Tuberculosis in the United States1993–2017

National Tuberculosis Surveillance System

Division of Tuberculosis Elimination

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Slide 1 (title slide). Tuberculosis in the United States—National Tuberculosis Surveillance System, Highlights from 2017. This slide set was prepared by the Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (HHS). It provides trends for the recent past and highlights data collected through the National Tuberculosis Surveillance System for 2017. Since 1953, through the cooperation of state and local health departments, CDC has collected information on newly reported cases of tuberculosis (TB) disease in the United States. The data presented here were collected by the revised TB case report introduced in 2009. Each individual TB case report (Report of Verified Case of Tuberculosis, or RVCT) is submitted electronically to CDC. The data for this slide set are based on TB case reports for 1993–2017 received by CDC as of June 1, 2018. All case counts and rates for years 1993–2016 have been updated and data from 2017 has been added.

1

Reported Tuberculosis (TB) Cases and Rates United States, 1993–2017

Slide 2. Reported Tuberculosis (TB) Cases and Rates, United States, 1993–2017. The modern era of TB surveillance began in 1993. Case counts decreased each year from 1993 to 2014, and again in 2016 and 2017. However, in 2015, a slight increase occurred in the total number of TB cases reported in the United States. From 1993 until 2000, TB case counts decreased at an average annual percent change APC) of -6.24%, and the incidence rate during this period also declined at a similar pace (APC = -7.30%). The rate of decline in case counts slowed during 2000–2007 (APC = -2.83%) with a similar deceleration in the rate of decline of the incidence rate during this period (APC = -3.70%). Declines in case counts accelerated again during 2007–2012 (APC = -5.88%) with a corresponding decrease in the incidence rate during this period (APC = -6.70%). However, since 2012 the rate of decline has slowed considerably with an APC of -1.50% for the case count and an APC of -2.20% for the incidence rate during this period. In 2017, a total of 9,105 cases (incidence rate = 2.8 cases per 100,000 persons) were reported from the 50 states and the District of Columbia (DC). While this represents the lowest case count and incidence rate on record for the United States, the recent slowing of progress toward TB elimination is of concern.

2

Year

No. of Cases

Cases per 100,000 Population

TB Case Rates,* United States, 2017

*Cases per 100,000

DC, District of Columbia; NYC, New York City (excluded from New York state)

≤2.8 (2017 national average)

>2.8

DC

NYC

Slide 3. TB Case Rates, United States, 2017. Thirty-nine reporting areas reported a rate ≤2.8 cases/100,000 population, the 2017 national average. Eleven states, the District of Columbia (DC) and New York City (NYC) reported a rate >2.8 cases/100,000 population; these accounted for 59% of the national total in 2017.

3

TB Case Rates* by Age Group, United States, 1993–2017

*Cases per 100,000 population

 Cases per 100,000 population

Age (yrs.)

Slide 4. TB Case Rates by Age Group, United States, 1993–2017. During 2017, case rates in all age groups declined by >50% from their 1993 values: persons aged ≥65 years, from 17.7 cases/100,000 population in 1993 to 4.5 in 2017; persons aged 45–64 years, from 12.5 to 3.3; persons aged 25–44 years, from 11.6 to 3.2; persons aged 15–24 years, from 5.0 to 2.0; persons aged 5 to 14 years, from 1.7 to 0.5; and persons aged ≤4 years, from 5.2 to 1.1.

4

Reported TB Cases by Age Group, United States, 2017

Slide 5. Reported TB Cases by Age Group, United States, 2017. Three percent of TB cases were among children aged 0–4 years; 2% were among those aged 5–14 years; 9% were among persons aged 15–24 years; 30% were among adults aged 25–44 years; 30% were among adults aged 45–64 years; and 25% were among adults aged ≥65 years.

5

[CATEGORY NAME] (3%)[CATEGORY NAME] ([VALUE])[CATEGORY NAME] ([VALUE])[CATEGORY NAME]  ([VALUE])[CATEGORY NAME] ([VALUE])[CATEGORY NAME] (25%)0–4 yrs	5–14 yrs	15–24 yrs	25–44 yrs	45–64 yrs	≥65 yrs	0.03	0.02	0.09	0.3	0.3	0.25	
TB Case Rates by Age Group and Sex, United States, 2017*

*Cases per 100,000 population

 Cases per 100,000 persons

Age group (years)

Slide 6. TB Case Rates by Age Group and Sex, United States, 2017. Case rates tended to increase with age, ranging from <1 case/100,000 children aged 5–14 years to a high of 6.6 cases/100,000 men aged ≥65 years.  As age increased, the case rate among men increased faster than women; the rates among men aged ≥45 years were approximately twice those among women of the same age.

6
Male	<	5	5–14 	15–24	25–44	45–64	≥65	1.1000000000000001	0.5	2.2000000000000002	3.7	4.4000000000000004	6.6	Female	<	5	5–14 	15–24	25–44	45–64	≥65	1.2	0.50173904740917352	1.7	2.7	2.2000000000000002	2.9	
TB Case Rates by Race/Ethnicity* United States, 1993–2017

* 	All races are non-Hispanic;  multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin.

† 	Asian race category reporting includes Pacific Islander from 1993–2002; Native Hawaiian/Other Pacific Islander race first reported separately in 2003.

¶ Multiple race rates first reported in 2003.

.

