Tuberculosis in the United States

National Tuberculosis Surveillance SystemHighlights from 2016

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 2016. 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 2016. 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 updates received by CDC as of June 21, 2017. All case counts and rates for years 1993–2016 have been updated.

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Reported Tuberculosis (TB) Cases United States, 1982–2016*

*As of June 21, 2017.

No. of cases

Year

Slide 2. Reported Tuberculosis (TB) Cases, United States, 1982–2016. The resurgence of TB in the mid-1980s was marked by years of increasing case counts until its peak in 1992. Case counts decreased from 1993 and 2014, and again in 2016. However, in 2015, a slight increase occurred in the total number of TB cases reported in the United States. From 1992 until 2008, the total number of TB cases decreased 2%–7% annually. An unprecedented decrease occurred in 2009, when the total number of TB cases decreased by more than 10% from 2008 to 2009. In 2016, a total of 9,272 cases were reported from the 50 states and the District of Columbia (DC). This represents a decrease of 2.9% from 2015, and a 65.2% decrease from 1992.

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TB Morbidity United States, 2011–2016
| Year | No.    | Rate* |
|------|--------|-------|
| 2011 | 10,509 | 3.4   |
| 2012 | 9,940  | 3.2   |
| 2013 | 9,561  | 3.0   |
| 2014 | 9,398  | 3.0   |
| 2015 | 9,547  | 3.0   |
| 2016 | 9,272  | 2.9   |

*	Cases per 100,000 population; as of June 21, 2017.

Slide 3. TB Morbidity, United States, 2011–2016. This slide provides the total number of reported U.S. TB cases and the associated rates for each of the past 6 years. Rate is defined as the number of cases per 100,000 population. The number of TB cases decreased from 10,509 in 2011 to 9,272 in 2016, and the TB rate decreased from 3.4 in 2011 to 2.9 in 2016.

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TB Case Rates,* United States, 2016

*Cases per 100,000; as of June 21, 2017.

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

≤2.9 (2016 national average)

>2.9

DC

NYC

Slide 4. TB Case Rates, United States, 2016. Forty-one states reported a rate ≤2.9 cases/100,000 population, the 2016 national average. Nine states, the District of Columbia (DC) and New York City (NYC) reported a rate >2.9 cases/100,000 population; these accounted for 63% of the national total in 2016.

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Map of U.S.-Affiliated Pacific Islands, by TB Case Rates,* 2016

*Cases per 100,000 population; as of June 21, 2017.

Federated States of Micronesia

Marshall Islands

Northern Mariana Islands

American Samoa

Guam

Palau

≥50

10–49.9

≤9.9

Slide 5. Map of the U.S.-Affiliated Pacific Islands, by TB Case Rates, 2016. The Federated States of Micronesia, Republic of the Marshall Islands, Northern Mariana Islands and Palau had case rates at or above 50/100,000 population. The lowest case rates were in Guam and American Samoa.

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TB Case Rates,* U.S.-Affiliated Pacific Islands, 2016

*Cases per 100,000 population; as of June 21, 2017.

Slide 6. TB Case Rates, U.S.-Affiliated Pacific Islands, 2016. Case rates range from 1.8/100,000 population in American Samoa to 248.9/100,000 in the Republic of the Marshall Islands, compared with the substantially lower overall U.S. case rate (2.9/100,000).

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[VALUE]46.1Marshall Islands	Federated States of Micronesia	Palau	Northern Mariana Islands	Guam	American Samoa	Hawaii	United States overall	243.9	120.3	98.4	50.5	46.1	1.8	8.3000000000000007	2.9	
TB Case Rates* by Age Group, United States, 1993–2016

*Cases per 100,000 population; as of June 21, 2017.

 Cases per 100,000 population

Age (yrs.)

Slide 7. TB Case Rates by Age Group, United States, 1993–2016. During 2016, 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 4.6 in 2016; adults aged 45–64 years, from 12.5 to 3.4; adults aged 25–44 years, from 11.6 to 3.3; persons aged 15–24 years, from 5.0 to 2.2; children aged 5 to 14 years, from 1.7 to 0.4; and children aged ≤4 years, from 5.2 to 1.1.

