OBJECTIVE: To describe the tuberculosis (TB) epidemiology in Greenland in 1998-2002 and to identify possible obstacles for reducing the TB incidence. STUDY DESIGN/METHODS: TB notification data were collected from the annual reports of the Chief Medical Officer, and culture verification data were collected from the International Reference Laboratory of Mycobacteriology at Statens Serum Institut, Denmark. RESULTS: The TB incidence in Greenland reached a peak of 185/100,000 in 2001. In 1999-2001, the majority of cases were related to an outbreak in the Southern districts. In 1998-2002, 0.5% drug-resistance was found among patients living in Greenland in contrast to 13.1% drug-resistance found previously among Inuit patients in Denmark. In 1998-2001, microscopy positive cases made up 65% of all culture confirmed cases and DNA subtyping demonstrated the emergence of Mycobacterium tuberculosis strains that were previously infrequently found. CONCLUSION: It is important to eliminate factors that fuel the epidemic and to improve general living conditions in Greenland. Treatment seems effective as limited drug-resistance is detected. TB reduction will therefore depend on early detection of active disease and thorough contact tracing. Greenland will face a pool of persons latently infected some of whom will progress to active disease. Sufficient resources need to be allocated for TB control in the years to come.