New report from the Robert Koch Institute for 2022: Tuberculosis case numbers have also risen again in Germany for the first time
On December 20, 2023, the Robert Koch Institute published its annual report on the epidemiology of tuberculosis (TB) in Germany. The figures apply to the year 2022.
A total of 4,076 newly diagnosed TB cases were registered across Germany. This corresponds to an incidence of 4.9 new cases per 100,000 inhabitants. This represents the first slight increase in TB case numbers since 2016, with a rise of 3.5%.
Demographically, men (with an incidence of 6.5/100,000 inhabitants, almost twice as often as women) and young adults in the 25 to 29 age group (incidence of 10.7/100,000) were again among the groups most frequently affected by TB in 2022. The number of cases of childhood TB has also risen in line with the total number of cases: In 2022, a total of 190 children contracted TB (incidence of 1.6/100,000), most commonly infants under the age of 5.
Around 71% of all patients had a foreign nationality in 2022. When analyzed by country of birth, more than three quarters were born abroad and Afghanistan, Ukraine and Romania were mentioned most frequently. As in the previous year, the majority of cases (84%) were reported after passive case detection, but the number of cases detected as part of statutory screening examinations (300 cases, share of 8.6%; 2021: 171 cases, 5.1%) increased proportionally in 2022. The same applies to environmental examinations (183 cases, 5.3%; 2021: 162 cases, 4.8%).
The incidence of multidrug-resistant (MDR) TB has also risen significantly in parallel with the total number of cases. Compared to the previous year (2021: 77 cases, 2.6%), the number of MDR-TB cases more than doubled in 2022 (166 cases, 5.7%), with the highest proportion among patients born in one of the post-Soviet states (29.8% vs. 1.7% among those born in Germany). Pre-extensively resistant (pre-XDR-TB) and XDR-TB occurred in 33 and 4 cases respectively.
The development of TB case numbers remains well below the targets declared by the WHO for low-incidence countries such as Germany. In order to reduce the annual TB incidence to below 1/100,000 inhabitants by 2035, the number of cases would have to decrease by at least 10% each year. This was last the case in 2019 and 2020. The treatment results for TB in 2021 also fall short of the WHO targets (figures due to the long treatment duration and delayed data transmission from the previous year). The data available so far on treatment outcomes from 2021 showed 2,581 (77%) cases in which treatment was successfully completed (cf. WHO treatment target of 90%). Older people in the >80 age group in particular, with a treatment success rate of only 51%, continue to represent a risk group with increased mortality from TB, but also from other causes. In 5% of cases, the patients had moved to an unknown address, meaning that no treatment outcome could be determined for them - an indication of a particular individual need for support.
In summary, the TB notification figures for 2022 have risen in all areas compared to the previous year and are of particular relevance to the public health system due to the increased proportion of MDR and pediatric TB. In Germany, as a resource-rich low-incidence country for TB, a temporary slight increase in case numbers is manageable. However, continued good networking and cooperation between all stakeholders in the healthcare system is required in order to continue to respond appropriately to the changing epidemiological situation and to achieve the internationally declared goals in the long term.
