full report in German

In 2023, 4,481 tuberculosis cases were registered in Germany. The total incidence was 5.3/100,000 population. Compared with the previous year (4,082 cases, total incidence 4.8), there was an increase of 10.4%. The number of cases in children also increased from 192 to 242 (+26%). The number of cases with rifampicin-resistant tuberculosis (RR/MDR-TB) also increased (from 189 to 208 cases).

3,425 (76.4%) patients had pulmonary tuberculosis, 592 also had extrapulmonary tuberculosis and 1,009 had exclusively extrapulmonary tuberculosis (including 17 cases of tuberculous meningitis, five of which were in children < 5 years of age). Of the pulmonary tuberculosis cases, 82% were laboratory confirmed and were therefore potentially infectious.

The prevalence of tuberculosis is higher among persons born abroad than among those born in Germany. The proportion of patients born abroad remained largely unchanged from the previous year at 76.8%. In 2023, the three most frequent countries of birth of tuberculosis cases in Germany (in descending order) were Afghanistan, Romania and Ukraine.

The majority of tuberculosis cases (80.4%) were diagnosed passively, i.e. by examination of symptoms or incidental findings. As a result of contact investigations in the environment of an infectious index case 5.7% of tuberculosis cases were diagnosed, and 11.4% were diagnosed through the legally required screening according to §36 IfSG.

Due to the long duration of treatment, complete data on the treatment outcome of the cases registered in 2023 are not yet available. The treatment success rate for rifampicin-sensitive, culture-confirmed pulmonary tuberculosis cases (from 2022) was 63%, and for rifampicin-resistant tuberculosis cases (from 2021) 51%.

Deaths due to tuberculosis were recorded in 127 cases, including two in children.

Conclusion: With a tuberculosis incidence rate of less than 10 per 100,000 inhabitants, Germany is considered a low-incidence country. The decrease in the number of cases observed after the peak in 2015 and 2016 had already slowed down in 2021. Similar to 2022, an increase was observed in 2023, including childhood tuberculosis.

The epidemiology of tuberculosis is influenced by international migration and mobility from crisis areas: currently in particular by the consequences of the war of aggression against Ukraine, but also by the global epidemiological development of tuberculosis.

Screening and contact investigations contribute to the early detection of cases. However, tuberculosis needs always to be considered in persons at risk for tuberculosis as part of primary health care, and has to be considered as differential diagnosis in general. Despite, or perhaps because of, being a rare disease, tuberculosis should always be considered in children.

Particular challenges include multidrug-resistant tuberculosis, further improvements in the recording and reporting of treatment outcomes, and the completeness of reported data.