TB is surging. Should we be worried?

Cases of the world's deadliest infection are climbing in the UK and US. Why is tuberculosis returning and how do we fight back?

- by DR KERRY MILLINGTON & DR TOM WINGFIELD

Tuberculosis (TB) is an airborne infection that many people think of as a disease of the past. But after decades of steady decline in high-income countries such as the UK and the US, the number of people diagnosed with TB is climbing.

In England, the UK Health Security Agency reported that TB diagnoses increased by 13 per cent in 2024 compared with the previous year, to 5,480 people. This number is still small relative to other high-burden countries, and England remains, just, under the World Health Organization (WHO) threshold for ‘low incidence’ status — 10 cases per every 100,000 population.

But these figures, and similar trends in the US, are a clear sign that previous progress has stalled and we're no longer on the right trajectory for ending TB.

WAKE-UP CALL

So is TB really making a comeback? The short answer is that the disease never really went away.

In fact, TB is the world’s deadliest infectious disease, killing about 1.23 million people in 2024 alone. That’s more than HIV and malaria combined, and puts TB among the top 10 causes of death worldwide.

WHO reports that more than 10 million people continue to fall ill with TB annually and, shockingly, roughly a quarter of them are never diagnosed or treated. The COVID-19 pandemic disrupted years of hard-won global progress in TB prevention and care, but that doesn’t tell the whole story.

TB is caused by the bacterium Mycobacterium tuberculosis. It spreads through the air when a person with infectious TB in their lungs coughs, sneezes, sings or even talks.

Classic symptoms of TB are a cough that lasts more than three weeks, fever, night sweats, weight loss and fatigue. Most people with TB have it in the lungs, but it can affect any organ in the body.