important facts
In 2023, a total of 1.25 million people died from tuberculosis (TB), including 161,000 people living with HIV. Around the world, tuberculosis appears to be back as the world’s biggest single infectious pathogen killer, after three years of being replaced by coronavirus disease (COVID-19). Tuberculosis is also the leading cause of death among people infected with HIV and the leading cause of death associated with antimicrobial resistance. In 2023, TB will affect an estimated 10.8 million people worldwide, including 6 million men, 3.6 million women, and 1.3 million children. Tuberculosis exists in all countries and age groups. Tuberculosis is treatable and preventable. Multidrug-resistant tuberculosis (MDR-TB) remains a public health crisis and a threat to health security. In 2023, only two in five people with drug-resistant tuberculosis received treatment. Since 2000, global efforts to fight tuberculosis have saved an estimated 79 million lives. US$22 billion per year is required to achieve the prevention, diagnosis, treatment and care of tuberculosis, a global goal by 2027 agreed at the 2023 United Nations High-Level Meeting on Tuberculosis. Ending the tuberculosis epidemic by 2030 is one of the health goals of the United Nations Sustainable Development Goals (SDGs).
overview
Tuberculosis (TB) is an infectious disease caused by bacteria that most often affects the lungs. It spreads through the air when people with tuberculosis cough, sneeze, or spit.
Tuberculosis is preventable and treatable.
It is estimated that approximately one-quarter of the world’s population is infected with Mycobacterium tuberculosis. Approximately 5-10% of people infected with tuberculosis eventually develop symptoms and develop tuberculosis disease.
People who are infected but not sick are not contagious. Tuberculosis is usually treated with antibiotics, but untreated it can be fatal.
In some countries, the bacillus Calmette-Guérin (BCG) vaccine is given to infants or young children to prevent tuberculosis. Vaccines prevent deaths from tuberculosis and protect children from severe tuberculosis.
Certain conditions may increase your risk of tuberculosis.
Diabetes (hyperglycemia) A weakened immune system (such as from HIV or AIDS) Malnutrition Tobacco use Harmful use of alcohol.
symptoms
People infected with tuberculosis do not feel sick and are not contagious. Even if infected with tuberculosis, only a small proportion of people will develop the disease or symptoms of tuberculosis. Babies and children are at increased risk.
Tuberculosis occurs when bacteria multiply in the body and affect various organs. Because symptoms of tuberculosis may be mild for many months, people can easily spread the disease to others without knowing it. Some people with tuberculosis do not show any symptoms.
Common symptoms of tuberculosis are:
Prolonged cough (sometimes with blood) Chest pain Weakness Fatigue Weight loss Fever Night sweats
The symptoms a person experiences depend on which part of the body is infected with tuberculosis. Tuberculosis usually affects the lungs, but can also affect the kidneys, brain, spine, and skin.
prevention
To prevent infection and spread of tuberculosis, follow these steps:
Early treatment of tuberculosis can help stop the spread of the disease and increase your chances of recovery, so see your doctor if you have symptoms such as a persistent cough, fever, or unexplained weight loss. Get tested for tuberculosis if you have an increased risk of: You are infected with HIV or have been in contact with someone in your family or workplace who has tuberculosis. Preventive tuberculosis treatment (TPT) prevents disease from occurring due to infection. If you are prescribed TPT, please complete the entire course. If you have tuberculosis, avoid contact with others, wear a mask, cover your mouth and nose when coughing or sneezing, and properly dispose of phlegm and used tissues. Maintain good hygiene when doing so. Special measures such as respiratory and ventilation measures are important. Reduce infections in healthcare facilities and other institutions.
diagnosis
WHO recommends the use of rapid molecular diagnostic tests as an initial diagnostic test for all people with signs and symptoms of tuberculosis.
Rapid diagnostic tests recommended by the WHO include the Xpert MTB/RIF Ultra and Truenat assays. These tests have high diagnostic accuracy and represent a significant improvement in the early detection of tuberculosis and drug-resistant tuberculosis.
The tuberculin skin test (TST), interferon gamma release assay (IGRA), or the newer antigen-based skin test (TBST) can be used to identify infected people.
Diagnosis of multidrug-resistant tuberculosis and other resistant forms of tuberculosis (see section on multidrug-resistant tuberculosis below) and HIV-associated tuberculosis can be complex and expensive.
Tuberculosis is especially difficult to diagnose in children.
process
Tuberculosis disease is treated with special antibiotics. Treatment is recommended for both tuberculosis infection and tuberculosis disease.
The most commonly used antibiotics are:
Isoniazidorifampicin pyrazinamide ethambutol.
To be effective, the drug must be taken daily for 4 to 6 months. It is dangerous to stop taking drugs early or without your doctor’s advice because the tuberculosis bacteria in your body can become resistant to the drugs.
Tuberculosis that does not respond to standard drugs is called drug-resistant tuberculosis, and requires treatment with a variety of drugs.
Multidrug-resistant tuberculosis (MDR-TB)
Drug resistance occurs when TB drugs are used inappropriately, due to incorrect prescribing by health care providers, low-quality drugs, or patients stopping treatment prematurely.
