Slide 1: This slide set is an introduction on the basics of tuberculosis, often referred to as TB.

Slide 2: This Slide Deck Coversthe Following Topics about Tuberculosis(TB):

1. What is Tuberculosis(TB)?

2. How TB spreads

3. Latent TB Infection and TB Disease

4. Risk Factors

5. TB Testing

6. Treatment

7. TB Elimination

Slide 3: What is Tuberculosis(TB)?

Slide 4: TB is an airborne disease that spreads from person to person through the air. When a person 

breathes in TB germs, the germs can settle in the lungs and begin to grow. From there, the germs can 

move through the blood to other parts of the body, like the kidney, spine, or brain. Pulmonary TB is TB in 

the lungs. Extrapulmonary TB is TB disease that occurs in places other than the lungs.

Slide 5: Tuberculosis is preventable and treatable but remains the world’s deadliest infectious-disease 

killer. After decreasing considerably in 2020, TB cases increased in 2021 and 2022, but remain lower than 

in 2019.

Slide 6: This graph shows the number of TB cases for each year from 1982 to 2022 (the most recent year 

for which TB data are available). In 1992, the U.S. had the highest number of reported TB cases during 

this period.

2022 saw some of the lowest number of U.S. TB cases and lowest incidence rate on record, continuing a 

trend of declining cases and incidence since 1992. There were 8,331 TB cases in the United States in 2022.

Reaching the goal of TB elimination in the United States requires maintaining and strengthening current 

TB control priorities, while increasing efforts to identify and treat latent TB infection (LTBI) among highrisk populations. The TB elimination threshold is <1 case per 1,000,000 population, which is 

approximately 330 cases per year for the current U.S. population.

Slide 7: TB is still a life-threatening problem in this country, and it impacts people across the United 

States. TB knows no borders, and people in the United States are suffering from TB. Anyone can get TB.

CDC has worked with the We Are TB Survivors Network and the National TB Coalition of America to 

highlight the personal experiences of people who have been diagnosed with and treated for TB 

disease, as well as the work of TB control professionals. These stories provide insight into some of the 

challenges TB survivors have had to overcome regarding their diagnosis and treatment of TB.

Slide 8: This video shares a personal story of a TB survivor in the United States.

Tenzin’s treatment for multidrug-resistant TB lasted for over 2 years. With the help of his local and state 

TB programs, Tenzin began the long and challenging treatment process.

Slide 9: How TB Spreads

Slide 10: This image shows how TB germs spread through the air. The TB germs are put into the air when a 

person with TB disease (on the left) of the lungs or throat coughs, speaks, or sings. People nearby may
breathe in these germs (illustrated by the person on the right) and become infected. The person on the 

left has TB disease and is putting TB germs into the air. The person on the right is breathing in the TB 

germs into their lungs.

The best way to stop TB spread is to

- Identify people who have TB.

- Isolate those who are contagious.

- Provide treatment assoon as possible to anyone who is contagious.

People with TB disease are most likely to spread it to people they spend time with every day, including 

family members, friends, coworkers, or schoolmates.

Slide 11: TB is not spread by:

- Sharing toothbrushes

- Saliva from kissing

- Shaking someone’s hand

- Touching bed linens or toilets

- Sharing food, drink, or utensils

Slide 12: Inactive TB and TB Disease

Slide 13: Not everyone infected with TB germs becomes sick. As a result, two TB-related conditions exist: 

Inactive TB (also called latent TB infection) and TB disease.

TB germs can live in the body without making you sick. This is called inactive TB or latent TB infection.

People with inactive TB have TB germs in their bodies, but do not have TB disease and cannot spread the 

infection to other people.

TB germs become active if the immune system can’t stop them from growing. When TB germs are active 

(multiplying in your body), this is called TB disease.

On this slide, the lung with inactive TB (top) has a small amount of TB due to the immune system 

controlling the germs. The lung with TB disease (bottom) is full of TB because the immune system cannot 

stop the TB germs from growing and multiplying.

Slide 14: Not everyone who is infected with TB becomes sick.

Person with Inactive TB:

- Has a small amount of TB germs in his/her body that are alive but inactive

- Cannotspread TB germs to others

- Does not feel sick, but may become sick if the germs become active in his/her body

- Usually has a positive TB skin test or TB blood test result indicating TB infection

- Should consider treatment for latent TB infection to prevent TB disease

Person with TB disease:

- Has a large amount of active TB germs in his/her body

- May spread TB germs to others

- May feel sick and may have symptoms such as a cough, fever, and/or weight loss

- Usually has a positive TB skin test or TB blood test result indicating TB infection
- Needs treatment for TB disease

Both inactive TB and TB disease usually result in a positive TB skin test or TB blood test.

