With a great interest we have read the flesh of M.Balinska, Warsaw
published as News in your journal (2000, 320:959 8 April). We agree with
the author that the TB situation in some countries of Central and Eastern
Europe is rather unsatisfactory in terms of morbidity and increase of
resistant cases.
It should be, however, noted that this is not a situation in all
countries of the area. In Slovenia, Slovakia and particularly in the Czech
Republic the annual notification rate is below 20/100 000 inhabitants (TB
of all forms and localizations) resp below 10/100 000 inhabitants as
regards definite cases of pulmonary TB. The level of resistance remains
below 2% in those countries. Most new detected cases are elder than 65
years and thus the disease may be regarded as a reactivation of TB
infection acquired many years ago (in a post-war time). In fact, the TB
situation in above mentioned three countries is approaching that in
Western Europe. It is strictly monitored by obligatory initial and
follow-up notifications of all new detected cases. In the Czech Republic
estimated incidence rates are equal to notification rates, as stated by
the WHO surveys.
The reason for a diversity in TB situation among countries of Central
and Eastern Europe is caused, among others, by the existence TB control
and surveillance systems, which were established more than 25 years ago
(by the advent of antimicrobial treatment), sustained and continuously
amended up to the present time. The systems act under commitment of
respective governments and are generally well accepted by a medical
staff and by the publicity. The up-to-date methods of prevention, case
finding, diagnostic and treatment are recommended and in fact used without
any administrative pressure. As an example in the Czech Republic the
implementation of DOT strategy increased in routine country-wide
conditions from 30% to 90% in the course of 1999 as stated by analysis of
quarterly cohorts of notified in 1998.
In the country Central TB register and bacteriological Register
(ISBT) closely cooperate in continuous cross-checking of stored data.
Thus, escape of new TB patients is largely prevented. However, there are
still problems persisting in above mentioned countries (TB control in
nonadherent high risk groups, etc). It would be advisable that other
countries may profit from long-term experiences of the countries of
Central and Eastern Europe which exerted a big effort until a relatively
favourable TB situation was achieved in them.
Frantisek Krejbich
Ludek Trnka
Nat.TB Surveillance Unit of the Czech Republic, Prague 8-Bulovka
Rapid Response:
TB in Slovenia, Slovakia and the Czech Republic
Dear Editor,
With a great interest we have read the flesh of M.Balinska, Warsaw
published as News in your journal (2000, 320:959 8 April). We agree with
the author that the TB situation in some countries of Central and Eastern
Europe is rather unsatisfactory in terms of morbidity and increase of
resistant cases.
It should be, however, noted that this is not a situation in all
countries of the area. In Slovenia, Slovakia and particularly in the Czech
Republic the annual notification rate is below 20/100 000 inhabitants (TB
of all forms and localizations) resp below 10/100 000 inhabitants as
regards definite cases of pulmonary TB. The level of resistance remains
below 2% in those countries. Most new detected cases are elder than 65
years and thus the disease may be regarded as a reactivation of TB
infection acquired many years ago (in a post-war time). In fact, the TB
situation in above mentioned three countries is approaching that in
Western Europe. It is strictly monitored by obligatory initial and
follow-up notifications of all new detected cases. In the Czech Republic
estimated incidence rates are equal to notification rates, as stated by
the WHO surveys.
The reason for a diversity in TB situation among countries of Central
and Eastern Europe is caused, among others, by the existence TB control
and surveillance systems, which were established more than 25 years ago
(by the advent of antimicrobial treatment), sustained and continuously
amended up to the present time. The systems act under commitment of
respective governments and are generally well accepted by a medical
staff and by the publicity. The up-to-date methods of prevention, case
finding, diagnostic and treatment are recommended and in fact used without
any administrative pressure. As an example in the Czech Republic the
implementation of DOT strategy increased in routine country-wide
conditions from 30% to 90% in the course of 1999 as stated by analysis of
quarterly cohorts of notified in 1998.
In the country Central TB register and bacteriological Register
(ISBT) closely cooperate in continuous cross-checking of stored data.
Thus, escape of new TB patients is largely prevented. However, there are
still problems persisting in above mentioned countries (TB control in
nonadherent high risk groups, etc). It would be advisable that other
countries may profit from long-term experiences of the countries of
Central and Eastern Europe which exerted a big effort until a relatively
favourable TB situation was achieved in them.
Frantisek Krejbich
Ludek Trnka
Nat.TB Surveillance Unit of the Czech Republic, Prague 8-Bulovka
Competing interests: No competing interests