Cited by 547Tuberculosis Research and EpidemiologyInfectious Diseases and TuberculosisHIV, TB, and STIs Epidemiology

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The global prevalence of latent tuberculosis: a systematic review and meta-analysis

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Cohen, Adam, Mathiasen, Victor Dahl, Schön, Thomas, Wejse, Christian·2019·European Respiratory Journal

DOI 10.1183/13993003.00655-2019

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Abstract

In 1999, the World Health Organization (WHO) estimated that one-third of the world's population had latent tuberculosis infection (LTBI), which was recently updated to one-fourth. However, this is still based on controversial assumptions in combination with tuberculin skin test (TST) surveys. Interferon-γ release assays (IGRAs) with a higher specificity than TST have since been widely implemented, but never used to estimate the global LTBI prevalence. We conducted a systematic review and meta-analysis of LTBI estimates based on both IGRA and TST results published between 2005 and 2018. Regional and global estimates of LTBI prevalence were calculated. Stratification was performed for low, intermediate and high TB incidence countries and a pooled estimate for each area was calculated using a random effects model. Among 3280 studies screened, we included 88 studies from 36 countries with 41 IGRA (n=67 167) and 67 TST estimates (n=284 644). The global prevalence of LTBI was 24.8% (95% CI 19.7–30.0%) and 21.2% (95% CI 17.9–24.4%), based on IGRA and a 10-mm TST cut-off, respectively. The prevalence estimates correlated well to WHO incidence rates (Rs=0.70, p<0.001). In the first study of the global prevalence of LTBI derived from both IGRA and TST surveys, we found that one-fourth of the world's population is infected. This is of relevance, as both tests, although imperfect, are used to identify individuals eligible for preventive therapy. Enhanced efforts are needed targeting the large pool of latently infected individuals, as this constitutes an enormous source of potential active tuberculosis.

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Additional file 2 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
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Additional file 4 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
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Additional file 7 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
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Additional file 1 of The burden and predictors of latent tuberculosis infection among immigrants in South Korea: a retrospective cross-sectional study
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Additional file 6 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
Wilson, L., Gracie, L., Kidy, F., Thomas, G. N., Nirantharakumar, K., Greenfield, S., Manaseki-Holland, S., Ward, D. J., & Gooden, T. E. (2024) · Figshare · doi:10.6084/m9.figshare.26571367
Additional file 5 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
Wilson, L., Gracie, L., Kidy, F., Thomas, G. N., Nirantharakumar, K., Greenfield, S., Manaseki-Holland, S., Ward, D. J., & Gooden, T. E. (2024) · Figshare · doi:10.6084/m9.figshare.26571364
Additional file 3 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
Wilson, L., Gracie, L., Kidy, F., Thomas, G. N., Nirantharakumar, K., Greenfield, S., Manaseki-Holland, S., Ward, D. J., & Gooden, T. E. (2024) · Figshare · doi:10.6084/m9.figshare.26571358
Additional file 1 of Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model
Kunin, M., Timlin, M., Lemoh, C., Sheffield, D. A., Russo, A., Hazara, S., & McBride, J. (2022) · Figshare · doi:10.6084/m9.figshare.18318163
Additional file 1 of Safety and efficacy of tuberculosis vaccine candidates in low- and middle-income countries: a systematic review of randomised controlled clinical trials
Wilson, L., Gracie, L., Kidy, F., Thomas, G. N., Nirantharakumar, K., Greenfield, S., Manaseki-Holland, S., Ward, D. J., & Gooden, T. E. (2024) · Figshare · doi:10.6084/m9.figshare.26571352
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Wang, X.-D., Niu, D., Lv, W., Wang, L., Zhang, C. Y., Zhang, C., Song, J., Hu, X., & Wang, C. (2026) · Journal of Global Antimicrobial Resistance · doi:10.1016/j.jgar.2025.12.015
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Caminero, J. A., Anibarro, L., Tabernero, E. M., Alcaide, F., Pérez-Mendoza, G., Millet, J.-P., Guna, R., de Souza-Galvão, M. L., López-Roa, P., Sánchez‐Montalvá, A., et al. (2026) · Enfermedades Infecciosas y Microbiología Clínica · doi:10.1016/j.eimc.2025.503037
DIAGNOSTIC EVALUATION OF EXTRAPULMONARY TUBERCULOSIS: A COMPARATIVE STUDY OF FNAC, ZN STAINING, AND CB-NAAT TECHNIQUES
KUMARI, P., MISHRA, P. P., & C., V. (2026) · International Journal of Current Pharmaceutical Research · doi:10.22159/ijcpr.2026v18i1.8055
Diagnostic utility of quantitative interferon-gamma release assays in elderly patients with tuberculosis
Mutoh, Y., Minato, Y., Kawamoto, Y., Hanai, S., Umemura, T., Suzuki, H., Nishina, Y., Hiramitsu, K., Ichihara, S., Hagimoto, S., et al. (2026) · Microbiology Spectrum · doi:10.1128/spectrum.02763-25

Authors: Cohen, A., Mathiasen, V. D., Schön, T., & Wejse, C.
Affiliations: St Olav's University Hospital (NO)
Linköping University (SE)
Bandim Health Project (GW)
ORCID: Cohen, Adam
Mathiasen, Victor Dahl
Schön, Thomas
Wejse, Christian
Venue: European Respiratory Journal
Publisher: European Respiratory Society (ERS)
Published: 2019-06-20
Volume: 54
Issue: 3
Pages: 1900655
ISSN: 0903-1936 (ISSN-L)
1399-3003
DOI: 10.1183/13993003.00655-2019
OpenAlex: W2950875755
Cited by: 547
References: 123
Citations by year: 2026: 61 · 2025: 78 · 2024: 94 · 2023: 89 · 2022: 101 · 2021: 73 · 2020: 47 · 2019: 4
FWCI: 7.86
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.ersjournals.com/user-licence (vor)
Locations: European Respiratory Journal (publishedVersion)
PubMed (publishedVersion)
Funders: Novo Nordisk (NNF15OC0018034)
Hjärt-Lungfonden (20150236)
Forskningsrådet om Hälsa, Arbetsliv och Välfärd (201602043)
Topics: Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › HIV, TB, and STIs Epidemiology
Keywords: latent tuberculosis infection, global prevalence, interferon-gamma release assay, tuberculin skin test, tuberculosis prophylaxis
MeSH terms: Algorithms, Communicable Disease Control, Humans, Tuberculin Test, Global Health, World Health Organization, Incidence, Prevalence, Latent Tuberculosis, Interferon-gamma Release Tests

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The global prevalence of latent tuberculosis: a systematic review and meta-analysis

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