APH 1998, 56, 199-208:

Tuberculosis incidence and surveillance in Belgium.

M. Fortuin, M. Uydebrouck, M. Wanlin, P. Vermeire, W. Schandevyl, and A. Gyselen

Keywords: tuberculosis, epidemiology, surveillance, Belgium

After decennia of regular decrease, tuberculosis incidence in Belgium remains almost constant since 1992. In 1996, 1,352 cases of newly detected active tuberculosis were reported, ie. 13.3/100,000 population. The recent change in trend is mainly due to an increase of tuberculosis incidence in non-Belgians, particularly of non-Western origin. The highest incidence rates are observed in Brussels and other major cities, where a large part of the population is of low socio-economic status. The new cases of multi-drug resistant tuberculosis represent less than 1% (0.8-0.5) of the yearly registered sputum-positive patients.

The three main pillars of tuberculosis surveillance are early diagnosis and treatment, close contact tracing and systematic screening in groups at risk. The Mantoux tuberculin skin test is the appropriate screening method in persons who recently had contact with infectious patients and, obviously, also in health care workers and other professionally exposed individuals. Chest radiography is the most effective screening method in the highest risk groups, such as asylum seekers, prisoners and socially marginalised people.

Transmission of tuberculosis infection should be prevented by strict isolation of contagious patients, coughing hygiene, provision of ample daylight and proper ventilation in patients'rooms, and the wearing of a protective mask by patients or visitors. Health care workers should be informed of their tuberculin and HIV serologic status as both conditions influence their resistance to infection. BCG immunisation, for which there are hardly any indications left in countries like Belgium, should still be considered for health care workers in services and settings, which regularly deal with multi-drug resistant cases and where strict adherence to preventive measures is problematic.