title: Drug-resistant tuberculosis in the WHO European Region: an analysis of surveillance data.
abstract: To review the latest information about levels of anti-tuberculosis (TB) drug resistance in the European Region of the World Health Organization (WHO) and time-trends in multidrug-resistant TB (resistance to isoniazid and rifampicin; MDR-TB) over the past fifteen years. We analysed data on drug resistance among new and previously treated TB cases reported from 1997 to 2012. Data are collected in surveys of representative samples of TB patients or from surveillance systems based on diagnostic drug susceptibility testing. A total of 15.7% (95% confidence limits (CI): 9.5-21.9) of new and 45.3% (95%CI: 39.2-51.5) of previously treated TB cases are estimated to have MDR-TB in the Region. Extensively drug-resistant TB (MDR-TB and resistance to fluoroquinolones and second-line injectables; XDR-TB) had been reported by 38 of the 53 countries of the region (72%). The proportion of MDR-TB cases with XDR-TB is 11.4% (95%CI: 8.6-14.2). Between 1997 and 2012, population rates of MDR-TB declined in Estonia, Latvia and Germany and increased in the United Kingdom, Sweden and Tomsk Oblasts of the Russian Federation. Surveillance of drug resistance has been strengthened in the WHO European Region, which has the highest proportions of MDR-TB and XDR-TB ever reported globally. More complete data are needed particularly from the Russian Federation.
authors.affiliation: Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland. Electronic address: zignolm@who.int.
authors.forename: Matteo
authors.initials: M
authors.lastname: Zignol
authors.affiliation: TB and M/XDR-TB Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Masoud
authors.initials: M
authors.lastname: Dara
authors.affiliation: Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Dean
authors.affiliation: Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Dennis
authors.initials: D
authors.lastname: Falzon
authors.affiliation: TB and M/XDR-TB Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Andrei
authors.initials: A
authors.lastname: Dadu
authors.affiliation: TB and M/XDR-TB Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kremer
authors.affiliation: IML (Institute of Microbiology and Laboratory Medicine), synlab MVZ, Gauting, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Hoffmann
authors.affiliation: The Public Health Agency of Sweden, Solna, Sweden; MTC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Hoffner
authors.affiliation: Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Katherine
authors.initials: K
authors.lastname: Floyd
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D005060:Europe / Q000453:epidemiology; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D012293:Rifampin / Q000494:pharmacology; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin
keywords: Drug-resistance; European Region; MDR-TB; Surveillance; Tuberculosis