Epidemiology and control of tuberculosis in Western European cities.
METHODS
Major cities of Western Europe.


OBJECTIVE
To describe major variations in the epidemiology and control of tuberculosis in large Western European Cities.


METHODS
Postal survey using contacts identified through the EURO-TB surveillance network.


RESULTS
Twenty cities responded. In most cities, notification rates were substantially higher than national rates. Rates ranged from less than 10 per 100,000 in Reykjavik and Belfast to over 70 per 100,000 in Lisbon. MDR-TB ranged from less than 1% of cases in many cities to over 5% in Rome and Milan. The proportion of patients estimated to be HIV-positive ranged from less than 5% in many countries to over 20% in Milan. These variations in epidemiology were accompanied by major variations in control policy, particularly in approaches to new entrant screening and BCG vaccination.


CONCLUSIONS
In Western Europe, tuberculosis is primarily a problem of large cities. Some of these cities have very high rates of tuberculosis. There is little consensus about the best approaches to control. The evidence base for the effectiveness of different aspects of TB control needs to be strengthened.
Hayward
A C
AC
Centre for Infectious Disease Epidemiology-Department of Primary Care and Population Sciences, University College London, Royal Free and University College Medical School, London, United Kingdom. a.hayward@pcps.ucl.ac.uk
Darton
T
T
Van-Tam
J N
JN
Watson
J M
JM
Coker
R
R
Schwoebel
V
V
D000995:Antitubercular Agents / Q000008:administration & dosage*; D002947:Cities; D023801:Directly Observed Therapy; D016021:Epidemiologic Studies; D005060:Europe / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D014376:Tuberculosis / Q000453:epidemiology*
D000995:Antitubercular Agents