Please note that the following numbers should be interpreted in the context of COVID-19
1. Key messages
- Belgium is a low-incidence country for tuberculosis, with 7.2 new tuberculosis cases per 100,000 inhabitants in 2020.
- There were important regional differences, with the Brussels Capital Region having the highest incidence.
- The incidence of tuberculosis was higher in men, whatever the age, region or nationality.
- More cases were reported in big cities with the city of Brussels reporting the highest incidence.
- In Belgium, 56.9% of the tuberculosis cases occurred among people who did not have a Belgian nationality.
2. Tuberculosis incidence
Belgium is a low incidence country for tuberculosis with 7.2 cases per 100,000 inhabitants in 2020
In 2020, 830 new cases of tuberculosis were reported in Belgium (7.2 cases/100,000 inhabitants). Men were almost 2 times more often affected by the disease than women, with 65.8% of new cases occurring among men in 2020 in Belgium. Of all cases, 39.6% of the tuberculosis patients diagnosed in 2020 were aged 25-44 years.
Among the regions of Belgium, the Brussels Capital Region has the highest incidence of tuberculosis
Of the total number of new registered cases, 43.4% of tuberculosis cases were registered in the Flemish Region (n=360), 32.2% in the Brussels Capital Region (n=267) and 24.5% in the Walloon Region (n=203). Considering the number of inhabitants in each region, the incidence rate was 3.9 times higher in the Brussels Capital Region (21.9 cases/100,000) as compared to the Walloon Region (5.6 cases/100,000) and 4.1 higher as compared to the Flemish Region (5.4 cases/100,000). The incidence rates in the Flemish Region and the Walloon Region were similar.
Tuberculosis occurs more often among people with a foreign nationality
In 2020, 56.9% of the new tuberculosis cases occurred among people with a foreign nationality in Belgium. This proportion was higher in the Brussels Capital Region (62.2%) compared to the Walloon Region and the Flemish Region (respectively 52.2% and 55.6%). Among Belgians, the incidence rate was 4.7 times higher in the Brussels Capital Region (12.8/100,000) compared to the Flemish Region (2.7/100,000), and 4.3 times higher compared to the Walloon Region (3.0/100,000). Among non-Belgians, the incidence rate was 1.4 times higher in the Brussels Capital Region (38.6/100,000) compared to the Flemish Region (28.0/100,000), and 1.2 times higher compared to the Walloon Region (32.3/100,000).
- Crude rate
- Number of cases
The distribution of the incidence by age and sex was different according to nationality in 2020. Among Belgians, the incidence increased with age in men and is higher in men across all age categories. The overall male-female ratio tends to increase with age: the incidence rate was 3.2 times higher in men among people over 75 years. Among non-Belgians, the incidence was highest in age group 15-29 years and lower in older age groups. The incidence rate was 1.5-2.3 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).
Cases of tuberculosis are more often reported in the bigger cities in Belgium
In 2020, tuberculosis occurred more frequently in big cities where more people at risk are living:
- The incidence in the city of Brussels was the highest (21.9 new cases/100,000); it was 3.0 times higher compared to the overall incidence in Belgium (7.2 new cases/100,000).
- The incidence was also high in Antwerp (17.0 new cases/100,000), followed by Liège (16.2 new cases/100,000), Charleroi and Ghent (respectively 12.3 and 11.4 new cases/100,000).
- On the contrary, the tuberculosis incidence was lower in the cities of Bruges and Namur where the rates were similar or lower compared to the national average (respectively 7.2 and 4.2 new cases/100,000).
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]
In 2020, the incidence of tuberculosis dropped further to the lowest rate ever recorded in Belgium
The number of new cases of tuberculosis is decreasing for more than 30 years, although the diminution is slowing down since the nineties and tends to stagnate over 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 2020, the incidence rate (7.2 cases/100,000; n=830) was lower compared to the incidence rate of 2019 (8.5 cases/100,000; n=968).
Since 1981, the incidence rate is decreasing in all three regions, with more variations in Brussels due to migration flows:
- In the Walloon Region, the incidence rate has decreased below the national average since 1987, except in 1991 and 1999. In 2020, the lowest rate ever in terms of incidence (5.6 cases/100,000) was recorded.
- In the Flemish Region, the incidence rate dropped from 6.1 cases/100,000 in 2019 to 5.4 cases/100,000 in 2020, which is the lowest incidence ever recorded.
- In the Brussels Capital Region, the incidence rate decreased from 28.1 cases/100,000 in 2019 to 21.9 cases/100,000 in 2020, which is the lowest incidence ever recorded.
Source: Belgian tuberculosis registry, FARES/VRGT [2,3]
Although being a low incidence country, Belgium is ranked third in terms of tuberculosis incidence among EU countries
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  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.
Source: WHO/ECDC 
3. Read more
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 2019. 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 .
Tuberculosis can nowadays be effectively treated with a success rate of 81.2% in 2019 in Belgium. In Belgium, treatment is free of charge for the entire population (even for people without health insurance). However, 9.4% of tuberculosis patients still die before the end of treatment (half of these deaths are due to comorbidity) .
The main risk factors for tuberculosis are contacts with 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 2020 report written by the Fonds des Affections Respiratoires (FARES)  and the Vlaamse Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding (VRGT) .
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.
- The EU-14 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, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since they have left the EU.
- Tuberculosis case
- According to the WHO-recommended definitions , a tuberculosis case is defined as 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” .
- Global tuberculosis report 2021. Geneva: World Health Organization; 2021 https://www.who.int/publications/i/item/9789240037021
- Registre belge de la tuberculose 2020, FARES asbl, March 2022. https://www.fares.be/tuberculose/publications/rapports-epidemiologiques/fares-registretbc2020_vd-1.pdf
- Tuberculoseregister België 2020, Vlaamse Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding VRGT vzw. https://tuberculose.vrgt.be/facts-figures-tuberculose
- WHO Regional Office for Europe/European Centre for Disease Prevention and Control. Tuberculosis surveillance and monitoring in Europe 2022 – 2020 data. Copenhagen: WHO Regional Office for Europe; 2022. https://www.ecdc.europa.eu/en/tuberculosis/surveillance-and-disease-data/annual-tb-surveillance
- Definitions and reporting framework for tuberculosis – 2013 revision, updated December 2014. Geneva: World Health Organization; 2015. https://www.who.int/tb/publications/definitions/en/