Towards the development of EU/EEA Standards for Tuberculosis Care (ESTC)

Tuberculosis (TB) continues to pose a public-health threat to the people of the member states of the European Union (EU) and European Economic Area (EEA). EU/EEA countries comprise Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, the Republic of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK. In 2009, almost 80,000 TB cases were notified in the EU/EEA, and while several countries are progressing towards achieving and sustaining low levels of TB incidence, the contrasts in TB disease burden remain great within the EU/EEA [1]. Some countries are faced with a significant burden of drug-resistant TB, and multidrug-resistant (MDR)-TB. In 2009, 5.3% of all active TB cases reported in the EU/EEA were MDR-TB, and 14.1% were resistant to any of the first-line TB drugs [1]. HIV co-infection is still low, with an overall proportion of 2.3% of TB cases being HIV-seropositive, although accurate surveillance data reporting is suboptimal in many countries [1–3]. TB CONTROL AND ELIMINATION STRATEGIES IN THE EU/EEA The EU/EEA member states were proactive in adopting the existing global strategies for TB control, including Directly Observed Treatment Short Course (DOTS) and the Stop TB Strategy [4]. The stepwise adoption of these principles was facilitated by the development of a set of European-specific, consensus-based documents born within the Wolfheze initiative [5]. A European group of experts, country representatives and international organisations (World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and the KNCV Tuberculosis Foundation) developed guidance and policy documents on TB control and elimination, surveillance, screening and management of immigrants, treatment outcome monitoring, drug susceptibility testing [6–10] and, more recently, contact tracing [11].