Tuberculosis continues to decline in the U.S., but progress toward elimination is slowing

New CDC data underscore need for dual approach to tackle this deadly disease.

New data released today by the Centers for Disease Control and Prevention (CDC) show tuberculosis (TB) cases declining in the United States, but at a rate too slow to achieve TB elimination in this century. In 2017, 9,093 new cases of TB were reported in the U.S., a 1.8 percent drop from the prior year. However, the current TB rate (2.8 cases per 100,000 persons) remains at levels 28 times higher than the TB elimination target rate.

“I had hoped we would eliminate TB in my children’s lifetime, but the goal is elusive,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Nine thousand TB cases in this country is far too many. Each case represents a human and financial burden shouldered by those with TB, their families, and the nation’s health care system.”

TB continues to affect every corner of the country – with half of all new cases reported in four states, California, New York, Texas, and Florida. TB disease is preventable and curable, however, the disease continues to impact thousands of lives. Treatment for TB disease involves taking medication every day for six months or more, at times with serious or even, potentially life-threatening side effects. The cost of TB treatment starts at about $18,000 per case and rises to more than $500,000 for cases that are extensively drug resistant. Left untreated, TB severely damages the lungs, and can cause spinal pain, joint damage, meningitis, and liver or kidney problems. If not treated, it can be fatal.

Dual approach needed to accelerate progress

Eliminating TB will require a dual approach: strengthening existing TB programs and systems to diagnose and treat active TB disease, and intensifying efforts to identify and treat people who have latent TB infections.

Traditional TB control strategies prioritize the early diagnosis, isolation, and treatment of those with active, infectious TB disease. This protects the patient’s health, prevents transmission to others, and allows for timely contact investigations to detect and prevent additional TB cases. However, more than 80 percent of U.S. TB cases are now associated with reactivation of longstanding, untreated latent TB infections. People with latent TB infection have TB bacteria in their bodies, but they do not feel sick, do not have symptoms, and cannot spread the bacteria to others. Unfortunately, left untreated, latent TB infection can progress to infectious TB disease.

Testing and treatment is especially important for people at higher risk for progressing from latent TB infection to TB disease, including those with weak immune systems (people living with HIV infection). CDC also recommends testing and treatment for latent TB infection among people with a higher risk of exposure to TB disease, such as people who have lived in, long-term care facilities, homeless shelters or correctional facilities, and those who were born in, lived in or traveled for long periods in countries with high rates of TB. Latent TB infection affects up to 13 million people in the United States, the vast majority of whom do not know it.

“While we are seeing signs of success – the fewest cases and lowest rates ever recorded – we must continue to pursue prevention efforts with fervor,” said Philip LoBue, M.D., director of CDC’s Division of Tuberculosis Elimination. “Challenges remain and progress to elimination is slower than we would like. The good news is that the path to accelerated progress is clear: expanded implementation of testing and treatment of latent TB infection and a commitment to the research of newer, more efficient diagnostic tools.”

CDC is committed to making TB a disease of the past

Over the past 20 years, health departments and CDC TB control efforts have prevented an estimated 300,000 cases of TB disease, averting up to $14 billion dollars in costs. To sustain progress, CDC is leveraging new tools and technologies including:

• Electronic directly observed therapy, or eDOT, to make TB treatment less expensive and more convenient for patients and staff;
• A shorter, 12-week latent TB treatment regimen that enables TB patients to complete treatment faster and with fewer side effects;
• A diagnostic blood test that provides results in a single medical visit and accurate results even for people who were vaccinated for TB (the TB vaccine, routinely provided in many countries with high TB prevalence, can cause other types of diagnostic tests to return false-positive results); and
• Support of 2016 recommendations from the U.S. Preventive Services Task Force encouraging health care providers to test for latent TB infection among groups at increased risk.

For more information from CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, visit www.cdc.gov/nchhstp/newsroom.

###

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESExternal

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.