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Do not fill this in! == Epidemiology == Roughly one-quarter of the world's population has been infected with ''M. tuberculosis'',<ref name=WHO2018Fact/> with new infections occurring in about 1% of the population each year.<ref name=WHO2002/> However, most infections with ''M. tuberculosis'' do not cause disease,<ref name=CDC>{{cite web|publisher=[[Centers for Disease Control and Prevention]] (CDC)|url=https://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm|title=Fact Sheets: The Difference Between Latent TB Infection and Active TB Disease|date=20 June 2011|access-date=26 July 2011|url-status=live|archive-url=https://web.archive.org/web/20110804005502/http://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm|archive-date=4 August 2011}}</ref> and 90β95% of infections remain asymptomatic.<ref name=Book90/> In 2012, an estimated 8.6 million chronic cases were active.<ref>{{cite web|title=Global tuberculosis report 2013|url=https://www.who.int/tb/publications/global_report/en/index.html|publisher=World Health Organization (WHO)|year=2013|url-status=live|archive-url=https://web.archive.org/web/20061212123736/http://www.who.int/tb/publications/global_report/en/index.html|archive-date=12 December 2006}}</ref> In 2010, 8.8 million new cases of tuberculosis were diagnosed, and 1.20β1.45 million deaths occurred (most of these occurring in [[Developing nation|developing countries]]).<ref name=WHO2011/><ref name=Loz2012>{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, etal | s2cid = 1541253 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095β128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl = 10536/DRO/DU:30050819 | url = https://zenodo.org/record/2557786 | hdl-access = free | access-date = 18 March 2020 | archive-date = 19 May 2020 | archive-url = https://web.archive.org/web/20200519152712/https://zenodo.org/record/2557786 | url-status = live }}</ref> Of these, about 0.35 million occur in those also infected with HIV.<ref name=WHO2011Control>{{cite web|title=Global Tuberculosis Control 2011 |url=https://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf |publisher=World Health Organization (WHO) |access-date=15 April 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120617064025/http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf |archive-date=17 June 2012 }}</ref> In 2018, tuberculosis was the leading cause of death worldwide from a single infectious agent.<ref>{{cite web |title=Tuberculosis |url=https://www.who.int/news-room/fact-sheets/detail/tuberculosis |website=WHO |date=24 March 2020 |access-date=31 May 2020 |archive-date=30 July 2020 |archive-url=https://web.archive.org/web/20200730165218/https://www.who.int/news-room/fact-sheets/detail/tuberculosis |url-status=live }}</ref> The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002.<ref name="WHO2011" /> Tuberculosis{{Clarify|reason=Which one? Pulmonary?|date=December 2022}} incidence is seasonal, with peaks occurring every spring and summer.<ref>{{cite journal | vauthors = Douglas AS, Strachan DP, Maxwell JD | title = Seasonality of tuberculosis: the reverse of other respiratory diseases in the UK | journal = Thorax | volume = 51 | issue = 9 | pages = 944β946 | date = September 1996 | pmid = 8984709 | pmc = 472621 | doi = 10.1136/thx.51.9.944 }}</ref><ref>{{cite journal | vauthors = Martineau AR, Nhamoyebonde S, Oni T, Rangaka MX, Marais S, Bangani N, Tsekela R, Bashe L, de Azevedo V, Caldwell J, Venton TR, Timms PM, Wilkinson KA, Wilkinson RJ | display-authors = 6 | title = Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 108 | issue = 47 | pages = 19013β19017 | date = November 2011 | pmid = 22025704 | pmc = 3223428 | doi = 10.1073/pnas.1111825108 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Parrinello CM, Crossa A, Harris TG | title = Seasonality of tuberculosis in New York City, 1990-2007 | journal = The International Journal of Tuberculosis and Lung Disease | volume = 16 | issue = 1 | pages = 32β37 | date = January 2012 | pmid = 22236842 | doi = 10.5588/ijtld.11.0145 }}</ref><ref name="Korthals2012">{{cite journal | vauthors = Korthals Altes H, Kremer K, Erkens C, van Soolingen D, Wallinga J | title = Tuberculosis seasonality in the Netherlands differs between natives and non-natives: a role for vitamin D deficiency? | journal = The International Journal of Tuberculosis and Lung Disease | volume = 16 | issue = 5 | pages = 639β644 | date = May 2012 | pmid = 22410705 | doi = 10.5588/ijtld.11.0680 }}</ref> The reasons for this are unclear, but may be related to vitamin D deficiency during the winter.