Dear Colleague Letters
CDC Releases 2020 Provisional U.S. Tuberculosis (TB) Data
March 25, 2021
World Tuberculosis (TB) Day is an opportunity to recognize achievements and to renew our commitment to ending TB disease in the United States and around the world. This year we also acknowledge the impact that COVID-19 has had on our TB community. I would like to thank CDC Director Dr. Rochelle Walensky for recognizing the important contributions of healthcare workers and TB programs to both TB prevention and control activities, and the COVID-19 pandemic.
On March 25, 2021, CDC published provisional TB data in CDC’s Morbidity and Mortality Weekly Report. The provisional 2020 TB data reveal a dramatic decline in the number of reported cases of TB disease in the United States. In 2020, a total of 7,163 TB cases were reported in the United States compared to 8,909 TB cases in 2019, which represents a 20% decrease from the previous year. The incidence rate of TB disease in the United States in 2020 was 2.2 per 100,000 persons compared with 2.7 per 100,000 persons during 2019. Data reveal a decrease in the incidence of TB disease among both U.S.-born and non-U.S.–born persons during 2020 compared with 2019.
The decline in the reported number of TB disease cases is far larger than we have observed in recent years. The steep decline in reported cases is likely due to multiple factors related to the COVID-19 pandemic that have led to an underascertainment of cases and a true decline in TB incidence. For example, changes in immigration and travel patterns in 2020 as well as pandemic mitigation efforts (e.g., mask-wearing and social distancing) might have contributed to the decrease in the reported incidence of TB disease. CDC is conducting additional analyses to better understand how the 2020 TB data compared to previous years.
The magnitude of the decrease in reported TB disease cases raises concern regarding potentially missed or delayed TB disease diagnoses. Healthcare providers should consider TB disease when evaluating patients with signs and symptoms consistent with TB (e.g., cough of >2 weeks in duration, unintentional weight loss, and hemoptysis), especially when diagnostic tests for SARS-CoV-2 are negative. Limited access to and reluctance to seek medical care because of the COVID-19 pandemic might also contribute to underdiagnoses. People with signs and symptoms of TB disease are encouraged to seek medical care and to follow up with their healthcare provider for any illness that persists or returns after their initial treatment. Timely TB diagnoses save lives and prevent the spread of TB disease.
CDC remains committed in our efforts to end TB, even as the COVID-19 pandemic has created unprecedented challenges within our communities. CDC’s U.S. TB Elimination Champions project recognizes organizations and individuals who have played an important role in the COVID-19 response while continuing to work towards TB elimination.
Our goal is to turn TB elimination into a reality. CDC has resources and information you can use to continue the World TB Day momentum, including new TB Personal Stories and the recently updated Core Curriculum on Tuberculosis: What the Clinician Should Know. Visit CDC’s TB website for more information.
Thank you for your dedication to TB elimination.
Philip LoBue, MD, FACP, FCCP
Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention