Key Facts About Tuberculosis in 2023

In 2023, tuberculosis (TB) emerged as a significant global health crisis, claiming the lives of approximately 1.25 million individuals, including 161,000 people living with HIV. This alarming statistic marks a return to TB as the world’s leading cause of death from a single infectious agent, following a three-year period dominated by the COVID-19 pandemic. TB remains the primary killer of individuals with HIV and is a major contributor to deaths associated with antimicrobial resistance.

Globally, an estimated 10.8 million people fell ill with TB in 2023, comprising 6.0 million men, 3.6 million women, and 1.3 million children. TB is a disease that affects individuals across all countries and age groups, yet it is both preventable and curable. However, the challenge of multidrug-resistant TB (MDR-TB) continues to pose a public health crisis and a significant health security threat, with only about 40% of those with drug-resistant TB receiving treatment in 2023.

To combat TB effectively, an annual investment of US$ 22 billion is required for prevention, diagnosis, treatment, and care. This funding is crucial to meet the global targets set for 2027, as agreed upon during the 2023 UN high-level meeting on TB. Ending the TB epidemic by 2030 is a key health target within the United Nations Sustainable Development Goals (SDGs).

Overview of Tuberculosis

Tuberculosis is an infectious disease primarily caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. The disease spreads through the air when an infected person coughs, sneezes, or spits. While TB is preventable and curable, it remains a significant global health challenge.

Approximately one-quarter of the global population is estimated to be infected with TB bacteria, but only 5-10% of those infected will develop symptoms and progress to TB disease. Importantly, individuals who are infected but do not exhibit symptoms cannot transmit the disease. TB disease is typically treated with antibiotics, and without treatment, it can be fatal.

In some countries, the Bacille Calmette-Guérin (BCG) vaccine is administered to infants and young children to prevent severe forms of TB and reduce mortality rates. Certain conditions, such as diabetes, a weakened immune system (e.g., due to HIV/AIDS), malnutrition, tobacco use, and harmful alcohol consumption, can increase the risk of developing TB disease.

Symptoms of Tuberculosis

Individuals with TB infection often do not feel sick and are not contagious. However, when TB bacteria multiply and affect various organs, symptoms may arise. TB symptoms can be mild for extended periods, making it easy to unknowingly spread the disease.

Common symptoms of TB include:

• Prolonged cough (sometimes with blood)
• Chest pain
• Weakness and fatigue
• Weight loss
• Fever
• Night sweats

While TB primarily affects the lungs, it can also impact other parts of the body, including the kidneys, brain, spine, and skin.

Prevention of Tuberculosis

Preventing TB infection and its spread involves several key steps:

1. Seek Medical Attention: If you experience symptoms such as a prolonged cough, fever, or unexplained weight loss, seek medical care promptly. Early treatment can halt the spread of the disease and improve recovery chances.

2. Get Tested: Individuals at increased risk, such as those with HIV or those in contact with TB patients, should get tested. TB preventive treatment (TPT) can help prevent infection from progressing to disease.

3. Practice Good Hygiene: If diagnosed with TB, maintain good hygiene by avoiding close contact with others, wearing a mask, and properly disposing of tissues and sputum.

4. Implement Special Measures: In healthcare facilities and other institutions, measures such as respirators and proper ventilation are vital to reduce the risk of TB transmission.

Diagnosis of Tuberculosis

The World Health Organization (WHO) recommends rapid molecular diagnostic tests as the initial diagnostic tool for individuals exhibiting signs and symptoms of TB. Tests such as Xpert MTB/RIF Ultra and Truenat assays offer high diagnostic accuracy, significantly improving early detection of both TB and drug-resistant TB.

Other diagnostic methods include the tuberculin skin test (TST), interferon gamma release assay (IGRA), and newer antigen-based skin tests. Diagnosing multidrug-resistant TB and HIV-associated TB can be complex and costly, particularly in children.

Treatment of Tuberculosis

TB disease is treated with specific antibiotics, and treatment is recommended for both TB infection and disease. The most commonly used antibiotics include:

• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol

To be effective, these medications must be taken daily for 4-6 months. Stopping treatment prematurely or without medical guidance can lead to drug resistance, complicating future treatment options.

Multidrug-Resistant Tuberculosis (MDR-TB)

MDR-TB arises when TB medications are misused, whether through incorrect prescriptions, poor-quality drugs, or patients discontinuing treatment prematurely. This form of TB is resistant to isoniazid and rifampicin, the two most effective first-line TB drugs. While MDR-TB is treatable and curable, it requires more expensive and toxic medications.

Extensively drug-resistant TB (XDR-TB) can develop when bacteria do not respond to the most effective drugs in MDR-TB treatment regimens, leaving patients with limited treatment options. In 2023, only about 40% of individuals with MDR-TB accessed treatment.

WHO has introduced new guidelines prioritizing a short, all-oral regimen known as BPaLM/BPaL for eligible patients, significantly reducing treatment duration and improving patient outcomes.

TB and HIV

Individuals living with HIV are 16 times more likely to develop TB disease than those without HIV. TB remains the leading cause of death among people with HIV. In 2023, approximately 161,000 people died from HIV-associated TB.

The WHO African Region bears the highest burden of HIV-associated TB. Despite improvements, only 56% of TB patients known to be living with HIV were receiving antiretroviral therapy (ART) in 2023. WHO recommends a comprehensive approach to TB-HIV collaboration to reduce mortality rates.

Impact of Tuberculosis

TB primarily affects adults in their most productive years, but individuals of all ages are at risk. Over 80% of TB cases and deaths occur in low- and middle-income countries. In 2023, the highest number of new TB cases was reported in the WHO South-East Asia Region, followed by the African Region and the Western Pacific Region.

Globally, about 50% of individuals treated for TB and their households face catastrophic costs, which can exceed 20% of total household income. This financial burden is far from the WHO End TB Strategy target of zero catastrophic costs.

Investments to End TB

To achieve global TB targets by 2027, an annual investment of US$ 22 billion is necessary. In 2023, 80% of TB service funding came from domestic sources, with international donor funding remaining crucial for low- and middle-income countries. However, there has been a decline in domestic funding, particularly in countries like Brazil, India, and South Africa.

Investments in TB research and innovation also fall short of the global target of US$ 5 billion per year, with only US$ 1 billion allocated in 2022.

WHO Response to Tuberculosis

The WHO is actively collaborating with countries, partners, and civil society to enhance the global TB response. Six core functions guide WHO’s efforts:

1. Global Leadership: Developing strategies, engaging politically, and fostering partnerships.
2. Research and Innovation: Shaping the TB research agenda and promoting knowledge dissemination.
3. Setting Norms and Standards: Establishing guidelines for TB prevention and care.
4. Policy Development: Promoting ethical and evidence-based policies.
5. Technical Support: Providing specialized support to member states and partners.
6. Monitoring and Reporting: Tracking the TB epidemic and progress in financing and implementation.

In conclusion, while tuberculosis remains a formidable global health challenge, concerted efforts in prevention, diagnosis, treatment, and funding can pave the way toward ending the TB epidemic by 2030. The collaboration of governments, health organizations, and communities is essential to achieving this goal and saving millions of lives.