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 0– 4	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	5.1540452113455881	5.0507337320181191	4.5770646362930814	3.9913947602421005	3.8430830447835933	3.3597944353483653	3.1780988654820557	2.8365402489157927	2.8137314447236239	2.8616733006704549	2.791892344631191	2.7747053012791696	2.3798286925000252	2.4173871725913632	2.3203859770777666	2.4468299172512706	1.990662361040159	1.8078624582204224	1.7440137597220071	1.3062730283798076	1.4858367272950173	1.3231010833129082	1.2253610157117898	1.1241008886569539	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	1.7482791425886997	1.7721430272083472	1.6917333502541803	1.5243237062146471	1.3307249066015152	1.1207411739654021	1.1039307784762868	1.0218593226707666	0.93798509138307595	0.94326233306991669	0.88702161632689025	0.98615185852797571	0.92853378407368004	0.79107244434435697	0.76438172503349899	0.71118754859730315	0.59740867133299969	0.66076574410927336	0.55299092817164297	0.54931901577879982	0.4560489385145603	0.47342991157858799	0.47703991088699754	0.39709577306897442	15–24	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	5.0358514738521363	5.070183573302649	4.6897119906097426	4.5201459203612142	4.5695541417234935	4.1455806484832669	4.0186890750322606	4.1053879995093832	3.9712962564626815	3.6667035050430026	3.8005401164284471	3.8213877182362821	3.6281248373675372	3.5757762538767532	3.6620005903237662	3.3255367204243633	2.9350391165674536	2.7444761123568835	2.3498522011407781	2.3173251345657517	2.2247057321054351	2.1866405319511641	2.1357888402451879	2.1557753624156009	25–44	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	11.6073829879803	10.903925539801891	9.8456373362608964	9.0467056631827276	8.2371723629992157	7.6103857318301893	7.3258160052064287	6.5620581702449252	6.6372251505543911	6.2959655041097307	6.0840786819338746	5.947018732422813	5.7234901787530443	5.675287860522964	5.2260526529895097	5.143206442614856	4.7268525719375329	4.4622319510016757	4.0818330151460023	3.7657398420525596	3.5567461508632761	3.3621261718830215	3.3815419862230751	3.3201249048135923	45–64	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	12.496904267681714	12.039765423075117	11.410773029519842	10.37414989734302	9.5198919025112563	8.6546158565595075	8.2106462584465127	7.4245483279628832	7.0009157631983587	6.270285656042355	6.2226769020379074	5.9096160872606687	5.6414364519187661	5.3698486944420756	5.2382058201747688	4.9963424178659439	4.2629692430381798	4.1931531934829716	3.974487796638257	3.7566461059256704	3.5552477682849521	3.5430258054055166	3.6032149259060171	3.3816094782774799	≥65	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	17.736379618498397	16.681463687028039	15.848034482324758	14.948239512025381	13.640322795035825	12.729299336846257	11.635776175610758	10.022934984542724	9.3311783685773513	8.8451711347777451	8.3483139654215286	7.7644814830375077	7.6698922051357554	7.1655159102840811	6.8048952206080147	6.4367022412231005	5.7617795646108627	5.4964541941688028	5.4225774997653158	5.0952817690818302	4.8802170863832455	4.7650284821895488	4.7973896837099836	4.5974962124977372	
Reported TB Cases by Age Group, United States, 2016*

*Cases per 100,000 population; as of June 21, 2017.

Slide 8. Reported TB Cases by Age Group, United States, 2016. Two percent of TB cases were among children aged 0–4 years; 2% were among those aged 5–14 years; 10% were among persons aged 15–24 years; 31% were among adults aged 25–44 years; 31% were among adults aged 45–64 years; and 24% were among adults aged ≥65 years.

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Column1	
[CATEGORY NAME] (2%)[CATEGORY NAME] ([VALUE])[CATEGORY NAME] ([VALUE])[CATEGORY NAME]  ([VALUE])[CATEGORY NAME] ([VALUE])[CATEGORY NAME] (24%)0–4 yrs	5–14 yrs	15–24 yrs	25–44 yrs	45–64 yrs	≥65 yrs	0.02	0.02	0.1	0.31	0.31	0.24	
TB Case Rates by Age Group and Sex, United States, 2016*

*Cases per 100,000 population; as of June 21, 2017.

 Cases per 100,000 population

Age group (yrs)

Slide 9. TB Case Rates by Age Group and Sex, United States, 2016. Case rates tended to increase with age, ranging from <1 case/100,000 children aged 5–14 years to a high of 6.4 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.

