Tuberculosis surveillance and monitoring in Europe

Transcription

1 Tuerculosis surveillnce nd monitoring in Europe 219 dt

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3 Tuerculosis surveillnce nd monitoring in Europe 219 dt

4 Astrct With just over 28 tuerculosis (TB) cses reported in, TB remins mjor pulic helth prolem in the WHO Europen Region, including the countries of the Europen Union/Europen Economic Are (EU/EEA). This report provides n overview of the ltest TB epidemiologicl sitution nd is pulished jointly y the WHO Regionl Office for Europe nd the Europen Centre for Disese Prevention nd Control (ECDC). It finds tht epidemic ptterns nd trends vry widely, with the EU/EEA pproching the low incidence level of 1 per 1 popultion while the Region hs nine out of 3 countries with the highest multidrug-resistnt TB urden in the world. Overll, TB mortlity nd incidence rtes hve fllen. Despite the notle progress chieved in the fight ginst TB, countries still fce vriety of chllenges in reching the gol to end the TB epidemic in the Region. Keywords TUBERCULOSIS EPIDEMIOLOGY TB EPIDEMIOLOGY TB SURVEILLANCE World Helth Orgniztion 219 All rights reserved. Upon request to the World Helth Orgniztion Regionl Office for Europe, the right to trnslte or reproduce this puliction, in prt or in full, my e grnted. The designtions employed nd the presenttion of the mteril in this puliction do not imply the expression of ny opinion whtsoever on the prt of the World Helth Orgniztion concerning the legl sttus of ny country, territory, city or re or of its uthorities, or concerning the delimittion of its frontiers or oundries. Dotted lines on mps represent pproximte orderlines for which there my not yet e full greement. The mention of specific compnies or of certin mnufcturers products does not imply tht they re endorsed or recommended y the World Helth Orgniztion in preference to others of similr nture tht re not mentioned. Errors nd omissions excepted, the nmes of proprietry products re distinguished y initil cpitl letters. All resonle precutions hve een tken y the World Helth Orgniztion to verify the informtion contined in this puliction. However, the pulished mteril is eing distriuted without wrrnty of ny kind, either express or implied. The responsiility for the interprettion nd use of the mteril lies with the reder. In no event shll the World Helth Orgniztion e lile for dmges rising from its use. The views expressed y uthors, editors, or expert groups do not necessrily represent the decisions or the stted policy of the World Helth Orgniztion. The WHO Regionl Office for Europe is responsile for the ccurcy of the trnsltion of the Russin summry. Europen Centre for Disese Prevention nd Control, 219 Reproduction is uthorised, provided the source is cknowledged. This puliction follows WHO terminologicl prctice. The nmes nd designtions of countries used in this puliction should not e understood s n endorsement y ECDC of the terminology used in this puliction. The designtions used, nd the presenttion of the mps therein, do not represent ECDC s officil position on the legl sttus of ny country, territory, city or re or of its uthorities, or the delimittion of its frontiers nd oundries. Cover picture: Science Photo Lirry Suggested cittion for full report. WHO Regionl Office for Europe/Europen Centre for Disese Prevention nd Control. dt. Copenhgen: WHO Regionl Office for Europe; 219. Suggested cittion for tles nd figures. WHO Regionl Office for Europe/Europen Centre for Disese Prevention nd Control. Tuerculosis surveillnce nd monitoring in Europe 219 dt. ECDC Pper ISBN ; ISSN ; doi: 1.29/512553; TQ-AO-19-1-EN-C ECDC PDF ISBN ; ISSN ; doi: 1.29/96924; TQ-AO-19-1-EN-N WHO ISBN ISBN Address requests out pulictions of the WHO Regionl Office for Europe to: Pulictions WHO Regionl Office for Europe UN City, Mrmorvej 51 DK-21 Copenhgen Ø, Denmrk Alterntively, complete n online request form for documenttion, helth informtion, or for permission to quote or trnslte, on the Regionl Office wesite ( euro.who.int/purequest).

5 Contents Acknowledgements.... Arevitions.... v vi Executive summry... 1 The WHO Europen Region... 3 Europen Union nd Europen Economic Are countries Min fcts out tuerculosis... 7 References Technicl note Dt reporting nd nlysis Definitions Tles, figures, mps nd country profiles References Commentry The WHO Europen Region Europen Union nd Europen Economic Are countries References Commentry monitoring References Annexes Annex 1. Tuerculosis surveillnce system overview, EU/EEA, Annex 2. List of vriles for tuerculosis dt collection Annex 3. Completeness of reported dt, EU/EEA, reporting yer Annex 4. Reporting completeness into Glol TB dtse, Annex 5. Lortory network cpcity, Europen Region, Tles Trend tles Country profiles iii

6 6. Tles Summry tle. TB surveillnce dt y region, Europen Region, Tle 1. Estimtes of the TB disese urden, Europen Region Tle 2. Estimtes for TB/HIV coinfection nd MDR-TB, Europen Region, Tle 3. TB cses, notifiction rtes per 1 popultion nd men nnul chnge in rtes, Europen Region, Tle 4. New TB cses nd relpses, notifiction rtes per 1 popultion nd men nnul chnge in rtes, Europen Region, Tle 5. TB cses y history of previous TB tretment, Europen Region,... 5 Tle 6. TB cses y site of disese, EU/EEA, Tle 7. New nd relpse pulmonry TB cses y dignostic method, EU/EEA, Tle 7. New nd relpse TB cses y dignostic method, EU/EEA, Tle 7. TB cses y history of previous TB tretment, site of disese nd dignostic method ccording to the WHO definitions, Europen Region, Tle 8. TB cses ccording to EU cse definition, EU/EEA, Tle 9. New TB cses nd relpses, y ge group nd mle-to-femle rtio, Europen Region, Tle 1. TB cses y origin, Europen Region, Tle 11. Drug resistnce surveillnce of cteriologiclly confirmed pulmonry TB cses, Europen Region, Tle 12. Drug resistnce surveillnce of cteriologiclly confirmed pulmonry TB cses y previous TB tretment history, Europen Region,... 6 Tle 13. Drug resistnce in ll lortory-confirmed TB cses, EU/EEA, Tle 14. XDR-TB cses mong ll lortory-confirmed MDR-TB cses, Europen Region, Tle 15. RR/MDR- nd XDR-TB cses enrolled to tretment, Europen Region, Tle 16. New nd relpse TB cses with HIV infection, Europen Region, Tle 16. All TB cses with HIV infection, EU/EEA, Tle 17. TB in prisons, Europen Region, Tle 18. Tretment outcome of ll TB cses notified in 216, Europen Region, Tle 19. Tretment outcome of new TB cses nd relpses notified in 216, Europen Region, Tle 2. Tretment outcome of new nd relpse TB cses in children ( 14 yers) notified in 216, Europen Region,... 7 Tle 21. Tretment outcome of HIV-positive new nd relpse TB cses notified in 216, Europen Region, Tle 22. Tretment outcome fter 24 months of RR/MDR-TB cses strted on second-line tretment in 215, Europen Region, Tle 23. Tretment outcome fter 24 months of lortory-confirmed MDR-TB cses notified in 215, EU/EEA, Tle 24. Tretment outcome fter 24 months of XDR-TB cses strted on second-line tretment in 215, Europen Region, Tle 25. Tretment outcome fter 36 months of XDR-TB notified in 214, EU/EEA, Trend tles Tle I. Estimted TB mortlity per 1 popultion, Europen Region, Tle II. Estimted TB incidence per 1 popultion, Europen Region, Tle III. TB cses in children under 15 yers, Europen Region, Tle IV. TB cses y origin, Europen Region, Tle V. MDR-TB notifiction mong new cteriologiclly confirmed pulmonry TB cses with ville DST results, Europen Region, Tle VI. MDR-TB notifiction mong previously treted cteriologiclly confirmed pulmonry TB cses with ville DST results, Europen Region, Tle VII. MDR-TB notifiction mong ll cteriologiclly confirmed TB cses with ville DST results, Europen Region, 88 Tle VIII. XDR-TB notifiction mong pulmonry MDR-TB cses with second-line DST results, Europen Region, Tle IX. TB cses with HIV infection, Europen Region,... 9 Tle X. Tretment success fter 12 months for new TB cses nd relpses, Europen Region, Tle XI. Tretment success fter 12 months of ll TB cses, Europen Region, Tle XII. Tretment success fter 24 months of RR/MDR-TB cses strted on tretment, Europen Region, Tle XIII. Tretment success fter 24 months of XDR-TB cses strted on tretment, Europen Region, Tle XIV. Tretment success fter 36 months of XDR-TB cses notified in EU/EEA, Tle XV. New nd relpse TB cses tested using WRD such s Xpert MTB/RIF, Europen Region, iv

7 Acknowledgements This report hs een pulished jointly y the WHO Regionl Office for Europe nd the Europen Centre for Disese Prevention nd Control (ECDC). The Regionl Office developed the overview of the Europen Region s whole nd vlidted the figures for the non-europen Union/Europen Economic Are (EU/EEA) countries nd res nd ECDC developed the overview of the EU/EEA countries nd vlidted the EU/EEA figures. Dt collection, vlidtion, nlysis nd overll preprtion of the report ws coordinted y Hnn Merk (ECDC) nd Giorgi Kuchukhidze (consultnt, WHO Regionl Office for Europe). Contriuting uthors: Andrei Ddu, 1 Msoud Dr, 1 Soudeh Ehsni, 1 Ogty Gozlov, 1 Arx Hovnesyn, 1 Cs Ködmön, 2 Brigit Molnrov, 2 Mrtin vn den Boom 1 nd Mrieke J. vn der Werf. 2 1 WHO Regionl Office for Europe. 2 Europen Centre for Disese Prevention nd Control. The report ws sent for consulttion nd review to the opertionl contct points for epidemiology or ntionl focl points for tuerculosis (TB) in the EU/EEA Memer Sttes nd TB surveillnce correspondents in the non-eu/eea Memer Sttes nd res. The entire report is ville online t eu/en/pulictions-dt/tuerculosis-surveillnce-ndmonitoring-europe-219 nd ECDC nd the WHO Regionl Office for Europe would like to thnk the nominted opertionl contct points for TB surveillnce from EU/EEA Memer Sttes nd the TB surveillnce focl points from the non-eu/eea Memer Sttes nd res of the WHO Europen Region for providing dt nd vlule comments on this report: Alni: Donik Mem; Andorr: Clr Plm Jordn; Armeni: Hyk Dvtyn; Austri: Bernhrd Benk; Azerijn: Sevinj Tghiyev; Belrus: Dzmitry Klimuk; Belgium: Mryse Wnlin, Wouter Arrozl de Oñte; Bosni Pvel Slezák; Denmrk: Peter Henrik Andersen; Estoni: Piret Viiklepp; Finlnd: Hnn Soini, Outi Lyytikäinen; Frnce: Jen-Pul Guthmnn; Georgi: Mmuk Chinchruli, Nino Lomtdze; Germny: Nit Peruml, Wlter Hs; Greece: Ourni Klkouni; Hungry: Gor Kovács; Icelnd: Guðrún Sigmundsdóttir, Thorsteinn Blondl; Irelnd: Srh Jckson, Jon O Donnell; Isrel: Yn Levin; Itly: Stefni D Amto; Kzkhstn: Elen Aruzov; Kyrgyzstn: Jekterin Mljukov; Ltvi: Dce Mihlovsk; Liechtenstein: Mrin Jmnicki Aegg; Luxemourg: Pierre Weicherding; Mlt: Anlit Pce Ascik, Tny Melillo; Monco: Jen Lorenzi; Montenegro: North Mcedoni: Mj Zkosk; Norwy: Krin Rønning, Durte; Repulic of Moldov: Andrei Corlotenu; Romni: Domnic Ion Chiotn, Nicolet Vlentin Ciorn; Russin Federtion: Sergey Sterlikov; Seri: Mj Stosic; Slovki: Arce Arnáez, Ros Cno Portero; Sweden: Mri Axelsson, Jerker Jonsson; Switzerlnd: Ekkehrdt Altpeter; Tjikistn: Firuz Shripov; Turkey: Aysegul Yildirim; Turkmenistn: Aisoltn Chryev; Ukrine: Lriss Korinchuk; United Kingdom: Arlene Reynolds, Cthrion Kerns, Colin Cmpell, Eisin McDonld, Grce Smith, Jennifer Dvidson, Jim McMenmin, Lucy Thoms, Meve Llor; Uzekistn: Slihdjn Alimov. Also Kosovo: 1 Xhevt Kurhsni. 1 For the purposes of this puliction, ll references to Kosovo, including in the iliogrphy, should e understood/red s Kosovo (in ccordnce with Security Council resolution 1244 (1999)). v

8 Arevitions AFB ART CISID DRS DST ECDC EEA EQA EU EU/EEA HIV HPCs MDR MDR-TB RR-TB RR/MDR-TB TB TESSy TME TOM WRD XDR XDR-TB cid-fst cilli ntiretrovirl therpy Centrlized Informtion System for Infectious Diseses drug-resistnce surveillnce drug-susceptiility testing Europen Centre for Disese Prevention nd Control Europen Economic Are externl qulity ssessment Europen Union Europen Union/Europen Economic Are humn immunodeficiency virus high-priority countries (Armeni, Azerijn, Belrus, Bulgri, Estoni, Georgi, Kzkhstn, Kyrgyzstn, Ltvi, Lithuni, the Repulic of Moldov, Romni, the Russin Federtion, Tjikistn, Turkey, Turkmenistn, Ukrine nd Uzekistn) multidrug resistnce multidrug-resistnt tuerculosis rifmpicin-resistnt tuerculosis rifmpicin-resistnt nd multidrug-resistnt tuerculosis tuerculosis The Europen Surveillnce System WHO Tuerculosis Monitoring nd Evlution pltform tretment outcome monitoring WHO-recommended rpid dignostics extensive drug resistnce extensively drug-resistnt tuerculosis vi

9 Executive summry 1

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11 Executive summry The WHO Europen Region Despite the notle progress chieved in the fight ginst tuerculosis (TB) in the WHO Europen Region nd the susequent consistent decline in incidence, TB still poses pulic helth thret in most countries nd res within the Region nd should not e underestimted. TB urden The yer sw nother decrese in TB epidemics, with 275 incident TB cses ( ) estimted in the WHO Europen Region, corresponding to 3 cses (26 34) per 1 popultion. The verge nnul decline in the TB incidence rte ws 4.7% during the period 28 nd etween nd, which is the fstest decline mong ll WHO regions, ut still not enough to chieve the End TB Strtegy milestones. There were n estimted 24 TB deths in mong humn immunodeficiency virus (HIV)-negtive people in the Europen Region, n lmost 6% decrese since 28 nd equivlent to 2.6 deths per 1 popultion (rnge ). With decline of 1.2% on verge per yer during the lst five yers, this rte is notly higher thn the glol verge (3% etween ). In, there were n estimted 77 cses of rifmpicinresistnt nd multidrug-resistnt TB (RR/MDR-TB) mong notified pulmonry cses in the Region. This represents out 23% of the 33 glol RR/MDR-TB urden in the sme cohort. The proportion of RR/MDR-TB mong new nd previously treted TB cses in the Region lso exceeds the glol verge significntly, with 17% in new nd 53% in previously treted cses compred to 3.5% nd 18% respectively. HIV prevlence in incident TB cses ws estimted to e 12% in, mrking the first yer of hlted growth fter n unprecedented increse from 3% to 12% during There were 34 HIV-positive TB cses estimted in the Region, with the Russin Federtion (55%) nd Ukrine (24%) contriuting to the highest urden of coinfection. TB disese notifiction nd tretment outcomes Overll, 21% decrese ws oserved in the notifiction rtes of new TB cses nd relpses during (incident TB cses), from 32.9 to 25.9 cses per 1 popultion. In, incident TB cses were notified, mounting to 88% of the estimted new nd relpse cses in the Region. The percentge of newly notified TB ptients tested using WHO-recommended rpid dignostic tests incresed from 21.6% in 215 to 5.9% in, overchieving the trget of 3% in the Tuerculosis ction pln for the WHO Europen Region A totl of (83%) pulmonry cses were notified mong incident TB cses, of which 65% were lortory confirmed, mrking nother yer of increse in lortory confirmtion of TB dignosis, strting with 57.1% in. Among cteriologiclly confirmed pulmonry TB cses, 81% were tested for first-line drug susceptiility (DST), decresed rtio compred to the previous yer (85.6% in 216). Overll, 27.9% of pulmonry TB cses tested for drug susceptiility hd MDR-TB. Prevlence of MDR-TB mong new nd previously treted cteriologiclly confirmed pulmonry TB cses ws 18.1% nd 47.9% respectively, in line with the trend oserved during the lst five yers. Extensively drug-resistnt TB (XDR-TB) shows n incresing trend, with 91.3% second-line DST coverge; 18.6% of pulmonry MDR-TB cses hd XDR-TB in. In solute numers, XDR-TB cses mong pulmonry TB cses incresed from 575 in to 5591 in. Of the new nd relpse TB ptients notified from countries nd res reporting HIV testing dt, 91.4% were screened for HIV. A totl of TB cses were detected with HIV-positive sttus, which is 12.8% of those tested, slight decrese compred to lst yer (13.4% in 216) nd in line with the tendency oserved in coinfection estimtions. A totl of (66.6%) of HIV-positive cses re reported to hve received ntiretrovirl therpy (ART). ART coverge showed n incresing trend over the lst five yers ut is still fr elow the WHO trget of universl ART coverge for TB/HIV coinfected ptients. Despite universl tretment coverge for TB nd RR/MDR-TB ptients, the tretment success rte in the Region remins elow the 85% nd 75% regionl trgets respectively. Compring dt collected in 216 to 218, however, slow ut sustinle increse is documented in oth incident TB nd RR/MDR-TB cohorts, from 75.8% to 77.2% nd 48.7% to 57.2% respectively. Europen Union nd Europen Economic Are countries Epidemiology In, cses of TB were reported in the 31 Europen Union nd Europen Economic Are (EU/EEA) countries, resulting in notifiction rte of 1.7 per 1 popultion in the EU/EEA. The overll notifiction rte nd the rte in most countries hs een decresing over the lst five yers. 3

12 Of ll notified TB cses, (72.1%) were newly dignosed nd 37 7 (68.1%) were confirmed y culture, or smer nd nucleic cid mplifiction test. Overll, dult ge groups hd higher new nd relpse TB notifiction rte thn children under 15 yers. Children under 15 yers ccounted for 4.4% of ll new nd relpse TB cses, corresponding to notifiction rte of 2.9 per 1 popultion. The highest rtes mong 4-yer-olds were noted in Bulgri nd Romni. For every femle new nd relpsed cse of TB in the EU/EEA, lmost two mle new nd relpsed cses were reported. Thirty-three per cent of ll TB cses reported in the EU/EEA were of foreign origin, ut 2% or less of TB cses from countries with TB notifiction rtes higher thn 1 per 1 popultion were reported s eing of foreign origin. MDR-TB ws reported for 141 (3.8%) of cses with the relevnt DST results nd continues to e highest (more thn 1%) in the three Bltic Sttes. XDR-TB ws reported for 24.3% of 77 MDR-TB cses tested for second-line drug susceptiility. After remining t.3 per 1 popultion from to 216, the rte of notified MDR-TB cses decresed to.2 in. During the sme period, the proportion of resistnce to second-line nti-tb drugs incresed mong pulmonry MDR-TB cses. It should e noted, however, tht in excess of 45% of these pulmonry XDR-TB cses were reported from Lithuni nd Romni in those yers. Although the numer of countries reporting dt on HIV coinfection incresed from 216 to, the dt remin incomplete. Of ll TB cses with reported HIV sttus, 3.9% were coinfected with the virus. TB in prisons remins poorly reported. For the 15 EU/EEA countries reporting dt, the notifiction rte mounted to 155 new nd relpse TB cses per 1 inmtes, tht is, reltive risk of 11.4 compred to the generl popultion in the sme countries. Tretment monitoring Of ll TB cses notified in 216 with tretment outcome reported in, 7.7% were treted successfully nd 7.3% died. Of 1217 MDR-TB cses notified in 215 with tretment outcome reported in, 44.8% were treted successfully nd 16.2% died. 4

