SETTING: Millions of pilgrims visit Makkah (Mecca), Saudi Arabia, from regions of endemic tuberculosis. Little consideration has been given to the potential impact of this disease on the local population. OBJECTIVES: To assess knowledge about TB among residents of Makkah and Jeddah (Makkah's principal travel gateway). METHODS: A cross-sectional survey of 1004 residents. Data were analyzed by gender. RESULTS: Spread of TB by coughing was a transmission route known by 44.2% of males and 59.6% of females (P < 0.001); 20.0% of participants knew that TB is caused by bacteria; 71.6% of females and 52.3% of males knew TB is infectious (P < 0.001). Regarding approaches to TB prevention, 48.0% of respondents answered patient isolation and 15.2% vaccination. Overall, 50.6% of males and 38.3% of females (P < 0.001) would seek modern medical treatment if hemoptysis occurred. With a persistent cough, 65.4% of respondents would do nothing or wait before consulting a healthcare provider. High numbers of "don't know" responses were recorded throughout the survey. CONCLUSIONS: Within the population across pilgrimage areas in Saudi Arabia, knowledge is lacking concerning TB transmission, the cause of the disease, means of prevention and the success of treatment, highlighting an urge need for better public education.