Key points
Latent TB infection prevalence data is critical in order to track the United States' progress in testing and treating persons with latent TB infection. All published estimates conclude that millions of people in the United States have latent TB infection.
Why it's important
Latent TB infection prevalence data is critical in order to track the United States' progress in testing and treating persons with latent TB infection. More than 80% of TB cases in the United States result from longstanding, untreated latent TB infection.
TB disease is a nationally notifiable disease; however latent TB infection is not. Some states now require reporting of latent TB infection to their health departments. For national estimates of latent TB infection, CDC has primarily relied on nationally representative surveys of tests for TB infection. Currently, CDC has standardized latent TB infection reporting methods that are voluntary. Beginning in 2023, some jurisdictions have adopted these new standards and are reporting latent TB infection cases to CDC.
About the data
CDC's primary source for estimating latent TB infection prevalence is the TB infection component of the National Health and Nutrition Examination Survey (NHANES), which was most recently conducted as part of the 2011–2012 NHANES. Based on NHANES data, CDC estimates that up to 13 million people in the United States have latent TB infection. However, the prevalence of latent TB infection could vary between certain populations.
The information below describes current estimates published by CDC. CDC also collaborated with external partners to update estimates of the prevalence of latent TB infection in the United States through existing data sources and novel methods. Those vary based on assumptions used in their development and can be useful in developing different approaches to considering which populations are at risk of TB disease in the United States.
Although there is some variation, all published estimates conclude that millions of people in the United States have latent TB infection. Without treatment, people with latent TB infection are at risk for developing TB disease.
Highlights
Miramontes R., et al. (2015) PLoS ONE 10(11): e0140881. doi:10.1371/journal.pone.0140881.
Methods/Data Sources
NHANES, persons age 6 years and older, tuberculin skin test (TST) positive based on cut-point of ≥10 mm for the mean of up to 3 measurements, adjusted for non-return for TST reading and mm digit preference
NHANES, persons age 6 years and older, measured as positive by QuantiFERON-TB Gold In-Tube test, adjusted public data set for coding positive per manufacturer’s package insert
National Estimate as Percent (confidence limits or bounds)
Using TST: 4.7% [95% confidence interval 3.4 - 6.3]
Using QuantiFERON-TB Gold In-Tube test: 5.0% [95% confidence interval 4.2 - 5.8]
National Estimate in Population (confidence limits or bounds)
Using TST: 13.2 million persons [95% confidence interval 9.6 - 17.8 million]
Using QuantiFERON-TB Gold In-Tube test: 14.1 million persons [95% confidence interval 11.8 - 16.4 million]
Population Denominator or Any Restrictions
2011 American Community Survey data restricted to match NHANES population of noninstitutionalized civilian U.S. population ages 6 years and older
Time Frame
2011-2012
Haddad M.B., et al. (2018) Emerg. Infect. Dis. 24(10):1930-1933. doi: 10.3201/eid2410.180716.
Methods/Data Sources
Estimation based on:
- Annual TB case counts averaged 2008-2015 by county,
- Estimate of recent transmission (RT) averaged 2011-2015 by county, with assumption that:
- All cases not considered RT are latent TB infection reactivation,
- Non-genotyped TB cases have the same RT percentage as genotyped cases, and
- Uniform 0.1% annual risk of reactivation from latent TB infection.
- All cases not considered RT are latent TB infection reactivation,
National Estimate as Percent (confidence limits or bounds)
3.1% [uncertainty limits 2.2-5.2% based on higher or lower risk of reactivation assumptions]
National Estimate in Population (confidence limits or bounds)
8.9 million persons with untreated latent TB infection [uncertainty limits 6.3-14.8 million based on higher or lower risk of reactivation assumptions]
Population Denominator or Any Restrictions
2010 U.S. Census population
Time Frame
2011-2015
Vonnahme L.A., et al. (2019) Emerg. Infect. Dis. 25(10), 1949-1951. doi.org/10.3201/eid2510.190439.
Methods/Data Sources
Latent TB infection prevalence in the U.S., 2011-2012, estimated as positive QuantiFERON-TB Gold In-Tube test, after excluding persons who reported having received prior treatment for TB disease or latent TB infection.
National Estimate as Percent (confidence limits or bounds)
Not published
National Estimate in Population (confidence limits or bounds)
12.6 million persons [95% confidence interval 10.5–14.7 million] with untreated latent TB infection
Population Denominator or Any Restrictions
2011 American Community Survey data restricted to match NHANES population of noninstitutionalized civilian U.S. population ages 6 years and older
Time Frame
2011-2012
Methods/Data Sources
Cascade of self-reported engagement in the care of latent TB infection in the U.S., 2011-2012, among persons 6 years and older with a positive QFT result
National Estimate as Percent (confidence limits or bounds)
5.0%
National Estimate in Population (confidence limits or bounds)
14.0 million
Population Denominator or Any Restrictions
2011 American Community Survey data restricted to match NHANES population of noninstitutionalized civilian U.S. population ages 6 years and older
Time Frame
2011-2012
Mirzazadeh A., et al. (2021) PLoS ONE 16(4):e0249012. doi.org/10.1371/journal.pone.0249012.
Methods/Data Sources
Latent TB infection prevalence in 2015 estimated by creating mathematical model using all TB disease cases reported during 2013-2017
National Estimate as Percent (confidence limits or bounds)
2.7% [95% confidence interval 2.6-2.8
National Estimate in Population (confidence limits or bounds)
8.6 million persons [95% confidence interval 8.3-8.8 million] with untreated latent TB infection
Population Denominator or Any Restrictions
2015 American Community Survey midpoint estimates for state population size by age group, race/ethnicity, and nativity.
Time Frame
2013-2017
What CDC is doing
CDC is working to help state and local TB programs increase their surveillance for latent TB infection. With the introduction of standardized reporting methods and platform, a national latent TB infection surveillance system (TB Latent Infection Surveillance System [TBLISS]) is now possible. CDC is continuing to work with its partners to define the scale and scope of TBLISS.
The TB Epidemiologic Studies Consortium (TBESC) is working with three sites to describe the latent TB infection care cascade and identify gaps, barriers, and facilitators to latent TB infection testing and treatment completion. TBESC is also using site-specific electronic medical record data to identify and track performance measures across the latent TB infection care cascade.