FIGHTING TUBERCULOSIS IN FINLAND

UNCLAS SECTION 01 OF 02 HELSINKI 000083

SIPDIS

STATE FOR EUR/CARC, EUR/PGI/DTESSLER AND
OES/IHB/ALAURIZEN
SIPDIS

E.O. 12958: N/A
TAGS: TBIO WHO XG FI
SUBJECT: FIGHTING TUBERCULOSIS IN FINLAND

REF: STATE 6989


1. Per reftel request, Post contacted Ministry of Social
Affairs and Health's Ministerial Counselor Anni
Virolainen-Julkunen and Finnish Lung Health Association's
Medical Adviser Arvid Nyberg to gain information on the
status of implementation in Finland of the Berlin
Declaration on Tuberculosis. The assessment is contained
in the following paragraphs.


2. Finland has a long history of Tuberculosis (TB)
diagnostics, treatment and monitoring. Due to determined
and persistent efforts TB has dropped significantly in
Finland in the last 40 years and the rate of the spread
of infection between population groups when it does occur
is very low. According to the World Health Organization
(WHO),the TB incidence rate was six per 100,000 (339
cases) in 2005, only 3 percent of the level prevailing in
the early 1960s (TB incidence 172/100,000). The positive
trend has continued: in 2006, 295 new TB cases were
reported and in 2007 the number of new cases was 266,
according to the national TB expert organization, the
National Public Health Institute (KTL). Finland differs
from the other Nordic countries in that the majority of
TB cases are detected in people aged 65 and older (who
contracted TB infection in their youth) and only a
smaller proportion (10-20%) of cases are detected in
immigrants. Childhood TB is very rare in Finland, with
four to ten cases registered in children in the whole
country. As a result of Finland meeting the International
Union Against Tuberculosis and Lung Disease (IATLD)
criteria for discontinuing universal Bacille Calmette-
Gurin (BCG) vaccination programs and following an
increase of BCG vaccination complications, Finland halted
mass BCG vaccination of newborns in September 2006. A new
KTL supervised BCG vaccination program was introduced and
Finland moved to target risk groups instead (immigrants
from high TB risk countries).

New TB control program


3. To enhance awareness and knowledge of TB and to
support the change to the new BCG vaccination program,
Finnish Lung Health Association (Filha)in cooperation
with KTL and supported by the Ministry for Social Affairs
and Health (MoSAH),drafted a new Tuberculosis Control
Program for Finland, which was released in August 2006,
and will be updated by 2012. The goal of the program is
early detection, efficient and successful treatment in 80
percent of those with infectious pulmonary TB, efficient
prevention of new infections, reduction in the risk of
contracting TB and improved knowledge and skills of
Finland's health care staff. The implementation of the
new TB control Program addresses commitments taken by the
Berlin Declaration signatories.


4. Compared with previous practices, the most significant
changes in the new TB Control Program are specific
measures aimed at risk groups, more efficient prevention
of TB transmission in institutions, the appointment of a
national expert group, specific guidelines for hospital
districts, more effective supervision of treatment and
co-ordination of monitoring, targeting BCG vaccinations
at risk groups, and increasing training and research. All
hospital districts in Finland have appointed persons
responsible for regional TB know-how and they were tasked
to draw up hospital district specific guidelines by the
end of 2007.


5. To address the extremely-drug resistant (XDR)-TB
challenge, all hospital personnel are instructed on how
to handle the XDR-TB disease, and incubation units have
already been set up in some hospitals to handle XDR
patients. Two national TB Expert Groups have been
established to monitor and support the implementation of
the National Tuberculosis program. The National TB
Prevention expert group, headed by KTL Research Professor
Petri Ruutu, which meets 2-3 times a year, is presently
drafting a TB treatment outcome monitoring system for
Finland to be released in 2008. The National TB Treatment
expert group, headed by Specialist in Respiratory
Medicine at Turku University Hospital Tuula Vasankari,
acts as the national expert body to be consulted in
problematic TB, multi-drug resistant (MDR)/XDR cases.
This group meets as needed, but at least 3-4 times a
year. The possibility that MDR-TB and XDR-TB may spread
to Finland from neighboring countries has been a cause of
concern, although one which has so far not been realized.
There have been a few separate MDR-TB cases (2-5 per
year) but no outbreaks detected. KTL anticipates
Individual XDR cases as opposed to a widespread outbreak.

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National TB Expert Organizations


6. KTL's Department of Infectious Disease Epidemiology
and Control (INFE),the national coordinator for the EU
monitoring network of infectious diseases (EuroTB),works
in close collaboration with the European Center for
Disease Prevention and Control (ECDC) to gather
information about the occurrence of infectious diseases,
epidemics and suspected epidemics, as well as the related
risk factors, and provide instructions for municipal
authorities to obtain and manage epidemic information
and, when necessary, assist them in these matters. In
addition to applied epidemiological research, INFE's HIV
laboratory and viral vaccine laboratory conduct basic
research in the field of microbiology and cell biology,
and is in charge of the quality control of laboratories
specializing in clinical diagnostic microbiology.


7. INFE's weekly updated and publicly available
Infectious Diseases Register provides detailed statistics
about infectious diseases, including TB, in Finland.
Doctors are obliged to report on infectious diseases (TB,
diphtheria, hepatitis, malaria, HIV, poliomyelitis,
cholera and rabies),and microbiological laboratories
report any occurrence of infectious diseases and related
observations. As part of an effort to improve the fight
against TB, and meet the Berlin declaration commitments,
the TB treatment outcome also must be submitted to INFE's
Infectious Disease Register, starting January 1, 2008.


8. Finnish Lung Health Association (Filha - former
Finnish Anti-Tuberculosis Association) implements in
Finland the new National Tuberculosis Control Program
together with MoSAH and KTL, by working nationally and
internationally to promote public health in the field of
TB and lung diseases. Filha's main task is to enhance
prevention, treatment and rehabilitation of these
diseases, by acting as a collaborative body of experts in
designing and implementing national disease control
programs, providing consulting, training and information
for health care personnel in Finland, Russia and Estonia,
collaborating with the public and private sectors in its
activities, promoting international collaboration in lung
diseases and expert exchange, supporting the battle
against TB in Russia and high incidence countries in
collaboration with Ministry for Foreign Affairs and
Ministry of Justice, and supporting medical research in
the field of lung diseases. Filha is the WHO
Collaborating Centre for Prevention, Control and
Treatment of TB, partner in the "Stop TB" strategy, and
member of the International Union Against Tuberculosis
and Lung Diseases (IUATLD),and the Tuberculosis
Surveillance Unit (TSRU).


9. Finland is an active partner in the international
effort to combat TB. Each year Finland funds numerous
joint projects in St Petersburg, the Leningrad region,
the Karelian Republic and Murmansk (Filha's Karelia
Republic TB Project 2000-2010, Murmansk Region TB Project
1997-2007, and St Petersburg TB Project 2002-2008 etc).
The main issues of cooperation are the eradication of
contagious diseases such as TB and HIV. Finland also
supports WHO's projects in Russia on TB and HIV.

WARE