Factoring Prior Treatment Into Tuberculosis Infection Prevalence Estimates

United States, 2011-2012

Laura A. Vonnahme; Maryam B. Haddad; Thomas R. Navin


Emerging Infectious Diseases. 2019;25(10):1949-1951. 

In This Article

Abstract and Introduction


To refine estimates of how many persons in the United States are candidates for treatment of latent tuberculosis, we removed from analysis persons who self-reported prior treatment on the National Health and Nutrition Examination Survey 2011–2012. We estimate that 12.6 million persons could benefit from treatment to prevent active tuberculosis.


In the United States, although tuberculosis (TB) incidence is at historic lows, the average annual rate of decline has slowed to 2%.[1] To achieve TB elimination by 2100, sustained annual declines of twice that magnitude are needed.[2] Most new cases of TB in the United States result from progression of Mycobacterium tuberculosis infections acquired years earlier.[3] TB elimination requires scaling up treatment of latent TB infection (LTBI) to prevent progression to active TB. The National Health and Nutrition Examination Survey (NHANES) 2011–2012 determined that ≈5% of the US population had LTBI on the basis of positivity of a tuberculin skin test (TST) or an interferon-γ release assay (IGRA).[4] However, these TB test results may remain positive even after a patient has received effective treatment for active TB or LTBI. Specifically, the TST is widely believed to remain positive for life; whether the IGRA blood test remains positive is still undetermined.[5–7] To better estimate the number of persons in the United States who are candidates for LTBI treatment,[8] we refined the NHANES-based estimate of the national LTBI prevalence by excluding from analysis persons who reported having received prior treatment for active TB or LTBI.