 Cases per 100,000 population

Slide 7. TB Case Rates by Race/Ethnicity, United States, 1993–2017. The rates among most race/ethnicity groups indicate a declining trend in TB since 1993. Asians consistently had the highest yearly TB rates, but their rates declined from 29.3 cases/100,000 population in 2003 to 17.7 in 2017, a 39.7% decrease. Rates also declined among the following racial/ethnic groups: non-Hispanic blacks/African Americans, from 11.7 in 2003 to 4.7 in 2017 (–60.0%); Hispanics, from 10.2 to 4.4 (–57.5%); non-Hispanic whites, from 1.4 to 0.5 (–61.9%); American Indians and Alaska Natives, from 8.3 to 3.9 (–53.0%). Among Native Hawaiian/Other Pacific Islanders the rate increased, from 15.7 to 19.1 (+21.6%). Because of the low TB case counts and population estimates for Native Hawaiians/Other Pacific Islanders in the United States, case rates for this group might appear high. (Percentage change are based on unrounded data.)

Certain key factors likely contribute to the disproportionate burden of TB among minority groups. For persons who were born in countries where TB is common, TB disease can result from infection acquired in their country of origin. Unequal distribution of TB risk factors (e.g., human immunodeficiency virus [HIV] infection) also might contribute to increased exposure to TB or to an increased risk for experiencing TB after becoming infected with Mycobacterium tuberculosis.

7
American Indian/Alaska Native	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	14.433751204581444	17.12621127355116	16.508601550670022	14.675967923549969	13.341547144428819	12.685880614875643	11.945473356658267	11.037270292758837	10.66073439251975	8.6573279835726034	8.3173530186647913	7.237160838754674	7.0901774511315239	7.489477284415397	5.9901788090893984	6.0787447749612928	4.5284868460776204	6.7880762591881458	5.7662292049898847	5.7561205305671637	5.3198358230021974	4.9769528797415044	6.1198993804129449	4.6509035951484785	3.9113016645501251	Asian†	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	42.20519839986823	42.758904638830018	43.408807760138302	39.909799064068402	38.618710539814707	35.649239467682634	34.547543516504035	31.294448934923139	30.939589986325213	28.236185023741591	29.319447326723129	27.291348028926372	25.288666853533666	25.172287395906636	25.482971431275079	24.333775129405741	22.30968771032834	21.40740444262223	20.732585038886072	19.364669564473118	19.110239114321558	18.419198982911311	19.055617253126989	17.92011293200272	17.686084073795431	Black/African American	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	29.053248886781919	26.860267365236545	23.91248145745973	22.212306268674634	20.420935973995775	17.79779286584505	16.768189912729564	14.962593516209475	13.749170506965442	12.715605589184715	11.735906492676515	11.369477600997765	10.938561799886399	10.213312842452311	9.4158748886826817	8.7957566052176706	7.6161963886694792	6.9894020199608589	6.269970226367807	5.7900782251174157	5.3342186910103235	5.0957702450283664	5.0088706372335841	4.909962507546151	4.6983736370565401	Native Hawaiian/Other Pacific Islander†	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	15.685044310250175	14.957939698134531	12.437238011884473	11.616762988993118	20.608582281391751	14.540826003211626	14.971656398434744	19.206453368331761	16.068349271045619	12.475816110309246	11.635937781514624	16.746719667273965	18.38533499161845	13.784498800925331	19.071627832786902	White	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	3.6009967859577836	3.4133556973573205	3.0890574752868418	2.8278081447770154	2.4770708554975505	2.2900110995174856	2.1560888456526284	1.8589511656492479	1.7073622619045439	1.5509287371188027	1.4228001481505943	1.3391919051361858	1.3070832831712575	1.2121969755868356	1.1202397765887591	1.0862975957906424	0.92054449456630105	0.88859956996542977	0.83246109319145212	0.79031930696181496	0.71525170514311953	0.63042672857258286	0.62827254558051615	0.60505088900046244	0.54245868351809257	Multiple Race¶	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	0.91895944979662425	0.8030168872089567	1.0345199051750058	0.83485104972886615	0.48887324494505063	0.79485153336554104	0.88701154537923343	0.74372600708912551	0.96153383877962129	0.94944568196268087	0.82452132899257891	1.2555800725003323	0.65540827667862256	0.9927059816758329	0.98006857597477182	Hispanic/Latino	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	20.366971029381286	19.186006440213685	17.833003111663523	15.986155391551552	14.450444655293841	13.516652059162277	12.330423961715438	10.664046502309118	10.793101547013016	10.288049859105765	10.249834023850877	10.074365005978718	9.3994893130084325	9.0771921144331511	8.3880172530366952	7.9508245685082279	6.8339176964795438	6.3464477556618002	5.7866450857937552	5.2556016708777795	4.9849242518688852	4.9716719593541852	4.7783444579681422	4.5000469491041395	4.3564758275221687	
TB Case Rates by Age Group and Race/Ethnicity,United States, 2017*

 Cases per 100,000 population

* 	All races are non-Hispanic;  multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin.

Slide 8. TB Case Rates by Age Group and Race/Ethnicity, United States, 2017. After early childhood (ages 0–4 years), risk typically increased with age across all racial/ethnic groups, except among Native Hawaiians/Other Pacific Islanders, which did not indicate a trend. Rates were consistently higher among minority racial/ethnic groups than among non-Hispanic whites. Rates were the highest among Asians and Native Hawaiians/Other Pacific Islanders.

