Tuberculosis in the United States in 2018

Acid fast bacilli bacteria under microscope
Acid fast bacilli bacteria under microscope
The incidence of tuberculosis in the United States in 2018 was 2.8 cases per 100,000 persons, which is the lowest ever reported.

The incidence of tuberculosis (TB) in the United States in 2018 was 2.8 cases per 100,000 persons, which is the lowest ever reported, according to an article published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.

A total of 9029 new cases of TB were reported in the United States in 2018, which was a 0.7% decrease from 2017. The decrease in incidence from 2017 to 2018 was 1.3%. The rate in non-US-born citizens was >14-fold greater than that in US-born citizens and non-US-born persons accounted for approximately two-thirds of cases. In 2018 46.3% of TB cases in non-US-born persons received a TB diagnosis ≥10 years after first arriving in the US.

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State specific incidences for 2018 ranged from 0.2 to 8.5 per 100,000 persons, in Wyoming and Alaska, respectively. The median rate was 1.9 per 100,000 persons. Alaska, California, Florida, Hawaii, Maryland, Massachusetts, Minnesota, New Jersey, New York, Texas, and Washington, DC, reported TB incidence above the national rate. California, Florida, New York, and Texas accounted for approximately half of reported TB cases, a situation that has not changed for 2 decades.

According to the report, both the CDC and the US Preventive Services Task Force recommended testing populations at increased risk for TB, including persons born in or who frequently travel to countries where TB is prevalent and persons who currently live, or previously lived, in congregate settings. The CDC further recommended TB testing for healthcare workers who work in places with a high risk for TB transmission, for persons who are contacts of an individual withTBand for people with compromised immune systems, who have a higher risk for TB disease developing once infected. For treatment of latent TB infection, the CDC recommendation is either 3 months of once-weekly rifapentine plus isoniazid or 4 months of daily rifampin.

The findings in the report were limited by constraints on the analysis, which used only reported provisional number of TB cases and incidence for 2018 and that incidences are calculated using estimated population numbers as denominators.

The report concluded that despite TB case counts and incidence in the US being the lowest ever reported, progress has slowed and, “the current decline in TB incidence is insufficient to eliminate TB in the United States in the 21st century.” To reach the goal of elimination, the report stated that the US must expand detection and treatment of latent TB infection and disease. Finally, the report authors cautioned that, “TB is a global problem, and its elimination will depend on cooperative measures to detect and treat [latent TB infection] and TB disease around the world.”


Talwar A, Tsang CA, Price SF, et al. Tuberculosis — United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68:257-262.