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Male	<	5	5–14 	15–24	25–44	45–64	≥65	1.1987107767341243	0.3	2.4	3.8	4.5999999999999996	6.4	Female	<	5	5–14 	15–24	25–44	45–64	≥65	1	0.50173904740917352	1.9	2.8	2.2000000000000002	3.2	
TB Case Rates by Race/Ethnicity,* United States, 2003–2016†

* 	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.

† 	As of June 21, 2017.

 Cases per 100,000 population

Slide 10. TB Case Rates by Race/Ethnicity, United States, 2003–2016. By race/ethnicity, the rates indicate a declining trend in TB since 2003. Asians consistently had the highest yearly TB rates, but their rates declined from 29.3 cases/100,000 population in 2003 to 18.0 in 2016, a 38.6% decrease. Rates also declined among the following racial/ethnic groups: non-Hispanic blacks/African Americans, from 11.7 in 2003 to 4.9 in 2016 (–58.2%); Hispanics, from 10.2 to 4.5 (–55.8%); non-Hispanic whites, from 1.4 to 0.6 (–57.1%); American Indians and Alaska Natives, from 8.3 to 4.7 (–43.6%); and Native Hawaiian/Other Pacific Islanders, from 15.7 to 13.9 (–11.2%). 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 off of unrounded numbers.)

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.

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American Indian/Alaska Native	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	8.3173530186647913	7.237160838754674	7.0901774511315239	7.489477284415397	5.9901788090893984	6.0787447749612928	4.5284868460776204	6.6558556763649674	5.7660100695503127	5.7556472420063578	5.3191808804617047	4.8488581151807963	6.1191039268610936	4.691254705391299	Asian	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	29.319447326723129	27.291348028926372	25.288666853533666	25.172287395906636	25.482971431275079	24.333775129405741	22.316650783895859	21.587184904463502	20.764925989795355	19.410925271953754	19.152195328892727	18.475593908243717	19.134060369557393	18.008667495572656	Black/African American	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	11.735906492676515	11.369477600997765	10.938561799886399	10.213312842452311	9.4185844929671951	8.7957566052176706	7.6188519662108565	7.0366107095215815	6.2718528360781987	5.7896225001080559	5.3352428460474792	5.0926506798777247	5.0054219553154251	4.9093649205766674	Native Hawaiian/Other Pacific Islander	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	15.685044310250175	14.957939698134531	12.437238011884473	11.616762988993118	20.608582281391751	14.540826003211626	14.971656398434744	19.204455433660609	16.060544334936775	12.463496336690808	11.629717304081469	16.720287956431708	18.346973648709419	13.927871257104977	White	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	1.4228001481505943	1.3391919051361858	1.3070832831712575	1.2127050212597554	1.1202397765887591	1.0862975957906424	0.92105140232762617	0.89110973857358078	0.83283116230028387	0.79058737095905718	0.71494499064590034	0.62808758356445071	0.62435467564516978	0.61019467190135568	Hispanic/Latino	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	10.249834023850877	10.074365005978718	9.3994893130084325	9.0771921144331511	8.3880172530366952	7.952916890763098	6.8339176964795438	6.3659920547454041	5.7892720761946039	5.2629099993704882	4.992217670900545	4.979166320136259	4.790683092301979	4.5258169669485033	
TB Case Rates by Age Group and Race/Ethnicity,*United States, 2016†

 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.

† 	As of June 21, 2017.

Slide 11. TB Case Rates by Age Group and Race/Ethnicity, United States, 2016. After infancy (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. 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. 

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American Indian/Alaska Native	<	5	5–14	15–24	24–44	45–65	≥65	2.4	1.7	1.6	3.9	7.5	10.4	Asian	<	5	5–14	15–24	24–44	45–65	≥65	2.9	1.7	13.6	16.399999999999999	20.5	44.7	Black/African American	<	5	5–14	15–24	24–44	45–65	≥65	1.9	1.1000000000000001	3.5	5.8	6.7	7.4	Native Hawaiian/Other Pacific Islander	<	5	5–14	15–24	24–44	45–65	≥65	19.600000000000001	2.4	15.3	15.3	12.6	24.4	White	<	5	5–14	15–24	24–44	45–65	≥65	0.2	0	0.2	0.4	0.8	1.2	Multiple race	<	5	5–14	15–24	24–44	45–65	≥65	0.1	0	0.4	1.9	2.4	1.9	Hispanic/Latino	<	5	5–14	15–24	24–44	45–65	≥65	2.1	0.5	3.3	5.2	6.6	12.5	
Reported TB Cases by Race/Ethnicity,*United States, 2016†

