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Comparison of tuberculosis surveillance systems in low-incidence industrialised countries

¹ Public Health Services, Ministry of Health, Jerusalem, Israel, ² Rollins School of Public Health, Emory University, ⁴ Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention (CDC), ⁵ Northrop Grumman Information Technology, CDC Programs, Atlanta, GA, USA, ³ WHO Collaborating Centre for TB and Lung Diseases, S. Maugeri Foundation, Care and Research Institute, Tradate, Italy, ⁶ German Central Committee against Tuberculosis, Berlin, Germany, ⁷ National TB Surveillance Unit, Bulovka Hospital, Prague, Czech Republic.

CORRESPONDENCE: M. F. Iademarco, Fax, 84 48505028. E-mail: iademarcoMF{at}state.gov

Keywords: Global health, National Tuberculosis Programme, surveillance, tuberculosis

Received: March 19, 2008
Accepted July 24, 2008

The comparative analysis of National Tuberculosis Control Programmes (NTPs) in industrialised, low-tuberculosis-incidence countries is limited. Analysis of applied methods, function and accumulated experience contributes to improving global tuberculosis control.

A questionnaire addressing NTP surveillance infrastructure and characteristics was completed in 19 industrialised countries, with populations of >3 million and annual notified tuberculosis incidence rates of <16 cases per 100,000 population (2003 data).

All European countries surveyed adopted World Health Organization Collaborating Centre for the Surveillance of Tuberculosis in Europe (EuroTB) definitions. Surveillance information, which usually includes names, was transferred electronically to the national level in 17 out of the 19 countries. Surveillance systems capture process and social determinants. Case notification to the central level occurred within a median period of 7 days, independent of mandatory notification requirements. The mean completeness of tuberculosis case-reporting was estimated to be 93.5% (range 65–100%). Integration between HIV and tuberculosis registries was performed in two countries, and, in seven others, both databases were cross-matched periodically.

National Tuberculosis Control Programme function in industrialised low-incidence countries utilises well-established infrastructure and relies upon centralised operations. Approaches are consistent with current World Health Organization surveillance recommendations. The present study lays collaborative groundwork for additional multinational analyses for the enhancement of global tuberculosis surveillance, which may assist policy-makers in countries moving from medium to low rates of incidence.