Substantial underreporting of tuberculosis in West Greece: implications for local and national surveillance.

In order to estimate the reliability of the officially reported national tuberculosis (TB) incidence rates we performed a retrospective review of data collected in regional and national public health framework. TB notifications for the period 2000-2003 were obtained from two major hospitals and three relevant Public Health Departments (PHDs) in the region of West Greece, and subsequently compared with the data reported to the Hellenic Centre for Diseases Control (KEELPNO). During the four-year study period a total of 161 cases of TB were reported to the PHDs in West Greece; 70% of these cases were reported to the KEELPNO. Furthermore only 72 (38.7%) out of the 186 cases of TB identified in the two hospitals were notified to the PHDs. Assuming that the degree of undernotification observed for the two hospitals is the same throughout the region, we estimated that the case detection rate was 14 cases per 100,000 persons per year, i.e. 3.7 times higher than the rate officially reported for the period 2000-2003. Male predominance (2.1, male/female ratio) and an increased incidence in the elders (older than 60 years) and adolescents (10-14 years old) were also evident. The study demonstrated a substantial underestimation of TB burden in West Greece. In the face of the massive influx of immigrants and refugees coming from regions with high TB incidence and the increase of the number of drug-resistant cases a reliable and complete notification of TB is crucial in the planning of programs and development of appropriate control policies.