Hispanic/Latin 28%

Native Hawaiian/Pacific Islander 1%

American Indian/Alaskan Native  1%

Black/African American 21%

Asian 35%

Multiple race 1%

White 13%

* 	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; as of June 21, 2017.

Slide 12. Reported TB Cases by Race/Ethnicity, United States, 2016. During 2016, approximately 86% of all reported TB cases occurred among racial/ethnic minorities: Asians, 35%; Hispanics, 28%; non-Hispanic blacks/African Americans, 21%; American Indians/Alaska Natives, 1%; and Native Hawaiians/Other Pacific Islanders, 1%. In contrast, 13% 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.

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Sales	American Indian/Alaska Native	Asian	Black/African American	Native Hawaiian	White	Hispanic/Latino	Multiple race	Unknown/missing	0.01	0.35	0.21	0.01	0.13	0.28000000000000003	0.01	0	
Number of TB Cases Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016*

No. of cases

*As of June 21, 2017.

Slide 13. Number of TB Cases Among U.S.-Born versus Non-U.S.–Born Persons, United States 1993–2016. The graph illustrates the increase in the percentage of cases occurring among non-U.S.–born persons during the study period, from 30% in 1993 to 69% in 2016. 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 6,999, and that trend continued through 2013, with the number of cases among non-U.S.–born persons decreasing to 6,222. However, in 2014 and 2015 the number of cases among non-U.S.–born persons increased to a high of 6,406 in 2015. In 2016, the number of cases decreased from 2015 to 6,351 cases. Among U.S.-born persons the number of cases decreased from >17,000 in 1993 to 2,901 in 2016.

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U.S.-born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	17433	16180	14663	13385	11924	10609	9783	8632	7848	7263	6842	6601	6290	5859	5431	5237	4501	4331	3941	3627	3330	3129	3135	2901	Non-U.S.–born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	7403	7762	8010	7752	7753	7623	7624	7634	8034	7737	7947	7875	7745	7845	7780	7644	6999	6817	6563	6309	6222	6264	6406	6351	
Trends in TB Cases Among Non-U.S.–Born Persons,United States, 1993–2016*

*As of June 21, 2017.

Slide 14. Trends in TB Cases Among Non-U.S.–Born Persons, United States, 1993–2016. The percentage of TB cases accounted for among non-U.S.–born persons increased from 30% in 1993 to 69% in 2016.  

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Number of cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	7403	7762	8010	7752	7753	7623	7624	7634	8034	7737	7947	7875	7745	7845	7780	7644	6999	6817	6563	6309	6222	6264	6406	6351	Percentage of total cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	29.5	32.1	35.200000000000003	36.5	39.299999999999997	41.7	43.6	46.8	50.4	51.4	53.6	54.3	55.1	57.1	58.6	59.3	60.8	61.1	62.5	63.5	65.099999999999994	66.7	67.099999999999994	68.5	
Year

Reported TB Cases by Origin and Race/Ethnicity*, United States, 2016†

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; as of June 21, 2017.

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

Slide 15. Reported TB Cases, by Origin and Race/Ethnicity, United States, 2016. Among U.S.-born persons with TB in 2016, 37% were non-Hispanic black/African American; 32% were non-Hispanic white, 21% were Hispanic/Latino; 5% were Asian; 4% were American Indian/Alaska Native; and 1% 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, 48% were Asian; 31% were Hispanic/Latino; 14% were non-Hispanic black/African American; 5% 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 0.3% of the cases among non-U.S.–born persons and are not included on the charts.  

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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	American Indian/Alaska Native	0.31	0.48	0.14000000000000001	0.01	0.05	0.01	Sales	[CATEGORY NAME]21%[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	0.21	0.04	0.05	0.37	0.01	0.31	0.01	
Percentage of Non-U.S.–Born PersonsAmong TB Cases, United States,* 2006 and 2016

2006

2016

DC

DC

≥50%

25%–49%

≤24%

*As of June 21, 2017.