Slide 15: If the immune system can’t stop TB germs from growing,

they become active (multiplying in your body); this is called TB disease.

Most people diagnosed with TB disease in the United States become sick after living with inactive TB for 

years.

It is estimated that up to 13 million people in the United States have Inactive TB. Inactive TB

treatment is 90% effective in preventing the development of TB disease.

Progression from untreated inactive TB to TB disease accounts for approximately 80% of U.S. TB cases. 

People can have inactive TB for years and not know it.

Many people who have inactive TB never develop TB disease. Some people develop TB disease soon after

becoming infected (within weeks), before their immune system can fight the TB germs. Other people may 

get sick years later when their immune system becomes weak for another reason.

While not everyone with inactive TB will develop TB disease, about 5–10% will develop TB disease over

their lifetimes if not treated. The progression from inactive TB to TB disease may occur at any time, but it 

is most common within the first two years of infection.

Slide 16: TB disease is only the tip of the iceberg. This graphic helps summarize TB disease and inactive TB

in the United States. TB disease is just the tip of the iceberg that is visible above the water. TB disease can

be seen because of the active germs in a person’s body and the symptoms they experience. People with 

TB disease can spread TB to others.

However, the larger part of the iceberg that is hidden underwater represents inactive TB. Like the 

iceberg, inactive TB can be easily hidden because TB germs are inactive and people with inactive TB

germs do not feel sick. Many people with inactive TB do not know they are infected with TB. There are

up to 13 million people in the U.S. with inactive TB. Without treatment, they could develop TB disease.

Slide 17: Possible TB disease symptoms are Nigh sweats, fever, chills, weakness or fatigue, weight loss, 

no appetite, cough lasting longer than 3 weeks, pain in chest, coughing up blood or sputum (phlegm 

inside the lungs). Pulmonary TB disease develops in the lungs while extrapulmonary TB disease can 

develop in other parts of the body. Symptoms can vary depending on the type of TB Disease.

Slide 18: People with TB disease feel sick and can spread TB germs, especially to people they spend time 

with every day.

A person with TB disease typically requires 180 days of medication plus X-rays, lab tests, and follow-up 

and testing of contacts.

TB disease is a serious condition and can lead to death if not treated. TB disease can almost always be 

treated and cured with medicine.
TB germs become active if the immune system can’t stop them from growing. When TB germs are active 

(multiplying in your body), this is called TB disease.

Slide 19: Public Health Workers are Responsible for finding people who have been exposed to someone 

with TB. A person who was exposed to someone with contagious TB disease is considered a TB contact.

Persons exposed to someone with TB can include family members, roommates or housemates, close 

friends, coworkers, classmates, and others. People with TB disease can spread TB germs to those around 

them. The local health department will conduct a contact investigation by following up and testing those 

who have been close to someone with TB. Conducting contact investigations is a priority for tuberculosis 

(TB) programs in the United States. The goals of a contact investigation are to successfully stop the 

spread of TB and prevent future cases and outbreaks of TB disease.

Slide 20: Risk factors

Slide 21: Who is at higher risk for becoming infected with TB germs? Anyone can get TB Some 

people have a higher risk of getting infected with TB:

- People who have contact with someone who hasinfectious TB disease

- People who were born in or who frequently travel to countries where TB disease is common, 

including Mexico, the Philippines, Vietnam, India, China, Haiti, Guatemala, and other countries 

with high rates of TB

- Health care workers and others who work or live in places at high risk for TB transmission, such 

as homeless shelters, jails, and nursing homes

Others at higher risk include:

- Employees of high-risk congregate settings

- Health care workers who serve patients with TB disease

- Populations defined locally as having an increased incidence of latent TB infection or TB disease, 

including medically underserved populations, low-income populations, or people who abuse 

drugs or alcohol

- Infants, children, and adolescents exposed to adults who are at increased risk for latent TB 

infection or TB disease

Slide 22: TB disease in the United States is most common among people who were born in countries with 

high rates of TB.

Demographic characteristics of TB patients have remained fairly consistent over the last several years. 

For example, since 2010, the majority of reported TB disease cases in the U.S. occur among non-U.S.-

born persons. The data on this slide is from 2022.

