Tuberculosis remains one of the most common infectious diseases on the planet. In 2024, eight countries alone accounted for two thirds of all global cases, and the disease killed 1.23 million people that year. While TB rates are low in the United States and other high-income countries, the infection is widespread across much of South and Southeast Asia, sub-Saharan Africa, and parts of the Western Pacific.
Global Cases at a Glance
India carries the largest share of the world’s TB burden, accounting for roughly 25% of all cases in 2024. Indonesia follows at 10%, then the Philippines (6.8%), China (6.5%), Pakistan (6.3%), Nigeria (4.8%), the Democratic Republic of the Congo (3.9%), and Bangladesh (3.6%). Together, these eight countries make up about two thirds of every new TB diagnosis worldwide.
The disease is caused by bacteria that spread through the air when someone with active TB coughs, sneezes, or speaks. Most people who breathe in the bacteria never get sick, because their immune system walls off the infection. This “walled off” state is called latent TB. An estimated one quarter of the world’s population carries latent TB, but only 5 to 10% of those people will ever develop active disease. The rest carry the bacteria for life without symptoms and cannot spread it to others.
How Common Is TB in the United States?
TB is relatively rare in the U.S. compared to high-burden countries. In 2024, the national case count was 10,388, translating to an incidence rate of 3.1 per 100,000 people. That’s a small fraction of the rates seen in countries like the Philippines or India, where incidence can exceed 200 per 100,000.
Within the U.S., the burden is not evenly distributed. The TB incidence rate among non-U.S.-born individuals is 15.7 per 100,000, nearly 20 times higher than the rate of 0.8 per 100,000 among U.S.-born individuals. This gap largely reflects the fact that many people who move to the U.S. from high-burden countries carry latent infections acquired years or decades earlier. Reactivation of those latent infections, rather than new transmission within the U.S., drives most American TB cases.
Who Is Most at Risk?
Several groups face higher odds of developing active TB. People living with HIV are especially vulnerable because the virus weakens the immune cells that normally keep TB bacteria in check. About 8% of the estimated 10 million people who develop TB each year are also living with HIV. In 2024, roughly 150,000 TB deaths occurred among people with HIV.
Children are another heavily affected group. In 2023, an estimated 1.25 million children under age 15 fell ill with TB worldwide. Young children are more likely than adults to progress rapidly from infection to active disease, and diagnosing TB in children is harder because they often can’t produce sputum samples for testing.
Other factors that raise your risk include malnutrition, diabetes, tobacco use, heavy alcohol consumption, and any condition or medication that suppresses the immune system. Crowded living conditions, limited access to healthcare, and poverty all increase the likelihood of both exposure and delayed diagnosis.
TB Deaths and Drug Resistance
TB killed 1.23 million people in 2024, making it one of the top infectious disease killers globally. Most of these deaths, about 1.08 million, occurred in people without HIV. The disease is treatable with a standard course of antibiotics lasting four to six months, so the high death toll reflects gaps in diagnosis and access to care rather than a lack of effective treatment.
Drug-resistant TB complicates the picture. In 2023, an estimated 400,000 people developed multidrug-resistant or rifampicin-resistant TB, meaning the bacteria no longer respond to the most effective first-line medications. Treatment for drug-resistant TB takes longer, involves more medications with harsher side effects, and costs significantly more. Cure rates are also lower. Drug resistance tends to emerge when patients don’t complete their full treatment course or when healthcare systems provide inconsistent drug supplies.
Latent TB vs. Active TB
Understanding the difference between latent and active TB matters for gauging how common the disease really is. The raw numbers of active cases, while large, represent only the visible surface. Beneath that, roughly a quarter of the global population harbors latent TB bacteria. These individuals feel perfectly healthy, have no symptoms, and cannot transmit the infection. But latent TB can reactivate years or even decades later if the immune system weakens due to aging, illness, or medication.
This is why TB screening and preventive treatment are important for people in higher-risk categories, including those who have recently moved from a high-burden country, people starting immunosuppressive therapy, and close contacts of someone with active TB. A short course of preventive antibiotics can dramatically reduce the chance that latent TB will ever become active disease.