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

NYC

NYC

Slide 16. Percentage of Non-U.S.–Born Persons Among TB Cases, United States, 2006 and 2016. The number of states with <25% of their TB cases occurring among non-U.S.–born persons decreased from 6 states in 2006 to 4 states in 2016. The number of states with ≥25%–49% of cases among non-U.S.–born persons decreased from 16 states and DC in 2006 to 8 states in 2016. However, the number of states that had ≥50% of their cases among non-U.S.–born persons increased from 28 states in 2006 to 38 states and DC in 2016.

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TB Case Rates Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016*

 Cases per 100,000 population

*As of June 21, 2017.

Slide 17. TB Case Rates Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016. TB rates among non-U.S.–born remain higher than those among the U.S.-born population. During 1993–2016, the rate among U.S.-born persons decreased from 7.4 cases/100,000 population to 1.1, whereas the rates among non-U.S.–born persons decreased from 34.0 cases/100,000 population to 14.7.

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U.S. overall	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	9.6576394143846311	9.1994012248611661	8.5346767133298709	7.8732182751138104	7.2441675254543947	6.6288663952594309	6.2711401463892464	5.7796500753603217	5.5953463422006795	5.2342424677660278	5.1136140423984893	4.951754663947372	4.7594619211220692	4.600845917536164	4.4089057479360036	4.2388213648408932	3.7542597377085802	3.6066155395321804	3.371907454067796	3.1656214378100338	3.0236722321843277	2.9501186727456901	2.9751014702186733	2.8694554400262411	U.S.-born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	2.2743657590062014	2.0905754698341257	2.0043412799743314	1.7038128207966583	1.6292121783696851	1.4737260264862633	1.3475250145151516	1.227461150098955	1.1468664072757118	1.1441770367062942	1.0524469925875517	Non-U.S.–born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	20.180940986271416	18.784601146743672	17.771486370935786	17.033559980295781	15.981160822988492	15.691099497433401	15.535098584138456	15.24831292032685	14.730731004698015	
TB Case Rates Among U.S.-Born versus Non-U.S.–Born Persons, United States*, 1993–2016†

 Cases per 100,000 population

* Includes the same data as previous slide, but rates are presented on a logarithmic scale.

† 	As of June 21, 2017.

Slide 18. TB Case Rates Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016. The chart presents the same data as on Slide 17, but uses a logarithmic scale to better illustrate the trends. The trend lines indicate a greater rate of decrease among U.S.-born, compared with non-U.S.–born , persons during the study period.

18
U.S. overall	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	9.6576394143846311	9.1994012248611661	8.5346767133298709	7.8732182751138104	7.2441675254543947	6.6288663952594309	6.2711401463892464	5.7796500753603217	5.5953463422006795	5.2342424677660278	5.1136140423984893	4.951754663947372	4.7594619211220692	4.600845917536164	4.4089057479360036	4.2388213648408932	3.7542597377085802	3.6066155395321804	3.371907454067796	3.1656214378100338	3.0236722321843277	2.9501186727456901	2.9751014702186733	2.8694554400262411	U.S.-born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	2.2743657590062014	2.0905754698341257	2.0043412799743314	1.7038128207966583	1.6292121783696851	1.4737260264862633	1.3475250145151516	1.227461150098955	1.1468664072757118	1.1441770367062942	1.0524469925875517	Non-U.S.–born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	20.180940986271416	18.784601146743672	17.771486370935786	17.033559980295781	15.981160822988492	15.691099497433401	15.535098584138456	15.24831292032685	14.730731004698015	
Countries of Birth Among Non-U.S.–Born Persons Reported with TB, United States, 2016

*Percentages are rounded; as of June 21, 2017.

Slide 19. Countries of Birth Among Non-U.S.–Born Persons Reported with TB, United States, 2016. 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 2016, the top seven countries accounted for 60% of all cases among non-U.S.–born persons, with Mexico accounting for 19%; the Philippines, 12%; India, 9%; Vietnam, 8%; China, 6%; Guatemala, 3%; and Haiti, 3%. Persons from 135 other countries each accounted for ≤2% of the total, but altogether, accounted for 40% of non-U.S.–born persons reported with TB.

