TB Cases Rising Globally, Who Says. Should the US Be Worried?

• The WHO reports that the number of tuberculosis cases in children is rising in Europe.
• The health officials add that the treatment success rate for the disease is also well below target goals.
• Experts say a rise in TB cases in Europe could mean a future surge in cases in the United States.

A new report from the World Health Organization (WHO) shows rising tuberculosis rates among children in Europe.

On March 24, the WHO announced a 10% increase in new or relapsed tuberculosis cases in children under 15 years of age in the agency’s European Region, which covers Europe and Central Asia.

There were 7,500 TB cases recorded in 2023, including more than 2,400 in children under the age of 5, who have higher risks of serious illness or death from the disease.

Childhood cases now account for more than 4% of all people with new or relapsed tuberculosis cases in the European Region.

Overall, WHO officials said more than 172,000 people in the European Region were reported to have new or relapsed tuberculosis in 2023, similar to 2022 levels.

The death rate from tuberculosis declined, but officials said the decrease was at a smaller rate than seen before the COVID-19 pandemic in 2020.

WHO officials noted the treatment success rate among people with new or relapsed tuberculosis was about 75% in the European Region. They said that figure is well below the 90% success rate set by global targets.

In addition, WHO officials said they are concerned about emerging multidrug-resistant tuberculosis (MDRTB). They said the treatment success rate in the region for those strains is less than 60%.

They noted several challenges in reversing the trend in tuberculosis cases. These challenges include delays in diagnosis, the need for more effective treatments, and insufficient access to current treatments.

These issues are escalating as funding for international aid is being reduced. The United States, for example, has contributed between $163 million and $816 million annually to WHO in the past decade. In January, the Trump administration announced that the U.S. would withdraw from the WHO and halt funding.

In the face of these obstacles, WHO leaders are urging European and global leaders to scale up efforts to detect and treat people with tuberculosis (TB).

“Ending TB is not a dream. It’s a choice. Sadly, the current TB burden and the worrying rise in children with TB serves as a reminder that progress against this preventable and curable disease remains fragile,” Hans Henri P. Kluge, MD, WHO’s regional director for Europe, said in a news release.

Health experts in the U.S. agreed with Kluge’s assessment of rising TB cases.

“TB cases are rising again in Europe and elsewhere because of disruption of diagnostic and therapeutic services due to armed conflicts, COVID-related avoidance of direct medical care, and a reduction in financial support,” said William Schaffner, MD, an infectious disease expert and a professor of medicine at Vanderbilt University in Nashville, TN.

“People have to be contacted in order to be diagnosed and, once diagnosed, must take anti-TB medicines for months in order to be cured,” Schaffner told Healthline.

“This takes trained public health workers to provide months-long education, supervision, and support of the patients. If the public health workers are not supported, new cases will not be diagnosed or treated, and they will continue to spread TB to others.”

Monica Gandhi, MD, an infectious disease specialist and a professor of medicine at the University of California San Francisco, told Healthline there are various reasons for the increase in TB cases in the European Region.

“Even before these funding cuts, TB cases were rising in Europe likely because of failure to complete treatment (which be long and arduous for patients at 6 months or longer), failure to test people for TB, and the increased number of refugees coming into the country, especially from Ukraine (with a relatively higher incidence of MDR-TB),” Gandhi explained.

Experts say the European situation should concern people in the U.S.

“Europe and the U.S. are both in what are called ‘high income’ regions and so what happens in Europe often happens in the U.S. as well,” said Gandhi. “Therefore, we should be braced for an increase in TB cases here in the United States and be screening for them going forward.”

“Whatever infectious disease is ‘over there,’ it could be imported here,” added Schaffner. “The TB bacteria does not need a passport. Once here, the newly imported TB infection can spread to others in the U.S. and keep the infection going in our own population.”

Jason Andrews, MD, an infectious disease specialist and a professor of medicine at Stanford University, agreed.

“Because we live in such an interconnected world, failure to control TB anywhere will have effects everywhere, so we are seeing either rising cases or slowed progress in TB control in many places,” he told Healthline.

“This is coming at a time when the U.S. is reducing its financial commitments to TB programs worldwide, so many TB experts are worried that things will further worsen.”

WHO officials report that nearly 11 million people globally became ill from tuberculosis in 2023, and more than 1.2 million died from the disease that year.

They estimate that tuberculosis has regained its status as the world’s leading cause of death from a single infectious agent after being replaced at the top by COVID-19 for three years.

The Centers for Disease Control and Prevention (CDC) identified more than 10,000 tuberculosis cases in the U.S. in 2024, a slight rise from 2023 and the fourth straight year of an increase.

Tuberculosis, which was once called “consumption,” is a highly infectious disease that mainly affects the lungs.

The disease is spread by bacteria that is transmitted through droplets in the air that can be inhaled by anybody who is in the vicinity.

“It is one of the few predominantly airborne infectious diseases, which means that an individual with TB can infect another person without close contact and without even being in the same room at the same time,” said Andrews.

“So, we can’t think about TB as a problem for some specific group or in some specific place. TB is a threat to human health everywhere.”

The tuberculosis bacteria can remain dormant in a person for years before symptoms arise. Those symptoms include:

• cough lasting more than 3 weeks
• coughing up blood or phlegm
• chest pain
• unexplained fatigue
• night sweats
• loss of appetite and/or weight

Tuberculosis can be diagnosed with a skin test or a blood test. A chest X-ray is usually conducted on someone who tests positive for the disease.

Jimmy Johannes, MD, an internist, pulmonologist, and critical care medicine specialist at MemorialCare Long Beach Medical Center in California, said tuberculosis can leave people with permanent lung damage and other after-effects.

He added the disease can be particularly serious for people who are immunocompromised, particularly people living with HIV.

“Tuberculosis is by no means a low-risk proposition for these people,” Johannes told Healthline.

People diagnosed with tuberculosis usually have to take a combination of medications for six to nine months.

If a tuberculosis treatment regimen isn’t completed, the disease will likely return, perhaps in a form that is resistant to the original medications.

“Tuberculosis treatments are not simple,” Johannes said.

He added that even after treatment, tuberculosis remains in a person’s body. The immune system usually controls the disease in those situations but can flare up again.

“At any time, it can activate,” Johannes said. “It can be a bit of a ticking time bomb inside the body.”

Experts said this stubbornness and seriousness of tuberculosis is what makes it a dangerous disease, but they note it needs to be brought under control.

“In the modern era, we have the accurate diagnostic tests and effective anti-TB drugs to reduce TB to a historical anecdote,” Schaffner said.

“If we have the determination and provide the resources, the world’s community could achieve that goal.”