Inventory study on completeness of tuberculosis case notifications in Poland in 2018.

BackgroundEvaluating tuberculosis (TB) notification completeness is important for monitoring TB surveillance systems, while estimating the TB disease burden is crucial for control strategies.AimWe conducted an inventory study to assess TB reporting completeness in Poland in 2018.MethodsUsing a double-pronged inventory approach, we compared notifications of culture-positive TB cases in the National TB Register to records of diagnostic laboratories. We calculated under-reporting both with observed and capture-recapture (CRC)-estimated case numbers. We further compared the notifications by region (i.e. voivodship), sex, and age to aggregated data from hospitalised TB patients, which provided an independent estimate of reporting completeness.ResultsIn 2018, 4,075 culture-positive TB cases were notified in Poland, with 3,789 linked to laboratory records. Laboratories reported further 534 TB patients, of whom 456 were linked to notifications from 2017 or 2019. Thus, 78 (534 - 456) cases were missing in the National TB Register, yielding an observed TB under-reporting of 1.9% (78/(4,075 + 78) × 100). CRC-modelled total number of cases in 2018 was 4,176, corresponding to 2.4% ((4,176 - 4,075)/4,176 × 100) under-reporting. Based on aggregated hospitalisation data from 13 of 16 total voivodeships, under-reporting was 5.1% (3,482/(3,670 - 3,482) × 100), similar in both sexes but varying between voivodeships and age groups.ConclusionsOur results suggest that the surveillance system captures ≥ 90% of estimated TB cases in Poland; thus, the notification rate is a good proxy for the diagnosed TB incidence in Poland. Reporting delays causing discrepancies between data sources could be improved by the planned change from a paper-based to a digital reporting system.

Tuberculosis in Poland in 2021. / Gruzlica w Polsce w 2021 r.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2021 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2021, data from Statistics Poland on deaths from tuberculosis in 2020, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2021 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." RESULTS: In 2021, 3704 TB cases were reported in Poland. The incidence rate was 9.7 cases per 100,000 with large variability between voivodeships from 5.4 to 12.6 per 100,000. A decrease in the incidence with respect to 2020 was found in 8 voivodeships, the most significant in lubuskie voivodship (42.6%). The number of all pulmonary tuberculosis cases was 3,553 i.e. 9.3 per 100,000. Pulmonary cases represented 95.9% of all TB cases. In 2021, 151 extrapulmonary TB cases were notified (4.1% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,970 cases (83.6% of all pulmonary TB cases, the incidence rate 7.8 per 100,000). The number of smear-positive pulmonary TB cases was 2,085 i.e. 5.5 per 100,000 (58.7% of all pulmonary TB cases). In 2021, there were 54 cases (25 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.9% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 0.6 per 100,000 among children (0-14 years) to 15.8 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 11.7 per 100,000. There were 37 cases in children up to 14 years of age (1.0% of the total) and 51 cases in adolescents between 15 and 19 years of age - rates 0.6 and 2.8 per 100,000 respectively. In 2021, there were 2,690 cases of tuberculosis in men and 1,014 in women. The TB incidence in men - 14.6 per 100,000 was almost 3.0 times higher than among women - 5.1. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55-59 years, 30.5 vs. 6.6 and in age group 60 to 64 years, 26.0 vs. 5.7. In 2021, there were 132 patients of foreign origin among all cases of tuberculosis in Poland (3.6%). In 2020, TB was the cause of death for 474 people (mortality rate - 1.2 per 100,000). CONCLUSIONS: The incidence of tuberculosis in Poland in 2021 was 10.2% higher than in 2020. The percentage of tuberculosis cases with bacteriological confirmation was 82.6%, higher than the average in EU/EEA countries (72.0%). The percentage of MDR-TB cases was lower than the average in EU/EEA countries (1.9% vs. 3.8%). The highest incidence rates are found in Poland in the older age groups (in EU/EEA countries in people aged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.0%, the average in the EU/EEA countries was 3.5%. The incidence of tuberculosis in men was nearly three times higher than in women in Poland. The impact of migration on the epidemiological situation of tuberculosis in Poland in 2021 was smaller than in the EU/EEA countries (in Poland, the percentage of foreigners among all TB patients was 3.6 vs. 33.8% in the EU/EEA).

Tuberculosis incidence in foreign-born people residing in European countries in 2020.

