# Zoonotic Tuberculosis as a One Health Challenge: Global Evidence, Transmission Dynamics, and Policy Gaps in Indonesia

## TL;DR

Zoonotic tuberculosis from animals to humans is underdiagnosed in Indonesia, requiring better surveillance and food safety to control its spread.

## Contribution

The paper highlights Indonesia as a high-risk area for zoonotic TB due to weak diagnostics and food safety practices, emphasizing the need for integrated One Health strategies.

## Key findings

- Zoonotic TB in Indonesia is underdiagnosed due to limited diagnostics and informal food practices.
- Bovine TB and co-infections in livestock increase human exposure risks through dairy and beef value chains.
- Strengthened One Health systems are critical for controlling zoonotic TB transmission.

## Abstract

What are the main findings?
Zoonotic tuberculosis (Mycobacterium bovis) is underdiagnosed and underreported in LMICs.zTB likely exceeds the estimated 1–1.5% of global human TB cases due to limited diagnostics.Rising bovine TB, raw milk consumption, and informal slaughtering increase human exposure in Indonesia.Livestock co-infections complicate zTB detection and may enhance bacterial shedding.Strengthened One Health surveillance, diagnostics, and food-safety systems are critical for zTB control.

Zoonotic tuberculosis (Mycobacterium bovis) is underdiagnosed and underreported in LMICs.

zTB likely exceeds the estimated 1–1.5% of global human TB cases due to limited diagnostics.

Rising bovine TB, raw milk consumption, and informal slaughtering increase human exposure in Indonesia.

Livestock co-infections complicate zTB detection and may enhance bacterial shedding.

Strengthened One Health surveillance, diagnostics, and food-safety systems are critical for zTB control.

What are the implications of the main findings?
The findings highlight zoonotic tuberculosis as a substantially underrecognized contributor to the tuberculosis burden in low- and middle-income countries, with Indonesia representing a high-risk setting due to increasing bovine TB prevalence, raw milk consumption, informal slaughtering practices, and weak food-safety oversight. Underdiagnosis driven by limited molecular diagnostic capacity and fragmented human–animal surveillance systems likely obscures the true extent of Mycobacterium bovis transmission to humans. Co-infections in livestock further compromise disease detection and may enhance pathogen shedding, increasing exposure risk along dairy and beef value chains. These challenges underscore the urgent need for strengthened One Health approaches that integrate public health, veterinary, and food-safety systems, supported by improved laboratory capacity, coordinated surveillance, and targeted risk mitigation measures to reduce zoonotic TB transmission and support national TB control goals.

The findings highlight zoonotic tuberculosis as a substantially underrecognized contributor to the tuberculosis burden in low- and middle-income countries, with Indonesia representing a high-risk setting due to increasing bovine TB prevalence, raw milk consumption, informal slaughtering practices, and weak food-safety oversight. Underdiagnosis driven by limited molecular diagnostic capacity and fragmented human–animal surveillance systems likely obscures the true extent of Mycobacterium bovis transmission to humans. Co-infections in livestock further compromise disease detection and may enhance pathogen shedding, increasing exposure risk along dairy and beef value chains. These challenges underscore the urgent need for strengthened One Health approaches that integrate public health, veterinary, and food-safety systems, supported by improved laboratory capacity, coordinated surveillance, and targeted risk mitigation measures to reduce zoonotic TB transmission and support national TB control goals.

Zoonotic tuberculosis (zTB), mainly caused by Mycobacterium bovis, is an underdiagnosed yet important disease transmitted from animals to humans through the consumption of raw milk, contaminated animal products, and close contact with infected livestock. Global estimates suggest that zTB accounts for approximately 1–1.5% of human tuberculosis cases; however, the true burden is likely underestimated due to limited diagnostic capacity, particularly in low- and middle-income countries. In Indonesia, increasing bovine tuberculosis cases in regions such as West Java, East Java, and Bali, combined with weak food-safety practices and limited access to molecular diagnostics, heighten the risk of undetected zoonotic transmission. Co-infections in livestock further complicate diagnosis and control efforts. This review summarises the global and Indonesian epidemiology of zTB, outlines transmission pathways at the human–animal interface, examines associations between zTB and other livestock infections, and identifies key gaps in surveillance and diagnostic capacity. Finally, it underscores the need for strengthened One Health approaches in Indonesia, including enhanced laboratory infrastructure, improved coordination between public and animal health sectors, and stronger food-safety regulation to mitigate zTB risk.

Zoonotic tuberculosis (zTB), predominantly caused by Mycobacterium bovis, remains an underrecognized public health threat in many low- and middle-income countries. Although global estimates suggest that zTB accounts for approximately 1–1.5% of all human tuberculosis cases, limited molecular diagnostic capacity and underreporting likely obscure its true burden. In Southeast Asia, particularly Indonesia, increasing detection of bovine tuberculosis in dairy and beef production systems—combined with high rates of raw milk consumption, informal slaughtering practices, and weak intersectoral surveillance—may amplify the risk of human exposure. Co-infections in livestock, including mastitis and respiratory pathogens, further complicate clinical detection and may enhance bacterial shedding. This review synthesises global and national epidemiological patterns of zTB, describes major transmission pathways at the human–animal interface, and examines interactions between M. bovis infection and other livestock diseases. Critical gaps in diagnostics, surveillance integration, and food-safety regulation are identified. Strengthening One Health approaches through improved laboratory capacity, coordinated public–animal health systems, and enhanced risk mitigation along dairy and beef value chains is essential to reduce the burden of zTB in Indonesia.