Tuberculosis

Tuberculosis (TB) is a serious infectious disease in humans caused by a bacillus called Mycobacterium tuberculosis. It is passed by airborne transmission and typically requires prolonged exposure to an infectious case in a confined space. It also depends on the degree of contagiousness and length of the contact. It is nevertheless less contagious than diseases such as flu.

Although TB is a disease for which effective treatment exists and therefore must be clearly acknowledged to be preventable, inadequate treatment or insufficient compliance may result in failure of cure, early relapse or the development of drug-resistant TB.

In the European Union (EU), the incidence of TB has declined steadily over the past decades but attention shouldn't be wandering. In 2006, a total of 88 113 tuberculosis cases were reported in the 27 EU countries plus the EEA/EFTA countries.

In several countries, the decrease in awareness and reduction of resources and services for TB prevention and control led to the re-emergence of the disease fuelled by the HIV epidemic and the development of strains resistant to the most effective anti-TB drugs.

Therefore, actions need to be taken in order to maintain and enhance the current achievements

A framework action plan to fight Tuberculosis in the EU

In March 2007, the EU Health Commissioner, Markos Kyprianou, called on the European Centre for Disease Prevention and Control (ECDC) to develop a proposal for an action plan to fight tuberculosis (TB) in the EU.

The framework action plan issued by the ECDC on 17th March 2008 is intended to cover essential elements that need to be addressed to control effectively and finally eliminate tuberculosis in the EU.

This framework action plan offers an opportunity to start developing an EU approach to the fight against TB and will have now to be developed in practical actions at national and Community level.

EURO-TB and ECDC

Tuberculosis has been considered a priority issue in the EU since many years; it has been included in the list of priority diseases to be placed progressively under EU-wide surveillance under Decision 2000/96/CE. To reach this objective a specific surveillance network for tuberculosis was created in 1996 co-funded by the European Commission and the Institute de veille sanitaire (France).

During the last ten years Euro-TB has been co-ordinating and strengthening the surveillance of tuberculosis in the 53 countries of the WHO European Region.

Euro-TB has been working in close cooperation with WHO Europe and was a WHO Collaborating Centre for tuberculosis. Such collaboration helped to improve the international surveillance and to avoid duplication of notifications from the countries.

According to the remit of the ECDC, Euro-TB activities have been transferred to ECDC at the end of 2007. From 2008 onwards ECDC and WHO Regional Office for Europe will work in collaboration on the coordination and further implementation of TB surveillance in the WHO European Region.

This strengthened collaboration between ECDC, WHO Europe, the 53 Member States in the WHO European Region (27 EU and 3 EEA/EFTA), neighbouring countries and the Commission will for sure contribute to better results.

Expected results in 2008

The following actions, based on the goals and aims described in the ECDC framework action plan, are expected for 2008:

• EuroTB activities fully transferred to the ECDC and WHO/EURO for the surveillance of TB.
• The framework TB Action Plan will be made available
• Development of a framework for national plans and indicators for monitoring progress
• Analysis of the situation on TB reference laboratories in the EU finalised
• Analysis of the situation on screening policies on migrants in the EU finalised.
• Standard Operating Procedures on contact investigations of TB transmission will be drafted
• Country visits to some EU Member States with high incidence of TB in order to assess their situation and identify priorities where EU institutions and other partners can provide support.

Research

The European Commission has a regulatory role and is responsible for supporting countries in areas of management. These are not limited to the health area but span other important policy areas (e.g. research, social or economic) which should be involved in order to be successful in the control and final elimination of tuberculosis.

As an example, the Framework Programme of the European Community (EC) for research and technological development provides support for projects in the field of tuberculosis research between EU research teams and those from international partner countries including Eastern European and Central Asian countries.

The global fund to fight aids, tuberculosis and malaria

The progress towards elimination of TB is only achievable if the global burden can be decreased. Cooperation with key partners and with countries beyond the EU is vital and therefore strategies developed within and outside the EU should be complementary.

The Commission, together with the EU Member States, account for over half of the total financial contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria which was created in 2002 to increase resources to fight three of the world's most devastating diseases, and to direct those resources to areas of greatest need.