Reported TB Cases

United States, 1982-2008

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

28,000

1984 1987 1990 1993 1996 1999 2002 2005 2008

Year

No. of Cases

TB Elimination:

Now is the Time!

TB Elimination:

Now is the Time!

TB Elimination: Now is the Time!

Many people think that tuberculosis (TB) is a disease of the past — an illness that no longer threatens us 

today. One reason for this belief is that, in the United States, we are currently experiencing a decline in 

TB. We are at an all-time low in the number of persons diagnosed with active TB disease. 

That very success makes us vulnerable to complacency and neglect. But it also gives us an opportunity 

to eliminate TB in this country. Now is the time to take decisive actions, beyond our current efforts, that 

will ensure that we reach this attainable goal.

Back on Track Toward TB Elimination

The nation’s mobilization of additional 

resources in the 1990s has paid off:

w We are now at an all-time low in 

reported TB cases, with 16 consecutive 

years of decline.

w In 2008, there were 12,904 persons with 

TB disease reported in the United States, 

declining from 15,056 cases in 2002. 

w However, compared to the 3.2% decline 

in the number of cases in 2007, the 

decline in 2008 was smaller at 2.9%.

Finishing the Job:

What is Needed to 

Eliminate TB in the United States

Maintaining Control: By strengthening current TB control, treatment, and prevention systems, we 

ensure the ability to diagnose and provide proper treatment to people with active TB disease. This will 

prevent spread to others; as well as prevent the emergence of MDR TB and XDR TB. 

Accelerating the Decline: By finding better methods of identifying and treating latent TB infection and 

improving strategies for reaching at-risk populations, we will speed our progress toward elimination. 

Developing New Tools for Diagnosis, Treatment, and Prevention: Through research to develop 

more effective methods of testing for latent TB infection, better drugs to treat latent TB infection, and 

an effective TB vaccine, we can find vital ways to stop the progression from latent infection to contagious 

disease.

Engaging in Global TB Prevention and Control: In providing leadership, contributing technical 

support, and forming international partnerships, we improve global health. Worldwide control of TB is in 

the nation’s best interest. 

Mobilizing Support for TB Elimination: By reaching leaders of high-risk groups, we can work together 

to eliminate a disease that burdens their communities.

Monitoring Progress: By assessing the impact of our elimination efforts, we can continually monitor our 

progress and identify and address any lapses in our efforts. 

Contact Information

Centers for Disease Control and Prevention

Division of Tuberculosis Elimination Website: www.cdc.gov/tb 

State TB Control Offices

Website: www.cdc.gov/tb/links/tboffices.htm

Resources

TB Education and Training Resources Website 

Website: www.findtbresources.org 

TB-Related News and Journal Items Weekly Update 

Website: www.cdcnpin.org/lyris/ui/listservs.aspx#journal 

World Health Organization 

The World Health Organization is the United Nations specialized agency for health.

 

wStop TB Department 

Website: www.who.int/tb/en/

wExtensively Drug-Resistant TB (XDR TB)

Website: www.who.int/tb/challenges/en/

Safer • Healthier • PeopleTM

The Price of Neglect

In the 1970s and early 1980s, the nation let 

its guard down and TB control efforts were 

neglected. The country became complacent about 

TB, and many states and cities redirected TB 

prevention and control funds to other programs. 

Consequently, the trend toward elimination was 

reversed and the nation experienced a resurgence 

of TB, with a 20% increase in TB cases reported 

between 1985 and 1992. Many of these were 

persons with difficult-to-treat drug-resistant TB. 

TB Elimination TM

CS207416-A
A Global 

Perspective

on Tuberculosis

TB is one of the world’s 

deadliest diseases:

One third of the world’s 

population are infected 

with TB. 

Each year, nearly 9 million 

people around the world 

become sick with TB.

Each year, there are almost 

2 million TB-related deaths 

worldwide. 

TB is the leading killer 

of people who are HIV 

infected.

What is TB?

TB is caused by bacteria called Mycobacterium tuberculosis. When a person 

with active TB disease of the lung or throat coughs or sneezes, tiny particles 

containing M. tuberculosis may be expelled into the air. If another person 

inhales air that contains these particles, the bacteria may enter the lungs 

causing infection. 

