One in five cases of tuberculosis in the European region goes undiagnosed as drug resistance remains higher than in other parts of the world, a new report by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) has warned.
While the overall number of cases has dropped, tuberculosis (TB) remains a public health issue in the European Union, and the progress towards elimination remains insufficient, according to the report.
Tuberculosis is the leading cause of death from a single infectious agent worldwide. It is an infectious disease that spreads from person to person when an individual with pulmonary TB expels bacteria into the air by coughing.
Symptoms differ depending on which part of the body is affected. The most common include persistent cough for more than 2 weeks, fever, night sweats, and weight loss.
Incidence across the WHO European Region, encompassing 53 countries in Europe and Central Asia, has fallen by 39 percent since 2015, and the number of deaths by 49 percent.
But both figures fall short of the WHO’S End TB Strategy’s 2025 milestones of 50 percent and 75 percent, respectively.
In the European Union, cases have decreased by 33 percent and deaths by 17 percent, not enough to achieve its 2030 targets, “resulting in thousands of new infections and deaths that could be prevented,” the health agencies noted.
In 2024, more than 160,000 newly diagnosed TB cases were reported in the region while the estimated number of actual cases was 204,000 – meaning only 79 percent of the estimated new and relapse cases were notified.
According to Hans Kluge, WHO Regional Director for Europe, the number of undiagnosed cases represents not only a failure in detection, but a missed opportunity to treat patients earlier, prevent suffering, and stop further transmission.
“By investing in rapid diagnosis, shorter all-oral treatment regimens and stronger follow-up, countries can reach more people earlier, improve outcomes and put us back on track toward our targets,” he added.
Delayed diagnosis, the report found, not only affects the person infected as it is harder to treat but also increases the risk of transmission to others.
Growing antibiotic resistance
Drug-resistant TB continues to pose a major challenge across Europe, the report found. Multi-drug resistant tuberculosis among new and previously treated cases was 23 percent and 51 percent, respectively, which significantly exceeds the global average of 3.2 percent and 16 percent.
According to the report, the high number of drug resistance, particularly among previously treated patients, significantly exceeds global averages and reflects ongoing transmission.
Standard treatment of non-resistant TB consists of a six-month regimen of four first-line drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide), with success rates usually above 85 percent.
Antibiotic resistant variants require longer treatments with more drugs and are associated with lower success rates.
Most European countries are low-incidence countries, with a notification rate below 10 per 100,000, in which TB predominantly affects vulnerable populations such as migrants, prison inmates and people with HIV coinfections.
According to Ralf Otto-Knapp, from the German Central Committee against Tuberculosis, who did not participate in the report, the lower numbers in Western Europe are turning people’s attention away from the disease, making it more difficult to combat new cases of multidrug-resistant tuberculosis.
“We must be prepared for this by strengthening treatment and prevention services, ensuring easy access to new medicines and fostering cross-border cooperation,” he added.
