Tuberculosis

Essential

• In total, 1.23 million people died from tuberculosis in 2024 (of which 150,000 also had an HIV infection). Tuberculosis is the disease caused by a single infectious agent that causes the most deaths and is one of the top 10 causes of mortality worldwide.
• Tuberculosis was also the leading cause of death among people living with HIV in 2024 and one of the main causes of deaths related to antimicrobial resistance.
• Estimates suggest that 10.7 million people, including 5.8 million men, 3.7 million women, and 1.2 million children, contracted tuberculosis worldwide in 2024. Tuberculosis is present in all countries and affects all age groups.
• Multi-drug-resistant tuberculosis (TB-MR) 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 people since 2000.
• Tuberculosis is a preventable and curable disease.

Overview

Tuberculosis is a bacterial disease that most often affects the lungs. It is transmitted through the air when infected people cough, sneeze, or spit.

Tuberculosis is a preventable and curable disease.

It is estimated that about a quarter of the world’s population has been infected with the tuberculosis bacillus. Generally, people with latent tuberculosis infection do not feel sick and are not contagious. Approximately 5% to 10% of infected individuals will eventually develop symptomatic tuberculosis. Infants and children are at higher risk of contracting the disease if exposed to tuberculosis infection.

Tuberculosis is usually treated with antibiotics and can be fatal if left untreated.

In some countries, the tuberculosis vaccine (Bacille Calmette-Guérin vaccine) is administered to infants or young children preventively. The vaccine prevents tuberculosis-related deaths and protects children from severe forms of the disease.

Some conditions can increase the risk of tuberculosis:

• Diabetes;
• Weakened immune system (due to HIV infection, for example);
• Malnutrition;
• Tobacco consumption; and
• Harmful alcohol use.

Symptoms

Generally, people with latent tuberculosis infection do not feel sick and are not contagious. Only a small percentage of individuals infected with the tuberculosis bacillus will develop symptoms of the disease. Infants and children are at higher risk of contracting the disease if exposed to tuberculosis infection.

Tuberculosis symptoms occur when the bacillus multiplies and affects different organs. These symptoms may be mild for several months, making it easy to unknowingly transmit tuberculosis. Symptoms depend on the specific part of the body affected. While tuberculosis usually affects the lungs, it can also affect the kidneys, brain, and spine.

Some people with tuberculosis may not show any symptoms but can still transmit the disease.

The typical symptoms of tuberculosis include:

• Persistent cough (sometimes bloody);
• Chest pain;
• Fatigue;
• Severe weight loss;
• Fever; and
• Night sweats.

Symptoms depend on the specific part of the body affected. While tuberculosis usually affects the lungs, it can also affect the kidneys, brain, spine, and skin.

Prevention

To prevent tuberculosis infection and its spread:

• Consult a doctor if you experience symptoms such as persistent cough, fever, and unexplained weight loss, as early tuberculosis treatment can help stop the disease’s spread and improve your chances of recovery.
• Get screened for tuberculosis if you are at increased risk, such as living with HIV or being in contact with people with tuberculosis at home or work.
• Preventive tuberculosis treatment prevents the onset of symptoms. If prescribed preventive treatment, follow it until completion.
• If you have tuberculosis, practice good hygiene when coughing: avoid contact with others, wear a mask, cover your mouth and nose when coughing or sneezing, and dispose of sputum and used tissues properly.
• Special measures such as ventilation of spaces and wearing respiratory protective masks should be implemented to reduce infection in healthcare facilities and other types of structures.

Diagnosis

WHO recommends that all people with signs and symptoms of tuberculosis undergo rapid diagnostic testing.

WHO specifically recommends rapid diagnostic tests based on biomarkers for use at the point of care and molecular tests. These tests are precise and can provide initial results to guide treatment decisions within 48 hours of sample collection. These tests will lead to significant improvements in the early detection of drug-sensitive and drug-resistant forms of tuberculosis.

Diagnosing drug-resistant forms, including multidrug-resistant tuberculosis (MDR-TB), as well as HIV-associated tuberculosis and childhood tuberculosis, can be complex. WHO recommends specific sample types, tests, and strategies to detect these forms of tuberculosis to increase the chances of diagnosing the disease early and accurately.

An intradermal tuberculin test, an interferon-gamma release assay, or a newly developed skin antigen test can be used to search for tuberculosis infection. The test results help determine which high-risk individuals will benefit most from preventive treatment.

