Tunisia: Tackling Tuberculosis via One Health Approach | 1500 Cases Annually

Tunisia is currently confronting a notable burden of tuberculosis (TB), with approximately 3,000 cases reported in both 2024 and 2025. While the World Health Organization (WHO) champions the ambitious goal of eliminating TB globally with the 2026 slogan “Yes, People can end TB,” the situation in Tunisia highlights the complexities of achieving this target. A significant proportion of these cases – 64% – present as extrapulmonary TB, affecting organs like the intestines, liver, and lymph nodes, compared to 36% of pulmonary cases. This distribution underscores the diverse ways the disease can manifest and the challenges in diagnosis.

Dr. Ahmed Rejeb, President of the National Order of Veterinarians in Tunisia, emphasizes the critical role of a “One Health” approach in tackling a specific form of the disease: tuberculous lymphadenitis. This concept recognizes the interconnectedness of human, animal, and environmental health, and is vital for controlling zoonotic diseases – those that can transmit from animals to humans. According to Dr. Rejeb, Tunisia sees around 1,500 cases of tuberculous lymphadenitis annually, with a striking 80% originating from animal sources.

The Role of Unpasteurized Milk

A key transmission route for tuberculous lymphadenitis is the consumption of unpasteurized milk and dairy products. The bacteria responsible for the disease can survive for over 300 days on contaminated surfaces, making proper hygiene and pasteurization crucial. Dr. Rejeb points out that much of this transmission occurs through informal channels, where milk is produced and sold without adequate treatment or boiling. Pasteurization, a process of heating milk to kill harmful bacteria, is a cornerstone of preventing this type of TB.

Beyond milk, transmission can too occur through respiratory droplets, though this is a less common route according to Dr. Rejeb. Tuberculous lymphadenitis specifically affects the lymph nodes, causing swelling and potential complications. It’s important to note that TB, in general, isn’t just a respiratory illness; it can affect nearly any organ in the body.

Zoonotic Disease Burden

The prevalence of zoonotic diseases in Tunisia is substantial. Dr. Rejeb highlights that over 60% of bacterial and parasitic diseases affecting humans in Tunisia originate from animals. Out of 1,450 identified diseases, 870 are classified as zoonoses. This underscores the importance of veterinary public health and the necessitate for collaborative efforts between medical and veterinary professionals to prevent and control these diseases.

Global TB Statistics and the Path Forward

The situation in Tunisia reflects a global challenge. The WHO estimates that 10.7 million people developed TB in 2024, and 1.23 million died from the disease. While these numbers are sobering, the WHO’s “Yes, we can end TB” campaign emphasizes that elimination is achievable with intensified efforts. This requires strengthening multisectoral cooperation, increasing investment in TB control programs, and implementing internationally recommended strategies.

The “One Health” approach advocated by Dr. Rejeb is central to these strategies. Protecting livestock, particularly cattle, from TB infection is a key preventative measure. This involves robust surveillance programs, vaccination where appropriate, and improved biosecurity practices on farms. Public health education campaigns are needed to raise awareness about the risks associated with consuming unpasteurized dairy products.

Understanding Extrapulmonary TB

The higher proportion of extrapulmonary TB cases in Tunisia compared to pulmonary TB warrants further investigation. Extrapulmonary TB occurs when the infection spreads beyond the lungs to other parts of the body. It can be more hard to diagnose than pulmonary TB, as symptoms can be varied and non-specific. The involvement of organs like the intestines, liver, and lymph nodes can lead to a range of clinical presentations, requiring specialized diagnostic tests.

What’s Next: Strengthening Surveillance and Collaboration

Moving forward, a strengthened national TB surveillance system is crucial for monitoring trends, identifying outbreaks, and evaluating the effectiveness of control measures. This system should integrate data from both human and animal health sources, reflecting the “One Health” approach. Increased collaboration between physicians, veterinarians, public health officials, and agricultural authorities is also essential. Regular reviews of national TB control strategies, informed by the latest scientific evidence and epidemiological data, will be necessary to adapt to evolving challenges. The WHO recommends a multi-pronged approach including early case detection, effective treatment, and preventative measures.

Further research is needed to understand the specific risk factors for tuberculous lymphadenitis in Tunisia and to develop targeted interventions. This includes investigating the prevalence of Mycobacterium bovis, the bacterium responsible for bovine TB, in cattle populations and assessing the effectiveness of different pasteurization methods. Continued investment in laboratory capacity and training of healthcare professionals are also vital for improving TB diagnosis and treatment.