100 1 458 1 181 (81.0) 1 476 1 209 (81.9) 1 634 1 380 (84.5) 1 716 1 461 (85.1) Macedonia, the former Yugoslav Republic of 0 50 100 164 146 (89.0) 200 161 (80.5) 200 167 (83.5) 189 159 (84.1) Moldova 0 50 100 1 060 683 (64.4) 1 145 618 (54.0) 1 025 668 (65.2) 1 530 944 (61.7) Monaco - - - - - - - - - - - - Montenegro 0 50 100 - - - - - - - - - - - - Russia 0 50 100 4 079 2 740 (67.2) 5 171 3 447 (66.7) 6 311 3 873 (61.4) 25 678 15 466 (60.2) San Marino - - - - - - - - - - - - Serbia 0 50 100 - - - - - - - - - - - - Serbia excluding UN Administered Province of Kosovob 0 50 100 - - - - - - - - - - - - UN Administered Province of Kosovob - - - - - - - - - - - - Switzerland - - - - - - - - - - - - Tajikistan 0 50 100 670 480 (71.6) 107 84 (78.5) 927 423 (45.6) 1 055 593 (56.2) Turkey 0 50 100 4 359 3 140 (72.0) 5 190 3 348 (64.5) 6 082 4 372 (71.9) 5 816 4 936 (84.9) Turkmenistan 0 50 100 1 243 797 (64.1) 1 254 925 (73.8) 1 197 844 (70.5) - - - Ukraine 0 50 100 - - - - - - - - - - - - Uzbekistan 0 50 100 854 649 (76.0) 2 544 2 030 (79.8) 4 674 3 971 (85.0) 5 034 4 139 (82.2) Subtotal non-EU/EEA 0 50 100 26 524 19 718 (74.3) 29 939 21 857 (73.0) 37 434 26 913 (71.9) 57 140 39 155 (68.5) Total European Region 0 50 100 55 799 40 890 (73.3) 61 020 45 647 (74.8) 68 413 51 486 (75.3) 87 479 62 920 (71.9) Subtotal 18 HPC 0 50 100 38 793 28 251 (72.8) 43 909 32 702 (74.5) 51 956 38 943 (75.0) 70 273 49 755 (70.8) 127 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2005 2006 2007 2008 2009 2010 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) N (%) N (%) 196 154 (78.6) 186 168 (90.3) 181 153 (84.5) 170 154 (90.6) 171 153 (89.5) 145 132 (91.0) 5 4 (80.0) 8 6 (75.0) 2 2 (100.0) 3 3 (100.0) 3 3 (100.0) - - - 581 421 (72.5) 580 402 (69.3) 490 343 (70.0) 487 357 (73.3) 440 319 (72.5) 339 243 (71.7) 1 561 922 (59.1) 1 454 867 (59.6) 1 356 782 (57.7) 1 392 782 (56.2) 1 480 918 (62.0) 1 919 1 470 (76.6) - - - 1 072 750 (70.0) 1 987 1 466 (73.8) 1 902 1 355 (71.2) 2 160 1 389 (64.3) 2 184 1 447 (66.3) 1 035 999 (96.5) 993 960 (96.7) 1 267 1 227 (96.8) 757 697 (92.1) 852 845 (99.2) 441 434 (98.4) 391 181 (46.3) 898 265 (29.5) 637 389 (61.1) 602 347 (57.6) 234 148 (63.2) 181 136 (75.1) 1 489 1 081 (72.6) 1 813 1 368 (75.5) 1 975 1 523 (77.1) 2 196 1 596 (72.7) 2 352 1 773 (75.4) 2 500 1 908 (76.3) 227 191 (84.1) 206 168 (81.6) 242 194 (80.2) 178 157 (88.2) 202 173 (85.6) 99 75 (75.8) 6 884 4 894 (71.1) 6 113 4 408 (72.1) 6 140 4 206 (68.5) 6 167 3 949 (64.0) 5 355 3 341 (62.4) 4 919 2 995 (60.9) 1 897 1 607 (84.7) 1 833 1 507 (82.2) 1 718 1 455 (84.7) 1 640 1 385 (84.5) 1 543 1 272 (82.4) - - - 179 151 (84.4) 178 155 (87.1) 197 172 (87.3) 188 167 (88.8) 199 180 (90.5) 143 128 (89.5) 1 690 1 048 (62.0) 1 671 1 041 (62.3) 1 599 991 (62.0) 1 533 943 (61.5) 1 318 715 (54.2) 1 267 724 (57.1) - - - - - - - - - - - - - - - - - - 63 19 (30.2) 58 19 (32.8) 76 60 (78.9) 65 55 (84.6) 78 67 (85.9) 39 34 (87.2) 25 692 14 805 (57.6) 30 745 17 922 (58.3) 31 857 18 378 (57.7) 32 356 18 579 (57.4) 32 316 17 862 (55.3) 30 123 15 984 (53.1) - - - - - - - - - - - - - - - - - -(85.8) 1 154 976 (84.6) 1 157 971 (83.9) 1 145 967 (84.5) 1 391 1 191 (85.6) 1 392 1 197 (86.0) 702 602 (85.8) 1 154 976 (84.6) 1 157 971 (83.9) 1 145 967 (84.5) 1 391 1 191 (85.6) 1 392 1 197 (86.0) 702 602 (85.8) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 729 1 422 (82.2) 1 932 1 636 (84.7) 2 073 1 713 (82.6) 2 044 1 682 (82.3) 1 972 1 604 (81.3) 2 290 1 834 (80.1) 7 450 6 653 (89.3) 7 865 7 132 (90.7) 7 510 6 870 (91.5) 6 993 6 408 (91.6) 6 007 5 456 (90.8) 5 375 4 905 (91.3) 995 844 (84.8) 1 155 998 (86.4) 1 288 1 077 (83.6) 1 331 1 107 (83.2) 1 375 1 152 (83.8) - - - - - - 10 351 6 127 (59.2) 11 068 6 533 (59.0) 14 407 8 927 (62.0) 13 111 7 822 (59.7) 13 279 7 935 (59.8) 5 336 4 296 (80.5) 5 642 4 550 (80.6) 6 326 5 010 (79.2) 5 117 4 158 (81.3) 4 959 4 037 (81.4) 4 711 3 819 (81.1) 58 554 40 668 (69.5) 75 910 51 420 (67.7) 79 134 53 511 (67.6) 80 919 53 999 (66.7) 77 519 50 426 (65.0) 70 656 44 805 (63.4) 86 769 62 888 (72.5) 104 949 74 494 (71.0) 108 668 76 894 (70.8) 108 466 75 901 (70.0) 105 470 72 490 (68.7) 98 433 66 132 (67.2) 70 346 50 480 (71.8) 86 255 60 509 (70.2) 90 150 62 531 (69.4) 90 952 62 254 (68.4) 88 045 59 046 (67.1) 81 044 53 232 (65.7) 128 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Table X: Treatment success of previously treated laboratory confirmed pulmonary TB cases, European Region, 2001–2010 Country Trend in percentage, 2001–2010 2001 2002 2003 2004 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) EU/EEA Austria 0 50 100 15 11 (73.3) 11 10 (90.9) 12 9 (75.0) 16 12 (75.0) Belgium 0 50 100 80 49 (61.3) 67 49 (73.1) 60 37 (61.7) 58 30 (51.7) Bulgaria 0 50 100 - - - - - - 117 80 (68.4) - - - Cyprus 0 50 100 - - - 2 2 (100.0) 0 0 . 1 1 (100.0) Czech Republic 0 50 100 25 16 (64.0) 21 10 (47.6) 25 20 (80.0) 13 8 (61.5) Denmarka 0 50 100 17 12 (70.6) 17 14 (82.4) 11 8 (72.7) 18 14 (77.8) Estonia 0 50 100 206 70 (34.0) 154 60 (39.0) 98 29 (29.6) 90 31 (34.4) Finland 0 50 100 - - - - - - - - - - - - France - - - - - - - - - - - - Germany 0 50 100 327 207 (63.3) 288 184 (63.9) 293 183 (62.5) 231 147 (63.6) Greece 0 50 100 - - - - - - - - - - - - Hungary 0 50 100 165 72 (43.6) 157 73 (46.5) 183 87 (47.5) 163 68 (41.7) Iceland 0 50 100 0 0 - 0 0 . 0 0 . 0 0 . Ireland 0 50 100 21 10 (47.6) 17 10 (58.8) 23 13 (56.5) 16 8 (50.0) Italy 0 50 100 33 13 (39.4) 21 13 (61.9) 15 15 (100.0) - - - Latvia 0 50 100 331 149 (45.0) 298 121 (40.6) 245 113 (46.1) 229 106 (46.3) Liechtenstein - - - - - - - - - - - - Lithuania 0 50 100 556 242 (43.5) 486 204 (42.0) 497 164 (33.0) 449 137 (30.5) Luxembourg - - - - - - - - - - - - Malta 0 50 100 0 0 . 0 0 . 0 0 . 0 0 . Netherlands 0 50 100 21 17 (81.0) 25 18 (72.0) 21 15 (71.4) 9 9 (100.0) Norway 0 50 100 11 7 (63.6) 22 17 (77.3) 19 13 (68.4) 19 14 (73.7) Poland 0 50 100 730 511 (70.0) 724 487 (67.3) 724 511 (70.6) 0 0 . Portugal 0 50 100 217 155 (71.4) 261 201 (77.0) 266 204 (76.7) 243 170 (70.0) Romania 0 50 100 3 903 1 807 (46.3) 5 431 2 543 (46.8) 4 740 2 353 (49.6) 5 350 2 594 (48.5) Slovakia 0 50 100 104 85 (81.7) 86 77 (89.5) 50 46 (92.0) 47 43 (91.5) Slovenia 0 50 100 23 19 (82.6) 30 23 (76.7) 26 20 (76.9) 25 17 (68.0) Spain 0 50 100 - - - - - - ` - - - - - Sweden 0 50 100 14 6 (42.9) 22 15 (68.2) 19 16 (84.2) 15 0 (0.0) United Kingdom 0 50 100 185 115 (62.2) 209 124 (59.3) 193 132 (68.4) 197 126 (64.0) Subtotal EU/EEA 0 50 100 6 984 3 573 (51.2) 8 349 4 255 (51.0) 7 637 4 068 (53.3) 7 189 3 535 (49.2) ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). 129 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2005 2006 2007 2008 2009 2010 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) N (%) N (%) 20 16 (80.0) 11 9 (81.8) 10 4 (40.0) 8 8 (100.0) 22 12 (54.5) 15 9 (60.0) 34 18 (52.9) 50 29 (58.0) 49 32 (65.3) 42 26 (61.9) 51 37 (72.5) 51 32 (62.7) - - - - - - 146 61 (41.8) 152 91 (59.9) 190 110 (57.9) 196 101 (51.5) 0 0 . 0 0 . 1 0 (0.0) 3 3 (100.0) 4 1 (25.0) 0 0 . 55 40 (72.7) 37 24 (64.9) 44 32 (72.7) 38 27 (71.1) 38 26 (68.4) 30 20 (66.7) 14 14 (100.0) 23 12 (52.2) 18 9 (50.0) 23 20 (87.0) 28 22 (78.6) 26 16 (61.5) 68 33 (48.5) 65 32 (49.2) 69 44 (63.8) 76 45 (59.2) 63 35 (55.6) 60 33 (55.0) - - - - - - 7 7 (100.0) 9 6 (66.7) 6 5 (83.3) 7 6 (85.7) - - - - - - - - - - - - - - - - - - 243 150 (61.7) 218 137 (62.8) 183 124 (67.8) 158 122 (77.2) 186 116 (62.4) 185 131 (70.8) 20 0 (0.0) 18 7 (38.9) - - - - - - - - - - - - 129 62 (48.1) 119 61 (51.3) 130 71 (54.6) 126 63 (50.0) 86 46 (53.5) 87 43 (49.4) 0 0 . 0 0 . 1 0 (0.0) 0 0 . 1 1 (100.0) 0 0 . 21 17 (81.0) 23 9 (39.1) 28 16 (57.1) 16 8 (50.0) 25 17 (68.0) 18 11 (61.1) - - - - - - - - - - - - - - - - - - 200 141 (70.5) 179 117 (65.4) 167 121 (72.5) 147 112 (76.2) 141 83 (58.9) 106 65 (61.3) - - - - - - 0 0 . - - - - - - - - - 435 150 (34.5) 436 182 (41.7) 423 130 (30.7) 354 155 (43.8) 401 163 (40.6) 360 113 (31.4) - - - - - - 0 0 . 0 0 . 0 0 . 0 0 . 0 0 . 0 0 . 1 0 (0.0) 3 2 (66.7) 0 0 . 2 1 (50.0) 27 23 (85.2) 20 14 (70.0) 19 17 (89.5) 23 18 (78.3) 25 20 (80.0) 26 17 (65.4) 14 11 (78.6) 16 11 (68.8) 18 16 (88.9) 16 14 (87.5) 17 15 (88.2) 22 14 (63.6) 628 265 (42.2) 668 316 (47.3) 690 426 (61.7) 635 408 (64.3) 633 384 (60.7) 587 350 (59.6) 226 0 (0.0) 223 173 (77.6) 182 140 (76.9) 174 135 (77.6) 176 119 (67.6) 127 0 (0.0) 5 833 3 099 (53.1) 5 156 2 992 (58.0) 4 942 2 654 (53.7) 4 656 2 522 (54.2) 4 506 2 561 (56.8) 4 228 2 236 (52.9) 61 55 (90.2) 60 42 (70.0) 42 36 (85.7) 58 47 (81.0) 35 27 (77.1) 29 24 (82.8) 26 23 (88.5) 7 5 (71.4) 13 10 (76.9) 14 11 (78.6) 7 6 (85.7) 11 7 (63.6) - - - 0 0 . - - - - - - - - - 224 128 (57.1) 11 7 (63.6) 6 0 (0.0) 13 9 (69.2) 24 21 (87.5) 25 21 (84.0) 24 17 (70.8) 204 131 (64.2) 184 124 (67.4) 196 155 (79.1) 207 156 (75.4) 263 195 (74.1) 187 121 (64.7) 8 269 4 255 (51.5) 7 519 4 296 (57.1) 7 392 4 114 (55.7) 6 962 4 020 (57.7) 6 929 4 022 (58.0) 6 608 3 495 (52.9) 130 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 b In accordance with the UN Security Council Resolution No. 1244 (1999). Country Trend in percentage, 2001–2010 2001 2002 2003 2004 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) Non-EU/EEA Albania 0 50 100 24 18 (75.0) 10 7 (70.0) 7 7 (100.0) 37 32 (86.5) Andorra 0 50 100 - - - - - - - - - - - - Armenia 0 50 100 46 31 (67.4) 62 19 (30.6) 356 169 (47.5) 143 69 (48.3) Azerbaijan 0 50 100 268 100 (37.3) 67 43 (64.2) 802 410 (51.1) 2 188 900 (41.1) Belarus 0 50 100 - - - - - - - - - - - - Bosnia and Herzegovina 0 50 100 71 68 (95.8) 58 54 (93.1) 98 92 (93.9) 97 89 (91.8) Croatia 0 50 100 - - - - - - - - - 132 38 (28.8) Georgia 0 50 100 677 307 (45.3) 983 376 (38.3) 1 172 486 (41.5) 2 034 1 006 (49.5) Israel 0 50 100 7 5 (71.4) 14 13 (92.9) 15 13 (86.7) 13 11 (84.6) Kazakhstan 0 50 100 2 900 1 916 (66.1) 3 307 2 109 (63.8) 7 952 4 034 (50.7) 4 294 2 097 (48.8) Kyrgyzstan 0 50 100 296 225 (76.0) 850 365 (42.9) 849 630 (74.2) 885 651 (73.6) Macedonia, the former Yugoslav Republic of 0 50 100 26 14 (53.8) 29 20 (69.0) 102 72 (70.6) 70 61 (87.1) Moldova 0 50 100 49 28 (57.1) 453 167 (36.9) 1 940 716 (36.9) 1 486 566 (38.1) Monaco - - - - - - - - - - - - Montenegro 0 50 100 - - - - - - - - - - - - Russia 0 50 100 854 413 (48.4) 1 924 888 (46.2) 1 892 848 (44.8) 3 011 1 172 (38.9) San Marino 0 50 100 - - - - - - 2 2 (100.0) - - - Serbia 0 50 100 Serbia excluding UN Administered Province of Kosovob 0 50 100 - - - - - - - - - - - - UN Administered Province of Kosovob - - - - - - - - - - - - Switzerland - - - - - - - - - - - - Tajikistan 0 50 100 98 55 (56.1) - - - 114 76 (66.7) 648 479 (73.9) Turkey 0 50 100 - - - - - - 101 66 (65.3) - - - Turkmenistan 0 50 100 554 387 (69.9) 529 333 (62.9) 558 347 (62.2) - - - Ukraine 0 50 100 - - - - - - - - - - - - Uzbekistan 0 50 100 - - - 519 318 (61.3) 1 610 1 100 (68.3) 6 195 5 012 (80.9) Subtotal non-EU/EEA 0 50 100 5 870 3 567 (60.8) 8 805 4 712 (53.5) 17 570 9 068 (51.6) 21 233 12 183 (57.4) Total European Region 0 50 100 12 854 7 140 (55.5) 17 154 8 967 (52.3) 25 207 13 136 (52.1) 28 422 15 718 (55.3) Subtotal 18 HPC 0 50 100 10 738 5 730 (53.4) 15 063 7 546 (50.1) 23 043 11 621 (50.4) 27 002 14 820 (54.9) 131 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 2005 2006 2007 2008 2009 2010 Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success Ca se s re po rte d Success N (%) N (%) N (%) N (%) N (%) N (%) 30 22 (73.3) 29 25 (86.2) 25 21 (84.0) 28 21 (75.0) 21 16 (76.2) 30 27 (90.0) - - - 3 2 (66.7) 1 1 (100.0) - - - 2 2 (100.0) - - - 327 133 (40.7) 502 218 (43.4) 590 274 (46.4) 534 272 (50.9) 542 344 (63.5) 451 302 (67.0) 1 314 489 (37.2) 1 272 590 (46.4) 1 081 479 (44.3) 3 084 1 557 (50.5) 1 687 897 (53.2) 4 194 2 626 (62.6) - - - 898 574 (63.9) 862 537 (62.3) 815 477 (58.5) 616 258 (41.9) 792 379 (47.9) 106 98 (92.5) 93 88 (94.6) 156 144 (92.3) 77 58 (75.3) 116 97 (83.6) 101 96 (95.0) 92 30 (32.6) 82 51 (62.2) - - - - - - 22 11 (50.0) 37 28 (75.7) 2 037 1 111 (54.5) 1 873 1 057 (56.4) 1 847 1 031 (55.8) 1 542 765 (49.6) 1 521 908 (59.7) 1 421 879 (61.9) 7 6 (85.7) 5 4 (80.0) 8 8 (100.0) 4 3 (75.0) 9 6 (66.7) 5 4 (80.0) 4 085 1 911 (46.8) 21 242 7 816 (36.8) 18 722 9 922 (53.0) 8 662 3 616 (41.7) 9 392 4 549 (48.4) 8 734 4 119 (47.2) 845 600 (71.0) 933 662 (71.0) 1 035 696 (67.2) 897 631 (70.3) 924 655 (70.9) - - - 97 55 (56.7) 72 43 (59.7) 71 46 (64.8) 56 40 (71.4) 56 44 (78.6) 52 34 (65.4) 1 713 710 (41.4) 1 715 734 (42.8) 2 167 781 (36.0) 1 865 643 (34.5) 1 663 569 (34.2) 1 702 545 (32.0) - - - - - - - - - - - - - - - - - - 10 2 (20.0) 19 6 (31.6) 23 13 (56.5) 10 8 (80.0) 11 8 (72.7) 14 12 (85.7) 10 855 4 003 (36.9) 28 419 13 417 (47.2) 18 527 6 619 (35.7) 18 070 6 562 (36.3) 16 726 5 663 (33.9) 14 609 4 984 (34.1) - - - - - - - - - - - - - - - - - - 284 207 (72.9) 322 238 (73.9) 355 260 (73.2) 309 234 (75.7) 244 180 (73.8) 172 129 (75.0) 284 207 (72.9) 322 238 (73.9) 355 260 (73.2) 309 234 (75.7) 244 180 (73.8) 172 129 (75.0) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 762 1 343 (76.2) 1 715 1 248 (72.8) 1 995 1 495 (74.9) 1 881 1 422 (75.6) 1 618 1 165 (72.0) 1 732 1 243 (71.8) 1 593 1 118 (70.2) 1 951 1 474 (75.6) 1 885 1 435 (76.1) 1 692 1 262 (74.6) 1 459 1 069 (73.3) 1 368 940 (68.7) 142 97 (68.3) 240 176 (73.3) 116 48 (41.4) 737 596 (80.9) - - - - - - - - - 9 380 4 055 (43.2) 5 240 2 866 (54.7) 7 152 2 960 (41.4) 10 424 4 909 (47.1) 9 812 4 540 (46.3) 3 999 2 758 (69.0) 5 248 4 066 (77.5) 4 617 3 468 (75.1) 5 046 3 608 (71.5) 2 451 1 689 (68.9) 4 527 3 284 (72.5) 29 298 14 693 (50.2) 76 013 36 544 (48.1) 59 323 30 144 (50.8) 52 461 24 735 (47.1) 49 504 23 039 (46.5) 49 753 24 171 (48.6) 37 567 18 948 (50.4) 83 532 40 840 (48.9) 66 715 34 258 (51.3) 59 423 28 755 (48.4) 56 433 27 061 (48.0) 56 234 27 666 (49.2) 35 208 17 696 (50.3) 81 224 39 410 (48.5) 64 431 32 661 (50.7) 57 362 27 296 (47.6) 54 324 25 627 (47.2) 54 292 26 389 (48.6) 132 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 ‘European Region’ comprises the 53 countries of the WHO European Region and Liechtenstein. WHO European Region 18 TB High Priority Countries presented in italics. a Excluding Greenland data (see Chapter 1.1). Table XI: Treatment success of all MDR-TB cases, European