1. World Tuberculosis Day, 2012
Urban Tuberculosis Control in
the European Union
Dr. Andreas Sandgren
European Centre for Disease Prevention and Control
Milan, Italy, 23 March, 2012

2. From surveillance to
public health action

3. From surveillance to public health action –
ECDC’s added value
Action Plan and Surveillance and
Monitoring Framework Monitoring Report
Surveillance Identify and
assess needs
 A basic public health component for TB control Public Health
Action
Monitoring
SE ESS
 Epidemiological and operational indicators RAI AREN
AW
 Assess progress towards TB elimination
Action
 Provide guidance for public health interventions
 Identify and assess needs for vulnerable groups
 Raise awareness and promote action

4. The epidemiological patterns of
TB are heterogeneous within EU

5. Norway
Iceland
United kingdom
Sweden
Spain
The 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
Lithuania
heterogeneous 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

6. Pattern of TB situation in big cities
differs across the EU
Figure 1: TB notification rates in a selection < 20 cases ≥ 20 cases
of 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 / 16.6
Disclaimer: Survey performed by the Metropolitan TB network, www.metropolitantb.org Please note that ECDC does not
collect city-level TB surveillance data and take no responsibility for accuracy of data collected for this survey.

7. Pattern of TB situation in big cities
differs across the EU
Low-incidence countries High-incidence countries
The TB case load appears to The TB case load appears to be
accumulate disproportionate to big more generalised in the population
cities compared to the country and distributed more evenly within
overall. the country.
Notification rates are 2-5 times Notification rates are the same or
higher in big cities compared to lower in big cities compared to the
the country overall. country overall.
Two different
epidemiological
settings

8. Accumulation of TB
among vulnerable groups
in urban settings

9. Accumulation of TB among
vulnerable groups
TB is a disease disproportionate
affecting the socially and
economically 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

10. Vulnerable groups in urban settings
The most vulnerable and High-risk groups
excluded groups are the ones -Refugees, asylum seekers, migrants
that carry the most significant -Homeless people
burden of disease and which -Prisoners
have the poorest access to -Illicit drug users
services. - 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

11. Reaching out to vulnerable
groups in urban settings

12. Prioritize vulnerable groups
ECDC’s added value
More focus is needed on
vulnerable groups in the EU
‘Identify and describe vulnerable
populations for TB’:
-Surveillance
-Ad hoc surveys
-‘Tailor interventions to vulnerable
populations’:
-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

13. Providing guidance, advocate and monitor
ECDC’s added value
Action and outputs from ECDC of
relevance for urban TB control
-Follow-up to the Action Plan and Report on
surveillance and monitoring of TB in Europe
-Guidance on prevention and control of
infectious disease among people who inject
drugs (incl. TB)
-European Union Standards for TB Care
-Guidance on management of MDR-TB and
XDR-TB contacts
-Scientific output on migrants, social
determinants and health inequality
-Advocacy, scientific output and guidance on
childhood TB
-ECDC internal strategy and action plan for
addressing health inequalities and
communicable diseases in the EU
-Facilitate the work of the metropolitan TB
control initiative and collaborate with other
stakeholders such as WHO and the Union.

14. Reaching out to vulnerable groups
in urban settings
Vulnerable groups are often
hard to reach with standard
public health strategies
It is every patient’s right to receive the
highest standard of care.
Find novel intervention approaches to
target the hard to reach groups with.
Collaborate between cities affected by a
disproportionate burden of TB. Working jointly
Share best practises to target the
vulnerable groups. towards the goal to
eliminate TB in the
EU

15. Contact the ECDC TB Programme
http://ecdc.europa.eu