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15 1. Min fcts out tuerculosis 7

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17 1. Min fcts out tuerculosis Tuerculosis (TB) is n infectious disese cused y group of Mycocterium species clled the Mycocterium tuerculosis complex (1). Although TB typiclly ffects the lungs (pulmonry TB), it cn cuse disese in ny orgn (extrpulmonry TB). TB is trnsmitted from person to person, for exmple, when people with pulmonry TB expel cteri y coughing. M. tuerculosis will develop TB disese during their lifetime, ut the risk is much higher mong immunocompromised individuls (such s people infected with the humn immunodeficiency virus (HIV)). Sputum-smer microscopy hs een the most common initil TB dignostic method worldwide, ut culture remins the gold stndrd, while the use of rpid moleculr testing is incresing. Stndrd tretment of non-resistnt TB consists of sixmonth regimen of four first-line drugs (isonizid, rifmpicin, ethmutol nd pyrzinmide), with success rtes usully ove 8% (2). Multidrug-resistnt (MDR) nd extensively drug-resistnt (XDR) TB require longer tretments with more drugs nd re ssocited with lower success rtes. WHO estimted tht 1 million people fell ill with TB in. Most cses were estimted to occur in the WHO South-Est Asi Region (44%), the WHO Africn Region (25%) nd the WHO Western Pcific Region (18%). Smller proportions of cses were estimted for the WHO Estern Mediterrnen Region (7.7%) nd the WHO Region of the Americs (2.8%). The WHO Europen Region ccounted for 2.7% of ll cses (2). Overll, this report shows tht in the Europen Union nd Europen Economic Are (EU/EEA), TB remins pulic helth issue. Most EU/EEA countries, however, re lowincidence countries ( notifiction rte elow 1 per 1 ) in which TB predominntly ffects vulnerle popultions, such s migrnts, prison inmtes or people coinfected with HIV. The overll im of TB surveillnce is to help inform pulic helth ction. The nnul TB surveillnce nd monitoring report presents key figures nd trends nd provides n overview of the TB sitution in the EU/EEA nd the WHO Europen Region. References 1. Lwn SD, Zuml AI. Tuerculosis. Lncet 211;378(9785): Glol tuerculosis report 218. Genev: World Helth Orgniztion; 218 ( hndle/1665/274453/ eng.pdf?u=1). 9

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21 Technicl note Between 1996 nd 27, TB surveillnce dt from the Europen Region were collected nd nlyzed nnully under the EuroTB project. Since 1 Jnury 28, the Europen Centre for Disese Prevention nd Control (ECDC) nd the WHO Regionl Office for Europe hve jointly coordinted the collection nd nlysis of TB surveillnce dt in Europe, iming to ensure dt stndrdiztion nd high qulity cross the WHO Europen Region. The underlying stndrds nd definitions hve een greed y leding Europen experts. The definitions used in this report re in line with the ltest WHO revised definitions (1). In the EU/EEA the reporting follows the EU cse definitions (2). The report covers the 53 countries of the WHO Europen Region nd Liechtenstein. These re collectively referred to s the Europen Region. Dt pulished in the report my differ from figures in ntionl reports due to vritions in reporting periods nd the dedlines for dt collection. The dedline for updting the dt used in this report ws 5 Octoer 218. Dt reporting nd nlysis Designted experts within ntionl surveillnce institutes sumitted their TB surveillnce nd control progrmme mngement dt for electroniclly to the ECDC WHO Regionl Office for Europe Joint TB Informtion System vi common portl. 1 TB surveillnce dt from the EU/EEA countries nd Switzerlnd, strting, were redirected to The Europen Surveillnce System (TESSy) pltform hosted y ECDC (Annex 1). Surveillnce dt from non-eu/eea countries nd res nd progrmme mngement dt from the entire Europen Region were processed through WHO s Tuerculosis Monitoring nd Evlution (TME) pltform in ggregted formt. All 31 EU/EEA Memer Sttes reported cse-sed dt. All countries in the Europen Region were lso sked to provide updtes for 214, 215 nd 216 to llow for the exclusion of duplicte cses, or those found lter not to hve TB, nd for the reporting of tretment outcomes in previously notified cses. The TESSy vrile list for collection of the dt (Annex 2) hs undergone some chnges compred to the previous yer. The following vriles hve een removed: Clssifiction, Lortory result, SIR_CIP (susceptiility to ciprofloxcin), nd RflpCode (restriction frgment length polymorphism code). The following vriles hve een dded: SIR_PZA (susceptiility to pyrzinmide) nd DteOfEntryToCountry. In ddition, the vlue MCAPRAE (Mycocterium cpre) hs een dded to the vrile Pthogen. Reporting completeness (Annexes 3 nd 4) vried mong countries nd res due to differences in legisltion, specifics of ntionl surveillnce systems nd TB cse scertinment. Although the qulity nd comprility of reported dt hve improved in recent yers, reders should e cutious when mking comprisons cross countries. Reporting completeness in the EU/EEA is generlly high, with few exceptions, such s HIV sttus nd drug-susceptiility testing (DST) dt, nonetheless reders should e cutious when mking comprisons cross countries. Estimtes of TB disese urden presented in Tles 1, 2, I nd II re provided y WHO using methodology developed y the Glol Tsk Force on TB Impct Mesurement. Estimtes re updted nnully using the ltest ville dt nd nlyticl methods (3). Popultion denomintors were otined from United Ntions Popultion Division sttistics (4) for the clcultion of rtes in these tles. For the clcultion of notifiction rtes, country totl popultion denomintors y ge group nd gender were otined from Eurostt (5) (2 April 218) for the EU/EEA countries nd from United Ntions Popultion Division sttistics for ll other countries nd res. Reported dt were nlysed using the min epidemiologicl (time, plce, gender, ge, ptient origin) nd cse mngement (history of previous nti-tb tretment, locliztion of disese, lortory results, HIV sttus nd tretment outcome) vriles. Associtions etween vriles were, if indicted, quntified s risk rtios nd their 95% confidence intervls, nd results were considered significnt if the confidence intervl did not include 1. TB/HIV coinfection Cse-sed HIV sttus for ws reported y Belgium, Bulgri, Croti, Cyprus, the Czech Repulic, Denmrk, Estoni, Greece, Hungry, Icelnd, Irelnd, Ltvi, Lithuni, Luxemourg, Mlt, the Netherlnds, Norwy, Portugl, Romni, Slovki, Sloveni, Spin nd the United Kingdom. The proportion of HIV/TB coinfection ws expressed s percentge of reported TB cses with known HIV sttus. HIV sttus hd to e ville for more thn 5% of ll TB cses to e considered complete in the country profiles. For the reported new nd relpse TB cses with known HIV sttus in, strt or continution on ntiretrovirl therpy (ART) ws reported y 1 EU/EEA Memer Sttes. 1 ECDC/WHO Europe Joint Surveillnce cn e ccessed t: 13

22 Lortory network performnce nd drug resistnce Results of DST from initil isoltes of M. tuerculosis hve een collected for isonizid nd rifmpicin since the reporting yer EU/EEA countries hve lso reported susceptiility to ethmutol nd streptomycin, with lmost 7% of EU/EEA countries reporting the ltter for the lst five yers ( ). Dt on second-line drug resistnce to mikcin, cpreomycin, knmycin, ciprofloxcin nd ofloxcin hve een reported vi TESSy since 28 nd vi the Centrlized Informtion System for Infectious Diseses (CISID)/TME since 29. Dt on ciprofloxcin re no longer collected in TESSy (since ), s ciprofloxcin is no longer recommended for tretment of drugsusceptile or drug-resistnt TB. Dt on resistnce to gtifloxcin, levofloxcin nd moxifloxcin were dded in, edquiline nd delmnid in 216, nd pyrzinmide in. Cse-sed informtion on DST is collected in countries/res where DST results re linked to TB cse notifictions (29 countries in ). Where individul DST dt re not ville, dt hve een otined from TME in ggregted formt, when possile nd deemed dequte. Informtion on the orgniztion nd lortory prctices for nti-tb DST in the country/re is collected using the TME module of the joint TB surveillnce system. Drugresistnce surveillnce (DRS) methods vry cross countries nd res. Initil DST results my e collected routinely for ll culture-positive TB cses notified, or only for cses included in specific surveys or dignosed in/referred to selected lortories. DRS dt were considered complete if: they were collected ntionwide; or culture results were ville for 9% or more of ll cses; nd more thn 5% of ll cses were culture-positive; nd more thn 75% of ll culture-positive cses hd DST results ville for isonizid nd rifmpicin; nd t lest 95% of the externl qulity ssessment (EQA) results were confirmed y suprntionl reference lortory. DRS dt re considered incomplete for Alni, Andorr, Azerijn, Frnce, Itly, Kzkhstn, Kyrgyzstn, the Repulic of Moldov, Sn Mrino, Turkmenistn nd Uzekistn. EQA systems re essentil for ensuring ccurte dignosis of TB nd drug-resistnt TB. Implementing EQA y orgnizing regulr EQA rounds nd identifying trining needs is one of the key ctivities of the Europen TB Reference Lortory Network (ERLTB-Net) (6). The EQA test results for re pulished in Annex 5. s of lortory-confirmed drug-resistnt cses were clculted using cses with known DST results (for t lest isonizid nd rifmpicin) s the denomintor. The results of DST for second-line drugs were nlysed for multidrug-resistnt TB (MDR-TB) cses only. Tretment outcome monitoring Tretment outcome dt hve een provided y EU/EEA countries since the reporting yer 22 through the sumission of n updted dtset for cses notified one yer prior to the yer of reporting. The sme pplies to MDR-TB tretment outcome for cses reported two yers erlier nd extensively drug-resistnt TB (XDR-TB) tretment outcome for cses reported three yers erlier. As prt of the 218 dt cll, for dt, outcome dt were collected for TB cses reported in 216, MDR-TB cses in 215 nd XDR-TB cses in 214. Non-EU/EEA countries nd res hve reported ggregted tretment outcome dt following the sme principle since. If enrolment to tretment is tken into ccount for tretment outcome monitoring (TOM) nlysis, two types of TB cses re included: cses enrolled to tretment, nd cses with no indiction of enrolment to tretment. For countries nd res reporting cse-sed dt, the most recently updted informtion ws used. This my result in denomintors differing from the numer of notified cses reported in the previous yer s report. For countries nd res reporting ggregte outcome dt, completeness of cohorts is ssessed y compring the totl numer of cses included in TOM cohorts with those initilly notified s pulmonry nd culture- or smer-positive, depending on the type of cohort. Geogrphicl res The following 31 EU/EEA countries re presented seprtely in tles nd in Chpter 3: Austri, Belgium, Bulgri, Croti, Cyprus, the Czech Repulic, Denmrk, Estoni, Finlnd, Frnce, Germny, Greece, Hungry, Icelnd, Irelnd, Itly, Ltvi, Liechtenstein, Lithuni, Luxemourg, Mlt, the Netherlnds, Norwy, Polnd, Portugl, Romni, Slovki, Sloveni, Spin, Sweden nd the United Kingdom. The 23 remining (non-eu/eea) countries in the WHO Europen Region re: Alni, Andorr, Armeni, Azerijn, Belrus, Bosni nd Herzegovin, Georgi, Isrel, Kzkhstn, Kyrgyzstn, the Repulic of Moldov, Monco, Montenegro, North Mcedoni, the Russin Federtion, Sn Mrino, Seri, Switzerlnd, Tjikistn, Turkey, Turkmenistn, Ukrine nd Uzekistn. Dt from Seri include TB cses reported from Kosovo, 2 nd these re lso strtified in tles to reflect United Ntions Security Council Resolution 1244 (1999). Dt from the 18 high-priority countries (HPCs) identified in the Pln to stop TB in 18 high-priority countries in the WHO Europen Region, (7) re presented in itlics nd s sutotls longside the sutotls for the EU/EEA countries nd non-eu/eea countries nd res. The 18 HPCs in the WHO Europen Region re: Armeni, Azerijn, Belrus, Bulgri, Estoni, Georgi, Kzkhstn, Kyrgyzstn, Ltvi, Lithuni, the Repulic of Moldov, Romni, the Russin Federtion, Tjikistn, Turkey, Turkmenistn, Ukrine nd Uzekistn. 2 For the purposes of this puliction, ll references to Kosovo, including in the iliogrphy, should e understood/red s Kosovo (in ccordnce with Security Council resolution 1244 (1999)). 14

23 TB notifictions from Frnce include overses territories. TB notifictions from Greenlnd re not included in the report. Definitions TB cse definition for surveillnce Informtion from EU/EEA countries ws collected to enle the clssifiction of cses ccording to the cse definition pproved y EU Memer Sttes nd pulished y the Europen Commission (2). This clssifies cses s possile, prole or confirmed. Possile cses meet clinicl criteri only. Prole cses re defined y the dditionl detection of cid-fst cilli (AFB), M. tuerculosis complex nucleic cid or grnulomt. Confirmed cses require positive culture, or detection of oth AFB y microscopy nd M. tuerculosis complex y nucleic cid mplifiction testing. Dt from ll countries nd res in the Europen Region lso follow the WHO-recommended definitions, revision (1). They define cse of tuerculosis s ptient in whom TB hs een confirmed y cteriology or dignosed y clinicin. A cteriologiclly confirmed TB cse is one from whom iologicl specimen is positive y smer microscopy, culture or WHO-recommended rpid dignostics (WRD) such s Xpert MTB/RIF. A cliniclly dignosed TB cse is one tht does not fulfil the criteri for cteriologicl confirmtion, ut hs een dignosed with ctive TB y clinicin or other medicl prctitioner who hs decided to give the ptient full course of TB tretment. Cses discovered postmortem s hving gross pthologicl findings consistent with ctive TB tht would hve indicted nti-tb tretment, hd the ptient een dignosed efore dying, lso fit the clinicl criteri nd re included. Previous nti-tb tretment sttus New cses hve never een treted for TB or hve tken nti-tb drugs for less thn one month. For EU/EEA countries, cses reported s hving een dignosed efore 1951 re nlysed s new cses. Previously treted ptients hve received one month or more of nti-tb drugs in the pst. They re further clssified y the outcome of their most recent course of tretment s follows: relpse: ptients hve previously een treted for TB, were declred cured or to hve completed their tretment t the end of their most recent course of tretment, nd re now dignosed with recurrent episode of TB (either true relpse or new episode of TB cused y reinfection); tretment fter filure: ptients who hve previously een treted for TB nd whose tretment filed t the end of their most recent course of tretment; tretment fter loss to follow-up: ptients hve previously een treted for TB nd were declred lost to followup t the end of their most recent course of tretment (these were previously clssified s tretment fter defult ); nd other previous tretment: ptients who hve previously een treted for TB ut whose outcome fter their most recent course of tretment is unknown or undocumented. Ptients with unknown previous TB tretment history do not fit ny of the ctegories listed ove. New cses nd relpses of TB re incident TB cses. Site of disese Pulmonry TB refers to ny cteriologiclly confirmed or cliniclly dignosed cse of TB involving the lung prenchym or the trcheoronchil tree (lryngel TB is clssified s pulmonry). A ptient with oth pulmonry nd extrpulmonry TB should e clssified s cse of pulmonry TB. Extrpulmonry TB refers to ny cteriologiclly confirmed or cliniclly dignosed cse of TB involving orgns or ntomicl sites other thn the lungs (such s pleur, lymph nodes, domen, genitourinry trct, skin, joints nd ones, or meninges). Notes on the definition The ove TB cse definition, nd the definition of previous nti-tb tretment sttus nd site of disese, re in ccordnce with the Europen Commission s pproved definitions for TB surveillnce. All possile, prole nd confirmed cses re reported to the joint Europen surveillnce dtse. For countries nd res with lortory-sed reporting where no clinicl informtion is ville, lortory-confirmed cses should e reported. Cses should e notified only once in given 12-month period, ut cse should e reported gin if the dignosis of confirmed TB is mde following completion of nti-tb tretment (relpse), even if this occurs within 12 months of reporting the initil disese episode. Cses tht hve never een treted re commonly referred to s new cses, lthough this term should not e considered to indicte incidence in the strict epidemiologicl sense. Among re-treted cses, relpses re included in notifictions from ll countries, wheres cses re-treted fter filure or loss to follow-up nd chronic cses re not included or further defined y Belgium, Cyprus, Denmrk, Frnce, Luxemourg, Mlt, Norwy, Spin nd the United Kingdom. DST dt were nlysed for lortory-confirmed cses. Origin of cses The geogrphic origin of TB cse is clssified ccording to the plce of irth of person with TB disese (orn in the country/orn outside of the country) for Bulgri, Croti, Cyprus, the Czech Repulic, Denmrk, Estoni, 15

24 Finlnd, Frnce, Germny, Icelnd, Irelnd, Isrel, Itly, Kyrgyzstn, Ltvi, Liechtenstein, Lithuni, Luxemourg, Mlt, the Netherlnds, North Mcedoni, Norwy, Portugl, Romni, Slovki, Sloveni, Spin, Sweden, Switzerlnd, Tjikistn, Turkey, the United Kingdom nd Uzekistn. For Alni, Andorr, Armeni, Austri, Belrus, Belgium, Bosni nd Herzegovin, Georgi, Greece, Hungry, Kzkhstn, the Repulic of Moldov, Montenegro, Polnd, the Russin Federtion, Seri, Turkmenistn nd Ukrine, origin is clssified ccording to citizenship (citizen/ non-citizen). Azerijn, Georgi, Kyrgyzstn, Monco nd Turkmenistn did not report informtion on origin. In Denmrk, the irthplce of the prents is lso used to clssify origin (similrly in the Netherlnds, where for cses orn in the Netherlnds the irthplce of prents is notified for cse mngement purposes). The country of origin is included in cse-sed dt. The term ntive s used in this report refers to cses orn in, or hving the citizenship (ntionlity) of, the reporting country. Foreign origin refers to cses orn in (or citizens of) country different to the reporting country. Drug resistnce Resistnce mong cses never treted (new TB cses) indictes primry drug resistnce due to infection with resistnt cilli. Resistnce mong cses previously treted usully indictes cquired drug resistnce emerging during tretment following selection of drug-resistnt mutnt cilli. It cn lso result from exogenous re-infection with resistnt cilli. Multidrug resistnce (MDR) refers to resistnce to t lest isonizid nd rifmpicin. Extensive drug resistnce (XDR) refers to resistnce to: (i) isonizid nd rifmpicin (tht is, MDR); (ii) fluoroquinolone; nd (iii) one or more of the following injectle drugs: mikcin, cpreomycin or knmycin (1). Rifmpicin resistnce refers to resistnce to rifmpicin detected using phenotypic or genotypic methods, with or without resistnce to other nti-tb drugs. This includes ny resistnce to rifmpicin, whether monoresistnce, multidrug resistnce, polydrug resistnce or extensive drug resistnce. Tretment outcome Cohorts A cohort is defined s ll TB cses notified in the clendr yer of interest, fter exclusion of cses with finl dignosis other thn TB, or cses found to hve een reported more thn once. In ccordnce with the WHO tretment outcome definitions (1), this report distinguishes etween two types of cses: ptients treted for drug-susceptile TB; nd ptients treted for rifmpicin-resistnt TB (RR-TB), tht is, those plced on second-line tretment (defined s comintion chemotherpy for drug-resistnt TB). The two groups re mutully exclusive. Any ptient reported s hving RR-TB is ssumed to e on second-line tretment nd is excluded from the drug-susceptile TB outcome cohort. Period of oservtion All cses re oserved until the first outcome ssessment up to mximum of 12 months fter the strt of tretment. For MDR-TB cses in EU/EEA countries, tretment outcome fter 24 months should e reported if tretment lsts longer thn 12 months nd the reported 12-month outcome is coded s still on tretment. 3 For XDR-TB cses in EU/EEA countries, tretment outcome fter 36 months should e reported if tretment lsts longer thn 24 months nd the reported 12-month nd 24-month outcomes re coded s still on tretment. 4 Non-EU/EEA countries nd res evlute tretment outcomes ccording to the WHO definition. Tretment outcome ctegories All outcome ctegories ut one pply to the entire Region nd follow the WHO recommendtions in Definitions nd reporting frmework for tuerculosis revision (1). The dditionl ctegory still on tretment only pplies to the EU/EEA Memer Sttes. The ctegories re s follows. Cured is pulmonry TB ptient with cteriologiclly confirmed TB t the eginning of tretment who ws smeror culture-negtive in the lst month of tretment nd on t lest one previous occsion. Cured of MDR-TB is tretment completed s recommended under ntionl policy without evidence of filure AND three or more consecutive cultures tken t lest 3 dys prt re negtive fter the intensive phse. Tretment completed is tretment completed ut does not meet the criteri to e clssified s cure or tretment filure. Tretment filed is TB ptient whose sputum smer or culture is positive t month 5 or lter during tretment. Tretment filed for MDR-TB cse is tretment terminted or the need for permnent regimen chnge of t lest two nti-tb drugs ecuse of: lck of conversion y the end of the intensive phse; or cteriologicl reversion in the continution phse fter conversion to negtive; or evidence of dditionl cquired resistnce to fluoroquinolones or second-line injectle drugs; or dverse drug rections. 3 The degree of dherence to the 12-month limit is unknown, nd numer of countries re known to exceed it. 4 The degree of dherence to the 24-month limit is unknown. 16

