Why Tuberculosis Still Matters Today

Tuberculosis (TB) is an infectious disease that many Australians rarely encounter nowadays. With Australia maintaining one of the world’s lowest TB rates (around 5–6 cases per 100,000 people​), it’s easy to assume TB is a problem of the past. However, globally TB remains a major public health concern, causing millions of illnesses and over a million deaths each year. In fact, in 2018 around 10 million people fell ill with TB and 1.5 million died, making TB the leading cause of death from an infectious disease worldwide at the time. On World Tuberculosis Day (24 March), let’s explore what TB is, how it spreads, and why even Australians should stay informed about this ancient but persistent disease.

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What is Tuberculosis?

Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis. These bacteria typically attack the lungs, although TB can affect other organs like the lymph nodes, bones, or kidneys. When a person breathes in TB bacteria, the microbes can settle in the lungs and trigger an infection. Interestingly, not everyone infected gets sick right away – the body can harbor the bacteria in an inactive state (called latent TB infection) for months or years. People with latent TB do not feel sick and aren’t contagious, but the bacteria remain in their body​. If the immune system weakens or fails to contain the infection, the bacteria can become active and cause TB disease. At that point, symptoms appear and the person can spread TB to others. The good news is that TB is curable and even preventable with proper medical care which we’ll discuss more below.

Symptoms of TB

TB disease often develops slowly, and symptoms can be mild at first. It’s common for someone with TB to be contagious for weeks before they even realize they’re sick​. Classic symptoms of active TB can include:

• Persistent cough (lasting 3 weeks or more, and sometimes producing blood)​
• Chest pain and difficulty breathing
• Fatigue and weakness (feeling unusually tired or weak)​
• Weight loss and loss of appetite
• Fever (often low-grade) and night sweats (waking up drenched in sweat)

These symptoms reflect the old term “consumption” that was once used for TB – patients appear as if they are being “consumed” by illness, losing weight and energy. Because the symptoms (like a persistent cough or fever) can be confused with a bad cold or flu, TB often isn’t detected right away. If you or someone you know has a cough that just won’t go away – especially after traveling abroad – it’s important to get it checked by a doctor. In fact, a cough lasting more than 3 weeks should raise suspicion and prompt medical attention​.

How TB Spreads (Airborne)

TB is an airborne disease, meaning it spreads through tiny droplets in the air. When a person with active pulmonary TB (TB in the lungs) coughs, sneezes, speaks or sings, they expel microscopic droplets that contain TB bacteria​. If someone nearby inhales these bacteria-laden droplets, they can become infected. Unlike many other infections, TB doesn’t spread by shaking hands, sharing food/drinks, or touching surfaces – it’s really about breathing the same air as an infectious person.

Here are a few key points on TB transmission:

• Close, prolonged contact is usually required. TB is not as easily catching as, say, the flu. Typically, you have to spend a lot of time around an infectious TB patient (for example, living in the same household or sitting in the same poorly ventilated room for hours) to inhale enough bacteria to get infected.
• Good ventilation helps. TB bacteria in droplets can linger in the air, especially in cramped, enclosed spaces with little fresh air. Proper ventilation (open windows, fans) disperses the bacteria and lowers the risk of transmission. (On the flip side, TB spreads more readily in crowded places like prisons or shelters with limited airflow.)
• Covering coughs stops the spread. A person with TB can greatly reduce transmission by covering their mouth when coughing or by wearing a mask. Practicing cough etiquette and isolation during treatment are standard public health measures to protect others​.

It’s worth noting that even if you do breathe in TB germs, your immune system usually prevents immediate illness. For about 90% of people with a normal immune system, infection stays latent – they don’t get sick unless something later triggers the bacteria to activate​. That said, those who do develop active TB can unknowingly spread it to others, which is why early diagnosis and treatment are so important.

TB Treatment: Curable but Challenging

One of the most important things to know about TB is that it is curable with the right treatment. TB is caused by bacteria, so doctors use antibiotics to kill the germs. However, treating TB isn’t as simple as taking a short course of typical antibiotics for a week or two. Standard TB treatment requires multiple antibiotics taken together daily for 4–6 months​.