Slide 23: As seen on the previous slide, TB disease in the United States is most common among people who 

were born in countries outside the U.S., usually countries with high rates of TB.

This pie chart shows the most common countries of birth among non-U.S.-born persons with TB disease 

reported in the U.S.

The most common countries of birth among non-U.S.-born TB patients remained fairly consistent over 

the last several years. This slide shows data from 2022 with Mexico (19%) the most frequently
reported country of birth, followed by the Philippines (11%), India (9%), Vietnam (8%), and China (6%).

There are countries other than those you see here (grouped as Other Countries for this chart) with much 

higher rates of TB (i.e., cases per 100,000 people) for people who now live in the U.S., but a smaller 

number of people born in those countries now live in the U.S.

Slide 24: In 2022, non-Hispanic Asian persons (34%) and Hispanic persons (34%) represented the largest 

proportion of TB patients, followed by non-Hispanic Black persons (16%), non- Hispanic White persons

(10%), Native Hawaiian/Other Pacific Islander persons (2%), American Indian/Alaska Native persons 

(1%), and persons of multiple races (1%).

Slide 25: People at high risk for developing TB disease generally fall into two categories:

- Those who have been recently infected with TB germs

- Those with medical conditionsthat weaken the immune system,such as:

o HIV Infection

o Diabetes

o Substance abuse

o Specialized treatment for rheumatoid arthritis or Chron’s disease

o Organ transplants

o Sever kidney disease

o Head or neck cancer

o Medical treatments such as corticosteroids

o Silicosis

o Low body weight

While not everyone with latent TB infection will develop TB disease, about 5–10% will develop TB disease

over their lifetimes if not treated. Progression from untreated latent TB infection to TB disease is 

estimated to account for approximately 80% of U.S. TB cases.

Babies and young children are also at higher risk because they often have weak immune systems.

Slide 26: TB testing

Slide 27: Health care providers are encouraged to use newer TB blood tests to screen for TB infection. A 

positive TB skin test or TB blood test only tells that a person has been infected with TB germs. It does not

tell whether the person has inactive TB or has progressed to TB disease. Other tests, such as a chest x-ray 

and a sample of sputum, are needed to see whether the person has TB disease.

Generally, it is not recommended to test a person with both a TB skin test and a TB blood test.

Slide 28: Blood tests measure a person’s immune reactivity to TB germs. White blood cells from most 

people that have been infected with TB germs will release interferon-gamma (IFN-g) when mixed with 

antigens (substances that can produce an immune response) derived from TB germs.

Results for blood tests can be read as positive or negative. If the result is not a clear positive or negative, 

the test can be repeated.

Positive: Inactive TB likely
Negative: Inactive TB unlikely, but cannot be excluded, especially if Patient has 

signs and symptoms consistent with TB disease

Patient has a high risk for developing TB disease once infected with TB germs

Blood tests are the preferred test for people who have received the bacille Calmette-Guerin (BCG) 

vaccine. See slides 30 and 31 for more info on BCG.

Slide 29: The TB skin test, also called the Mantoux tuberculin skin test (TST), requires two visits with a 

healthcare provider.

On the first visit, the skin test is placed by injecting a small amount of fluid (called tuberculin) into the 

skin on the lower part of the arm. The skin will react if there are TB germs in the body.

A person given the tuberculin skin test must return within 48–72 hours to have a trained health care 

worker look for a reaction on the arm. The result depends on the size of the raised, hard area where the 

skin reacted.

The image on the left shows a TB skin test being administered into a patient’s arm. The image on the 

right shows the test being read by measuring the reaction at the test injection site.

A skin test is NOT a vaccine for TB disease.

Slide 30: BCG is a vaccine for preventing TB disease. It is a weak form of bacteria that is closely related to 

the germs that cause TB. This vaccine is not widely used in the United States, but it is often given to infants 

and small children in other countries where TB is common. BCG vaccine does not always protect people 

from getting TB and protection goes away as people get older.

Slide 31: Many people born outside of the United States have received the TB vaccine.

The TB vaccine may cause a false-positive reaction to the TB skin test, which can complicate decisions 

about treatment. The presence or size of a TB skin test reaction in those who have been vaccinated with 

BCG does not predict whether the vaccine will provide protection against TB disease.

TB blood tests, unlike the TB skin test, are not affected by prior TB vaccination and are easier to interpret 

in people who have received the TB vaccine.

Slide 32: Treatment

Slide 33: People with inactive TB do not have symptoms, and they cannot spread TB germs to others. 

