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RR RUEHAG RUEHAST RUEHDA RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA RUEHLN
RUEHLZ RUEHPOD RUEHROV RUEHSR RUEHVK RUEHYG
DE RUEHHE #0083/01 0601244
ZNR UUUUU ZZH
R 291244Z FEB 08
FM AMEMBASSY HELSINKI
TO RUEHC/SECSTATE WASHDC 4084
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE

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. 
 
HELSINKI 00000083  002 OF 002 
 
 
 
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