Consolidated Guidelines

With a burden of disease that accounts for more than 10 million new cases per year, of which less than two thirds are reported, tuberculosis (TB) continues to be a major global health threat (1).

These guidelines were developed in accordance with the process described in the WHO handbook for guideline development. ²² Confidence in the certainty of the evidence underpinning the recommendations was ascertained using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Guideline Development Group, an international group of experts, was convened to advise WHO in this process, to provide input into the scope of these guidelines and to assist the WHO Steering Group in developing the key questions.

Worldwide, tuberculosis (TB) continues to be the most important cause of death from a single infectious microorganism.¹⁴ Although recent decades have witnessed increased efforts in the fight to end TB, fundamental gaps are hampering these efforts, particularly in resource-constrained settings and in settings with a high burden of disease.

These guidelines have been developed to provide updated, evidence-informed recommendations on tuberculosis (TB) infection prevention and control (IPC) in the context of the global targets of the Sustainable Development Goals (SDGs) and the World Health Organization (WHO) End TB Strategy.

General

Antimicrobial resistance (AMR) The loss of effectiveness of any anti-infective medicine, including antiviral, antifungal, antibacterial and antiparasitic medicines.

Grading of Recommendations Assessment, Development and Evaluation (GRADE) An approach to grading in health care that aims to overcome the shortcomings of current grading systems. For further information, see the GRADE website.¹

The key changes in the current second edition of these guidelines are highlighted in Box 1, after the Executive summary.

Table A1.1. Recommendations in the 2020 guidelines and recommendations in the current update (2024)

TPTs for an infection with M. tuberculosis strains presumed to be drug-susceptible can be broadly categorized into two types: monotherapy with isoniazid for at least 6 months (IPT) and treatment with regimens containing a rifamycin (rifampicin or rifapentine). IPT has been the most widely used form of TPT, but the shorter duration of rifamycin regimens presents a clear advantage, making these regimens increasingly preferred. TPT for MDR/RR-TB requires a different approach, primarily with levofloxacin.

Testing for TBI increases the certainty that individuals targeted for TPT will benefit better from it. There is, however, no gold standard test for diagnosing TBI. All the currently available tests – TST, IGRA and TBST – are indirect and require a competent immune response for a valid result. A positive test result by any one method is not by itself a reliable indicator of the risk of progression to TB disease. The evidence and the recommendations for TBI testing are discussed in this section.

1. Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med. 2015;372(22):2127–35. doi:10.1056/NEJMra1405427.
2. Dodd PJ, Gardiner E, Coghlan R, Seddon JA. Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study. Lancet Glob Health. 2014;2(8):e453–9. doi:10.1016/S2214-109X(14)70245-1.
3. Houben RMGJ, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS Med. 2016;13(10):e1002152.