• The most common first-line TB medications include isoniazid, rifampicin, pyrazinamide, and ethambutol​. Patients usually start on a combination of four drugs for the first two months, then continue with two of the drugs for at least four more months. This long regimen is needed to ensure all TB bacteria (which grow slowly and can hide in the body) are eliminated.
• It is crucial to complete the full course of TB treatment, even if you start feeling better sooner. Stopping medications too early or missing doses can allow the bacteria to survive and develop resistance to the drugs​. Incomplete treatment is the main reason for the rise of drug-resistant TB.

Multidrug-resistant TB (MDR-TB) refers to TB strains that have become resistant to at least isoniazid and rifampicin, the two most powerful TB drugs. Treating MDR-TB is even more challenging – it requires second-line medications that often have more side effects, and treatment can stretch to 9–12 months or more. Sadly, MDR-TB remains a public health crisis and a health security threat worldwide​. Only about 2 in 5 people with drug-resistant TB currently get effective treatment, according to the WHO.

The good news is that with proper support, most people with TB (including MDR-TB) can be cured. Australia’s healthcare system and TB clinics follow up with patients to help them complete therapy (sometimes through supervised dosing programs) to ensure the bacteria are fully wiped out. TB treatment is provided for free in Australia’s public health system, reflecting the commitment to stop TB from spreading further.

TB in Australia: Low Incidence, Ongoing Vigilance

Australia is considered a low TB incidence country, meaning we have very few cases relative to our population. Over the past few decades, Australia has consistently recorded on the order of 5–6 TB cases per 100,000 population each year​ – that’s only around 1,300 to 1,500 cases annually in the whole country. To put that in perspective, many high-incidence countries see 100–300+ cases per 100,000 each year, and some places even more. Australia’s TB rate has been stable and among the lowest in the world since the 1980s.

Why is TB so uncommon in Australia today? A combination of strong public health measures and good fortune:

• Effective TB control programs: Australia was one of the early adopters of TB control, with sanatorium treatment and then antibiotics drastically reducing cases by the mid-20th century. Today, every TB case is tracked and managed by health authorities. Contact tracing is done to test and treat anyone exposed. This vigilance prevents isolated cases from igniting into outbreaks.
• Immigration screening: Because the majority of Australian TB cases are in people born overseas, the government has screening programs for migrants from high-TB countries. People applying for long-term visas typically undergo health checks, including chest X-rays, to catch active TB before arrival. This doesn’t catch latent TB, but it helps intercept infectious cases.
• High living standards: Overall, Australia’s population has good nutrition, less overcrowding, and access to healthcare – conditions that make it harder for TB to spread and take hold. Even when TB does occur, our healthcare system can diagnose and treat it effectively.

It’s important to note that TB has not been completely eliminated in Australia, and certain populations are affected more than others. Nearly 90% of TB cases in Australia occur in people who were born overseas in countries with higher TB rates​. Within the Australian-born population, TB is very rare, though Indigenous Australians and elderly Australians have slightly higher rates than other groups, reflecting historical and social factors. The highest numbers of TB notifications are in New South Wales and Victoria, our most populous states – likely due to their larger migrant populations.

Despite the low incidence, Australia remains vigilant. Health authorities aim for eventual elimination of TB here, but progress has stalled in part because of ongoing reintroduction of TB from abroad​. This simply means that as part of a globalized world, we will continue to see a trickle of TB cases via travel and migration. It’s a reminder that to protect our hard-earned low rates, we need to support TB control not just at home but internationally.

TB Around the World: A Major Health Concern

Global incidence of TB (new and relapsed cases per 100,000 people) in 2016. Countries in darker blue have higher TB rates per capita, with the greatest burdens in parts of Southeast Asia and sub-Saharan Africa​. Australia and other low-incidence countries appear in very light colors.

While TB is uncommon in Australia, it remains one of the top infectious disease threats worldwide. TB is found in every country, but its impact is heaviest in developing nations. The World Health Organization’s latest figures show that about 10.8 million people fell ill with TB in 2023, and 1.25 million people died from it that year​. To put it bluntly, TB kills over a million people each year – a tragic toll for a disease that is largely curable. In terms of infectious diseases, only the recent COVID-19 pandemic temporarily unseated TB from being the biggest infectious killer; TB has now likely returned to the top of that grim ranking.

