CDC Releases "Reported Tuberculosis in the United States, 2023"

Dear Colleague Letters

November 13, 2024

Dear Colleague:

On March 28, 2024, CDC published provisional tuberculosis (TB) data in CDC's Morbidity and Mortality Weekly Report. The full final report, Reported Tuberculosis in the United States, 2023, is now available exclusively on the CDC website. The report describes cases of TB disease reported to CDC during 1993–2023.

In 2023, all jurisdictions fully implemented the revised TB case report form. This year's annual report includes select data from new variables from the revised form, including pregnancy, smoking, and history of experiencing homelessness. The new variables on the revised form provide additional understanding of characteristics and risk factors among persons with TB disease.

The number of reported TB disease cases and incidence rate increased in 2023 for the third year since 2020, surpassing pre-COVID-19 pandemic levels. In 2023, the United States reported 9,633 cases of TB disease and an incidence rate of 2.9 cases per 100,000 persons, an increase of 8.3% and 6.2% respectively compared with 2019. The TB case count in 2023 is the highest reported since 2013, and the incidence rate is the highest since 2016.

Key Highlights

• Increases in 2023 were reported in most jurisdictions. Of the 50 U.S. states, New York City, and the District of Columbia (D.C.), 42 jurisdictions reported both increases in case counts and incidence rates.
• In 2023, TB disease continued to disproportionally affect non-U.S.–born persons and persons from racial and ethnic minority groups in the United States.
  • The TB incidence rate was 18.5 times higher among non-U.S.–born persons compared with U.S.-born persons.
  • In 2023, 90.1% of TB cases occurred among persons who identified as racial and ethnic minorities in the United States.
• Chest imaging and bacteriologic examination of a sputum specimen are components of a complete medical evaluation for TB disease. Among persons diagnosed with TB disease in 2023, more than 90% received a chest radiograph and almost 90% had a sputum sample collected.
• Multidrug-resistant (MDR) TB disease continues to be rare in the United States. In 2023, TB programs reported 100 (1.4%) cases of MDR TB disease.

CDC created a slide set and infographic to highlight findings from the 2023 surveillance report.

Although most people in the United States are not at risk of developing TB disease, TB impacts thousands of lives in our nation and millions globally. The increase in TB disease in the United States in 2023 highlights a necessity to advance TB prevention efforts to regain momentum toward the United States’ goal of TB elimination.

Despite the increases, the United States continues to maintain one of the lowest TB incidence rates in the world. This is a testament to the tireless efforts of U.S. TB programs. Adherence to proven strategies for TB disease management in the United States, including diligent follow-up efforts by public health personnel, greatly reduces the risk of TB disease transmission or developing multidrug-resistant TB disease. As the 2023 annual report demonstrates, U.S. TB programs provided effective health care and treatment services for persons with TB disease even with the challenges associated with the COVID-19 pandemic.

We gratefully acknowledge the contributions of all state and local health departments throughout the United States whose staff collected and reported the information used in the 2023 surveillance report.

Thank you for your work and commitment to eliminate TB in the United States.

Sincerely,
Philip LoBue, MD, FACP, FCCP
Director
Division of Tuberculosis Elimination
National Center for HIV, Viral Hepatitis, STD, and TB Prevention