Communicable diseases recognise no borders and TB continues to pose a serious threat to individuals and public health across the world. Despite notable efforts from WHO Europe, which has worked in partnership with several European countries to improve the situation, there is still room for improvement in order to tackle the spread of TB in Europe and across the world.
The WHO estimates that there were 8.7 million new TB cases and 1.4 million deaths due to TB across 204 countries in 2011. Of these, 380 000 new patients and 45 000 deaths due to TB come from the European region. Perhaps more significantly, many come from migrant communities. 15% of new cases and 44% of previously treated cases are multi-drug resistant (MDR- TB), of which about 10% are extensively drug-resistant (XDR- TB). The proportion of tested TB patients in the WHO Europe region who are co-infected with HIV has increased from 2.8% in 2006 to 6.5% of in 2011 (~20% per year). While these alarming statistics may partly reflect better surveillance and monitoring, the figures clearly show that TB is one of the most important indicators of health inequalities across the world. Indeed, TB is particularly prevalent among vulnerable populations with a lower socioeconomic status (e.g. people who have no identity documents and no access to healthcare, and people subject to discrimination, hostility or economic adversity).
A recently published consensus paper in the European Respiratory Journal describes in detail the minimum package of cross-border TB control and care needed to improve the situation in Europe. The report was prepared by a task force following a literature review, and with input from managers of national TB control programmes and the Wolfheze 2011 conference. Several issues were identified in cross-border TB control and care, including limited access to early diagnosis, lack of continuity of care and information during migration, and the availability of and access to health services in the new country. The recommendations are clear and should be taken on board by all governments in order to address this current problem. They are not listed in detail here but they can be grouped into three pillars:
Political commitment (including the implementation of a legal framework for TB cross-border collaboration and tobacco control).
Adequate health service delivery (prevention, infection control, contact management, diagnosis and treatment, and psychosocial support).