Tuberculosis in Portugal Hits Record Low, But Drug-Resistant Cases Surge and Migrant Communities Face Critical Risk

The Portugal Directorate-General of Health has confirmed record-low tuberculosis (TB) numbers for 2024, yet officials warn that progress has slowed dangerously and a rising tide of drug-resistant cases threatens to undermine decades of public health gains. The country recorded 1,536 cases last year—a historic minimum—but the rate of decline has stalled since 2020, raising doubts about meeting World Health Organization elimination targets by 2035.

Why This Matters:

• Treatment delays remain critical: The average gap between symptom onset and treatment start is 81 days, allowing transmission to continue.

• Migrant communities face 2.7 times the national infection rate, accounting for nearly 40% of all cases and approximately two-thirds of multidrug-resistant TB cases.

• Drug-resistant tuberculosis surged 63.6% in a single year, with 36 cases reported in 2024 compared to 22 in 2023.

• Lisbon and Porto have launched specialized reference centers for complex cases, part of a nationwide care system overhaul.

The Numbers Behind the Alarm

Portugal's notification rate dropped to 14.3 cases per 100,000 inhabitants in 2024, down 31.8% from 2015 levels. Mortality figures look even better: just 50 deaths from TB in 2024, a near-70% collapse compared to nine years earlier. Treatment success reached 82.1%, the highest on record domestically.

Yet these achievements mask worrying trends. The WHO's End TB Strategy calls for a 90% reduction in incidence by 2035, which would require Portugal to accelerate its current pace significantly. Instead, the rate of improvement has decelerated between 2020 and 2024, according to the national surveillance report released today to coincide with World TB Day.

Of the 1,536 cases, 1,418 were newly diagnosed infections and 118 were retreatments—patients who had relapsed or interrupted therapy previously. Men accounted for 64.4% of all notifications, a gender imbalance that health authorities attribute to occupational exposure, smoking rates, and delayed health-seeking behavior.

Geographic Concentration and Urban Vulnerability

Lisbon and the Tagus Valley recorded the highest incidence at 17.1 cases per 100,000 residents, closely followed by the North region with 16.4 cases per 100,000. Sofia Sousa, deputy director of the National Tuberculosis Programme, explained that these zones combine high population density with overcrowded housing, vulnerable populations, and comorbidities like HIV and diabetes—factors that have driven elevated case numbers for years.

Children and adolescents under 15 represented 2.4% of notifications, with 37 cases split between the zero-to-five age bracket (19 cases) and the six-to-14 bracket (18 cases). One particularly troubling case involved a four-year-old child of Angolan origin diagnosed with multidrug-resistant TB, underscoring the disease's capacity to strike across age groups.

Migrants Bear Disproportionate Burden

Foreign-born residents remain the single most vulnerable demographic, with a notification rate 2.7 times the national average. In 2024, migrants accounted for 39.1% of all TB cases, up from 35.7% the previous year. This increasing proportion reflects both demographic changes and the particular vulnerability of migrant populations to infection.

The majority of migrant TB patients hail from Portuguese-speaking countries—Angola, Brazil, and Guinea-Bissau lead the list—but cases have also been detected among arrivals from Ukraine, Romania, and Moldova. This diversity reflects both historical ties and recent migration flows linked to conflict and economic displacement.

Of the 36 multidrug-resistant cases in 2024, 24 occurred in migrants. This concentration underscores the urgent need for targeted screening and preventive care in migrant communities. Public health authorities are working to strengthen protocols and improve access to diagnosis and treatment for these populations.

What This Means for Residents

If you or someone in your household experiences persistent cough (lasting more than three weeks), unexplained weight loss, night sweats, or fever, seek medical evaluation promptly. TB is both curable and preventable, but the average 81-day delay between symptom onset and treatment start allows the bacterium to spread and, in some cases, develop drug resistance.

In 2024, the Portugal health system treated 4,315 cases of latent TB infection—the highest number ever—demonstrating that preventive therapy works when administered to high-risk groups such as household contacts of active cases, people living with HIV, and immunosuppressed individuals. If you have been in close contact with a diagnosed TB patient, ask your doctor about screening and preventive treatment.

The government has reorganized care delivery by integrating TB consultations into community respiratory clinics at local health units across the country. For complicated infections, especially multidrug-resistant strains, specialized reference centers in Lisbon and Porto now provide advanced diagnostics and treatment protocols. This two-tier model aims to accelerate diagnosis in primary care while reserving hospital-level resources for the most challenging cases.

The Multidrug-Resistant Threat

The 63.6% year-on-year surge in drug-resistant TB is the report's most alarming finding. These cases are concentrated in Lisbon and the Tagus Valley (63.9%), and most occur in men. Multidrug resistance develops when patients fail to complete treatment regimens, allowing resistant bacteria to proliferate, or when individuals contract an already-resistant strain from another patient.

Sousa emphasized that authorities are deploying targeted strategies to identify and monitor multidrug-resistant cases and interrupt transmission chains before they establish themselves in new communities. However, the increase suggests that both adherence to therapy and infection control measures need urgent reinforcement.

Persistent Delays in the Care Pathway

The 81-day interval from symptom onset to treatment initiation breaks down into two components: 41 days of patient delay (the time it takes individuals to seek help, down from 43 days in 2023) and 14 days of health system delay (the time from first contact with a provider to treatment start, up from 13 days in 2023).

Sousa described the 81-day total as "still very high" and called for enhanced health literacy campaigns and closer proximity between services and vulnerable populations. The slight increase in health system delay suggests diagnostic bottlenecks—possibly linked to laboratory capacity or referral coordination—that the new care model aims to resolve.

Stigma and the Path Forward

Public health officials stress that combating stigma remains as critical as medical intervention. Many residents still view TB as a disease of the past or associate it exclusively with poverty, delaying diagnosis and fueling social isolation for patients. The National Tuberculosis Programme encourages open conversation about the disease and amplifying the voices of those affected, framing TB as a treatable respiratory infection rather than a mark of shame.

The Portugal Directorate-General of Health has acknowledged that the country's trajectory falls short of international benchmarks and called for a "strategic reorientation" to meet WHO milestones. This includes expanding preventive treatment, accelerating diagnostic pathways, reinforcing infection control in congregate settings like shelters and prisons, and tailoring interventions to migrant populations through partnerships with community organizations.

For residents, the message is clear: persistent respiratory symptoms warrant immediate medical attention, latent infection screening is available for those at risk, and TB treatment is free under the national health system. The disease may have retreated to historic lows, but complacency could reverse decades of hard-won progress.