8
American Indian/Alaska Native	<	5	5–14	15–24	24–44	45–65	≥65	3.6	1.4	3.3	2.9	5.3	7.3	Asian	<	5	5–14	15–24	24–44	45–65	≥65	3.9	1.7	11.9	14.6	20.8	46.2	Black/African American	<	5	5–14	15–24	24–44	45–65	≥65	2.1	0.9	3	6.3	5.9	6.3	Native Hawaiian/Other Pacific Islander	<	5	5–14	15–24	24–44	45–65	≥65	24.5	22	16.5	19.899999999999999	16.899999999999999	17	White	<	5	5–14	15–24	24–44	45–65	≥65	0.1	0	0.2	0.4	0.7	1.1000000000000001	Multiple race	<	5	5–14	15–24	24–44	45–65	≥65	0.3	0.1	0.7	1.4	2	3.4	Hispanic/Latino	<	5	5–14	15–24	24–44	45–65	≥65	1.9	0.8	3.1	4.7	6.3	12.2	
Reported TB Cases by Race/Ethnicity,*United States, 2017†

Hispanic/Latino 28%

Native Hawaiian/Pacific Islander 1%

American Indian/Alaska Native  1%

Black/African American 21%

Asian 36%

Multiple race 1%

White 12%

* 	All races are non-Hispanic;  multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin.

† 	Percentages are rounded.

Slide 9. Reported TB Cases by Race/Ethnicity, United States, 2017. During 2017, approximately 88% of all reported TB cases occurred among racial/ethnic minorities: Asians, 36%; Hispanics, 28%; non-Hispanic blacks/African Americans, 21%; American Indians/Alaska Natives, 1%; and Native Hawaiians/Other Pacific Islanders, 1%. In contrast, 12% of cases occurred among non-Hispanic whites. Persons reporting two or more races, not including persons of Hispanic or Latino ethnicity, accounted for 1% of all cases. Unknown or missing data on race accounted for <0.5% of all cases.

9
Sales	American Indian/Alaska Native	Asian	Black/African American	Native Hawaiian	White	Hispanic/Latino	Multiple race	Unknown/missing	0.01	0.36	0.21	0.01	0.12	0.28000000000000003	0.01	0	
TB Cases and Rates Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2017

No. of cases

Cases per 100,000 Population

Slide 10. TB Cases and Rates Among U.S.-Born versus Non-U.S.–Born Persons, United States 1993–2017. The graph illustrates the increase in the percentage of cases occurring among non-U.S.–born persons during the study period, from 29% in 1993 to 70% in 2017. Overall, the number of cases among non-U.S.–born remained stable before 2009, with approximately 7,400–8,000 cases/year. During 2009, the number decreased to 6,996, and that trend continued through 2013, with the number of cases among non-U.S.–born persons decreasing to 6,222. In 2014 and 2015 the number of cases among non-U.S.–born persons increased to a high of 6,406 in 2015. However, in 2016, the number of cases decreased to 6,356 cases, yet increased again in 2017 to 6,384. Among U.S.-born persons the number of cases decreased from >17,000 in 1993 to 2,705 in 2017. The incidence rate for U.S.-born persons decreased from 7.4 in 1993 to 1.0 in 2017, but the incidence rate among non-U.S.–born persons is considerably higher, although it has also decreased from 34.0 in 1993 to 14.7 in 2017.

10
U.S.-born Cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	17433	16180	14663	13385	11924	10609	9783	8632	7848	7263	6842	6601	6290	5858	5429	5237	4501	4323	3939	3625	3330	3129	3136	2889	2705	Non-U.S.–born Cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	7403	7762	8010	7752	7753	7623	7624	7634	8034	7737	7947	7875	7745	7845	7780	7643	6996	6768	6560	6306	6222	6264	6406	6356	6384	U.S.-born Rate	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	7.3859568103919431	6.7926527997276622	6.0869929806339558	5.5737582149742204	4.9356972486356367	4.3716824981131381	3.9965217719112598	3.5200139195508733	3.1711672175141978	2.9221689650479785	2.7062156925260541	2.5944950694590667	2.4524869927829465	2.2739775757396017	2.0898056022333766	2.0043412799743314	1.7038128207966583	1.6262027815959708	1.4729781320297872	1.3467819623979664	1.227461150098955	1.1468664072757118	1.1445420054580346	1.04809354070508	0.97732041799643821	Non-U.S.–born Rate	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	34.030523122184427	36.077953665161267	38.013657770964528	32.03564717875544	30.874488732125762	28.884921532896222	28.135519912965883	26.47114406037668	27.642608800279469	25.533568920686434	23.882313297303607	23.223548223749493	22.293722689290185	21.651582133130983	20.902244581355042	20.178300351373828	18.776549453153127	17.643746020674413	17.02577380325161	15.973561602435481	15.691099497433401	15.535098584138456	15.24831292032685	14.742328179162428	14.691151673990458	
Reported TB Cases by Origin and Race/Ethnicity*, United States, 2017†

U.S.-born persons

Non-U.S.–born persons§

* 	All races are non-Hispanic;  multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin.

† 	Percentages are rounded.

§	American Indian/Alaska Native accounted for <1% of cases among non-U.S.–born persons and are not shown.

Slide 11. Reported TB Cases, by Origin and Race/Ethnicity, United States, 2017. Among U.S.-born persons with TB in 2017, 37% were non-Hispanic black/African American; 30% were non-Hispanic white, 22% were Hispanic/Latino; 5% were Asian; 3% were American Indian/Alaska Native; and 2% were Native Hawaiian/Other Pacific Islander. Persons reporting two or more races totaled 1% of cases among U.S.-born persons. Among non-U.S.–born persons with TB, 49% were Asian; 31% were Hispanic/Latino; 14% were non-Hispanic black/African American; 4% were non-Hispanic white; 1% were Native Hawaiian/Pacific Islander; and 1% were persons reporting two or more races, not including persons of Hispanic/Latino origin. Cases among American Indians/Alaska Natives constituted 0.03% of the cases among non-U.S.–born persons and are not included on the charts.  

