Tuberculosis Overtakes COVID-19 as Leading Infectious Disease Killer with 8.2 Million New Cases

Despite being both preventable and treatable, tuberculosis remains a silent epidemic. As of 2023, around 10.8 million people developed tuberculosis globally, with 1.25 million deaths, including 161,000 among people with HIV. These alarming numbers have established tuberculosis again as the world’s leading cause of death from a single infectious agent, replacing coronavirus after three years.

Key Statistics

• Total TB cases (2023): 10.8 million (6.0 million men, 3.6 million women, 1.3 million children)
• Newly diagnosed TB cases (2023): 8.2 million
• TB deaths (2023): 1.25 million (161,000 HIV-related)
• Drug-resistant TB treatment access (2023): Approximately 40% of drug-resistant TB patients received treatment globally 
• Projected Estimated New TB cases (2024): 10.84 million
• Estimated TB deaths (2024): 1.70 million
• Estimated Drug-resistant TB (RR/MDR-TB) cases (2024): 454,036

5%-10% Lifetime Risk of Active TB and the Rising Threat of Drug-Resistant Strains

Tuberculosis (TB) is a contagious infection that is caused by a bacterium called Mycobacterium tuberculosis. The bacteria primarily affect the lungs, but other parts of the body such as the spine, brain, and kidneys can also be impacted. It spreads through the air when someone with active tuberculosis coughs, sneezes or even speaks. 

For most people, the bacteria stay dormant (latent tuberculosis) with no evident symptoms. However, if the immune system weakens, (due to certain conditions like diabetes, HIV, or malnutrition) the dormant bacteria may cause active tuberculosis. The Centers for Disease Control and Prevention (CDC) estimates that up to 13 million people in the United States have latent tuberculosis infection, and without treatment, 5%-10%  of those individuals will develop active TB over their lifetimes.

What makes tuberculosis trickier to manage is when it turns drug resistant. This occurs when the bacteria evolve to survive medicines meant to kill them, often as a result of incomplete or improper treatment. Drug-resistant tuberculosis poses a serious challenge to the healthcare system as it not only takes longer to treat but also requires more expensive medication.

Tuberculosis Patient Profile:  Age, Gender, and Risk Factors Linked to Millions of Cases

Tuberculosis is reported to impact various populations differently, with considerable disparities observed across age groups, genders, and associated risk factors. The symptoms of tuberculosis can often be subtle at first, starting with a persistent cough, fatigue, weight loss, and fever, progressing to more severe signs such as coughing up blood, chest pain, and night sweats. In some cases, tuberculosis spreads beyond the lungs, complicating both diagnosis and treatment.

Age Groups Most Affected: Adults aged 18 to 34 years are estimated to be the most affected, with 488 cases per 100,000 individuals. The risk of developing tuberculosis increases with age, reaching nearly 577 cases per 100,000 among those aged 65 and older. 

Gender-Specific Prevalence: Globally, men are more frequently diagnosed  with tuberculosis than women. In India, out of the 27.4 lakh diagnosed cases of tuberculosis, the ratio is estimated to be around 2:1  between men and women.

Table 1: Key Risk Factors and Their Impact on Tuberculosis

Key Risk Factors:

• HIV Infection: People with HIV are 16 times  more likely to develop active tuberculosis compared to people without HIV.
• Malnutrition: Malnutrition is a significant contributor to tuberculosis, with nearly 1 million new tuberculosis cases  attributable to undernutrition annually.
• Smoking: Estimated to cause 0.70 million new tuberculosis cases in 2023
• Alcohol Abuse: Associated with 0.75 million cases in 2023
• Diabetes: Increases vulnerability, with 0.38 million cases of tuberculosis linked to diabetes in 2023 

Global Tuberculosis Epidemiology  Trends: Declining Incidence and Rising MDR-TB Challenges

TB Trends in Incidence and Mortality: 10.84 Million New Cases Estimated with 1.7 Million Deaths in 2024. According to the EMR analysis published in the Tuberculosis Epidemiology Forecast Report, tuberculosis cases across the globe showed a consistent decline from 10.91 million in 2016 to 10.14 million in 2020. However, the coronavirus pandemic and other factors disrupted health systems, causing a rise in incidence to 10.84 million by 2024. Further, the incidence of tuberculosis is projected to drop by 2031, reaching 9.46 million cases, a positive sign of ongoing progress in combating the disease.

Tuberculosis-related deaths have followed a fluctuating path. While the number of deaths decreased in earlier years, they have shown a slower rate of decline in recent times. In 2023, approximately 1.25 million people  died from tuberculosis, which highlights the need for sustained efforts to reduce mortality further. On the other hand, a positive trend observed is the increase in the number of people seeking treatment for tuberculosis, growing from 5.66 million in 2020 to 6.46 million by 2024.