Treatment

Tuberculosis is treated with specific antibiotics. Treatment is recommended for both tuberculosis infection and disease.

The most commonly used antibiotics are:

• Rifampicin;
• Isoniazid;
• Pyrazinamide; and
• Ethambutol.

For the medications to be effective, they must be taken daily for four to six months. Stopping treatment too early or without medical advice can be dangerous, as the still-living bacillus can 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 anti-tuberculosis 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 caused by a bacillus that does not respond to rifampicin and isoniazid, the two most effective first-line anti-tuberculosis drugs. However, MDR-TB can still be treated and cured with second-line drugs, which are usually more expensive and have more side effects. Individuals exposed to MDR-TB can receive preventive treatment with levofloxacin.

In some cases, extensively drug-resistant tuberculosis (XDR-TB) can occur. When the disease-causing bacilli are not sensitive to the most effective drugs against MDR-TB, it becomes very difficult to find therapeutic options.

MDR-TB continues to pose a public health crisis. Only two out of five people with multidrug-resistant tuberculosis had access to treatment in 2024.

According to WHO guidelines, the diagnosis of MDR-TB should be based on bacteriological confirmation and evidence of drug resistance using rapid molecular tests or culture methods.

In 2022, new WHO guidelines recommended a six-month, entirely oral treatment regimen (BPaLM/BPaL) for patients meeting criteria. Globally, in 2024, approximately 34,000 people with MDR-TB had started a shorter six-month treatment (known as BPaLM and BDLLfxC), compared to only 5,653 in 2023 and 1,744 in 2022. The shorter duration, limited number of doses, and high efficacy of this new treatment regimen can help alleviate the burden on healthcare systems and save valuable resources to expand diagnosis and treatment to all those in need. WHO recommends expanding access to fully oral treatment regimens.

Tuberculosis and HIV

The risk of contracting tuberculosis is 12 times higher for people living with HIV than for those who are not infected. Tuberculosis is the leading cause of death among people 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 a documented HIV testing result stood at 82% in 2024, compared to 81% in 2023. The WHO African Region is the most affected by HIV-associated tuberculosis. Globally, in 2024, only 61% of estimated people living with HIV who had tuberculosis received antiretroviral therapy (ART).

In 2004, WHO first recommended joint activities for tuberculosis and HIV infection to reduce morbidity and mortality related to HIV-associated tuberculosis. These activities include screening, prevention, and treatment of both infections. The expansion of antituberculosis treatment and ART since 2005 is estimated to have prevented 9.8 million deaths.

Impact

Tuberculosis mainly affects adults in the prime of their lives. However, 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 of the world. In 2024, the WHO Region with the highest number of new tuberculosis cases was the Southeast Asia Region (34%), followed by the Western Pacific Region (27%) and the African Region (25%). Approximately 87% of new tuberculosis cases occurred in the 30 heavily affected countries, with two-thirds of the global total found 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 WHO’s zero target in the strategy to end tuberculosis. Immunocompromised individuals, such as those with HIV infection, malnutrition, or diabetes, or those who consume tobacco, have a higher risk of illness. In 2024, an estimated 0.97 million new tuberculosis cases worldwide were attributable to undernutrition, 0.93 million cases to diabetes, 0.74 million cases to alcohol use 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 globally agreed targets set at the United Nations General Assembly High-Level Meeting on Tuberculosis in 2023 by 2027.

Similar to the past decade, most spending on tuberculosis control services in 2024 (82%) came from national sources. In absolute terms, South Africa, Brazil, China, the Russian Federation, and India accounted for $3.1 billion (64%) out of the $4.8 billion from national sources in low- and middle-income countries. International donor funding amounted to $1.1 billion, ranging from $1.1 billion to $1.2 billion almost every year since 2015. Funding for tuberculosis research and innovation, totaling $1.2 billion in 2023, also falls significantly short of the global target of $5 billion per year. Progress to date has been limited by the overall level of investment.

WHO’s Action

WHO works closely with countries, partners, and civil society to intensify the tuberculosis response. It strives to ensure six essential functions to contribute to achieving the targets set in the Political Declaration resulting from the 2023 UN High-Level Meeting, the Sustainable Development Goals, the End TB Strategy, and WHO’s strategic priorities.