25 Died is TB ptient who dies for ny reson efore strting, or during the course of, tretment. Lost to follow-up is TB ptient who did not strt tretment or whose tretment ws interrupted for two consecutive months or more (defined in previous reports s defulted ). Still on tretment is: 5 ptient reported s still on tretment t 12 months without ny other outcome during tretment; or ptient reported s still on tretment t 12 months nd still on tretment t 24 months without ny other outcome. Not evluted is TB ptient for whom no tretment outcome is ssigned; this includes cses trnsferred out to nother tretment unit nd cses for whom the tretment outcome is unknown to the reporting unit. In this report, success is the sum of cured nd tretment completed. Tles, figures, mps nd country profiles The report presents two sets of tles towrds the end of the document: trend tles (Tles I XV) dt tles (Summry Tle, Tles 1 25). Also included re series of figures (Fig. 1 5) nd mps. The report ends with series of country profiles summrizing dt t country level. References 1. Definitions nd reporting frmework for tuerculosis revision, updted Decemer 214. Genev: World Helth Orgniztion; 215 ( pulictions/definitions/en/). 2. Europen Union Commission. 218/945: Commission Decision of 22 June 218 on the communicle diseses nd relted specil helth issues to e covered y epidemiologicl surveillnce s well s relevnt cse definitions. OJ L 17, , p Glol tuerculosis report 218. Genev: World Helth Orgniztion; 218:28 ( pulictions/glol_report/en/). 4. World popultion prospects: the revision, medium vrint. In: United Ntions DESA/Popultion Division [wesite]. New York (NY): United Ntions DESA/ Popultion Division; ( wpp/). 5. Eurostt [wesite]. Brussels: Eurostt; 218 ( ec.europ.eu/eurostt/we/min/home). 6. Europen Reference Lortory Network for TB (ERLTB-Net). In: Europen Centre for Disese Prevention nd Control [wesite]. Soln: ECDC; 219 ( europ.eu/en/out-us/prtnerships-nd-networks/ disese-nd-lortory-networks/erlt-net). 7. Pln to stop TB in 18 high-priority countries in the WHO Europen Region, Copenhgen: WHO Regionl Office for Europe; 27 ( who.int/ dt/ssets/pdf_file/5/6818/e9149. pdf). 5 This definition is pplicle to EU/EEA countries only. 17

26

27 3. Commentry

28

29 3. Commentry The WHO Europen Region TB urden estimtes An estimted 275 new nd relpse TB cses (rnge ) occurred in countries nd res of the WHO Europen Region in, equivlent to n verge incidence of 3 cses (26 34) per 1 popultion. This represents out 2.8% of the totl urden of TB in the world. The solute numer of incident TB cses in the WHO Europen Region fell y 15 in compred to the previous yer. Aout 83% of the estimted TB cses in the Region occur in the 18 HPCs, where estimted TB incidence ws 56.3 cses per 1 popultion, which is out four times higher thn the EU/EEA verge. The six countries with the solute numer of incident TB cses over 1 were the Russin Federtion (86 ), Ukrine (37 ), Uzekistn (23 ), Romni (14 ), Turkey (14 ) nd Kzkhstn (12 ). The numer reltive to popultion (incidence rte) ws highest in Kyrgyzstn (144 per 1 popultion), followed y the Repulic of Moldov (95), Georgi (86), Tjikistn (85) nd Ukrine (84). The estimted numer of TB cses in the Region hs een decresing consistently since 2. The verge nnul decline in the TB incidence rte ws 4.7% during the period 28, with 5.2% etween 216 nd, which is notly higher thn the glol rte of decline for TB incidence (1.8%). Yet despite this eing the fstest decline in the world compred to other regions (1), it still needs to ccelerte to chieve the milestone of reducing TB incidence s prt of the End TB Strtegy. It should nevertheless e emphsized tht ll the HPCs in the Region hve lso experienced decline in the TB incidence rte. Those countries with the highest nnul rte of decline during There were n estimted 24 TB deths mong people who were HIV-negtive in the Europen Region in, equivlent to 2.6 deths per 1 popultion (rnge ). Considerle vrition ws seen cross the Region, rnging from less thn one TB deth per 1 popultion in western Europen countries to more thn nine per 1 in HPCs. The TB mortlity rte ws highest in Turkmenistn (9.9 deths per 1 ), followed y Ukrine (8.7) nd Azerijn (8.7). Together, the 18 HPCs ccounted for over 83% of TB deths in the Region. The TB mortlity rte t regionl level fell y 59%, from 6.3 to 2.6 deths per 1 popultion, etween 28 nd (Tle I), which on verge is decline of 9.3% per yer. This decline hs een over 1% nnully in the lst five yers, which is notly higher thn the glol rte of decline for TB mortlity (3.2% etween 216 nd ). An estimted 12.% (rnge 9.1% 16.%) of incident TB cses in were coinfected with HIV (Tle 2). The proportion of TB cses coinfected with HIV ws highest in Ukrine (21.6%), followed y the Russin Federtion (2.9%), Frnce (14.1%) nd Portugl (12.5%). The top five countries with the highest solute numer of TB/HIV coinfection cses were the Russin Federtion (18 ) nd Ukrine (8), mounting to 79% of the totl numer of cses, followed y Uzekistn (12), Frnce (83), Kzkhstn (53), Itly (47) nd the United Kingdom (41). Nine out of the 3 countries with the highest MDR-TB urden in the world re in the WHO Europen Region. 6 There were n estimted 19 (rnge ) incident cses of rifmpicin-resistnt nd multidrugresistnt TB (RR/MDR-TB) in the WHO Europen Region in, with MDR-TB ccounting for 84%. An estimted 17% (95% CI: 16 18%) of new cses nd 53% (95% CI: 46 61%) of previously treted cses hd RR/MDR-TB. If ll notified pulmonry TB ptients were tested for drug resistnce to rifmpicin nd isonizid, it is estimted tht round 77 (rnge ) would e detected. TB notifiction nd trends In, TB cses were reported from 52 countries 7 in the WHO Europen Region, of which were new, relpses or hd n unknown previous tretment history (Tle 4). This represents 84% of ll TB cses notified in. The notifiction rte of new nd relpse cses vries widely mong countries nd res, from zero (Sn Mrino) to 11.6 (Kyrgyzstn) per 1 popultion (Mp 1 nd Tle 4). Thirty-eight countries, ll locted in the western nd centrl prt of the Region nd mostly high-income countries, hd low notifiction of new nd relpse cses (less thn 2 cses per 1 ) in. Six reported new or relpse cse rtes of etween 2 nd 5 per 1 popultion nd nine reported etween 5 nd 1 cses per 1 popultion (the Repulic of Moldov (82.9), Kzkhstn (68.4), Georgi (66.4), Tjikistn (66.1), Romni (62.7), Ukrine (61.6), the Russin Federtion (58.7), Azerijn (53.2) nd Uzekistn (52.8)). The 18 HPCs with new nd relpse cse notifictions ccount for out 83% of the regionl urden. The lrgest proportion of new nd relpse 6 The 1 countries with the highest glol MDR-TB urden (in lpheticl order) re: Azerijn, Belrus, Kzkhstn, Kyrgyzstn, the Repulic of Moldov, the Russin Federtion, Somli, Tjikistn, Ukrine nd Uzekistn. 7 Monco did not report nd Sn Mrino reported zero cses in

30 cses (84 51, or 35.4%) comes from the Russin Federtion, even though the Russin Federtion ccounts for only 16% of the Region s popultion. Most HPCs rtes continue to show decresing trend compred to the previous yer, the exceptions eing Azerijn, Kzkhstn nd Uzekistn. Mp 1. TB notifiction rtes of new TB cses nd relpses per 1 popultion, Europen Region, Not included or not reporting Andorr Liechtenstein Luxemourg Mlt Monco Sn Mrino During the period, n overll downwrd trend of 21.3% ws oserved in the notifiction of incident TB (Tle 4). This trend reflects genuine reduction in the spred of the disese, significntly influenced y the decrese in notifiction rtes throughout the Region s 18 fiction rte of new nd relpse cses in the 18 HPCs is lmost twice s high s for the Region overll (49.1 cses five times higher thn the rte in the EU/EEA (1.2 cses Previous tretment history Previously treted cses represented 1.% nd 31.7% in the EU/EEA nd non-eu/eea respectively in. The verge in the 18 HPCs ws 31.2%, impcting the pn- Europen verge of 27.4%. Previously treted cses ccounted for 15% or more of ll TB cses in 16 countries: Azerijn (45.7%), the Russin Federtion (37.9%), Ukrine (3.7%), the Repulic of Moldov (3.3%), Kzkhstn (27.2%), Kyrgyzstn (26.8%), Georgi (26.1%), Armeni (25.4%), Belrus (25.%), Uzekistn (24.7%), Romni (2.2%), Lithuni (19.5%), Tjikistn (16.7%), Estoni (16.6%), Slovki (16.5%) nd Turkmenistn (15.8%). Resons for the high percentge of previously treted cses include clinicl filure or poor tretment dherence in previous tretment episodes, nd possile re-infection nd misclssifiction during the current tretment episode. Disese locliztion Pulmonry locliztion ws notified in out 83% of the incident TB cses in the Region in (Tle 7). The proportion of ptients with pulmonry locliztion in the non-eu/eea ws slightly higher compred to EU/EEA countries. Extrpulmonry TB ws notified on verge for 17% of ll incident TB cses in the Region. Eight countries reported more thn 3% of their TB cses hving extrpulmonry locliztion: Alni, the Netherlnds, Norwy, Sweden, Tjikistn, Turkey, the United Kingdom nd Uzekistn. Bcteriologicl confirmtion Bcteriologicl confirmtion of TB dignosis ws reported for (64.8%) of ll new nd relpse pulmonry cses in the Region (Tle 7). Testing of cses using WRD (such s Xpert MTB/RIF) ws much lower in EU/EEA countries (25.%) thn in the non-eu/eea countries nd 22

31 Fig. 1. Sn Mrino Andorr Liechtenstein Isrel Icelnd Greece Slovki Finlnd Denmrk Norwy Netherlnds Czech Repulic Sweden Luxemourg Sloveni Cyprus Switzerlnd Irelnd Itly Austri Germny Hungry Frnce United Kingdom Belgium Croti Mlt Spin North Mcedoni Montenegro Estoni Polnd Turkey Seri Portugl Alni Bulgri Bosni nd Herzegovin Ltvi Armeni Belrus Turkmenistn Lithuni Uzekistn Azerijn Russin Federtion Ukrine Romni Tjikistn Georgi Kzkhstn Repulic of Moldov Kyrgyzstn Europen Region Sutotl 18 HPCs Rte per 1 23

32 res (58.3%). The three-yer trend nevertheless shows constnt increse in usge of WRDs in the Region, from 21.6% in 215 to 5.9% in (Tle XV). Testing lso vried considerly mong countries nd res, from.4% to 93.2% in Bulgri nd the Repulic of Moldov respectively. Bcteriologicl confirmtion of new nd relpse pulmonry cses ws elow 6% in five countries, underlining the need to strengthen dignostics: Turkmenistn (46.6%), Uzekistn (51.%), the Russin Federtion (51.9%), Hungry (53.4%) nd Armeni (56.6%). In 34 countries, cteriologicl confirmtion of new nd relpse pulmonry cses ws 75% nd ove. Age nd sex There is wide vrition in the distriution of ge- nd sex-specific notifiction rtes cross countries nd res (Tle 9). Notifiction rtes in estern Europen countries re highest in young dults (25 44 yers) nd susequently decrese, while in the countries of centrl Asi nd in Turkey, the notifiction rtes either increse with ge or re reltively constnt cross dult ge groups. The rte of TB in children under 5 yers in the group of 18 HPCs ws lower thn the notifiction rte mong children ged 5 14, indicting tht detection of TB remins especilly chllenging in young children. In countries with t lest 1 new nd relpse TB cses, the proportion of TB cses notified in children ( 14 yers) vried t country level from elow 1% (Estoni, Belrus, Hungry nd Turkmenistn) to 19.7% (Slovki) of ll new cses nd relpses. The difference in proportions of childhood TB cses cross the countries nd res my reflect differences in cse-finding prctice (such s contct trcing), popultion ge structure nd under-/overdignosis or reporting of childhood TB. The verge percentge of new nd relpse TB ptients under 15 yers in the Region is round 4.%. There were twice s mny mles s femles reported mong ll incident TB cses, ut lrge vrition ws oserved for mle predominnce in the sex distriution of TB cses, rnging from lmost even distriution to over three times greter in Armeni. In most countries nd res, gender differences in notifiction rtes pper to e more significnt mong middle-ged nd older dults. TB rtes in mles nd femles pper to e more similr in children nd younger dults ( 14 nd yers). This gender difference in TB cse notifiction most likely reflects the overrepresenttion of mles in the vrious TB risk groups, notly homeless people, prisoners, sesonl migrnt workers, people living with HIV, men who hve sex with men nd people who inject drugs. Drug resistnce Fifty countries in the Region reported on first-line DST results in. Overll, first-line DST coverge mong cteriologiclly confirmed pulmonry TB cses in the Region ws 81.2%, with 35 countries chieving 85% or higher coverge. Coverge in five countries, however, ws less thn 5%: Tjikistn (21.1%), Bosni nd Herzegovin (26.9%), Alni (37.7%), Kzkhstn (42.1%) nd Seri (45.6%). The percentge of confirmed MDR-TB cses mong new pulmonry TB cses tested for first-line DST in the Region ws 18.1%, which is slightly higher thn the rte oserved in 216 (17.6%) (Mp 2, Fig. 2, Tle 12 nd Tle V). While 16 countries reported no MDR-TB or less thn 1% mong new TB cses, the rte ws over 2% in eight (Tle 12). With the exception of four EU/EEA Memer Sttes, where MDR-TB mong new cses vried from 7.7% in Ltvi to 21.8% in Estoni, the prevlence ws lower thn 5% in ll EU/EEA countries, with n verge of 2.4% (Fig. 3). Three non-eu/eea countries hd n MDR-TB prevlence rnging from 1 19% mong new cses tested for first-line DST: Azerijn (12.8%), Armeni (12.5%) nd Georgi (1.5%). Four hd 2 29% MDR-TB mong new cses: the Russin Federtion (28.2%), the Repulic of Moldov (26.6%), Kyrgyzstn (22.4%) nd Ukrine (21.4%); nd three hd n MDR-TB prevlence over 35%: Tjikistn (83.3%), Belrus (37.2%) nd Kzkhstn (32.9%). It should e noted, though, tht less thn 35% of new cteriologiclly confirmed pulmonry TB cses hd DST results ville in Tjikistn nd Kzkhstn, so the prevlence is overestimted in these countries. The percentge of confirmed MDR-TB cses mong previously treted cteriologiclly confirmed pulmonry TB cses whose isoltes were tested for first-line DST ws 47.9%, which is lower thn the 216 rte (51.9%) (Fig. 2, Tle 12 nd Tle VI). Ten countries hd etween 15% nd 49% MDR-TB mong previously treted TB cses tested for first-line DST. The rte ws even higher in some HPCs: Tjikistn (86.4%), Belrus (65.6%), the Russin Federtion (58.9%), the Repulic of Moldov (54.4%), Lithuni (51.5%), Kyrgyzstn (5.2%) nd Estoni (5.%) (Fig. 4, Tle 12). It should e noted, however, tht only 1 cses in Estoni were reported in solute numers. The rte of MDR-TB notifiction mong new cteriologiclly confirmed pulmonry TB cses with ville DST results t regionl level ws 1.7 per 1 in. This represents n verge nnul decrese of 2.3% etween nd (Tle V). Trends in the MDR percentge mong new cteriologiclly confirmed pulmonry TB cses nd trends in the notifiction rte hve differed significntly y country in recent yers (Tle V). The proportion of MDR mong new pulmonry TB cses decresed slightly in the EU/EEA suregion over the lst five yers, from 2.6% to 2.4%, nd the rte of notified MDR-TB cses remined stle t round.1 cse per 1 popultion. The MDR percentge mong new cteriologiclly confirmed pulmonry TB cses in the non-eu/eea countries nd res incresed from 16.8% in to 18.1% in ut remins stle, rnging within the 2% difference during the lst five yers. Thirty-six countries reported on second-line DST dt in. The Russin Federtion ccounts for more thn hlf of MDR-TB cses notified in the Region. The country hs 24

33 een reporting second-line DST coverge since 216, which sustntilly increses the totl numer of lortoryconfirmed MDR-TB cses nd the numer of cses tested for second-line drug susceptiility. Most countries hve second-line DST coverge close to 1%. Dt on second-line DST were ville for out 91.3% of ll notified MDR-TB cses. Of the MDR-TB cses sujected to second-line DST, 6759 (18.6%) were XDR-TB (Tle 14). XDR-TB cses mong those with MDR-TB re rising in solute numers: 575 cses were notified mong pulmonry MDR-TB cses in nd 5591 in (Tle VIII). In EU/EEA countries, where 74% of MDR-TB cses were tested for second-line drugs, the prevlence of XDR mong MDR cses ws 24.3%. Among the countries reporting t lest 3 MDR cses with second-line DST results, eight reported over 2% XDR prevlence mong MDR-TB cses: Tjikistn (54.2%), Uzekistn (52.8%), Belrus (48.3%), Ltvi (39.1%), Lithuni (34.9%), Romni (3.8%), Estoni (26.5%) nd Ukrine (21.7%) (Tle 14). It should e noted, however, tht Tjikistn nd Uzekistn reported low coverge of first-line DST, nd the XDR-TB prevlence might e overestimted in these countries. There is no cler trend of XDR-TB prevlence in countries with long history of second-line drug DST surveillnce mong pulmonry MDR-TB cses (with dt reported every yer from to ). An lrming increse in XDR ws oserved in Belrus in 216, reching 45.9% of XDR prevlence, ut this decresed to 31.5% in (Tle VIII). An incresing trend in XDR-TB hs een oserved in Estoni, Ltvi, Romni, Lithuni nd Armeni, while XDR prevlence mong MDR-TB cses remined stle in Georgi over the pst five yers t round 16 18% (Tle 14). Of the RR/MDR-TB ptients notified, (91.9%) were enrolled into MDR-TB tretment progrmmes. Six HPCs reported gp of over 5% etween the numer of ptients enrolled nd the numer dignosed: Turkey (8.2%), the Russin Federtion (83.2%), Kyrgyzstn (85.%), Azerijn (85.2%), Georgi (93.2%) nd Estoni (94.4%) (Tle 15). Access to XDR-TB tretment in 216 t regionl level ws 88.5%, which is higher thn the 76.6% tretment coverge reported in the previous yer. This trend is influenced y the Russin Federtion, s it includes more thn hlf of XDR-TB ptients detected in the Region. Mp 2. of notified TB cses with multidrug resistnce mong new lortory confirmed pulmonry TB cses, Europen Region, Not included or not reporting Andorr Liechtenstein Luxemourg Mlt Monco Sn Mrino 25