11
Column1	
[CATEGORY NAME][VALUE][CATEGORY NAME] [PERCENTAGE][CATEGORY NAME] 1%[CATEGORY NAME] [PERCENTAGE]Hispanic/Latino	Asian	Black/African American	Native Hawaiian/Pacific Islander	White	Multiple race	0.31	0.49	0.14000000000000001	0.01	0.04	0.01	Sales	[CATEGORY NAME]22%[CATEGORY NAME][VALUE][CATEGORY NAME][VALUE][CATEGORY NAME]5%[CATEGORY NAME]37%[CATEGORY NAME][VALUE][CATEGORY NAME][VALUE]Hispanic/Latino	American Indian/Alaska Native	Asian	Black/African American	Native Hawaiian/Pacific Islander	White	Multiple race	0.22	0.03	0.05	0.37	0.02	0.3	0.01	
Percentage of Non-U.S.–Born PersonsAmong TB Cases, United States, 2007 and 2017

2007

2017

DC

DC

≥50%

25%–49%

≤24%

DC, District of Columbia

NYC, New York City (excluded from New York state)

NYC

NYC

Slide 12. Percentage of Non-U.S.–Born Persons Among TB Cases, United States, 2007 and 2017. The number of states with <25% of their TB cases occurring among non-U.S.–born persons decreased from 7 states in 2007 to 3 states in 2017. The number of states with ≥25%–49% of cases among non-U.S.–born persons decreased from 14 states in 2007 to 10 states in 2017. However, the number of states that had ≥50% of their cases among non-U.S.–born persons increased from 29 states, DC, and NYC in 2007 to 37 states, DC, and NYC in 2017.

12

Countries of Birth Among Non-U.S.–Born Persons Reported with TB, United States, 2017

*Percentages are rounded.

Slide 13. Countries of Birth Among Non-U.S.–Born Persons Reported with TB, United States, 2017. The top seven countries are displayed in the chart; those countries have remained relatively constant since 1986, when information regarding country of birth was first reported by all areas submitting reports to CDC. During 2017, the top seven countries accounted for 61% of all cases among non-U.S.–born persons, with Mexico accounting for 19%; the Philippines, 13%; India, 9%; Vietnam, 8%; China, 6%; Guatemala, 3%; and Haiti, 3%. Persons from 139 other countries each accounted for ≤2.5% of the total, but altogether, accounted for 39% of non-U.S.–born persons reported with TB.

13
Column1	
[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]

[CATEGORY NAME] [PERCENTAGE]
Mexico	Philippines	India	Vietnam	China	Guatemala	Haiti	Other countries	19	12.5	9.4	8.4	6.3	2.8	2.6	39.000000000000007	Column2	Mexico	Philippines	India	Vietnam	China	Guatemala	Haiti	Other countries	60.999999999999993	
Percentage of Non-U.S.–Born Persons with TB,by Time of Residence in U.S. Before Diagnosis, 2017

Percentage

Slide 14. Percentage of Non-U.S.–Born Persons with TB, by Time of Residence in U.S. Before Diagnosis, 2017. The chart indicates the distribution for the top three countries of birth (Mexico, the Philippines, and India). Among persons born in Mexico, 12.0% had been in the United States for <1 year; 8.1%, 1–4 years; 8.6%, 5–9 years; 21.0%, 10–19 years; and 36.9% for ≥20 years. Among persons born in the Philippines, 10.8% had been in the United States for <1 year; 12.5%, 1–4 years; 11.1%, 5–9 years; 21.1%, 10–19 years; and 33.5%, ≥20 years. Among persons born in India, 16.7% had been in the United States for <1 year; 24.8%, 1–4 years; 12.5%, 5–9 years; 18.3%, 10–19 years; and 18.0%, ≥20 years. Values for unknown length of residence in the United States for these top three countries ranged from 9.7 to 13.4% for 2017. For all other non-U.S.–born persons, 18.8% had been in the United States for <1 year; 18.9%, 1–4 years; 13.2%, 5–9 years; 16.4%, 10–19 years; 24.3%, ≥20 years; and 8.4%, unknown length of residence. Overall, 16.3% had been in the United States for <1 year; 16.6%, 1–4 years; 12.0%, 5–9 years; 18.1%, 10–19 years; 27.2%, ≥20 years; and 9.8%, unknown length of residence.

14
Unknown	Mexico	Philippines	India	All other non-U.S.–born	13.4	11.1	9.6999999999999993	8.44	≤12 mos.	Mexico	Philippines	India	All other non-U.S.–born	12	10.8	16.7	18.760000000000002	1–4 years	Mexico	Philippines	India	All other non-U.S.–born	8.1	12.5	24.8	18.95	5–9 years	Mexico	Philippines	India	All other non-U.S.–born	8.6	11.1	12.5	13.15	10–19 years	Mexico	Philippines	India	All other non-U.S.–born	21	21.1	18.3	16.43	≥20 years	Mexico	Philippines	India	All other non-U.S.–born	36.9	33.5	18	24.27	
Primary Anti-TB Drug Resistance, United States, 1993–2017*

* 	 Based on initial isolates from persons with no prior history of TB; multidrug-resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.	

Resistant (%)

Year

Slide 15. Primary Anti-TB Drug Resistance, United States, 1993–2017. The graph starts in 1993, the year in which the individual TB case reports submitted to the national surveillance system began collecting information regarding initial susceptibility test results for patients with culture-positive TB. Data were available for >87.1% of culture-positive cases for each year. Primary resistance was calculated by using data from persons with no reported prior TB episode. Resistance to at least isoniazid was 8.2% in 1993; however, by 2017, this had increased to 8.8%. Resistance to at least isoniazid and rifampin, known as multidrug-resistant TB (MDR TB), was 2.5% in 1993. The percent of primary MDR TB has remained approximately stable since it decreased to 1.0% in 1998. However, in 2017, the percent of primary MDR TB increased to 1.6%.

15
Isoniazid	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	8.1999999999999993	8.1999999999999993	7.3	7.4	7.5	7.5	7.1	7.5	6.9	7.6	7.7	7.6	7.6	7.8	7.4	8.3000000000000007	8.4	8	9.1	9	9.1	9.1999999999999993	9.1	8.8000000000000007	8.8000000000000007	MDR TB	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2.5	2.2000000000000002	1.6	1.3	1.1000000000000001	1	1	1	1	1.2	0.9	1	1	1	1	0.9	1.2	1.1000000000000001	1.3	1.1000000000000001	1.2	1	1	1.2	1.6	
Primary MDR TB, United States, 1993–2017*

* 	 Based on initial isolates from persons with no prior history of TB; multidrug-resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.	

Slide 16. Primary MDR TB, United States, 1993–2017. This graph focuses on trends in primary multidrug-resistant TB (MDR TB), which is based on initial isolates from persons with no prior history of TB. The number of primary MDR-TB cases, represented by the bars, decreased steadily from 407 in 1993 to 115 in 2001, with a slight increase to 132 in 2002. Since then, the total number of primary MDR-TB cases has fluctuated from 70 to 103 cases, with 97 cases reported for 2017. Primary MDR TB, indicated by the trend line, decreased from 2.5% in 1993 to approximately 1.0% in 1998, and had changed little until 2017 when it increased to 1.6%.

16
Number of cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	407	353	254	207	155	132	127	120	115	132	94	100	98	103	101	88	90	87	101	77	83	70	72	78	97	Percentage of total cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2.5	2.2000000000000002	1.6	1.3	1.1000000000000001	1	1	1	1	1.2	0.9	1	1	1	1	0.9	1.2	1.1000000000000001	1.3	1.1000000000000001	1.2	1	1	1.2	1.6	
Year

Primary Isoniazid Resistance Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2017*

Isoniazid-Resistant (%)

* 	 Based on initial isolates from persons with no prior history of TB.	

Slide 17. Primary Isoniazid Resistance Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2017. On the basis of initial isolates from persons with no prior history of TB, the percentage of isoniazid resistance has remained higher among non-U.S.–born persons than among U.S.-born persons for all years measured. Among non-U.S.–born persons, the percentage declined from 12.1% in 1993 to 10.1% in 2017. In U.S.-born persons, the percentage decreased from 6.7% in 1993 to 4.2% in 2007. From 2008 to 2016 the percentage of cases ranged from 5.2% in 2008 to a high of 7.5% in 2014. During 2017, the percentage of primary isoniazid resistance among U.S.-born cases was 5.4%.

17
U.S.-born	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	6.7	6.4	5.4	5.0999999999999996	5	4.8	4.0999999999999996	4.4000000000000004	4.3	4.0999999999999996	4.4000000000000004	4.5999999999999996	4.3	4.2	4.2	5.2	6.2	5.6	6.4	6	5.7	7.5	6.8	6.1	5.4	Non-U.S.–born	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	12.1	11.9	10.9	11.2	11.2	11.3	11	10.9	9.4	10.8	10.3	10.1	10	10.3	9.5	10.3	9.8000000000000007	9.5	10.6	10.7	10.7	10.1	10.1	10.1	10.1	
Primary MDR TB Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2017*

* 	 Based on initial isolates from persons with no prior history of TB; multidrug-resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.	

Multidrug-Resistant (%)

Slide 18. Primary MDR TB in U.S.-born versus Non-U.S.–born Persons, United States, 1993–2017. This graph highlights primary MDR TB in U.S.-born versus non-U.S.–born persons. The percentage with primary MDR TB has declined among both groups since 1993, although the decline in the U.S.-born has been greater. The proportion of primary MDR-TB cases in the United States that are attributed to non-U.S.–born persons increased from approximately 25% in 1993 to 85% in 2017 (not shown on slide). Among the U.S.-born, the percentage with primary MDR TB has been less than 1% since 1997 and was 0.9% in 2017. The percentage among non-U.S.–born persons has fluctuated year by year, although it has remained between 1.2 and 1.8% since 1995. In 2017, the percentage of primary MDR TB among non-U.S.–born persons was 1.8%.

18
U.S.-born	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2.5	2.2000000000000002	1.6	1.1000000000000001	0.9	0.7	0.6	0.7	0.6	0.7	0.5	0.6	0.5	0.5	0.5	0.6	0.4	0.5	0.6	0.5	0.3	0.5	0.5	0.4	0.9	Non-U.S.–born	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2.2000000000000002	2.1	1.5	1.8	1.4	1.3	1.6	1.4	1.4	1.7	1.2	1.3	1.4	1.5	1.4	1.2	1.7	1.5	1.7	1.4	1.7	1.3	1.3	1.5	1.8	
XDR TB* Case Count, Defined on Initial DST,† by Year, 1993–2017§

*	XDR TB, extensively drug-resistant TB.

†	DST, drug susceptibility test.

§	XDR TB is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-TB drugs.

Case count

Year of diagnosis

Slide 19. XDR TB Case Count, Defined on Initial DST, United States, 1993–2017. Extensively drug-resistant TB (XDR TB) at first drug susceptibility test (DST) is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-TB drugs. Two cases of XDR TB were reported in 2017, and the most reported in a single year was 10 in 1993. No cases were reported in 2003 and 2009, and no apparent trend exists in the number of cases over time.

