APH 2000, 58, 241-251:

Recent trends in tuberculosis incidence in Belgium.

M. Wanlin, M. Uydebrouck, P. Vermeire, P. Bartsch, W. Schandevyl, P. Dierckx

Keywords: tuberculosis, incidence, MDR, Belgium

After decades of continous decrease, tuberculosis incidence in Belgium slightly increased to a peak in 1994 (15.1/100,000) but it has slowed down again at an exponential rate during the subsequent years to 11.8/100,000 in 1998.  However, in 1998 this favourable trend failed to occur in every region of the country.  In the Brussels region the incidence reached 32.5/100,000 that year.  In cities of more than 100,000 inhabitants TB-incidence is 2,5-times higher than in smaller cities.

The most striking result of the registration is the high and still increasing proportion of non-Western subjects in the overall TB-incidence (24% in 1992 vs. 30% in 1998).  Incidence is now 111/100,000 in the non-Western population (subjects from Eastern Europe, Asia (except Japan), Africa, Central and South America) vs 8.6/100,000 in the Western population.

Almost half of the pulmonary TB cases were smear positive and consequently contagious.  Four percent of the patients were known to be co-infected with HIV, but the results of serological testing were known for only 13% of the subjects.  Among the 1,203 new cases registered in 1998, 53 were of a low socio-economic status, 50 were asylum seekers, 40 illegals, 11 detainees.

Since 1992 the results of drug susceptibility testing have been analyses and related to clinical information.  Until 1998 no more than 10 new cases of multiresistant TB per year were being detected, an incidence still below 0.1/100,000.  In 1999, however, 18 new cases of MDR have been recorded, stressing a persistent need for maintaining close surveillance and screening of at risk groups.