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

Tuberculosis in Poland in 2020.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2020 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2020, data from Statistics Poland on deaths from tuberculosis in 2019, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." RESULTS: In 2020, 3,388 TB cases were reported in Poland. The incidence rate was 8.8 cases per 100,000 with large variability between voivodeships from 5.5 to 13.3 per 100,000. A decrease in the incidence was found in 15 voivodeships, the most significant in Slaskie voivodship (63.9%). The number of all pulmonary tuberculosis cases was 3,237 i.e. 8.4 per 100,000. Pulmonary cases represented 95.5% of all TB cases. In 2020, 151 extrapulmonary TB cases were notified (4.5% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,573 cases (79.5% of all pulmonary TB cases, the incidence rate 6.7 per 100,000). The number of smear-positive pulmonary TB cases was 1,771 i.e. 4.6 per 100,000 (54.7% of all pulmonary TB cases). In 2020, there were 38 cases (15 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.6% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with increasing age from 0.7 per 100,000 among children (0-14 years) to 15.0 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 12.1 per 100,000. There were 39 cases in children up to 14 years of age (1.2% of the total) and 49 cases in adolescents between 15 and 19 years of age - rates 0.7 and 2.7 per 100,000 respectively. In 2020, there were 2,506 cases of tuberculosis in men and 882 in women. The TB incidence in men - 13.5 per 100,000 was 3.0 times higher than among women - 4.5. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 26.8 vs. 4.1 and in age group 55 to 59 years - 28.7 vs. 4.8. In 2020, there were 116 patients of foreign origin among all cases of tuberculosis in Poland (3.4%). In 2019, TB was the cause of death for 456 people (mortality rate - 1.2 per 100,000). CONCLUSIONS: TB incidence in Poland in 2020 was 36.7% lower than in 2019. Such significant declines in the incidence have not been observed in the last two decades. As in previous years, there were differences in incidence rates between voivodeships with an unexpectedly sharp decrease in incidence in Silesia (Slaskie voivodeship). The percentage of tuberculosis cases with bacteriological confirmation exceeded 78%, more than in EU/EEA countries (67.3%). The percentage of MDR-TB cases was still lower than the average in EU/EEA countries (1.6% vs. 3.8%). The highest incidence rates were found in Poland in the older age groups (EU/EEAaged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.2%, less than the average in EU/EEA countries (3.8%). The incidence of tuberculosis in men was three times higher than in women in Poland, and six times higher in patients aged 50 to 59. The impact of migration on the TB pattern in Poland has not yet become significant in 2020. The percentage of foreigners among TB patients was 3.4% (33% in EU/EEA countries).

Tuberculosis in Poland in 2019.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2019 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2019, data from Central Statistical Office on deaths from tuberculosis in 2018, data from National Institute of Public Health - National Institute of Hygiene on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2021 - 2019 data". RESULTS: In 2019, 5321 TB cases were reported in Poland. The incidence rate was 13.9 cases per 100,000 with large variability between voivodeships from 8.0 to 20.0 per 100,000. The number of all pulmonary tuberculosis cases was 5075 i.e. 13.2 per 100,000. Pulmonary cases represented 95.4% of all TB cases. In 2019, 246 extrapulmonary TB cases were notified (4.6% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 3926 cases (77.4% of all pulmonary TB cases, the incidence rate 10.2 per 100,000). The number of smear-positive pulmonary TB cases was 2565 i.e. 6.7 per 100,000 ( 48.2% of all pulmonary TB cases). In 2019, there were 41 cases (18 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.1% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 1.4 per 100,000 among children (0-14 years) to 23.9 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 19.8 per 100,000. There were 81 cases in children up to 14 years of age (1.5% of the total) and 48 cases in adolescents between 15 and 19 years of age - rates 1.4 and 2.6 per 100,000 respectively. In 2019, there were 3897 cases of tuberculosis in men and 1424 in women. The TB incidence in men - 21.0 per 100,000 was 2.9 times higher than among women - 7.2. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 40.2 vs. 8.1 and in age group 55 to 59 years - 45.1 vs. 9.0. In 2019, there were 121 patients of foreign origin among all cases of tuberculosis in Poland (2.3%). In 2018, TB was the cause of death for 519 people (mortality rate - 1.4 per 100,000). CONCLUSIONS: TB incidence in Poland in 2019 was lower than in the previous year. Differences in incidence between voivodships persist. The percentage of TB cases with bacteriological confirmation exceeded 75%, more than in EU/EEA countries (67.1%). In Poland, MDR-TB is less common than the average in the EU/EEA countries. In Poland, the highest incidence rates are found in older age groups. The percentage of children up to 14 years of age among all TB patients was 1.5%, lower than the average in EU/EEA countries (3.9%). The incidence of tuberculosis in men is nearly three times as high as in women. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. The percentage of foreign-born persons among TB patients is low.

BCG Moreau Vaccine Safety Profile and NK Cells-Double Protection Against Disseminated BCG Infection in Retrospective Study of BCG Vaccination in 52 Polish Children with Severe Combined Immunodeficiency.

OBJECTIVES: The aim of the study was to estimate the rate of adverse reactions to live BCG Moreau vaccine, manufactured by Biomed in Poland, in severe combined immunodeficiency (SCID) patients. MATERIAL: The profiles of 52 SCID patients vaccinated at birth with BCG, hospitalized in Children's Memorial Health Institute, Warsaw (CMHI), in the years 1980-2015 were compared with those of 349 BCG-vaccinated SCID patients from other countries analyzed by Beatriz E. Marciano et al. in a retrospective study (Marciano et al. J Allergy Clin Immunol. 2014;133(4):1134-1141). RESULTS: Significantly less disseminated BCG infections (10 out of 52 SCID, 19%) occurred in comparison with Marciano study-119 out of 349, 34% (p = 0.0028), with no death in patients treated with SCID anti-TB drug, except one in lethal condition. In our study, disseminated BCG infection was observed only in SCID with T-B+NK- phenotype and significantly lower NK cell counts (p = 0.0161). NK cells do not influence on the frequency of local BCG reaction. A significantly higher number of hematopoietic stem cells transplantations (HSCT) were performed in CMHI study (p = 0.0001). Anti-TB treatment with at least two medicines was provided. CONCLUSION: The BCG Moreau vaccine produced in Poland, with well-documented genetic characteristics, seems to be safer than other BCG substrains used in other regions of the world. Importantly, NK cells seem to play a role in protecting SCID patients against disseminated BCG complications, which NK- SCID patients are more prone to. HSCT and TB therapy could be relevant due to the patients' survival and the fact that they protect against BCG infection.