Where is TB most common? The highest rates of TB are in sub-Saharan Africa, South Asia, and parts of East Asia. For example, countries like India, Indonesia, Pakistan, South Africa, Nigeria, China, and the Philippines report large numbers of cases annually. In 2016, Southeast Asia and sub-Saharan Africa recorded the most cases per capita​, as illustrated in the map above. These regions often face challenges like limited healthcare access, poverty, malnutrition, and high HIV rates – all of which fuel TB. By contrast, TB is much less common in high-income countries (North America, Western Europe, Australia/New Zealand), thanks to better living conditions and robust health systems.

Some global TB facts and challenges:

• TB is a disease of poverty in many ways. It spreads more easily in crowded living conditions and among people with weakened health. Communities with less access to medical care may not get diagnosed or treated in time, allowing TB to spread further.
• HIV and TB: People living with HIV are at extremely high risk of developing TB if infected. TB is actually the leading cause of death for people with HIV globally. The overlap of the HIV epidemic with TB, especially in Africa, has been devastating. Treating HIV and TB together is a major global health focus.
• Drug-resistant TB: As mentioned earlier, the rise of MDR-TB (and even more extensive resistance in some strains) is a global concern. Countries like India, Russia, South Africa, and China have significant numbers of MDR-TB cases. Managing these requires expensive treatments and international support.
• Global efforts: The world isn’t ignoring TB. There are large-scale programs aiming to “End TB” by 2030, one of the UN Sustainable Development Goals. These efforts include improving diagnostics (like rapid molecular tests for TB), ensuring patients complete treatment, vaccinating infants in high-risk areas, and investing in the development of new TB vaccines and drugs. Thanks to global TB control efforts, it’s estimated about 79 million lives were saved since 2000 through TB diagnosis and treatment​. However, we still have a long way to go.

In short, TB remains a major global health problem. As long as it continues to sicken millions across the globe, it demands attention – even from countries where local cases are few. Diseases don’t carry passports, and TB anywhere can eventually become TB everywhere if left unchecked. This is why health experts emphasize a global approach to fighting TB, treating it as the worldwide epidemic that it is.

Who is Most at Risk of TB?

Anyone can catch TB, but it tends to strike certain groups more often. TB risk is higher for people who:

• Have weakened immune systems: Our immune system usually keeps TB in check, so anything that undermines it raises the risk. The biggest risk factor globally is HIV infection – HIV-positive individuals are far more likely to develop active TB if exposed​. Other immune-weakening conditions like diabetes, kidney failure, or certain cancers and treatments (e.g. chemotherapy) also increase TB risk. Malnutrition (poor diet) is another factor that can weaken immunity and make TB more likely​.
• Live or work in high-risk settings: TB spreads in enclosed, populated environments. This means people in crowded living conditions or institutional settings are at higher risk. For example, TB can spread in prisons, homeless shelters, or among groups of people who live closely together under stress. Outbreaks have been known to occur in such settings. Health care workers who care for TB patients also have a higher risk of exposure if proper precautions aren’t taken.
• Are very young or elderly: Young children (especially under 5) have immature immune systems and are more likely to develop severe forms of TB if infected. The elderly may have waning immunity or other health issues that make them susceptible. In Australia, for instance, older adults born decades ago (when TB was more common globally) represent a chunk of cases, sometimes due to latent infections reactivating later in life.
• Have lifestyle factors that affect health: Smoking tobacco and heavy alcohol use have been linked to higher TB risk. Smoking damages the lungs’ defenses, and alcohol can weaken the immune system and lead to poor nutrition, all contributing to vulnerability to TB.

It’s important to emphasize that simply being in a high-TB country doesn’t guarantee you’ll get TB – it’s prolonged close contact that usually spreads it. However, those listed factors above can tip the balance toward infection or illness if exposure happens. Public health programs often focus on these at-risk groups for TB screening and preventive therapy (for example, giving medication for latent TB infection to people with HIV or recent close contacts of TB cases, to stop progression to disease).