However, not everyone infected with TB bacteria becomes sick. As a result, two 

TB-related conditions can exist: latent TB infection and active TB disease. 

What You Can Do to Help 

w Find out more about TB services in your area. 

w Educate your community about TB. 

w Ensure that efforts to eliminate TB continue.

TB Continues to Lurk Beneath the Surface

There are an estimated 9 million to 14 million persons in the 

United States infected with M. tuberculosis.

On average, without treatment about 5-10% of infected individuals 

will develop active TB disease at some point in their lives. 

Some underlying conditions increase the risk that latent TB 

infection will progress to active TB disease — for example, the risk 

is higher in persons with HIV infection or diabetes.

The Threat of Drug-Resistant TB

Drug resistance poses a serious threat to our ability to treat and control TB, both in the United 

States and abroad. Drug-resistant TB is extremely difficult and costly to treat. Persons with drugresistant TB are more likely to die of TB than persons with drug-susceptible TB.

Multidrug-Resistant Tuberculosis (MDR TB)

w MDR TB is active TB disease caused by bacteria that are resistant to the two drugs most 

 commonly used for treatment (isoniazid and rifampin).

w Forty-eight states and the District of Columbia have reported diagnosing and caring for 

 persons with MDR TB. 

w It has been estimated that one MDR TB case can cost as much as $1.5 million 

 (direct medical expenses and productivity losses).

Extensively Drug-Resistant Tuberculosis (XDR TB)

w There has been a global emergence of XDR TB, a rare type of MDR TB. 

w XDR TB is resistant to almost all drugs used to treat TB, raising concerns of an epidemic 

 of virtually untreatable TB.

w XDR TB has been found in every region of the world, including the United States. 

w XDR TB is much more expensive to treat (two times that of MDR TB); there are also more 

 side effects from the medications, and the person is more likely to die.

The Global Challenge

In 2008, foreign-born persons accounted for 59% 

of all TB cases diagnosed in the United States, as 

compared to 42% of all TB cases in 1998. 

The number of states with at least 50% of TB 

cases occurring among foreign-born persons has 

increased from 12 states in 1998 to 29 states and 

the District of Columbia in 2008.

HIV and TB Coinfection

Because HIV weakens the immune system, persons with both latent TB infection and HIV infection have 

a very high risk of progressing to active TB disease. 

It is crucial that persons with both latent TB infection and HIV infection receive treatment, coordinated 

in consultation with experts, for both of these conditions. 

The Burden of TB in Minorities

Disparities in TB persist among members of racial and ethnic minority populations. In 2008, the majority 

(81%) of all reported TB cases in the United States occurred in racial and ethnic minorities. 

Several factors likely contribute to the burden of 

TB in minorities:

w Among people from countries where TB is

common, TB disease may result from an

infection acquired in their country of origin. 

w Among racial and ethnic minorities, unequal

distribution of TB risk factors, particularly HIV

infection, can also increase the chance of 

developing the disease.

Percentage of TB Cases Among

Foreign-born Persons, United States* 

>50% 25% –49% <25%

1998 2008

DC DC

*Updated as of May 20, 2009.

Reported TB Cases by Race/Ethnicity*

United States, 2008 

Hispanic or Latino

(29%) Black or 

African-American

(25%)

Asian

(26%)

White

(17%)

American Indian or

Alaska Native (1%)

Native Hawaiian or

Other Pacific Islander

(<1%) 

*All races are non-Hispanic. Persons reporting two or more races

accounted for less than 1% of all cases. 

A Person with

Latent TB Infection

A Person with 

Active TB Disease

w	Usually has a skin test or blood test 

result indicating TB infection

w	Usually has a skin test or blood test 

result indicating TB infection

w	Has a normal chest x-ray and a 

negative sputum test

w	May have an abnormal chest x-ray 

or positive sputum smear or culture

w	Has TB bacteria in his/her body that 

are alive, but inactive

w	Has active TB bacteria in his/her body

w	Does not feel sick w	Feels sick and may have symptoms such 

as coughing, fever, and weight loss

w	Cannot spread TB bacteria to others w	May spread TB bacteria to others

w	Should consider treatment for latent 

TB infection to prevent active 

TB disease

w	Needs treatment for active 

TB disease