Purpose
This Aggregate Reports for Tuberculosis Program Evaluation (ARPE) report summarizes national contact investigation efforts related to tuberculosis (TB) cases diagnosed in 2022, as reported to CDC through August 20, 2024, and summary data from 2018-2021 as reported to CDC through August 20, 2024.
About the report
Follow-up examination and treatment of contacts to patients with tuberculosis (TB) is a national TB prevention and elimination strategic priority in the United States.
Each year, TB programs report results of their contact investigation activities to CDC by entering the data into the Aggregate Reports for Tuberculosis Program Evaluation (ARPE) form via the National Tuberculosis Indicators Project performance-monitoring tool.
ARPE data provide the only national-level data on contact investigations and are reported in three categories:
- Sputum smear-positive
- Sputum smear-negative/culture-positive
- Other
The data are also used by awardees as a tool to evaluate and coordinate TB prevention activities.
Data summary
In 2022, there were 3,406 acid-fast bacillus (AFB) smear-positive and 1,682 AFB smear-negative, culture-positive cases for investigation in the United States. The number of sputum acid-fast bacillus (AFB) smear-positive TB cases identified in 2022 (3,406) was higher than the annual number identified in 2021 (3,227), 2020 (2,879), and 2018 (3,398) but lower than the number reported in 2019 (3,481).
Elicitation of contacts
The number of contacts increased in 2022 (33,576) as compared to 2021 (28,736) but remained below the numbers reported during the 2018-2020 period (35,918-53,783). The percentage of cases with contacts elicited in 2022 was 89.9% (3,061/3,406 cases) compared with annual percentages achieved during 2018-2021 (range: 91.8% - 94.5%), with all years falling below the 2025 National Performance Target of 100%.
Evaluation of contacts
Among the 33,576 contacts elicited to smear-positive cases in 2022, 24,339 (72.5%) were evaluated.
Evaluation of contacts to smear-positive cases in 2022 remained below the 2025 National Performance Target of 94%, as were performance levels achieved annually from 2018-2021 (range: 75.7% -78.7%).
Diagnosis and treatment of latent TB infection
Of those who were evaluated, 4,716 (19.4%) were diagnosed with latent TB infection. Among those diagnosed with latent TB infection, 76.2% (3,592) initiated treatment, of whom 79.7% (2,862) completed treatment. Latent TB infection treatment initiation and completion performance remains below the 2025 National TB Performance Targets of 92% and 93%, respectively.
Additionally, among persons diagnosed with latent TB infection and determined to be contacts of smear-positive TB cases in 2022, contacts choosing to stop treatment accounted for 33.6% of those not completing treatment, while contacts lost to follow-up accounted for 39.4%.
Appendix A: Sputum smear-positive TB cases
Appendix A. Counts and Indices for Investigation of Sputum Acid-fast Bacillus (AFB) Smear-Positive TB Cases, 2018-2022A
| Cases and Contacts | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Cases for investigation | 3,398 | 3,481 | 2,879 | 3,227 | 3,406 |
| Cases, no contacts | 187 | 193 | 206 | 266 | 345 |
| Number of contacts | 53,783 | 51,419 | 35,918 | 28,736 | 33,576 |
| Evaluated | 42,302 | 38,942 | 27,806 | 21,951 | 24,339 |
| TB disease | 352 | 345 | 351 | 395 | 396 |
| Latent TB infection | 6,044 | 5,587 | 4,290 | 4,518 | 4,716 |
| • Started treatment | 4,583 | 4,271 | 3,332 | 3,356 | 3,592 |
| • Completed treatment | 3,623 | 3,423 | 2,660 | 2,739 | 2,862 |
| • Treatment outcome unknown/missing | 366 | 283 | 290 | 259 | 293 |
| Reason | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts stopping treatment (n) | 594 | 565 | 382 | 358 | 437 |
| Active TB developed | 6 (1.0%) | 4 (0.7%) | 2 (0.5%) | 2 (0.6%) | 9 (2.1%) |
| Adverse effect of medicine | 51 (8.6%) | 47 (8.3%) | 40 (10.5%) | 41 (11.5%) | 27 (6.2%) |
| Contact chose to stop | 256 (43.1%) | 185 (32.7%) | 119 (31.1%) | 116 (32.4%) | 147 (33.6%) |
| Contact lost to follow-up | 190 (32.0%) | 249 (44.1%) | 158 (41.4%) | 157 (43.8%) | 172 (39.4%) |
| Contact moved (follow-up unknown) | 35 (5.9%) | 38 (6.7%) | 29 (7.6%) | 22 (6.1%) | 50 (11.4%) |
| Death | 4 (0.7%) | 8 (1.4%) | 7 (1.8%) | 8 (2.2%) | 8 (1.8%) |
| Provider decision | 52 (8.7%) | 34 (6.1%) | 27 (7.1%) | 12 (3.4%) | 24 (5.5%) |
| Evaluation Indices (%) | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contact elicitation (%) | 94.5% | 94.5% | 92.8% | 91.8% | 89.9% |
| Contacts per case (N, Average) | 15.8 | 14.8 | 12.5 | 8.9 | 9.9 |
| Contact evaluation (%) | 78.7% | 75.7% | 77.4% | 76.4% | 72.5% |
| TB disease (%) | 0.8% | 0.9% | 1.3% | 1.8% | 1.6% |
| Latent TB infection (%) | 14.3% | 14.3% | 15.4% | 20.6% | 19.4% |
| Latent TB infection treatment initiated (%) | 75.8% | 76.4% | 77.7% | 74.3% | 76.2% |
| Latent TB infection treatment completed (%) | 79.1% | 80.1% | 79.8% | 81.6% | 79.7% |
Figure 1: Proportion of TB patients with contacts elicited
National objective
Increase the proportion of TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited to 100.0% by 2025.
