From surveillance to public health action –ECDC’s added valueAction Plan and Surveillance andMonitoring Framework Monitoring ReportSurveillance Identify and assess needs A basic public health component for TB control Public Health ActionMonitoring SE ESS Epidemiological and operational indicators RAI AREN AW Assess progress towards TB eliminationAction Provide guidance for public health interventions Identify and assess needs for vulnerable groups Raise awareness and promote action
The epidemiological patterns ofTB are heterogeneous within EU
Norway Iceland United kingdom Sweden SpainThe epidemiological patterns of TB are Slovenia Slovakia Source: Surveillance report, TB Surveillance in Europe 2012 (2010 data) Romania Portugal Poland Netherlands Malta Luxembourg 14.6/100,000 EU/EEA 2010 Lithuaniaheterogeneous within EU Latvia Italy Ireland Hungary Greece Germany France Finland Estonia Denmark Czech Republic Cyprus Bulgaria Belgium Austria 100.0 80.0 60.0 40.0 20.0 0.0
Pattern of TB situation in big citiesdiffers across the EUFigure 1: TB notification rates in a selection < 20 cases ≥ 20 casesof countries and big cities of EU/EEA, in 2009. per 100,000 population per 100,000 population Riga / Latvia Copenhagen / Denmark 43.0 / 43.2 16.9 / 6.0 Rotterdam / Netherlands Vilnius / Lithuania 21.3 / 7.0 31.9 / 62.1 London / United Kingdom Warsaw / Poland 44.4 / 14.8 17.8 / 21.6 Paris / France Bucharest / Romania 23.4 / 8.2 81.0 / 108.2 Milan / Italy 33.2 / 6.5 Sofia / Bulgaria Barcelona / Spain 31.9 / 38.3 24.3 / 16.6Disclaimer: Survey performed by the Metropolitan TB network, www.metropolitantb.org Please note that ECDC does notcollect city-level TB surveillance data and take no responsibility for accuracy of data collected for this survey.
Pattern of TB situation in big citiesdiffers across the EULow-incidence countries High-incidence countriesThe TB case load appears to The TB case load appears to beaccumulate disproportionate to big more generalised in the populationcities compared to the country and distributed more evenly withinoverall. the country.Notification rates are 2-5 times Notification rates are the same orhigher in big cities compared to lower in big cities compared to thethe country overall. country overall. Two different epidemiological settings
Accumulation of TBamong vulnerable groupsin urban settings
Accumulation of TB amongvulnerable groupsTB is a disease disproportionateaffecting the socially andeconomically disadvantaged The higher TB incidence seen in big cities of Western Europe is an expression of a declining epidemic with an accumulation of TB among vulnerable groups
Vulnerable groups in urban settingsThe most vulnerable and High-risk groupsexcluded groups are the ones -Refugees, asylum seekers, migrantsthat carry the most significant -Homeless peopleburden of disease and which -Prisonershave the poorest access to -Illicit drug usersservices. - Alcoholics - HIV-seropositive people Other vulnerable groups - Children - Elderly Characteristics of urban settings -High population density -Complex social structure Interaction between individual risk factors and urban characteristics create specific opportunities for TB transmission
Reaching out to vulnerablegroups in urban settings
Prioritize vulnerable groupsECDC’s added valueMore focus is needed onvulnerable groups in the EU‘Identify and describe vulnerablepopulations for TB’:-Surveillance-Ad hoc surveys-‘Tailor interventions to vulnerablepopulations’:-Approaches for detection and care-Intensified case finding The ECDC Framework Action Plan sets strategies to reach TB elimination in the EU It specifically addresses vulnerable populations
Providing guidance, advocate and monitorECDC’s added valueAction and outputs from ECDC ofrelevance for urban TB control-Follow-up to the Action Plan and Report onsurveillance and monitoring of TB in Europe-Guidance on prevention and control ofinfectious disease among people who injectdrugs (incl. TB)-European Union Standards for TB Care-Guidance on management of MDR-TB andXDR-TB contacts-Scientific output on migrants, socialdeterminants and health inequality-Advocacy, scientific output and guidance onchildhood TB-ECDC internal strategy and action plan foraddressing health inequalities andcommunicable diseases in the EU-Facilitate the work of the metropolitan TBcontrol initiative and collaborate with otherstakeholders such as WHO and the Union.
Reaching out to vulnerable groupsin urban settingsVulnerable groups are oftenhard to reach with standardpublic health strategiesIt is every patient’s right to receive thehighest standard of care.Find novel intervention approaches totarget the hard to reach groups with.Collaborate between cities affected by adisproportionate burden of TB. Working jointlyShare best practises to target thevulnerable groups. towards the goal to eliminate TB in the EU
Contact the ECDC TB Programmehttp://ecdc.europa.eu