Region, 2005–2009 Country Trend in percentage, 2005–2009 2005 2006 2007 2008 2009 M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success N (%) N (%) N (%) N (%) N (%) EU/EEA Austria 0 50 100 13 7 (53.8) 10 4 (40.0) 9 0 (0.0) 15 6 (40.0) 23 10 (43.5) Belgium 0 50 100 11 7 (63.6) 18 12 (66.7) 14 10 (71.4) 21 16 (76.2) 10 4 (40.0) Bulgaria 0 50 100 - - - - - - 76 22 (28.9) 31 15 (48.4) 43 8 (18.6) Cyprus 0 50 100 - - - - - - - - - 1 1 (100.0) 4 0 (0.0) Czech Republic 0 50 100 13 5 (38.5) 12 5 (41.7) 8 3 (37.5) 11 7 (63.6) 8 0 (0.0) Denmarka 0 50 100 5 5 (100.0) 3 3 (100.0) - - - - - - 2 1 (50.0) Estonia 0 50 100 78 38 (48.7) 55 25 (45.5) 82 44 (53.7) 73 39 (53.4) 85 35 (41.2) Finland - - - - - - - - - - - - - - - France - - - - - - - - - - - - - - - Germany 0 50 100 103 48 (46.6) 82 42 (51.2) 66 46 (69.7) 49 28 (57.1) 62 38 (61.3) Greece - - - - - - - - - - - - - - - Hungary 0 50 100 17 10 (58.8) 14 8 (57.1) 12 6 (50.0) 13 4 (30.8) 18 3 (16.7) Iceland - - - - - - - - - - - - - - - Ireland 0 50 100 3 3 (100.0) 4 1 (25.0) 7 1 (14.3) 2 0 (0.0) - - - Italy - - - - - - - - - - - - - - - Latvia 0 50 100 161 112 (69.6) 142 87 (61.3) 99 63 (63.6) 128 84 (65.6) 131 77 (58.8) Liechtenstein - - - - - - - - - - - - - - - Lithuania 0 50 100 - - - - - - - - - 276 81 (29.3) 322 97 (30.1) Luxembourg - - - - - - - - - - - - - - - Malta 0 50 100 - - - 2 2 (100.0) 1 1 (100.0) - - - - - - Netherlands 0 50 100 8 5 (62.5) 6 5 (83.3) 6 6 (100.0) 15 14 (93.3) 20 12 (60.0) Norway 0 50 100 - - - - - - 3 3 (100.0) 4 3 (75.0) 8 5 (62.5) Poland 0 50 100 - - - - - - 22 14 (63.6) 19 9 (47.4) 21 12 (57.1) Portugal - - - - - - - - - - - - - - - Romania 0 50 100 - - - 673 212 (31.5) 673 147 (21.8) 792 155 (19.6) 624 102 (16.3) Slovakia 0 50 100 8 2 (25.0) 7 4 (57.1) 7 2 (28.6) 4 1 (25.0) 1 0 (0.0) Slovenia 0 50 100 - - - - - - - - - 2 1 (50.0) 1 0 (0.0) Spain - - - - - - - - - - - - - - - Sweden 0 50 100 - - - - - - 15 14 (93.3) 11 10 (90.9) 13 11 (84.6) United Kingdom 0 50 100 - - - - - - 56 29 (51.8) 53 34 (64.2) 60 45 (75.0) Subtotal EU/EEA 0 50 100 417 239 (57.3) 1 024 409 (39.9) 1 149 410 (35.7) 1 518 508 (33.5) 1 456 460 (31.6) 133 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT b In accordance with the UN Security Council Resolution No. 1244 (1999). Country Trend in percentage, 2005–2009 2005 2006 2007 2008 2009 M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success M DR -T B ca se s ( N) Success N (%) N (%) N (%) N (%) N (%) Non-EU/EEA Albania 0 50 100 - - - 1 0 (0.0) - - - - - - - - - Andorra - - - - - - - - - - - - - - - Armenia 0 50 100 - - - 27 11 (40.7) 57 30 (52.6) 77 42 (54.5) 134 69 (51.5) Azerbaijan 0 50 100 - - - - - - - - - 23 13 (56.5) 100 74 (74.0) Belarus 0 50 100 - - - - - - - - - - - - 1 422 572 (40.2) Bosnia and Herzegovina 0 50 100 - - - - - - - - - - - - 1 1 (100.0) Croatia 0 50 100 - - - - - - - - - - - - 2 1 (50.0) Georgia 0 50 100 - - - - - - 61 23 (37.7) 417 235 (56.4) 503 270 (53.7) Israel 0 50 100 16 14 (87.5) 20 18 (90.0) 14 12 (85.7) 11 10 (90.9) 6 5 (83.3) Kazakhstan 0 50 100 - - - 930 752 (80.9) 1 609 1 237 (76.9) 2 268 1 680 (74.1) 3 897 2 851 (73.2) Kyrgyzstan 0 50 100 - - - 66 32 (48.5) 132 66 (50.0) 262 130 (49.6) 545 193 (35.4) Macedonia, the former Yugoslav Republic of 0 50 100 - - - 6 2 (33.3) 9 2 (22.2) 2 0 (0.0) 1 0 (0.0) Moldova 0 50 100 - - - - - - 254 133 (52.4) 522 253 (48.5) - - - Monaco - - - - - - - - - - - - - - - Montenegro 0 50 100 - - - 3 2 (66.7) 3 0 (0.0) - - - 1 1 (100.0) Russia 0 50 100 - - - - - - - - - 1 537 783 (50.9) - - - San Marino - - - - - - - - - - - - - - - Serbia 0 50 100 - - - - - - - - - - - - 10 6 (60.0) Serbia excluding UN Administered Province of Kosovob 0 50 100 - - - - - - - - - - - - 10 6 (60.0) UN Administered Province of Kosovob - - - - - - - - - - - - - - - Switzerland - - - - - - - - - - - - - - - Tajikistan 0 50 100 - - - - - - - - - - - - 52 37 (71.2) Turkey 0 50 100 - - - 249 177 (71.1) 240 155 (64.6) 263 180 (68.4) 222 147 (66.2) Turkmenistan - - - - - - - - - - - - - - - Ukraine 0 50 100 - - - - - - - - - - - - 3 299 906 (27.5) Uzbekistan 0 50 100 - - - - - - 330 180 (54.5) 294 193 (65.6) 464 285 (61.4) Subtotal non-EU/EEA 0 50 100 16 14 (87.5) 1 302 994 (76.3) 2 709 1 838 (67.8) 5 676 3 519 (62.0) 10 659 5 418 (50.8) Total European Region 0 50 100 433 253 (58.4) 2 326 1 403 (60.3) 3 858 2 248 (58.3) 7 194 4 027 (56.0) 12 115 5 878 (48.5) Subtotal 18 HPC 0 50 100 239 150 (62.8) 2 142 1 296 (60.5) 3 613 2 100 (58.1) 6 963 3 883 (55.8) 11 843 5 723 (48.3)

135 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 5. Maps & fi gures 136 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Map 1a: Estimated TB mortality per 100 000 population, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 30 Not included or not reporting ≤ 1 1.1–2 20.1–30 10.1–20 2.1–10 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 137 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Map 1c: Estimated TB incidence per 100 000 population, European Region, 2011a Map 1b: Estimated TB prevalence per 100 000 population, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 150 Not included or not reporting ≤ 10 11–20 101–150 51–100 21–50 Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 150 Not included or not reporting ≤ 10 11–20 101–150 51–100 21–50 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 138 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Map 2: TB notification rates per 100 000 population, European Region, 2011a Map 3: TB notification rates, new and relapse cases per 100 000 population, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 150 Not included or not reporting ≤ 10 11–20 101–150 51–100 21–50 Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 100 Not included or not reporting ≤ 10 11–20 51–100 21–50 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 139 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Map 4: Percentages of notified TB cases of foreign origin among all TB cases, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 50 Not included or not reporting ≤ 5 5–19 20–49 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia Map 5: Percentages of notified extrapulmonary TB cases among all TB cases, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 40 Not included or not reporting ≤ 10 11–20 31–40 21–30 140 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia Map 6: Percentages of smear positive pulmonary TB cases among new pulmonary TB, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 60 Not included or not reporting ≤ 20 21–30 41–60 31–40 Map 7: Percentage of TB cases confirmed by culture and smear among new pulmonary TB cases, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino ≥ 75 Not included or not reporting < 40 40–54 55–74 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 141 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Map 8: Percentage of notified TB cases with multidrug resistance among new laboratory-confirmed pulmonary TB cases, European Region, 2011a Map 9: Percentage of notified TB cases with multidrug resistance among previously treated laboratory-confirmed pulmonary TB cases, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 15 Not included or not reporting < 1 1–1.9 10–15 6–9.9 2–5.9 Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 30 Not included or not reporting < 1 1–1.9 10–19.9 20–29.9 6–9.9 2–5.9 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 142 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Map 11: Percentage of notified TB cases with extensive drug resistance among MDR-TB cases with second-line DST results, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 10 Not included or not reporting < 1 1–1.9 5–10 3–4.9 2–2.9 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia Map 10: Percentage of notified TB cases with multidrug resistance among all TB cases with DST results, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino › 30 Not included or not reporting < 1 1–1.9 10–19.9 20–29.9 6–9.9 2–5.9 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 143 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Map 12: Percentage of HIV positive TB cases among all TB cases with known HIV status, European Region, 2011a Liechtenstein Andorra Luxembourg Malta Monaco San Marino Not included or not reporting 0 < 1 > 10 1–5 5–10 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia Map 13: Success rate of new laboratory-confirmed pulmonary TB cases, European Region, 2010a Liechtenstein Andorra Luxembourg Malta Monaco San Marino ≥ 85 Not included or not reporting ≤ 60 60–70 71–84 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 144 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Map 15: Success rate of all MDR-TB cases after 24 months, European Region, 2009a Liechtenstein Andorra Luxembourg Malta Monaco San Marino ≥ 85 Not included or not reporting ≤ 50 50–64 65–84 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia Map 14: Success rate of previously treated laboratory-confirmed pulmonary TB cases, European Region, 2010a Liechtenstein Andorra Luxembourg Malta Monaco San Marino ≥ 85 Not included or not reporting ≤ 60 60–70 71–84 a Data from UN Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia 145 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Figure 1: TB estimated incidence and notification per 100 000 population, European Region, 2002–2011 0 20 40 60 80 100 2011201020092008200720062005200420032002 Uncertainty band Incidence Ra te p er 10 0 00 0 Notification European Region 0 50 100 150 200 2011201020092008200720062005200420032002 Uncertainty band Incidence Ra te p er 10 0 00 0 Notification 18 High Priority Countries 146 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Figure 2: Estimated TB prevalence per 100 000 population, European Region, 2002–2011 0 50 100 150 200 250 2011201020092008200720062005200420032002 Uncertainty band Prevalence Ra te p er 10 0 00 0 European Region 0 100 200 300 400 500 2011201020092008200720062005200420032002 Uncertainty band Prevalence Ra te p er 10 0 00 0 18 High Priority Countries 147 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Figure 3: Estimated TB mortality per 100 000 population, European Region, 2002–2011 0 2 4 6 8 10 2011201020092008200720062005200420032002 Uncertainty band Mortality rate Ra te p er 10 0 00 0 European Region 0 5 10 15 20 2011201020092008200720062005200420032002 Uncertainty band Mortality rate Ra te p er 10 0 00 0 18 High Priority Countries 148 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Figure 4: Total TB notifications by previous treatment history and total TB case rates, Europe, 2002–2011 0 20000 40000 60000 80000 100000 120000 2011201020092008200720062005200420032002 0 10 20 30 40 Treatment history unknown Previously treated New TB c as es TB c as es / 10 0 00 0 Total TB cases / 100 000 (right axis) EU/EEA countries* 0 100000 200000 300000 400000 500000 2011201020092008200720062005200420032002 0 20 40 60 80 100 Treatment history unknown Previously treated New TB c as es TB c as es / 10 0 00 0 Total TB cases / 100 000 (right axis) European Region* 0 100000 200000 300000 400000 500000 2011201020092008200720062005200420032002 0 50 100 150 Treatment history unknown Previously treated New TB c as es TB c as es / 10 0 00 0 Total TB cases / 100 000 (right axis) 18 High Priority Countries* * Excluded: 2002–2011: Liechtenstein * Excluded: 2002: Belarus, Liechtenstein, Montenegro, Russian Federation, Tajikistan, Turkey, Ukraine; 2003: Belarus, Liechtenstein, Monaco, Montenegro, Tajikistan, Ukraine; 2004: Kyrgyzstan, Liechtenstein, Monaco, Montenegro, Turkey, Ukraine; 2005: Liechtenstein, Monaco, San Marino, Ukraine; 2006: Liechtenstein, Monaco, San Marino; 2007: Monaco, San Marino; 2008: Austria, Liechtenstein, Monaco,San Marino; 2009: Liechtenstein, Monaco, San Marino; 2010: Liechtenstein, San Marino; 2011: Liechtenstein, Monaco, San Marino, Turkmenistan * Exluded: 2002: Belarus, Russian Federation, Tajikistan, Turkey, Ukraine; 2003: Belarus, Tajikistan, Ukraine; 2004: Kyrgyzstan, Turkey, Ukraine; 2005: Ukraine; 2011: Turkmenistan Data sources: TESSy, CISID, EuroTB historical database: Sitebac. 