34 Fig. 2. s of MDR mong lortory-confirmed pulmonry TB cses, Europen Region, 6 New 5 Retretment previous tretment history Fig. 3. s of MDR mong lortory-confirmed pulmonry TB cses y previous tretment history, EU/EEA, 2 New 15 1 Previously treted previous tretment history Fig. 4. s of MDR mong lortory-confirmed pulmonry TB cses, 18 HPCs, 6 New 5 Retretment previous tretment history

35 TB/HIV coinfection Forty-three countries provided surveillnce dt on TB/ HIV coinfection (Tle 16). Of the new nd relpse TB ptients notified in the reporting countries, were screened for HIV (91.4%). Ten HPCs chieved testing level ove 9%: Armeni, Azerijn, Belrus, Estoni, Georgi, the Repulic of Moldov, the Russin Federtion, Tjikistn, Ukrine nd Uzekistn. A totl of TB cses were detected with HIV-positive sttus, representing 12.8% of those tested versus 13.4% recorded in 216. Among countries reporting representtive HIV testing (ove 5% HIV testing coverge), four documented significnt overlp of the HIV nd TB epidemics y exceeding 1% HIV prevlence mong new nd relpse TB cses (Tle 16): Ukrine (22.4%), the Russin Federtion (19.3%), Portugl (1.9%) nd Ltvi (1.8%). Eight countries with representtive routine surveillnce hd 5 1% HIV prevlence mong TB ptients: the Repulic of Moldov (8.3%), Estoni (8.2%), Belgium (8.%), Armeni (7.9%), Spin (7.4%), Belrus (7.3%), Uzekistn (5.6%) nd Isrel (5.1%). Twenty-two countries in the Region provided informtion on ART enrolment mong TB cses with HIV-positive sttus in. Of HIV-positive TB cses, (66.6%) hd received ART. This is somewht higher thn in 215 (65.1%), ut fr elow the WHO trget of universl ART coverge. Eleven of the HPCs chieved coverge of over 75%: Armeni, Azerijn, Belrus, Bulgri, Estoni, Georgi, Kzkhstn, Romni, Tjikistn, Turkey nd Uzekistn. Origin of cses TB cses of foreign origin represent 7.9% of ll TB cses notified Region-wide: 33.1% in EU/EEA countries, nd only 1.9% in non-eu/eea countries nd res (Tle 1). TB cses of foreign origin represent lrge mjority in mny countries: Mlt (92.9%), Sweden (9.%), Norwy (88.5%), Isrel (81.2%), Switzerlnd (79.8%), Luxemourg (78.1%), the Netherlnds (74.5%) nd Cyprus (71.7%). TB in prisons Twenty-nine countries in the Region provided informtion on TB cse detection nd tretment in prisons during (Tle 17). Overll, (5.3%) of the new nd relpse TB cses in the Region were reported from prisons, (96.3%) of which were in the HPCs. The proportion of TB cses in prisons represented only 1.6% of the country totl in EU/EEA countries; the proportion ws 6.1% in non- EU/EEA countries nd res. The notifiction rte in prisons in the non-eu/eea countries nd res ws 956 new TB cses per 1 popultion, which is out six times higher thn in the EU/EEA suregion (155 per 1 ). The overll notifiction rte for new TB cses in prisons in the WHO Europen Region ws 752 per 1 popultion. The TB notifiction rte exceeded 1 cses per 1 detinees in six countries: Azerijn, Kzkhstn, Kyrgyzstn, the Repulic of Moldov, the Russin Federtion nd Ukrine. The highest TB-relted risks in prison (reltive to incidence in the generl popultion) re clculted to e in Slovki (52.3), Azerijn, Ltvi nd the Russin Federtion (23 ech). Tretment outcome The tretment success rte mong new TB cses nd relpses hving strted tretment in 216 ws 77.2% (Tle 19). The verge rte of ptients cured nd treted for the 18 HPCs ws 78.5%. The tretment success rte ws slightly lower in the EU/EEA countries thn in non-eu/eea countries nd res (75.6% versus 77.7%), oth showing slight improvement compred to the previous yer. Only 15 countries chieved n 85% tretment success rte in this tretment cohort. Another 13 were close to the trget, with success rtes of 8 85%. Five countries hd tretment success rtes elow 6%, with very high proportion of cses not evluted. A totl of (8.1%) cses were reported to hve died in the sme cohort, 4.6% to hve een lost to follow-up nd 3.9% to hve hd tretment tht filed. These unfvourle outcomes were lower in the EU/EEA countries thn in the rest of the Region, exemplified y the proportion of ptients with filed tretment.6% in the EU/EEA countries versus 4.8% in non-eu/eea countries nd res (Tle 19). Countries reporting ftl outcomes in excess of 1% were Croti (15.5%), the Czech Repulic (16.4%), Estoni (15.7%), Hungry (11.9%), Montenegro (12.6%), the Russin Federtion (1.1%) nd Sloveni (2.3%): the Russin Federtion ccounted for lmost hlf of the deths in the Region in solute numers. The tretment success rte mong the 781 child TB cses in the 216 cohort ws 92.8% (Tle 2). The tretment success rte in EU/EEA countries ws somewht lower compred to the non-eu/eea countries nd res (88.2% versus 94.2%). Among child TB cses in the Region,.8% died, nother.8% filed nd 1.1% were lost to follow-up. Of 7599 TB/HIV coinfected ptients who strted tretment throughout the Region in 216, only 4778 (62.9%) hd successful tretment outcome (Tle 21). Tretment outcome dt re ville only for 29% of notified HIV/TB cses. The tretment outcome ws notified for the 215 cohort of lortory-confirmed RR/MDR-TB cses reported y 47 countries (Tle 22). The tretment success rte for the whole Region ws 57.2%, which is higher thn the 54.7% rte reported for the 214 RR/MDR-TB tretment cohort nd continues to show the nnul trend of improvement. The tretment success rte for RR/MDR-TB ptients ws higher in non-eu/eea countries nd res thn in the EU/EEA countries (57.4% versus 47.3%). The countries tht performed est were Belgium (1%), Austri nd Sweden (oth 92.3%). In the Region s whole, 14.3% of RR/MDR-TB cses died, 12.% filed nd 1.2% were lost to follow-up. Conclusions for the WHO Europen Region As in pst yers, the fstest nnul decline in TB incidence in the world in ws oserved in the WHO Europen 27

36 Region (5.2%), ut it is less thn the projected ccelertion of the decline needed to rech the End TB Strtegy milestone y 225. There were n estimted 24 TB deths mong people who were HIV-negtive in, with considerle vrition cross the Region, nd 83% of TB deths were ttriuted to the 18 HPCs. Twelve per cent of incident TB cses were estimted to e coinfected with HIV, mrking the first yer of hlted growth fter the unprecedented increse from 3% to 12% during Two countries, the Russin Federtion nd Ukrine, ccount for lmost 8% of the estimted TB/HIV coinfected ptients in the Region. Eighty-eight per cent of the estimted new nd relpse cses were notified in the Region in, sustntilly higher thn the glol detection rte of 64%. The Region fces the issue of the high urden of RR/MDR-TB. Nine of the 3 countries with the highest RR/MDR-TB urden in the world re in the WHO Europen Region (Azerijn, Belrus, Kzkhstn, Kyrgyzstn, the Repulic of Moldov, the Russin Federtion, Tjikistn, Ukrine nd Uzekistn). Around 11 people in the Region re estimted to ecome ill with RR/MDR-TB ech yer, nd it is of the utmost importnce to hve cpcity t country level to rpidly detect resistnt TB. Lortory confirmtion mong new nd relpse pulmonry TB cses incresed from 57% in to 65% in, minly due to the growing uptke of the WRD. The three-yer trend shows incresed use of rpid dignostics in the Region; 51% of incident TB cses were tested using this pltform in, compred to 22% in 215. Overll, most countries chieved 85% or higher coverge of first-line DST mong cteriologiclly confirmed pulmonry TB cses, ut countries should im to hve universl coverge. Ninety-one per cent of ll notified MDR-TB cses in the Region hd second-line DST ville, with most countries reporting coverge close to 1%. TB is mjor cuse of deth mong people living with HIV, so rpid detection nd pproprite tretment re vitl. In, 76% of n estimted 34 HIV ptients coinfected with TB were detected, nd 65% of them were offered ART. Only out 29% of coinfected ptients notified in 216 hd TB tretment outcomes ville in. This underlines the need to strengthen collortion etween TB nd HIV progrmmes nd surveillnce of coinfection in the Region. Most of the countries hve universl ccess to TB nd MDR-TB tretment. Ninety-two per cent of RR/MDR-TB cses nd 89% of XDR-TB cses notified in were enrolled into the respective tretment progrmmes. The regionl verge is hevily influenced y the Russin Federtion, s it includes more thn hlf of ll MDR-TB nd XDR-TB ptients detected in the Region. Compring TB tretment outcomes collected in 216 to 218, slow ut sustinle increse is documented in oth incident TB nd RR/MDR-TB cohorts, from 75.8% to 77.2% nd 48.7% to 57.2% respectively. Europen Union nd Europen Economic Are countries Dt completeness TB notifiction dt for were reported y ll 31 countries. The reporting of non-mndtory vriles in ws complete or ner-complete for ge, gender, TB site nd vriles defining the origin of cse (Annex 3). Previous tretment history ws ville for 82.1% of cses, which ws higher thn in the 218 report (76.8%) ut lower thn tht reported in the reports pulished in 215 (89.6%, 87.7% nd 84.3% respectively). The over 8% completeness for this vrile lso msked sustntil differences cross countries: for exmple, previous tretment history ws not ville from Luxemourg nd only ville for 6.3% of cses from Germny. The reporting completeness for culture results (82.5%) ws similr to tht reported for 216 dt (82.2%), with only five countries remining elow 75.% (Frnce, Greece, Irelnd, Portugl nd the United Kingdom). Reporting completeness for microscopy (82.9%) ws higher thn tht reported for 216 dt (72.5%) in contrst to the decline reported in the previous three yers. For, drug-susceptiility reporting completeness ws 72.5% for the first-line TB drugs isonizid nd rifmpicin. Notly, no dequte dt on DST were ville from Frnce nd Itly. Secondline DST reporting completeness ws 1% for countries tht reported t lest one MDR-TB cse. Four countries (Croti, Icelnd, Liechtenstein nd Mlt) reported no MDR-TB cses (Tle 13). The numer of countries reporting HIV sttus incresed from 2 in 216 to 23. HIV sttus ws ville for 46.2% of ll cses reported in, which is the highest proportion reported in the lst five yers. As in the previous nnul report, Austri, Finlnd, Frnce, Germny, Itly, Liechtenstein, Polnd nd Sweden did not report HIV sttus. Furthermore, HIV sttus reporting completeness ws less thn 1% for Croti, Hungry nd Luxemourg. In, tretment outcome t 12 months, 24 months nd 36 months ws ville for 82.5% of ll reported cses, 98.1% of MDR-TB nd 1% of XDR-TB cses respectively. Tretment outcome ws not reported y Greece, Itly, Luxemourg or Mlt, nd ws not reported for MDR-TB cses y Spin. Time nd plce In, cses of TB were reported in the 31 EU/EEA countries (Tle 3). As in the previous five yers, three countries (Polnd, Romni nd the United Kingdom) ccounted for nerly 45% of ll reported cses, with Romni lone ccounting for 23.5% of ll TB cses reported in. The EU/EEA notifiction rte in ws 1.7 per 1 popultion, continuing the downwrd trend oserved since the lunch of Europen enhnced TB surveillnce in

37 decline in the notifiction rte ws 4.5%. As reported for previous yers, country-specific notifiction rtes differed considerly in, rnging from 2.6 in Liechtenstein to 66.2 per 1 in Romni. Rtes were elow 1 per 1 in 24 countries nd elow 2 per 1 in 27 countries. The highest notifiction rtes in the EU/EEA were reported from Bulgri, Estoni, Ltvi, Lithuni, Polnd, Portugl nd Romni (Tle 3). Notifiction rtes in the mjority of countries hve fllen since (Tle 3). The downwrd trend ws prticulrly pronounced in Estoni, Ltvi, Norwy nd Slovki, where the verge nnul rte of decrese exceeded 1%. Two of these countries (Estoni nd Ltvi) re WHO HPCs nd EU/EEA Memer Sttes. Previous tretment, lortory confirmtion nd TB site The distriution of cses y previous tretment history ws similr in to tht reported in previous yers: (72.1%) of TB cses reported in were newly dignosed, 5556 (1.%) hd een previously treted for TB nd 9878 (17.9%) hd n unknown previous tretment sttus (Tle 5). The Memer Sttes with the lowest proportions of new cses hd the highest proportions of cses with unknown previous tretment sttus. The proportion of previously treted cses ws ove 2% in one country (Romni) nd more thn 1% in nother nine: Bulgri, Estoni, Greece, Hungry, Icelnd, Ltvi, Lithuni, Polnd nd Slovki. Lortory confirmtion ws reported for 37 7 (68.1%) of the TB cses reported in (Tle 8). Countryspecific proportions of lortory-confirmed cses rnged from 47.6% in Bulgri to 97.3% in Sloveni nd 1% in Liechtenstein. Of the five HPCs, the three Bltic Sttes (Estoni, Ltvi nd Lithuni) hd proportions of confirmed cses ove 8%. The incresing proportion of lortoryconfirmed TB cses reported in the previous five yers (61.9% in 212 to 71.% in 216) did not continue in. Of ll TB cses reported in, (68.8%) were dignosed with pulmonry TB, (22.6%) with extrpulmonry TB, 4323 (7.8%) with comintion of oth nd 443 (.8%) hd no TB site reported (Tle 6). The proportion of extrpulmonry TB ws highest in the Netherlnds (41.7%), Norwy (39.5%) nd the United Kingdom (45.%), nd lowest in Hungry (3.9%) nd Liechtenstein (%). Of 4 74 new nd relpse pulmonry TB cses reported in, (8.4%) were confirmed y culture, smer nd/or nucleic cid mplifiction test (Tle 7). Hungry reported the highest proportion of new nd relpse pulmonry TB cses dignosed only cliniclly (46.6%), followed y Bulgri (34.%). According to the EU cse definition, 37 7 (68.1%) of TB cses reported in would e clssified s confirmed, 4466 (8.1%) s prole nd (23.8%) s possile (Tle 8). Five countries reported less thn one tenth of their TB cses s possile cses (tht is, only cliniclly dignosed). When nlysing ll reported TB cses for the percentge of cliniclly dignosed cses, Hungry Fig Cses per Source: ECDC. 29

38 remined the country with the highest proportion (47.2%), followed y Bulgri (43.9%). It is uncler if the high proportion of only cliniclly dignosed cses reflects potentil risk tht TB is eing overdignosed in these countries, or if it is relted to underreporting of lortory results to the ntionl surveillnce systems. Age nd sex Of new TB cses nd relpses reported in, (63.7%) were ged etween 25 nd 64 yers (Tle 9). The highest notifiction rte ws oserved in the ge group yers (12.9 per 1 ). Overll, dults over 64 yers ccounted for less thn 2% of ll cses, ut more thn one third of ll cses reported y Croti, Finlnd nd Sloveni were in this ge group. Children under 15 yers ccounted for 234 (4.4%) of new TB cses nd relpses reported in nd hd lower notifiction rte thn the dult ge groups (Tle 9). The notifiction rte for ll TB cses in children under 15 yers of ge ws 2.9 per 1 (Tle III). Three countries (Bulgri, Lithuni nd Romni) reported notifiction rtes of more thn 1 per 1 children under 15 yers. More specificlly, the highest rtes of new nd relpse TB cses mong 4-yer-olds were noted in Bulgri nd Romni, nd the highest rtes for 5 14-yerolds were reported from Bulgri, Lithuni nd Romni. In, the mle-to-femle rtio in new TB cses nd relpses ws 1.9, higher thn the rtio reported in 216 (Tle 9). More mle thn femle new nd relpse TB cses were reported y ll EU/EEA Memer Sttes ut one (Cyprus). For children under 15 yers, the mle-to-femle rtio mong new nd relpsed cses ws 1.1. Origin of cses Of the TB cses notified in, (64.1%) were orn in, or were citizens of, the reporting country (referred to s ntive ), (33.1%) were of foreign origin nd 1592 (2.9%) were of unknown origin (Tle 1). From countries with TB notifiction rtes higher thn 1 per 1 popultion, 2% or less were reported s eing of foreign origin. The nnul numer nd proportion of ntive TB cses hs declined since (from to , nd from 68.7% to 64.1% respectively) (Tle IV). The proportion of TB cses of foreign origin incresed over the sme period from 27.1% in to 33.1% in 216 nd, while the proportion of cses of unknown origin decresed. Of the cses of foreign origin in, (58.1%) were reported y Frnce, Germny nd the United Kingdom. Country-specific proportions of foreignorigin TB cses rnged from elow 1% in Bulgri, Croti, Liechtenstein nd Romni to ove 8% in Mlt, Norwy nd Sweden. Drug resistnce Annex 5 displys prticiption nd performnce in n EQA scheme for DST y Memer Stte. Of lortory-confirmed TB cses notified in, (84.7%) hd isonizid nd rifmpicin susceptiility testing results reported (Tle 13). Resistnce to t lest one nti-tb drug ws reported for 2985 (1.9%) of the cses with results for t lest isonizid nd rifmpicin susceptiility, nd for % of cses with results in Estoni, Greece, Ltvi nd Lithuni. Overll, MDR-TB ws reported for 141 (3.8%) of cses with the relevnt DST results, with the highest proportion reported in Estoni, Ltvi nd Lithuni ( %). After remining t.3 per 1 popultion from to 216, the rte of notified MDR-TB cses decresed to.2 in (Tle VII). Overll, XDR-TB ws reported for 187 (24.3%) of 77 MDR-TB cses with results for second-line DST (Tle 14). Ltvi, Lithuni nd Romni reported 8.2% of ll reported XDR-TB cses. The proportion of XDR-TB cses mong pulmonry MDR-TB cses with results for second-line DST incresed from 18.6% in to 24.6% in (Tle VIII). During tht period, Lithuni nd Romni reported more thn 45% of the pulmonry XDR-TB cses nnully. Of new confirmed pulmonry TB cses with DST results, 459 (2.4%) were resistnt to isonizid nd rifmpicin (Tle 12). In contrst, 51 (15.%) of 335 previously treted confirmed pulmonry TB cses with DST results were resistnt to isonizid nd rifmpicin. Compred with new pulmonry cses, previously treted pulmonry TB cses hd six times higher risk of eing reported s resistnt to isonizid nd rifmpicin. HIV coinfection HIV sttus ws reported for (76.%) of TB cses reported from the 23 countries tht reported HIV sttus of TB cses (Tle 16). Of the cses with known HIV sttus, 16 (3.9%) were reported s HIV positive. The proportion of coinfected cses mong countries with t lest 5% reporting completeness for HIV sttus ws highest in Estoni, Ltvi nd Portugl, t 8.6%, 11.% nd 11.4% respectively. Dt reported over the lst five yers show decresing proportion of HIV coinfected TB cses (Tle IX). TB in prisons For, 15 EU/EEA countries reported 57 new nd relpse TB cses in prisons, resulting in notifiction rte of 155 per 1 inmtes nd reltive risk of 11.4 compred to the generl popultion in the sme countries (Tle 17). TB cses in prisons ccounted for 1.6% of ll new nd relpse cses notified in the 15 reporting EU/EEA countries, ut this proportion ws ove 4% in the Czech Repulic, Lithuni nd Slovki. Tretment outcome Of ll TB cses notified in 216 with tretment outcome reported in, (7.7%) were treted successfully, 3997 (7.3%) died, 457 (.8%) experienced tretment filure, 2518 (4.6%) were lost to follow-up, 1965 (3.6%) were still on tretment in nd 761 (12.9%) were not evluted (Tle 18). Greece, Itly, Luxemourg nd Mlt did not report tretment outcome. Among the TB cses notified in 216 nd clssified s new 3

