Tunisia is facing a complex public health challenge with tuberculosis (TB), a disease that continues to impact communities despite global efforts toward eradication. While often associated with pulmonary infections, a significant portion of cases in Tunisia involve extrapulmonary forms, affecting organs like the intestines, liver, and lymph nodes. Recent data highlights the critical demand for a comprehensive, collaborative approach to combatting TB, one that recognizes the interconnectedness of human, animal, and environmental health – a concept known as “One Health.”
The country recorded over 3,000 cases of tuberculosis in 2024 and 2025, with a notable shift towards extrapulmonary manifestations, accounting for 64% of diagnoses compared to 36% of pulmonary cases. This trend underscores the evolving nature of the disease and the importance of accurate diagnosis and targeted treatment strategies. A particularly concerning aspect of the Tunisian TB landscape is the prevalence of tuberculous lymphadenitis, often referred to as scrofula, with approximately 1,500 cases reported annually. A substantial 80% of these cases are linked to animal sources, primarily cattle.
Ahmed Rajeb, President of the Tunisian Order of Veterinarians, emphasized the potential for eradicating tuberculous lymphadenitis through the adoption of the “One Health” approach. This strategy recognizes that the health of humans is inextricably linked to the health of animals, plants, and the environment. Rajeb’s statement, made to the Agence Tunis Afrique Presse, highlights the necessity of preventative measures to protect livestock, particularly cattle, from the bacterium responsible for the disease, which can survive for over 300 days on contaminated surfaces. The transmission to humans primarily occurs through the consumption of unpasteurized milk and dairy products, often sold informally without proper treatment or boiling.
The Animal-Human Connection: A Zoonotic Threat
The link between animal health and human TB cases in Tunisia is a significant public health concern. More than 60% of bacterial and parasitic diseases affecting humans in Tunisia are zoonotic – meaning they originate in animals – representing a total of 870 zoonoses out of 1,450 identified diseases. This underscores the importance of veterinary surveillance and control measures to prevent the spread of disease from animals to humans. Effective control requires not only treating infected animals but also implementing rigorous testing and sanitation protocols throughout the dairy production chain.
The risk associated with raw milk consumption is particularly acute. Without pasteurization, harmful bacteria, including Mycobacterium bovis – the causative agent of bovine tuberculosis – can survive and infect consumers. Informal dairy production, often lacking quality control measures, exacerbates this risk. Strengthening regulations and promoting safe food handling practices are crucial steps in mitigating the spread of zoonotic TB.
Global Efforts and Tunisia’s Role
The World Health Organization (WHO) has chosen “Yes, we can end TB” as the slogan for the 2026 World Tuberculosis Day, reaffirming the global commitment to eliminating the disease. The WHO is calling for accelerated efforts, strengthened multisectoral cooperation, increased investment, and the implementation of international recommendations. Globally, TB remains a major health threat, with 10.7 million new cases reported in 2024 and 1.23 million deaths attributed to the disease that same year, according to WHO data. WHO Tuberculosis Fact Sheet
Tunisia’s efforts to combat TB align with these global initiatives. However, addressing the unique challenges posed by the high prevalence of extrapulmonary TB and the zoonotic link requires a tailored approach. This includes strengthening diagnostic capabilities, improving access to treatment, and enhancing surveillance systems to track both human and animal cases.
Challenges and Future Directions
One of the key challenges in controlling TB in Tunisia is the need for improved coordination between the human and animal health sectors. A truly “One Health” approach requires seamless communication and collaboration between physicians, veterinarians, public health officials, and policymakers. This collaboration should extend to data sharing, joint surveillance programs, and the development of integrated control strategies.
Further research is also needed to better understand the epidemiology of TB in Tunisia, including the specific strains of the bacterium circulating in both human and animal populations. This information can inform the development of more effective diagnostic tools and treatment regimens. Investing in laboratory infrastructure and training personnel are essential components of this research effort.
Addressing the socioeconomic factors that contribute to TB transmission is also crucial. Poverty, malnutrition, and overcrowding can increase the risk of infection and hinder access to healthcare. Targeted interventions aimed at improving living conditions and promoting health education can assist to reduce the burden of TB in vulnerable communities.
Looking ahead, Tunisia’s National Tuberculosis Control Program will be crucial in coordinating efforts and monitoring progress. The program’s next major evaluation is scheduled for late 2026, providing an opportunity to assess the effectiveness of current strategies and identify areas for improvement. Continued investment in TB control, coupled with a strong commitment to the “One Health” approach, will be essential to achieving the WHO’s goal of ending TB in Tunisia and globally.
Have your own thoughts on Tunisia’s fight against tuberculosis? Share your comments below, and please share this article with your network to raise awareness about this vital public health issue.
Worth a look
