Tuberculosis surveillance in Germany. Data of the tuberculosis report 2013

Transcription

1 1 Tuberculosis surveillance in Germany Data of the tuberculosis report 2013 Robert Koch Institute (RKI) Respiratory Infections Unit

2 Outline 2 Tuberculosis notification system in Germany Epidemiological situation in Germany in 2013 Research activities related to tuberculosis at the RKI

3 Estimated tuberculosis incidence per 100,000 population, European Region, Germany ECDC. European Centre for Disease Prevention and Control (ECDC) / WHO Regional Office for Europe: Tuberculosis surveillance and monitoring in Europe URL:

4 Germany 4 Basic facts 16 Federal States 81 million inhabitants, of which ~9% having foreign citizenship and ~20% having any migration background Tuberculosis situation 2013 No. of new TB cases: 4,318 Notification rate: 5.3 new TB cases per 100,000 population Karte RKI

5 5 Tuberculosis notification system in Germany

6 Legal framework for tuberculosis surveillance in Germany Communicable Disease Law (Bundesseuchengesetz - BSeuchG) Since January 2001 Protection against Infection Act (Infektionsschutzgesetz - IfSG) Innovations: TB case definition case-based data set continuously updated data electronic data transfer drug susceptibility data treatment outcome data

7 Tuberculosis case definition 7 (1) Clinical feature The attending physician decides that the administration of complete antituberculotic therapy is indicated OR post-mortem findings reveal that in the lifetime such therapy would have been indicated. (2) Laboratory confirmation Cultural isolation of M.tuberculosiscomplex OR complex positive AFB microscopy result AND positive nucleic acid amplification test (e.g. PCR) of the same specimen (3) Epidemiological confirmation A. Clinically diagnosed disease (1) B. Clinically-/laboratory-confirmed disease (1)+(2) C. Clinically-/epidemiologically-confirmed disease (1)+(3) Tuberculosis case

8 Mandatory notification of tuberculosis cases 8 patient care Clinician Laboratory Within 24 hours (fax) Local Health Authority administrative level Case notification by physicians IfSG 6.1, 6.2 Laboratory notifications - laboratory confirmation IfSG clinical case or death of TB - treatment default - drug susceptibility testing results - initially: evidence of acid-fast bacilli in the sputum

9 Local Health Authority Collection and transfer of case-based data sets 9 patient care Clinician Laboratory Within 24 hours (fax) Local Health Authority administrative level Collected and transferred key variables for tuberculosis cases Age Sex Country of birth Prior treatment Start of treatment Major site of disease Positive AFB microscopy result Culture and drug susceptibility testing results Treatment outcome

10 Data analysis and reporting 10 Within 24 hours (fax) Next working day (electronically) Next working day (electronically) Clinician Laboratory Local Health Authority State Health Department Robert Koch Institute weekly patient care administrative level annually annually international level European Centre for Disease Prevention and Control WHO Regional Office for Europe

11 11 Epidemiological situation in Germany in 2013

12 Tuberculosis in children (<15yrs) and adults in Germany, Case numbers for 2013 All cases Adults Children <15yrs 169

13 Tuberculosis in Germany 2013 by Federal State (N=4,308) 13 average incidence 5.3

14 Tuberculosis in Germany 2013 by country of birth (N=4,066) 14 Newly Independent States of the Former Soviet Union (NIS): Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyztan, Moldowa, Russian Federation, Tajikistan, Turkmenistan, Ukraine, Uzbekistan and the three Baltic States Lativa, Lithuania, and Estonia

15 Tuberculosis in Germany 2013 by country of birth according to WHO Region (N=4,318) 15

16 Drug resistance situation 2013 by country of birth (N=2,839) 16 multidrug resistance: any drug resistance: resistance to Isoniazid and Rifampicin resistance to at least one of the five standard drugs

17 Treatment outcome 2012 by age group and sex (N=3,873) 17 85% 79.3%

18 Treatment outcome 2012 by age group and drug resistance (N=2,719) 18

19 19 Research activities related to tuberculosis at the RKI

20 Current tuberculosis related research activities at the RKI (selection) Detailed analyses of the nationwide tuberculosis (TB) surveillance data set on topics including Long-term trends in the TB situation in Germany 20 TB in children, in the elderly, and in the foreign born population Drug resistance patterns HIV/TB co-morbidity in Germany Diagnostic of HIV among tuberculosis patients (cooperation with local public health departments) TB treatment outcome monitoring in Germany and in EU/EEA Member States (EU collaboration) TB in European metropolitan cities (EU collaboration)

21 Summary 21 Germany is a low-incidence country for tuberculosis; Since 2009 we observe a stagnation in case notifications and incidence; Within Germany, the tuberculosis incidence is above-average in City States (mainly in Hamburg and Berlin), and in Federal States with big cities; Migration plays a role: The tuberculosis incidence is particular high among foreign citizens; The proportion of drug resistant tuberculosis cases is highest among individuals born abroad, mainly in the NIS. Tuberculosis incidence is highest and treatment outcome is poorest in the elderly. Treatment outcome is poor among MDR-TB patients.

22 Conclusion 22 The surveillance system in Germany provides detailed information on the current epidemiological tuberculosis situation and trends. For a continuing decrease in tuberculosis incidence and for the achievement of treatment outcome targets in Germany we need to address the specific subpopulations at risk with targeted prevention, surveillance and control; we need to act in a Europe-wide and international context given migration and the drug resistance situation in Eastern Europe.

23 23 Foto RKI Thank you. Foto RKI