Sputum AFB smear-positive TB Cases with contacts elicited = Number of sputum AFB smear-positive TB cases for investigation - Number of sputum AFB smear-positive TB cases with no contacts.
Indicator
Percent of sputum AFB smear-positive TB cases with contacts elicited
Cohort
Sputum AFB smear-positive TB cases are counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data sources
ARPEs (Contacts) fields, a1 (Sputum smear+ Cases for Investigation), b1 (Sputum smear + Cases with No Contacts)
Calculation
[(Number of sputum AFB smear-positive TB cases with contacts elicited) / Cohort] x 100.
Figure 2: Evaluation of contacts
National objective
Increase the proportion of contacts to sputum AFB smear-positive TB cases who are examined for infection and disease to 94.0% by 2025.
Contacts are counted as evaluated if they have been tested and examined to the point where a final determination of diagnosis is either latent TB infection or TB disease.
Indicator
Percent of contacts to sputum AFB smear-positive TB cases examined for infection and disease
Cohort
Contacts to sputum AFB smear-positive TB cases counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data sources
ARPEs (Contacts) fields, c1 (Number of Contacts to Sputum smear+ Cases), d1 (Contacts to Sputum smear + Cases Evaluated)
Calculation
[Number of contacts to sputum AFB smear-positive TB cases evaluated / Cohort] x 100.
Figure 3: Latent TB infection treatment initiation
National objective
Increase the proportion of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who start treatment to 92.0% by 2025.
Indicator
Percent of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who started treatment. Contacts are counted as having started treatment after taking the first dose of a treatment course.
Cohort
Contacts to sputum AFB smear-positive TB cases who have newly diagnosed latent TB infection, counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data Sources
ARPEs (Contacts) fields, f1 (Contacts to Sputum smear+ Cases with Latent TB Infection), g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment)
Calculation
[Number of contacts diagnosed with latent TB infection who started treatment/ Cohort] x 100.
Figure 4: Latent TB infection treatment completion
National objective
For contacts to sputum AFB smear-positive TB cases who have started treatment for latent TB infection, increase the proportion who complete treatment to 93.0% by 2025.
Indicator
Percent of contacts to sputum AFB smear-positive TB cases who complete treatment.
Cohort
Contacts to sputum AFB smear-positive TB cases with newly diagnosed latent TB infection and have started treatment are counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data sources
ARPEs (Contacts) fields, g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment), h1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Completed Treatment)
Calculation
[Number of contacts diagnosed with latent TB infection who completed treatment / Cohort] x 100
Figure 5: Number of contacts to AFB-smear positive TB cases
Appendix B: Sputum smear-negative, culture positive TB cases
Appendix B. Counts and Indices for Investigation of Sputum AFB Smear-Negative, Culture-Positive TB Cases, 2018-2022B
| Cases and Contacts | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Cases for investigation | 1,903 | 1,784 | 1,343 | 1,434 | 1,682 |
| Cases, no contacts | 258 | 257 | 207 | 251 | 270 |
| Number of contacts | 13,589 | 12,679 | 8,829 | 8,128 | 9,830 |
| Evaluated | 10,713 | 9,908 | 6,927 | 6,267 | 6,944 |
| TB disease | 72 | 63 | 64 | 78 | 82 |
| Latent TB infection | 1,428 | 1,147 | 901 | 866 | 1,004 |
| • Started treatment | 958 | 747 | 567 | 524 | 620 |
| • Completed treatment | 744 | 606 | 413 | 427 | 477 |
| • Treatment outcome unknown/missing | 40 | 33 | 91 | 39 | 66 |
| Reason | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts stopping treatment (n) | 174 | 108 | 63 | 58 | 77 |
| Active TB developed | 4 (2.3%) | 2(1.8%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Adverse effect of medicine | 21 (12.1%) | 12 (11.1%) | 12 (19.0%) | 5 (8.6%) | 1 (1.3%) |
| Contact chose to stop | 71 (40.8%) | 38 (35.2%) | 25 (39.7%) | 21 (36.2%) | 29 (37.7%) |
| Contact lost to follow-up | 54 (31.0%) | 42 (38.5%) | 20 (31.7%) | 25 (43.1%) | 37 (48.0%) |
| Contact moved (follow-up unknown) | 10 (5.7%) | 6 (5.6%) | 2 (3.2%) | 3 (5.2%) | 5 (6.5%) |
| Death | 2 (1.1%) | 4 (3.7%) | 2 (3.2%) | 3 (5.2%) | 0 (0%) |
| Provider decision | 12 (7.0%) | 4 (3.7%) | 2 (3.2%) | 1 (1.7%) | 5 (6.5%) |
| Evaluation Indices (%) | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contact elicitation (%) | 86.4% | 85.6% | 84.6% | 82.5% | 83.9% |
| Contacts per case (N, Average) | 7.1 | 7.1 | 6.6 | 5.7 | 5.8 |
| Contact evaluation (%) | 78.8% | 78.1% | 78.5% | 77.1% | 70.6% |
| TB disease (%) | 0.7% | 0.6% | 0.9% | 1.2% | 1.2% |
| Latent TB infection (%) | 13.3% | 11.6% | 13.0% | 13.8% | 14.5% |
| Latent TB infection treatment initiated (%) | 67.1% | 65.1% | 62.9% | 60.5% | 61.8% |
| Latent TB infection treatment completed (%) | 77.7% | 81.1% | 72.8% | 81.5% | 76.9% |
Appendix C: Other*
Appendix C. Counts and Indices for Investigation of Other* Cases, 2018-2022C
* Other: Contact investigations not captured in investigating sputum acid-fast bacillus (AFB) smear-positive or sputum AFB smear-negative, culture-positive. For example: Associate-contact or source-case investigations done because of a child with TB disease.