39 nd relpse cses, including those with unknown previous tretment history nd excluding those tht were strted on second-line tretment, (75.6%) were treted successfully (Tle 19). In countries where t lest 75% of these new confirmed TB cses nd relpses hd known outcome, tretment success rnged from 58.4% in Croti to 1.% in Liechtenstein. The overll proportion of successfully treted cses mong these new TB cses nd relpses decresed from 77.2% in cses notified in 212 to 75.6% in 216 (Tle X). In four countries (Croti, the Czech Repulic, Estoni nd Sloveni), over 15.% of the new nd relpse cses notified in 216 died, including those with unknown previous tretment history nd excluding those strted on second-line tretment. In contrst, the proportion ws less thn 1.% in 2 of the 25 countries tht reported tretment outcome for this cohort. Of 1217 MDR-TB cses notified in 215 with tretment outcome reported in, 545 (44.8%) were treted successfully, 197 (16.2%) died, 188 (15.4%) experienced tretment filure, 149 (12.2%) were lost to follow-up, 55 (4.5%) were still on tretment in nd 83 (6.8%) were not evluted (Tle 23). Aprt from the countries tht did not report tretment outcome dt or dt on DST, notly Cyprus, Icelnd, Liechtenstein, Luxemourg nd Sloveni did not report ny MDR-TB cses for 215. Overll, the 24-month tretment success rte for RR/MDR-TB remins low, lthough it hs improved (from 4.7% for cses reported in 211 to 47.3% for cses reported in 215) (Tle XII). Thirteen countries reported 17 XDR-TB cses for 214 nd tretment outcome for these cses in : 47 (27.6%) were treted successfully, 44 (25.9%) died, 43 (25.3%) experienced tretment filure, 18 (1.6%) were lost to follow-up, nd 18 (1.6%) were not evluted (Tle 25). Overll, the 36-month XDR-TB tretment success rte remins low; vritions over time should e interpreted with cution due to the smll numer of cses (Tle XIV). Of 717 HIV-positive TB cses notified in 216 who were not strted on second-line tretment nd hd tretment outcome reported in, 452 (63.%) were reported s successfully treted, 98 (13.7%) died, four (.6%) experienced tretment filure, 53 (7.4%) were lost to follow-up, 83 (11.6%) were still on tretment in nd 27 (3.8%) were not evluted (Tle 21). WHO disese urden estimtes According to WHO, the estimted TB incidence in the EU/EEA overll (excluding Liechtenstein) ws 11.9 per 1 popultion in. The incidence in 2 of the 3 countries with estimtes ws less thn 1. per 1 popultion nd ws estimted to e less thn 2. per 1 popultion in 25 countries (Tle II). The overll numer of estimted TB deths, excluding HIV deths in people who were HIV positive, ws 4 for the EU/EEA in, decrese compred to the 42 estimted for 216 nd the 67 estimted for 28 (Tle I). Conclusions for the Europen Union/Europen Economic Are In, ll EU/EEA countries reported TB notifiction dt. The overll TB notifiction rte continued the decline oserved since 22 nd reched 1.7 per 1 popultion. As in previous yers, few countries reported lrge numers of cses, including Romni, which ccounted for 23.5% of ll reported cses in. Overll, the decresing notifiction rtes oserved in most countries re ressuring, ut when the sitution is evluted sed on the im to rech n 8% reduction in the TB incidence rte in 23 compred to 215 ( United Ntions Sustinle Development Gol 3 trget), the chllenge hed ecomes evident. The trget t EU/EEA level is notifiction rte of 2.4 per 1 (8% reduction of 215 TB notifiction rte of 11.9 per 1 ). Though the EU/EEA TB notifiction rte hs declined since 215, so fr it hs only reched 1.7 per 1. Furthermore, if the men nnul chnge in rte ( ) in low-incidence EU/EEA countries continues t the current pce, WHO clcultions (2) suggest the WHO trget of TB elimintion y 25 in Europen low-incidence countries will not e met y pproximtely four fifths of the countries currently in this group. In mny low-incidence countries, lrge proportion of TB cses is of foreign origin. Notly, more thn hlf of ll TB cses reported in two thirds of the low-incidence EU/EEA countries were of foreign origin. In the EU/EEA overll, the proportion of cses of foreign origin remined round one third of ll TB cses. A recently pulished ECDC pulic helth guidnce document concluded tht screening for ctive TB or ltent TB infection mong newly rrived migrnts from high-incidence countries is likely to e oth effective nd cost effective for TB disese prevention (3). Nonetheless, the fct tht overll the mjority of cses notified in the EU/EEA were ntive cses should not e overlooked. Dt on HIV coinfection remined incomplete in the EU/EEA. Although the numer of countries reporting HIV sttus ws higher thn in 216, HIV sttus ws reported for less thn hlf of ll reported TB cses, limiting the conclusions tht cn e drwn. Since, the proportion of HIV coinfected TB cses hs een decresing, nd ws 3.9% in for the EU/EEA overll. Dt on TB in prisons remin even scrcer for the EU/EEA thn dt on HIV sttus. Only 15 countries provided such dt for. Although the proportion of inmtes mong ll new nd relpse TB cses in these countries ws low, the dt indicte tht inmtes fce n 11.4 times higher risk thn the generl popultion of eing reported s TB cse. ECDC nd Europen Monitoring Centre for Drugs nd Drug Addiction pulic helth guidnce concluded in 218 tht despite limited evidence, ut given current TB knowledge nd the chrcteristics of prison settings, it is dvisle to offer universl testing for ctive TB t prison entry so tht tretment cn e initited nd trnsmission prevented (4). 31

40 A decline in the overll MDR-TB notifiction rte mong cses with relevnt DST results ws seen in the EU/EEA in, nd the numer of XDR-TB cses ws low compred to the totl numer of reported TB cses. Given the high numer of drug-resistnt TB cses in the Europen Region HPCs ordering the EU/EEA, however, countries need to remin vigilnt nd prepred to dignose nd tret drugresistnt TB. The surveillnce dt indicte tht tretment success rtes fter 12 months re considerly elow the WHO trget of 85% (5). Moreover, lthough the success rte for MDR-TB hs improved, the tretment success rte fter 24 months is low, s is the tretment success rte fter 36 months for XDR-TB. Lstly, ECDC notes tht t United Ntions high-level meeting on 26 Septemer 218, the EU/EEA countries reffirmed their commitment to ending the epidemic in ll countries (6). The TB sitution reflected in this report indictes tht the countries fce severl chllenges in reching this gol nd need to intensify their pulic helth mesures ginst TB. As previously, ECDC remins committed to supporting the EU/EEA countries in these efforts. References 1. Glol tuerculosis report 218. Genev: World Helth Orgniztion; :37 ( pulictions/glol_report/en/). 3. Pulic helth guidnce on screening nd vccintion for infectious diseses in newly rrived migrnts within the EU/EEA. Stockholm: ECDC; 218 ( europ.eu/en/news-events/ecdc-issues-migrntscreening-nd-vccintion-guidnce). 4. Pulic helth guidnce on ctive cse finding of communicle diseses in prison settings. Stockholm nd Lison: ECDC nd EMCDDA; 218 ( eu/en/pulictions-dt pulic-helth-guidnce-ctivecse-finding-communicle-diseses-prison-settings). 5. Rodmp to implement the tuerculosis ction pln for the WHO Europen Region Towrds ending tuerculosis nd multidrug-resistnt tuerculosis. Copenhgen: WHO Regionl Office for Europe; 216 ( rodmp-to-implement-the-tuerculosis-ctionpln-for-the-who-europen-region towrds-ending-tuerculosis-nd-multidrug-resistnttuerculosis-216). 6. Resolution dopted y the Generl Assemly on 1 Octoer 218. Politicl declrtion of the high-level meeting of the Generl Assemly on the fight ginst tuerculosis. New York (NY): United Ntions; 218 (A/ RES/73/3; sp?symol=a/res/73/3). 2. Towrds TB elimintion: n ction frmework for lowincidence countries. Genev: World Helth Orgniztion 214 ( 65/132231/ _eng.pdf?sequence=1). 32

41 4. Commentry monitoring

42 4. Commentry monitoring To ddress the chllenges to TB nd M/XDR-TB prevention nd cre, the WHO Regionl Office for Europe, working in close consulttion with representtives from the countries nd res, experts nd communities, hs developed the Tuerculosis ction pln for the WHO Europen Region (1). This ction pln is sed on lessons lerned from implementing the seven res of intervention in the Consolidted ction pln to prevent nd comt multidrugnd extensively drug-resistnt tuerculosis in the WHO Europen Region (2) nd is in line with the glol End TB Strtegy nd other helth policy guidnce, such s the Europen policy for helth nd well-eing, Helth 22 (3). The Tuerculosis ction pln for the WHO Europen Region is supported y monitoring nd evlution frmework to monitor progress towrds defined trgets. The frmework consists of 26 indictors tht enle performnce monitoring in the ction pln s res of intervention nd follow on from the Berlin Declrtion on Tuerculosis of 27 (4). Nine re core indictors for monitoring nd reporting to the WHO Regionl Committee for Europe. In ddition, the selection of indictors ws hrmonized with the End TB Strtegy s recommended top-1 glol indictors. The sttus of the core indictors, which is nlysed on n nnul sis, is included in the surveillnce report every second yer. The next updte will e presented in the TB surveillnce nd monitoring in Europe 22 report. At the time of puliction of this report, the World Helth Orgniztion ws developing multisectorl ccountility frmework to document progress on implementing the United Ntions politicl declrtion on TB (5) s greed in World Helth Assemly resolution WHA73.3 of 1 Octoer 218. WHO Europen Region Memer Sttes will e supported lter on to dpt it to their settings. References 1. Tuerculosis ction pln for the WHO Europen Region Copenhgen: WHO Regionl Office for Europe; 216 (EUR/RC65/17 Rev.1; who.int/en/out-us/governnce/regionl-committeefor-europe/pst-sessions/65th-session/documenttion/ working-documents/eurrc6517-rev.1-tuerculosis-ctionpln-for-the-who-europen-region-21622). 2. Consolidted ction pln to prevent nd comt multidrug- nd extensively drug-resistnt tuerculosis in the WHO Europen Region Copenhgen: WHO Regionl Office for Europe; 211 (EUR/RC61/15 + EUR/RC61/Conf.Doc./8; out-us/governnce/regionl-committee-for-europe/ pst-sessions/65th-session/documenttion/workingdocuments/eurrc6517-rev.1-tuerculosis-ctionpln-for-the-who-europen-region Helth 22: Europen policy frmework supporting ction cross government nd society for helth nd well-eing. Copenhgen: WHO Regionl Office for Europe; 212 ( en/pulictions/strcts/helth-22--europenpolicy-frmework-supporting-ction-crossgovernment-nd-society-for-helth-nd-well-eing). 4. The Berlin Declrtion on Tuerculosis. Copenhgen: WHO Regionl Office for Europe; 27 (EUR/7/561622/5; 5. Resolution dopted y the Generl Assemly on 1 Octoer /3. Politicl declrtion of the highlevel meeting of the Generl Assemly on the fight ginst tuerculosis. New York (NY): United Ntions; 218 (A/RES/73/3; 34

43 5. Annexes

44 Annex 1. Tuerculosis surveillnce system overview, EU/EEA, Country Dt source Dt ville Legl Compre Ntionl chrcter hensiveness Type coverge EuroTB TESSy ggregted dt cse sed dt Austri AT TUBERKULOSEGESETZ Cp Co C Y Belgium BE TUBERCULOSIS Cp Co C Y Bulgri BG MOH Cp Co C Y Croti c HR CNIPH Cp Co C Y Cyprus CY NOTIFIED_DISEASES Cp Co C Y Czech Repulic CZ TUBERCULOSIS Cp Co C Y Denmrk DK MIS Cp Co C Y Estoni EE TBC Cp Co C Y Finlnd FI NIDR Cp Co C Y Frnce FR MANDATORY_INFECTIOUS_ DISEASES Cp Co C Y Germny DE SURVNET@RKI 7.1/6 Cp Co C Y Greece EL NOTIFIABLE_DISEASES Cp Co C Y Hungry HU TUBERCULOSIS Cp Co C Y Icelnd IS TUBERCULOSIS Cp Co C Y Irelnd IE CIDR Cp Co C Y Itly IT NRS Cp Co C Y Ltvi LV TB Cp Co C Y Liechtenstein CH SFOPH LI Cp Co C Y Lithuni LT TB_REGISTER Cp Co C Y Luxemourg LU SYSTEM1 Cp Co C Y Mlt MT DISEASE_SURVEILLANCE Cp Co C Y Netherlnds NL NTR Cp Co C Y Norwy NO MSIS_A Cp Co C Y Polnd PL_CR Cp Co C Y Portugl PT TUBERCULOSIS Cp Co C Y Romni RO NTBSy Cp Co C Y Slovki SK NRT Cp Co C Y Sloveni SI TUBERCULOSIS Cp Co C Y Spin ES STATUTORY_DISEASES Cp Co C Y Sweden SE SweTBReg Cp Co C Y United Kingdom UK TUBERCULOSIS Cp Co C Y Cp = compulsory reporting. Co = comprehensive. C = cse-sed. Y = yes. TESSy = the Europen Surveillnce System. For some yers dt from Frnce, Spin nd Itly relted to drug-susceptiility testing hve een collected in ggregted formt from the WHO TB Monitoring nd Evlution dtse (TME). c Dt reported since 212 to TESSy, historicl dt extrcted from WHO TB Monitoring nd Evlution dtse (TME). 36

45 Annex 2. List of vriles for tuerculosis dt collection List Description Common set of vriles 1 RecordId Unique identifier for ech record generted y the ntionl surveillnce system 2 RecordType Structure nd formt of the dt 3 RecordTypeVersion Indictes which version the sender uses when generting the dt for uplod 4 Suject Disese to report 5 Sttus Sttus of reporting NEW/UPDATE or DELETE (inctivte) 6 DtSource The dt source (surveillnce system) tht the record origintes from 7 ReportingCountry The country reporting the record 8 PlceOfNotifiction Plce of the first notifiction of the cse to regionl uthority 9 PlceOfResidence Plce of residence of ptient t the time of disese onset 1 Age Age of ptient in yers s reported in the ntionl system 11 Gender Gender of the reported cse 12 DteOfDignosis First dte of clinicl or l dignosis 13 DteOfNotifiction Dte when the cse is first reported to pulic helth uthorities 14 DteUsedForSttistics The reference dte used for stndrd reports (usully one of the ove) Disese-specific vriles 15 BornReportingCountry The ptient ws orn in the country of report 16 CountryOfBirth Country of irth of ptient 17 CountryOfNtionlity Country of ntionlity of ptient 18 DteOfEntryToCountry Dte of entry to country for TB cses not orn in the reporting country 19 NtionlityReportingCountry Origin of the ptient (sed on citizenship) 2 MjorSiteOfTB Mjor site of the disese 21 MinorSiteOfTB Minor site of the disese 22 PrevDignosis Previous dignosis of tuerculosis 23 PrevDignosisYer Yer of previous dignosis 24 PrevTretment Previous nti TB drug tretment (t lest one month of drug comintion) 25 PrevTretmentCompletion Completion of the previous nti TB drug tretment 26 DignosedAnteMortem Vitl sttus of the ptient t the time of dignosis 27 EnrolledToTretment Ptient strted pproprite TB tretment ccording to interntionl recommendtions 28 Outcome12Months Ptient first outcome t 12 months from the strt of the tretment 29 Outcome24Months The first outcome oserved 13 to 24 months from the strt of tretment 3 Outcome36Months The first outcome oserved 25 to 36 months from the strt of tretment 31 ResultCulture The result of the culture test for Mycocterium tuerculosis complex 32 ResultMicroscopy The result of the microscopy test performed 33 ResultOtherTest Additionl l test results 34 Pthogen Species nd gene (M. tuerculosis complex) of the pthogen which is the cuse of the reported disese 35 HIVSttus Result of the lst HIV test 36 SIR_AMK Susceptiility to mikcin 37 SIR_BDQ Susceptiility to edquiline 38 SIR_CAP Susceptiility to cpreomycin 39 SIR_DLM Susceptiility to delmnid 4 SIR_ETH Susceptiility to ethmutol 41 SIR_GAT Susceptiility to gtifloxcin 42 SIR_INH Susceptiility to isonizid 43 SIR_KAN Susceptiility to knmycin 44 SIR_LVX Susceptiility to levofloxcin 45 SIR_MFX Susceptiility to moxifloxcin 46 SIR_OFX Susceptiility to ofloxcin 47 SIR_PZA Susceptiility to pyrzinmide 48 SIR_RIF Susceptiility to rifmpicin 49 SIR_STR Susceptiility to streptomycin 5 IsolteID Unique identifier for ech isolte within the dt source/l system relted to the cse 51 ECDCIsolteID Identifier for ech isolte record tht is gurnteed to e unique cross countries/ls/pthogens nd not contin dditionl encoded informtion 52 SpoligoCode Spoligo pttern code 53 MiruCode MIRU pttern code 54 BeijingGenotype Beijing genotype identifiction Notifiction of TB cses for, tretment outcome dt updted for cohort 216 nd MDR-TB tretment outcome dt updted for cohort 215 nd XDR-TB tretment outcome dt updted for cohort 214. Optionl vrile. No need to e reported if the IsolteID or ECDCIsolteID is provided. 37

46 Annex 3. Completeness of reported dt, EU/EEA, reporting yer Outcome 36 months g (%) Outcome 24 months f (%) Outcome 12 months e (%) Enrolled in tretment (%) HIV Sttus (%) DST SLD d (%) DST FLD c (%) Result other test (%) Result microscopy (%) Result culture (%) Dignosed ntemortem (%) Previous tretment history (%) Country of origin (%) Country Site (%) Origin (%) Gender (%) Age (%) Austri (86.) Belgium (64.1) Bulgri (6.6) Croti (.) Cyprus (32.1) Czech Repulic (77.4) Denmrk (78.9) Estoni (83.4) Finlnd (46.8) Frnce (.) Germny (76.6) Greece (47.5) Hungry (.) Icelnd (1.) Irelnd (43.1) Itly (.) Ltvi (38.6) Liechtenstein (1.) Lithuni (1.) Luxemourg (.) Mlt (31.) Netherlnds (13.5) Norwy (89.7) Polnd (18.7) Portugl (33.4) Romni (3.3) Slovki (29.3) Sloveni (95.5) Spin (33.2) Sweden (88.3) United Kingdom h (15.) Totl EU/EEA (28.7) Note: WHO Europen Region TB high-priority countries presented in itlics. For determining the origin, two vriles merged: BornReportingCountry nd NtionlityReportingCountry, depending on Memer Stte s preference. History of previous tretment defined y previous dignosis of TB for cses reported y Belgium, Denmrk, Irelnd, Norwy nd the United Kingdom. c DST FLD = drug-susceptiility testing for the first-line nti-tb drugs isonizid nd rifmpicin, clculted for confirmed TB cses. d DST SLD = drug-susceptiility testing for second-line nti-tb drugs, clculted only for MDR-TB cses. e Dt for the 216 cohort. f Dt for the MDR-TB 215 cohort cses tht re previously reported s still on tretment. g Dt for the XDR-TB 214 cohort cses tht re previously reported s still on tretment. h DST results re only reported for culture-confirmed cses. 38

