Except for Portugal, all countries reported rates lower than 25. Among the indigenous population of most countries, TB occurred largely among the elderly, except in Portugal where, in 1990, more than half of all cases occurred in persons aged 15-44 years. The death rate for the most recent year available in each country ranged from 0.3 to 2.8 per 100,000 population. HL Rieder, MD, Tuberculosis Section, International Union Against Tuberculosis and Lung Disease, Paris. Nonetheless, the general trends in TB morbidity suggest that the declines of the 1970s are no longer being sustained in several countries of Western Europe.
Factors contributing to the observed trends in TB morbidity probably vary between countries.
An increasing proportion of cases among foreign-born persons probably has contributed to a change from expected downward trends. The HIV seroprevalence among persons with TB is not widely available, however, and the prevalence of TB among persons with AIDS is used in this report as an indicator of the impact of HIV on TB morbidity. Properly designed disease surveillance systems and standardized case definitions are critical to monitoring TB trends and identifying high-risk groups. Analysis of standardized surveillance data will allow each country to more effectively prevent, diagnose, and treat TB and will make comparison of TB data between countries feasible. Raviglione MC, Sudre P, Rieder HL, Spinaci S, Kochi A. Secular trends of tuberculosis in Western Europe.