Substantial underreporting of tuberculosis in West Greece - implications for local and national surveillance

Abstract

In order to estimate the reliability of the officially reported national tuberculosis (TB) incidence rates we performed a retrospective review of data collected in regional and national public health framework. TB notifications for the period 2000-2003 were obtained from two major hospitals and three relevant Public Health Departments (PHDs) in the region of West Greece, and subsequently compared with the data reported to the Hellenic Centre for Diseases Control (KEELPNO). During the four-year study period a total of 161 cases of TB were reported to the PHDs in West Greece; 70% of these cases were reported to the KEELPNO. Furthermore only 72 (38.7%) out of the 186 cases of TB identified in the two hospitals were notified to the PHDs. Assuming that the degree of undernotification observed for the two hospitals is the same throughout the region, we estimated that the case detection rate was 14 cases per 100,000 persons per year, i.e. 3.7 times higher than the rate officially reported for the period 2000-2003. Male predominance (2.1, male/female ratio) and an increased incidence in the elders (older than 60 years) and adolescents (10-14 years old) were also evident. The study demonstrated a substantial underestimation of TB burden in West Greece. In the face of the massive influx of immigrants and refugees coming from regions with high TB incidence and the increase of the number of drug-resistant cases a reliable and complete notification of TB is crucial in the planning of programs and development of appropriate control policies.

Tuberculosis in Greece: bacteriologically confirmed cases and anti-tuberculosis drug resistance, 1995-2009

“…This trend could be attributed to several factors, including improved accessibility to healthcare services for immigrants. However, the degree of undernotification of TB cases remains high, leading to substantial underestimation of the disease burden in Greece [4].…”

“…In Greece, according to the recently published report by the European Centre for Disease prevention and Control and the World Health Organization (WHO) Regional Office for Europe, the case notification rate was 6.0 cases per 100,000 population in 2008, while only 37.7% of all reported TB cases were confirmed by bacterial culture [3]. Underreporting is an important problem for TB control in Greece, where various limitations in the national TB monitoring system exist [4]. Reluctance to notify TB cases and failure to collect data at regional and national level makes TB surveillance and trend analysis problematic.…”

Current clinical, laboratory, and treatment outcome characteristics of visceral leishmaniasis: results from a seven-year retrospective study in Greece

“…3,4 Nevertheless, the true prevalence of VL is probably underestimated, as infectious diseases are generally under-reported in many countries, including Greece. 5,6 Data on VL in Greece are scarce. Therefore, the aim of this study was to report the epidemiological and clinical characteristics, risk factors, diagnostic tools, treatment, and outcome of VL among patients treated in two tertiary care Greek hospitals during the last 7 years.…”

Characterization of Mycobacterium Tuberculosis Complex Strains: A Multicenter Retrospective Greek Study

“…This issue was also addressed in a previous Greek study that used anti-tuberculosis drug consumption from 2004-8, where underreporting was approximately 80% corresponding to an incidence of five times higher than the official notification rate [13]. Since underreporting with the present applicable procedures remains high, a need for an alternative notification system, which may be based on anti-tuberculosis drug consumption, is imperative [14,15]. Strains from the present study belonged to multiple Families and most of them (70.1%) were not classified into any known Family.…”