Tuberculosis in Poland in 2018.

AIM OF THE STUDY: To evaluate the main features of tuberculosis (TB) epidemiology in 2018 in Poland and to compare with the situation in the EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2018, data from National Institute of Public Health- National Institute of Hygiene on HIV-positive subjects for whom TB was an AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from the report " European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2020- 2018 data. Stockholm: European Centre for Disease Prevention and Control, 2020". RESULTS: In 2018, 5487 TB cases were reported in Poland. The incidence rate was 14.3 cases per 100000, with large variability between voivodeships from 7.3 to 23.4 per 100 000. The mean annual decrease of TB incidence in 2014- 2018 was 3.8%. In 2018, 4852 cases were newly diagnosed with no history of previous treatment i.e. 12.6 per 100 000. 635 cases i.e. 1.7 per 100 000 - 11.6% of all registered subjects were previously treated for tuberculosis. In 2018, the number of all pulmonary tuberculosis cases was 5224 i.e. 13.7 per 100000. Pulmonary cases represented 95.2% of all TB cases. In 2018, 243 extrapulmonary TB cases were found i.e. 0.6 per 100 000. In the whole country there were 52 pediatric cases of tuberculosis. TB in children represented 0.9% of all cases notified in Poland in 2018. The incidence rates of tuberculosis were growing along with the age group from 0.9 per 100 000 among children to 24.7 per 100 000 among subjects in the age group 45-64 years (the highest incidence rate). In 2018, the incidence rate in the age group ≥65 years was 21.3 per 100 000. The TB incidence among men i.e. 21.0 per 100 000 was 2.6 times higher than among women i.e. 8.0 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55 to 59 years - 44.9 vs. 9.8 and in age group 60- 64 years - 43.7 vs. 10.2. The TB incidence in rural population was lower than in urban, respectively 13.4 per 100 000 and 14.9 per 100 000. The number of all registered culture positive TB cases was 4075. Pulmonary tuberculosis was bacteriologically confirmed in 3935 subjects. Cases confirmed by culture represented 74.3% of all TB cases and 75.3% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2018 was 2324 i.e. 6.1 per 100 000 accounting for 44.3% of all pulmonary TB cases and 59.1% of pulmonary TB cases confirmed by culture. In all patients with tuberculosis in Poland in 2018 there were 48 cases with MDR-TB (among them 14 foreigners) and 83 patients with resistance to isoniazid only, representing respectively 1.3% and 2.2% of cases with known DST results (DSTs were available in 90.7% of all culture-confirmed TB cases). In 2018, there were 97 patients of foreign origin among all cases of tuberculosis in Poland. TB was AIDS-indicative disease in 14 subjects with HIV co-infection. There were 490 deaths due to tuberculosis reported in 2017 - 1.3 per 100 000; 468 people died from pulmonary and 22 from extrapulmonary tuberculosis. Mortality among males - 2.1 per 100 000 - was 3.6 X higher than among females - 0.5. 40.2% of all TB deaths were cases 65 years old and older - 3.1 per 100 000. In 2017, there was no death from tuberculosis in children and no deaths in adolescents. In 2017, tuberculosis represented 0.1% of total mortality in Poland and 25.4% of mortality from infectious and parasitic diseases. CONCLUSIONS: In 2018, the incidence of tuberculosis in Poland was lower than in 2017. Despite a continuous decline it is still higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The participation of pediatric cases is smaller than average in the EU/EEA countries. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. In Poland, MDR-TB is less common than the average in the EU/EEA countries.

Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014.

INTRODUCTION: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. AIM: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. METHODS: In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002-14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. RESULTS: A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6-0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2-1.5), male sex (OR: 1.3; 95% CI: 1.1-1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1-1.4), positive HIV status (OR: 3.3; 95% CI: 1.6-6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5-2.2). CONCLUSIONS: This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.