19
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	18.8	12.4	9.3000000000000007	7.8	6	3	2.6	40.1	
Percentage of Non-U.S.–Born Persons with TB,by Time of Residence in U.S. Before Diagnosis, 2016*

* 	 As of June 21, 2017. 

† 	 Non-U.S.–born persons for whom information on length of residence in the United States before diagnosis is unknown or missing.

Percentage

                   †

Slide 20. Percentage of Non-U.S.–Born Persons with TB, by Time of Residence in U.S. Before Diagnosis, 2016. The chart indicates that the distribution for the top three countries of birth is Mexico, the Philippines, and India. Among persons born in Mexico, 11.2% had been in the United States for <1 year; 6.5%, 1–4 years; 8.4%, 5–9 years; 22.9%, 10–19 years; and 39.8% for ≥20 years. Among persons born in the Philippines, 11.6% had been in the United States for <1 year; 9.9%, 1–4 years; 12.4%, 5–9 years; 21.4%, 10–19 years; and 33.2%, ≥20 years. Among persons born in India, 21.1% had been in the United States for <1 year; 26.8%, 1–4 years; 13.2%, 5–9 years; 18.8%, 10–19 years; and 13.8%, ≥20 years. Values for unknown length of residence in the United States for these top three countries ranged from 6.3 to 11.5% for 2016. For all other non-U.S.–born persons, 20.4% had been in the United States for <1 year; 17.9%, 1–4 years; 12.9%, 5–9 years; 18.1%, 10–19 years; 22.8%, ≥20 years; and 7.9%, unknown length of residence. Overall, 17.6% had been in the United States for <1 year; 15.6%, 1–4 years; 12.0%, 5–9 years; 19.5%, 10–19 years; 26.5%, ≥20 years; and 8.8%, unknown length of residence.

20
Unknown	Mexico	Philippines	India	All other non-U.S.–born	11.2	11.5	6.3	7.88	≤12 mos.	Mexico	Philippines	India	All other non-U.S.–born	11.2	11.6	21.099999999999998	20.37	1–4 years	Mexico	Philippines	India	All other non-U.S.–born	6.5	9.9	26.8	17.940000000000001	5–9 years	Mexico	Philippines	India	All other non-U.S.–born	8.4	12.4	13.2	12.88	10–19 years	Mexico	Philippines	India	All other non-U.S.–born	22.9	21.4	18.8	18.100000000000001	≥20 years	Mexico	Philippines	India	All other non-U.S.–born	39.799999999999997	33.200000000000003	13.8	22.83	
Primary Anti-TB Drug Resistance, United States, 1993–2016*

* 	 As of June 21, 2017. 

Note: 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 21. Primary Anti-TB Drug Resistance, United States, 1993–2016. 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 >86.9% 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 2016, this had increased to 8.7%. 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. In 2016 the percent of primary MDR TB was 1.2%.

21
Isoniazid	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	8.6999999999999993	MDR-TB	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	
Primary MDR-TB, United States, 1993–2016*

* 	 As of June 21, 2017. 

Note: 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 22. Primary MDR-TB, United States, 1993–2016. 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 78 cases reported for 2016. Primary MDR-TB, indicated by the trend line, decreased from 2.5% in 1993 to approximately 1.0% in 1998, and has fluctuated approximately 1.0% since then. During 2016, the percentage was 1.2%.

22
Number of cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	407	353	254	207	155	132	127	120	115	132	94	100	98	103	101	88	91	87	101	77	83	70	72	78	Percentage of total cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	
Year

Primary Isoniazid Resistance Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016*

Resistant (%)

* 	 As of June 21, 2017. 

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

Slide 23. Primary Isoniazid Resistance Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016. 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 10.0% in 2016. In U.S.-born persons, the percentage decreased from 6.7% in 1993 to a low of 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 2016, the percentage of primary isoniazid resistance among U.S.-born cases was 5.9%.

23
U.S.-born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	6.7	5.9	Non-U.S.–born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	9.9	9.5	10.6	10.7	10.7	10.1	10.1	10	
Primary MDR-TB Among U.S.-Born versus Non-U.S.–Born Persons, United States, 1993–2016*

* 	 As of June 21, 2017. 