However, if inactive TB germs become active in the body and multiply, the person will go from having 

inactive TB to being sick with TB disease. For this reason, people with inactive TB should be treated to 

prevent them from developing TB disease. Treatment of inactive TB is essential to controlling TB in the 

United States because it substantially reduces the risk that inactive TB will progress to TB disease.

Slide 34: Treating inactive TB is effective in preventing TB disease. There are several options for the 

treatment of inactive TB. There have been advances in shortening the length of inactive TB infection 

treatment from 6–9 months to 3–4 months. Short-course inactive TB treatments are effective, safe, and 

have higher completion rates than longer treatments. Shorter regimens help patients finish treatment.

Slide 35: It is very important that people who have TB disease are treated, take the medicine exactly as 

prescribed, and finish all the medicine. If they stop taking the medicine too soon, they can become sick 

again; if they do not take the medicine correctly, the TB germs that are still alive may become resistant 

to those drugs. Resistance means that the drug can no longer kill the TB germs. Drug-resistant TB can 

occur when the drugs used to treat TB are misused or mismanaged. Examples of misuse or 

mismanagement include when
- People do not complete a full course of TB treatment.

- Health care providers prescribe the wrong treatment (the wrong dose or length of time).

- Drugsfor proper treatment are not available.

Slide 36: Directly observed therapy (DOT) for tuberculosis treatment involves observing a patient ingest 

medication, monitoring the patient for side effects, and providing support. DOT is typically conducted in 

person; however, scheduling in-person DOT can present logistical challenges. 

DOT can reduce the development of drug resistance, treatment failure, or relapse after the end of 

treatment. DOT can be given anywhere the patient and health care worker agree upon, provided the time 

and location are convenient and safe. It is important that the location is convenient for the patient.

Slide 37: vDOT can assist TB programs meet the U.S. standard of care for patients undergoing tuberculosis 

treatment, while using resources efficiently. It Facilitates patient monitoring outside of normal clinic hours, 

during an emergency, or when patients are traveling. vDOT allows persons undergoing TB treatment the 

opportunity to use video-enabled phones, tablets, or computers to remotely interact with health care 

workers in real time (synchronous) or through recorded videos (asynchronous).

Slide 38: TB Elimination

Slide 39: Current TB control measures, including early identification of TB disease, prompt and appropriate 

treatment for persons with TB disease, and ensuring that TB patients complete treatment, continue to be 

critical. Identifying and treating persons with latent TB infection is also paramount to TB elimination. 

Eliminating TB in the U.S. will require this dual approach which includes strengthening existing systems to

track and stop transmission of infectious TB disease and expanding efforts to address latent TB infection.

It’s Time to End TB, meaning

• It’s time to test for and treat latent TB infection.

• It’stime to strengthen TB education and awareness among health care providers.

• It’stime to find, cure, and prevent all forms of TB in the United States and around the world.

• It’s time to end stigma.

• It’s time to speak up.

Slide 40: The key to diagnosing TB is for clinicians to “think TB” when they see a patient with signs and 

symptoms of TB disease. Because TB is not as common as it was years ago in the United States, many 

clinicians do not consider the possibility of TB when evaluating patients who have symptoms of TB. When

this happens, the diagnosis of TB may be delayed or even overlooked, and the patient will remain ill and 

possibly infectious.

Slide 41: TB control and prevention is a complex undertaking that requires the collaborative efforts of a 

broad range of individuals, organizations, and institutions in both the public and private health sectors.

State and local health departments have the primary responsibility for preventing and controlling TB. This 

includes the essential role of planning, coordinating, and evaluating program activities.

Health care workers in doctors’ offices and hospitals, community health centers, and academic 

institutions implement TB control efforts such as testing, treating, and reporting to health departments.

Slide 42: CDC’s Think. Test. Treat TB campaign aims to reach those most at risk for latent TB infection and 

their health care providers to encourage TB testing and get closer to the elimination of TB. Think. Test. 

Treat TB is the first national multilingual communications campaign to increase testing for inactive TB, a 

major health disparity among Asian Americans.
Slide 43: Resources:

- CDC TB website: www.cdc.gov/tb/

- State & Local TB Control Offices: www.cdc.gov/tb/links/tboffices.htm

- Find TB Resources: https://findtbresources.cdc.gov 

- TB Centers of Excellence: TB Centers of Excellence | Professional Resources & Tools | TB | CDC

- Facebook: www.facebook.com/CDCTB

- Twitter: www.twitter.com/cdc_tb