Tuberculosis in Poland in 2017

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2017 in Poland and to compare with the situation in the EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2017, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report "European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2019-2017 data. Stockholm: European Centre for Disease Prevention and Control, 2019". RESULTS: In 2017, 5 787 TB cases were reported in Poland. The incidence rate was 15.1 cases per 100 000, with large variability between voivodeships from 8.9 to 21.9 per 100 000. The mean annual decrease of TB incidence in 2013-2017 was 4.2%. In 2017, 5127 cases were newly diagnosed with no history of previous treatment i.e. 13.3 per 100 000. 660 cases i.e. 1.7 per 100 000 ­ 11.4% of all registered subjects were previously treated for tuberculosis. In 2017, the number of all pulmonary tuberculosis cases was 5 531 i.e. 14.4 per 100 000. Pulmonary cases represented 95.6% of all TB cases. In 2017, 256 extrapulmonary TB cases were found. In the whole country there were 68 pediatric cases of tuberculosis. TB in children represented 1.2% of all cases notified in Poland in 2017. The incidence rates of tuberculosis were growing along with the age group from 1.2 per 100 000 among children to 25.6 per 100 000 among subjects in the age group 45-64 years (the highest incidence rate). In 2017, the incidence rate in the age group ≥65 years was 22.6 per 100 000. The TB incidence among men i.e. 22.2 per 100.000 was 2.4 times higher than among women i.e. 8,4 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 45 to 49 years ­ 36.1 vs. 8.1 and in age group 55- 59 years ­ 45.2 vs. 10.7. The TB incidence in rural population was lower than in urban, respectively 14.2 per 100.000 and 15.6 per 100 000. The number of all registered culture positive TB cases was 4 179. Pulmonary tuberculosis was bacteriologically confirmed in 4 057 subjects. Culture-confirmed cases represented 72.2% of all TB cases and 73.4% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2017 was 2 472 i.e. 6.4 per 100 000 accounting for 44.7% of all pulmonary TB cases and 60.9% of culture confirmed pulmonary TB cases.. TB was AIDS indicative disease in 16 subjects. In all patients with tuberculosis in Poland in 2017 there were 44 cases with MDR-TB (among them 12 foreigners) and 85 patients with resistance to isoniazid only, representing respectively 1.2% and 2.2% of cases with known DST results (DSTs were available in 90.5% of all cultureconfirmed TB cases). In 2017, there were 108 patients of foreign origin among all cases of tuberculosis in Poland. TUBERCULOSIS MORTALITY: There were 543 deaths due to tuberculosis reported in 2016 ­ 1.4 per 100 000; 526 people died from pulmonary and 17 from extrapulmonary tuberculosis. Mortality among males ­ 2.2 per 100 000 ­ was 3.7 X higher than among females ­ 0.6. 37.9% of all TB deaths were cases 65 years old and older ­ 3.3 per 100 000. In 2016, there was one death from tuberculosis in children and no deaths in adolescents. In 2016, tuberculosis represented 0.14% of total mortality in Poland and 28.1% of mortality from infectious diseases. CONCLUSIONS: In 2017, the incidence of tuberculosis in Poland was lower than in 2016. Despite a continuous decline it is still higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. In Poland, tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB is less common than the average in the EU/EEA countries.

Tuberculosis in Poland in 2016

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2016 in Poland and to compare with the situation in the EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2016, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report " European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2018- 2016 data. Stockholm: European Centre for Disease Prevention and Control, 2018". RESULTS: In 2016, 6 444 TB cases were reported in Poland. The incidence rate was 16.8 cases per 100 000, with large variability between voivodships from 8.1 to 24.3 per 100 000. The average decline of TB incidence was 3.0% per year during 2012- 2016. 5 713 cases were new, never treated i.e. 14.9 per 100 000. 731 cases i.e. 1.9 per 100 000 ­ 11.3% of all registered subjects were previously treated. In 2016, 6 116 pulmonary tuberculosis cases occurred in Poland, equivalent to 15.9 per 100 000. Pulmonary cases represented 94.9% of all TB cases. The number of pulmonary TB cases with bacteriological confirmation was 4475 i.e. 12,0 per 100 000. In 2016, only 328 extrapulmonary TB cases were reported. Pediatric cases represented 1.6% of the total TB cases in Poland; 103 children with TB were notified. The incidence of tuberculosis has been growing along with the age group from 1.8 per 100 000 among children to 27.8 per 100 000 among patients aged 45 to 64 years. In the age group 65 years old and older the incidence was 26.0 per 100 000. The incidence among men i.e. 24.0 per 100 000 was >2 times higher than among women i.e. 10.0 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55 to 59 years ­ 51.9 vs. 11.5 and in subjects aged 60 to 64 years (45.9 vs. 11.7). The TB incidence in urban population was higher than in rural, respectively 17.3 per 100 000 and 15.9 per 100 000. In 2016, the number of all culture positive TB cases was 4619. Culture-confirmed cases represented 71.7% of all TB cases; culture-confirmed pulmonary TB ­ 73.2% of all pulmonary TB cases. In 2016, the number of smear-positive/culture positive pulmonary TB cases was 2612 (6.8 per 100 000) what represented 42.7% of all pulmonary TB cases. TB was initial AIDS indicative disease in 17 persons. In 2016, 46 cases with MDR-TB (among them 10 foreigners) and 101 patients with resistance solely to isoniazid were reported in Poland, representing respectively 1.1% and 2.4% of cases with known DST results (DSTs were done in 90.7% of all culture-confirmed TB cases). In 2016, there were 92 TB cases of foreign origin. In 2015, there were 537 deaths due to tuberculosis in Poland, which is equivalent to 1.4 deaths per 100 000 population; 520 people died from pulmonary and 17 from extrapulmonary tuberculosis. Mortality among males ­ 2.3 per 100 000 ­ was 3.8 x higher than among females ­ 0.6. The highest mortality rate was observed in subjects 65 years old and older ­ 3.3 per 100 000. There were no deaths from tuberculosis in children and adolescents. In 2015, TB mortality represented 0.14% of total mortality in Poland and 28.0% of mortality from infectious diseases. CONCLUSIONS: In 2016, the incidence of tuberculosis in Poland was slightly higher than in 2015 and higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is low. In Poland, tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB is less common than the average in the EU/EEA countries.

