Spatio-Temporal Distribution of Tuberculosis in an Urban Setting in Germany A Ten Year Analysis

Background Big cities in Europe have the highest incidence rates of TB in otherwise low incidence settings. Understanding of the spatio-temporal patterns of TB incidence can support efforts for TB prevention and control in line with the End-TB Strategy of the WHO in such settings for low incidence settings. Methods Data from the municipal TB register of Cologne collected between 2006 and 2015 under the infection prevention legislation were retrieved, addresses geographically identified and all notified incident TB cases retrospectively analysed for their spatial and temporal distribution in this large German city using a geographic information system. Results During the analysed period 1,038 incident cases were reported, equivalent to an incidence rate of 10.03 cases per 100,000 inhabitants. Contagious pulmonary TB contributed 57% of all cases. Distribution patterns changed over time with decreases in 37 and increases in 22 of the 77 urban sub-districts, three of which showing constant high rates of TB incidence. Conclusion The study presents a complementary method to monitor the distribution and development of incident TB cases at a disaggregated level of urban sub-districts. Identification of areas with comparatively high incidence can support identification of clusters respectively their prevention and allow better planning for targeted local TB services.