Tuberculosis

1. Key messages

2. Tuberculosis incidence

Belgium is a low incidence country for tuberculosis with 7.4 cases per 100,000 inhabitants in 2022

In 2022, 852 new cases of tuberculosis were reported in Belgium (7.4 cases/100,000 inhabitants). Men were approximately 2 times more often affected by the disease than women, with 68% of new cases occurring among men in 2022 in Belgium. Of all cases, 39% of the tuberculosis patients diagnosed in 2022 were aged 25-44 years.

Among the regions of Belgium, the Brussels Capital Region has the highest incidence of tuberculosis

Of the total number of new registered cases, 44% of tuberculosis cases were registered in the Flemish Region (n=371), 32% in the Brussels Capital Region (n=272) and 25% in the Walloon Region (n=209). Considering the number of inhabitants in each region, the incidence rate was four times higher in the Brussels Capital Region (22.2 cases/100,000) as compared to the Walloon Region (5.7 cases/100,000) and the Flemish Region (5.5 cases/100,000). The incidence rates in the Flemish Region and the Walloon Region were similar, with slightly higher rates in the Walloon Region.

Tuberculosis occurs more often among people with a foreign nationality

In 2022, 62% of the new tuberculosis cases occurred among people with a foreign nationality in Belgium. This proportion was higher in the Brussels Capital Region (70%) compared to the Walloon Region and the Flemish Region (respectively 54% and 62%). Among Belgians, the incidence rate was 4.3 times higher in the Brussels Capital Region (10.3/100,000) compared to the Flemish Region (2.4/100,000), and 3.4 times higher compared to the Walloon Region (3.0/100,000). Among non-Belgians, the incidence rate was 1.5 times higher in the Brussels Capital Region (43.5/100,000) compared to the Flemish Region (29/100,000), and 1.2 times higher compared to the Walloon Region (34.8/100,000).

The distribution of the incidence by age and sex varied according to nationality in 2022. Among Belgians, the incidence increased with age in men, peaking in the 60-74 years group. Incidence was higher in men than in women across all age categories, except for children (0-14 years). The overall male-female ratio tended to increase with age, with incidence rates being 4.0 times higher in men among those over 75 years.

Among non-Belgians, the highest incidence was observed in the 15-29 years age group, with particularly high rates in men. The lowest incidence rates among non-Belgians were seen in women aged 60-74 and in boys (0-14 years). Excluding children (0-14 years), the incidence rate was 1.6 to 4.3 times higher in men compared to women across the all age groups, with the highest male-to-female ratios in the 60-74 years and 15-29 years age groups.

Cases of tuberculosis are more often reported in the bigger cities in Belgium

In 2022, tuberculosis occurred more frequently in big cities where more people at risk are living:

• The incidence in the city of Brussels was the highest (22.2 new cases/100,000); it was 3 times higher compared to the overall incidence in Belgium (7.4 new cases/100,000).
• The incidence was also high in Antwerp (14.9 new cases/100,000), followed by Ghent (11.7 new cases/100,000), Liège (11.3 new cases/100,000), and Charleroi (10.9 new cases/100,000).
• Bruges was the only city where the tuberculosis incidence rate was lower than the national average (5.1 new cases/100,000).

In 2022, the incidence of tuberculosis remained low

The number of new cases of tuberculosis is decreasing for more than 40 years, although the diminution is slowing down since the nineties and tends to stagnate over the last few years. The incidence rate dropped below the level of 10 cases/100,000 for the first time in 2007, ranking the country among low-incidence countries. In 2022, the incidence rate (7.4 cases/100,000; n=852) remained low and was even slightly lower compared to the incidence rate of 2021 (7.6 cases/100,000; n=875). It is slightly higher than in 2020 (7.2/100,000), which was the lowest incidence ever observed in Belgium, probably due to the context of the COVID-19 pandemic (including difficulty accessing healthcare, more complex data collection, under-reporting, containment measures, barrier measures, provision of emergency housing for vulnerable populations, border closures, etc.,). While the lower incidences in 2020 and 2021 could be explained by COVID-19, this is no longer the case for the low incidence in 2022.

