By David Cohn, MD
As reported in the May/June Pulmonary Reviews, the European Union Standards for Tuberculosis (TB) Care were recently adapted from the International Standards for TB Care. In this post, David Cohn, MD, Professor of Medicine, Division of Infectious Diseases at the University of Colorado Health Sciences Center, Denver, provides insight into the significance of these documents.
With 80,000 cases of tuberculosis (TB) per year in European Union countries, and the fact that not all clinicians are following minimal standards for the diagnosis, treatment and prevention of TB, the European Centre for Disease Prevention and the European Respiratory Society chose to adapt the excellent International Standards for TB Care (ISTC). They are meant to complement other guidelines and are consistent with those of the WHO. Although many countries in Europe have a low incidence of TB (as is true in the US), there are a significant number of a cases of multidrug resistant and extremely drug resistant TB in several eastern European countries, including Russia and former countries of the Soviet Union. The European standards adapted and modified the ISTC to be be more in line with current and new technologies that are available in Europe—but not necessarily in resource-limited settings.
While the adapted standards have a European focus, the most important issue for US physicians is to keep TB in mind, given the international importance of this disease and the ISTC document this was based upon—which many US doctors don’t know about, but should.
The ISTC were first developed in 2006 and then updated in 2009, a multi-organizational effort spearheaded by Phil Hopewell of the American Thoracic Society and WHO. Initially, the main audience of the ISTC was clinicians in low- and medium-income countries, both in the private and public sectors. The goals were to establish a minimum set of standards for TB care, including proper diagnosis and treatment of TB, and also prevention and public health obligations by persons involved in TB care. Now, the comprehensive ISTC have applicability to all clinicians inlvolved in TB care, and are accompanied by Power Point slides that are in the public domain and can be used by anybody for training purposes. See http://www.istcweb.org/Home.html.
(Click here to read our feature article, "The ERS and ECDC Jointly Adapt International Standards for Tuberculosis Care.")