Tuberculosis in Poland in 2015

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2015 in Poland and to compare with the data on the same phenomena in the EU/EEA countries. METHODS: Analysis of case ­ based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2015, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report " European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017. Stockholm: European Centre for Disease Prevention and Control, 2017". RESULTS: 6430 TB cases were reported in Poland in 2015. The incidence rate was 16.7 cases per 100 000, with large variability between voivodeships from 8.3 to 26.5 per 100 000. The mean annual decrease of TB incidence in 2011- 2015 was 5.5%. 5757 cases were new, never treated i.e. 15.0 per 100 000. 673 cases i.e. 1.8 per 100 000 ­ 10.5% of all registered subjects were previously treated. The number of all notified pulmonary tuberculosis cases in 2015 was 6078 i.e. 15.8 per 100 000. Pulmonary cases represented 94.5% of all TB cases. The number of pulmonary TB cases with bacteriological confirmation was 4472 i.e. 11,6 per 100 000. In 2015, only 352 extrapulmonary TB cases were reported. Children accounted for 1.3% of all TB cases in Poland; 81 pediatric cases were notified. The incidence of tuberculosis has been growing along with the age group from 1.4 per 100 000 among children to 28.1 per 100 000 among patients aged 45 to 64 years. In the age group 65 years old and older the incidence was 26.9 per 100 000. The incidence among men i.e. 24.0 per 100 000 was >2 times higher than among women i.e. 9.9 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50 to 54 years ­ 45.6 vs. 12.4 and in subjects aged 55 to 59 years (53.3 vs. 12.8). The TB incidence in rural population was lower than in urban, respectively 16.5 per 100 000 and 16.9 per 100 000. The number of all registered culture positive TB cases, including cases previously treated, was 4630. Cultureconfirmed cases constituted 72.0% of all TB cases; culture-confirmed pulmonary TB ­ 73.6% of all pulmonary TB cases. The number of smear-positive/culture positive pulmonary TB cases reported in 2015 was 2714 i.e. 7.1 per 100 000 respectively what constituted 44.7% of all pulmonary TB cases. TB was initial AIDS indicative disease in 20 persons. In Poland in 2015 there were 35 cases with MDR-TB (among them 5 foreigners) and 95 patients with resistance solely to isoniazid, constituting respectively 0.8% and 2.3% of cases with known DST results (DSTs were done in 91.6% of all culture-confirmed TB cases). There were 52 cases of tuberculosis registered among foreigners in 2015. There were 526 deaths due to tuberculosis reported in 2014 ­ 1.4 per 100 000; 504 people died from pulmonary and 22 from extrapulmonary tuberculosis. Mortality among males ­ 2.2 per 100 000 ­ was 3.6 x higher than among females ­ 0.6. The highest mortality rate was in subjects 65 years old and older ­ 3.8 per 100 000. There were no deaths from tuberculosis in children. TB was cause of death in one adolescent. TB mortality in 2014 constituted 0.14% of total mortality in Poland and 27.4% of mortality from infectious diseases. CONCLUSIONS: In Poland in 2015 the incidence of tuberculosis was lower than in the past but higher than the average in the EU/EEA countries. The highest incidence rates occurred in older age groups. The incidence in men was more than 2 times higher than in women. In Poland, tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB are less common than in the EU/EEA countries.

Tuberculosis in Poland in 2014

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2014 in Poland and to compare with the data on the same phenomena in EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drugsusceptibility testing results in cases notified in 2014, data from National Institute of Public Health- NationalInstitute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office ondeaths from tuberculosis based on death certificates, data from ECDC report " European Centre for DiseasePrevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2016. Stockholm: European Centre for Disease Prevention and Control, 2016". RESULTS: 6 698 TB cases were reported in Poland in 2014. The incidence rate was 17.4 cases per 100 000, withlarge variability between voivodeships from 9.3 to 26.5 per 100 000. The mean annual decrease of TB incidence in 2010- 2014 was 2.1%. 6 066 cases had no history of previous treatment i.e. 15.8 per 100 000. 632 cases i.e. 1.6 per 100 000 ­ 9.4% of all registered subjects were relapses. The number of all notified pulmonary tuberculosis cases in 2014 was 6311 i.e. 16.4 per 100 000. Pulmonary cases represented 94.2% of all TB cases. In the presented year 387 extrapulmonary TB cases were reported. Children with TB (70 cases) accounted for 1.0% of all cases notified in Poland. The incidence of tuberculosis increases with age from 1.2 per 100 000 among children to 30.4 per 100 000 among patients 65 years old and older. The incidence among men i.e. 24.6 per 100 000 was 2.3 times higher than among women i.e. 10.7 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 45 to 49 years ­ 40.4 vs. 9.3. The TB incidence in rural population was lower than in urban, respectively 17.0 per 100 000 and 17.7 per 100 000. The number of all registered culture positive TB cases, including relapses, was 4 781. Culture-confirmed cases constituted 71.4% of all TB cases and 72.9% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2014 was 2800 i.e. 7.3 per 100 000 respectively what constituted 44.4% of all pulmonary TB cases. TB was initial AIDS indicative disease in 13 persons. In Poland in 2014 there were 35 cases with MDR-TB (including 7 patients of foreign origin) and 97 patients with resistance to isoniazid only, constituting respectively 0.8% and 2.2% of cases with known DST results (DSTs were done in 93.3% of all culture-confirmed TB cases). In 2014, there were 49 foreign-origin TB cases reported in Poland. There were 532 deaths due to tuberculosis reported in 2013 ­ 1.4 per 100 000; 518 and 14 from extrapulmonary tuberculosis. Mortality among males ­ 2.2 per 100.000 ­ was 3.6 X higher than among females ­ 0.6. 38,5% of all TB deaths were cases 65 years old and older ­ 3.7 per 100 000. There were no deaths from tuberculosis in children. TB was cause of death in one adolescent. TB mortality in 2013 constituted 0.14% of total mortality in Poland and 27.1% of mortality from infectious diseases. CONCLUSIONS: In Poland in 2014 the incidence of tuberculosis was higher than the average in EU/EEA countries. The highest incidence rates occurred in older age groups. The incidence in men was more than 2 times higher than in women. In Poland, unfavorable phenomena as tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB are less common than in EU/EEA countries.