19
Series 1	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	10	6	1	3	2	1	6	1	4	6	0	4	3	4	2	6	0	2	5	2	5	2	1	1	2	
Reporting of HIV Test Results Among Persons with TB, by Age Group, United States, 1993–2017*

* 	 Includes persons with positive, negative, or indeterminate human immunodeficiency virus (HIV) test results and persons from California with co-diagnosis of TB and acquired immunodeficiency syndrome (AIDS) (co-diagnosis with AIDS in California was only for a period ending in 2004). Rhode Island did not report HIV test results for years 1993–1997. HIV test results for Vermont are not included for years 2007–2013. HIV test results for California are not included for years 2005–2010.

With test results (%)

Slide 20. Reporting of HIV Test Results in Persons with TB by Age Group, United States, 1993–2017. This slide shows the completeness of reporting of HIV test results in persons with TB by age group from 1993 through 2017. The percentage of TB patients for whom test results were reported increased from 30% among all ages in 1993 to 89% in 2017. Among adults 25–44 years of age, the percentage increased from 45% in 1993 to 93% in 2017. California began reporting HIV test results to CDC in 2011; this accounts for the substantial percentage increase for that year.

20
All ages	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	29.9	32.799999999999997	36.299999999999997	42	45	46	48.9	50.3	51.4	53.8	55.4	59.2	59.2	61.4	63.6	64.599999999999994	65.099999999999994	68.400000000000006	84.8	86.7	89.4	89.9	90.3	90.6	88.9	Ages 25–44 yrs	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	45.1	48.7	51.8	57.4	60.1	60.9	62.7	63.2	63.9	66.400000000000006	67.5	69.599999999999994	69.2	70.3	73.400000000000006	73.5	73.599999999999994	76.3	91.4	93	94.9	95	95.7	95.3	93.4	
Estimated HIV Coinfection Among Persons Reported with TB, United States, 1993–2017*

Coinfection (%)

* 	Minimum estimates are based on reported HIV-positive status among all TB patients in the age group.	

Slide 21. Estimated HIV Coinfection in Persons Reported with TB, United States, 1993–2017. This slide provides minimum estimates of HIV coinfection among persons reported with TB from 1993 through 2017. Since the addition of the request for HIV status to the individual TB case report in 1993, incomplete reporting has provided a challenge to calculating reliable estimates, although reporting improved substantially beginning in 2011. Results from the cross-matching of TB and AIDS registries have been used to supplement reported HIV test results. For all ages, the estimated percentage of HIV coinfection in persons who reported HIV testing (positive, negative, or indeterminate test results) with TB decreased from 48% to 6% overall from 1993–2017, and from 63% to 9% among persons 25 to 44 years of age during this period. 

21
All ages	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	48.2	44.5	36.1	28.6	23.3	21.5	20	17.5	17.100000000000001	17	15.9	13.7	12.5	11.3	10.199999999999999	9.6999999999999993	9.4	8	7.4	7.2	6.4	5.9	5.4	5.5	5.5	Ages 25–44 yrs	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	62.5	58.9	49.6	41.4	34.700000000000003	31.3	30	26.4	25.2	23.7	23.1	19.3	18.399999999999999	16.7	14.9	12.9	13.5	11.3	10.8	11.4	9.3000000000000007	8.6	7.5	8.5	9.1999999999999993	
TB Cases Among Persons Ages ≥15 Years Residing in Correctional Facilities, United States, 1993–2017*

No. of cases

Percentage

* 	 Resident of correctional facility at time of TB diagnosis.	

Slide 22. TB Cases by Residence in Correctional Facilities, Ages ≥15, United States, 1993-2017. This graph highlights the number of cases among persons who were residents of any type of correctional facility at the time of TB diagnosis. Cases must have occurred in persons 15 years of age or older. The number of cases among persons residing in a correctional facility has decreased from a high of 1,117 cases in 1994 to 268 cases in 2017. Between the years 2000 and 2010, the number of cases residing in a correctional facility ranged between the mid to high-400s and high-500s; 2011 was the first year to drop below this range to 423 cases. Of total cases, the percentage of cases among persons residing in a correctional facility has ranged from 5.0% in 1994 to 3.1% in 2017. The 1990s saw a decreasing trend in percentage until 2002. Since 2002, there was an increasing trend in percentage until 2015 when the percentage dropped below 4.0% again. In 2017, the percentage of total cases was 3.1%.

22
No. of cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	950	1117	937	782	747	657	576	587	522	460	476	495	537	508	481	497	464	491	423	391	364	377	334	329	268	Percentage of total cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	4.0599999999999996	4.96	4.42	3.94	4.04	3.82	3.5	3.83	3.48	3.26	3.42	3.65	4.0599999999999996	3.93	3.85	4.1100000000000003	4.2699999999999996	4.6900000000000004	4.26	4.1399999999999997	4.01	4.22	3.67	3.71	3.09	
TB Cases Reported Among Homeless Persons During the 12 Months Before Diagnosis, Ages ≥15 Years, United States, 1993–2017*

No. of cases

Percentage

* 	 Homeless during the 12 months before TB diagnosis.	

Slide 23. TB Cases by Homeless Status, Ages ≥15, United States, 1993–2017. This graph highlights the status of cases that occurred among persons experiencing homelessness within twelve months before TB diagnosis during 1993–2017. Cases shown occurred in persons 15 years of age or older. The number of cases among persons experiencing homelessness has decreased from a high of 1,379 cases in 1994 to 397 in 2017. This category has seen an overall decrease in cases since 1994, with the exception of the slight increases observed in years 2003, 2006, and 2010. Of total cases, the percentages of cases occurring in persons experiencing homelessness have declined overall from 5.2% in 1993 to 4.6% in 2017.

