Overview
In total, 1.23 million people died from tuberculosis in 2024, of which 150,000 also had an HIV infection. Tuberculosis is a disease caused by a single infectious agent that results in the highest number of deaths and is one of the top 10 leading causes of mortality worldwide.
- Tuberculosis was also the leading cause of mortality among people living with HIV in 2024, and one of the main causes of deaths related to antimicrobial resistance.
- Estimates show that 10.7 million people, including 5.8 million men, 3.7 million women, and 1.2 million children, contracted tuberculosis globally in 2024. Tuberculosis is present in all countries and affects all age groups.
- Multi-drug-resistant tuberculosis (MDR-TB) continues to pose a public health crisis and remains a threat to health security. Only two out of five people with drug-resistant tuberculosis had access to treatment in 2024.
- Efforts on a global scale to combat tuberculosis are estimated to have saved 83 million lives since 2000.
- Tuberculosis is a preventable and curable disease.
Generalities
Tuberculosis is a bacterial disease that primarily affects the lungs. It is transmitted through the air when infected individuals cough, sneeze, or spit.
Tuberculosis is preventable and curable.
It is estimated that about one-quarter of the world’s population has been infected with the tuberculosis bacillus. Generally, individuals with latent tuberculosis infection do not feel sick and are not contagious. About 5% to 10% of infected individuals will eventually develop active tuberculosis. Infants and children are more at risk of contracting the disease if exposed to tuberculosis.
Tuberculosis is typically treated with antibiotics and can be fatal without treatment.
In some countries, the tuberculosis vaccine (BCG) is administered to infants or young children for preventive purposes. The vaccine prevents tuberculosis-related deaths and protects children from severe forms of the disease.
Certain conditions can increase the risk of tuberculosis, including diabetes, weakened immune system (e.g., HIV infection), malnutrition, tobacco use, and harmful alcohol consumption.
Symptoms
In general, individuals with latent tuberculosis infection do not feel sick and are not contagious. A small percentage of those infected by the tuberculosis bacillus will develop symptoms of the disease. Infants and children are more at risk of developing the disease if exposed to tuberculosis.
The symptoms of tuberculosis occur when the bacillus multiplies and affects different organs. These symptoms can be mild for several months, making it easy to unknowingly transmit tuberculosis. Symptoms depend on the affected body part. Although tuberculosis primarily affects the lungs, it can also affect the kidneys, brain, and spine.
Some individuals with tuberculosis may not have any symptoms but can still transmit the disease.
Common symptoms of tuberculosis include:
- Persistent cough (sometimes bloody)
- Chest pain
- Fatigue
- Severe weight loss
- Fever
- Night sweats
Symptoms depend on the affected body part, as tuberculosis can also affect the kidneys, brain, spine, and skin.
Prevention
To prevent tuberculosis infection and spread, individuals are advised to:
- Consult a doctor if they experience symptoms like persistent cough, fever, and unexplained weight loss, as early tuberculosis treatment can help stop disease spread and enhance recovery chances.
- Get tested for tuberculosis if at increased risk, such as living with HIV or being in contact with tuberculosis patients at home or work.
- Undergo preventive tuberculosis treatment to prevent symptomatic onset. If prescribed preventive treatment, it should be completed.
- Practice good hygiene when coughing, such as avoiding contact with others, wearing a mask, covering the mouth and nose when coughing or sneezing, and disposing of spit and used tissues properly.
- Implement specific measures like ventilation of spaces and wearing respiratory protective masks to contain infection in healthcare facilities and other settings.
Diagnosis
The WHO recommends rapid diagnostic testing for all individuals showing signs and symptoms of tuberculosis.
Rapid diagnostic tests based on biomarkers usable at the point of care, as well as molecular tests, are recommended by the WHO. These precise tests can provide initial results to guide treatment decisions within 48 hours of sample collection. These tests lead to significant improvements in early detection of drug-sensitive and drug-resistant forms of tuberculosis.
Diagnosing drug-resistant forms like multi-drug-resistant tuberculosis (MDR-TB) and tuberculosis associated with HIV and tuberculosis in children can be challenging. Specific sample types, tests, and strategies are recommended by the WHO to detect these tuberculosis forms accurately and increase diagnostic chances.
An intradermal tuberculin test, interferon-gamma release assay, or recently developed skin antigen test can be used to detect tuberculosis infection. Test results help identify individuals at high risk who will benefit most from preventive treatment.
Treatment
Tuberculosis is treated with specific antibiotics. Treatment is recommended for both tuberculosis infection and disease.
Commonly used antibiotics include:
- Rifampicin
- Isoniazide
- Pyrazinamide
- Ethambutol
For effectiveness, medications should be taken daily for four to six months. Stopping treatment too early or without medical advice can be dangerous, as the living bacillus may become resistant to antibiotics.
Tuberculosis that does not respond to standard medications is called drug-resistant tuberculosis. It requires treatment with alternative medications.
