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.