47 Annex 4. Reporting completeness into Glol TB dtse, Country/re Identifiction (%) (15 fields) Notifiction (%) (54 fields) Anti tuerculosis drug resistnce surveillnce (%) (4 fields) Tretment outcome of TB cses y risk ctegories (%) (57 fields) Implementing End TB Strtegy (%) (98 fields) Budget nd expenditure (%) (81 fields) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo (1.) (92.6) (52.5) (1.) (72.4) (1.) Switzerlnd (93.3) (63.) (67.5) (56.1) (44.9) (11.1) Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. For the purposes of this puliction, ll references to "Kosovo" in the tles nd nnexes, should e understood/red s "Kosovo (in ccordnce with Security Council resolution 1244 (1999)". 39

48 Annex 5. Lortory network cpcity, Europen Region, Country/re Microscopy Numer of lortories performing EQA pssed c Culture Numer of lortories performing DST for isonizid nd rifmpicin Numer of lortories performing Country lortory network Line proe ssy Xpert MTB/ Rif (N) Interntionl proficiency testing of ntionl reference lortory greement of results for: EU/EEA Austri Belgium Y Bulgri Y Croti Cyprus Czech Repulic Y Denmrk Estoni N Finlnd Y Frnce Y Germny Y Greece Hungry Icelnd Irelnd Y Itly Y Ltvi Y Liechtenstein Lithuni Y Luxemourg Y Mlt Netherlnds Y Norwy Polnd Y Portugl Romni Y Slovki Y Sloveni Spin Sweden N United Kingdom Sutotl EU/EEA Y Non-EU/EEA Alni Y Andorr Armeni Y Azerijn Y Belrus Y Bosni nd Herzegovin Y Georgi Y Isrel Y Kzkhstn Kyrgyzstn Y Monco Montenegro Y North Mcedoni Y Repulic of Moldov Y Russin Federtion Sn Mrino Seri Y Seri excluding Kosovo e Y Kosovo e N Switzerlnd Tjikistn Y Turkey Y Turkmenistn N Ukrine Uzekistn Y Sutotl non-eu/eea Y Totl Europen Region Y Sutotl 18 HPCs N Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. Dt otined from WHO Tuerculosis Monitoring nd Evlution dtse (TME). DST = drug-susceptiility testing. c EQA = externl qulity ssessment. d Acceptle performnce defined s reference lortory chieving 95% performnce (smer nd DST). e (In ccordnce with Security Council Resolution 1244 (1999)). EQA pssed c Yer isonizid rifmpicin Acceptle performnce d 4

49 6. Tles 41

50

51 Summry tle. TB surveillnce dt y region, Europen Region, Tle showing dt y country Numer of reporting countries Region EU/EEA Non-EU/EEA Totl Numer of reporting countries Numer of reporting countries 18 high-priority countries (HPCs) Totl popultion (millions) Estimtes of TB disese urden, c Estimted TB mortlity rte (excluding HIV-relted deths) per 1 popultion Estimted TB incidence rte per 1 popultion Estimted RR-TB mong ll notified pulmonry TB cses Estimted percentge of HIV infection mong incident TB cses (new nd relpses) Notifictions of TB cses, Totl numer of TB cses All TB cses per 1 popultion Men nnul percentge chnge of notifiction rte ( ) Numer of new TB cses nd relpses New TB cses nd relpses per 1 popultion Men nnul percentge chnge of notifiction rte of new TB cses nd relpses ( ) of new cses mong ll TB cses of retretment cses mong ll TB cses of pulmonry TB mong ll TB cses of lortory-confirmed TB cses mong ll TB cses Mle-to-femle rtio of new TB cses nd relpse of foreign TB cses mong ll TB cses TB cse lortory confirmtion, multidrug resistnce (MDR) nd extensive drug resistnce (XDR), of lortory-confirmed cses mong new pulmonry TB cses d of DST results reported mong new cteriologiclly confirmed pulmonry TB cses of MDR-TB mong new pulmonry TB cses of MDR-TB mong previously treted pulmonry TB cses of DST results reported mong ll confirmed TB cses of MDR-TB mong ll TB cses of XDR-TB mong ll MDR-TB cses with DST e for SLD f TB/HIV coinfection, of new TB cses nd relpses with known HIV sttus of HIV-positive cses mong new TB cses nd relpses with known HIV sttus of HIV-positive cses strted on ART of ll TB cses with known HIV sttus of HIV-positive cses mong ll TB cses with known HIV sttus Tretment outcome Tretment success of ll TB cses reported in 216 Tretment success of new TB cses nd relpses notified in 216 Tretment success of childhood TB cses notified in 216 Tretment success of HIV/TB cses notified in 216 tretment in 215 Tretment success of ll MDR-TB cses notified in 215 Tretment success of ll XDR-TB cses notified in 215 Note: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. HPCs: the 18 high-priority countries to STOP TB in the WHO Europen Region re: Armeni, Azerijn, Belrus, Bulgri, Estoni, Georgi, Kzkhstn, Kyrgyzstn, Ltvi, Lithuni, Repulic of Moldov, Romni, Russin Federtion, Tjikistn, Turkey, Turkmenistn, Ukrine nd Uzekistn. Numer of countries with ville dt included in the sttistics. c WHO estimtes, s pulished in Glol tuerculosis report 218. d Lortory-confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu/eea countries nd res. For EU/EEA countries: culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses. e DST = drug-susceptiility testing. f SLD = second-line nti-tb drugs. Numer of reporting countries 43

52 Tle 1. Estimtes of the TB disese urden, Europen Region Estimted numer of deths from TB (ll forms. excluding HIV) Estimted numer of incident cses (ll forms) Country/re Popultion Numer Per 1 Numer Per 1 Best Low High Best Low High Best Low High Best Low High EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HIV = humn immunodeficiency virus. HPCs = high-priority countries. Popultion estimte 218 y UN Sttisticl dtse for ll countries. 44

53 Estimted incidence of child TB cses Estimted incidence of TB mong femles Numer Per 1 Numer Per 1 Country Best Low High Best Low High Best Low High Best Low High EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs 45

54 Tle 2. Estimtes for TB/HIV coinfection nd MDR-TB, Europen Region, Country/re Estimted HIV infection mong incident TB cses (new nd relpses) Estimted percentge of RR-TB cses mong new TB ptients Numer % % Best Low High Best Low High Best Low High EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HIV = humn immunodeficiency virus. HPCs = high-priority countries. RR-TB = rifmpicin-resitnt tuerculosis. 46

55 Estimted percentge of RR-TB cses mong retreted TB ptients Estimted RR-TB cses mong notified pulmonry TB ptients Country/re % Numer Best Low High Best Low High EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs 47

56 Tle 3. TB cses, notifiction rtes per 1 popultion nd men nnul chnge in rtes, Europen Region, Men nnul % Country/re N Rte N Rte N Rte N Rte N Rte chnge in rte, EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. For TB cses nd notifiction rtes y country nd yer for the period , see: ECDC (). Surveillnce tls of infectious diseses. In: Europen Centre for Disese Prevention nd Control [wesite]. Stockholm: ECDC ( The dt pulished in this report might differ from figures in ntionl reports due to different times of reporting. The dedline for correcting nd updting the dt used in this report in the joint dtse ws 5 Octoer 218. HPCs = high-priority countries. For the purposes of this puliction, ll references to "Kosovo" in the tles nd nnexes, should e understood/red s "Kosovo (in ccordnce with Security Council resolution 1244 (1999)". 48

57 Tle 4. New TB cses nd relpses, notifiction rtes per 1 popultion nd men nnul chnge in rtes, Europen Region, Men nnul % Country/re N Rte N Rte N Rte N Rte N Rte chnge in rte, EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. The dt pulished in this report might differ from figures in ntionl reports due to different times of reporting. The dedline for correcting nd updting the dt used in this report in the joint dtse ws 5 Octoer 218. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. Previous TB history is defined y previous dignosis. c (In ccordnce with Security Council Resolution 1244 (1999)). 49

58 Tle 5. TB cses y history of previous TB tretment, Europen Region, Previously treted Other Country/re retretment All TB New previous TB Previously Previous Previous Lost to follow-up (incl. unknown cses history treted totl tretment tretment filed from previous previous completed tretment tretment detils) N (%) c N (%) c N (%) c N (%) d N (%) d N (%) d N (%) d N EU/EEA Austri Belgium e Bulgri Croti Cyprus Czech Repulic Denmrk e Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd e Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy e Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom e Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov 2 69 (69.7) Russin Federtion Sn Mrino Seri (92.4) Seri excluding Kosovo f Kosovo f Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. For non-eu/eea countries nd res, cses with unknown previous TB history re included mong new TB cses. Defined s "defulted" in previous reports. c mong ll TB cses. d mong previously treted TB cses. e Previous TB history is defined y previous dignosis. f (In ccordnce with Security Council Resolution 1244 (1999)). 5

59 Tle 6. TB cses y site of disese, EU/EEA, Pulmonry Extrpulmonry No site reported Totl Country Pulmonry only Pulmonry nd Totl pulmonry extrpulmonry N (%) N (%) N (%) N (%) N (%) N EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Totl EU/EEA Note: WHO Europen Region TB HPCs re presented in itlics. HPCs = high-priority countries. 51

60 Tle 7. New nd relpse pulmonry TB cses y dignostic method, EU/EEA, Country N (%) d New nd relpse pulmonry TB cses Confirmed y culture, smer nd/or nucleic cid mplifiction test c Confirmed cses y Confirmed y other WHO-recommended cteriologicl N (%) e rpid tests such s Xpert MTB/RIF test only f Cliniclly dignosed cses All pulmonry TB cses N (%) g N (%) g N (%) e N (%) h EU/EEA Austri Belgium i Bulgri Croti Cyprus Czech Repulic Denmrk i Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd i Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy i Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom i Totl EU/EEA Note: WHO Europen Region TB HPCs re presented in itlics. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. For the EU/EEA countries, cses with no disese site reported re included mong pulmonry TB cses. c Microscopy results from ny specimen re included for EU/EEA countries. d mong ll pulmonry TB cses. e mong ll new nd relpse pulmonry TB cses. f All nucleic cid mplifiction tests re counted s "confirmed y WHO-recommended rpid dignostics" for EU/EEA countries. g mong ll new nd relpse pulmonry TB cses confirmed y culture, smer nd/or nucleic cid mplifiction test. h mong ll TB cses. i Previous TB history is defined y previous dignosis. 52

61 Tle 7. New nd relpse TB cses y dignostic method, EU/EEA, Country N (%) c New nd relpse TB cses Confirmed y culture, smer nd/or nucleic cid mplifiction test Confirmed cses y WHO-recommended Confirmed y other rpid dignostics N (%) d such s cteriologicl test Xpert MTB/RIF e Cliniclly dignosed cses N (%) f N (%) f N (%) d N EU/EEA Austri Belgium g Bulgri Croti Cyprus Czech Repulic Denmrk g Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd g Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy g Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom g Totl EU/EEA Note: WHO Europen Region TB HPCs re presented in itlics. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. Microscopy results from ny specimen re included for EU/EEA countries. c mong ll TB cses. d mong ll new nd relpse TB cses. e All nucleic cid mplifiction tests re counted s "confirmed y WHO-recommended rpid dignostics" for EU/EEA countries. f mong ll new nd relpse TB cses confirmed y culture, smer nd/or nucleic cid mplifiction test. g Previous TB history is defined y previous dignosis. All TB cses 53

62 Tle 7. TB cses y history of previous TB tretment, site of disese nd dignostic method ccording to the WHO definitions, Europen Region, New nd relpse TB cses Country/re cses cses N (%) Lortoryconfirmed dignosed Pulmonryd Cliniclly Extrpulmonry c N (%) e Previously treted All TB N (%) g N (%) g N (%) e N (%) c N EU/EEA Austri Belgium h Bulgri 356 (25.3) Croti Cyprus Czech Repulic Denmrk h Estoni 7 (4.1) Finlnd Frnce Germny Greece Hungry Icelnd Irelnd h Itly Ltvi 3 (5.5) Liechtenstein Lithuni 12 (8.) Luxemourg Mlt Netherlnds Norwy h Polnd Portugl Romni (15.8) Slovki Sloveni Spin Sweden United Kingdom h Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni 189 (22.5) Azerijn 1 24 (19.6) Belrus 214 (7.7) Bosni nd Herzegovin Georgi Isrel 63 (26.9) Kzkhstn Kyrgyzstn (23.6) Monco Montenegro 5 (6.7) North Mcedoni 45 (2.8) Repulic of Moldov (87.) Russin Federtion Sn Mrino Seri Seri excluding Kosovo i Kosovo i Switzerlnd Tjikistn Turkey 4 54 (34.3) Turkmenistn 48 (24.4) Ukrine (9.2) Uzekistn (33.6) Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. WHO (215). Definitions nd reporting frmework for tuerculosis revision, updted Decemer 214. Genev: World Helth Orgniztion ( int/t/pulictions/definitions/en/). Cses with unknown previous TB history re included mong new TB cses. c mong ll TB cses. d For the EU/EEA countries, cses with no disese site reported re included mong pulmonry TB cses. e mong ll new nd relpse TB cses. f Confirmed y culture, smer nd/or nucleic cid mplifiction test. Microscopy results from ny specimen re included for EU/EEA countries. g mong ll new nd relpse pulmonry TB cses. h Previous TB history is defined y previous dignosis. i (In ccordnce with Security Council Resolution 1244 (1999)). 54

63 Tle 8. TB cses ccording to EU cse definition, EU/EEA, Country Meeting only the smer-positive nd nucleic cid testpositive criterion All lortory-confirmed cses Meeting only the culture-positive criterion Meeting oth criteri Confirmed cses Prole cses Possile cses N (%) c N (%) c N (%) c N (%) d N (%) d N (%) d Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Totl EU/EEA Note: WHO Europen Region TB HPCs re presented in itlics. HPCs = high-priority countries. Lortory-confirmed TB cses ccording to the EU cse definition. Culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive. c mong ll lortory-confirmed TB cses. d mong ll TB cses. All TB cses (N) 55

64 Tle 9. New TB cses nd relpses, y ge group nd mle-to-femle rtio, Europen Region, Country/re N (%) Rte per 1 M/F rtio N (%) Rte per 1 M/F rtio N (%) Rte per 1 M/F rtio N (%) Rte per 1 EU/EEA Austri Belgium Bulgri Croti N/F Cyprus N/F N/F Czech Repulic N/F Denmrk N/F Estoni Finlnd Frnce Germny Greece Hungry N/F N/M Icelnd Irelnd Itly Ltvi Liechtenstein N/F Lithuni Luxemourg N/M N/F Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni N/F Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. M = mle. F = femle. N/F = no femle in sugroup. N/M = no mle in sugroup. Cses with unknown previous TB history re included mong new TB cses. Previous TB history is defined y previous dignosis. c (In ccordnce with Security Council Resolution 1244 (1999)). M/F rtio 56

65 N (%) > 64 Totl Rte per 1 M/F rtio N (%) Rte per 1 M/F rtio N (%) Rte per 1 Country/re EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd N/F Frnce Germny N/F Greece Hungry N/F N/F Icelnd Irelnd Itly Ltvi N/F Liechtenstein Lithuni Luxemourg N/F Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs N M/F rtio 57

66 Tle 1. TB cses y origin, Europen Region, Country/re Origin criterion Ntive Foreign origin All TB cses N (%) N (%) N (%) N EU/EEA Austri Citizenship Belgium Citizenship Bulgri Birthplce Croti Birthplce Cyprus Birthplce Czech Repulic Birthplce Denmrk Birthplce Estoni Birthplce Finlnd Birthplce Frnce Birthplce Germny Birthplce Greece Citizenship Hungry Citizenship Icelnd Birthplce Irelnd Birthplce Itly Birthplce Ltvi Birthplce Liechtenstein Birthplce Lithuni Birthplce Luxemourg Birthplce Mlt Birthplce Netherlnds Birthplce Norwy Birthplce Polnd Citizenship Portugl Birthplce Romni Birthplce Slovki Birthplce Sloveni Birthplce Spin Birthplce Sweden Birthplce United Kingdom Birthplce Sutotl EU/EEA Non-EU/EEA Alni Citizenship Andorr Citizenship Armeni Citizenship Azerijn Citizenship Belrus Citizenship Bosni nd Herzegovin Birthplce Georgi Citizenship Isrel Birthplce Kzkhstn Citizenship Kyrgyzstn Birthplce Monco Birthplce Montenegro Citizenship North Mcedoni Birthplce Repulic of Moldov Citizenship Russin Federtion Citizenship Sn Mrino Seri Seri excluding Kosovo Citizenship Kosovo Birthplce Switzerlnd Birthplce Tjikistn Birthplce Turkey Birthplce Turkmenistn Citizenship Ukrine Citizenship Uzekistn Birthplce Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. (In ccordnce with Security Council Resolution 1244 (1999)). 58

67 Tle 11. Drug resistnce surveillnce of cteriologiclly confirmed pulmonry TB cses, Europen Region, Country/re Source of dt Coverge Bcteriologicllyconfirmed cses Cses with DST results t lest for RIF c nd INH d Cses resistnt to ny nti-tb drug e Multidrug-resistnt TB cses Reporting completeness f N (%) N (%) N (%) N (%) EU/EEA Austri TESSy g Ntionl Y Belgium TESSy Ntionl Y Bulgri TESSy Ntionl Y Croti TESSy Ntionl Y Cyprus TESSy Ntionl Y Czech Repulic TESSy Ntionl Y Denmrk TESSy Ntionl Y Estoni TESSy Ntionl Y Finlnd TESSy Ntionl Y Frnce Germny TESSy Ntionl Y Greece TESSy Ntionl Y Hungry TESSy Ntionl Y Icelnd TESSy Ntionl Y Irelnd TESSy Ntionl Y Itly h NRL-TME i Prtil N Ltvi TESSy Ntionl Y Liechtenstein TESSy Ntionl Y Lithuni TESSy Ntionl Y Luxemourg TESSy Ntionl Y Mlt TESSy Ntionl Y Netherlnds TESSy Ntionl Y Norwy TESSy Ntionl Y Polnd TESSy Ntionl Y Portugl TESSy Ntionl Y Romni TESSy Ntionl Y Slovki TESSy Ntionl Y Sloveni TESSy Ntionl Y Spin TESSy Ntionl Y Sweden TESSy Ntionl Y United Kingdom TESSy Ntionl Y Sutotl EU/EEA Non-EU/EEA Alni NRL-TME Ntionl N Andorr NRL-TME Ntionl Y Armeni NRL-TME Ntionl Y Azerijn NRL-TME Ntionl N Belrus NRL-TME Ntionl Y Bosni nd Herzegovin NRL-TME Ntionl N Georgi NRL-TME Ntionl Y Isrel NRL-TME Ntionl Y Kzkhstn NRL-TME Ntionl N Kyrgyzstn NRL-TME Ntionl N Monco NRL-TME Ntionl Y Montenegro North Mcedoni NRL-TME Ntionl Y Repulic of Moldov NRL-TME Ntionl N Russin Federtion NRL-TME Ntionl Y Sn Mrino Y Seri Ntionl N Seri excluding Kosovo j NRL-TME Ntionl N Kosovo j Ntionl N Switzerlnd NRL-TME Ntionl Y Tjikistn NRL-TME Suntionl N Turkey NRL-TME Ntionl N Turkmenistn NRL-TME Y Ukrine NRL-TME Ntionl Y Uzekistn NRL-TME Suntionl N Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. Bcteriologiclly confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu/eea countries nd res. For EU/EEA countries: cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy. DST = drug-susceptiility testing. c RIF = rifmpicin. d INH = isonizid. e For non-eu/eea countries nd res ny resistnce to isonizid, rifmpicin, ethmutol or streptomycin expressed s percentge of cses with DST results ville for t lest isonizid nd rifmpicin. No routine testing for ethmutol nd streptomycin in ll countries. For EU/EEA countries, cses with DST results for t lest RIF nd INH tht hve ny resistnce to isonizid, rifmpicin, ethmutol, streptomycin, ciprofloxcin, gtifloxcin, levofloxcin, moxifloxcin, ofloxcin, mikcin, cpreomycin, knmycin or pyrzinmide expressed s percentge of cses with DST results ville for t lest isonizid nd rifmpicin. f Dt considered complete when collected ntionwide OR culture results externl qulity ssessment results confirmed y suprntionl reference lortory. g TESSy = the Europen Surveillnce System. h Dt from Itly re reported y the Ntionl Reference Lortory (NRL) nd my differ from dt shown elsewhere in this report. i TME = the WHO glol TB dt collection system. j (In ccordnce with Security Council Resolution 1244 (1999)). 59

68 Tle 12. Drug resistnce surveillnce of cteriologiclly confirmed pulmonry TB cses y previous TB tretment history, Europen Region, Country/re 6 Cses with DST results New... Previously treted... cteriologiclly pulmonry TB Cses with DST cteriologiclly MDR-TB cses confirmed cses results MDR-TB cses confirmed pulmonry TB pulmonry TB cses cses pulmonry TB cses N (%) c N (%) d N (%) e N (%) f N (%) c N (%) d N (%) e N (%) f EU/EEA Austri Belgium k Bulgri Croti Cyprus Czech Repulic Denmrk k Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd k Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy k Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom k Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo l Kosovo l Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. Bcteriologiclly confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu/eea countries nd res. For EU/EEA countries: culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses. Previous tretment unknown pulmonry TB cses re excluded. c mong cteriologiclly confirmed pulmonry cses with DST results nd the respective previous TB tretment history. d mong ll pulmonry TB cses with DST results nd the respective previous TB tretment history. e mong ll pulmonry TB cses with the respective previous TB tretment history. f mong ll pulmonry TB cses. For EU/EEA, excluding the cses with unknown previous tretment history.

