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Tuberculosis (TB) is still the world's deadliest infectious disease. In Taiwan, where the population is aging quickly, most TB patients are now older than 65. A new study from Kaohsiung, southern Taiwan, published in The Lancet Microbe, suggests that older adults may play a larger role in spreading TB than previously recognized. Understanding their role could help public health teams find new ways to prevent infections.

A team led by researchers at National Taiwan University and Kaohsiung Medical University studied TB bacteria from 4,168 patients diagnosed between 2019 and 2023.

The researchers read the complete DNA of the bacteria and looked for similarities between samples. Nearly identical bacteria suggest that TB was passed on recently from one person to another. The team then combined these findings with patient information and location data to work out how TB was spreading across the city.

About one in four patients was linked to others in this way. People ages 65 and older accounted for about four in 10 linked cases, and people ages 55 to 74 appeared to be the source of about half of all the cases of spread the team could trace. TB also tended to spread between people of similar ages.

The study also found that different types of TB bacteria spread in different ways. One group, known as the Beijing strain, spread easily throughout the city.

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