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

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.