Problems to control TB in eastern Europe and consequences in low incidence countries.

The regular decline in tuberculosis (TB) notification rates observed in the majority of industrialised countries over the past decades has levelled off or reversed in recent years in both the USA and in Europe, where relevant differences between Central/Eastern and Western countries have become more and more apparent. In the countries of the Central and Eastern European sub-region, notification rates have ceased to decline or markedly increased since the 1990s, particularly in the Baltic States, in Romania, Russian Federation and other countries belonging to the previous USSR. The evaluation of age-specific notification rates shows that the majority of the countries in the Central and Eastern European sub-region still have a pattern of middle-income countries, where TB is affecting significantly the younger cohorts, and the infection in the community is still rampant. The aim of the present paper is to discuss the main determinants of the deteriorated TB control in Eastern Europe, the main consequences of this situation for Western European Countries, and the possible solutions. The major constraints described are: socio-economic crisis, health system weaknesses, HIV pandemic, multidrug-resistant TB (MDRTB) and failure to control TB in prisons and in other risk groups. The main consequences of the sub-optimal TB control achieved in Eastern Europe, are the exportation of TB trough immigration and, as part of this phenomenon, the exportation of drug resistance and MDRTB. Proper TB control is possible in the sub-region, as testified by the successful results achieved in the Czech republic, Slovakia and Slovenia. A global reform of health systems is necessary, particularly in the previous USSR countries, based on cost-effective interventions. MDRTB should be managed promptly as an international emergency, based on a cooperative approach of donor and assisted countries. As opportunities for improved funding of TB control in the region exist, there is the potential to reverse to TB pandemic before the explosion of the HIV epidemic expected in Eastern Europe.