Epidemiology of resistant tuberculosis in Europe.

About one-third of the world's population has been infected with Mycobacterium tuberculosis (MTB). Active disease develops in eight to ten million people per year, and tuberculosis is responsible for three million deaths every year. This makes it the leading cause of death due to infections in the world. In 1996, 315,892 cases of tuberculosis were reported in 50 countries of the WHO European region. The notification rate was less than 20 per 100,000 in 21 countries, all of which are situated in the western part of Europe except the Czech Republic and Israel. The rate was 20 cases per 100,000 or more in 29 countries located in the eastern part of Europe except for Portugal and Spain. In addition to the rise of tuberculosis observed worldwide, the emergence of drug-resistant tuberculosis (TB) poses a major threat to TB control efforts. The prevalence of resistance is increasing dramatically, predominantly in eastern Europe. The aim of this article is to describe the situation of resistant TB in Europe, and to point out reasons for the increase of drug-resistant MTB strains.