The prevalence and proportion of asymptomatic tuberculosis among adolescents and young adults: a systematic review and meta-analysis

Background Recent studies report ≥ 50% of people with tuberculosis (TB) have asymptomatic disease, which is likely to be infectious. Asymptomatic TB among adolescents and young adults (AYAs; defined as individuals aged 10 to 24 years) has been poorly studied. To estimate the prevalence of asymptomatic TB in the population of adolescents and young adults and the proportion of TB that remains asymptomatic in this group. Methods A systematic review and meta-analysis were conducted using PubMed, Web of Science, Scopus, and CINAHL from inception to October 2025. Studies reporting asymptomatic TB among AYAs were included. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Outcomes included (1) prevalence (asymptomatic TB cases among those screened) and (2) proportion (asymptomatic TB cases among diagnosed TB cases). Pooled estimates were calculated using mixed-effects meta-analysis. The review was registered in PROSPERO (CRD420250652821). Results Of 3,185 articles initially found, sixteen studies were included after full-text review. Included studies were conducted in Africa ( n = 8), Asia ( n = 7) and Europe ( n = 1). The pooled prevalence of asymptomatic TB from 11 included studies among AYAs was 1% (95% confidence interval [CI]: 1%-3%), driven by high prevalence among household contact studies. The pooled proportion of asymptomatic TB from 12 included studies among AYAs with TB was 62% (95% CI: 40% -80%). Conclusion We found high prevalence and proportion of asymptomatic TB among AYAs in many regions, underlining the importance of symptom-agnostic screening and preventative strategies in high-risk populations.