Tuberculosis

1. Key messages

  • Belgium is a low-incidence country for tuberculosis, with 8.5 new tuberculosis cases per 100,000 inhabitants in 2019 (n=968), a similar rate compared to 2018 (n=981).
  • There are important geographical differences: in 2019, the incidence rate was 4.8 times higher in the Brussels-Capital Region when compared with Wallonia and Flanders, where the incidence rates were similar.
  • The incidence of tuberculosis was higher in men, whatever the age, region or nationality.
  • Big cities reported more cases, potentially related to a higher concentration of risk groups. Brussels was the city with the highest incidence.
  • In Belgium, in 2019, 38.9% of the tuberculosis cases occurred among people who did not have a Belgian nationality. This proportion was higher in Brussels (65.9%) ompared to Wallonia (52.2%) and Flanders (49.5%).

2. Background

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

According to the World Health Organization (WHO), there were 10 million new cases of tuberculosis in 2018. This disease is one of the top 10 causes of death worldwide. 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 81.2% in 2018 in Belgium, higher than in 2017 (77.7%). In Belgium, treatment is free of charge for the entire population (even for people without health insurance). However, 8.2% of tuberculosis patients still die before the end of treatment (half of these deaths are due to comorbidity) [2].

The main risk factors for tuberculosis are contacts of 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 2019 report written by the Fonds des Affections Respiratoires (FARES) [2] and the Vlaamse Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding (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-Belgian is slightly overestimated, as cases in unregistered migrants are counted in the numerator, while the denominator could only include the registered migrants.

3. Tuberculosis incidence

Situation in 2019

Belgium

In 2019, 968 new cases of tuberculosis were reported in Belgium (8.5 cases/100,000 inhabitants). Men were 2 times more often affected by the disease than women, with 66.7% of new cases occurring among men in 2019 in Belgium. 40.3% of the tuberculosis patients diagnosed in 2019 were aged 25-44 years.

Regional differences

41.7% of tuberculosis cases were registered in Flanders (n=404), 35.1% in Brussels (n=340) and 23.1% in Wallonia (n=224). When related to the number of inhabitants, the incidence rate was 4.6 times higher in Brussels (28.1 cases/100,000) as compared to Wallonia (6.2 cases/100,000) and 4.5 higher as compared to Flanders (6.1 cases/100,000). Incidence rates in Flanders and Wallonia were similar.

Tuberculosis distribution by nationality

In 2019, in Belgium, 38.9% of new tuberculosis cases occurred among people with a foreign nationality: 85.8% of those come from countries with high prevalence of the disease (mostly from Eastern Europe, Africa and South Asia countries). This proportion was higher in Brussels (65.9% of the new tuberculosis cases among people with foreign origin) than in Wallonia and Flanders (respectively 52.2% and 49.5%).

Among Belgians, the incidence rate was 4.5 times higher in Brussels (16.8/100,000) compared to Flanders (3.7/100,000), and 4.7 times higher than in Wallonia (3.6/100,000).

Among non-Belgians, the incidence rate was 1.6 times higher in Brussels (53.1/100,000) compared to Flanders (33.6/100,000), and 1.7 times higher compared to Wallonia (31.3/100,000).

  • Crude rate
  • Number of cases

Tuberculosis incidence per 100,000 by nationality and by region, Belgium, 2019
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]

New cases of tuberculosis by nationality and by region, Belgium, 2019
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]

The distribution of the incidence by age and sex is different according to nationality:

  • In 2019 among Belgians, the incidence increased with age in men and is higher in men across all age categories. The overall male-female ratio was 2, and tends to increase with age: the incidence rate was 3.2 times higher in men among people over 75 years.
  • In 2019, among non-Belgians, the incidence was highest in age group 15-29 years and lower in upper age groups. The incidence rate was 2.0-2.4 times higher in men compared to women across almost all age groups (15-29 years, 30-44 years, 45-59 years and over 75 years).
  • Belgians
  • Non-Belgians

Tuberculosis incidence per 100,000 by age and sex, Belgian people, 2019
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]

Tuberculosis incidence per 100,000 by age and sex, non-Belgian people, 2019
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]

Incidence in big cities

In 2019, tuberculosis occurred more frequently in big cities where people at risk are over-represented:

  • The incidence in Brussels was the highest (28.1/100,000); it was almost 3.3 times higher than in Belgium as a whole (8.5 /100,000).
  • The incidence was also quite high in Liege (20.8 new cases/100,000), followed by Antwerp (20.7 new cases/100,000), Charleroi and Namur (more than 8.5 new cases/100,000).
  • On the contrary, the tuberculosis incidence was lower in the cities of Bruges and Ghent where the rates were similar to the national average (respectively 8.5 and 8.4 new cases/100,000).
Tuberculosis incidence per 100,000 in cities >100,000 inhabitants, Belgium, 2019
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]

Trends

Belgium

The number of new cases of tuberculosis is decreasing since more than 30 years, although the diminution is slowing down since the nineties and tends to stagnate 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 2019, the incidence rate (8.5 cases/100,000; n= 968) was similar to the incidence rate of 2018 (8.6 cases/100,000; n=981).

Regional specificities

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

  • In Wallonia, the incidence rate has decreased below the national average since 1987, except in 1991 and 1999. The lowest rate that was ever observed (6.2/100,000) in 2018 has stabilized in 2019.
  • In Flanders, the incidence rate of 6.1/100,000 remained stable in 2019 compared to 2018.
  • In Brussels, the incidence rate decreased from 29.5/100,000 in 2018 to 28.1/100,000 in 2019.
Tuberculosis incidence per 100,000, Belgium and regions, 1981-2019
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]

International comparison

In 2018, according to WHO [4], the estimated incidence rate in Belgium was above the EU-15 mean, ranking the country 4th in the EU-15 after Portugal, Spain, 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 underreporting, over and under-diagnosis in tuberculosis estimates. This explains why the incidence rate in Belgium presented in this international comparison is different compared to the incidence rate extracted from the Belgian tuberculosis registry publication.

Tuberculosis incidence per 100,000, EU-15 countries, 2019
Source: WHO/ECDC [4]

4. Read more

View the metadata for this indicator

Vlaamse Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding (VRGT)

Definitions

EU-15
The EU-15 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, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
Tuberculosis case
According to the WHO-recommended definitions [5], a tuberculosis case is defined by 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 2019. Geneva: World Health Organization; 2019 https://www.who.int/tb/publications/global_report/en/
  2. Registre belge de la tuberculose 2019, FARES asbl, march 2021. https://www.fares.be/tuberculose/journee-mondiale-de-la-tuberculose/fares-registretbc2019_vd_version-web.pdf
  3. Tuberculoseregister België 2019, Vlaamse Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding VRGT vzw. https://tuberculose.vrgt.be/facts-figures-tuberculose
  4. WHO Regional Office for Europe/European Centre for Disease Prevention and Control. Tuberculosis surveillance and monitoring in Europe 2021 – 2019 data. Copenhagen: WHO Regional Office for Europe; 2021. https://www.ecdc.europa.eu/en/tuberculosis/surveillance-and-disease-data/annual-tb-surveillance
  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/