<p class="first" id="d2434538e85">Tuberculosis is the number one cause of death from
infectious disease globally and
drug-resistant forms of the disease are a major risk to global health security. On
the occasion of World Tuberculosis Day (March 24, 2018), we provide an up-to-date
review of the status of the tuberculosis epidemic, recommended diagnostics, drug treatments
and vaccines, progress in delivery of care and prevention, progress in research and
development, and actions needed to accelerate progress. This Review is presented in
the context of the UN Sustainable Development Goals and WHO's End TB Strategy, which
share the aim of ending the global tuberculosis epidemic. In 2016, globally there
were an estimated 10·4 million new cases of tuberculosis, and 600 000 new cases with
resistance to rifampicin (the most powerful first-line drug). All countries and age
groups are affected by tuberculosis, but most cases (90%) in 2016 were in adults,
and almost two-thirds were accounted for by seven countries: India, Indonesia, China,
Philippines, Pakistan, South Africa, and Nigeria. The sex ratio (male to female) was
1·9 and 10% of patients with newly diagnosed tuberculosis were also HIV-positive.
There were 1·7 million deaths from tuberculosis in 2016, including 0·4 million deaths
among people co-infected with HIV (officially classified as deaths caused by HIV/AIDS).
Progress in care and prevention means that the global mortality rate (deaths per 100 000
people per year) is decreasing by 3·4% per year and incidence (new cases per 100 000
people per year) is decreasing by 1·9% per year. From 2000 to 2016, the annual global
number of tuberculosis deaths decreased by 24% and the mortality rate declined by
37%. Worldwide, an estimated 53 million deaths were averted through successful treatment.
Nonetheless, major gaps in care and prevention remain. For example, the 6·3 million
new cases of tuberculosis reported globally in 2016 represented only 61% of the estimated
incidence; only one in five of the estimated number of people with drug-resistant
tuberculosis was enrolled in treatment. Pipelines for new diagnostics, drugs, and
vaccines are progressing, but slowly. Actions needed to accelerate progress towards
global milestones and targets for reductions in the burden of tuberculosis disease
set for 2020, 2025, 2030, and 2035 include closing coverage gaps in testing, reporting
of cases, and overall access to health care, especially in countries that account
for the largest share of the global gap; multisectoral efforts to reduce prevalence
of major risk factors for infection and disease; and increased investment in research
and development.
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