Tuberculosis — United States, 2022

Kimberly R. Schildknecht, MPH; Robert H. Pratt; Pei-Jean I. Feng, MPH; Sandy F. Price; Julie L. Self, PhD


Morbidity and Mortality Weekly Report. 2023;72(12):297-303. 

In This Article


U.S. TB incidence increased during 2022, compared with that during 2020 and 2021, but remained lower than incidence during the prepandemic years; after a substantial 20.2% decline in 2020 and partial rebound (9.8% increase) in 2021,[1] incidence appears to be returning to prepandemic levels among U.S.-born and non–U.S.-born populations.

COVID-19–associated mortality was high among persons aged ≥65 years, which might account, in part, for the lower TB incidence observed among that population.[3] Even though the decrease in TB incidence was small, reduction of the population aged ≥65 years at risk for TB might have similar effects on TB incidence in future years. The increase in TB incidence among children aged ≤4 years might represent both recent transmission in the United States and infection in countries with higher TB incidence. An analysis of TB incidence among indigenous persons during 2009–2019 found a higher prevalence of underlying chronic medical conditions, and TB incidence was at least 10 times higher among AI/AN and NH/OPI persons than among White persons.[2] These factors likely contributed to the higher TB incidence in these populations in this report. Among non–U.S.-born persons with TB, the higher proportion reported <1 year after arrival in the United States might reflect greater migration from higher TB incidence areas than what existed at the beginning of the pandemic.§§§

Although preventing TB transmission in the United States remains a priority, >80% of U.S. TB cases are attributed to reactivation of LTBI.[1] To achieve TB elimination in the United States, the U.S. Preventive Services Task Force recommends testing and treatment among populations at higher risk for LTBI, including non–U.S.-born persons and persons in congregate living settings.[4] To treat LTBI, CDC recommends short-course (3- or 4-month), rifamycin-based regimens.[5] Shorter regimens are also available to treat TB: in 2022, CDC recommended a 4-month treatment regimen for drug-susceptible pulmonary TB as an alternative to the standard 6-month regimen.[6] Shorter treatment durations improve treatment adherence and completion.[5,6]

Higher TB incidence among AI/AN and NH/OPI persons represents an ongoing health disparity[2] in the United States. Alaska reported an increase of TB in 2022 and identified Alaska Native persons as among those at highest risk for TB.[7] CDC is working to raise awareness about TB and LTBI among communities at risk for TB and their health care providers through the Think. Test. Treat TB campaign,¶¶¶ which offers resources in multiple languages for general audiences and health care providers.**** CDC also partners with community health clinics and organizations, including the TB Elimination Alliance,†††† to address TB health disparities through education and innovation.

Higher proportions of TB cases among persons experiencing homelessness or residing in correctional or long-term care facilities might be partially explained by transmission events in congregate settings. For example, gaps in TB infection control practices when resources were diverted to COVID-19 prevention and control efforts likely led to a TB outbreak in at least one state's prison system during 2021–2022.[8]

The findings in this report are subject to at least two limitations. First, this analysis and case counts are based on provisional 2022 TB surveillance data and might change. Second, rates are calculated with population estimates that are subject to future refinement.

Knowledge of the effects of the COVID-19 pandemic on U.S. TB epidemiology is evolving. As COVID-19 incidence declines, TB remains an important public health challenge characterized by persistent inequities, particularly among AI/AN and NH/OPI populations, persons experiencing homelessness, and persons who are incarcerated. Timely detection and treatment of TB and LTBI among persons at risk are needed to achieve TB elimination in the United States.