A mathematical modeling study estimated the global burden of viable Mycobacterium tuberculosis (Mtb) infection in 2022. There were 133.7 million people (95% CI: 104.0–171.1) recently infected (within 2 years), which is 1.7% (95% CI: 1.3–2.2) of the world population. Overall, 288.9 million people (95% CI: 242.2–342.7), i.e. 3.7% (95% CI: 3.1–4.3) of the population, have viable Mtb infection. Among the recently infected, 12.0% (95% CI: 11.4–12.7) are children younger than 15 years. Most recent infections are in Southeast Asia (49.0%), the Western Pacific (19.7%), and Africa (17.9%); India (39.1 million), Indonesia (12.0 million) and China (11.2 million) have the highest burden. The model accounts for reinfection, self-clearance, and age-specific mixing, but the estimates are affected by uncertainties in the self-clearance data. The authors emphasize the need for new diagnostics to detect individuals with viable Mtb, especially those at risk for progression to tuberculosis.