[Tuberculosis: actual problems with diagnosis and treatment]. / Gruzilica: aktualne problem rozpoznawania i leczenia.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex. It remains health problem also in developed countries. Most common form of tuberculosis is pulmonary disease but other sites of the body can be affected (extrapulmonary TB). As TB incidence falls, the probability of developing active diseases in people infected with M. tuberculosis is higher among imunocompromised people and in people from risk groups. People who present with unexplained cough lasting two or more weeks or with findings suggestive of tuberculosis on chest radiographs should be evaluated for tuberculosis. For patients suspected of having pulmonary or extrapulmonary tuberculosis specimens from the sites of involvement should be obtained for microbiological tests. Bronchoscopy and BAL should be performed in patients that do not produce sputum and with negative sputum smears. Ct scan may also play an important role in the evaluation of patients suspected of having TB but with negative sputum smears. The standard therapy for TB should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol in the initial phase and of isoniazid and rifampicin given for 4 months (the continuation phase).

What factors may influence epidemiological situation of tuberculosis in Poland and in the world?

The authors present the review of factors influencing epidemiological situation of tuberculosis in Poland and in the world. The groups of increased risk of tuberculosis, and clinical conditions predisposing to activation of latent tuberculosis infection (LTBI) such as HIV, uremia, diabetes mellitus, transplantation of organs, treatment with glucocorticosteroids and with antibodies to TNF and to its receptors, were presented. The higher prevalence and worse prognosis of tuberculosis in elderly people was emphasised. The methods of LTBI recognition, according to recent recommendations, with special consideration to patients in immunosupression, were shown. Methods of treatment to prevent LTBI activation, according to WHO experts, were also presented. All data were discussed in relation to the actual epidemiological situation of tuberculosis in Poland.

Tuberculosis in Poland in 2013.

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2013 in Poland and to compare with the corresponding EU/EEA data. METHODS: Analysis of case- based clinical and demographic data on TB patients from Central TB Register, of data submitted by laboratories on anti-TB drug susceptibility testing results in cases notified in 2013, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report "European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015. Stockholm: European Centre for Disease Prevention and Control, 2015". RESULTS: 7250 TB cases were reported in Poland in 2013. The incidence rate was 18.8 cases per 100 000, with large variability between voivodships from 9.9 to 27.4. The mean annual decrease of TB incidence in 2009-2013 was 2.0%. 6403 cases had no history of previous treatment (rate 16.6). The number of all notified pulmonary tuberculosis cases was 6835; 17.8 per 100 000. The proportion of extrapulmonary tuberculosis among all registered cases was 5.7% (415 cases). In 2013, 34 patients had fibrous-cavernous pulmonary tuberculosis (0.5% of all cases of pulmonary tuberculosis). TB was diagnosed in 116 children (1.6% of all cases, incidence 2.0). The incidence of tuberculosis increased progressively with age to 33.7 among patients 65 years old and older. The mean age of new TB cases was 53.5 years. The incidence among men (26.8) was more than two times higher than among women (11.4). The incidence rate in rural population was lower than in urban areas; 17.1 vs. 20.0. Bacteriologically confirmed pulmonary cases (4825) constituted 68,2% of all pulmonary TB cases. The number of smear positive pulmonary TB cases was 2859 (61.3% of culture confirmed pulmonary cases). There were 52 foreigners registered among all cases of tuberculosis in Poland (0.7%) and 250 cases registered among prisoners (rate 298.0). There were 40 patients with MDR-TB (0.8% of cases with known DST results). TB was AIDS indicative disease in 35 cases. There were 630 deaths due to tuberculosis in 2012 (1.6 TB deaths per 100 000). Mortality among males--2.6--was more than 3 times higher than among females--0.8. CONCLUSIONS: In Poland in 2013 the incidence of tuberculosis was higher than the average in EU/EEA countries. The highest incidence rates occurred in older age groups. The incidence in men was more than 2 times higher than in women. The incidence of tuberculosis in children and the percentage of patients with drug- resistant tuberculosis are lower than average in the EU/EEA and that is favorable for epidemiological situation of tuberculosis in our country.

Tuberculosis in homeless persons in Poland.