149 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Figure 5: Percentages of MDR among laboratory-confirmed TB cases, European Region, 2002–2011 0 5 10 15 20 25 2011201020092008200720062005200420032002 Unknown Previously treated New Pe rc en ta ge EU/EEA countries* 0 10 20 30 40 50 2011201020092008200720062005200420032002 Unknown Previously treated New Pe rc en ta ge European Region* 0 20 40 60 80 100 2011201020092008200720062005200420032002 Unknown Previously treated New Pe rc en ta ge 18 High Priority Countries* 150 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Figure 6: Percentage of TB cases with HIV infection among TB cases with known HIV status, Europe, 2008–2011 0 1 2 3 4 5 6 7 8 2011201020092008 Pe rc en ta ge 0 1 2 3 4 5 6 7 8 2011201020092008 Pe rc en ta ge 0 1 2 3 4 5 6 7 8 2011201020092008 Pe rc en ta ge * Excluded: 2008: Austria, Finland, France, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Norway, Poland, Romania, Sweden, United Kingdom; 2009: Austria, Cyprus, Finland, France, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Norway, Poland, Sweden, United Kingdom; 2010: Austria, Finland, France, Germany, Greece, Hungary, Italy, Lithuania, Norway, Poland, Romania, Sweden, United Kingdom; 2011: Austria, Cyprus, Denmark, Finland, Germany, Greece, Hungary, Italy, Liechtenstein, Norway, Poland, Portugal, Sweden, United Kingdom * Excluded: 2008: Andorra, Austria, Bosnia and Herzegovina, Croatia, Finland, France, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Monaco, Norway, Poland, San Marino, Serbia, Sweden, Switzerland, Turkey, Turkmenistan, United Kingdom; 2009: Andorra, Austria, Azerbaijan, Bosnia and Herzegovina, Croatia, Cyprus, Finland, France, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Monaco, Norway, Poland, San Marino, Serbia, Sweden, Switzerland, Turkey, Turkmenistan, United Kingdom; 2010: Andorra, Austria, Azerbaijan, Bosnia and Herzegovina, Croatia, Cyprus, Denmark, Finland, France, Germany, Greece, Hungary, Italy, Lithuania, Monaco, Norway, Poland, San Marino, Serbia, Sweden, Switzerland, United Kingdom; 2011: Andorra, Austria, Bosnia and Herzegovina, Croatia, Cyprus, Denmark, Finland, Germany, Greece, Hungary, Italy, Liechtenstein, Monaco, Norway, Poland, Portugal, San Marino, Sweden, United Kingdom, Turkmenistan * Excluded: 2008: Lithuania, Turkey, Turkmenistan; 2009: Azerbaijan, Lithuania, Turkey, Turkmenistan; 2010: Azerbaijan, Lithuania; 2011: Turkmenistan EU/EEA countries* European Region* 18 High Priority Countries* 151 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Figure 7: Treatment outcome, new laboratory-confirmed pulmonary TB cases, Europe, 2001–2010 0 20 40 60 80 100 2010200920082007200620052004200320022001 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es EU/EEA countries* 0 20 40 60 80 100 2010200920082007200620052004200320022001 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es European Region* 0 20 40 60 80 100 2010200920082007200620052004200320022001 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es 18 High Priority Countries * Excluded: France, Greece, Italy, Liechtenstein, Luxembourg * Excluded: 2010: Andorra, France, Greece, Italy, Monaco, Portugal, San Marino, Switzerland, Turkmenistan * Excluded: 2010: Turkmenistan 152 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Figure 8: Treatment outcome, previously treated laboratory-confirmed pulmonary TB cases, Europe, 2001–2010 0 20 40 60 80 100 2010200920082007200620052004200320022001 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es EU/EEA countries* 0 20 40 60 80 100 2010200920082007200620052004200320022001 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es European Region* 0 20 40 60 80 100 2010200920082007200620052004200320022001 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es 18 High Priority Countries* * Excluded: France, Greece, Italy * Excluded: Andorra, France, Greece, Italy, Monaco, Portugal, San Marino, Switzerland, Turkmenistan * Excluded: Turkmenistan 153 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Figure 9: Treatment outcome after 24 months of MDR-TB cases, Europe, 2007–2009 0 20 40 60 80 100 200920082007 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es EU/EEA countries* 0 20 40 60 80 100 200920082007 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es European Region 0 20 40 60 80 100 200920082007 Failed Still on treatment Defaulted, transferred or unknown Died Success % c as es 18 High Priority Countries* * Excluded: Finland, France, Greece, Liechtenstein, Luxembourg, Portugal, Spain * Excluded: 2010: Turkmenistan

155 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 6. Country profi les

157 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Liechtenstein Andorra Luxembourg Malta Monaco San Marino ES FR IE UK IS NO SWE FI RU KZ UZ KG TJ TMAZ GE AM TR IL CY EL MT BG RO UA MD BY EE LV LT PL SK HU RS MKAL ME BA HR SI AT CZ DE DK NL BE LU CH IT ADPT AD Andorra AL Albania AM Armenia AT Austria AZ Azerbaijan BA Bosnia and Herzegovina BE Belgium BG Bulgaria BY Belarus CH Switzerland CY Cyprus CZ Czech Republic DE Germany DK Denmark EE Estonia EL Greece ES Spain FI Finland FR France GE Georgia HR Croatia HU Hungary IE Ireland IL Israel IS Iceland IT Italy KG Kyrgyzstan KZ Kazakhstan LT Lithuania LU Luxembourg LV Latvia MD Moldova ME Montenegro MK The former Yugoslav Republic of Macedonia MT Malta NL Netherlands NO Norway PL Poland PT Portugal RO Romania RS Serbia RU Russia SE Sweden SI Slovenia SK Slovakia TJ Tajikistan TM Turkmenistan TR Turkey UA Ukraine UK United Kingdom UZ Uzbekistan

159 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Albania 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 25 30 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 25 30 20102008200620042002 1 2 3 4 5 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 100 200 300 400 500 600 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 3 215 988 Tuberculosis case notifications, 2011 Total number of cases 431 Notification rate per 100 000 13.4 New & relapses (lab+) number 422 New & relapses (lab+) notification rate per 100 000 13.1 Pulmonary 294 (68.2%) of which smear-positive 189 (64.3%) Laboratory-confirmed pulmonary TB cases 218 (74.1%) Mean age of new TB cases, nationals 45 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 413 (95.8%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 205 (100.0%) Cases resistant to isoniazid 27 (13.2%) Cases resistant to rifampicin 11 (5.4%) Estimated MDR N, (best-low-high) 8-2-14 MDR cases 5 (2.4%) of which XDR cases - - Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 170 (39.4%) HIV-positive TB cases 2 (1.2%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 145 Success 132 (91,0%) Died 4 (2.8%) Failed 0 (0.0%) Defaulted 6 (3.5%) Still on treatment - - Lost to follow up 5 (3.4%) 160 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Andorra 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 5 10 15 20102008200620042002 No . o f c as es UnknownForeign originNative Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 5 10 15 20 25 30 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 No case reported No MDR cases reported Population estimate 2011 by UN Statistical Database: 86 165 Tuberculosis case notifications, 2011 Total number of cases 4 Notification rate per 100 000 4.6 New & relapses (lab+) number 3 New & relapses (lab+) notification rate per 100 000 3.5 Pulmonary 3 (75.0%) of which smear-positive 1 (33.3%) Laboratory-confirmed pulmonary TB cases 1 (33.3%) Mean age of new TB cases, nationals 40 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 3 (75.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 2 (66.7%) Cases resistant to isoniazid 1 (50.0%) Cases resistant to rifampicin 0 (0.0%) Estimated MDR N, (best-low-high) 0-0-0 MDR cases 0 (0.0%) of which XDR cases - - Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 No case reported New TB cases - notification rates by age group, 2002–2011 161 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Armenia 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 500 1000 1500 2000 2500 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10 20 30 40 50 60 20102008200620042002 0 50 100 150 200 250 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 500 1000 1500 2000 2500 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 3 100 236 Tuberculosis case notifications, 2011 Total number of cases 1 582 Notification rate per 100 000 51.0 New & relapses (lab+) number 1 261 New & relapses (lab+) notification rate per 100 000 40.7 Pulmonary 1 056 (66.8%) of which smear-positive 404 (38.3%) Laboratory-confirmed pulmonary TB cases 521 (49.3%) Mean age of new TB cases, nationals 41,1 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 1 200 (75.9%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting No Cases with DST results 529 (100.0%) Cases resistant to isoniazid 164 (31.0%) Cases resistant to rifampicin 94 (17.8%) Estimated MDR N, (best-low-high) 250-220-280 MDR cases 79 (14.9%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 1 499 (94.8%) HIV-positive TB cases 49 (3.3%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 339 Success 243 (71.7%) Died 15 (4.4%) Failed 51 (15.0%) Defaulted 27 (8.0%) Still on treatment - - Lost to follow up 3 (0.9%) 162 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Austria 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 1000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 20102008200620042002 0 5 10 15 20 25 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 8 404 252 Data not available Tuberculosis case notifications, 2011 Total number of cases 687 Notification rate per 100 000 8.2 New & relapses (laboratory-confirmed) number 401 New & relapses (laboratory-confirmed) notification rate per 100 000 4.8 Pulmonary 540 (78.6%) of which smear-positive 133 (24.6%) Laboratory-confirmed pulmonary TB cases 388 (71.9%) Mean age of new TB cases, nationals 55 years Mean age of new TB cases, non-nationals 33.9 years Foreign origin of all TB cases 326 (47.5%) New (not previously treated) 396 (57.6%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 450 (96.6%) Cases resistant to isoniazid 49 (10.9%) Cases resistant to rifampicin 21 (4.7%) Estimated MDR N, (best-low-high) 12-4-19 MDR cases 19 (4.2%) of which XDR cases 6 (31.6%) Cases resistant to ethambutol 15 (3.3%) Cases resistant to streptomycin 38 (8.4%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 206 Success 133 (64.6%) Died 13 (6.3%) Failed 0 (0.0%) Defaulted 13 (6.3%) Still on treatment 31 (15.0%) Lost to follow up 16 (7.8%) 163 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Azerbaijan 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 20 40 60 80 100 20102008200620042002 0 200 400 600 800 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 2000 4000 6000 8000 10000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 2000 4000 6000 8000 10000 12000 0 10 20 30 40 50 60 70 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es Population estimate 2011 by UN Statistical Database: 9 306 023 Tuberculosis case notifications, 2011 Total number of cases 9 805 Notification rate per 100 000 105.4 New & relapses (lab+) number 6 515 New & relapses (lab+) notification rate per 100 000 70.0 Pulmonary 6 290 (64.2%) of which smear-positive 2 652 (29.7%) Laboratory-confirmed pulmonary TB cases 3 541 (39.6%) Mean age of new TB cases, nationals 28.8 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 5 296 (54.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting No Cases with DST results 720 (33.1%) Cases resistant to isoniazid 178 (24.7%) Cases resistant to rifampicin 100 (13.9%) Estimated MDR N, (best-low-high) 3400-3200-3700 MDR cases 90 (12.5%) of which XDR cases 3 (3.3%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 6 179 (63.0%) HIV-positive TB cases 76 (1.2%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 1 919 Success 1 470 (76.6%) Died 64 (3.3%) Failed 86 (4.5%) Defaulted 188 (9.8%) Still on treatment - - Lost to follow up 111 (5.8%) 164 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Belarus 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 1000 2000 3000 4000 5000 6000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary definite cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 1000 2000 3000 4000 5000 6000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 20102008200620042002 0 500 1000 1500 2000 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Population estimate 2011 by UN Statistical Database: 9 559 441 Tuberculosis case notifications, 2011 Total number of cases 5 118 Notification rate per 100 000 53.5 New & relapses (lab+) number 4 697 New & relapses (lab+) notification rate per 100 000 49.1 Pulmonary 4 634 (90.5%) of which smear-positive 1 739 (37.5%) Laboratory-confirmed pulmonary TB cases 3 087 (66.6%) Mean age of new TB cases, nationals 43.8 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 4 043 (79.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting No Cases with DST results 3 032 (96.7%) Cases resistant to isoniazid 1 713 (56.5%) Cases resistant to rifampicin 1 637 (54.0%) Estimated MDR N, (best-low-high) 2 000-1 900-2 100 MDR cases 1 594 (52.6%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 4 747 (92.8%) HIV-positive TB cases 217 (4.6%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 2 184 Success 1 447 (66.3%) Died 183 (8.4%) Failed 491 (22.5%) Defaulted 12 (0.5%) Still on treatment - - Lost to follow up 51 (2.3%) 165 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Belgium 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 1000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 20102008200620042002 0 5 10 15 20 25 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 200 400 600 800 1000 1200 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 10 951 266 Tuberculosis case notifications, 2011 Total number of cases 1 044 Notification rate per 100 000 9.5 New & relapses (laboratory-confirmed) number 705 New & relapses (laboratory-confirmed) notification rate per 100 000 6.4 Pulmonary 747 (71.6%) of which smear-positive 338 (45.2%) Laboratory-confirmed pulmonary TB cases 592 (79.3%) Mean age of new TB cases, nationals 43.3 years Mean age of new TB cases, non-nationals 35.7 years Foreign origin of all TB cases 544 (52.1%) New (not previously treated) 705 (67.5%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 754 (94.6%) Cases resistant to isoniazid 50 (6.6%) Cases resistant to rifampicin 17 (2.3%) Estimated MDR N, (best-low-high) 18-10-26 MDR cases 15 (2.0%) of which XDR cases 3 (20.0%) Cases resistant to ethambutol 17 (2.3%) Cases resistant to streptomycin 0 (0.0%) TB cases tested for HIV 845 (80.9%) HIV-positive TB cases 44 (5.2%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 474 Success 357 (75.3%) Died 33 (7.0%) Failed 0 (0.0%) Defaulted 53 (11.2%) Still on treatment 16 (3.4%) Lost to follow up 15 (3.2%) 166 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Bosnia and Herzegovina 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 500 1000 1500 2000 2500 3000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 2 4 6 8 10 12 20102008200620042002 0 5 10 15 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success HIV status not reported New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear/culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 3 752 228 Tuberculosis case notifications, 2011 Total number of cases 1 385 Notification rate per 100 000 36.9 New & relapses (lab+) number 1 360 New & relapses (lab+) notification rate per 100 000 36.2 Pulmonary 1 259 (90.9%) of which smear-positive 587 (46.6%) Laboratory-confirmed pulmonary TB cases 748 (59.4%) Mean age of new TB cases, nationals 52.6 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 1 320 (95.