Since 1981, the incidence rate is decreasing in all three regions, with more variations in Brussels:

• In the Walloon Region, the incidence decreased to 5.7/100,000 in 2022, following a significant but statistically non-significant increase to 7.2/100,000 in 2021, up from 5.6/100,000 in 2020.
• In the Flemish Region, the incidence rose to 5.5 cases/100,000 in 2022, after a continued decline from 5.4 cases/100,000 in 2020 to 5.1 cases/100,000) in 2021.
• In the Brussels Capital Region, the incidence rate slightly decreased from 22.8 cases/100,000 in 2021 to 22.2 cases/100,000 in 2022..

Despite being a low incidence country, Belgium is ranked third in terms of tuberculosis incidence among EU countries

In 2022, according to World Health Organization (WHO) [4], the estimated incidence rate in Belgium was above the EU-14 average, ranking the country 3rd in the EU-14 after Portugal and Luxembourg.

International comparisons made on reported data must be interpreted with caution, since methods for collecting data are different depending on the country. That is why the WHO Global Task Force on TB Impact Measurement [1] has developed a methodology to take into account under reporting, over and under-diagnosis in tuberculosis estimates. This explains why the incidence rate in Belgium presented in this international comparison (7.8 new cases per 100,000) is different compared to the incidence rate extracted from the Belgian tuberculosis registry publication (7.4 cases per 100,000).

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View the metadata for this indicator

Fonds des affections respiratoires (FARES)
Vereniging voor Respiratoire Gezondheid (VRGT)

Background

Tuberculosis is a disease caused by a bacterium called Mycobacterium tuberculosis that usually affects the lungs.

According to the World Health Organization (WHO), more than 10 million new cases of tuberculosisoccur every year. The disease is one of the top 10 causes of death worldwide, and the second leading cause of death from a single infectious agent after COVID-19 in 2022. Belgium is situated among the “low-incidence countries” with less than 10 new cases of tuberculosis per 100,000 inhabitants per year [1].

Tuberculosis can nowadays be effectively treated with a success rate of 81% in 2021 in Belgium. In Belgium, treatment is free of charge for the entire population, also for people without health insurance. However, 7.4% of tuberculosis patients still die before the end of treatment [2].

The main risk factors for tuberculosis are contacts with infected people, poverty, poor nutritional status and immunodeficiency. Some people are more likely to get infected with tuberculosis since they are more exposed to the risk factors, like health care professionals and vulnerable populations such as homeless people, prisoners and migrants originating from countries with high tuberculosis prevalence.

Data presented in this chapter are extracted from the Belgian tuberculosis registry 2022 report written by the Fonds des Affections Respiratoires (FARES) [2] and the Vereniging voor Respiratoire Gezondheid (VRGT) [3].

The incidence rate is calculated as the number of new cases divided by the number of people registered at the National registry. Incidence rate in non-Belgians is slightly overestimated, as cases in unregistered migrants are counted in the numerator, while the denominator could only include the registered migrants.

Definitions

EU-14

The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since they have left the EU.

Tuberculosis case

According to the WHO-recommended definitions [5], a tuberculosis case is defined as a case of active tuberculosis clinically diagnosed by a clinician or other medical practitioner or bacteriologically confirmed. Clinically diagnosed cases include “cases diagnosed on the basis of X-ray abnormalities or suggestive histology and extrapulmonary cases without laboratory confirmation” [5].

References

1. Global tuberculosis report 2023. Geneva: World Health Organization; 2023 https://www.who.int/publications/i/item/9789240083851
2. Registre belge de la tuberculose 2022, FARES asbl, March 2024. https://fares.be/tuberculose/publications/rapports-epidemiologiques/fares-registretbc2022_3.pdf
3. Tuberculoseregister België 2022, Vereniging Respiratoire Gezondheid (VRGT) vzw. https://tuberculose.vrgt.be/sites/default/files/2022%20Tuberculoseregister%20Belgi%C3%AB%20finaal_0.pdf
4. WHO Regional Office for Europe/European Centre for Disease Prevention and Control. Tuberculosis surveillance and monitoring in Europe 2024 – 2022 data. Copenhagen: WHO Regional Office for Europe; and Stockholm: European Centre for Disease Prevention and Control; 2024. https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2024-2022-data
5. Definitions and reporting framework for tuberculosis – 2013 revision, updated December 2014. Geneva: World Health Organization; 2015. https://www.who.int/tb/publications/definitions/en/

Please cite this page as: Sciensano. Communicable Diseases: Tuberculosis, Health Status Report, 29 July 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/communicable-diseases/tuberculosis