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Consensus Statement |

Global Burden of Tuberculosis:  Estimated Incidence, Prevalence, and Mortality by Country

Christopher Dye, DPhil; Suzanne Scheele, MS; Paul Dolin, DPhil; Vikram Pathania, MBA; Mario C. Raviglione, MD; for the WHO Global Surveillance and Monitoring Project
JAMA. 1999;282(7):677-686. doi:10.1001/jama.282.7.677.
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Objective To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997.

Participants A panel of 86 TB experts and epidemiologists from more than 40 countries was chosen by the World Health Organization (WHO), with final agreement being reached between country experts and WHO staff.

Evidence Incidence of TB and mortality in each country was determined by (1) case notification to the WHO, (2) annual risk of infection data from tuberculin surveys, and (3) data on prevalence of smear-positive pulmonary disease from prevalence surveys. Estimates derived from relatively poor data were strongly influenced by panel member opinion. Objective estimates were derived from high-quality data collected recently by approved procedures.

Consensus Process Agreement was reached by (1) participants reviewing methods and data and making provisional estimates in closed workshops held at WHO's 6 regional offices, (2) principal authors refining estimates using standard methods and all available data, and (3) country experts reviewing and adjusting these estimates and reaching final agreement with WHO staff.

Conclusions In 1997, new cases of TB totaled an estimated 7.96 million (range, 6.3 million–11.1 million), including 3.52 million (2.8 million–4.9 million) cases (44%) of infectious pulmonary disease (smear-positive), and there were 16.2 million (12.1 million–22.5 million) existing cases of disease. An estimated 1.87 million (1.4 million–2.8 million) people died of TB and the global case fatality rate was 23% but exceeded 50% in some African countries with high HIV rates. Global prevalence of MTB infection was 32% (1.86 billion people). Eighty percent of all incident TB cases were found in 22 countries, with more than half the cases occurring in 5 Southeast Asian countries. Nine of 10 countries with the highest incidence rates per capita were in Africa. Prevalence of MTB/HIV coinfection worldwide was 0.18% and 640,000 incident TB cases (8%) had HIV infection. The global burden of tuberculosis remains enormous, mainly because of poor control in Southeast Asia, sub-Saharan Africa, and eastern Europe, and because of high rates of M tuberculosis and HIV coinfection in some African countries.

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Figure 1. Estimated Per Capita Incidence Rates of Tuberculosis (All Forms) by Country in 1997
Graphic Jump Location
No estimates are available for disputed territories Taiwan, Kashmir, and Western Sahara. Estimates for French Guyana and Guadeloupe are included with France, following their system of case notification. Circled arrows represent islands off the map. Left, top to bottom: Cook Islands, French Polynesia, Pitcairn Island, Niue. Right, Tokelau, Samoa, American Samoa, Wallis and Futuna, Tonga. Printed with permission from the World Health Organization.
Figure 2. Estimated Numbers of Tuberculosis Cases (All Forms) by Country in 1997
Graphic Jump Location
No estimates are available for disputed territories Taiwan, Kashmir, and Western Sahara. Estimates for French Guyana and Guadeloupe are included with France, following their system of case notification. Circled arrows represent islands off the map. Left, top to bottom: Cook Islands, French Polynesia, Pitcairn Island, Niue. Right, Tokelau, Samoa, American Samoa, Wallis and Futuna, Tonga. Printed with permission from the World Health Organization.

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