The Role of Vaccination (BCG) in TB Prevention

Currently, the world has one main vaccine for tuberculosis: the BCG vaccine. BCG stands for Bacille Calmette–Guérin, named after the French scientists who developed it over a century ago. It’s a live vaccine derived from a cousin of the TB bacterium.

What BCG does: The BCG vaccine doesn’t completely prevent people from catching TB bacteria, but it does offer protection against the most severe forms of TB in children. In particular, BCG is effective at preventing TB meningitis (a dangerous TB infection of the brain lining) and miliary TB (a widespread form) in young kids​. This can be life-saving in high-TB settings.

Use of BCG around the world: BCG is one of the most widely used vaccines globally – over 100 million babies receive it each year in countries where TB is common. It’s usually given shortly after birth or in early childhood. If you were born in Asia, Africa, Eastern Europe, or South America, there’s a good chance you got a BCG shot as a baby. The vaccine typically leaves a small, round scar on the upper arm (often seen as a badge of immunization in those regions).

In Australia and other low-incidence countries, BCG is not part of routine childhood vaccinations anymore. Australia stopped mass BCG vaccinations decades ago once TB became rare domestically. Instead, BCG here is targeted to individuals who need it:

• Infants or young children traveling to/highly likely to live in TB-endemic countries: For example, if a family is moving to a country with high TB rates, or if grandparents overseas want a young Aussie-born child to visit for an extended stay, doctors may recommend BCG. The Australian immunisation handbook recommends BCG for children under 5 who will be spending extended time in countries where TB is common​. The vaccine is ideally given a few months before travel.
• Newborns in high-risk communities: In certain circumstances, if a baby is born into a community with higher TB risk (for instance, some Aboriginal or Torres Strait Islander communities in the past, or if there’s a TB outbreak in a localized area), BCG might be offered. These cases are fairly limited in Australia today.
• Some healthcare workers or laboratory personnel: If someone is going to work in settings with frequent TB exposure (e.g. a healthcare worker volunteering in a TB ward overseas, or a lab worker handling TB bacteria), BCG vaccination could be considered as an extra layer of protection.

For most Australian adults, BCG is not routinely recommended even if travelling – it’s less effective at preventing adult pulmonary TB and can interfere with TB skin tests later. Instead, the focus for travelers (besides young kids) is on awareness and early detection (more on that below).

It’s also worth noting that BCG’s protection can wane over time. People vaccinated as infants might still catch TB as adults. That’s why the search is on for new TB vaccines that could be more effective or booster shots later in life. Several TB vaccine candidates are in research pipelines worldwide, but BCG remains the only game in town for now.

Bottom line: BCG vaccine has been a valuable tool in the global fight against TB, especially to shield babies from deadly TB complications​. If you’re an Australian parent and plan to take your little one to a country with high TB rates, talk to your doctor or a travel clinic about whether BCG is advised.

Why Global Vigilance Is Still Important

With TB so well controlled here, you might wonder: why should Australians worry about TB at all? The answer lies in our interconnected world. Even in a low-incidence country, global vigilance against TB matters for several reasons:

• TB knows no borders. A disease that affects millions anywhere can potentially affect us. International travel and migration mean that diseases can spread across continents. Each year, Australia sees a small number of TB cases imported via new arrivals or returning travelers. Our low TB rates could rise if global TB were left unchecked. For instance, places like Western Sydney have higher TB incidence than the national average because of migration from TB-endemic countries​. Staying engaged in global TB control helps protect Australia’s health security.
• Drug-resistant TB can spread globally. One of the biggest fears is that highly resistant TB strains could travel. Multidrug-resistant TB requires lengthy, costly treatment and has lower cure rates. Cases of MDR-TB have occurred in Australia, almost all in people who contracted it overseas. If MDR or XDR (extensively drug-resistant) TB becomes more common globally, no country is immune to seeing those tough cases. We all have a stake in preventing that scenario by supporting proper TB treatment everywhere.
• Moral and humanitarian responsibility. Australia, as part of the international community, has committed to the goal of ending TB as an epidemic by 2030. That means contributing to global efforts – through funding, research, and policy – to make sure people in poorer countries have access to diagnosis and treatment. It’s the right thing to do, and it aligns with our public health interest. Infections like TB don’t remain isolated to “over there.” Helping others control TB ultimately helps us too.
• TB can linger undetected. Because TB can stay latent for years, someone could live in Australia for a long time without knowing they carry TB infection, then develop active TB later (this sometimes happens when an older migrant who was infected long ago gets sick in their senior years). Continued awareness among healthcare providers is needed so that even rare TB cases here are caught and treated promptly. Australia’s medical community continues to train and stay prepared for TB – which is part of global vigilance as well.