UNLABELLED: The fall in rates of tuberculosis (TB) in many countries has been accompanied by the concentration of cases in the social risk groups including homeless persons. AIM: Comparison of TB features in homeless persons and in non-homeless patients. METHODS: TB cases reported to National TB Register in Poland in whom information about the social status was available (the data about the social status were collected obligatorily in the years 2004-2013 only) were analysed. The results of DSTs were obtained from laboratory records and were available for the cases reported since 2010. Treatment outcome after 12 months was analysed for the cases registered between 2004-2012. The significance (Si) of the differences in proportions was assessed with chi-square test. P<0.05 was regarded as statistically significant. Test F was used to evaluate the significance of differences of the means of age. The multivariate logistic regression models were applied to find out the independently operating determinants of not achieving of success of treatment. RESULTS: 2,349 homeless persons (HP) and 72,989 other patients (OP) with TB were included. In the group of HP, there was a greater proportion of males in comparison with OP (90.5% vs. 66.3%) (Si). The mean age of HP was 49.8 years (SD±10.9); of OP-52.9 years (SD±17.5) (Si). 16.6% of HP and 10.4% of OP were previously treated for TB (Si). The previous treatment was adequate in 62.2% of HP and in 85.8% of OP (Si). Pulmonary TB was in 98.0%, extrapulmonary TB in 2.0% of HP and, respectively, in 92.5% and 7.5% of OP (Si). Pulmonary TB was confirmed by culture in 76.3% of HP and in 64.5% of OP (Si). Sputum smears were positive in 70.7% of HP and in 62.5% of OP (Si). Caseous pneumonia occurred in 2.7% of homeless subjects and in 1.1% of OP (Si); infiltrative TB in 95.5% of HP and in 97.5% of OP (Si). Resistance to isoniazid was observed in 2.9% of HP and in 3.1% of OP; to rifampicin in 0.0% of HP and in 0.2% of OP; to isoniazid and rifampicin in 0.4% of HP and in 0.8% of OP. These differences were not Si. Treatment success rate among HP was 44.1%; default rate 24.8%; 4.0% of HP died from tuberculosis; 3.2% died from other causes; 5.2% were transferred and their outcomes were unknown; 0.4% were still on treatment; 0.4% had treatment failure; in 17.9% of HP results of treatment were not available. Among other TB patients the rate of success was 66.8%; of default--8.8%; 1.9% died from TB; 3.1% died from other causes; 2.6% were transferred; 0.5% were still treated; 0.2% had treatment failure; in 16.1% the results were not reported. Differences between both groups were Si, except for the category "died from other causes", "still on treatment" and "treatment failure". CONCLUSIONS: In the group of homeless persons with tuberculosis phenomena which indicate a delay in diagnosis of disease and in some cases the possibility of a recent infection and also unfavorable treatment outcomes occur in a greater proportion than among other patients. Targeted screening for TB and directly observed treatment could likely improve the epidemiological situation of tuberculosis in the population of homeless.

Tuberculosis in Poland in 2012.

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2012 in Poland and to compare with the corresponding EU data. METHODS: Analysis of case- based clinical and demographic data on TB patients from Central TB Register, of data submitted by laboratories on anti-TB drug susceptibility testing results in cases notified in 2012, data from National Institute of Public Health - National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report "Tuberculosis Surveillance in Europe, 2014 (situation in 2012). RESULTS: 7 542 TB cases were reported in Poland in 2012. The incidence rate was 19.6 cases per 100 000, with large variability between voivodships from 10.6 to 30.2. The mean annual decrease of TB incidence in 2008-2012 was 2.4%. 6 665 cases had no history of previous treatment; 17.3 per 100 000. The number of all notified pulmonary tuberculosis cases was 7 018; 18.2 per 100 000. The proportion of extrapulmonary tuberculosis among all registered cases was 6.9% (524 cases). In 2012, 36 patients had fibrous-cavernous pulmonary tuberculosis (0.5% of all cases of pulmonary tuberculosis). TB was diagnosed in 95 children (1.3% of all cases, incidence 1.6). The incidence of tuberculosis increased progressively with age to 34.8 among patients 65 years old and older. The mean age of new TB cases was 53.1 years. The incidence among men (27.4) was more than two times higher than among women (12.2). The incidence rate in rural population was lower than in urban; 20.2 vs. 18.6. Bacteriologically confirmed pulmonary cases (4870) constituted 69,4% of all pulmonary TB cases. The number of smear positive pulmonary TB cases was 2 778 (39.6% of all pulmonary cases). In 2012 in the all group of TB patients in Poland there were 276 (3.7%) of homeless and 1 905 (25.3%) of unemployed. There were 48 foreigners registered among all cases of tuberculosis in Poland (0.6%) and 243 cases registered among prisoners (rate 288.0). There were 31 patients with MDR-TB (0.7% of 4659 cases with known anti-TB DST results). TB was initial AIDS indicative disease in 26 cases. There were 640 deaths due to tuberculosis in 2011 (1.7 TB deaths per 100 000). Mortality among males - 2.7 - was four times higher than among females - 0.7. CONCLUSIONS: CONCLUSIONS. In Poland in 2012 the incidence of tuberculosis was higher than the average in EU countries. The highest incidence rates occurred in older age groups. The incidence in men was more than 2 times higher than in women. The incidence of tuberculosis in children and the percentage of patients with drug-resistant tuberculosis are lower than average in EU and that is favorable for epidemiological situation of tuberculosis in our country.

Epidemiological situation of tuberculosis in Poland: part II. What are the causes of the different epidemiological situation in various regions of Poland?

