Despite significant progress in global health, tuberculosis (TB) remains a persistent and evolving threat, particularly in Europe. The latest estimates from the World Health Organization (WHO) Regional Office for Europe indicate approximately 204,000 new cases and 19,000 deaths occurred in 2024. Alarmingly, drug-resistant forms of the disease account for up to 55,000 of those cases. This reality, far from a relic of the past, is underscored by the Association of Clinical Microbiologists (AMCLI) in observance of World Tuberculosis Day on March 24th.
While incidence rates in Italy remain relatively low, with around 4,000 new cases annually, the numbers aren’t declining, and transmission of drug-resistant strains is a growing concern. “Tuberculosis is not a disease of the past,” emphasizes Daniela Maria Cirillo, director of the Emerging Pathogens Unit at the IRCCS San Raffaele in Milan and coordinator of the AMCLI mycobacteria working group. “The stability of cases and the spread of drug-resistant forms highlight the necessitate for continued vigilance, especially among vulnerable populations, and for strengthening surveillance and control activities.”
The Challenge of a Resurgent Disease
Several factors are contributing to the continued spread of TB, including ongoing conflicts, forced migrations, and disruptions to healthcare systems. These circumstances create environments where the disease can thrive and hinder effective prevention and treatment efforts. The WHO reports that TB remains one of the leading causes of death worldwide, particularly in low- and middle-income countries, but its impact is increasingly felt in Europe as well.
The rise in drug-resistant TB is particularly troubling. Multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) require longer, more complex, and more expensive treatment regimens, often with significant side effects. These strains emerge when TB bacteria develop mutations that build them resistant to the most commonly used anti-TB drugs. The WHO estimates that globally, around 4.8% of new TB cases and 19% of previously treated cases have MDR-TB.
Advances in Diagnosis and the Path Forward
Despite the challenges, significant strides are being made in the diagnosis and management of TB. Rapid molecular tests, automated platforms for detecting drug resistance, and the increasing application of genomic sequencing are enabling earlier and more accurate identification of the disease. “Innovation allows us to obtain fundamental information about the pathogen and resistance profiles much more quickly,” explains Cirillo. “This allows us to initiate targeted therapies sooner and improve clinical management and surveillance, which are crucial, especially in high-risk transmission settings.”
These diagnostic advancements are critical for interrupting transmission chains and preventing the development of further drug resistance. Genomic sequencing, in particular, provides a detailed understanding of the genetic makeup of TB bacteria, allowing for precise tracking of outbreaks and identification of transmission patterns. This information can then be used to tailor public health interventions and optimize treatment strategies.
The 53rd AMCLI congress, scheduled to take place in Rimini from March 27th to 30th, will focus on these advancements and the ongoing fight against TB. The event will bring together experts from across the field to share the latest research and best practices. The congress aligns with the international slogan for World Tuberculosis Day 2026: “Yes! We can end tuberculosis: led by countries, powered by people,” emphasizing the importance of a collaborative approach involving institutions, the scientific community, and citizens.
A key component of this collaborative approach is addressing the social determinants of TB. Poverty, malnutrition, overcrowding, and limited access to healthcare all contribute to the spread of the disease. Effective TB control programs must address these underlying factors to achieve lasting success. The WHO highlights the importance of a multi-sectoral approach, involving collaboration between health, social welfare, and economic development agencies.
increased investment in TB research and development is essential. New drugs, diagnostics, and vaccines are needed to combat drug-resistant strains and ultimately eliminate TB as a public health threat. The development of a more effective TB vaccine remains a high priority for researchers worldwide.
The ongoing situation in Ukraine and other regions experiencing conflict underscores the vulnerability of displaced populations to TB. Disrupted healthcare systems, overcrowded living conditions, and limited access to essential medicines create ideal conditions for the spread of the disease. International organizations and national governments must prioritize TB control efforts in these settings to prevent outbreaks and protect vulnerable populations.
Looking ahead, the focus must remain on strengthening surveillance systems, expanding access to rapid diagnostics, and ensuring that all individuals with TB receive prompt and effective treatment. The AMCLI congress in Rimini will be a crucial forum for discussing these priorities and charting a course towards a future free from the burden of tuberculosis. The next major update on European TB incidence and drug resistance patterns is expected from the WHO in late 2025.
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