69 Cses with DST results MDR-TB cses Totl... All cteriologiclly confirmed pulmonry TB cses All pulmonry TB cses Country/re EU/EEA Austri Belgium k Bulgri Croti Cyprus Czech Repulic Denmrk k Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd k Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy k Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom k Sutotl EU/EEA Non EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo l Kosovo l Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs g mong ll cteriologiclly confirmed pulmonry cses with DST results. For EU/EEA, excluding the cses with unknown previous tretment history. h mong ll pulmonry TB cses with DST results. For EU/EEA excluding the cses with unknown previous tretment history. i mong ll pulmonry TB cses. For EU/EEA excluding the cses with unknown previous tretment history. j mong ll TB cses. k Previous TB history is defined y previous dignosis. l (In ccordnce with Security Council Resolution 1244 (1999)). 61

70 Tle 13. Drug resistnce in ll lortory-confirmed TB cses, EU/EEA, Country Source of dt Coverge Lortory-confirmed TB cses Cses with DST results (t lest INH nd RIF) Cses resistnt to ny nti-tb drug Multidrug-resistnt TB cses Reporting completeness c N (%) N (%) N (%) N (%) EU/EEA Austri TESSy Ntionl Y Belgium TESSy Ntionl Y Bulgri TESSy Ntionl Y Croti TESSy Ntionl Y Cyprus TESSy Ntionl Y Czech Repulic TESSy Ntionl Y Denmrk TESSy Ntionl Y Estoni TESSy Ntionl Y Finlnd TESSy Ntionl Y Frnce Germny TESSy Ntionl Y Greece TESSy Ntionl Y Hungry TESSy Ntionl Y Icelnd TESSy Ntionl Y Irelnd TESSy Ntionl Y Itly Ltvi TESSy Ntionl Y Liechtenstein TESSy Ntionl Y Lithuni TESSy Ntionl Y Luxemourg TESSy Ntionl Y Mlt TESSy Ntionl Y Netherlnds TESSy Ntionl Y Norwy TESSy Ntionl Y Polnd TESSy Ntionl Y Portugl TESSy Ntionl Y Romni TESSy Ntionl Y Slovki TESSy Ntionl Y Sloveni TESSy Ntionl Y Spin TESSy Ntionl Y Sweden TESSy Ntionl Y United Kingdom TESSy Ntionl Y Totl EU/EEA Note: WHO Europen Region TB HPCs re presented in itlics. HPCs = high-priority countries. TESSy = The Europen Surveillnce System. DST = drug-susceptiility testing. NH = isonizid. RIF = rifmpicin. Lortory-confirmed cses culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses. Cses with DST results for t lest RIF nd INH tht hve ny resistnce to isonizid, rifmpicin, ethmutol, streptomycin, ciprofloxcin, gtifloxcin, levofloxcin, moxifloxcin, ofloxcin, mikcin, cpreomycin, knmycin or pyrzinmide expressed s percentge of cses with DST results ville for t lest isonizid nd rifmpicin. c 62

71 Tle 14. XDR-TB cses mong ll lortory-confirmed MDR-TB cses, Europen Region, TB cses with MDR-TB mong ll TB cses Country/re first-line DST with first-line DST MDR-TB with second-line DST c XDR-TB N N (%) N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo d Kosovo d Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. DST = drug susceptiility testing. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. XDR-TB = extensively drug-resistnt tuerculosis. Bcteriologiclly-confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu countries nd res, culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses for EU/EEA countries. First-line DST drug susceptiility tested for t lest two min first-line nti-tb drugs: isonizid nd rifmpicin. c Second-line DST drug susceptiility testing for second-line nti-tb drugs (t lest one fluoroquinolone (ciprofloxcin, gtifloxcin, levofloxcin, moxifloxcin nd ofloxcin) nd one injectle drug (mikcin, cpreomycin nd knmycin)). d (In ccordnce with Security Council Resolution 1244 (1999)). 63

72 Tle 15. RR/MDR- nd XDR-TB cses enrolled to tretment, Europen Region, Country/re Totl numer of RR/MDR-TB cses detected RR/MDR-TB cses enrolled on tretment Totl numer of XDR-TB cses detected XDR-TB cses enrolled on tretment N N (%) N N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. RR/MDR-TB = rifmpicin-resitnt nd multidrug-resistnt tuerculosis. XDR-TB = extensively drug-resistnt tuerculosis. For countries/res tht do not provide informtion on tretment strt, ll reported cses re used s proxy. For some non-eu/eea countries nd res, ptients who were dignosed efore ut strted on tretment in re included, resulting in over 1% coverge. c (In ccordnce with Security Council Resolution 1244 (1999)). 64

73 Tle 16. New nd relpse TB cses with HIV infection, Europen Region, New nd relpse Country/re cses TB cses with known HIV-sttus HIV-positive TB cses HIV-positive cses strted ART c N N (%) N (%) N (%) EU/EEA Austri Belgium d Bulgri Croti Cyprus Czech Repulic Denmrk d Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd d Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy d Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom d Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion e Sn Mrino Seri Seri excluding Kosovo f Kosovo f Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn g Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. ART = ntiretrovirl therpy. HIV = humn immunodeficiency virus. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. Countries/res re only included in this nlysis if the totl numer of cses tested for HIV nd test results re provided. For EU/EEA countries, countries re only included in this nlysis if the totl numer of cses tested for HIV is more thn zero. c Dt from WHO glol TB dtse. s clculted for countries tht reported dt on ART. d Previous TB history is defined y previous dignosis. e The Russin Federtion reported dt on new TB cses in the civilin popultion only. f (In ccordnce with Security Council Resolution 1244 (1999)). g Uzekistn reported dt mong ll TB cses. 65

74 Tle 16. All TB cses with HIV infection, EU/EEA, Country All TB cses TB cses with known HIV sttus HIV-positive TB cses N N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Totl EU/EEA Note: WHO Europen Region TB HPCs re presented in itlics. HIV = humn immunodeficiency virus. HPCs = high-priority countries. Countries re only included in this nlysis if the totl numer of cses tested for HIV is more thn zero. 66

75 Tle 17. TB in prisons, Europen Region, Country/re New nd relpsed TB cses (ll forms) Prison popultion Proportion of new nd notified in prisons relpsed TB cses TB reltive risk in Rte per 1 in prisons out of the prisons N N prisoners country totl (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. HPCs = high-priority countries. Dt from the WHO Glol TB dtse. In the clcultion of summry results, only countries/res reporting dt on prison popultion nd TB notifiction in prisons re included. c (In ccordnce with Security Council Resolution 1244 (1999)). 67

76 Tle 18. Tretment outcome of ll TB cses notified in 216, Europen Region, Country/re TB cses notified in Success Died Filed Lost to follow-up Still on tretment Not evluted 216 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. HPCs = high-priority countries. In previous reports defined s "defulted". In previous reports defined s "trnsferred out nd unknown". c (In ccordnce with Security Council Resolution 1244 (1999)). 68

77 Tle 19. Tretment outcome of new TB cses nd relpses notified in 216, Europen Region, New nd Country/re relpsed TB cses notified Success Died Filed Lost to follow-up c Still on tretment Not evluted d in 216 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium e Bulgri Croti Cyprus Czech Repulic Denmrk e Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd e Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy e Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom e Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo f Kosovo f Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. For non-eu/eea countries: Ptients strted on second-line tretment re excluded. For EU/EEA countries: Rifmpicin-resistnt TB cses re excluded. c In previous reports clssified s "defulted". d In previous reports defined s "trnsferred out nd unknown". e Previous TB history is defined y previous dignosis. f (In ccordnce with Security Council Resolution 1244 (1999)). 69

78 Tle 2. Tretment outcome of new nd relpse TB cses in children ( 14 yers) notified in 216, Europen Region, New nd relpse Success Died Filed Lost to follow-up c Still on tretment Not evluted d Country/re TB cses reported in 216 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium e Bulgri Croti Cyprus Czech Repulic Denmrk e Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd e Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy e Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom e Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo f Kosovo f Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. For non-eu/eea countries: Ptients strted on second-line tretment re excluded. For EU/EEA countries: Rifmpicin-resistnt TB cses re excluded. c In previous reports defined s "defulted". d In previous reports defined s "trnsferred out nd unknown". e Previous TB history is defined y previous dignosis. f (In ccordnce with Security Council Resolution 1244 (1999)). 7

79 Tle 21. Tretment outcome of HIV-positive new nd relpse TB cses notified in 216, Europen Region, HIV positive Country/re TB cses notified in Success Died Filed Lost to follow-up c Still on tretment Not evluted d 216 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium e Bulgri Croti Cyprus Czech Repulic Denmrk e Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd e Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy e Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom e Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo f Kosovo f Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome or HIV sttus re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HIV = humn immunodeficiency virus. HPCs = high-priority countries. Cses with unknown previous TB history re included mong new TB cses. For non-eu/eea countries: Ptients strted on second-line tretment re excluded. For EU/EEA countries: Rifmpicin-resistnt TB cses re excluded. c In previous reports defined s "defulted". d In previous reports defined s "trnsferred out nd unknown". e Previous TB history is defined y previous dignosis. f (In ccordnce with Security Council Resolution 1244 (1999)). 71

80 Tle 22. Tretment outcome fter 24 months of RR/MDR-TB cses strted on second-line tretment in 215, Europen Region, RR/MDR-TB cses strted Success Died Filed Lost to follow-up Still on tretment Not evluted c Country/re on secondline tretment in 215 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo d Kosovo d (1.) (.) (.) (.) (.) Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. RR/MDR-TB = rifmpicin-resistnt nd multidrug-resistnt tuerculosis. For EU/EEA countries, cses dignosed postmortem re excluded, nd cses with no tretment enrolment dt reported re ssumed to e enrolled to tretment. In previous reports defined s "defulted". c In previous reports defined s "trnsferred out nd unknown". d (In ccordnce with Security Council Resolution 1244 (1999)). 72

81 Tle 23. Tretment outcome fter 24 months of lortory-confirmed MDR-TB cses notified in 215, EU/EEA, All MDR-TB Success Died Filed Lost to follow-up Still on tretment Not evluted c Country cses notified in 215 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Totl EU/EEA Notes: WHO Europen Region TB HPCs re presented in itlics. Country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. Lortory-confirmed cses culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses. In previous reports defined s "defulted". c In previous reports defined s "trnsferred out nd unknown". 73

82 Tle 24. Tretment outcome fter 24 months of XDR-TB cses strted on second-line tretment in 215, Europen Region, XDR-TB cses strted on Success Died Filed Lost to follow up Still on tretment Not evluted c Country/re second line tretment in 215 N (%) N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo d Kosovo d Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non EU/EEA Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB high-priority countries re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. XDR TB = extensively drug-resistnt tuerculosis. For EU/EEA countries, cses dignosed postmortem re excluded, nd cses with no tretment enrolment dt reported re ssumed to e enrolled to tretment. In previous reports defined s "defulted". c In previous reports defined s "trnsferred out nd unknown". d (In ccordnce with Security Council Resolution 1244 (1999)). 74

83 Tle 25. Tretment outcome fter 36 months of XDR-TB notified in 214, EU/EEA, Country XDR-TB notified in Success Died Filed Lost to follow-up Not evluted 214 N (%) N (%) N (%) N (%) N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Totl EU/EEA Notes: WHO Europen Region TB HPCs re presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. XDR TB = extensively drug-resistnt tuerculosis. In previous reports defined s "defulted". In previous reports defined s "trnsferred out nd unknown". 75

84

85 7. Trend tles 77

86 Tle I. Estimted TB mortlity per 1 popultion, Europen Region, 28 Country N Rte per 1 N Rte per 1 N Rte per 1 N Rte per 1 N Rte per 1 N Rte per 1 EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. Excludes HIV coinfected cses. 78

87 N Men nnul % chnge Rte per Rte per Rte per Rte per in rte, 1 N 1 N 1 N 1 Men nnul % chnge in rte, 28 EU/EEA -13.6% -3.2% Austri 1.9% -3.1% Belgium Bulgri -7.1% -9.1% Croti 18.9% 7.1% Cyprus -1.7% -2.9% Czech Repulic 1.7%.% Denmrk Estoni -5.1% -9.% Finlnd -1.8% -7.4% Frnce -4.% -1.8% Germny -12.7% -6.7% Greece -13.9% -12.9% Hungry -1.% Icelnd 1.% -3.6% Irelnd 6.1% -1.8% Itly Ltvi Liechtenstein Lithuni Luxemourg -1.9% 7.5% Mlt -5.9% -6.2% Netherlnds -13.9% -9.7% Norwy -5.4% -7.% Polnd -2.4% -2.4% Portugl Romni 13.9% -2.3% Slovki 7.6% -11.1% Sloveni -4.2% -4.% Spin -12.8% -1.3% Sweden -.5% -3.2% United Kingdom -5.8% -5.7% Sutotl EU/EEA Non-EU/EEA.% -6.5% Alni Andorr Armeni Azerijn Belrus -2.5% -3.1% Bosni nd Herzegovin -2.2%.4% Georgi Isrel Kzkhstn Kyrgyzstn -1.% -1.% Monco.% -11.8% Montenegro.% -9.% North Mcedoni -1.5% -1.2% Repulic of Moldov -11.7% -1.1% Russin Federtion Sn Mrino -15.9% -1.3% Seri -4.5% -8.6% Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn -1.5% -1.7% Sutotl non-eu/eea -1.2% -9.3% Totl Europen Region Sutotl 18 HPCs Country 79

88 Tle II. Estimted TB incidence per 1 popultion, Europen Region, 28 Country N Rte per 1 N Rte per 1 N Rte per 1 N Rte per 1 N Rte per 1 N Rte per 1 EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. 8

89 N Men nnul % chnge Rte per N Rte per N Rte per N Rte per in rte, Men nnul % chnge in rte, 28 EU/EEA -3.1% -3.3% Austri -.3% -.9% Belgium Bulgri -8.1% -1.1% Croti 5.6%.% Cyprus 1.4% -5.4% Czech Repulic -6.6% -3.3% Denmrk Estoni -3.3% -4.2% Finlnd.3% -2.2% Frnce 6.2% 2.7% Germny -2.6% -3.% Greece -1.5% -7.8% Hungry 3.6% 8.3% Icelnd -4.3% -4.5% Irelnd 6.3% -.9% Itly Ltvi Liechtenstein Lithuni -5.8% -.5% Luxemourg -5.9% -1.8% Mlt -2.3% -2.8% Netherlnds -11.2% -3.8% Norwy -5.1% -2.8% Polnd -6.3% -4.4% Portugl Romni -13.1% -9.7% Slovki -5.3% -7.1% Sloveni -4.1% -5.9% Spin -6.% -1.3% Sweden -9.% -5.6% United Kingdom -3.9% -4.3% Sutotl EU/EEA Non-EU/EEA 1.3% 2.5% Alni -32.2% -13.4% Andorr Armeni Azerijn Belrus -11.5% -8.% Bosni nd Herzegovin Georgi -8.2% -5.3% Isrel Kzkhstn Kyrgyzstn -1.% -1.% Monco -1.7% -5.8% Montenegro -9.1% -7.8% North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino -8.4% -6.3% Seri 2.2%.3% Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn -5.1% -4.9% Sutotl non-eu/eea -4.7% -4.7% Totl Europen Region Sutotl 18 HPCs Country 81

90 Tle III. TB cses in children under 15 yers, Europen Region, Country/re N mong ll TB cses Rte per N mong ll TB cses Rte per N mong ll TB cses Rte per N mong ll TB cses Rte per N mong ll TB cses EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. For non-eu/eea countries nd res, new nd relpse cses under 15 yers of ge re included; for EU/EEA countries, ll TB cses under 15 yers of ge re included. For the purposes of this puliction, ll references to "Kosovo" in the tles nd nnexes, should e understood/red s "Kosovo (in ccordnce with Security Council resolution 1244 (1999))". Rte per 82

91 83

92 Tle IV. TB cses y origin, Europen Region, Country/re N Foreign mong ll TB N Ntive mong ll TB origin N mong ll TB All TB cses (N) N Foreign mong ll TB N Ntive mong ll TB origin N mong ll TB All TB cses (N) N Foreign mong ll TB N Ntive mong ll TB origin N mong ll TB All TB cses (N) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov 39 (.8) 5 12 (99.2) 5 51 (.) (1.) Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. Origin is defined s ntionlity (citizenship), nd if not reported it is defined s country of irth. (In ccordnce with Security Council Resolution 1244 (1999)). 84

93 216 N Foreign mong ll TB N Ntive mong ll TB origin N mong ll TB All TB cses (N) N Foreign mong ll TB N Ntive mong ll TB origin N mong ll TB All TB cses (N) Country EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs 85

94 Tle V. MDR-TB notifiction mong new cteriologiclly confirmed pulmonry TB cses with ville DST results, Europen Region, Country/re N % Men nnul Rte per 1 N % Rte per 1 N % Rte per 1 N % Rte per 1 N % Rte per 1 EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. DST = drug-susceptiility testing. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. Bcteriologiclly confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu/eea countries nd res, culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses for EU/EEA countries. Previous TB history is defined s previous dignosis. c (In ccordnce with Security Council Resolution 1244 (1999)). % chnge in rte, 86

