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1 Royal Netherlands Tuberculosis Association, The Hague, the Netherlands. 2 World Health Organization Collaborating Centre for Control of Tuberculosis and Lung Diseases in Europe, Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione, Care and Research Institute, Dept. Pneumonology, Tradate, Italy. 3 Tuberculosis Division of the International Union Against Tuberculosis and Lung Disease, Paris, France. 4 Dept of Health, London, UK. 5 National Public Health Institute, Helsinki, Finland. 6 German Central Committee against Tuberculosis, Berlin, Germany. 7 Communicable Disease Programme, World Health Organization, Geneva, Switzerland
CORRESPONDENCE: G.B. Migliori, WHO Collaborating Centre for Control of Tuberculosis and Lung Diseases, Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione, Care and Research Institute, via Roncaccio 16, 21049, Tradate (VA), Italy. Fax: 39 0331829402. E-mail: gbmigliori@fsm.it
Keywords: control, elimination, Europe, new framework, tuberculosis
Received: July 19, 2001
Accepted October 27, 2001
Abstract
As countries approach the elimination phase of tuberculosis, specific problems and challenges emerge, due to the steadily declining incidence in the native population, the gradually increasing importance of the importation of latent tuberculosis infection and tuberculosis from other countries and the emergence of groups at particularly high risk of tuberculosis.
Therefore, a Working Group of the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Royal Netherlands Tuberculosis Association (KNCV) have developed a new framework for low incidence countries based on concepts and definitions consistent with those of previous recommendations from WHO/IUATLD Working Groups.
In low-incidence countries, a broader spectrum of interventions is available and feasible, including: 1) a general approach to tuberculosis which ensures rapid detection and treatment of all the cases and prevention of unnecessary deaths; 2) an overall control strategy aimed at reducing the incidence of tuberculosis infection (risk-group management and prevention of transmission of infection in institutional settings) and 3) a tuberculosis elimination strategy aimed at reducing the prevalence of tuberculosis infection (outbreak management and provision of preventive therapy for specified groups and individuals).
Government and private sector commitment towards elimination, effective case detection among symptomatic individuals together with active case finding in special groups, standard treatment of disease and infection, access to tuberculosis diagnostic and treatment services, prevention (e.g. through screening and bacille Calmette-Guéria immunization in specified groups), surveillance and treatment outcome monitoring are prerequisites to implementing the policy package recommended in this new framework document.
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