Dear Colleague Letters
A Letter from Dr. Rochelle P. Walensky, CDC Director, on World Tuberculosis Day
March 24, 2023
World Tuberculosis (TB) Day acknowledges the impact of TB around the world and the progress made against this disease. TB is preventable and treatable, yet it remains one of the world’s deadliest infectious diseases, taking the lives of 4,300 people each day. The Centers for Disease Control and Prevention (CDC) is working in the United States and around the world to prevent, detect, and cure TB and to raise awareness of challenges that continue to impede our progress toward eliminating this devastating disease.
Globally, the coronavirus disease 2019 (COVID-19) pandemic had a profound effect on TB diagnosis and treatment. Available data show there were more than a million fewer new TB diagnoses in 2020 than in 2019, more than likely due to missed or delayed diagnoses. In 2021, there was only a slight increase in diagnoses, raising concerns that more people are living with undiagnosed and untreated TB. This concern is further supported by the increase seen in the estimated number of deaths from TB in 2021—1.6 million people died of TB that year—reversing years of progress.
In 2022, 8,300 TB cases were reported in the United States, compared with 7,874 cases reported in 2021. TB incidence also increased slightly in 2022 (2.5 cases per 100,000 persons). Reported TB cases and TB incidence in the United States are returning to pre-pandemic levels, according to new preliminary data released by CDC, following a substantial decline in 2020, likely due to factors associated with the COVID-19 pandemic including missed or delayed diagnoses. Timely diagnosis and treatment of both active TB disease and latent TB infection are critical steps to eliminating TB in the United States.
CDC and its partners are using innovative solutions to expand TB screening and treatment activities and address persistent inequities. CDC’s Think. Test. Treat TB campaign encourages healthcare providers to test for and treat latent TB infection with an emphasis on reaching populations most at risk in the United States. Partners such as the state and local TB programs and other organizations work with CDC to increase knowledge, testing, and treatment of TB and reduce health disparities. New CDC recommendations for the use of video Directly Observed Therapy (vDOT) can help TB programs reduce time and costs for patients and providers, enabling greater flexibility during treatment.
Our work to eliminate TB extends globally, with a focus on countries with high rates of TB, drug-resistant TB, and HIV-associated TB. For example, in Mumbai, India, a municipality with one of the highest burdens of drug-resistant TB in the world, CDC and its partners developed comprehensive, person-centered interventions, including adherence support, adverse event monitoring, and migration linkage to improve treatment outcomes in Mumbai’s Dharavi slum where historically less than half of people diagnosed with drug-resistant TB complete treatment. As a result of CDC-supported interventions, 88 percent of current drug-resistant TB patients remain on or have completed treatment as of January 2023.
Also globally, CDC is spearheading TB diagnosis, treatment, and prevention efforts for those most vulnerable to the disease, particularly people with HIV, among whom TB remains the leading cause of death. As part of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) implementing partners, CDC and its collaborators screened 10.2 million people living with HIV for TB, 61 percent of all people screened through PEPFAR in 2022. CDC also supported nearly 1.8 million people with HIV to complete a course of TB preventive treatment (TPT), 63 percent of all TPT completions, through PEPFAR. Additionally, results from Uganda, highlighted in Emerging Infectious Diseases, demonstrate the incredible impact of CDC and other PEPFAR implementing agencies’ work to prevent HIV-associated TB. Through strong partnerships with the Ugandan Ministry of Health, CDC and partners helped to increase TPT coverage from below one percent to 89 percent in less than six years.
While remarkable progress has been made, there is still much to do. Today, I encourage you to visit CDC’s World TB Day and Global HIV and TB websites to learn how you can help eliminate TB in your community. You can also view additional resources, testimonies from TB survivors, and success stories from domestic and global TB elimination champions.
I appreciate your steadfast efforts to eliminate TB. Together, we are creating a safer America and a safer world.
Rochelle P. Walensky, MD, MPH
Director, CDC, and
Administrator, Agency for Toxic Substances and Disease Registry