<ref name="Korthals2012"/><ref>{{cite journal | vauthors = Koh GC, Hawthorne G, Turner AM, Kunst H, Dedicoat M | title = Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study | journal = PLOS ONE | volume = 8 | issue = 3 | pages = e57752 | year = 2013 | pmid = 23483924 | pmc = 3590299 | doi = 10.1371/journal.pone.0057752 | doi-access = free | bibcode = 2013PLoSO...857752K }}</ref> There are also studies linking tuberculosis to different weather conditions like low temperature, low humidity and low rainfall. It has been suggested that tuberculosis incidence rates may be connected to climate change.<ref>{{cite journal | vauthors = Kuddus MA, McBryde ES, Adegboye OA | title = Delay effect and burden of weather-related tuberculosis cases in Rajshahi province, Bangladesh, 2007-2012 | journal = Scientific Reports | volume = 9 | issue = 1 | pages = 12720 | date = September 2019 | pmid = 31481739 | pmc = 6722246 | doi = 10.1038/s41598-019-49135-8 | bibcode = 2019NatSR...912720K }}</ref> === At-risk groups === Tuberculosis is closely linked to both overcrowding and [[malnutrition]], making it one of the principal [[diseases of poverty]].<ref name="Lancet11" /> Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients.<ref name="Griffith_1996">{{cite journal|vauthors=Griffith DE, Kerr CM|date=August 1996|title=Tuberculosis: disease of the past, disease of the present|journal=Journal of PeriAnesthesia Nursing|volume=11|issue=4|pages=240β45|doi=10.1016/S1089-9472(96)80023-2|pmid=8964016}}</ref> The rate of tuberculosis varies with age. In Africa, it primarily affects adolescents and young adults.<ref>{{cite web|title=Global Tuberculosis Control Report, 2006 β Annex 1 Profiles of high-burden countries|url=https://www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf|url-status=dead|archive-url=https://web.archive.org/web/20090726124358/http://www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf|archive-date=26 July 2009|access-date=13 October 2006|publisher=World Health Organization (WHO)}}</ref> However, in countries where incidence rates have declined dramatically (such as the United States), tuberculosis is mainly a disease of the elderly and [[immunocompromise]]d (risk factors are listed above).<ref name="Robbins" /><ref>{{cite web|date=12 September 2006|title=2005 Surveillance Slide Set|url=https://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm|url-status=live|archive-url=https://web.archive.org/web/20061123122326/http://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm|archive-date=23 November 2006|access-date=13 October 2006|publisher=Centers for Disease Control and Prevention}}</ref> Worldwide, 22 "high-burden" states or countries together experience 80% of cases as well as 83% of deaths.<ref name="EIU 2014" /> In Canada and Australia, tuberculosis is many times more common among the [[Indigenous peoples]], especially in remote areas.<ref>{{cite journal|vauthors=FitzGerald JM, Wang L, Elwood RK|date=February 2000|title=Tuberculosis: 13. Control of the disease among aboriginal people in Canada|journal=[[Canadian Medical Association Journal]]|volume=162|issue=3|pages=351β55|pmc=1231016|pmid=10693593}}</ref><ref>{{cite book| vauthors = Quah SR, Carrin G, Buse K, Heggenhougen K |url=https://books.google.com/books?id=IEXUrc0tr1wC&pg=PA424|title=Health Systems Policy, Finance, and Organization|publisher=Academic Press|year=2009|isbn=978-0-12-375087-7|location=Boston|page=424|name-list-style=vanc|archive-url=https://web.archive.org/web/20150906220918/https://books.google.com/books?id=IEXUrc0tr1wC&pg=PA424|archive-date=6 September 2015|url-status=live}}</ref> Factors contributing to this include higher prevalence of predisposing health conditions and behaviours, and overcrowding and poverty. In some Canadian Indigenous groups, genetic susceptibility may play a role.<ref name=":0" /> Socioeconomic status (SES) strongly affects TB risk. People of low SES are both more likely to contract TB and to be more severely affected by the disease. Those with low SES are more likely to be affected by risk factors for developing TB (e.g., malnutrition, indoor air pollution, HIV co-infection, etc.), and are additionally more likely to be exposed to crowded and poorly ventilated spaces. Inadequate healthcare also means that people with active disease who facilitate spread are not diagnosed and treated promptly; sick people thus remain in the infectious state and (continue to) spread the infection.<ref name=":0" /> === Geographical epidemiology === The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many African, Caribbean, South Asian, and eastern European countries test positive in tuberculin tests, while only 5β10% of the U.S. population test positive.<ref name="Robbins" /> Hopes of totally controlling the disease have been dramatically dampened because of many factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.<ref name="Lancet11" /> In developed countries, tuberculosis is less common and is found mainly in urban areas. In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the [[Medical Research Council (UK)|Medical Research Council]] was formed in Britain in 1913 its initial focus was tuberculosis research.<ref>{{cite web | work = [[Medical Research Council (UK)|Medical Research Council]] | url = http://www.mrc.ac.uk/index/about/about-history/about-history-2.htm | title = Origins of the MRC. | archive-url = https://web.archive.org/web/20080411164838/http://www.mrc.ac.uk/index/about/about-history/about-history-2.htm | archive-date=11 April 2008 | access-date = 7 October 2006 }}</ref> In 2010, rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139.<ref name="WHO2011Control" /> ==== Russia ==== Russia has achieved particularly dramatic progress with a decline in its TB mortality rateβfrom 61.9 per 100,000 in 1965 to 2.7 per 100,000 in 1993;<ref>{{Cite book |vauthors=Shkolnikov VM, MeslΓ© F |chapter=The Russian Epidemiological Crisis as Mirrored by Mortality Trends |page=142 |year=1996 |url=https://www.rand.org/pubs/conf_proceedings/CF124.html |language=en |veditors=DaVanzo J, Farnsworth G |title=Russia's Demographic "Crisis" |publisher=RAND Corporation |isbn=0-8330-2446-9 |access-date=20 February 2023 |archive-date=20 February 2023 |archive-url=https://web.archive.org/web/20230220171629/https://www.rand.org/pubs/conf_proceedings/CF124.html |url-status=live }}</ref><ref name=WHO2011a>{{cite web | url = https://www.who.int/tb/publications/global_report/en/index.html | title = Global Tuberculosis Control | archive-url = https://web.archive.org/web/20061212123736/http://www.who.int/tb/publications/global_report/en/index.html | archive-date=12 December 2006 | publisher = World Health Organization | date = 2011 }}</ref> however, mortality rate increased to 24 per 100,000 in 2005 and then recoiled to 11 per 100,000 by 2015.<ref>{{Cite web|url=https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=RU&LAN=EN&outtype=html|title=WHO global tuberculosis report 2016. Annex 2. Country profiles: Russian Federation|access-date=22 August 2020|archive-date=14 July 2017|archive-url=https://web.archive.org/web/20170714043942/https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=RU&LAN=EN&outtype=html|url-status=dead}}</ref> ==== China ==== China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010.<ref name=WHO2011Control/> The number of new cases has declined by 17% between 2004 and 2014.<ref name="EIU 2014"/> ==== Africa ==== In 2007, the country with the highest estimated incidence rate of TB was [[Eswatini]], with 1,200 cases per 100,000 people. In 2017, the country with the highest estimated [[Incidence (epidemiology)|incidence rate]] as a % of the population was [[Lesotho]], with 665 cases per 100,000 people.<ref name="Global tuberculosis report 2018">{{cite web|title=Global Tuberculosis Report 2018|url=http://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?ua=1|access-date=27 September 2019|archive-date=7 August 2020|archive-url=https://web.archive.org/web/20200807121356/https://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?ua=1|url-status=live}}</ref> In South Africa, 54 200 people died in 2022 from TB. The incidence rate was 468 per 100 000 people; in 2015, this was 988 per 100 000. The total incidence was 280 000 in 2022; in 2015, this was 552 000.<ref>{{Cite web |last=Tomlinson |first=Catherine |date=2023-11-10 |title=In-depth: What new WHO TB numbers mean for South Africa |url=https://www.spotlightnsp.co.za/2023/11/10/in-depth-what-new-who-tb-numbers-mean-for-sa/ |access-date=2024-03-27 |website=Spotlight |language=en-US}}</ref> ==== India ==== As of 2017, India had the largest total incidence, with an estimated 2,740,000 cases.<ref name="Global tuberculosis report 2018"/> According to the [[World Health Organization]] (WHO), in 2000β2015, India's estimated mortality rate dropped from 55 to 36 per 100,000 population per year with estimated 480 thousand people died of TB in 2015.