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 745 (100.0%) Cases resistant to isoniazid 7 (0.9%) Cases resistant to rifampicin 5 (0.7%) Estimated MDR N, (best-low-high) 3-0-8 MDR cases 5 (0.7%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 441 Success 434 (98.4%) Died 5 (1.1%) Failed 1 (0.2%) Defaulted 1 (0.2%) Still on treatment - - Lost to follow up 0 (0.0%) 167 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Bulgaria 10 20 30 40 50 60 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 20102008200620042002 0 20 40 60 80 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 1000 2000 3000 4000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary definite cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 7 504 868 Tuberculosis case notifications, 2011 Total number of cases 2 407 Notification rate per 100 000 32.1 New & relapses (laboratory-confirmed) number 2 173 New & relapses (laboratory-confirmed) notification rate per 100 000 29.0 Pulmonary 1 724 (71.6%) of which smear-positive 897 (52.0%) Laboratory-confirmed pulmonary TB cases 1 043 (60.5%) Mean age of new TB cases, nationals 44.8 years Mean age of new TB cases, non-nationals 58.4 years Foreign origin of all TB cases 9 (0.4%) New (not previously treated) 2 052 (85.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 733 (68.4%) Cases resistant to isoniazid 98 (13.4%) Cases resistant to rifampicin 65 (8.9%) Estimated MDR N, (best-low-high) 120-90-150 MDR cases 55 (7.5%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 47 (6.4%) Cases resistant to streptomycin 45 (6.1%) TB cases tested for HIV 1 698 (70.5%) HIV-positive TB cases 5 (0.3%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 946 Success 816 (86.3%) Died 75 (7.9%) Failed 15 (1.6%) Defaulted 29 (3.1%) Still on treatment 10 (1.1%) Lost to follow up 1 (0.1%) 168 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Croatia 0 10 20 30 40 50 60 70 80 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 1000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 1 2 3 4 5 20102008200620042002 0 2 4 6 8 10 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success Not reported New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 4 395 560 Tuberculosis case notifications, 2011 Total number of cases 619 Notification rate per 100 000 14.1 New & relapses (lab+) number 619 New & relapses (lab+) notification rate per 100 000 14.1 Pulmonary 602 (97.3%) of which smear-positive 230 (38.2%) Laboratory-confirmed pulmonary TB cases 388 (64.5%) Mean age of new TB cases, nationals 55.1 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 75 (12.1%) New (not previously treated) 619 (100.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 393 (100.0%) Cases resistant to isoniazid 14 (3.6%) Cases resistant to rifampicin 4 (1.0%) Estimated MDR N, (best-low-high) 1-0-5 MDR cases 2 (0.5%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 181 Success 136 (75.1%) Died 25 (13.8%) Failed 0 (0.0%) Defaulted 7 (3.9%) Still on treatment - - Lost to follow up 13 (7.2%) 169 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Cyprus 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10 20 30 40 50 60 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 100 20102008200620042002 0 1 2 3 4 5 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 20 40 60 80 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 839 751 Tuberculosis case notifications, 2011 Total number of cases 54 Notification rate per 100 000 6.4 New & relapses (laboratory-confirmed) number 31 New & relapses (laboratory-confirmed) notification rate per 100 000 3.7 Pulmonary 44 (81.5%) of which smear-positive 19 (43.2%) Laboratory-confirmed pulmonary TB cases 38 (86.4%) Mean age of new TB cases, nationals 54.0 years Mean age of new TB cases, non-nationals 37.4 years Foreign origin of all TB cases 45 (83.3%) New (not previously treated) 31 (57.4%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 40 (90.9%) Cases resistant to isoniazid 3 (7.5%) Cases resistant to rifampicin 1 (2.5%) Estimated MDR N, (best-low-high) 0-0-0 MDR cases 1 (2.5%) of which XDR cases 0 - Cases resistant to ethambutol 1 (2.5%) Cases resistant to streptomycin 1 (2.5%) TB cases tested for HIV 1 (1.9%) HIV-positive TB cases 1 - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 20 Success 5 (25.0%) Died 0 (0.0%) Failed 0 (0.0%) Defaulted 0 (0.0%) Still on treatment 0 (0.0%) Lost to follow up 15 (75.0%) 170 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Czech Republic 0 10 20 30 40 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 1000 1200 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 20102008200620042002 0 5 10 15 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 200 400 600 800 1000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 10 532 770 Tuberculosis case notifications, 2011 Total number of cases 600 Notification rate per 100 000 5.7 New & relapses (laboratory-confirmed) number 569 New & relapses (laboratory-confirmed) notification rate per 100 000 5.4 Pulmonary 522 (87.0%) of which smear-positive 198 (37.9%) Laboratory-confirmed pulmonary TB cases 395 (75.7%) Mean age of new TB cases, nationals 57.8 years Mean age of new TB cases, non-nationals 35.4 years Foreign origin of all TB cases 112 (18.7%) New (not previously treated) 569 (94.8%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 408 (95.8%) Cases resistant to isoniazid 12 (2.9%) Cases resistant to rifampicin 13 (3.2%) Estimated MDR N, (best-low-high) 12-4-20 MDR cases 7 (1.7%) of which XDR cases 2 (28.6%) Cases resistant to ethambutol 8 (2.0%) Cases resistant to streptomycin 16 (3.9%) TB cases tested for HIV 153 (25.5%) HIV-positive TB cases 4 (2.6%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 361 Success 249 (69.0%) Died 61 (16.9%) Failed 0 (0.0%) Defaulted 24 (6.6%) Still on treatment 14 (3.9%) Lost to follow up 13 (3.6%) 171 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Denmark 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 20102008200620042002 No . o f c as es UnknownForeign originNative Insufficient data for graphic presentation Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 100 200 300 400 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 5 560 628 Tuberculosis case notifications, 2011 Total number of cases 381 Notification rate per 100 000 6.9 New & relapses (laboratory-confirmed) number 359 New & relapses (laboratory-confirmed) notification rate per 100 000 6.5 Pulmonary 240 (63.0%) of which smear-positive 135 (56.3%) Laboratory-confirmed pulmonary TB cases 231 (96.3%) Mean age of new TB cases, nationals 48.4 years Mean age of new TB cases, non-nationals 41.1 years Foreign origin of all TB cases 235 (61.7%) New (not previously treated) 359 (94.2%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 271 (99.6%) Cases resistant to isoniazid 13 (4.8%) Cases resistant to rifampicin 3 (1.1%) Estimated MDR N, (best-low-high) 2-0-4 MDR cases 3 (1.1%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 3 (1.1%) Cases resistant to streptomycin 1 (0.4%) TB cases tested for HIV 9 (2.4%) HIV-positive TB cases 9 - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 218 Success 141 (64.7%) Died 23 (10.6%) Failed 5 (2.3%) Defaulted 1 (0.5%) Still on treatment 7 (3.2%) Lost to follow up 41 (18.8%) 172 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Estonia 0 20 40 60 80 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 50 60 20102008200620042002 0 30 60 90 120 150 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 100 200 300 400 500 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2008 by EUROSTAT: 1 340 194 Tuberculosis case notifications, 2011 Total number of cases 341 Notification rate per 100 000 25.4 New & relapses (laboratory-confirmed) number 297 New & relapses (laboratory-confirmed) notification rate per 100 000 22.2 Pulmonary 321 (94.1%) of which smear-positive 158 (49.2%) Laboratory-confirmed pulmonary TB cases 255 (79.4%) Mean age of new TB cases, nationals 44.0 years Mean age of new TB cases, non-nationals 56.7 years Foreign origin of all TB cases 48 (14.1%) New (not previously treated) 265 (77.7%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 262 (99.2%) Cases resistant to isoniazid 97 (37.0%) Cases resistant to rifampicin 79 (30.2%) Estimated MDR N, (best-low-high) 100-83-120 MDR cases 78 (29.8%) of which XDR cases 14 (17.9%) Cases resistant to ethambutol 79 (30.2%) Cases resistant to streptomycin 104 (39.7%) TB cases tested for HIV 313 (91.8%) HIV-positive TB cases 47 (15.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 192 Success 129 (67.2%) Died 20 (10.4%) Failed 3 (1.6%) Defaulted 7 (3.6%) Still on treatment 33 (17.2%) Lost to follow up 0 (0.0%) 173 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Finland 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 500 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20102008200620042002 0 2 4 6 8 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 5 375 276 Tuberculosis case notifications, 2011 Total number of cases 325 Notification rate per 100 000 6.0 New & relapses (laboratory-confirmed) number 312 New & relapses (laboratory-confirmed) notification rate per 100 000 5.8 Pulmonary 236 (72.6%) of which smear-positive 87 (36.9%) Laboratory-confirmed pulmonary TB cases 189 (80.1%) Mean age of new TB cases, nationals 67.0 years Mean age of new TB cases, non-nationals 32.3 years Foreign origin of all TB cases 79 (24.3%) New (not previously treated) 312 (96.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 245 (97.2%) Cases resistant to isoniazid 16 (6.5%) Cases resistant to rifampicin 5 (2.0%) Estimated MDR N, (best-low-high) 7-1-13 MDR cases 5 (2.0%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 4 (1.6%) Cases resistant to streptomycin 10 (4.1%) TB cases tested for HIV 3 0.9 HIV-positive TB cases 3 - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 185 Success 138 (74.6%) Died 16 (8.6%) Failed 0 (0.0%) Defaulted 4 (2.2%) Still on treatment 10 (5.4%) Lost to follow up 17 (9.2%) 174 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 France 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20102008200620042002 0 10 20 30 40 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es 0 1000 2000 3000 4000 5000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Not available Total population at 1 January 2011 by EUROSTAT: 65 048 412 Tuberculosis case notifications, 2011 Total number of cases 4 942 Notification rate per 100 000 7.6 New & relapses (laboratory-confirmed) number 2 639 New & relapses (laboratory-confirmed) notification rate per 100 000 4.1 Pulmonary 3 600 (72.8%) of which smear-positive 1 704 (47.3%) Laboratory-confirmed pulmonary TB cases 1 794 (49.8%) Mean age of new TB cases, nationals 49.0 years Mean age of new TB cases, non-nationals 40.2 years Foreign origin of all TB cases 2 456 (49.7%) New (not previously treated) 2 639 (53.4%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 1 568 (67.9%) Cases resistant to isoniazid 114 (7.3%) Cases resistant to rifampicin 43 (2.7%) Estimated MDR N, (best-low-high) 43-26-61 MDR cases 40 (2.6%) of which XDR cases - - Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 1 354 (27.4%) HIV-positive TB cases 95 (7.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Data not reported 175 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Georgia 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 20 40 60 80 100 20102008200620042002 0 100 200 300 400 500 Retreatment UnknownNew Total number of MDR-TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 2000 4000 6000 8000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 2000 4000 6000 8000 20102008200620042002 No . o f c as es UnknownForeign originNative Population estimate 2011 by UN Statistical Database: 4 329 026 Tuberculosis case notifications, 2011 Total number of cases 5 533 Notification rate per 100 000 127.8 New & relapses (lab+) number 4 547 New & relapses (lab+) notification rate per 100 000 105.0 Pulmonary 3 676 (66.4%) of which smear-positive 2 499 (68.0%) Laboratory-confirmed pulmonary TB cases 2 985 (81.2%) Mean age of new TB cases, nationals 36.8 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 4 223 (76.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 2 872 (97.2%) Cases resistant to isoniazid 810 (28.2%) Cases resistant to rifampicin 485 (16.9%) Estimated MDR N, (best-low-high) 760-700-820 MDR cases 453 (15.8%) of which XDR cases 28 (6.2%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 2 550 (46.1%) HIV-positive TB cases 50 (2.