Table 2: Global Tuberculosis Epidemiology Trends: Incidence, Treatment, and Mortality Projections; Source: Industry Experts, Analyst Reports, News Reports, EMR Analysis

Click here to read more: Tuberculosis Epidemiology Forecast 2032

Escalating MDR-TB Cases and Treatment Gaps Highlight Urgent Need for Action

Multidrug-resistant tuberculosis (MDR-TB) occurs when tuberculosis bacteria resist first-line tuberculosis treatment drugs such as isoniazid (INH) and rifampin (RIF). This might happen due to inappropriate treatment, substandard drugs, or treatment non-adherence. As per the EMR report, the MDR-TB cases are estimated to decline from 489,057 in 2016 to 420,071 in 2020 but have been rising since, with projections indicating 454,036 cases in 2024 and 479,698 cases by 2031.

In the United States, 8.4%  of tuberculosis cases were resistant to isoniazid, including 1.4% diagnosed as MDR-TB in 2022, according to the Centers for Disease Control and Prevention (CDC). Further, in China, a systematic review and meta-analysis published in the Journal of Global Antimicrobial Resistance  (2024) found that MDR-TB prevalence among newly diagnosed tuberculosis cases was 6.9%, with extensively drug-resistant TB (XDR-TB) reported at 0.9%.

Treatment coverage for multidrug-resistant tuberculosis has improved but remains insufficient. WHO reported that in 2023, only 2 in 5  patients with MDR-TB received treatment. High resistance rates, as reported by various global and regional studies, further complicate efforts to close treatment gaps.

87% of Global TB Cases Concentrated in 30 High-Burden Countries, Led by India

The burden of tuberculosis is unevenly distributed across regions, with low- and middle-income countries bearing most of its brunt. In 2023 , the WHO South-East Asia Region reported the highest number of new tuberculosis cases, contributing 45% of the global total, followed by the African Region at 24%, and the Western Pacific Region at 17%. These areas, home to many low- and middle-income countries, also account for over 80% of global tuberculosis-related cases and deaths.

The 30 high tuberculosis burden countries, including India, China, Bangladesh, Indonesia, Nigeria, and the Philippines, collectively represented 87% of new tuberculosis cases in 2023. Moreover, HIV co-infection exacerbates the challenge, with the African Region leading in HIV-associated tuberculosis cases. The WHO 2024 Global Tuberculosis Report  stated that 0.61 million new tuberculosis cases were linked to HIV in 2023, yet only 56% of tuberculosis patients living with HIV received antiretroviral therapy (ART), indicating gaps in care integration.

India reported the highest tuberculosis burden in 2023, as per the WHO 2024 Global Tuberculosis Report. The country accounted for 26%  of all the TB cases worldwide, with Indonesia (10%), China (6.8%), the Philippines (6.8%), and Pakistan (6.3%) following behind. Despite the substantial concentration of tuberculosis cases in India, the dedication towards the disease elimination is noteworthy, with the years between 2015 and 2023 witnessing a sharp 17.7%  decline in tuberculosis incidence.

Tuberculosis Incidence Set to Decline Supported by Promising Treatments and Global Elimination Efforts

The future epidemiological outlook for tuberculosis indicate a gradual decline in global incidence, with cases expected to decrease from 10.82 million in 2023 to 9.46 million by 2031, according to Expert Market Research estimates. The diagnosed and reported cases are likely to rise steadily, reaching an estimated 7.53 million by 2030, suggesting improved detection and reporting systems. However, drug-resistant tuberculosis (RR/MDR-TB) is anticipated to remain a major challenge, with the incidence projected to rise from 446,827 cases in 2023 to 479,698 cases in 2031, highlighting the urgent need for new therapeutic interventions.

In response, global efforts are intensifying to expand the tuberculosis drug pipeline, focusing on tackling both drug-sensitive and drug-resistant strains. For instance, Sirturo (bedaquiline ), developed by Johnson & Johnson, has received approval from both the European Commission (EC) and the US Food and Drug Administration (FDA) for the treatment of multidrug-resistant TB (MDR-TB). On the vaccine front, promising candidates like MTBVAC  (Biofabri, S.L.) and VPM1002  (Serum Institute of India Pvt. Ltd.) are advancing through Phase III clinical trials, offering hope for better prevention strategies.

These efforts are complemented by tuberculosis elimination initiatives, such as the WHO 1+1 Initiative, the Zero TB Initiative, and India’s National Tuberculosis Elimination Programme (NTEP). At the heart of these global projects is the WHO's End TB Strategy , which has set an ambitious goal to end the global tuberculosis epidemic by 2035. This strategy targets a 90% reduction in tuberculosis cases and a 95% reduction in tuberculosis-related deaths by 2035. Together, these initiatives are collectively aiming to build a future where tuberculosis is no longer a burden, but a chapter that exists only in history.