Tuberculosis prevention and control

To reduce TB incidence, approaches need to be tailored to the specific epidemiological situation in each country. In low-incidence countries people at risk of contracting TB are often found in vulnerable populations, for example prison inmates, migrants or refugees, and homeless. In medium and high-burden countries, TB is more prevalent in the general population.

ECDC coordinates networks of epidemiological and laboratory experts in Europe. Within these networks, countries collaborate on standardised approaches, exchanges of experience and best practices. They work to identify sustainable solutions tailored to the European context, collaborate on cross-border threats and address public health gaps. ECDC is supporting EU/EEA Member States in their efforts to achieve Sustainable Development Goal target 3.3 to end the tuberculosis epidemic by 2030.

Activities:

• Scientific advice
• Country visits
• Country support
• World TB Day campaign

Scientific advice

ECDC’s scientific advice provides a summary of primary evidence, acknowledging uncertainties and interpreting data to support informed decisions and actions at the EU and country level in relation to public health measures to prevent and/or control tuberculosis.

Public health guidance on management of contacts of MDR TB and XDR TB patients

Managing the contacts of MDR and XDR TB patients is a key intervention in preventing further transmission. Within the EU/EEA, contact investigation is widely implemented. ECDC has published an evidence-based guidance that outlines different options for the management of contacts.

Public health guidance on TB control in vulnerable and hard-to-reach populations

Tuberculosis disproportionately affects vulnerable and hard-to-reach populations, especially in low-TB-incidence countries. ECDC provides guidance on how to prevent and control TB among groups whose socioeconomic conditions or lifestyle make it difficult to access health services, self-administer treatment and attend regular healthcare appointments.

Public health guidance on investigation and control of TB incidents affecting children in congregate settings

Children have a high risk of becoming infected with TB following exposure in congregate settings such as schools and nurseries. Rapid identification of the source of transmission and contact investigation in settings around the primary case is therefore essential to stop transmission. The guidance ‘Investigation and control of tuberculosis incidents affecting children in congregate settings’ details common practices and provides expert opinions on the investigation and control of TB incidents affecting children in congregate settings.

European Union Standards for Tuberculosis Care

ECDC and the European Respiratory Society (ERS) have developed the European Union Standards for Tuberculosis Care (ESTC). These standards are tailored to EU/EEA settings and are in line with accepted international principles and guidance outlined in the International Standards for Tuberculosis Care and the WHO Compendium of Tuberculosis Guidelines and Associated Standards.

Expert Opinion on the introduction of new drugs for tuberculosis control in the EU/EEA

The ECDC Expert Opinion outlines some pre-conditions that are considered to be essential at the national level prior to the use of new drugs for the treatment of TB, as well as specific conditions needed in order to successfully implement new TB drugs/regimens. 

Evidence-based guidance for the implementation of programmatic management of latent tuberculosis infection in the EU/EEA.

Programmatic management of latent tuberculosis infection (LTBI) is a key component of any tuberculosis elimination strategy, as people with LTBI represent a large human reservoir for the disease. This guidance provides evidence-based guidance for the implementation of programmatic management of LTBI in the EU/EEA. The guidance covers four key areas in relation to programmatic management of LTBI: target risk groups; diagnosis; treatment; and programmatic issues of LTBI management.
 

Tuberculosis in prison settings

People in prisons have a higher prevalence of several communicable diseases than the general population. The ECDC ‘Systematic review on the diagnosis, treatment, care and prevention of tuberculosis in prison settings’ provides a review of data on the diagnosis, treatment, care and prevention of tuberculosis in prison settings, with a focus on the countries of the EU/EEA. The ‘Public health guidance on active case finding of communicable diseases in prison settings’ provides EU/EEA Member States with evidence-based scientific advice on active case finding options. These options can be applied to the planning and implementation of interventions that promote the early diagnosis of communicable diseases in prison settings.

Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA

In a number of EU/EEA Member States, subgroups of migrant populations are disproportionately affected by infectious diseases such as TB. Consequently, screening and vaccination programmes may be of benefit for newly arrived migrants. The guidance supports EU/EEA Member States to develop national strategies to strengthen infectious disease prevention and control among migrants and meet the health needs of these populations.

Country visits

ECDC conducts country visits jointly with the World Health Organization’s Regional Office for Europe at the formal request of the Ministry of Health or corresponding competent body in a Member State. In cooperation with representatives of the national TB programme, the experts participating in the country visit identify strengths and challenges in the national TB programme. Country visits have taken place in Romania (2015, 2014, 2009), Portugal (2009), Estonia (2010), Finland (2010), Norway (2011), Hungary (2012), Latvia (2012), Slovakia (2013), Netherlands (2019, 2013, 2008), Bulgaria (2014, 2008), and Lithuania (2016).

To request a country visit, please approach your Ministry of Health, or contact the ECDC TB programme to facilitate the process of a formal request.

Country support

ECDC organises exchange visits, trainings and ad-hoc consultancies, facilitated by international experts, for the high-burden TB Member States in the EU/EEA: Bulgaria, Estonia, Latvia, Lithuania, and Romania.

Exchange visits

The exchange visits take place in an EU country that has displayed exemplary progress in TB prevention and control. The country case study is explored through lectures, field visits and workshops in situ.

Past exchange visits:

2016 – TB contact investigation, Finland

2017 – From hospital to ambulatory care, Finland

2018 – Infection control: assessment and implementation of infection control procedures and measures, the Netherlands.

Training

The training takes place in a high-burden country centring on a challenge relevant to the local context, equipping participants with the necessary knowledge to champion further change in their respective countries. The training consists of group exercises, practical sessions and case studies.

Past trainings:

2016 - Latent tuberculosis infection management, Estonia

2017 - Prevention and control of TB among vulnerable, hard-to-reach groups and migrants, Bulgaria

2018 - Communication on tuberculosis to the general public, and use of social media, advocacy and communication to local government and policy makers, Lithuania.

Consultancies

Ad-hoc consultancies provide technical support to a country. Working with national representatives identified in the country, an outside expert collects and assesses background information and produces a draft guidance document, focusing on strengths and challenges in the national TB programme, system or service. The draft is developed further at a consensus-building meeting with a wide range of stakeholders and the finished output is disseminated in the country.

Past consultancies:

2016 – Integrated community support services for tuberculosis, Romania

2017 – LTBI guidelines for people living with HIV (PLHIV) and a plan for a surveillance registry of LTBI cases and TB contacts, Latvia

2018 – National guidelines on integrated services, with a focus on case management of MDR TB cases, TB/HIV co-infected cases and cases among vulnerable populations, Lithuania

World TB Day campaign