Executive Commentary

Reported Tuberculosis in the United States, 2024

National surveillance for TB disease has been conducted since 1953. In 1989, the United States first committed to the goal of eliminating TB, defined as <1 case per 1,000,000 population.12 That year, there were 23,495 TB disease cases reported, and the TB incidence rate was 9.5 per 100,000 population (Table 1). In 2024, 35 years later, the United States reported 10,388 TB cases with a corresponding incidence rate of 3.1. The 2024 data from the National Tuberculosis Surveillance System (NTSS) show that the United States has achieved a 56% decrease in cases and a 68% decrease in the incidence rate since 1989, resulting in one of the lowest incidence rates in the world.3

However, the overall TB case counts and rates have been increasing since 2021. For the fourth consecutive year, case counts and rates increased, including a 7.9% increase in case count and a 6.9% increase in rate in 2024 as compared with 2023. These increases in rates and case counts were smaller than the 15% increases in case counts and rates reported in 2023 as compared with 2022. Increases were widespread with 39 of 52 jurisdictions reporting increases in TB case counts and rates from 2023 to 2024; five jurisdictions reported case count increases of 50% or more (Table 2).

Clinical treatment and outcomes

TB prevention and elimination interventions are primarily conducted by staff members working in state, territorial, local, and tribal public health programs. These interventions include diagnosing TB disease and facilitating effective TB treatment to completion. Prompt TB treatment reduces risks of TB-associated morbidity, emergence of drug resistance, and transmission to others. In 2024, consistent with the prior year. 95% of persons with TB disease were initially started on a CDC-recommended treatment regimen or another multidrug regimen that contained at least four drugs (Table 15). Drug resistance for TB continued to be rare in the United States in 2024 with 115 total cases of multidrug-resistant TB (TB resistant to at least isoniazid and rifampin), reported (1.5% of 7,475 cases with drug susceptibility testing results for isoniazid and rifampin) (Table 12).

CDC receives data regarding clinical outcomes, which are reported to NTSS with a 2-year lag, making 2022 the most recent year for which these data are complete. In 2022, 91% of patients received at least some of their treatment through directly observed therapy and 66% received all treatment through directly observed therapy, higher than in any previous year reported (Table 16). Approximately 87% of patients who were eligible to complete therapy within one year did so in 2022 (Table 17).

NTSS data is used to describe TB deaths in the context of clinical outcomes. TB programs reported 858 deaths among persons with TB in 2022 (Table 19). Of those, 349 (41%) were related to TB disease or TB therapy, 246 (29%) were among persons who were dead at diagnosis, and 612 (71%) were among persons who died after diagnosis. Annual TB death rates are calculated from National Vital Statistics System (NVSS), with data available after a 1-year lag. During 2023, 572 deaths (0.2 per 100,000 persons) were attributed to TB in death certificate data reported to NVSS (Table 1). NVSS-reported TB death rates have remained stable since the early 2000s, despite recent increases in case counts.

Origin of birth

Most TB cases reported in 2024 (77%) occurred among non-U.S.–born persons (Table 3). Since TB case reporting began, the percentage of TB cases among non-U.S.–born persons has increased nearly every year; in 2024, 77% of TB cases were among non-U.S.–born persons. The incidence rate among non-U.S.–born persons was 15.7 per 100,000 population in 2024, nearly 20 times higher than the rate among U.S.-born persons (0.8).

Consistent with the past 5 years, the 4 most frequently reported countries of birth among non-U.S.–born persons with TB in the United States in 2024 were Mexico, Philippines, India, and Vietnam (Table 10). In 2024, Haiti replaced China as the 5th most frequently reported country of birth among non-U.S.–born persons.

In 2024, 51% of TB cases among non-U.S.–born persons occurred among those who have been in the United States for at least 5 years (Table 11). In recent years, the number of TB cases among non-U.S.–born persons has increased among those who have lived in the United States for less than one year. In 2024, 24% of TB cases among non-U.S.–born persons occurred among those who arrived in the United States less than one year prior to diagnosis.

Racial/ethnic identity

TB incidence also differs by self-identified race and ethnicity. In 2024, case counts were highest among persons identifying as Hispanic or Latino (3,882), followed by Asian (2,998), and Black or African American (2,063) (Table 4). TB incidence rates were highest among persons identifying as Native Hawaiian or Other Pacific Islander (37.2 per 100,000 persons) and Asian (13.6) and lower among persons identifying as Hispanic or Latino (5.7), Black or African American (4.8), Native American Indian or Alaska Native (4.6), Multiple race (1.7), and White (0.4).

Origin of birth continues to be an important factor when considering the impact of TB on certain racial/ethnic groups. Among U.S.-born persons in 2024, case counts were highest among persons identifying as Black or African American (769), followed by persons identifying as Hispanic or Latino (663) and White (513) (Table 5). Among non-U.S.–born persons, persons identifying as Hispanic or Latino had the highest case counts (3,194), followed by persons identifying as Asian (2,877) and Black or African American (1,276) (Table 6). The incidence rate per 100,000 population among non-U.S.–born Asian persons was much higher than the rate among U.S.-born Asian persons (22.4 vs.1.3, respectively). Similarly, the rate per 100,000 population was higher among non-U.S.–born Black or African American (24.5), Hispanic (13.1), and Native Hawaiian or Other Pacific Islander (54.7) persons compared with U.S.-born persons of the same racial/ethnic identity (Black or African American: 2.1, Hispanic: 1.6, Native Hawaiian or Other Pacific Islander: 10.0) (Tables 5 and 6).