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 2 500 Success 1 908 (76.3%) Died 70 (2.8%) Failed 289 (11.6%) Defaulted 173 (6.9%) Still on treatment - - Lost to follow up 60 (2.4%) 176 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Germany 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 5000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20102008200620042002 0 20 40 60 80 100 120 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 81 751 602 Tuberculosis case notifications, 2011 Total number of cases 4 316 Notification rate per 100 000 5.3 New & relapses (laboratory-confirmed) number 3 577 New & relapses (laboratory-confirmed) notification rate per 100 000 4.4 Pulmonary 3 346 (77.5%) of which smear-positive 1 133 (33.9%) Laboratory-confirmed pulmonary TB cases 2 485 (74.3%) Mean age of new TB cases, nationals 54.7 years Mean age of new TB cases, non-nationals 43.0 years Foreign origin of all TB cases 2 025 (46.9%) New (not previously treated) 3 490 (80.9%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 2 821 (91.9%) Cases resistant to isoniazid 203 (7.2%) Cases resistant to rifampicin 63 (2.2%) Estimated MDR N, (best-low-high) 110-61-150 MDR cases 56 (2.0%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 45 (1.6%) Cases resistant to streptomycin 203 (7.2%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 2 090 Success 1 600 (76.6%) Died 256 (12.2%) Failed 3 (0.1%) Defaulted 33 (1.6%) Still on treatment 54 (2.6%) Lost to follow up 144 (6.9%) 177 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Greece 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 50 20102008200620042002 0 5 10 15 20 25 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Not available Total population at 1 January 2011 by EUROSTAT: 11 309 885 Tuberculosis case notifications, 2011 Total number of cases 489 Notification rate per 100 000 4.3 New & relapses (lab+) number 452 New & relapses (lab+) notification rate per 100 000 4.0 Pulmonary 426 (87.1%) of which smear-positive 254 (59.6%) Laboratory-confirmed pulmonary TB cases 254 (59.6%) Mean age of new TB cases, nationals 55.8 years Mean age of new TB cases, non-nationals 30.9 years Foreign origin of all TB cases 216 (44.2%) New (not previously treated) 452 (92.4%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 159 (57.2%) Cases resistant to isoniazid 20 (12.6%) Cases resistant to rifampicin 6 (3.8%) Estimated MDR N, (best-low-high) 6-0-14 MDR cases 5 (3.1%) of which XDR cases 2 - Cases resistant to ethambutol 6 (3.8%) Cases resistant to streptomycin 22 (13.8%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Data not reported 178 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Hungary 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 3 6 9 12 15 20102008200620042002 0 5 10 15 20 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 9 985 722 Tuberculosis case notifications, 2011 Total number of cases 1 445 Notification rate per 100 000 14.5 New & relapses (laboratory-confirmed) number 1 278 New & relapses (laboratory-confirmed) notification rate per 100 000 12.8 Pulmonary 1 389 (96.1%) of which smear-positive 301 (21.7%) Laboratory-confirmed pulmonary TB cases 590 (42.5%) Mean age of new TB cases, nationals 53.7 years Mean age of new TB cases, non-nationals 34.1 years Foreign origin of all TB cases 27 (1.9%) New (not previously treated) 1 223 (84.6%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 479 (80.2%) Cases resistant to isoniazid 30 (6.3%) Cases resistant to rifampicin 8 (1.7%) Estimated MDR N, (best-low-high) 44-24-64 MDR cases 7 (1.5%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 3 (0.6%) Cases resistant to streptomycin 20 (4.2%) TB cases tested for HIV 1 0.1 HIV-positive TB cases 1 - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New laboratory- confirmed pulmonary TB cases Case-linked data reporting Yes Notified in 2010 515 Success 355 (68.9%) Died 64 (12.4%) Failed 0 (0.0%) Defaulted 51 (9.9%) Still on treatment 27 (5.2%) Lost to follow up 18 (3.5%) 179 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Iceland 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 5 10 15 20 20102008200620042002 No . o f c as es UnknownForeign originNative Insufficient data for graphic presentation Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 5 10 15 20 25 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es Total population at 1 January 2011 by EUROSTAT: 318 452 Tuberculosis case notifications, 2011 Total number of cases 9 Notification rate per 100 000 2.8 New & relapses (lab+) number 8 New & relapses (lab+) notification rate per 100 000 2.5 Pulmonary 3 (33.3%) of which smear-positive 1 (33.3%) Laboratory-confirmed pulmonary TB cases 0 (0.0%) Mean age of new TB cases, nationals 43.0 years Mean age of new TB cases, non-nationals 32.5 years Foreign origin of all TB cases 7 (77.8%) New (not previously treated) 8 (88.9%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 4 (100.0%) Cases resistant to isoniazid 0 (0.0%) Cases resistant to rifampicin 0 (0.0%) Estimated MDR N, (best-low-high) 0-0-0 MDR cases 0 (0.0%) of which XDR cases 0 - Cases resistant to ethambutol 0 (0.0%) Cases resistant to streptomycin 0 (0.0%) TB cases tested for HIV 8 (88.9%) HIV-positive TB cases 0 (0.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 16 Success 14 (87.5%) Died 1 (6.3%) Failed 0 (0.0%) Defaulted 0 (0.0%) Still on treatment 0 (0.0%) Lost to follow up 1 (6.3%) 180 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Ireland 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 20102008200620042002 No . o f c as es UnknownForeign originNative 0 3 6 9 12 15 20102008200620042002 0 2 4 6 8 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 100 200 300 400 500 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 4 480 858 Tuberculosis case notifications, 2011 Total number of cases 425 Notification rate per 100 000 9.5 New & relapses (lab+) number 280 New & relapses (lab+) notification rate per 100 000 6.2 Pulmonary 293 (68.9%) of which smear-positive 120 (41.0%) Laboratory-confirmed pulmonary TB cases 221 (75.4%) Mean age of new TB cases, nationals 45.4 years Mean age of new TB cases, non-nationals 34.1 years Foreign origin of all TB cases 179 (42.1%) New (not previously treated) 280 (65.9%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 239 (83.0%) Cases resistant to isoniazid 15 (6.3%) Cases resistant to rifampicin 3 (1.3%) Estimated MDR N, (best-low-high) 3-0-7 MDR cases 3 (1.3%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 4 (1.7%) Cases resistant to streptomycin 12 (5.0%) TB cases tested for HIV 94 (22.1%) HIV-positive TB cases 19 (20.2%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 164 Success 119 (72.6%) Died 12 (7.3%) Failed 0 (0.0%) Defaulted 2 (1.2%) Still on treatment 2 (1.2%) Lost to follow up 29 (17.7%) 181 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Israel 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 500 600 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 100 20102008200620042002 0 5 10 15 20 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 100 200 300 400 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 7 562 194 Tuberculosis case notifications, 2011 Total number of cases 418 Notification rate per 100 000 5.5 New & relapses (lab+) number 412 New & relapses (lab+) notification rate per 100 000 5.4 Pulmonary 351 (84.0%) of which smear-positive 139 (39.6%) Laboratory-confirmed pulmonary TB cases 249 (70.9%) Mean age of new TB cases, nationals 31.6 years Mean age of new TB cases, non-nationals 37.3 years Foreign origin of all TB cases 374 (89.5%) New (not previously treated) 408 (97.6%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 284 (100.0%) Cases resistant to isoniazid 27 (9.5%) Cases resistant to rifampicin 12 (4.2%) Estimated MDR N, (best-low-high) 14-6-22 MDR cases 11 (3.9%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 384 (91.9%) HIV-positive TB cases 24 (6.3%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 99 Success 75 (75.8%) Died 11 (11.1%) Failed 0 (0.0%) Defaulted 0 (0.0%) Still on treatment - - Lost to follow up 13 (13.1%) 182 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Italy 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 20102008200620042002 0 20 40 60 80 100 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Not available Not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 60 626 442 Tuberculosis case notifications, 2011 Total number of cases 3 521 Notification rate per 100 000 5.8 New & relapses (lab+) number 2 018 New & relapses (lab+) notification rate per 100 000 3.3 Pulmonary 2 582 (73.3%) of which smear-positive 1 040 (40.3%) Laboratory-confirmed pulmonary TB cases 969 (37.5%) Mean age of new TB cases, nationals 54.8 years Mean age of new TB cases, non-nationals 34.7 years Foreign origin of all TB cases 1 677 (47.6%) New (not previously treated) 2 018 (57.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** - Case-linked data reporting No Cases with DST results 2 542 (98.7%) Cases resistant to isoniazid 244 (9.6%) Cases resistant to rifampicin 99 (3.9%) Estimated MDR N, (best-low-high) 57-42-72 MDR cases 81 (3.2%) of which XDR cases 6 (7.4%) Cases resistant to ethambutol 72 (2.8%) Cases resistant to streptomycin 238 (9.4%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Data not reported 183 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Kazakhstan 0 50 100 150 200 250 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 100 200 300 400 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10 20 30 40 50 60 20102008200620042002 0 1000 2000 3000 4000 5000 6000 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 10000 20000 30000 40000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es 0 10000 20000 30000 40000 20102008200620042002 No . o f c as es UnknownForeign originNative New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 16 206 750 Tuberculosis case notifications, 2011 Total number of cases 23 076 Notification rate per 100 000 142.4 New & relapses (lab+) number 18 254 New & relapses (lab+) notification rate per 100 000 112.6 Pulmonary 20 806 (90.2%) of which smear-positive 10 398 (50.0%) Laboratory-confirmed pulmonary TB cases 13 905 (66.8%) Mean age of new TB cases, nationals 33.8 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 14 396 (62.4%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 11 555 (100.0%) Cases resistant to isoniazid 4 827 (41.8%) Cases resistant to rifampicin 4 634 (40.1%) Estimated MDR N, (best-low-high) 8 200-8 000-8 400 MDR cases 4 575 (39.6%) of which XDR cases 187 (4.1%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 22 480 (97.4%) HIV-positive TB cases 352 (1.6%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 4 919 Success 2 995 (60.9%) Died 158 (3.2%) Failed 329 (6.7%) Defaulted 116 (2.4%) Still on treatment - - Lost to follow up 1 321 (26.9%) 184 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Kyrgyzstan 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 20 40 60 80 100 20102008200620042002 0 200 400 600 800 1000 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success Data not reported New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 2000 4000 6000 8000 20102008200620042002 No . o f c as es UnknownForeign originNative Population estimate 2011 by UN Statistical Database: 5 392 580 Tuberculosis case notifications, 2011 Total number of cases 6 254 Notification rate per 100 000 116.0 New & relapses (lab+) number 5 529 New & relapses (lab+) notification rate per 100 000 102.5 Pulmonary 4 835 (77.3%) of which smear-positive 1 997 (41.3%) Laboratory-confirmed pulmonary TB cases 1 997 (41.3%) Mean age of new TB cases, nationals 36.6 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 5 180 (82.8%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting No Cases with DST results - - Cases resistant to isoniazid 919 - Cases resistant to rifampicin 849 - Estimated MDR N, (best-low-high) 1 500-1 400-1 700 MDR cases 806 - of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 153 (2.4%) HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Data not reported 185 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Latvia 0 20 40 60 80 100 120 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 100 120 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 500 1000 1500 2000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 50 20102008200620042002 0 50 100 150 200 250 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 500 1000 1500 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 2 229 641 Tuberculosis case notifications, 2011 Total number of cases 885 Notification rate per 100 000 39.7 New & relapses (lab+) number 866 New & relapses (lab+) notification rate per 100 000 38.8 Pulmonary 796 (89.9%) of which smear-positive 345 (43.3%) Laboratory-confirmed pulmonary TB cases 649 (81.5%) Mean age of new TB cases, nationals 39.3 years Mean age of new TB cases, non-nationals 51.8 years Foreign origin of all TB cases 59 (6.7%) New (not previously treated) 788 (89.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 644 (96.0%) Cases resistant to isoniazid 203 (31.5%) Cases resistant to rifampicin 96 (14.9%) Estimated MDR N, (best-low-high) 120-96-140 MDR cases 95 (14.8%) of which XDR cases 12 (12.6%) Cases resistant to ethambutol 78 (12.1%) Cases resistant to streptomycin 191 (29.7%) TB cases tested for HIV 752 (85.0%) HIV-positive TB cases 71 (9.4%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 596 Success 451 (75.7%) Died 47 (7.9%) Failed 3 (0.5%) Defaulted 37 (6.2%) Still on treatment 58 (9.7%) Lost to follow up 0 (0.0%) 186 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Lithuania 0 30 60 90 120 150 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 100 120 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 100 20102008200620042002 0 100 200 300 400 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 1000 2000 3000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 3 244 601 Tuberculosis case notifications, 2011 Total number of cases 1 904 Notification rate per 100 000 58.7 New & relapses (lab+) number 1 748 New & relapses (lab+) notification rate per 100 000 53.9 Pulmonary 1 714 (90.0%) of which smear-positive 971 (56.7%) Laboratory-confirmed pulmonary TB cases 1 369 (79.9%) Mean age of new TB cases, nationals 45.3 years Mean age of new TB cases, non-nationals 52.1 years Foreign origin of all TB cases 44 (2.3%) New (not previously treated) 1 532 (80.5%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 1 403 (100.0%) Cases resistant to isoniazid 446 (31.8%) Cases resistant to rifampicin 306 (21.8%) Estimated MDR N, (best-low-high) 360-320-390 MDR cases 296 (21.1%) of which XDR cases 53 (17.9%) Cases resistant to ethambutol 224 (16.0%) Cases resistant to streptomycin 438 (31.2%) TB cases tested for HIV 1 352 (71.0%) HIV-positive TB cases 22 (1.6%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 959 Success 656 (68.4%) Died 107 (11.2%) Failed 13 (1.4%) Defaulted 104 (10.8%) Still on treatment 75 (7.8%) Lost to follow up 4 (0.4%) 187 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Luxembourg 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10 20 30 40 50 20102008200620042002 No . o f c as es UnknownForeign originNative Insufficient data for graphic presentation New TB cases - notification rates by age group, 2002–2011*Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011* Not available 0 10 20 30 40 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es Total population at 1 January 2011 by EUROSTAT: 511 840 * No previous treatment history reported for 2007–2009 * No data available for 2006–2009 Tuberculosis case notifications, 2011 Total number of cases 26 Notification rate per 100 000 5.1 New & relapses (lab+) number 11 New & relapses (lab+) notification rate per 100 000 2.1 Pulmonary 22 (84.6%) of which smear-positive 9 (40.9%) Laboratory-confirmed pulmonary TB cases 17 (77.3%) Mean age of new TB cases, nationals 41.7 years Mean age of new TB cases, non-nationals 34.8 years Foreign origin of all TB cases 21 (80.8%) New (not previously treated) 11 (42.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 19 (100.0%) Cases resistant to isoniazid 3 (15.8%) Cases resistant to rifampicin 2 (10.5%) Estimated MDR N, (best-low-high) 0-0-0 MDR cases 2 (10.5%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 1 (5.3%) Cases resistant to streptomycin 4 (21.1%) TB cases tested for HIV 5 (19.2%) HIV-positive TB cases 2 (40.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 14 Success 0 (0.0%) Died 1 (7.1%) Failed 0 (0.0%) Defaulted 0 (0.0%) Still on treatment 0 (0.0%) Lost to follow up 13 (92.9%) 188 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 The former Yugoslav Republic of Macedonia 0 20 40 60 80 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 20102008200620042002 0 2 4 6 8 10 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 200 400 600 800 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 2 063 893 Tuberculosis case notifications, 2011 Total number of cases 362 Notification rate per 100 000 17.5 New & relapses (lab+) number 335 New & relapses (lab+) notification rate per 100 000 16.2 Pulmonary 271 (74.9%) of which smear-positive 160 (59.0%) Laboratory-confirmed pulmonary TB cases 209 (77.1%) Mean age of new TB cases, nationals 41.0 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 15 (4.1%) New (not previously treated) 307 (84.8%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 155 (100.0%) Cases resistant to isoniazid 7 (4.5%) Cases resistant to rifampicin 7 (4.5%) Estimated MDR N, (best-low-high) 2-0-6 MDR cases 1 (0.6%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 45 (12.4%) HIV-positive TB cases 0 (0.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 143 Success 128 (89.5%) Died 6 (4.2%) Failed 4 (2.8%) Defaulted 3 (2.1%) Still on treatment 0 (0.0%) Lost to follow up 2 (1.4%) 189 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Malta 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10 20 30 40 50 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 50 60 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es Insufficient data for graphic presentation Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 * By nationality for 2000–2006 Total population at 1 January 2011 by EUROSTAT: 417 617 Tuberculosis case notifications, 2011 Total number of cases 33 Notification rate per 100 000 7.9 New & relapses (lab+) number 22 New & relapses (lab+) notification rate per 100 000 5.3 Pulmonary 22 (66.7%) of which smear-positive 9 (40.9%) Laboratory-confirmed pulmonary TB cases 15 (68.2%) Mean age of new TB cases, nationals 77.3 years Mean age of new TB cases, non-nationals 31.5 years Foreign origin of all TB cases 28 (84.8%) New (not previously treated) 22 (66.7%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 22 (91.7%) Cases resistant to isoniazid 1 (4.5%) Cases resistant to rifampicin 0 (0.0%) Estimated MDR N, (best-low-high) - MDR cases 0 (0.0%) of which XDR cases - - Cases resistant to ethambutol 0 (0.0%) Cases resistant to streptomycin 3 (13.6%) TB cases tested for HIV 30 (90.9%) HIV-positive TB cases 5 (16.7%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 5 Success 4 (80.0%) Died 0 (0.0%) Failed 0 (0.0%) Defaulted 0 (0.0%) Still on treatment 0 (0.0%) Lost to follow up 1 (20.0%) 190 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Moldova 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 200 250 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 2000 4000 6000 8000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 20102008200620042002 0 500 1000 1500 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Transferred or unknownFailed Died Success 0 2000 4000 6000 8000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 3 544 864 Tuberculosis case notifications, 2011 Total number of cases 5 341 Notification rate per 100 000 150.7 New & relapses (lab+) number 4 208 New & relapses (lab+) notification rate per 100 000 118.7 Pulmonary 4 851 (90.8%) of which smear-positive 2 086 (43.0%) Laboratory-confirmed pulmonary TB cases 2 844 (58.6%) Mean age of new TB cases, nationals 39.1 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 3 836 (71.8%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 2 385 (93.1%) Cases resistant to isoniazid 1 214 (50.9%) Cases resistant to rifampicin 1 026 (43.0%) Estimated MDR N, (best-low-high) 1 600-1 500-1 700 MDR cases 1 001 (42.0%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 5 017 (93.9%) HIV-positive TB cases 285 (5.7%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 1 267 Success 724 (57.1%) Died 145 (11.4%) Failed 67 (5.3%) Defaulted 166 (13.1%) Still on treatment - - Lost to follow up 165 (13.0%) 191 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Montenegro 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 50 100 150 200 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 20102008200620042002 0 1 2 3 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 50 100 150 200 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011*Tuberculosis notification rates by treatment history, 2002–2011* Tuberculosis cases by geographical origin, 2002–2011* MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear and/or culture-positive cases, 2002–2010* TB-HIV co-infection, 2006–2011* * Established in 2006 following the split of Serbia and Montenegro; data starting from 2005. * Established in 2006 following the split of Serbia and Montenegro; data starting from 2005. Population estimate 2011 by UN Statistical Database: 632 261 * Established in 2006 following the split of Serbia and Montenegro; data starting from 2005.* Established in 2006 following the split of Serbia and Montenegro; data starting from 2005. * Established in 2006 following the split of Serbia and Montenegro; data starting from 2005. Tuberculosis case notifications, 2011 Total number of cases 112 Notification rate per 100 000 17.7 New & relapses (lab+) number 110 New & relapses (lab+) notification rate per 100 000 17.4 Pulmonary 107 (95.5%) of which smear-positive 60 (56.1%) Laboratory-confirmed pulmonary TB cases 69 (64.5%) Mean age of new TB cases, nationals 43.9 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 100 (89.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 72 (100.0%) Cases resistant to isoniazid 2 (2.8%) Cases resistant to rifampicin 2 (2.8%) Estimated MDR N, (best-low-high) 2-0-5 MDR cases 1 (1.4%) of which XDR cases - - Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 92 (82.1%) HIV-positive TB cases 0 (0.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 39 Success 34 (87.2%) Died 2 (5.1%) Failed 0 (0.0%) Defaulted 1 (2.6%) Still on treatment - - Lost to follow up 2 (5.1%) 192 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Netherlands 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 1000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 25 20102008200620042002 0 5 10 15 20 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 200 400 600 800 1000 1200 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 16 655 799 Tuberculosis case notifications, 2011 Total number of cases 1 007 Notification rate per 100 000 6.0 New & relapses (lab+) number 974 New & relapses (lab+) notification rate per 100 000 5.8 Pulmonary 563 (55.9%) of which smear-positive 190 (33.7%) Laboratory-confirmed pulmonary TB cases 464 (82.4%) Mean age of new TB cases, nationals 45.1 years Mean age of new TB cases, non-nationals 38.3 years Foreign origin of all TB cases 710 (70.5%) New (not previously treated) 958 (95.1%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 726 (99.2%) Cases resistant to isoniazid 62 (8.5%) Cases resistant to rifampicin 16 (2.2%) Estimated MDR N, (best-low-high) 11-5-17 MDR cases 15 (2.1%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 8 (1.1%) Cases resistant to streptomycin 47 (6.5%) TB cases tested for HIV 460 (45.7%) HIV-positive TB cases 31 (6.7%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 470 Success 365 (77.7%) Died 31 (6.6%) Failed 0 (0.0%) Defaulted 19 (4.0%) Still on treatment 18 (3.8%) Lost to follow up 37 (7.9%) 193 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Norway 0 5 10 15 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 20102008200620042002 0 2 4 6 8 10 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 4 920 305 Tuberculosis case notifications, 2011 Total number of cases 361 Notification rate per 100 000 7.3 New & relapses (lab+) number 314 New & relapses (lab+) notification rate per 100 000 6.4 Pulmonary 200 (55.4%) of which smear-positive 47 (23.5%) Laboratory-confirmed pulmonary TB cases 158 (79.0%) Mean age of new TB cases, nationals 48.7 years Mean age of new TB cases, non-nationals 31.1 years Foreign origin of all TB cases 317 (87.8%) New (not previously treated) 314 (87.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 257 (98.1%) Cases resistant to isoniazid 20 (7.8%) Cases resistant to rifampicin 4 (1.6%) Estimated MDR N, (best-low-high) 9-2-15 MDR cases 4 (1.6%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 3 (1.2%) Cases resistant to streptomycin 17 (6.6%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 139 Success 127 (91.4%) Died 4 (2.9%) Failed 1 (0.7%) Defaulted 0 (0.0%) Still on treatment 5 (3.6%) Lost to follow up 2 (1.4%) 194 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Poland 0 10 20 30 40 50 60 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 2000 4000 6000 8000 10000 12000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 2 4 6 8 10 12 20102008200620042002 0 10 20 30 40 50 60 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 38 200 037 Tuberculosis case notifications, 2011 Total number of cases 8 478 Notification rate per 100 000 22.2 New & relapses (lab+) number 7 950 New & relapses (lab+) notification rate per 100 000 20.8 Pulmonary 7 879 (92.9%) of which smear-positive 2 989 (37.9%) Laboratory-confirmed pulmonary TB cases 5 327 (67.6%) Mean age of new TB cases, nationals 53.3 years Mean age of new TB cases, non-nationals 35.9 years Foreign origin of all TB cases 38 (0.4%) New (not previously treated) 7 515 (88.6%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 4 993 (89.5%) Cases resistant to isoniazid 185 (3.7%) Cases resistant to rifampicin 49 (1.0%) Estimated MDR N, (best-low-high) 68-46-89 MDR cases 41 (0.8%) of which XDR cases 1 (2.4%) Cases resistant to ethambutol 19 (0.4%) Cases resistant to streptomycin 156 (3.1%) TB cases tested for HIV 26 (0.3%) HIV-positive TB cases 26 - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 3 998 Success 2 631 (65.8%) Died 242 (6.1%) Failed 10 (0.3%) Defaulted 354 (8.9%) Still on treatment 15 (0.4%) Lost to follow up 746 (18.7%) 195 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Portugal 0 20 40 60 80 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 50 60 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 5000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 2 4 6 8 10 20102008200620042002 0 10 20 30 40 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 1000 2000 3000 4000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 10 636 979 Tuberculosis case notifications, 2011 Total number of cases 2 540 Notification rate per 100 000 23.9 New & relapses (lab+) number 2 413 New & relapses (lab+) notification rate per 100 000 22.7 Pulmonary 1 857 (73.1%) of which smear-positive 966 (52.0%) Laboratory-confirmed pulmonary TB cases 1 385 (74.6%) Mean age of new TB cases, nationals 48.3 years Mean age of new TB cases, non-nationals 38.5 years Foreign origin of all TB cases 385 (15.2%) New (not previously treated) 2 325 (91.5%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 1 252 (78.8%) Cases resistant to isoniazid 98 (7.8%) Cases resistant to rifampicin 24 (1.9%) Estimated MDR N, (best-low-high) 32-17-47 MDR cases 22 (1.8%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 20 (1.6%) Cases resistant to streptomycin 146 (11.7%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Data not reported 196 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Romania 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10000 20000 30000 40000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 10 20 30 40 20102008200620042002 0 200 400 600 800 1000 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 5000 10000 15000 20000 25000 30000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 21 413 815 Tuberculosis case notifications, 2011 Total number of cases 19 212 Notification rate per 100 000 89.7 New & relapses (lab+) number 16 992 New & relapses (lab+) notification rate per 100 000 79.4 Pulmonary 16 431 (85.5%) of which smear-positive 10 852 (66.0%) Laboratory-confirmed pulmonary TB cases 12 446 (75.7%) Mean age of new TB cases, nationals 42.0 years Mean age of new TB cases, non-nationals 37.4 years Foreign origin of all TB cases 50 (0.3%) New (not previously treated) 14 543 (75.7%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 6 026 (48.4%) Cases resistant to isoniazid 867 (14.4%) Cases resistant to rifampicin 597 (9.9%) Estimated MDR N, (best-low-high) 850-650-1000 MDR cases 530 (8.8%) of which XDR cases 30 (5.7%) Cases resistant to ethambutol 218 (3.6%) Cases resistant to streptomycin 300 (5.0%) TB cases tested for HIV 9 383 (48.8%) HIV-positive TB cases 243 (2.6%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 9 445 Success 7 916 (83.8%) Died 441 (4.7%) Failed 379 (4.0%) Defaulted 538 (5.7%) Still on treatment 171 (1.8%) Lost to follow up 0 (0.0%) 197 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Russia 0 30 60 90 120 150 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 50000 100000 150000 200000 250000 20102008200620042002 No . o f c as es UnknownForeign originNative Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 50000 100000 150000 200000 250000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 10 20 30 40 50 60 20102008200620042002 0 5000 10000 15000 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Population estimate 2011 by UN Statistical Database: 142 835 555 Tuberculosis case notifications, 2011 Total number of cases 159 479 Notification rate per 100 000 111.7 New & relapses (lab+) number 112 910 New & relapses (lab+) notification rate per 100 000 79.0 Pulmonary 136 775 (85.8%) of which smear-positive 47 144 (34.5%) Laboratory-confirmed pulmonary TB cases 64 975 (47.5%) Mean age of new TB cases, nationals 38.7 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 2 821 (1.8%) New (not previously treated) 104 320 (65.4%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting No Cases with DST results 47 627 (91.7%) Cases resistant to isoniazid 13 785 (28.9%) Cases resistant to rifampicin 13 785 (28.9%) Estimated MDR N, (best-low-high) 44 000-40 000-48 000 MDR cases 13 785 (28.9%) of which XDR cases - - Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 79 494 (49.8%) HIV-positive TB cases 4 104 (5.2%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 30 123 Success 15 984 (53.1%) Died 3 531 (11.7%) Failed 6 970 (23.1%) Defaulted 2 131 (7.1%) Still on treatment - - Lost to follow up 1 507 (5.0%) 198 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Serbia 0 20 40 60 80 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 2 4 6 8 10 20102008200620042002 0 10 20 30 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary definite cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 9 853 969 Tuberculosis case notifications, 2011 Total number of cases 1 341 Notification rate per 100 000 13.6 New & relapses (lab+) number 1 296 New & relapses (lab+) notification rate per 100 000 13.2 Pulmonary 1 175 (87.6%) of which smear-positive 739 (62.9%) Laboratory-confirmed pulmonary TB cases 1 025 (87.2%) Mean age of new TB cases, nationals 51.8 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 6 (0.4%) New (not previously treated) 1 205 (89.9%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** No Case-linked data reporting Yes Cases with DST results 966 (94.2%) Cases resistant to isoniazid 25 (2.6%) Cases resistant to rifampicin 9 (0.9%) Estimated MDR N, (best-low-high) 20-9-31 MDR cases 9 (0.9%) of which XDR cases 2 (22.2%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 67 (5.0%) HIV-positive TB cases 6 (9.