INTRODUCTION: The different epidemiological situation of tuberculosis in various regions of Poland (higher and lower notification rates) was described previously by our group. The patients diagnosed with tuberculosis in the higher notification rate areas were younger and there were more cases of primary tuberculosis (tuberculous pleurisy and tuberculosis of chest lymph nodes) than in the patients diagnosed in the lower notification areas. The aim of the present study was to assess the possible causes of the different epidemiological situation of tuberculosis in various regions of Poland. MATERIAL AND METHODS: Analysis was done at the same regions as in the previous paper. A comparison was made between two groups: Group I, which included three voivodeships with higher rates of notification, from 23.7 to 32.3/100,000 (mean rates in the analysed period of time); and Group II, which included five voivodeships with lower notification rates (mean rates from 12.2 to 18.6/100,000). The wealth of the regions (GDP, gross domestic product per capita), the level of unemployment, and social status of the patients were analysed. We compared the population density in both regions. The results of treatment in both regions were also analysed. RESULTS: We did not find any differences in GDP and unemployment rates between the compared regions. The results of treatment were different in particular regions, but there was no clear tendency for worse results in voivodeships in Group I compared to voivodeships in Group II. However, the number of patients lost from observation was significantly higher in the regions from Group I than in those from Group II. There was also a significantly higher death rate from tuberculosis in younger patients (£ 59 years) from Group I than from Group II. This is additional proof that the epidemiological situation in the two regions was different. Finally, we found that the mean density of population in the regions from Group I was higher than that from Group II. The density of population may influence transmission of tuberculosis. There is also the possibility that the differences in the epidemiological situation in various regions of Poland are caused by historical events. In the past the epidemiological situation of tuberculosis was much worse in the east of Europe than in the west. Just after the Second World War, according to the changes of the Polish territory, many Polish citizens (mainly ancestors of those from Group I) were displaced from the east to the west. CONCLUSIONS: In conclusion, the greater number of patients lost from observation, together with the higher density of population in the regions from Group I in comparison with those from Group II, seems to be partly responsible for the difference in the epidemiological situation in the two regions. It is also possible that some patients from Group I are more susceptible to infection and disease caused by Mycobacterium tuberculosis due to their ancestors, who lived in the east of Europe.

The epidemiological situation of tuberculosis in Poland: Part I. According to notification rates, the incidence of tuberculosis varies in different regions of Poland: is this true?

INTRODUCTION: In 2012 the incidence rate of tuberculosis in Poland was 19.6/100,000 but these was great variability between regions concerning notification rates (from 10.9/100,000 to 30.2/100,000). The aim of the study was to assess whether there are elements that might confirm that these differences are true. To answer this question, we compared the population of TB patients from regions with higher notification rates to the population of patients from regions with lower notifications rates. The data collected during three consecutive years were analysed. We selected for comparison the regions with the lowest and highest notification rates and those in which the notification rates for 3 years (2010-2012) were relatively stable. MATERIAL AND METHODS: Eight regions were chosen: three regions (Group I) with high notification rates (from 23.7 to 32.3/100,000 - mean rates in the analysed period of time) and five (Group II) with low notification rates (mean rates from 12.2 to 18.6/100,000). RESULTS: It was found that the proportion of sputum culture-positive patients was significantly higher in Group II. Thus, the difference in the notification rate of cases with culture-confirmed tuberculosis was smaller than the difference in the whole notification rate. Nevertheless, it was still significant. Tubercle bacilli in patients from Group I were significantly more often resistant to one drug. The incidence of chronic fibro-cavernous disease and of tuberculous pneumonia was significantly higher in Group I. The proportion of patients with symptoms was higher in Group I than in Group II. In addition, patients in Group I had the so-called primary tuberculosis (tuberculous pleuritis and tuberculous lymphadenopathy in the chest) significantly more often. It was also found that among patients from Group I there were significantly more children, more (though not significantly) youngsters and significantly fewer elderly patients. CONCLUSIONS: Based on these observations, it was concluded that there is a real difference in the epidemiological situation of tuberculosis in the selected regions of Poland with high and low rates of notification. Possible causes of this situation will be presented in a following publication.

Tuberculosis in Poland in 2011.

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2011 in Poland and to compare with the corresponding EU data. METHODS: Analysis of case- based clinical and demographic data on TB patients from Central TB Register, of data submitted by laboratories on anti-TB drug susceptibility testing results in cases notified in 2011, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report "Tuberculosis surveillance in Europe 2011". RESULTS: 8478 TB cases were reported in Poland in 2011. The incidence rate was 22.2 cases per 100,000, with large variability between voivodeships from 12.8 to 37.0. The mean annual decrease of TB incidence in 2007 - 2011 was 0.4%. 7515 cases had no history of previous treatment i.e. 19.7 per 100,000. The number of all notified pulmonary tuberculosis cases was 7879 i.e. 20.6 per 100,000. The proportion of extrapulmonary tuberculosis was 7.1% (599 cases). TB was diagnosed in 111 children (1.3% of all cases, incidence 1.9). The incidence of tuberculosis increased with age to 41.9 among patients 65 years old and older. The mean age of TB patients was 53.3 years. The incidence among men i.e. 31.0 was more than two times higher than among women i.e. 14.0. The incidence in rural population was slightly lower than in urban, respectively 21.9 and 22.4. Bacteriologically confirmed cases (5327) constituted 67.6% of all pulmonary TB cases. The number of smear positive pulmonary TB cases was 2916 (37.0% of all pulmonary cases). There were 38 foreigners registered among all cases of tuberculosis in Poland and 204 cases registered among prisoners. There were 41 patients with MDR-TB (0.8% of 4993 cases with DST results). TB was initial AIDS indicative disease in 26 cases. There were 575 deaths due to tuberculosis in 2010 (1.5 TB deaths per 100,000). Mortality among males--2.5--was four times higher than among females--0.6. CONCLUSIONS: In Poland the incidence of tuberculosis is higher than the average in EU countries. In 2011 the highest incidence occurred in older age groups and was higher in men. Positive characteristic also when compared with the situation in many EU countries is the low incidence of tuberculosis in children and the low percentage of patients with drug-resistant tuberculosis.