European surveillance of infectious diseases: the case of AIDS and tuberculosis

In 1992, the Maastricht treaty gave specific responsibilities to the European Community in the field of research, information and health education. Several European surveillance systems for infectious diseases have been organised. The surveillance of AIDS was set up in 1984 after the emergence of this new disease. Seven western European countries participated initially. The system currently covers 48 of the 51 countries of the WHO European region. Based on a common case definition, it enables analysis of trends and comparisons which considerably facilitate the understanding of the epidemic and its determinants, and the evaluation of preventive actions. European countries have now decided to set up a reporting system for HIV infection. The surveillance of tuberculosis started in 1996 in response to the reversal of trends in reported cases observed in western Europe and to the threat of multi-drug resistant tuberculosis epidemics. Common recommendations on definitions and data collection procedures facilitated its establishment. Most countries of the WHO European region participated in the first year, revealing a very heterogeneous epidemiological situation. The next objective is to set up a surveillance system for antituberculosis drug resistance. The European surveillance of AIDS and tuberculosis are examples of systems adapted to the specific characteristics of Europe: similarities in diagnostic procedures, similarities in access to treatments, and common requirements regarding both the exchange of information and the coordinated response to public health threats. They are not simply looking for a common denominator. They are creating a real momentum among participating countries towards a better quality and a higher level of pertinence of the information.