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Abstract The study proposes a dynamic spatio‐temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012–2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio‐economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.

The study proposes a dynamic spatio-temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012-2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM 2.5 ) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio-economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2024 The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

Purpose: Romania has the highest tuberculosis (TB) burden in the European Union/European Economic Area (EU/EEA) comprising almost a quarter (23.4%) of the reported patients in 2017, and a TB notification rate six times higher than the EU/EEA average. Although the overall TB notification rate in Romania declined from 154/100.000 individuals to 66/100.000 individuals in the general population between 2002 and 2017, TB notification rates remain high in certain vulnerable populations groups such as prisoners, the homeless population and among drug users., Patients and Methods: We conducted a descriptive study regarding TB monitoring data in Romania, including the aforementioned TB risk groups., Results: Analysis regarding notified TB cases among these risk groups indicates that TB rates are 7 to 18 times higher than in the general population. One of the most alarming aspects regards the exceedingly high proportion of HIV-seropositivity among drug users and the high mortality rates among the homeless population and among drug users with TB., Conclusion: This data underlines the importance of early identification among social risk groups using outreach active case-finding (ACF) activities, possibly combining TB screening with screening for other common, possibly life-threatening, co-morbidities for which an effective treatment is available. ACF could have a decisive role in TB control and eradication in Romania, when aimed at these high-risk groups., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Munteanu et al.)

The implementation of programmes for Tuberculosis Control (NPTC) in the medium term, starting in 1997, who under the auspices and the coordination of the Ministry of Health, was the guarantor of the achievements in these years in TB control, therapeutic success rate of cases being a constant source of 80%. The global incidence of TB (IG) (new cases and relapses) has decreased in the past 10 years with 42%, from a maximum of 142.2per 100 thousand in 2002, to 79.2 per 100 thousand in 2012. The incidence of TB in children between 0 and 14 years of age has dropped significantly, from 48.2 per 100 thousand in 2002 (1843) a t28.3per 100 thousand in 2011 (770). Mortality declined from 10.8% in 2002 to 6% in 2011. To increase the control of TB, and in accordance with the envisaged country strategy for the period 2013-2017, the anti-TB Programme will give priority to the following measures: gradual introduction of rapid molecular techniques able to identify in the shortest time TB and chemoresistancies; centralized procurement anti-TB drugs; better integration ofpractices of diagnosis and treatment of TB in children with standard practices for tuberculosis control; for a proper diagnosis and treatment to all people suffering from MDR-TB (until 2015).

According to the World Health Organization and Stop TB Partnership, tuberculosis among children often remains undiagnosed, the main reported causes being lack of access to health services or because health professionals unrecognizing the signs and symptoms of tuberculosis in this age group. In Romania, consistent with TB endemic levels, the overall incidence progressively decreased from 142.2%ooo in 2002 to 82.8%ooo in 2011, incidence of TB in children 0-14 years dropped steadily from 47.2 %ooo (1784 cases) in the same "peak year"2002 to 23.6% ooo (766 cases) in 2011. The distribution of TB disease in children by counties shows variations between these, the explanations may be related both to differences in offer of the bacilli between different areas (prevalence of pulmonary patients smear and/or culture positive) and by deficiencies in the detection of cases and lack of rigor in diagnosis (variation in the incidence of TB in 0-14 years from 2.S%ooo in Sălaj county up to 53.2%ooo in Maramures county in 2011). The number of serious cases of TB in children (meningoencephalitis, miliary, cavitary) still maintains a constant high annual rate (65 cases in 2011), which demonstrates the severity of endemic TB in our country. Prompt assurance of TB diagnostic and also the accurate management of TB treatment constitute the guarantee of the decrease of this disease, goal applies to all age groups.

After reaching the lowest level of tuberculosis mortality rate in 1980, 3.7% hundred thousand (830 deaths), followed by a few years with low levels of mortality, the period following the year 1985 was marked by a gradual increase in the mortality rate and in 1995 it reached 11.3% hundred thousand (2560 deaths). The implementation since 1997 of TB control programmes on medium-term (under technical assistance of WHO experts) has led to a decrease in tuberculosis mortality rate to 1482 deaths, 6.9% hundred thousand, in 2010. Compared to standardized TB mortality rate in Europe, Romania is far from the countries of Western and Central Europe, with a rate 6.6 times greater than in the EU. Standardized mortality rate by sex reveals that the rate for males in Romania, in 2009, was 6.5 times higher than in women. Similar to 2009, in 2010, the deaths have reached a maximum per age group at 45-54 years old. In 2010 the tuberculosis fatality was 4.7% and the lethality was 0.6%. Consistency of tuberculosis control strategy, regarding both measures for early detection of tuberculosis and establishing TB treatment under the direct observation, represent the safety elements in the reduction of tuberculosis mortality rate. It should be reminded that one of the goals of Stop TB Partnership is reducing mortality rate in 2012 at half compared to 1990, Romania being one of the 18 countries included in this plan initiated by the WHO Europe Region Office.

Tuberculosis (TB) has not been eliminated from none of the world's regions up to now. Trends of TB endemic were constantly favorable in Romania in the recent years: number of new cases and relapses decreased with 13 235, incidence rate with 42%, incidence rate in children with 51% and mortality rate with 44%, from 2002 to 2011. The highest TB risk is being observed in men living in rural area and in those of 45-54 age group. The counties with the highest TB incidence rates are those in the South-West part of the country. The favorable trend of TB endemic in Romania has been achieved through a constant case detection rate over 70% and a treatment success rate over 80% in the recent years. The current major concerns in TB control in the country, as well as all over the world, are TB-HIV co-infection and micobacterial drug-resistance. Also, a negative aspect of TB endemic in Romania is that a number of severe forms of TB, TB-HIV, MDR-TB or deaths are still reported in children under 15 years old, each year. The response of health system to the TB problem consists in the development of the National TB Programme, which achieved many successes in the recent years, but in the same time is confronted with many challenges. However, the programatic control of the disease can be obtained by health services only in partnership with other services, institutions and organizations, which may offer economic and social support to the patients and their families.