<ref>{{Cite web|url=https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=IN&LAN=EN&outtype=html|title=WHO Global tuberculosis report 2016: India|access-date=22 August 2020|archive-date=6 February 2018|archive-url=https://web.archive.org/web/20180206193815/https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=IN&LAN=EN&outtype=html|url-status=dead}}</ref><ref>{{cite web|url=http://www.dnaindia.com/health/report-govt-revisits-strategy-to-combat-tuberculosis-nadda-2388967|title=Govt revisits strategy to combat tuberculosis|work=Daily News and Analysis|date=8 April 2017|access-date=22 August 2020|archive-date=3 June 2021|archive-url=https://web.archive.org/web/20210603072417/https://www.dnaindia.com/health/report-govt-revisits-strategy-to-combat-tuberculosis-nadda-2388967|url-status=live}}</ref> In India a major proportion of tuberculosis patients are being treated by private partners and private hospitals. Evidence indicates that the tuberculosis national survey does not represent the number of cases that are diagnosed and recorded by private clinics and hospitals in India.<ref>{{cite journal | vauthors = Mahla RS | title = Prevalence of drug-resistant tuberculosis in South Africa | journal = The Lancet. Infectious Diseases | volume = 18 | issue = 8 | pages = 836 | date = August 2018 | pmid = 30064674 | doi = 10.1016/S1473-3099(18)30401-8 | doi-access = free }}</ref> ==== North America ==== In the United States, [[Native Americans in the United States|Native Americans]] have a fivefold greater mortality from TB,<ref>{{cite book | vauthors = Birn AE |title= Textbook of International Health: Global Health in a Dynamic World |year= 2009 |page= 261 |publisher= Oxford University Press |isbn= 978-0-19-988521-3 |url= https://books.google.com/books?id=2XBB4-eYGZIC&pg=PT261 |url-status=live |archive-url= https://web.archive.org/web/20150906213750/https://books.google.com/books?id=2XBB4-eYGZIC&pg=PT261 |archive-date= 6 September 2015 }}</ref> and racial and ethnic minorities accounted for 84% of all reported TB cases.<ref>{{cite web|publisher=Centers for Disease Control and Prevention|url=https://www.cdc.gov/tb/statistics/surv/surv2012/slides/surv12.htm|title=CDC Surveillance Slides 2012 β TB|url-status=dead|archive-url=https://web.archive.org/web/20131109150519/http://www.cdc.gov/tb/statistics/surv/surv2012/slides/surv12.htm|archive-date=9 November 2013|date=24 October 2018|access-date=17 September 2017}}</ref> The overall tuberculosis case rate in the United States was 3 per 100,000 persons in 2017.<ref name="Global tuberculosis report 2018"/> In Canada, tuberculosis was endemic in some rural areas as of 1998.<ref>{{cite journal|url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102188560.html|title=Rural outbreaks of ''Mycobacterium tuberculosis'' in a Canadian province|journal=Abstr Intersci Conf Antimicrob Agents Chemother|year=1998|volume=38|page=555 |id=abstract no. L-27|vauthors=Al-Azem A, Kaushal Sharma M, Turenne C, Hoban D, Hershfield E, MacMorran J, Kabani A|url-status=dead|archive-url=https://web.archive.org/web/20111118161808/http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102188560.html |archive-date=18 November 2011 }}</ref> ==== Western Europe ==== In 2017, in the United Kingdom, the national average was 9 per 100,000 and the highest incidence rates in [[Western Europe]] were 20 per 100,000 in Portugal. <gallery widths="300" heights="210"> File:Tuberculosis incidence (per 100,000 people), OWID.svg|alt=Number of new cases of tuberculosis per 100,000 people in 2016.|Number of new cases of tuberculosis per 100,000 people in 2016<ref>{{cite web |title=Tuberculosis incidence (per 100,000 people) |url=https://ourworldindata.org/grapher/incidence-of-tuberculosis-sdgs |website=Our World in Data |access-date=7 March 2020 |archive-date=26 September 2019 |archive-url=https://web.archive.org/web/20190926041419/https://ourworldindata.org/grapher/incidence-of-tuberculosis-sdgs |url-status=live }}</ref> File:Tuberculosis world map-Deaths per million persons-WHO2012.svg|Tuberculosis deaths per million persons in 2012 File:Tuberculosis deaths by region, OWID.svg|alt=Tuberculosis deaths by region, 1990 to 2017.|Tuberculosis deaths by region, 1990 to 2017<ref>{{cite web |title=Tuberculosis deaths by region |url=https://ourworldindata.org/grapher/tuberculosis-deaths-region |website=Our World in Data |access-date=7 March 2020 |archive-date=8 May 2020 |archive-url=https://web.archive.org/web/20200508204644/https://ourworldindata.org/grapher/tuberculosis-deaths-region |url-status=live }}</ref> </gallery> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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