Note: 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 (%)

Slide 24. Primary MDR-TB in U.S.-born vs. Non-U.S.–born Persons, United States, 1993–2016. 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. As a result, the proportion of primary MDR-TB cases in the US that are attributed to non-U.S.–born persons increased from approximately 25% in 1993 to 90% in 2016 (not shown on slide). Among the U.S.-born, the percentage with primary MDR-TB has been less than 1% since 1997 and was 0.4% in 2016. 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 2016 the percentage of primary MDR-TB among non-U.S.–born persons was 1.5%.

24
U.S.-born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	Non-U.S.–born	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	
XDR-TB* Case Count, Defined on Initial DST,† by Year, 1993–2016§

*	XDR-TB , extensively drug-resistant TB.

†	DST, drug susceptibility test.

§	As of June 21, 2017.

Note: 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 25. XDR-TB Case Count, Defined on Initial DST, United States, 1993–2016. 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. One case of XDR-TB was reported in 2016, 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.

25
Series 1	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	10	6	1	3	2	1	6	1	4	6	0	4	3	4	2	6	0	1	5	2	5	2	1	1	
Reporting of HIV Test Results Among Persons with TB, by Age Group, United States, 1993–2016*

* 	 As of June 21, 2017. 

Note: 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).  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 26. Reporting of HIV Test Results in Persons with TB by Age Group, United States, 1993–2016. This slide shows the completeness of reporting of HIV test results in persons with TB by age group from 1993 through 2016. The percentage of TB patients for whom test results were reported increased from 30% among all ages in 1993 to 90% in 2016. Among adults 25–44 years of age, the percentage increased from 45% in 1993 to 95% in 2016. California began reporting HIV test results to CDC in 2011; this accounts for the substantial percentage increase for that year.

26
All ages	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	29.87277565275237	32.844927598504704	36.285531487066997	42.047845017367059	45.031967299025261	45.973513665821358	48.886138613861384	50.289526686807648	51.43572942763538	53.813242784380307	55.393204218071546	59.227195945945944	59.16781642582238	61.370414554130626	63.616071428571431	64.601629875781313	65.098526540031955	68.151406837136832	84.846123880015583	86.685173761052852	89.433155080213893	89.906562364189483	90.269749518304437	89.92607304424584	Ages 25–44 yrs	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	45.138814449565871	48.699602498580354	51.846307385229537	57.378378378378379	60.056237975432879	60.852898897939625	62.711014541200072	63.211492998727039	63.855855855855857	66.354783272866143	67.5417661097852	69.566107245190352	69.229131175468481	70.352839931153184	73.434935521688161	73.495122531525098	73.559937727036839	75.963656387665196	91.449144914491455	92.997741206840914	94.896223205171822	94.969675347841601	95.742434904996472	94.648590795576169	
Estimated HIV Coinfection Among Persons Reported with TB, United States, 1993–2016*

Coinfection (%)

* 	 As of June 21, 2017. 

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

Slide 27. Estimated HIV Coinfection in Persons Reported with TB, United States, 1993–2016. This slide provides minimum estimates of HIV coinfection among persons reported with TB from 1993 through 2016. 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 (see previous Slide 26). 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 1993–2016, and from 63% to 9% among persons 25 to 44 years of age during this period. 

27
All ages	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	5.6	Ages 25–44 yrs	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	10.9	11.4	9.3000000000000007	8.6	7.5	8.6	
TB Cases Among Persons Aged ≥15 Years Residing in Correctional Facilities, United States, 1993–2016*

No. of cases

Percentage

* 	 As of June 21, 2017. 

Note: Resident of correctional facility at time of TB diagnosis.	

Slide 28. TB Cases by Residence in Correctional Facilities, Age ≥15, United States, 1993-2016. This graph highlights the number of cases that were a resident of any type of correctional facility at the time of TB diagnosis. Cases must have been 15 years of age or greater. The number of cases residing in a correctional facility has decreased from a high of 1,117 cases in 1994 to 328 cases in 2016. 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 residing in a correctional facility has ranged from 5.0% in 1994 to 3.3% in 2002. The 1990s saw a decreasing trend in percentage until 2002. Since 2002, there has been an increasing trend in percentage. In 2016 percentage of total cases was 3.7%.

28
No. of cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	950	1117	937	782	747	657	576	587	522	460	476	495	537	508	481	496	464	488	423	391	364	377	333	328	Percentage of total cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	4.0999999999999996	4.2699999999999996	4.6399999999999997	4.26	4.1399999999999997	4.01	4.22	3.66	3.69	
TB Cases Reported Among Homeless Persons During the 12 Months Before Diagnosis, Ages ≥15 Years, United States, 1993–2016*

No. of cases

Percentage

* 	 As of June 21, 2017. 

