World Tuberculosis Day on 24 March commemorates the date in 1882 when Robert Koch presented his findings on the causing agent of tuberculosis (TB) – Mycobacterium tuberculosis
. This celebration provides a good opportunity to take stock of the achievements in controlling the disease so far – and the remaining challenges at global, regional, national and local level.
Within the European Union (EU), most activities regarding the control of TB rely on national efforts since the key measure to combat the disease is to ensure appropriate diagnosis and treatment for all. However, the European Centre for Disease Prevention and Control (ECDC) can provide an EU added value to the fight against TB as a catalyst for EU organisations and other partners working on TB control. Since 2008, ECDC together with the World Health Organization’s Regional Office Europe (WHO EURO) is co-ordinating the surveillance of TB in the European Region by collecting, validating and analysing TB data and further improving other surveillance activities. This follows on the work done by the European Commission and the Institute de veille sanitaire-funded network EuroTB (www.eurotb.org), which has been in charge of surveillance in the WHO European Region since 1996. The ECDC also supports countries in other areas such as enhancing laboratory services, proposing priorities for research or facilitating the tracing of people and other necessary activities when multi-country investigations are required.
In recent decades, TB has been on the decline in the EU. In 2006, the current 27 EU Member States plus the European Economic Area/European Free-Trade Association (EEA/EFTA) countries reported 88,113 TB cases. Despite some signs of convergence, we are still facing a diverse situation in the EU, where many countries show low notification rates whereas others still have TB rates of over 30 per 100,000 population. These and other data derived from the latest EuroTB report can be found in an article by Falzon et al  in this special issue of Eurosurveillance. The data show that there is no room for complacency. The EU is far from reaching the goal of TB elimination. Reasons for remaining active include the presence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB in the EU and its neighbouring countries; rising TB/human immunodeficiency virus (HIV) co-morbidity in some Member States; and EU countries with low notification rates in which TB is concentrating in vulnerable populations such as immigrants from areas with a high TB burden, the urban poor, prisoners and immuno-suppressed people. Attention should be paid to those threats and also to the increasing numbers of TB cases in countries neighbouring the EU which are described in a second article by Falzon and van Cauteren  on trends in TB in the World Health Organization’s (WHO) European Region from 1995 to 2005. The article analyses surveillance data of the EuroTB network.
Besides surveillance, well functioning laboratory services are key for the success in fighting TB. An article by Drobniewski et al.  maps the current National Reference Laboratory activities and points out the added value of cooperation and networking at the EU level with regard to strengthening laboratory services.
Following a request from the European Commissioner for Health in March 2007, the ECDC, in collaboration with many experts across Europe, developed a Framework Action Plan to Fight TB in the EU. The plan offers an excellent opportunity to invigorate the fight against TB in the EU and indicate the necessary steps towards controlling and ultimately eliminating TB in the EU. It is based on four main principles: ensuring prompt and quality TB care for all; strengthening health systems; developing and assessing new tools; and building partnerships and international collaboration. A rapid communication in this issue gives more details , and the plan, launched on 17 March, can be found at http://ecdc.europa.eu/pdf/080317_TB_Action_plan.pdf.
In the context of the Framework Action Plan, ECDC will support the Member States and collaborate with the relevant stakeholders in the assessment of the TB situation and the development and implementation of regional and national strategies. The next step in that direction will be to set up indicators and a 'framework for national plans' to enable the Member States to strengthen their current plans, effectively channel TB control activities and monitor their progress. The Framework Action Plan will be presented for information at the upcoming EU Council meeting in June 2008.