Multi-Drug-Resistant Tuberculosis (MDR-TB)
Resistance occurs when antituberculosis drugs are not used correctly, due to incorrect prescriptions by healthcare professionals, poor drug quality, or premature treatment interruption.
MDR-TB is a form of the disease resistant to rifampicin and isoniazid, which are the two most effective first-line antituberculosis drugs. However, MDR-TB can still be treated and cured with second-line medications, which are generally more expensive with more side effects. Individuals exposed to MDR-TB may receive levofloxacin preventively.
In some cases, extensively drug-resistant tuberculosis (XDR-TB) can emerge. When the disease-causing bacilli are not sensitive to the most effective drugs against MDR-TB, finding therapeutic options becomes challenging. MDR-TB continues to pose a public health crisis. Only two out of five individuals with MDR-TB had access to treatment in 2024.
According to WHO guidelines, MDR-TB diagnosis should be based on bacteriological confirmation and detecting drug resistance using rapid molecular tests or culture methods.
In 2022, new WHO guidelines advocated for a six-month oral-only treatment (BPaLM/BPaL) for patients meeting criteria. Globally, in 2024, approximately 34,000 MDR-RR tuberculosis patients began a shorter six-month treatment (known as BPaLM and BDLLfxC), compared to only 5653 in 2023 and 1744 in 2022. This shorter duration, reduced number of doses, and high effectiveness of this new therapeutic regimen can help alleviate the burden on healthcare systems and save valuable resources to expand diagnosis and treatment for all in need. The WHO recommends expanding access to fully oral therapeutic regimens.
Tuberculosis and HIV
The risk of contracting tuberculosis is 12 times higher in individuals infected with HIV than in those who are not. Tuberculosis is the leading cause of death among individuals living with HIV.
Tuberculosis and HIV form a deadly combination, each accelerating the progression of the other. In 2024, approximately 150,000 people died from HIV-associated tuberculosis. The percentage of tuberculosis cases with documented HIV testing results stood at 82% in 2024, compared to 81% in 2023. The African region is most affected by HIV-associated tuberculosis. Globally in 2024, only 61% of HIV-positive individuals with tuberculosis were receiving antiretroviral therapy (ART).
In 2004, the WHO recommended initiating joint activities for tuberculosis and HIV infection to reduce morbidity and mortality linked to HIV-associated tuberculosis. These activities include screening, prevention, and treatment for both infections. It is estimated that expanding antituberculosis and ART treatment since 2005 has prevented 9.8 million deaths.
Impact
Tuberculosis largely affects working-age adults, but all age groups are at risk. Over 80% of cases and deaths occur in low- and middle-income countries.
Tuberculosis is present in all regions globally. In 2024, the WHO Region with the highest number of new tuberculosis cases was the South-East Asia Region (34%), followed by the Western Pacific Region (27%) and the African Region (25%). Around 87% of new tuberculosis cases occurred in the 30 highly affected countries, with two-thirds of the global total in India (25%), Indonesia (10%), the Philippines (6.8%), China (6.5%), Pakistan (6.3%), Nigeria (4.8%), the Democratic Republic of the Congo (3.9%), and Bangladesh (3.6%). The top five countries accounted for 55% of the global total.
Worldwide, more than half of households affected by tuberculosis face catastrophic total costs (exceeding 20% of total household income), far from the WHO’s zero target in the Tuberculosis Strategy. Immunocompromised individuals, due to conditions like HIV infection, malnutrition, or diabetes, as well as those who use tobacco, are at higher risk. In 2024, an estimated 0.97 million new tuberculosis cases were attributable to undernutrition, 0.93 million cases to diabetes, 0.74 million cases to alcohol-related disorders, 0.7 million cases to smoking, and 0.57 million cases to HIV infection.
Investments to End Tuberculosis
An estimated $22 billion per year is needed for tuberculosis prevention, diagnosis, treatment, and care to achieve the global targets agreed upon at the high-level United Nations General Assembly meeting on tuberculosis held in 2023.
As in the past decade, most of the expenditures on tuberculosis control services in 2024 (82%) came from national sources. In absolute terms, South Africa, Brazil, China, the Russian Federation, and India contributed $3.1 billion (64%) out of $4.8 billion from national sources in low- and middle-income countries. International donor funding amounted to $1.1 billion annually, almost reaching $1.1-$1.2 billion each year since 2015. Funding for tuberculosis research and innovation, which totaled $1.2 billion in 2023, also falls well short of the global goal of $5 billion annually. Progress made to date has been limited by the overall level of investment.
WHO Action
The WHO is closely collaborating with countries, partners, and civil society to intensify the response to tuberculosis. It works to ensure six essential functions to achieve the targets set in the political declaration following the high-level United Nations meeting in 2023, sustainable development goals, the WHO’s strategy to end tuberculosis, and strategic priorities.