| Contacts | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Number of contacts | 10,667 | 8,309 | 5,627 | 8,014 | 9,493 |
| Evaluated | 8,837 | 6,207 | 4,292 | 6,029 | 7,510 |
| TB disease | 69 | 66 | 65 | 80 | 91 |
| Latent TB infection | 820 | 796 | 514 | 742 | 811 |
| • Started treatment | 577 | 551 | 343 | 423 | 563 |
| • Completed treatment | 493 | 457 | 282 | 338 | 452 |
| • Treatment outcome unknown/missing | 18 | 24 | 12 | 30 | 31 |
| Reason | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts stopping treatment (n) | 66 | 70 | 49 | 55 | 80 |
| Active TB developed | 1 (1.5%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Adverse effect of medicine | 9 (13.6%) | 14 (20.0%) | 6 (12.2%) | 4 (7.3%) | 2 (2.5%) |
| Contact chose to stop | 18 (27.3%) | 27 (38.6%) | 18 (36.7%) | 25 (45.4%) | 42 (52.5%) |
| Contact lost to follow-up | 26 (39.4%) | 21 (30.0%) | 19 (38.8%) | 22 (40.0%) | 28 (35.0%) |
| Contact moved (follow-up unknown) | 5 (7.6%) | 5 (7.1%) | 4 (8.2%) | 3 (5.5%) | 5 (6.25%) |
| Death | 1 (1.5%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Provider decision | 6 (9.1%) | 3 (4.3%) | 2 (4.1%) | 1 (1.8%) | 3 (3.75%) |
| Evaluation Indices (%) | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contact evaluation (%) | 82.8% | 74.7% | 76.3% | 75.2% | 79.1% |
| TB disease (%) | 0.8% | 1.1% | 1.5% | 1.3% | 1.2% |
| Latent TB infection (%) | 9.3% | 12.8% | 11.9% | 12.3% | 10.8% |
| Latent TB infection treatment initiated (%) | 70.4% | 69.2% | 66.7% | 57.0% | 69.4% |
| Latent TB infection treatment completed (%) | 85.4% | 82.9% | 82.2% | 79.9% | 80.3% |
- Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico, and eight large city jurisdictions (Los Angeles, CA; San Francisco, CA; San Diego, CA; Chicago, IL; Baltimore, MD; New York City, NY; Philadelphia, PA; Houston, TX). Missouri, Kansas, Nebraska, and the Virgin Islands did not report in 2018. Virgin Islands and Vermont did not report in 2019. Vermont did not report in 2020. Data shown in tables and figures are up to date as of August 20, 2024.
- Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico, and eight large city jurisdictions (Los Angeles, CA; San Francisco, CA; San Diego, CA; Chicago, IL; Baltimore, MD; New York City, NY; Philadelphia, PA; Houston, TX). Missouri, Kansas, Nebraska, and the Virgin Islands did not report in 2018. Virgin Islands and Vermont did not report in 2019. Vermont did not report in 2020. Data shown in tables and figures are up to date as of August 20, 2024
- Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico, and eight large city jurisdictions (Los Angeles, CA; San Francisco, CA; San Diego, CA; Chicago, IL; Baltimore, MD; New York City, NY; Philadelphia, PA; Houston, TX). Colorado, Idaho, Indiana, Kansas, Maine, Massachusetts, Nebraska, New Hampshire, and the Virgin Islands did not report 2018-2022 data. DC and New Mexico did not report 2018-2020 data. Alaska did not report 2018-2021 data. Montana did not report 2019-2022 data. Missouri did not report 2018 data. Mississippi did not report 2020 data. Data shown in tables and figures are up to date as of August 20, 2024.