95 Tle VI. MDR-TB notifiction mong previously treted cteriologiclly confirmed pulmonry TB cses with ville DST results, Europen Region, Country/re N % Men nnul Rte per 1 N % Rte per 1 N % Rte per 1 N % Rte per 1 N % Rte per 1 EU/EEA Austri -32.% Belgium 18.4% Bulgri -5.3% Croti Cyprus -1.% Czech Repulic Denmrk -1.% Estoni -2.4% Finlnd Frnce Germny -11.5% Greece -15.5% Hungry.3% Icelnd Irelnd Itly 11.5% Ltvi -1.1% Liechtenstein Lithuni 1.6% Luxemourg Mlt Netherlnds -36.4% Norwy -1.% Polnd -9.6% Portugl -32.8% Romni -1.4% Slovki -.1% Sloveni Spin -19.% Sweden -16.8% United Kingdom -18.9% Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni 15.2% Azerijn -11.7% Belrus -6.4% Bosni nd Herzegovin -1.% Georgi -9.% Isrel -1.5% Kzkhstn -31.3% Kyrgyzstn -7.% Monco Montenegro North Mcedoni -.1% Repulic of Moldov -24.9% Russin Federtion 21.% Sn Mrino Seri.4% Seri excluding Kosovo c Kosovo c Switzerlnd -3.% Tjikistn Turkey -14.1% Turkmenistn Ukrine -7.5% Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. DST = drug-susceptiility testing. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. Bcteriologiclly-confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu/eea countries nd res, culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses for EU/EEA countries. Previous TB history is defined s previous dignosis. c (In ccordnce with Security Council Resolution 1244 (1999)). % chnge in rte, 87

96 Tle VII. MDR-TB notifiction mong ll cteriologiclly confirmed TB cses with ville DST results, Europen Region, Country/re N % Men nnul Rte per 1 N % Rte per 1 N % Rte per 1 N % Rte per 1 N % Rte per 1 EU/EEA Austri 2.% Belgium -21.6% Bulgri -2.3% Croti Cyprus.3% Czech Repulic Denmrk -.6% Estoni -9.6% Finlnd Frnce Germny 1.4% Greece -8.% Hungry 2.7% Icelnd Irelnd Itly -4.5% Ltvi -11.8% Liechtenstein Lithuni.4% Luxemourg Mlt -1.% Netherlnds -11.5% Norwy 9.6% Polnd 2.5% Portugl -9.3% Romni -1.7% Slovki 18.8% Sloveni Spin -13.4% Sweden 7.1% United Kingdom -11.4% Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni -2.1% Azerijn -.2% Belrus -4.7% Bosni nd Herzegovin -1.% Georgi Isrel -1.5% Kzkhstn -7.7% Kyrgyzstn 2.7% Monco Montenegro North Mcedoni -.1% Repulic of Moldov Russin Federtion Sn Mrino Seri -2.2% Seri excluding Kosovo Kosovo Switzerlnd -1.% Tjikistn Turkey.9% Turkmenistn Ukrine -9.4% Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. Dt for non-eu/eea countries nd res includes ll confirmed RR/MDR-TB cses. DST = drug-susceptiility testing. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. Bcteriologiclly-confirmed cses cses with positive identifiction for M. tuerculosis complex confirmed y culture nd/or line proe ssy for non-eu/eea countries nd res, culture-positive OR microscopy-positive nd nucleic cid mplifiction test-positive cses for EU/EEA countries. (In ccordnce with Security Council Resolution 1244 (1999)). % chnge in rte, 88

97 Tle VIII. XDR-TB notifiction mong pulmonry MDR-TB cses with second-line DST results, Europen Region, Country/re MDR-TB tested for SLD (N) Percent- XDR-TB ge MDR-TB Percent- (N) mong tested XDR-TB ge MDR-TB Percenttested for SLD (N) mong tested XDR-TB ge MDR-TB Percentfor SLD (N) tested for SLD (N) mong tested XDR-TB ge MDR-TB for SLD (N) tested for SLD (N) mong tested XDR-TB for SLD (N) tested for SLD (N) for SLD (N) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. DST = drug-susceptiility testing. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. SLD = susceptiility to second-line nti-tb drugs. XDR-TB = extensively drug-resistnt tuerculosis. Includes only countries reporting second-line nti-tb testing for t lest one fluoroquinolone (ciprofloxcin, gtifloxcin, levofloxcin, moxifloxcin, nd ofloxcin) nd one injectle drug (mikcin, cpreomycin, nd knmycin). (In ccordnce with Security Council Resolution 1244 (1999)). mong tested for SLD 89

98 Tle IX. TB cses with HIV infection, Europen Region, Country/re All TB Cses with known cses HIV sttus HIV positive All TB Cses with known cses HIV sttus HIV positive All TB Cses with known cses HIV sttus HIV positive (N) N % N % (N) N % N % (N) N % N % EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HIV = humn immunodeficiency virus. HPCs = high-priority countries. HIV prevlence my e underestimted due to incomplete HIV testing nd/or reporting of HIV serosttus. Countries/res were only included in this nlysis if the totl numer of cses tested for HIV nd test results were provided. s clculted from TB cses with known HIV test results. c (In ccordnce with Security Council Resolution 1244 (1999)). 9

99 N % N % N % N % 216 All TB Cses with known cses HIV sttus HIV positive All TB Cses with known cses HIV sttus HIV positive Country (N) (N) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo c Kosovo c Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs 91

100 Tle X. Tretment success fter 12 months for new TB cses nd relpses, Europen Region, Success Country/re Cses Success Cses Success Cses Success Cses Success reported N (%) Cses reported N (%) reported N (%) reported N (%) reported N (%) EU/EEA Austri Belgium c Bulgri Croti Cyprus Czech Repulic Denmrk c Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd c Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy c Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom c Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo d Kosovo d Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. For EU/EEA countries, cses with unknown TB history re considered s new cses. Excluding rifmpicin-resistnt cses. c Previous TB history is defined s previous dignosis. d (In ccordnce with Security Council Resolution 1244 (1999)). 92

101 Tle XI. Tretment success fter 12 months of ll TB cses, Europen Region, Success Country/re Cses Success Cses Success Cses Success Cses Success reported N (%) Cses reported N (%) reported N (%) reported N (%) reported N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. (In ccordnce with Security Council Resolution 1244 (1999)). 93

102 Tle XII. Tretment success fter 24 months of RR/MDR-TB cses strted on tretment, Europen Region, Success Country/re Cses Success Cses Success Cses Success Cses Success reported N (%) Cses reported N (%) reported N (%) reported N (%) reported N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. MDR-TB = multidrug-resistnt tuerculosis. RR-TB = rifmpicin-resistnt tuerculosis. For EU/EEA countries, cses dignosed postmortem were excluded, nd cses with no dt on tretment enrolment were ssumed to e enrolled to tretment. (In ccordnce with Security Council Resolution 1244 (1999)). 94

103 Tle XIII. Tretment success fter 24 months of XDR-TB cses strted on tretment, Europen Region, Country/re XDR-TB Success XDR-TB Success XDR-TB Success MD-TB Success XDR-TB Success cses N (%) cses N (%) cses N (%) cses N (%) cses N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo Kosovo Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. XDR-TB = extensively drug-resistnt tuerculosis. For EU/EEA countries, cses dignosed postmortem re excluded, nd cses with no tretment enrolment dt reported re ssumed to e enrolled to tretment. (In ccordnce with Security Council Resolution 1244 (1999)). 95

104 Tle XIV. Tretment success fter 36 months of XDR-TB cses notified in EU/EEA, Country XDR-TB Success XDR-TB Success XDR-TB Success XDR-TB Success XDR-TB Success cses N (%) cses N (%) cses N (%) cses N (%) cses N (%) EU/EEA Austri Belgium Bulgri Croti Cyprus Czech Repulic Denmrk Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom Totl EU/EEA Notes: WHO Europen Region TB HPCs presented in itlics. EU/EEA: country dt re shown s missing ( ) when dt on tretment outcome re not reported. For inclusion in the cohort, drug-susceptiility dt re lso required. HPCs = high-priority countries. XDR-TB = extensively drug-resistnt tuerculosis. 96

105 Tle XV. New nd relpse TB cses tested using WRD such s Xpert MTB/RIF, Europen Region, New nd New nd New nd Country/re relpse Cses tested using relpse Cses tested using relpse Cses tested using TB cses WRD cd TB cses WRD c TB cses WRD c reported reported reported N N (%) N N (%) N N (%) EU/EEA Austri Belgium e Bulgri Croti Cyprus Czech Repulic Denmrk e Estoni Finlnd Frnce Germny Greece Hungry Icelnd Irelnd e Itly Ltvi Liechtenstein Lithuni Luxemourg Mlt Netherlnds Norwy e Polnd Portugl Romni Slovki Sloveni Spin Sweden United Kingdom e Sutotl EU/EEA Non-EU/EEA Alni Andorr Armeni Azerijn Belrus Bosni nd Herzegovin Georgi Isrel Kzkhstn Kyrgyzstn Monco Montenegro North Mcedoni Repulic of Moldov Russin Federtion Sn Mrino Seri Seri excluding Kosovo f Kosovo f Switzerlnd Tjikistn Turkey Turkmenistn Ukrine Uzekistn Sutotl non-eu/eea Totl Europen Region Sutotl 18 HPCs Notes: Europen Region comprises the 53 countries of the WHO Europen Region nd Liechtenstein. WHO Europen Region 18 TB HPCs presented in itlics. HPCs = high-priority countries. WRD = WHO-recommended rpid dignostics. WHO (). Automted rel-time nucleic cid mplifiction technology for rpid nd simultneous detection of tuerculosis nd rifmpicin resistnce. Xpert MTB/RIF ssy for the dignosis of pulmonry nd extrpulmonry TB in dults nd children: policy updte. Genev: World Helth Orgniztion; (WHO/HTM/TB/.16; Cses with unknown previous TB history re included mong new TB cses. c All nucleic cid mplifiction tests re counted s "tested using WHO-recommended rpid dignostics" for EU/EEA countries. d Non-EU/EEA countries nd res reporting zero coverge with the WRD does not necessrily men they do not do the testing; some of them experience technicl difficulties in reporting ctul testing coverge. e Previous TB history is defined s previous dignosis. f (In ccordnce with Security Council Resolution 1244 (1999)). 97

106

107 99

108

109 11 Liechtenstein Andorr Luxemourg Mlt Monco Sn Mrino ES ES FR FR IE IE UK UK IS IS NO NO SE SE FI FI RU RU KZ KZ UZ UZ KG KG TJ TJ TM TM AZ AZ GE GE AM AM TR TR IL IL CY CY EL EL MT MT BG BG RO RO UA UA MD MD BY BY EE EE LV LV LT LT PL PL SK SK HU HU RS RS MK MK AL AL ME ME BA BA HR HR SI SI AT AT CZ CZ DE DE DK DK NL NL BE BE LU LU CH CH LI LI IT IT AD AD PT PT AD Andorr AL Alni AM Armeni AT Austri AZ Azerijn BA Bosni nd Herzegovin BE Belgium BG Bulgri BY Belrus CH Switzerlnd CY Cyprus CZ Czech Repulic DE Germny DK Denmrk EE Estoni EL Greece ES Spin FI Finlnd FR Frnce GE Georgi HR Croti HU Hungry IE Irelnd IL Isrel IS Icelnd IT Itly KG Kyrgyzstn KZ Kzkhstn LI Liechtenstein LT Lithuni LU Luxemourg LV Ltvi MD Repulic of Moldov ME Montenegro MK North Mcedoni MT Mlt NL Netherlnds NO Norwy PL Polnd PT Portugl RO Romni RS Seri RU Russin Federtion SE Sweden SI Sloveni SK Slovki TJ Tjikistn TM Turkmenistn TR Turkey UA Ukrine UK United Kingdom UZ Uzekistn

110

111 Alni Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry new nd relpse: of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt No Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 2 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 include new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 6 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 6 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, 28 7 New Retretment Totl numer of MDR-TB 6 1 Success Died Filed Not evluted Lost to follow-up No. of cses cohorts include new cses only. 13

112 Andorr Popultion estimte 216 y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 New nd relpsed TB cses notifiction rtes y ge group, 28 New nd relpses Other retretment Totl > Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, No MDR-TB cses reported Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 14

113 Armeni Popultion estimte 216 y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 99 of which XDR-TB cses 13 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 12 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 25 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB 25 1 Success Died Filed Not evluted Lost to follow-up No. of cses cohorts include new cses only. 15

114 Austri Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 5 No. of cses MDR-TB cses y previous tretment history, New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

115 Azerijn Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses 37.1 yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 1 7 of which XDR-TB cses 118 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl Bcteriologiclly confirmed new TB cses in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome of new TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up

116 Belrus Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 1117 of which XDR-TB cses 343 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 All MDR-TB cses enrolled into MDR tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 6 Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 7 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 18

117 Belgium Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 6 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 12 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

118 Bosni nd Herzegovin Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 5 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 2 Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 2 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB 12 1 Success Died Filed Not evluted Lost to follow up No. of cses cohorts include new cses only. 11

119 Bulgri Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 6 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 35 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

120 Croti Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

121 Cyprus Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 1 5 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

122 Czech Repulic Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 1 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

123 Denmrk Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

124 Estoni Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

125 Finlnd Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses New (not previously treted) Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses N, (est low high) Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 3 25 No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

126 Frnce Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting No Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 35 3 No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 16 1 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

127 Georgi Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 324 of which XDR-TB cses 46 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 New TB cses notifiction rtes y ge group, 28 2 New nd relpses Other retretment Totl > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died cohorts include new cses only. Filed Not evluted Lost to follow-up

128 Germny Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 5 4 No. of cses MDR-TB cses y previous tretment history, New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

129 Greece Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Dt not ville TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Dt not ville 121

130 Hungry Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 2 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 2 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 2 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 2 2 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

131 Icelnd Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 2 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 25 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 1 2 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

132 Irelnd Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 3 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 6 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

133 Isrel Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 8 of which XDR-TB cses 1 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Cses with unknown previous tretment included to new cses. Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 5 Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 6 No. of cses No. of cses Dt up to 214 includes ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB 2 1 Success Died Filed Not evluted Lost to follow-up No. of cses cohorts include new cses only. 125

134 Itly Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt No Completeness of HIV dt Cse-linked dt reporting No Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Dt not ville TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 3 25 No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 15 1 Tretment outcome, new culture-confirmed pulmonry TB cses, Dt not ville No. of cses

135 Kzkhstn Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, 216 Completeness of DRS dt No Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses TB cses tested for HIV Notified MDR-TB 299 of which XDR-TB cses HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 35 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 127

136 Kyrgyzstn Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 1 25 of which XDR-TB cses 127 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses - notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome of new TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 128

137 Ltvi Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 12 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

138 Liechtenstein Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses _ Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 1 New nd relpses Other retretment Totl New nd relpsed TB cses - notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 2 No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 1 2 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

139 Lithuni Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 3 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 3 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

140 Luxemourg Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Dt not ville TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 12 3 Tretment outcome, new culture-confirmed pulmonry TB cses, Dt not ville No. of cses

141 Mlt Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Dt not ville TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 5 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 6 No. of cses No. of cses By ntionlity for 2 26 MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

142 Montenegro Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 1 of which XDR-TB cses 1 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome of new TB cses, New Retretment Totl numer of MDR-TB 3 1 Success Died Filed Not evluted Lost to follow-up No. of cses cohorts include new cses only. 134

143 Netherlnds Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 1 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 14 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Defulted

144 North Mcedoni Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 5 Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 136

145 Norwy Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 5 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

146 Polnd Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 1 8 No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

147 Portugl Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 3 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 35 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

148 Repulic of Moldov Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 679 of which XDR-TB cses 32 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 6 Ntive Foreign origin 12 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 7 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 14

149 Romni Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses MDR-TB cses y previous tretment history, New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

150 Russi Federtion Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. UN Popultion Division estimtes re lower thn the popultion registered y the Federl Stte Sttistics Service of the Russin Federtion. New nd relpses efore strt of tretment. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 142

151 Seri Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt No Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / >64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 35 No. of cses No. of cses MDR-TB cses y previous tretment history, New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

152 Slovki Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 No. of cses Ntive Foreign origin HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 1 8 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

153 Sloveni Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 2 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 25 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB 1 3 Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

154 Spin Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 2 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 6 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 1 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB In, 215 nd 216, only pulmonry MDR-TB cses were reported. No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

155 Sweden Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 1 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 7 6 No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted No. of cses

156 Switzerlnd Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt No Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 9 of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 1 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 Ntive Foreign origin Dt not ville 5 No. of cses MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Still on tretment Lost to follow-up Filed Not evluted

157 Tjikistn Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt No Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 643 of which XDR-TB cses 122 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 1 Ntive Foreign origin 12 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 1 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died cohorts include new cses only. Filed Not evluted Lost to follow-up

158 Turkey Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 239 of which XDR-TB cses 2 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only > 64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 2 Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 2 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Still on tretment Lost to follow-up Filed Not evluted cohorts include new cses only. 15

159 Turkmenistn Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which smer-positive of which lortory-confirmed Lortory confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt No Completeness of HIV dt No Cse-linked dt reporting Cses with DST results 1 85 (1.%) Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 343 of which XDR-TB cses 6 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted 59 Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 Cses / New nd relpses Other retretment Totl 215 Strting from onwrd, cses with unknown history re included in new nd relpses. New nd relpsed TB cses notifiction rtes y ge group, 28 Cses / Dt up to 212 includes new TB cses only >64 TB cses y geogrphicl origin, 28 TB/HIV coinfection, Ntive Foreign origin Dt not ville No. of cses MDR-TB cses y previous tretment history, 28 Tretment outcome of new TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 151

160 Ukrine Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per1 New nd relpses New nd relpses notifiction rte per1 Pulmonry of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB 6 51 of which XDR-TB cses 1 97 TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, >64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 6 Ntive Foreign origin 12 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 152

161 United Kingdom Totl popultion t 23 April 218 y EUROSTAT: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 Pulmonry of which microscopy-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new ntive TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, Completeness of DRS dt Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New culture positive pulmonry TB cses notified in 216 All MDR-TB cses notified in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Still on tretment Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, >64 Cses / Cses / TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 7 Ntive Foreign origin 1 HIV testing coverge All TB cses Proportion of HIV-positive TB cses mong tested 1 No. of cses No. of cses MDR-TB cses y previous tretment history, 28 New Retretment Totl numer of MDR-TB No. of cses Tretment outcome, new culture-confirmed pulmonry TB cses, Success Died Still on tretment Lost to follow-up Filed Not evluted

162 Uzekistn Popultion estimte y UN Sttisticl Dtse: TB cse notifictions, Totl numer of cses Notifiction rte per 1 New nd relpses New nd relpses notifiction rte per 1 of which smer-positive of which lortory-confirmed Lortory-confirmed TB cses Men ge of new nd relpse TB cses yers Men ge of new foreign TB cses yers Foreign origin of ll TB cses Cses with unknown previous tretment included in new cses. Drug resistnce surveillnce nd TB/HIV coinfection, 216 Completeness of DRS dt No Completeness of HIV dt Cse-linked dt reporting Cses with DST results Estimted RR-TB mong notified pulmonry cses Pulmonry MDR-TB cses notified of which XDR-TB cses Notified MDR-TB of which XDR-TB cses TB cses tested for HIV HIV-positive TB cses of these on ART Tretment outcome monitoring Geogrphicl coverge Outcome cohort Ntionl New nd relpsed TB cses notified in 216 cses enrolled into second-line tretment in 215 Cse-linked dt reporting Cses notified Success Died Filed Lost to follow-up Not evluted Tretment outcome s presented is tretment outcome fter 12 months. Tretment outcome s presented is tretment outcome fter 24 months. TB notifiction rtes y tretment history, 28 1 New nd relpses Other retretment Totl New nd relpsed TB cses notifiction rtes y ge group, > 64 Cses / Cses / Strting from onwrd, cses with unknown history re included in new nd relpses. Dt up to 212 includes new TB cses only. TB cses y geogrphicl origin, 28 TB/HIV coinfection, 28 3 Ntive Foreign origin 1 HIV testing coverge TB cses Proportion of HIV-positive TB cses mong tested 3 No. of cses No. of cses Dt up to 214 include ll TB cses. MDR-TB cses y previous tretment history, 28 Tretment outcome, new nd relpsed TB cses, New Retretment Totl numer of MDR-TB No. of cses Success Died Filed Not evluted Lost to follow-up cohorts include new cses only. 154

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