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Trends in Tuberculosis, 2017

Key Findings

The rate of decline in the United States remains too slow to achieve TB elimination in this century.

Eliminating tuberculosis (TB) will require interrupting TB transmission as well as major efforts to address latent TB infection. In 2017, a total of 9,105 TB cases were reported in the United States. This represents a 1.6% decrease from 2016.

The national incidence rate was 2.8 cases per 100,000 persons (2.3% decrease from 2016).

TB was reported in all 50 states

Eleven states, the District of Columbia (DC), and New York City reported incidence rates above the national average of 2.8 cases per 100,000.

TB case counts were highest in California, Texas, New York (including New York City), and Florida. These four states accounted for just under half of the total cases in the United States.

Icon - The percentage of TB cases that are drug resistant has remained stable for the last 20 years.

The percentage of TB cases that are drug resistant has remained stable for the last 20 years.

TB bacteria may become resistant to the drugs used to treat TB. This is called drug-resistant TB and means that the drug can no longer kill the bacteria.  Drug-resistant TB poses a serious threat to our ability to treat and control TB.

  • In 2017, the most common form of primary resistance was isoniazid (INH) resistance. INH resistance occurred in 608 cases (9.3% of cases with drug susceptibility results).
  • Multidrug-resistant TB (MDR TB) is resistant to at least isoniazid (INH) and rifampin (RIF). There were 123 MDR TB cases (1.9% of cases with drug susceptibility results) in 2017. The number of drug-resistant cases in 2017 increased slightly by 26 cases from 2016. However, the percentage of TB cases that are drug resistant has remained stable for the last 20 years.
  • Extensively drug-resistant TB (XDR TB) is resistant to INH and RIF, any fluoroquinolone, and at least three of the injectable second-line anti-TB drugs. There were 2 cases of XDR TB in the United States in 2017.
icon - the number of persons who died of TB decreased.

The number of persons who died of TB increased from 2015.

In 2016, the most recent data available, 528 deaths in the United States were attributed to TB. This is an increase from 470 deaths attributed to TB in 2015.

Icon - Incidence rates decreased for all racial and ethnic groups.

Incidence rates decreased for all racial and ethnic groups.

Minority populations continue to disproportionately bear the burden of TB disease.

Table report, persons identified as white, black, Asian, American Indian/Alaska Native, native Hawaiian or other Pacific Islander, or of multiple races are all non-Hispanic. Persons identified as Hispanic may be of any race. 
Race/Ethnicity Incidence Rate of TB Cases per 100,000 – 2017 Percentage of Reported TB Cases in the United States – 2017
American Indians or Alaska Natives 3.9 1%
Asians 17.7 35.7%
Blacks or African Americans 4.7 21%
Native Hawaiians and other Pacific Islanders 19.1 1.2%
Hispanics or Latinos 4.4 28.2%
Whites 0.5 11.8%

Note: for this report, persons identified as white, black, Asian, American Indian/Alaska Native, native Hawaiian or other Pacific Islander, or of multiple races are all non-Hispanic. Persons identified as Hispanic may be of any race.

CDC Recent TB Transmissions Icon

CDC estimated recent transmission of TB

CDC estimates that about 13% of U.S. TB cases with genotype data are attributed to recent transmission. Distinguishing the number of cases attributed to recent transmission from those likely due to reactivation of longstanding, untreated latent TB infection is one of many tools state and local TB programs can use to design and prioritize effective public health interventions. These estimates can be used by state and local TB programs to track progress in the control of recent transmission.

Risk Factors for TB in the United States

US Born

U.S. born and non-U.S.–born persons

TB disease in the United States is most common among people who travel to or who were born in countries with high rates of TB.

  • In 2017, a total of 70.1% of reported TB cases in the United States occurred among non-U.S.-born persons.
  • The case rate among non-U.S.–born persons (14.7 cases per 100,000 persons) was approximately 15 times higher than among U.S.-born persons (1.0 cases per 100,000 persons).
  • The percentage of U.S. TB cases among non-U.S.–born persons who have been in the United States for 10 years or longer are about equal to those who have been in the United States less than 10 years.
Icon - Additional Risk Factors for TB disease

Additional Risk Factors for TB disease

Of persons diagnosed with TB in 2017:

  • 19.9% reported having diabetes
  • 8.9% reported excessive alcohol use
  • 5.5% were co-infected with HIV (of TB cases with HIV test results reported)
  • 6.7% reported using non-injectable drugs (1.2% reported using injecting drugs)
  • 4.6% reported being homeless in the past year
  • 3.1% were residents of correctional settings at time of diagnosis
Icon - Completion of TB Treatment

Completion of TB Treatment

Prompt and effective treatment of TB disease is critical to prevent ongoing transmission of TB. In 2015, the most recent year for which completion data are available, of TB patients who could be appropriately treated within 1 year of diagnosis, 89.5% completed treatment.

The majority of TB patients (65.1%) received treatment by directly observed therapy (DOT) only, and 28.5% of patients received a combination of DOT and self-administered therapy. These numbers have remained stable since 2011.

Eliminating TB in the United States

TB elimination would have widespread health, economic, and social benefits for the United States. Ending TB will require maintaining and strengthening current TB control priorities while increasing efforts to identify and treat latent TB infection among high-risk populations.

Surveillance Data

The most recent surveillance report, Reported Tuberculosis in the United States, 2017, includes data from 60 reporting areas (the 50 states, the District of Columbia, New York City, Puerto Rico, and seven other U.S. jurisdictions in the Pacific and Caribbean).  An additional resource to accompany the surveillance report is the Tuberculosis in the United States, 2017 (Slide Set).

If you need additional state-specific data not available in this report, contact your state TB control office.

Additional Resources:

  • AtlasPlus: an interactive tool that allows users to observe trends and patterns by creating detailed reports, maps, and other graphics showing geographic patterns and time trends.
  • Online Tuberculosis Information System (OTIS): an interactive data system containing information on TB cases reported to CDC in 1993-2015. Users can select criteria to produce specific reports. Data are available by year, state, and demographic factors.

References

CDC. CDC. Reported Tuberculosis in the United States, 2017. Atlanta, GA: U.S. Department of Health and Human Services, CDC, October 2018. Available at http://www.cdc.gov/tb/statistics/reports/2017/

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