Note: Homeless during the 12 months before TB diagnosis.	

Slide 29. TB Cases by Homeless Status, Age ≥15, United States, 1993–2016. This graph highlights the status of cases that were homeless within twelve months prior of TB diagnosis from 1993 through 2016. Cases must have been 15 years of age or greater. The number of homeless cases has decreased from a high of 1,379 cases in 1994 to 430 in 2016. 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 homeless have had an overall decline from 5.2% in 1993 to 4.8% in 2016. 

29
No. of cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	1216	1379	1343	1319	1259	1150	1099	975	927	892	936	832	816	818	733	691	579	594	573	534	532	512	500	430	Percentage of total cases	1994	1996	1998	2000	2002	2004	2006	2008	2010	2012	2014	2016	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	5.65	5.77	5.65	5.86	5.73	5.49	4.84	
Mode of Treatment Administration Among Persons Reported with TB, United States, 1993–2014*

Percentage†

Year

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

*	As of June 21, 2017; data available through 2014 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 30. Mode of Treatment Administration in Persons Reported with TB, United States, 1993–2014. 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 63.9% in 2014, 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 29.0% in 2014.

30
DOT only	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	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	63.9	DOT + SA	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	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	31.1	29.2	29.1	28.8	29	SA only	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	63.83	51.42	41.25	35.1	29.21	25.75	22.97	21.68	18.84	16.84	15.02	13.38	12.52	12.09	10.79	10.130000000000001	10.08	9.66	8.6	9.09	7.95	7.11	
Completion of TB Treatment Therapy,United States, 1993–2014*

* 	 As of June 21, 2017; data available through 2014 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 31. Completion of TB Therapy, United States, 1993–2014. 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 2014. In 2014, the latest year with available data, completion of therapy was 97%. Completion in 1 year or less increased from 63% in 1993 to 90% in 2014. 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.

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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	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	89.7	89.7	90.1	89.8	90.1	Completed	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	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	96.2	96.6	
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 32. 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.

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National Tuberculosis Genotyping Surveillance Coverage* by Year: United States†, 2004–2016

National Goal, 

94% §

*	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%. 

Slide 33. National Tuberculosis Genotyping Surveillance Coverage by Year, United States, 2004–2016. This slide shows the increase in genotyping surveillance coverage from 2004 to 2016. In 2004 the proportion of positive cultures with at least one genotyped isolate was 52.6%; in 2016 it was 96.4%. The national goal for genotyping surveillance coverage is 94.0%.

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Coverage (%)	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	52.564668491215684	68.449393082048005	70.069799906933454	80.844124700239803	81.608621894022548	86.885061353146469	91.616412439399326	94.225299863979231	94.861038280020978	95.860477741585242	96.667588495575217	97.111231101511876	96.38369170622731	
Proportion of culture confirmed TB cases genotyped (%)

Number of County-Based Tuberculosis Genotype Clusters* by Cluster Size, United States, 2014–2016

*	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 34. Number of County-based Tuberculosis Genotype Clusters by Cluster Size, United States, 2014–2016. This slide shows the number of county-based TB genotype clusters by the size of the clusters; 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 2014–2016 three year time period, there were 878 two-case clusters, 263 three-case clusters, 105 four-case clusters, 43 five-case clusters, 25 six-case clusters, 26 seven-case clusters, 14 eight-case clusters, 10 nine-case clusters, and 37 case clusters that were greater or equal to 10 in size.

34
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	878	263	105	43	25	26	14	10	37	
Number of Persons in Cluster

Number of Clusters

Tuberculosis Genotype Clusters by TB GIMS* Alert Levels†, United States, 2014-2016

*	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 35. Tuberculosis Genotype Clusters by TB GIMS Alert Levels, United States, 2014–2016. This slide shows a chart with percentage 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 2014–2016 three year time period, high alerts made up 6% of the total, medium alerts were 23%, and no alert were 71%.

35

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

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

[CATEGORY NAME], [VALUE] ([PERCENTAGE])
High Alert	Medium Alert	No Alert	86	322	993	
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

MS E-10

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

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