Tuberculosis in Romania

Romania should be a good contributor to this multi-country project, based on its TB country profile. Although in Romania, for the past 10 years the incidence of tuberculosis constantly decreased  the figures are still very high. In 2013 the incidence value reached 87%000 2 compared with a peak of 142.2%000 in 2002. However, despite the success in managing drug-susceptible TB, drug-resistant tuberculosis is a major challenge to the effectiveness of National Tuberculosis Program in Romania, placing the country in the list of the 18 high-burden countries for MDR-TB in the WHO European Region. Compared to other countries in this region of WHO this incidence is low and Romania is not being considered as an MDR-TB hot spot. The proportion of MDR-TB tuberculosis was in 2012 of 4.23% in new TB cases and 10.7% in relapsed cases. Nonetheless, the incidence of MDR-TB is maintaining in the recent years and we can note a decrease in the percentage in new TB cases (in 2013, 2.8% MDR-TB in new cases and 11% in retreatment cases) . The global prevalence of MDR-TB in Romania is slowly increasing since 2007, from 1.360 cases (3.07% from all TB cases) to 1.442 in 2012 (4.23% from all TB cases)3. In what concerns the more severe type of DR, in 2007, the proportion of XDR cases among MDR strains was 11.4%. The drug-resistance survey (DRS) conducted during four months of 2009-2010 with results collected from 756 MDR-TB cases defined the level of XDR-TB among MDR-TB cases of 11.37% (among new MDR-TB cases – 9.9%, among retreatment cases – 11.6%). DRS also showed extremely high level of any resistance to Cm (69.3%), to Km (57.3%) and Am (54.7%) among tested strains. Another DRS study made by reports to the EuroTB network placed the level of XDR-TB in Romania at 6.6% in 2007 and 6.7% in 2008, from a number of 701 MDR-TB cases reported in 2007 and 816 MDR-TB cases reported in 2008 5. The available european TB DRS extensive data is published in yearly in the last 4 years. According to the report from 20136, in 2009-2011, in Romania, the number of notified MDR-TB cases was 624 in 2009 (10% of total TB cases) and among those there were 217 cases with SLD DST; from the 217 MDR-TB cases, 26 were XDR-TB (12%). In 2010 there were 574 MDR-TB notified cases (9.4% of TB cases) and 215 cases with SLD DST. From the 215 cases of MDT-TB with SLD-DST, 27 (12.6%) were XDR-TB. IN 2011 there were 530 MDR-TB cases (8.8% of TB cases) and 248 cases with SLD DST from which 13 (12.1%) were XDR-TB. The data from 2014 shows 530 (8.9%) MDR-TB reported cases from which 32 (6%) are XDR in 2012. The data from 2015 shows 555 (7.8%) MDR-TB reported cases from which 44 (7.9%) are XDR in 2013 8.

So from this data we can conclude that in the last 10 years the figures related to drug resistant tuberculosis are around: 4 to 5% MDR-TB from prevalent TB cases, (2.5 to 3% in new cases and 11% in retreatment cases); prevalence close to 12% XDR-TB cases of the MDR-TB cases in 2009-2011 are apparently decreasing to 8%. Therefore, it is reasonable to conclude that there is a reservoir of Romanian drug-resistant tuberculosis that needs thorough analysis. Also, in this body of evidence the figures regarding the neighboring country the Republic of Moldova are not included, which figures of drug-resistant TB are higher and probably this is increasing the Romanian reservoir in the context of last years’ population migration. Quite a large proportion of the Romanian population has crossed the borders in the last 20 years throughout the European Union presumably carrying local TB strains, possibly drug-resistant. In the context of increasing population migration it is essential to better characterize TB strains from across multiple countries to better achieve disease epidemiologic control globally. Therefore, this database should be a support for further molecular epidemiological studies and reference for drug susceptibility testing and new drug research, contributing to the decrease of the global burden of the disease.