Age and sex

In 2024, case counts and incidence rates were higher in all age groups compared with 2023, except among persons 65 years or older (Table 7). Among U.S.-born persons, incidence rates remained similar to 2023 for most age groups but were higher among those in the 0–4 and 15–24 age groups (Table 8). Among non-U.S.–born persons, the incidence rate was lower in 2024 among persons in age groups 0–4, 45–64, and 65 and older (Table 9); it was higher among persons in age groups 5–14, 15–24, and 25–44.

Consistent with previous years, TB case counts and rates in 2024 were higher among males than females in most age groups (Table 22). However, in the 5–14 age group, the case count and rate were higher among females, including when stratified by origin of birth.

Among females ages 15–44 with TB and pregnancy data available, 69 (4%) women reported pregnancy (Table 23).

Other risk factors

While anyone can get TB disease, some individuals are more vulnerable due to their likelihood of being exposed to TB bacteria or their increased risk of progressing to TB disease once infected.

Congregate settings (e.g., homeless shelters and correctional facilities) where people share airspace for prolonged periods of time, can increase the risk of TB exposure. In 2024, 866 (9%) of TB cases among persons ≥15 years occurred in those who reported having experienced homelessness ever; 698 (7% of TB cases among persons ≥15 years) reported experiencing homelessness in the year before diagnosis (Table 31). Likewise, 824 (9%) of TB cases among persons ≥15 years occurred among those who reported a history of ever being incarcerated; 342 (4% of TB cases among persons ≥15 years) reported incarceration at the time of diagnosis (Table 29).

Certain medications and health conditions weaken a person's immune system, putting them at higher risk of progressing to TB disease after being infected. Diabetes was the most frequently reported medical risk factor among persons with TB and was reported for 22% of cases in 2024 (Table 24). Each other medical risk factor was reported for less than 10% of cases (Table 24), including HIV, which was reported in 5% of cases (Table 18).

TB transmission

Even Though most TB cases in the United States are thought to represent progression of latent TB infection acquired elsewhere in the remote past, exposure to infectious TB, represented by TB transmission and outbreaks, still occurs in the United States. For the first time since 2021, this year's report includes estimates of recent transmission using an updated method that incorporates whole-genome sequencing data (Figure 2). Recent transmission is defined by CDC as transmission within the past 2 years. New content has also been added describing large outbreaks of TB, defined as 10 or more cases related by recent transmission during a 3-year period.

Recent transmission

During 2023–2024,12% of TB cases were attributed to recent transmission (1,804 of 14,648 genotyped cases), a proportion that is similar to that which was reported in 2021. Estimates for the 52 reporting jurisdictions ranged from 0%–62% (Table 35). At least one case was attributed to recent transmission in 470 counties or county-equivalent areas (Figure 1) and in all but 5 reporting jurisdictions (Table 35).

As was the case in 2021, attribution to recent transmission was more common for TB cases among U.S.-born persons (33% of cases) compared with those among non-U.S.–born persons (7% of cases) (Table 36). The percentage of cases attributed to recent transmission decreased with increasing age, from 58% of cases among children 0–4 years old to 4% of cases among adults ≥65 years old (Table 36). The percentage of cases attributed to recent transmission was higher than the national average among persons reporting substance use, incarceration, and homelessness (Table 36).

Large outbreaks

In 2024, 6 states reported large TB outbreaks (Figure 3), a number similar to that which is typically reported to CDC. 4These large outbreaks ranged in size from 10–64 cases (Table 37), with nearly 80% of cases identified through contact investigations, usually conducted by local health departments (Table 38). Approximately half (53%) of the cases associated with large outbreaks occurred among U.S.-born persons (Table 38) No large outbreaks involved cases with resistance to isoniazid or rifampin (Table 38).

Conclusion

TB programs in state, territorial, local, and tribal health departments conduct most TB interventions, including managing treatment and investigating outbreaks. The success of U.S. TB programs is underscored by the decades-long decline in TB cases in the United States coinciding with high treatment completion rates and low rates of drug resistance. Nevertheless, a fourth year of increasing case counts and rates moves the United States away from the goal of eliminating TB and represents preventable suffering. Recovery from pandemic-related health care disruptions, post-pandemic increases in travel and migration, and outbreaks in several states have all likely contributed to recent TB trends. As in recent years, most TB cases occurred in non-U.S.–born persons and are thought to represent progression of latent TB infection acquired years earlier outside of the United States. Although TB cases related to recent transmission account for a smaller proportion of cases, TB transmission and large outbreaks continue to occur and disproportionately affect U.S.-born persons. Maintaining nationwide capacity to prevent, detect, and stop recent transmission and outbreaks remains crucial.

TB disease is preventable and curable. Identification and treatment of latent TB infection prevents asymptomatic persons from developing symptomatic and contagious forms of TB disease. Prompt diagnosis and treatment of TB disease with recommended drug regimens through directly observed therapy reduces TB-associated morbidity and prevents transmission of TB bacteria in communities, thus preventing outbreaks. CDC provides financial support, outbreak response assistance, and other forms of technical assistance for TB programs that perform TB control and prevention activities within communities across the country. Sustained support for these TB programs and their activities is necessary to prevent harm to persons and communities and re-establish progress toward the goal of TB elimination.

Suggested citation

Centers for Disease Control and Prevention (CDC). Reported Tuberculosis in the United States, 2024. Atlanta, GA: US Department of Health and Human Services, CDC; 2025.