TUBERCULOSIS

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the
lungs. Tuberculosis is curable and preventable.

TB is spread from person to person through the air. When people with lung TB cough, sneeze or
spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to
become infected.

KEY FACTS:

 A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV).
Worldwide, TB is one of the top 10 causes of death and the leading cause from a single
infectious agent (above HIV/AIDS).
 In 2019, an estimated 10 million people fell ill with tuberculosis (TB) worldwide. 5.6
million men, 3.2 million women and 1.2 million children. TB is present in all countries and
age groups. However, TB is curable and preventable.
 In 2019, 1.2 million children fell ill with TB globally. Child and adolescent TB is often
overlooked by health providers and can be difficult to diagnose and treat.
 In 2019, the 30 high TB burden countries accounted for 87% of new TB cases. Eight
countries account for two thirds of the total, with India leading the count, followed by
Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
 Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security
threat. A global total of 206 030 people with multidrug or rifampicin-resistant TB
(MDR/RR-TB) were detected and notified in 2019, a 10% increase from 186 883 in 2018.
  Globally, TB incidence is falling at about 2% per year and between 2015 and 2019 the
cumulative reduction was 9%. This was less than half way to the End TB Strategy
milestone of 20% reduction between 2015 and 2020.
 An estimated 60 million lives were saved through TB diagnosis and treatment between
2000 and 2019.
 Ending the TB epidemic by 2030 is among the health targets of the United Nations
Sustainable Development Goals (SDGs).

About one-quarter of the world's population has a TB infection, which means people have been
infected by TB bacteria but are not (yet) ill with the disease and cannot transmit it.

People infected with TB bacteria have a 5–10% lifetime risk of falling ill with TB. Those with
compromised immune systems, such as people living with HIV, malnutrition or diabetes, or
people who use tobacco, have a higher risk of falling ill.

When a person develops active TB disease, the symptoms (such as cough, fever, night sweats,
or weight loss) may be mild for many months. This can lead to delays in seeking care, and
results in transmission of the bacteria to others. People with active TB can infect 5–15 other
people through close contact over the course of a year. Without proper treatment, 45% of HIV-
negative people with TB on average and nearly all HIV-positive people with TB will die.

High Risk

Tuberculosis mostly affects adults in their most productive years. However, all age groups are at
risk. Over 95% of cases and deaths are in developing countries.

People who are infected with HIV are 18 times more likely to develop active TB. The risk of active
TB is also greater in persons suffering from other conditions that impair the immune system.
People with undernutrition are 3 times more at risk. Globally in 2019, there were 2.2 million new
TB cases in 2018 that were attributable to undernutrition.

Alcohol use disorder and tobacco smoking increase the risk of TB disease by a factor of 3.3 and
1.6, respectively. In 2019, 0.72 million new TB cases worldwide were attributable to alcohol use
disorder and 0.70 million were attributable to smoking.
Global Impact of TB

In 2019, 87% of new TB cases occurred in the 30 high TB burden countries. Eight countries
accounted for two thirds of the new TB cases: India, Indonesia, China, Philippines, Pakistan,
Nigeria, Bangladesh and South Africa.

Symptoms and Diagnosis

Common symptoms of active lung TB are cough with sputum and blood at times, chest pains,
weakness, weight loss, fever and night sweats. Health professionals recommend the use of rapid
molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of
TB as they have high diagnostic accuracy and will lead to major improvements in the early
detection of TB and drug-resistant TB. Rapid tests recommended are the Xpert MTB/RIF.

Diagnosing multidrug-resistant and other resistant forms of TB as well as HIV-associated TB can

be complex and expensive.

Tuberculosis is particularly difficult to diagnose in children.

Treatment

TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a

standard 6-month course of 4 antimicrobial drugs that are provided with information and support
to the patient by a health worker or trained volunteer. Without such support, treatment
adherence is more difficult.

Since 2000, an estimated 63 million lives were saved through TB diagnosis and treatment.

TB and HIV

People living with HIV are 18 (15-21) times more likely to develop active TB disease than people
without HIV.

HIV and TB form a lethal combination, each speeding the other's progress. In 2019, about 208
000 people died of HIV-associated TB. The percentage of notified TB patients who had a
documented HIV test result in 2019 was 69%, up from 64% in 2018. In the WHO African Region,
where the burden of HIV-associated TB is highest, 86% of TB patients had a documented HIV
test result. Overall in 2019, 88% of TB patients known to be living with HIV were on ART.

WHO recommends a 12-component approach of collaborative TB-HIV activities, including actions

for prevention and treatment of infection and disease, to reduce deaths.

Multidrug-resistant TB

Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond

to isoniazid and rifampicin, the 2 most effective first-line anti-TB drugs. MDR-TB is treatable and
curable by using second-line drugs. However, second-line treatment options are limited and
require extensive chemotherapy (up to 2 years of treatment) with medicines that are expensive
and toxic.

TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs and
can leave patients without any further treatment options.

Worldwide, only 57% of MDR-TB patients are currently successfully treated. In 2020, scientists
recommended a new shorter (9-11 months) and fully-oral regimen for patients with MDB-TB.
This research has shown that patients find it easier to complete the regimen, compared with the
longer regimens that last up to 20 months. Resistance to fluoroquinolones should be excluded
prior to the initiation of treatment with this regimen.

Global commitments

On 26 September 2018, the United Nations (UN) held its first high-level meeting on TB, elevating
discussion about the status of the TB epidemic and how to end it to the level of heads of state
and government. It followed the first global ministerial conference on TB hosted by scientists and
the Russian government in November 2017. The outcome was a political declaration agreed by
all UN Member States, in which existing commitments to end the TB epidemic thanks to the
efforts by the SDGs were reaffirmed.

SDG target includes a 35% reduction in the number of TB deaths and a 20% reduction in the TB
incidence rate. The strategy also includes a 2023 milestone that no TB patients and their
households face catastrophic costs as a result of TB disease.