Tuberculosis is a disease caused by a bacillus (a mycobacterium of the Mycobacterium tuberculosis complex) that most commonly affects the lungs but can sometimes affect other organs as well. It is an airborne disease transmitted through droplets of bronchial secretions from an infectious patient, particularly when they cough. Santé publique France monitors tuberculosis in France through cases reported via mandatory reporting (via e-do tuberculosis) and publishes annual data from this surveillance every year. This is an opportunity to remind the public that BCG vaccination of children most at risk of tuberculosis is effective in protecting against the most severe forms of the disease.

Tuberculosis in France: 2021 Epidemiological Data

Nationally

• 4,306 reported cases, representing a reporting rate of 6.4 per 100,000, compared to 4,606 cases and 6.8 cases per 100,000 in 2020, respectively. This incidence has decreased significantly over the past two years, in connection with the COVID-19 pandemic, whereas it has been declining steadily but slightly for decades, at an average rate of –1.7% per year over the past 30 years.

• Three population groups have been identified as the most affected by the disease and on which control and prevention efforts must focus:

  • homeless people (68 cases per 100,000 inhabitants);

  • prisoners (44 cases per 100,000 inhabitants);

  • people born outside France (32 cases per 100,000 inhabitants);

• Decrease in the number of multidrug-resistant (MDR) tuberculosis cases: 43 cases in 2021 compared to 67 in 2020.

• The change in BCG vaccination policy in 2007 and the vaccine shortage over the past six years have not impacted the epidemiology of childhood tuberculosis. Tuberculosis reporting rates in this population group remain very low. Severe forms of childhood tuberculosis (meningeal or miliary) remain stable (11 cases in 2021 compared to 9 in 2020) and are consistent with predictions made when the mandatory BCG vaccination was suspended.

At the regional level

• Regional and population-based disparities are comparable to those observed in previous years. There is a heterogeneous distribution of tuberculosis across regions and populations.

• The highest incidence rates remain in the same three regions:

  • Mayotte (12.0 cases per 100,000 inhabitants);

  • Ile-de-France (13.2 cases per 100,000 inhabitants);

  • French Guiana (25.5 cases per 100,000 inhabitants);

  • Ile-de-France accounts for 38% of cases. Seine-Saint-Denis is the French department most affected by tuberculosis (24.3 cases per 100,000 inhabitants).

Tuberculosis Control and Prevention

Today in France, the rapid identification of tuberculosis cases (through the healthcare system and targeted screening) as well as the treatment of identified latent tuberculosis infections remain the main components of tuberculosis control, supplemented by BCG (Bacille Calmette-Guérin) vaccination, which primarily protects against severe forms of the disease in children. Tuberculosis vaccination is recommended starting at 1 month of age, ideally during the second month, and up to age 15 for all children at high risk of tuberculosis. Tuberculosis Control Centers (CLAT) play an essential role in control and prevention activities, particularly by screening for tuberculosis and latent infection among at-risk groups, conducting contact tracing for tuberculosis cases, and contributing to the monitoring and care of patients undergoing anti-tuberculosis treatment.

• Learn more: tuberculosis section on vaccination-info-service.fr