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 702 Success 602 (85.8%) Died 48 (6.8%) Failed 7 (1.0%) Defaulted 31 (4.4%) Still on treatment - - Lost to follow up 14 (2.0%) 199 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Slovakia 0 10 20 30 40 50 60 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 1000 1200 20102008200620042002 No . o f c as es UnknownForeign originNative 0 2 4 6 8 10 20102008200620042002 0 2 4 6 8 10 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 200 400 600 800 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 5 435 273 Tuberculosis case notifications, 2011 Total number of cases 399 Notification rate per 100 000 7.3 New & relapses (lab+) number 352 New & relapses (lab+) notification rate per 100 000 6.5 Pulmonary 337 (84.5%) of which smear-positive 123 (36.5%) Laboratory-confirmed pulmonary TB cases 178 (52.8%) Mean age of new TB cases, nationals 50.6 years Mean age of new TB cases, non-nationals 35.5 years Foreign origin of all TB cases 3 (0.8%) New (not previously treated) 323 (81.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 185 (98.4%) Cases resistant to isoniazid 9 (4.9%) Cases resistant to rifampicin 4 (2.2%) Estimated MDR N, (best-low-high) 5-0-11 MDR cases 3 (1.6%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 1 (0.5%) Cases resistant to streptomycin 6 (3.2%) TB cases tested for HIV 395 (99.0%) HIV-positive TB cases 0 (0.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 177 Success 149 (84.2%) Died 22 (12.4%) Failed 0 (0.0%) Defaulted 5 (2.8%) Still on treatment 0 (0.0%) Lost to follow up 1 (0.6%) 200 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Slovenia 0 10 20 30 40 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 20102008200620042002 No . o f c as es UnknownForeign originNative Insufficient data for graphic presentation Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success 0 50 100 150 200 250 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 2 050 189 Tuberculosis case notifications, 2011 Total number of cases 192 Notification rate per 100 000 9.4 New & relapses (lab+) number 190 New & relapses (lab+) notification rate per 100 000 9.3 Pulmonary 165 (85.9%) of which smear-positive 88 (53.3%) Laboratory-confirmed pulmonary TB cases 161 (97.6%) Mean age of new TB cases, nationals 55.8 years Mean age of new TB cases, non-nationals 45.5 years Foreign origin of all TB cases 57 (29.7%) New (not previously treated) 181 (94.3%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 182 (100.0%) Cases resistant to isoniazid 3 (1.6%) Cases resistant to rifampicin 0 (0.0%) Estimated MDR N, (best-low-high) 0-0-0 MDR cases 0 (0.0%) of which XDR cases - - Cases resistant to ethambutol 0 (0.0%) Cases resistant to streptomycin 4 (2.2%) TB cases tested for HIV 147 (76.6%) HIV-positive TB cases 0 (0.0%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 121 Success 104 (86.0%) Died 12 (9.9%) Failed 0 (0.0%) Defaulted 1 (0.8%) Still on treatment 2 (1.7%) Lost to follow up 2 (1.7%) 201 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Spain 0 10 20 30 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 1000 2000 3000 4000 5000 6000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 25 30 20102008200620042002 0 20 40 60 80 100 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es 0 2000 4000 6000 8000 10000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Total population at 1 January 2011 by EUROSTAT: 46 152 926 Tuberculosis case notifications, 2011 Total number of cases 6 762 Notification rate per 100 000 14.7 New & relapses (lab+) number 6 044 New & relapses (lab+) notification rate per 100 000 13.1 Pulmonary 4 979 (73.6%) of which smear-positive 2 471 (49.6%) Laboratory-confirmed pulmonary TB cases 3 584 (72.0%) Mean age of new TB cases, nationals 46.9 years Mean age of new TB cases, non-nationals 32.9 years Foreign origin of all TB cases 2 138 (31.6%) New (not previously treated) 6 044 (89.4%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting No Cases with DST results 1 273 (29.0%) Cases resistant to isoniazid 108 (8.5%) Cases resistant to rifampicin 45 (3.5%) Estimated MDR N, (best-low-high) 36-15-58 MDR cases 41 (3.2%) of which XDR cases 1 (2.4%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 4 541 (67.2%) HIV-positive TB cases 415 (9.1%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 3 574 Success 2 516 (70.4%) Died 211 (5.9%) Failed 5 (0.1%) Defaulted 27 (0.8%) Still on treatment 31 (0.9%) Lost to follow up 784 (21.9%) 202 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Sweden 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 200 400 600 800 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 25 20102008200620042002 0 5 10 15 20 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 9 415 570 Tuberculosis case notifications, 2011 Total number of cases 586 Notification rate per 100 000 6.2 New & relapses (lab+) number 457 New & relapses (lab+) notification rate per 100 000 4.9 Pulmonary 358 (61.1%) of which smear-positive 123 (34.4%) Laboratory-confirmed pulmonary TB cases 306 (85.5%) Mean age of new TB cases, nationals 46.4 years Mean age of new TB cases, non-nationals 33.5 years Foreign origin of all TB cases 524 (89.4%) New (not previously treated) 454 (77.5%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 475 (99.8%) Cases resistant to isoniazid 59 (12.4%) Cases resistant to rifampicin 19 (4.0%) Estimated MDR N, (best-low-high) 18-9-27 MDR cases 17 (3.6%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol 10 (2.1%) Cases resistant to streptomycin 23 (4.8%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 289 Success 246 (85.1%) Died 14 (4.8%) Failed 1 (0.3%) Defaulted 2 (0.7%) Still on treatment 17 (5.9%) Lost to follow up 9 (3.1%) 203 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Switzerland 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 2 4 6 8 10 12 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 100 200 300 400 500 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 20102008200620042002 0 5 10 15 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Data not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Not available Population estimate 2011 by UN Statistical Database: 7 701 690 Tuberculosis case notifications, 2011 Total number of cases 578 Notification rate per 100 000 7.5 New & relapses (lab+) number 379 New & relapses (lab+) notification rate per 100 000 4.9 Pulmonary 359 (62.1%) of which smear-positive 119 (33.1%) Laboratory-confirmed pulmonary TB cases 303 (84.4%) Mean age of new TB cases, nationals 56.1 years Mean age of new TB cases, non-nationals 36.5 years Foreign origin of all TB cases 428 (74.0%) New (not previously treated) 379 (65.6%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 454 (93.2%) Cases resistant to isoniazid 33 (7.3%) Cases resistant to rifampicin 11 (2.4%) Estimated MDR N, (best-low-high) 6-1-12 MDR cases 8 (1.8%) of which XDR cases 0 (0.0%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Data not reported 204 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Tajikistan 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 30 60 90 120 150 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 2000 4000 6000 8000 10000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 2000 4000 6000 8000 10000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 100 20102008200620042002 0 100 200 300 400 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Population estimate 2011 by UN Statistical Database: 6 976 958 Tuberculosis case notifications, 2011 Total number of cases 7 609 Notification rate per 100 000 109.1 New & relapses (lab+) number 6 290 New & relapses (lab+) notification rate per 100 000 90.2 Pulmonary 5 996 (78.8%) of which smear-positive 3 103 (51.8%) Laboratory-confirmed pulmonary TB cases 3 103 (51.8%) Mean age of new TB cases, nationals 32.8 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 5 935 (78.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting No Cases with DST results 576 (35.5%) Cases resistant to isoniazid 405 (70.3%) Cases resistant to rifampicin 395 (68.6%) Estimated MDR N, (best-low-high) 1 000-910-1 200 MDR cases 380 (66.0%) of which XDR cases 12 (3.2%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 6 241 (82.0%) HIV-positive TB cases 115 (1.8%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 2 290 Success 1 834 (80.1%) Died 111 (4.8%) Failed 246 (10.7%) Defaulted 72 (3.1%) Still on treatment - - Lost to follow up 27 (1.2%) 205 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Turkey 0 10 20 30 40 50 60 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 10 20 30 40 50 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 5000 10000 15000 20000 25000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 5 10 15 20 25 20102008200620042002 0 100 200 300 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 5000 10000 15000 20000 25000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 73 639 596 Tuberculosis case notifications, 2011 Total number of cases 15 679 Notification rate per 100 000 21.3 New & relapses (lab+) number 15 054 New & relapses (lab+) notification rate per 100 000 20.4 Pulmonary 9 909 (63.2%) of which smear-positive 5 643 (56.9%) Laboratory-confirmed pulmonary TB cases 7 245 (73.1%) Mean age of new TB cases, nationals 40.7 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 202 (1.3%) New (not previously treated) 14 417 (92.0%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** No Case-linked data reporting No Cases with DST results 4 823 (30.8%) Cases resistant to isoniazid 660 (13.7%) Cases resistant to rifampicin 325 (6.7%) Estimated MDR N, (best-low-high) 560-240-880 MDR cases 262 (5.4%) of which XDR cases 1 (0.4%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 7 241 (46.2%) HIV-positive TB cases 29 (0.4%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 5 375 Success 4 905 (91.3%) Died 165 (3.1%) Failed 40 (0.7%) Defaulted 136 (2.5%) Still on treatment - - Lost to follow up 129 (2.4%) 206 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 0 1000 2000 3000 4000 20102008200620042002 No . o f c as es UnknownForeign originNative Turkmenistan 0 20 40 60 80 100 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 30 60 90 120 150 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 10 20 30 40 50 60 20102008200620042002 0 5 10 15 20 25 30 35 40 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 1000 2000 3000 4000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Population estimate 2011 by UN Statistical Database: 5 105 301 Tuberculosis case notifications, 2011 Data not reported Drug resistance surveillance & TB-HIV co-infection, 2011 Data not reported Treatment outcome monitoring, 2010 Data not reported 207 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Ukraine 0 50 100 150 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 20 40 60 80 100 120 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 10000 20000 30000 40000 50000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear or culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 10000 20000 30000 40000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 20 40 60 80 20102008200620042002 0 1000 2000 3000 4000 5000 6000 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Population estimate 2011 by UN Statistical Database: 45 190 180 Tuberculosis case notifications, 2011 Total number of cases 42 676 Notification rate per 100 000 94.4 New & relapses (lab+) number 34 237 New & relapses (lab+) notification rate per 100 000 75.8 Pulmonary 33 165 (77.7%) of which smear-positive 16 764 (50.5%) Laboratory-confirmed pulmonary TB cases 16 764 (50.5%) Mean age of new TB cases, nationals 42.0 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 0 (0.0%) New (not previously treated) 31 188 (73.1%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting No Cases with DST results 14 765 (73.4%) Cases resistant to isoniazid 4 719 (32.0%) Cases resistant to rifampicin 4 530 (30.7%) Estimated MDR N, (best-low-high) 9 500-8 700-10 000 MDR cases 4 305 (29.2%) of which XDR cases - - Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 31 