MDR-TB is a type of tuberculosis caused by bacteria that do not respond to the two most effective first-line tuberculosis drugs, isoniazid and rifampicin. MDR-TB can be treated and cured using other drugs, but these drugs tend to be more expensive and toxic.
In some cases, extensively drug-resistant tuberculosis or XDR-TB may develop. MDR-TB Tuberculosis caused by bacteria that does not respond to the most effective drugs in treatment regimens can leave patients with very limited treatment options.
MDR-TB remains a public health crisis and a threat to health security. In 2023, only two in five people with multidrug-resistant tuberculosis received treatment.
According to WHO guidelines, detection of MDR-TB requires bacteriological confirmation of tuberculosis using rapid molecular tests or culture methods and testing for drug resistance.
The new 2022 WHO guidelines prioritized a 6-month short-term all-oral regimen known as BPaLM/BPaL as a treatment for eligible patients. In 2023, 5,646 MDR/RR-TB patients are reported to have started treatment with BPaLM/BPaL regimens worldwide, an increase from 1,744 in 2022. Shorter duration, lower drug burden, and higher efficacy of this new regimen have been reported to initiate treatment with the BPaLM/BPaL regimen. Reduce the burden on the healthcare system, conserve valuable resources, and further expand diagnostic and treatment coverage to all individuals in need. Previously, MDR-TB treatment lasted at least nine months and up to 20 months. WHO recommends expanding access to all-oral therapy.
Tuberculosis and HIV
People with HIV are 16 times (uncertainty interval 14 to 18) times more likely to develop tuberculosis than people without HIV. Tuberculosis is the leading cause of death in people infected with HIV.
HIV and tuberculosis form a deadly combination, each accelerating the progression of the other. In 2023, approximately 161,000 people died from HIV-related tuberculosis. The proportion of notified TB cases with a documented HIV test result in 2023 was 80%, the same level as in 2022, but up from 76% in 2021. The WHO African Region has the highest burden of HIV-associated tuberculosis. In all of 2023, only 56% of tuberculosis patients with known HIV infection were receiving antiretroviral therapy (ART).
WHO recommends a 12-component approach for joint TB and HIV action, including actions to prevent and treat infections and diseases, to reduce deaths.
impact
Tuberculosis primarily affects adults during their most productive years. However, all age groups are at risk. More than 80% of infections and deaths occur in low- and middle-income countries.
Tuberculosis occurs in all parts of the world. In 2023, the WHO Southeast Asia Region had the highest number of new TB cases (45%), followed by the Africa Region (24%) and the Western Pacific Region (17%). Approximately 87% of new TB cases occurred in the 30 high-burden countries, with more than two-thirds of the global cases occurring in Bangladesh, China, the Democratic Republic of the Congo, India, Indonesia, Nigeria, Pakistan, and the Philippines.
Globally, approximately 50% of people and their households receiving treatment for tuberculosis report a catastrophic amount (over 20% of total household income) of total costs (direct medical costs, non-medical expenses, indirect costs such as lost income). End Tuberculosis Strategy Goal: Zero. People with weakened immune systems, such as people with HIV, malnutrition, diabetes, and smokers, are at higher risk of getting sick. In 2023, it is estimated that there will be 960,000 new cases of tuberculosis due to malnutrition, 750,000 new cases of alcohol use disorder, 700,000 new cases of smoking, 610,000 new cases of HIV infection, and 380,000 new cases of diabetes worldwide. has been done.
Investing to eradicate tuberculosis
To meet the global targets for 2027 agreed at the 2023 United Nations High-Level Tuberculosis Conference, US$22 billion per year will be needed for tuberculosis prevention, diagnosis, treatment and care.
As in the past decade, most (80%) of spending on tuberculosis services in 2023 came from domestic sources. In low- and middle-income countries, funding from international donors remains important. From 2019 to 2023, available funding from domestic sources decreased (US$ 1.2 billion) and funding from international donors increased only slightly (US$ 0.1 billion). Most of the decline in domestic funding is primarily explained by the decline in domestic funding trends in Brazil, the Russian Federation, India, China and South Africa (BRICS). Funding for TB research and innovation in 2022 will be USD 1 billion, which remains far short of the global target of USD 5 billion per year, constrained by overall investment levels.
WHO response
WHO is working closely with countries, partners and civil society to strengthen the response to tuberculosis. To contribute to achieving the goals of the 2023 United Nations High-Level Conference Political Declaration, the Sustainable Development Goals, the Tuberculosis Elimination Strategy and WHO’s strategic priorities, WHO pursues six core functions.
Provide global leadership for TB elimination through strategy development, political and multisectoral engagement, review and accountability, advocacy, and strengthening partnerships with civil society; shape the TB research and innovation agenda promote and facilitate the generation, translation and dissemination of knowledge; promote and promote norms-setting standards and implementation of TB prevention and care, and the development of ethical and evidence-based policy options for TB prevention and care; Development and promotion, ensuring the provision of specialized technical assistance to Member States and partners in collaboration with WHO regional and country offices, promoting change and building sustainable capacity. Monitor and report on the status of the tuberculosis epidemic and progress on financing and implementation of the response at global, regional and national levels.