23
No. of cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	1216	1379	1343	1319	1259	1150	1099	975	927	892	936	832	816	818	733	691	579	587	573	533	532	512	503	434	397	Percentage of total cases	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	5.19	6.12	6.34	6.65	6.81	6.68	6.68	6.35	6.17	6.32	6.72	6.14	6.18	6.33	5.86	5.71	5.33	5.61	5.77	5.64	5.86	5.73	5.52	4.9000000000000004	4.58	
Mode of Treatment Administration Among Persons Reported with TB, United States, 1993–2015*

Percentage†

Year

DOT, directly observed therapy; SA, self-administered therapy.

*	Data available through 2015 only.

†	Percentage of total cases among persons alive at diagnosis, with an initial regimen of one or more drugs prescribed and excluding cases with unknown mode of treatment administration.

Slide 24. Mode of Treatment Administration in Persons Reported with TB, United States, 1993–2015. In 1993, the reporting areas began providing information about mode of treatment administration on the individual TB case report form. Treatment administered as only directly observed therapy (DOT) increased from 21.7% in 1993 to 65.1% in 2015, the latest year with available data. The proportion of patients who received at least some portion of their treatment as DOT (based on combining the percentage of patients who received only DOT and the percentage for whom some portion was self-administered) was 93.6% in 2015.

.

24
DOT only	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	21.7	28.1	37.299999999999997	42.5	47	47.7	49.4	52.5	53.6	55.4	56.5	58.9	57.9	57.5	56.3	56.4	59.6	59.3	62.2	61.8	63.2	63.8	65.099999999999994	DOT + SA	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	14.4	20.5	21.5	22.4	23.8	26.6	27.6	25.8	27.5	27.8	28.5	27.7	29.6	30.4	32.9	33.5	30.3	31	29.2	29.1	28.9	29.1	28.5	SA only	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	63.8	51.4	41.2	35.099999999999994	29.200000000000003	25.699999999999989	23	21.700000000000003	18.8	16.799999999999997	15	13.400000000000006	12.5	12.099999999999994	10.800000000000011	10.099999999999994	10.099999999999994	9.7000000000000028	8.5999999999999943	9.0999999999999943	7.9000000000000057	7.0999999999999943	6.4000000000000057	
Completion of TB Treatment Therapy,United States, 1993–2015*

* 	Data available through 2015 only.

Note: Includes persons alive at diagnosis, with initial drug regimen of one or more drugs prescribed, who did not die within one year of initiating treatment;

excludes persons with initial rifampin-resistant isolate, patients with bone and joint disease, meningeal disease, or disease of the central nervous system, or

pediatric patients (ages 0–14 years) with miliary disease or positive blood culture or a positive nucleic acid amplification test on a blood specimen, and those

who moved out of the country within one year of initiating treatment.

Percentage

Slide 25. Completion of TB Therapy, United States, 1993–2015. The reporting areas began providing information on completion of therapy in 1993 through the individual TB case report form. The calculations exclude persons with initial isolate rifampin resistant, or patient with bone and joint disease, meningeal disease or disease of the central nervous system, or pediatric patient (age <15) with miliary disease or positive blood culture or a positive nucleic acid amplification test on a blood specimen, and those who moved out of the country within one year of initiating treatment. Overall completion of therapy had remained at approximately 92-93% from 1998 through 2008, but increased to 95-97% from 2009 to 2015. In 2015, the latest year with available data, completion of therapy was 96%. Completion in 1 year or less increased from 63% in 1993 to 90% in 2015. The current DHHS Healthy People 2020 objective is completion of therapy in 1 year or less in 93% of patients. CDC is working with state and local health departments to determine and evaluate reasons for apparently delayed completion of therapy, which may vary by jurisdiction.

25
Completed in ≤1 year	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	63.4	68.599999999999994	74.099999999999994	76.8	78.7	81.2	81.400000000000006	82.2	82.5	83	83.6	84.3	84	84.8	85.6	86.1	88.8	89.6	89.7	90.1	89.9	90.2	89.5	Completed	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	86	86.8	89.2	90.2	91	92.2	92.2	92.5	92.7	92.5	92.8	92.6	92.5	93.2	93.9	93.3	95.6	96.1	96.4	96.4	96.3	96.8	95.8	
Definition for Tuberculosis Genotypingin the United States

Initial 12-locus MIRU-VNTR*: 223325173533

Spoligotype: 000000000003771

PCRType:PCR00002

Additional 12-locus MIRU-VNTR (MIRU2): 444534423428†

+

GENType:

G00010

Sequentially assigned for each unique spoligotype and initial 12-locus MIRU-VNTR combination

Sequentially assigned for each unique spoligotype and 24-locus MIRU-VNTR combination

*	Mycobacterial interspersed repetitive unit–variable number tandem repeat.

†	The complete set of 24 loci is referred to as 24-locus MIRU-VNTR and is used for GENType designation for genotype in the United States.

Slide 26. Definition for Tuberculosis Genotyping in the United States. This slide shows the schematic for sequential assignment of unique spoligotypes and initial 12-locus MIRU-VNTR combination or 24-locus MIRU-VNTR combination.

26

National Tuberculosis Genotyping Surveillance Coverage* by Year: United States†, 2004–2017

* The proportion of positive cultures with at least one genotyped isolate.

† Includes 50 states and the District of Columbia.