776 (74.5%) HIV-positive TB cases 5 893 (18.5%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting No Notified in 2010 13 279 Success 7 935 (59.8%) Died 1 665 (12.5%) Failed 2 212 (16.7%) Defaulted 1 009 (7.6%) Still on treatment - - Lost to follow up 458 (3.4%) 208 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 United Kingdom 0 5 10 15 20 25 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 5 10 15 20 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses 0 2000 4000 6000 8000 20102008200620042002 No . o f c as es UnknownForeign originNative 0 1 2 3 4 5 6 20102008200620042002 0 20 40 60 80 100 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 DefaultedLost to follow up Still on treatment Failed Died Success Not available New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary culture-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 Total population at 1 January 2011 by EUROSTAT: 62 498 612 Tuberculosis case notifications, 2011 Total number of cases 8 963 Notification rate per 100 000 14.3 New & relapses (lab+) number 7 850 New & relapses (lab+) notification rate per 100 000 12.6 Pulmonary 4 603 (51.4%) of which smear-positive 1 384 (30.1%) Laboratory-confirmed pulmonary TB cases 3 213 (69.8%) Mean age of new TB cases, nationals 41.6 years Mean age of new TB cases, non-nationals 38.4 years Foreign origin of all TB cases 6 287 (70.1%) New (not previously treated) 7 850 (87.6%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* Yes Completeness of HIV data** - Case-linked data reporting Yes Cases with DST results 5 127 (97.0%) Cases resistant to isoniazid 388 (7.6%) Cases resistant to rifampicin 89 (1.7%) Estimated MDR N, (best-low-high) 71-55-87 MDR cases 81 (1.6%) of which XDR cases 6 (7.4%) Cases resistant to ethambutol 58 (1.1%) Cases resistant to streptomycin 265 (5.2%) TB cases tested for HIV - - HIV-positive TB cases - - * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 2 603 Success 2 106 (80.9%) Died 135 (5.2%) Failed 0 (0.0%) Defaulted 154 (5.9%) Still on treatment 118 (4.5%) Lost to follow up 90 (3.5%) 209 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Uzbekistan 0 50 100 150 200 20102008200620042002 Ca se s / 10 0 00 0 >6445–6415–440–14 0 50 100 150 20102008200620042002 Ca se s / 10 0 00 0 Total Unknown Other retreatment New & Relapses Pe rc en ta ge 0 20 40 60 80 100 20102008200620042002 Defaulted Lost to follow upFailed Died Success 0 20 40 60 80 20102008200620042002 0 500 1000 1500 Retreatment UnknownNew Total number of MDR TB Pe rc en ta ge No . o f c as es 0 5000 10000 15000 20000 25000 30000 0 20 40 60 80 100 201120102009200820072006 Proportion of HIV positive TB cases among tested HIV testing coverage All TB cases Pe rc en ta ge No . o f c as es New TB cases - notification rates by age group, 2002–2011Tuberculosis notification rates by treatment history, 2002–2011 Tuberculosis cases by geographical origin, 2002–2011 MDR-TB cases by previous treatment history, 2002–2011 Treatment outcome, new pulmonary smear-positive cases, 2002–2010 TB-HIV co-infection, 2006–2011 0 5000 10000 15000 20000 25000 20102008200620042002 No . o f c as es UnknownForeign citizenNative Population estimate 2011 by UN Statistical Database: 27 760 267 Tuberculosis case notifications, 2011 Total number of cases 15 913 Notification rate per 100 000 57.3 New & relapses (lab+) number 14 501 New & relapses (lab+) notification rate per 100 000 52.2 Pulmonary 11 824 (74.3%) of which smear-positive 5 076 (42.9%) Laboratory-confirmed pulmonary TB cases 5 997 (50.7%) Mean age of new TB cases, nationals 38.1 years Mean age of new TB cases, non-nationals - Foreign origin of all TB cases 24 (0.2%) New (not previously treated) 13 995 (87.9%) Drug resistance surveillance & TB-HIV co-infection, 2011 Completeness of DRS data* No Completeness of HIV data** Yes Case-linked data reporting Yes Cases with DST results 2 217 (50.0%) Cases resistant to isoniazid 1 652 (74.5%) Cases resistant to rifampicin 1 408 (63.5%) Estimated MDR N, (best-low-high) 3 000-2 700-3 400 MDR cases 1 385 (62.5%) of which XDR cases 12 (0.9%) Cases resistant to ethambutol - - Cases resistant to streptomycin - - TB cases tested for HIV 15 913 (100.0%) HIV-positive TB cases 546 (3.4%) * National coverage 100% or culturing 90%, C+/All TB cases 50%, DST done for C+ 75%, EQA 95% ** More than 50% of TB cases tested for HIV. Treatment outcome monitoring, 2010 Geographical coverage National Outcome cohort New pulmonary culture positive Case-linked data reporting Yes Notified in 2010 4 711 Success 3 819 (81.1%) Died 272 (5.8%) Failed 276 (5.9%) Defaulted 215 (4.6%) Still on treatment - - Lost to follow up 129 (2.7%)

211 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT 7. Annexes

213 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Annex 1: Tuberculosis surveillance system overview, 2012 Country Data source Legal charactera Compre- hensive- nessb Typec Coveraged Data used: EuroTB aggregated data EuroTB case-based datae TESSy case-based dataf Austria AT-TUBERKULOSEGESETZ Cp Co C Y - - 1985–2011 Belgium BE-TUBERCULOSIS Cp Co C Y - 1995–2004 2005–2011 Bulgaria BG-MOH Cp Co C - 1995–2006 - 2007–2011 Cyprus CY-NOTIFIED_DISEASES Cp Co C Y 1995–2001 2002–2004 2005–2011 Czech Republic CZ-TUBERCULOSIS Cp Co C Y - 1995–2004 2005–2011 Denmark DK-EuroTB_Historical Cp Co C Y - 1995–2004 2005–2011 Estonia EE-TBC Cp Co C Y - 1995–2004 2005–2011 Finland FI-NIDR Cp Co C Y - - 1980–2011 France FR-MANDATORY_INFECTIOUS_DISEASES Cp Co C Y - 1995–1999 2000–2011 Germany DE-SURVNET@RKI-7.1/4 Cp Co C Y 1995–2000 2001–2004 2005–2011 Greece GR-NOTIFIABLE_DISEASES Cp Co C Y 1995–2001 2002–2004 2006–2011 Hungary HU-TUBERCULOSIS Cp Co C Y 1995–1998 1999–2004 2005–2011 Iceland IS-TUBERCULOSIS Cp Co C Y - 1995–2004 2005–2011 Ireland IE-TB Cp Co C Y 1995–1997 1998–2004 2005–2011 Italy IT-NRS Cp O C Y - 1995–2004 2005–2011 Latvia LV-TB Cp Co C Y 1995–2000 2001–2004 2005–2011 Liechtenstein - - - - - - - - Lithuania LT-TB_REGISTER Cp Co C - 1995–2002 2003, 2004 2005–2011 Luxembourg LU-SYSTEM0 Cp Co C Y - 1995–2006 2007–2011 Malta MT-DISEASE_SURVEILLANCE Cp Co C Y - 1995–2004 2005–2011 Netherlands NL-NTR Cp Co C Y - 1995–2004 2005–2011 Norway NO-MSIS_A Cp Co C Y - 1995–2005 2006–2011 Poland PL_CR Cp Co C Y 1995–1999 2000–2005 2006–2011 Portugal PT-TUBERCULOSIS Cp Co C Y 1995–1999 2000–2005 2006–2011 Romania RO-EuroTB_Historical Cp Co C Y - 1995–2004 2005–2011 Slovakia SK-NRT Cp Co C Y 1995 1996–2004 2005–2011 Slovenia SI-TUBERCULOSIS Cp Co C Y - 1995–2004 2005–2011 Spain ES-STATUTORY_DISEASES Cp Co C Y 1995–2006 - 2007–2011 Sweden SE-SweTBReg Cp Co C Y - 1995–2006 2007–2011 United Kingdom UK-TUBERCULOSIS Cp Co C Y 1995–1997 1998 1999–2011 a Legal: compulsory reporting - Cp b Comprehensiveness: comprehensive - Co, Sentinel - Se, Other - O c Type: case based - C, unknown - U d Coverage: national - Y. Not specified in TESSy “-” e Data uploaded to TESSy in 2010, not updated later. f TME data for DST analysis of France, Spain and Italy and aggregated HIV data for France, Latvia, the Netherlands and Poland 214 SURVEILLANCE REPORTTuberculosis surveillance and monitoring in Europe 2013 Annex 2: List of TESSy variables for 2012 TB data collectiona List Description Common set of variables 1 RecordId Unique identifier for each record generated by the national surveillance system 2 RecordType Structure and format of the data 3 RecordTypeVersion Indicates which version the sender uses when generating the data for upload 4 Subject Disease to report 5 Status Status of reporting NEW/UPDATE or DELETE (inactivate) 6 DataSource The data source (surveillance system) that the record originates from. 7 ReportingCountry The country reporting the record. 8 PlaceOfNotificationb Place of the first notification of the case to a regional authority. 9 PlaceOfResidenceb Place of residence of patient at the time of disease onset. 10 Age Age of patient in years as reported in the national system. 11 Gender Gender of the reported case. 12 Outcomec Information on whether the case is alive or deceased. (Not applicable for TB. Use DiagnosedAnteMortem instead). 13 DateOfOnsetb Date of onset of disease. (Optional for TB. Not reflected on reports.) 14 DateOfDiagnosis First date of clinical or lab diagnosis. 15 DateOfNotification Date when the case is first reported to public health authorities. 16 DateUsedForStatistics The reference date used for standard reports. Usually date of notification or date of diagnosis. 17 Classification Case classification according to EU case definition. 18 LaboratoryResult Laboratory criteria used to classify a case as confirmed or probable. 19 EpiLinked (OP) The criteria for an epidemiological link in the case definition is met. Not analysed for TB. Disease-specific variables 20 BornReportingCountry The patient was born in the country of report. 21 CountryOfBirth Country of birth of patient. 22 CountryOfNationality Country of nationality of patient. 23 NationalityReportingCountry Origin of the patient (based on citizenship). 24 MajorSiteOfTB Major site of the disease. 25 MinorSiteOfTB Minor site of the disease. 26 PrevDiagnosis Previous diagnosis of tuberculosis in the past. 27 PrevDiagnosisYear Year of previous diagnosis. 28 PrevTreatment Previous anti-TB drug treatment (at least one month of drug combination). 29 PrevTreatmentCompletion Completion of the previous anti-tuberculosis drug treatment. 30 DiagnosedAnteMortem Vital status of the patient at the time of diagnosis. Was TB diagnosed ante-mortem? 31 Outcome12Months Patient first outcome at 12 months from the start of the treatment. 32 Outcome24Months The first outcome observed 13 to 24 months from the start of treatment. 33 Outcome36Months The first outcome observed 25 to 36 months from the start of treatment. 34 ResultCulture The result of the culture test for M. tuberculosis complex. 35 ResultMicroscopy The result of the microscopy test performed. 36 ResultOtherTest Additional lab test results. 37 Pathogen Species and gene (M. tuberculosis complex) of the pathogen which is the cause of the reported disease. 38 HIVStatus Result of the last HIV test. 39 SIR_AMK Susceptibility to Amikacin (without Intermediate) 40 SIR_CAP Susceptibility to Capreomycin (without Intermediate) 41 SIR_CIP Susceptibility to Ciprofloxacin (without Intermediate) 42 SIR_ETH Susceptibility to Ethambutol. 43 SIR_INH Susceptibility to Isoniazid. 44 SIR_KAN Susceptibility to Kanamycin. 45 SIR_OFX Susceptibility to Ofloxacin. 46 SIR_RIF Susceptibility to Rifampicin. 47 SIR_STR Susceptibility to Streptomycin. 48 IsolateID Unique identifier for each isolate within the data source / lab system related to the case. 49 ECDCIsolateID Identifier for each isolate record that is guaranteed to be unique across countries/labs/pathogens and not contain additional encoded information. 50 SpoligoCode Spoligo pattern code. 51 RflpCode National cluster code based on IS6110 RFLP. 52 MiruCode MIRU pattern code. 51 RflpCode National cluster code based on IS6110 RFLP. 53 BeijingGenotype Beijing genotype identification. a Notification of TB cases for 2011, treatment outcome data updated for cohort 2010 and MDR-TB treatment outcome data updated for cohort 2009 b Optional for TB reporting c Not applicable for TB, use variable DiagnosedAnteMortem instead 215 Tuberculosis surveillance and monitoring in Europe 2013SURVEILLANCE REPORT Annex 3: Reporting completeness by TESSy variable Variable (for description, see Annex 2) 2010 2011 Number of reporting countries Completeness (%) Minimum (%) Maximum (%) Number of reporting countries Completeness (%) Minimum (%) Maximum (%) DateUsedForStatistics 29 (100.0) (100.0) (100.0) 29 (100.0) (100.0) (100.0) Classification 29 (100.0) (99.4) (100.0) 29 (100.0) (55.6) (100.0) Age 29 (99.9) (95.1) (100.0) 29 (99.9) (99.1) (100.0) Gender 29 (99.9) (99.5) (100.0) 29 (99.9) (99.2) (100.0) NationalityReportingCountry 5 (100.0) (100.0) (100.0) 5 (99.9) (99.0) (100.0) MajorSiteOfTB 29 (99.7) (80.9) (100.0) 29 (99.6) (75.4) (100.0) MinorSiteOfTB 25 - - - 26 - - - BornReportingCountry 24 (97.8) (92.5) (100.0) 24 (97.5) (86.6) (100.0) CountryOfNationality 5 (99.4) (96.1) (100.0) 5 (96.3) (99.6) (100.0) CountryOfBirth 24 (84.3) (25.0) (100.0) 24 (95.6) (83.5) (100.0) LaboratoryResult 29 (93.8) (53.1) (100.0) 29 (94.3) (72.7) (100.0) PrevDiagnosis 29 (88.8) (6.2) (100.0) 29 (92.6) (7.2) (100.0) PrevTreatment 29 (91.2) (11.9) (100.0) 29 (91.0) (5.2) (100.0) DateOfNotification 28 (90.4) (0.0) (100.0) 28 (90.5) (0.0) (100.0) DiagnosedAnteMortem 24 (73.1) (0.0) (100.0) 24 (83.4) (0.8) (100.0) PrevTreatmentCompletion 15 (81.5) (0.0) (100.0) 19 (81.5) (0.0) (100.0) ResultCulture 29 (83.2) (41.3) (100.0) 29 (77.8) (41.5) (100.0) ResultMicroscopy 28 (73.5) (27.0) (100.0) 29 (72.5) (26.3) (100.0) DateOfDiagnosis 20 (63.9) (1.1) (100.0) 19 (66.2) (46.3) (100.0) SIR_KAN 13 (60.2) (0.0) (100.0) 13 (66.0) (0.0) (100.0) SIR_OFX 16 (56.0) (0.0) (100.0) 18 (59.8) (0.0) (100.0) PrevDiagnosisYear 20 (60.0) (33.3) (100.0) 21 (57.6) (37.0) (100.0) Pathogen 28 (52.2) (0.2) (89.5) 28 (42.3) (0.6) (94.8) SIR_INH 26 (36.1) (32.8) (90.1) 26 (39.1) (31.4) (94.8) SIR_RIF 26 (36.1) (32.9) (90.1) 26 (39.1) (30.5) (94.8) SIR_AMK 15 (32.3) (0.0) (100.0) 17 (37.9) (0.0) (100.0) SIR_CAP 16 (32.5) (0.0) (100.0) 19 (36.0) (0.0) (100.0) SIR_ETH 26 (28.5) (3.5) (90.1) 26 (31.1) (4.0) (94.8) SIR_STR 26 (24.0) (1.4) (90.1) 26 (27.0) (1.0) (94.8) HIVStatus 14 (23.3) (2.5) (100.0) 16 (26.3) (0.9) (99.9) ResultOtherTest 20 (20.3) (3.5) (100.0) 18 21.7 (3.9) (100.0) SIR_CIP 4 (9.9) (0.0) (44.4) 6 (12.9) (0.0) (100.0) IsolateID 3 (0.1) (0.0) (91.7) 4 (1.1) (0.0) (86.3) ECDCIsolateID 0 - - - - - - - RflpCode 4 (1.2) (0.0) (100.0) 4 (1.0) (0.0) (100.0) MiruCode 5 (8.8) (0.0) (100.0) 6 (0.5) (0.0) (91.7) SpoligoCode 2 (0.1) (2.2) (2.5) 1 (0.03) (1.80) (1.80) BeijingGenotype 4 (0.1) (0.0) (4.6) 5 (0.0) (81.4) (81.4) Outcome12Monthsa 24 (74.9) (43.0) (100.0) 25 (77.7) (3.4) (100.0) Outcome24Monthsb 17 (41.4) (0.0) (100.0) 19 (39.4) (0.0) (100.0) Outcome36Monthsc 5 (50.0) (0.0) (100.0) 0 - - - a Data for 2009/2010 cohort b Data for 2008/2009 cohort c Data for 2007/2008 cohort

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