Key Facts About Tuberculosis (TB) in 2023

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

Overview of Tuberculosis

Tuberculosis is an infectious disease primarily caused by the bacterium Mycobacterium tuberculosis, which predominantly affects the lungs but can also impact other organs. The disease is transmitted through the air when an infected person coughs, sneezes, or spits. While TB is preventable and curable, it poses a significant public health threat, with an estimated 10.8 million new cases reported globally in 2023. This figure includes 6 million men, 3.6 million women, and 1.3 million children, highlighting that TB affects individuals across all demographics.

Despite its curability, about a quarter of the global population is estimated to be infected with TB bacteria, with 5-10% of these individuals eventually developing TB disease. Those who are infected but asymptomatic cannot transmit the disease, but once symptoms manifest, the risk of spreading TB increases significantly.

Symptoms of TB

Individuals with TB infection may not exhibit symptoms and are not contagious. However, when TB bacteria multiply and cause disease, symptoms can develop, often remaining mild for extended periods. Common symptoms of TB include:

• Prolonged cough (sometimes with blood)
• Chest pain
• Weakness and fatigue
• Unexplained 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 Strategies

Preventing TB infection and its spread involves several proactive measures:

1. Seek Medical Attention: If you experience symptoms such as a prolonged cough, fever, or unexplained weight loss, 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 close contacts of TB patients, should get tested for TB. Preventive treatment can help stop the infection from progressing to disease.

3. Practice Good Hygiene: Those diagnosed with TB should maintain good hygiene practices, including wearing masks and properly disposing of tissues.

4. Implement Special Measures: In healthcare settings, using respirators and ensuring proper ventilation can significantly reduce the risk of TB transmission.

Diagnosis of TB

The World Health Organization (WHO) recommends rapid molecular diagnostic tests as the initial diagnostic tool for individuals showing signs of TB. Tests such as Xpert MTB/RIF Ultra and Truenat assays offer high diagnostic accuracy, facilitating early detection of both TB and drug-resistant strains. Additional tests, including the tuberculin skin test (TST) and interferon gamma release assay (IGRA), can help identify individuals with TB infection.

Diagnosing multidrug-resistant TB (MDR-TB) and HIV-associated TB can be complex and costly, particularly in children, who are often more challenging to diagnose.

Treatment of TB

The treatment of TB disease involves a regimen of specific antibiotics, typically including isoniazid, rifampicin, pyrazinamide, and ethambutol. Treatment duration ranges from 4 to 6 months, and it is crucial to adhere to the prescribed regimen to prevent the development of drug-resistant TB.

Multidrug-Resistant TB (MDR-TB)

MDR-TB arises when TB medications are misused, leading to resistance. This form of TB does not respond to the two most effective first-line drugs, isoniazid and rifampicin. Although MDR-TB is treatable, it requires more expensive and toxic alternatives. In 2023, only about 40% of individuals with MDR-TB accessed treatment, underscoring the ongoing public health crisis.

The WHO has introduced a new treatment regimen known as BPaLM/BPaL, which offers a shorter, all-oral treatment option for eligible patients. This regimen has shown promise in improving treatment access and outcomes.

TB and HIV

The intersection of TB and HIV presents a significant health challenge. Individuals living with HIV are 16 times more likely to develop TB disease compared to those without HIV. In 2023, approximately 161,000 deaths were attributed to HIV-associated TB. Despite improvements in testing rates, only 56% of TB patients known to be living with HIV were receiving antiretroviral therapy (ART).

To combat this dual epidemic, the WHO recommends a comprehensive approach that includes prevention and treatment strategies tailored for individuals affected by both diseases.

Global Impact of TB

TB predominantly affects adults in their most productive years, but it poses a risk to all age groups. Over 80% of TB cases and deaths occur in low- and middle-income countries. In 2023, the WHO South-East Asia Region reported the highest number of new TB cases, followed by the African Region and the Western Pacific Region. The burden of TB disproportionately affects vulnerable populations, including those with compromised immune systems, undernutrition, and substance use disorders.

Investments Needed to End TB

To achieve global targets set for 2027, an estimated US$ 22 billion is required annually for TB prevention, diagnosis, treatment, and care. Despite the critical need for funding, there has been a decline in domestic funding sources, particularly in high-burden countries. International donor support remains vital, especially in low- and middle-income nations.

WHO’s Response to TB

The WHO is actively collaborating with countries, partners, and civil society to enhance the global response to TB. Key initiatives include:

• Providing global leadership and advocacy for TB strategies.
• Shaping the research and innovation agenda for TB.
• Establishing norms and standards for TB prevention and care.
• Offering technical support to member states.
• Monitoring the status of the TB epidemic and progress in response efforts.

Conclusion

Tuberculosis remains a formidable public health challenge in 2023, with millions affected and significant mortality rates. However, with concerted global efforts, increased funding, and effective treatment strategies, it is possible to combat this epidemic and work towards the goal of ending TB by 2030, as outlined in the United Nations Sustainable Development Goals. Awareness, prevention, and treatment are crucial in the fight against TB, and every individual has a role to play in this global health initiative.