§ For the year 2020, the national goal for TB genotyping surveillance coverage will change to 100%.

National Goal, 94%§

Slide 27. National Tuberculosis Genotyping Surveillance Coverage by Year, United States, 2004–2017. This slide shows the increase in genotyping surveillance coverage from 2004 to 2017. In 2004, the proportion of culture confirmed TB cases with at least one genotyped isolate was 52.6%; in 2017 it was 96.3%. The national goal for genotyping surveillance coverage is 94.0%.

27
Coverage (%)	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	52.564668491215684	68.449393082048005	70.067014147431124	80.844124700239803	81.606786427145707	86.880630630630634	91.583452211126954	94.223156853043051	94.872803566745347	95.860477741585242	96.667588495575217	97.142086815853332	97.420164551666431	96.343692870201096	National Goal	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	94	94	94	94	94	94	94	94	94	94	94	94	94	94	
Proportion of culture confirmed TB cases genotyped (%)

Number of County-based Tuberculosis Genotype Clusters* by Cluster Size, United States, 2015–2017

*Genotype cluster is defined as two or more cases with matching spoligotype and 24-locus MIRU-VNTR (GENType) within a county  during the specified 3-year time period.

Slide 28. Number of County-based Tuberculosis Genotype Clusters by Cluster Size, United States, 2015–2017. This slide shows the number of county-based TB genotype clusters by the size of the clusters; a genotype cluster is defined as two or more cases with matching spoligotype and 24-locus MIRU-VNTR (GENType) within a county during the specified three year time period. In the 2015–2017 three year time period, there were 928 two-case clusters, 229 three-case clusters, 110 four-case clusters, 46 five-case clusters, 22 six-case clusters, 17 seven-case clusters, 11 eight-case clusters, 10 nine-case clusters, and 36 case clusters that were greater or equal to 10 in size.

28
Number of clusters	2 case cluster	3 case cluster	4 case cluster	5 case cluster	6 case cluster	7 case cluster	8 case cluster	9 case cluster	≥10 case cluster	928	229	110	46	22	17	11	10	36	
Number of Persons in Cluster

Number of clusters

Tuberculosis Genotype Clusters by TB GIMS* Alert Levels†, United States, 2015–2017

*Tuberculosis  Genotyping Information Management System

†Alert level is determined by the log likelihood ratio statistic (LLR) for a given cluster, identifying higher than expected geospatial concentrations for a TB genotype cluster in a specific county, compared to the national distribution of that genotype; TB GIMS generates alert level notifications based on this statistic: “No alert” is indicated if LLR  is between 0 – <5, “medium” is for LLR of 5 – <10 and “high” alert is for clusters with LLR ≥ 10.

Slide 29. Tuberculosis Genotype Clusters by TB GIMS Alert Levels, United States, 2015–2017. This slide shows a chart with percentages of genotype clusters by alert level. Alert level is determined by the log likelihood ratio statistic (LLR) for a given cluster, identifying higher than expected geospatial concentrations for a TB genotype cluster in a specific county, compared to the national distribution of that genotype; TB GIMS generates alert level notifications based on this statistic: “No alert” is indicated if LLR is between 0–<5, “medium” is for LLR of 5–<10 and “high” alert is for clusters with LLR ≥10. In the 2015–2017 three year time period, high alerts made up 5% of the total, medium alerts were 24%, and no alert were 71%.

29
Number	
[CATEGORY NAME], [VALUE] ([PERCENTAGE])

[CATEGORY NAME], [VALUE] ([PERCENTAGE])

[CATEGORY NAME], [VALUE] ([PERCENTAGE])
High Alert	Medium Alert	No Alert	76	335	998	Percent	High Alert	Medium Alert	No Alert	5.3938963804116398E-2	0.23775727466288146	0.70830376153300212	
Division of Tuberculosis Elimination 

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention 

1600 Clifton Road NE

US 12-4

Atlanta, GA 30329

Phone: 404-639-8120

Internet Address: http://www.cdc.gov/tb/

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Slide 30. (final slide). For more information, please contact Division of Tuberculosis Elimination at http://www.cdc.gov/tb/.

30
image1.wmfimage7.pngMicrosoft_Excel_Worksheet.xlsxMicrosoft_Excel_Worksheet1.xlsxMicrosoft_Excel_Worksheet2.xlsxMicrosoft_Excel_Worksheet3.xlsxMicrosoft_Excel_Worksheet4.xlsxMicrosoft_Excel_Worksheet5.xlsxMicrosoft_Excel_Worksheet6.xlsxMicrosoft_Excel_Worksheet7.xlsxMicrosoft_Excel_Worksheet8.xlsxMicrosoft_Excel_Worksheet9.xlsxMicrosoft_Excel_Worksheet10.xlsxMicrosoft_Excel_Worksheet11.xlsxMicrosoft_Excel_Worksheet12.xlsxMicrosoft_Excel_Worksheet13.xlsxMicrosoft_Excel_Worksheet14.xlsxMicrosoft_Excel_Worksheet15.xlsxMicrosoft_Excel_Worksheet16.xlsxMicrosoft_Excel_Worksheet17.xlsxMicrosoft_Excel_Worksheet18.xlsxMicrosoft_Excel_Worksheet19.xlsxMicrosoft_Excel_Worksheet20.xlsxMicrosoft_Excel_Worksheet21.xlsxMicrosoft_Excel_Worksheet22.xlsxMicrosoft_Excel_Worksheet23.xlsxMicrosoft_Excel_Worksheet24.xlsxMicrosoft_Excel_Worksheet25.xlsximage3.wmfimage4.png