Epidemiological Profile of Tuberculosis in Tunisia

INTRODUCTION: Tuberculosis (TB) is still a public health problem causing significant morbidity in several countries. In 2020, TB was the second global leading cause of death from an infectious disease, behind COVID-19. Despite the continuous efforts of the national tuberculosis control program, Tunisia remains a country with intermediate tuberculosis endemicity. The objective of this study was to describe the incidence of tuberculosis from 2018 to 2021 and its epidemiological profile in Tunisia. METHODS: This is a descriptive study of the national tuberculosis surveillance data within the framework of the national tuberculosis control programme. All new confirmed cases notified and registered for treatment were included. Data was entered through a registration and notification platform (WEB TBS), which is available in all governorates. Data collected included age, gender, governorate, clinical form. Data analysis was using SPSS-21. RESULTS: The incidence rate decreased from 28/100,000 inhabitants in 2018 to 22.46/100,000 inhabitants in 2021. In 2021, 2647 new cases were recorded. The majority were aged between 15 and 64 years old (80.4%). More than half were females (52.4%). There was an increasing trend of extra-pulmonary tuberculosis. It affected 64.6% of cases in 2021, mainly lymph node forms (68.5%). The incidence varied considerably by region; from 59.3/ 100,000 inhabitants in Ariana to 7.3/ 100,000 inhabitants in Monastir (2021). The number of reported cases of co-infection (TB-HIV) increased from 0.09 to 0.14/100,000 inhabitants. CONCLUSIONS: Despite the overall decline, there is still a long way to go to reach the target of ending TB by 2030. More adherence to control activities is needed in the most affected regions, including early case detection, patient monitoring and epidemiological investigations. There is also an urgent need to develop an effective strategy to control lymph node tuberculosis, which becomes an increasing burden on the national program. KEY MESSAGES: • From 2018 to 2021, there was a national decline in TB incidence, but some regions remain highly endemic. • With the increase of extra-pulmonary tuberculosis, appropriate preventive and control measures should be taken.