In summary, “TB anywhere is TB everywhere.” As long as TB persists globally, no nation can consider itself completely safe or separate from the threat. World Tuberculosis Day is a reminder that we share the air – literally – with the rest of the world. In the same way we’ve seen with pandemics, an infectious disease problem in one part of the world can become a problem for all if not addressed. The encouraging news is that TB can be defeated with the tools we have, but it requires cooperation and commitment on a worldwide scale.

Travel and TB: Advice for Australian Travellers

Australia’s proximity to Asia and the increasing ease of international travel mean many Aussies will visit countries where TB is far more common. Does that mean you shouldn’t travel? Of course not! But being aware of TB during and after travel is wise, especially if you’re going off the beaten path or for extended periods. Here are some friendly tips for travelers:

• Know the TB risk at your destination. If you’re traveling to places like South and Southeast Asia (e.g. India, Indonesia, Vietnam, Philippines), Africa, or parts of Eastern Europe, TB is generally more prevalent there than in Australia. This doesn’t mean you’ll get TB – most short-term tourists have minimal risk – but understand the environment. If you’ll be living or working closely with locals (for example, volunteering in a clinic or teaching in a rural village for months), the risk exposure is higher than if you’re just passing through as a tourist.
• Consider vaccination for young children. As mentioned, infants or toddlers traveling to high-TB countries should get the BCG vaccine beforehand in most cases​. The vaccine takes some weeks to build immunity, so plan this at least 2–3 months before travel if possible. For older kids and adults, BCG is usually not recommended for travel unless specific high-risk exposure is expected. Instead, focus on avoiding exposure and consider TB testing after return.
• Avoid close contact with coughers. This sounds obvious, but in some places it’s common to encounter people with chronic coughs (which could be TB). TB spreads through the air, so try to avoid being stuck in a tight, unventilated space with someone who’s coughing a lot. If you’re taking long bus rides or living in dormitory-style lodging, good ventilation is your friend – open a window, or use an N95 mask in high-risk settings if you’re really concerned. These are simple precautions; no need to be paranoid, just practical.
• After travel, watch your health. TB has a long incubation – symptoms might only appear months after exposure. If you develop a persistent cough, fevers, or unexplained weight loss after a trip, especially a trip to a country with more TB, see your GP. Tell the doctor where you’ve been, so they consider TB testing if appropriate​. In general, any cough lasting more than 3 weeks should be investigated, travel or not. Your doctor might do a chest X-ray or a special TB blood test (called an IGRA) to check. It’s always better to catch TB early for treatment. Remember, TB is curable, but only if you diagnose and treat it.

Finally, an important reassurance: casual tourists are extremely unlikely to contract TB. The risk on a two-week holiday, where you mostly stay in hotels and do outdoor sightseeing, is very, very low. So don’t cancel your trip to Vietnam or South Africa out of fear – just be informed. The advice above mainly applies to long-term travelers, expats, or those in very rustic conditions. For peace of mind, some travelers opt to get a TB test after returning from a long journey or before starting certain jobs (like healthcare). Talk to your healthcare provider if you’re unsure.

Travel broadens the mind, and by traveling smart with health in mind, you’ll keep both wonderful memories and good health.

In conclusion, tuberculosis still matters today because it remains a global challenge that requires awareness and cooperation. Australia’s success in controlling TB is something to be proud of, but it shouldn’t lead to complacency. By understanding TB – its symptoms, spread, prevention, and global impact – we can all contribute to early detection and support efforts to finally relegate this disease to history. This World Tuberculosis Day, let’s remember that no one is safe from TB until everyone is safe from TB, and continue working towards a world free of this disease.

Stay informed, stay healthy, and take care – TB may be old, but our knowledge and vigilance keep us one step ahead.

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