The theme of World TB day 2003 - "DOTS cured me - it will cure you too!" promotes the worldwide expansion of directly observed treatment-short course (DOTS), a multi pronged TB control strategy including the adoption of standardised patient management and the evaluation of treatment outcome of TB patients. Treatment outcome is a core surveillance indicator recommended to assess the implementation of DOTS. In recent years, DOTS has been adopted increasingly in European countries, especially in the East. The EuroTB annual report 2000 (in press, http://www.eurotb.org/) includes data on treatment outcome for TB cases notified in 1999 in 30 of the 51 countries of the World Health Organization (WHO) European Region. The WHO Global Tuberculosis Control report, available from 24 March 2003 at http://www.who.int/gtb, contains current information on the DOTS situation in Europe and the rest of the world.

Of the 22 countries providing nationwide outcome data on all new sputum smear positive TB cases notified (Table), 19 reported outcome information for more than 90% of cases (median: 98%). In 1999, DOTS coverage exceeded 90% of the population in 14 of the 22 countries (5 in the West, 5 in the Centre, and 4 in the East) (1). The median proportion of success (cases completing treatment with or without bacteriological proof) was highest in the centre and lowest in the East. The success rate, however, in each geographic part, fell short of the WHO target of 85%, but was close to the global figure of 80% achieved by DOTS programmes worldwide (2). Death rates were similar in the three areas. Proportions of failure, default (ie treatment interruption), and transfer out were higher in the East, suggesting poorer programme performance. Data should be interpreted with caution, however, due to differences in definition, such as exclusion of post mortem diagnoses from analysis in some countries in the East and classification of failure in a category "still on treatment" in the West (reported as "other"). Further data standardisation is under consideration in Europe. Preliminary nationwide outcome data for 2000 are available for 32 countries, showing progress toward both programme improvement and increased coverage of international TB surveillance in Europe.

Table: Treatment outcome of new smear positive TB cases notified in 1999, WHO European Region, 22 countries providing nationwide data

 

	West (9/23 countries) N= 2,005			Centre (5/13 countries) N=1,664			East (8/15 countries) N=12,213
	median (%)	range (%)*		median (%)	range (%)		median (%)	range (%)
Success	77	48-79		84	74-90		73	60-83
Death	7	6-13		8	2-16		7	2-15
Failure	0	0		1	0-2		5	1-21
Default	3	2-16		2	1-9		5	3-22
Transfer out	0	0-3		1	0-2		2	0-10
Other/unknown	0	0-44		4	0-11		0	0-8

* excluding three countries with fewer than 10 cases notified

The EuroTB website also presents provisional data on TB notifications in Europe in 2001 and recent trends. In 2001, 390 803 cases of TB were notified in the region, most of which were new cases. The overall notification rate was 45 per 100 000, with substantial differences within the region. TB notification rates have declined since 1995 in most countries in western and central Europe, and increased in the East, where the average notification rate is now more than eight times higher than in the West.