Tuberculosis remains a common disease worldwide, even though it is rare in France. However, the disease is highly contagious, which means its epidemiological dynamics could still change. Santé publique France monitors tuberculosis in France through cases reported under mandatory reporting requirements and publishes annual data from this surveillance every year. According to the latest published data, there was a slight increase in incidence in 2023 at the national level compared to 2022. This is the first year in which a reversal of the trend has been observed since the onset of the COVID-19 pandemic.

On World Tuberculosis Day, Santé publique France aims to raise awareness about the important role of healthcare professionals in identifying and reporting cases to collect epidemiological data useful to all stakeholders. The agency also reminds the public that BCG vaccination of children most at risk of tuberculosis is effective in protecting against the most severe forms of the disease.

Rise in tuberculosis incidence in France in 2023: return to pre-pandemic levels after three years of decline

In 2023, France observed a 16.7% increase in the incidence of tuberculosis compared to the previous year, with a reporting rate of 7.1 cases per 100,000 inhabitants, for a total of 4,866 reported cases.

This is the first increase since the COVID-19 pandemic, which had led to a decrease in tuberculosis cases in 2020 (-10.4%), 2021 (-7.0%), and 2022 (-2.6%). The trend in 2023 likely reflects, following a steady decline over three years, a return to pre-pandemic levels. However, it is necessary to remain vigilant to confirm that this is indeed a one-time increase linked to exceptional circumstances and not an increase linked to intensified transmission of the tuberculosis bacillus within the population.

No increase in disease severity

In 2023, there was a slight but not significant increase in severe forms of tuberculosis (meningeal and miliary) and cases of multidrug-resistant tuberculosis, with no indication of an increase in disease severity. In 2023, 5.9% of cases were severe forms, comparable to 2022 (5.7%) and 2019 (5.4%).

The number of tuberculosis-related deaths also increased slightly, from 22 in 2022 to 30 in 2023, but this remains at relatively low levels (0.6% of cases) and below pre-pandemic levels. Surveillance must nevertheless continue to confirm that the COVID-19 pandemic has not had a negative impact on the severity of the disease.
Furthermore, 15 years after the suspension of mandatory BCG vaccination and amid declining vaccination coverage, there has been no increase in the incidence of tuberculosis among children. In 2023, there were 13 severe forms of tuberculosis (meningeal and/or miliary) among children under 15 years of age, including 3 in Île-de-France. This number has remained stable at around 10 cases per year for the past five years and corresponds to the projections made when the mandatory BCG vaccination was suspended.

Population and Regional Disparities

The most affected regions are French Guiana (24.0/100,000), Île-de-France (14.2/100,000), and Mayotte (12.8/100,000), with reported rates well above the national average. The most affected populations remain the same as those identified in previous years: homeless people, prisoners, and people born outside France, particularly those from sub-Saharan Africa and those who have been in France for less than two years. Tuberculosis screening and surveillance must continue as a priority among these populations, which remain the most affected by the disease in our country.

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What are the tuberculosis vaccination recommendations?

Tuberculosis vaccination is primarily intended for infants who are particularly exposed to the tuberculosis bacillus. Its main purpose is to protect young children from severe forms of tuberculosis (particularly meningitis, an infection of the brain’s membranes). It has not been mandatory since 2007.

Tuberculosis vaccination is recommended starting at 1 month of age, ideally during the second month, and up to age 15 for any child at high risk of tuberculosis.

• Learn more about tuberculosis vaccination | vaccination-info-service.fr

The importance of reporting and declaring cases via e-DO

Tuberculosis disease (TB) has been a notifiable disease (DO) since 1964. This refers to the reporting of tuberculosis at the time of diagnosis. These data are used to track the number of cases and their characteristics, in order to adapt treatment, screening, and prevention efforts, as well as to evaluate efforts to combat tuberculosis. Surveillance of active tuberculosis was expanded in 2003 to include latent tuberculosis infections (LTIs) in children under 15 years of age, and then extended to those under 18 in 2021. In 2007, it incorporated the monitoring of treatment outcomes (TOs) for patients with active tuberculosis.

Since 2022, these reports (active TB, LTBI, and TRE) have been submitted via the e-DO application. This system simplifies the reporting process and helps improve data completeness and quality compared to paper-based reporting. Numerous tools to help users get started with online reporting (tutorials, videos, brochures, FAQs) are available on the “e-DO” page on the Santé publique France website.

• See: e-DO - Mandatory online reporting of HIV infection, AIDS, and tuberculosis