Centers for Disease Control and Prevention

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

Tuberculosis (TB) in the United States

1993–2020*

Division of Tuberculosis Elimination

National Tuberculosis Surveillance System

*Data updated as of June 14, 2021
Progress Towards TB Elimination, 

United States, 1982–2020

0

5,000

10,000

15,000

20,000

25,000

30,000

1985 1990 1995 2000 2005 2010 2015 2020

Elimination threshold: ~330 cases or <1 case per 1,000,000 population

Number of cases

26,673 TB cases in 1992

Incidence rate: 10.4 per 100,000

7,174 TB cases in 2020

Incidence rate: 2.2 per 100,000

Year
TB Cases and Incidence Rates,

United States, 1993–2020

0

2

4

6

8

10

0

5,000

10,000

15,000

20,000

25,000

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Year

 Number of cases Incidence rate

Cases per 100,000 persons

Number of cases
TB Incidence Rates and Annual Percent Change in 

Rate, United States, 2010–2020

-6.1 -6.0 -4.5 -2.4 0.9 -3.8 -2.5

-1.2 -1.6

-19.7

-20

-15

-10

-5

0

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Year

Cases per 100,000 

persons

Annual percent 

change in rate

*

3.6 3.4 3.2 3.0 2.9 3.0 2.9 2.8 2.8 2.7

2.2

0

1

2

3

4

*Annual percent change in rate based on unrounded data
TB-Related Deaths* and Mortality Rates, 

United States, 1993–2019

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0

400

800

1,200

1,600

2,000

1994 1999 2004 2009 2014 2019 Year

 Number of deaths Mortality rate

*National Vital Statistics System Underlying Cause of Death (based on deaths reported through 2019)

Deaths per 100,000 persons

Number of deaths

526 TB-related 

deaths in 2019
*Cases per 100,000 persons

†

Includes NYC

TB Incidence Rates* by Reporting Area 

United States, 2020
Majority of TB Cases Occur in Four States, 

United States, 2020

California

24%

Florida

6%

Texas

12%

New York

8%
Top 10 TB Incidence Rates by Metropolitan Statistical 

Areas (MSAs), United States, 2020

San Francisco

5.5

San Jose

7.8 Bakersfield

3.7

Stockton

6.0

Los Angeles

4.8

San Diego

5.8

Honolulu

6.5

McAllen

4.1

Houston

4.2

New York City

3.9
TB Incidence Rates* by U.S.-Affiliated Pacific Islands 

and Hawaii, 2020

Federated States of 

Micronesia

73.7

Marshall Islands

252.5

Northern 

Mariana Islands

75.2

American 

Samoa

6.3

Guam 

33.8

Palau

50.0

Hawaii

6.5

*Cases per 100,000 persons
TB Cases and Incidence Rates by Origin of Birth, 

United States, 1993–2020

0

5

10

15

20

25

30

35

40

0

5,000

10,000

15,000

20,000

25,000

30,000

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

 U.S.-born persons

Non-U.S.–born persons

 U.S.-born rate

Non-U.S.–born rate

Year

Cases per 100,000 persons

Number of cases
TB Incidence Rates by Origin of Birth, 

United States, 2011–2020 

Non-U.S.–born

0

4

8

12

16

20

2011 2014 2017 2020

Cases per 100,000 persons

-18%

U.S.-born

0

0.4

0.8

1.2

1.6

2

2011 2014 2017 2020

Cases per 100,000 persons

-20%
TB Incidence Rates* and Percentages by Origin of 

Birth, United States, 2020 (N=7,145)

28%

72%

U.S.-born 

(Rate: 0.7 per 100,000)

Non-U.S.–born

(Rate: 11.7 per 100,000)

–

*Cases per 100,000 persons
Top Countries of Birth Among Non-U.S.–born Persons 

with TB, United States, 2020 (N=5,127)

Other countries, 

40%

Honduras, 3%

Guatemala, 3%

China, 5%

Vietnam, 8%

India, 

10%

Philippines, 12%

Mexico, 18%
Top Countries of Birth* Among Non-U.S.–born Persons with 

Highest Percentage of TB, United States, 2020 (N=5,127)

Other countries, 40%
Top 10 TB Incidence Rates,* by Country of Birth,†

United States, 2016–2020

45

52

59

64

64

68

73

81

121

164

Eritrea

Ethiopia

Federated States of Micronesia

Guinea

Nepal

Bhutan

Myanmar

Somalia

Republic of the Congo

Republic of the Marshall Islands

* Cases per 100,000 persons

† Populations for the countries of birth shown were selected based on their ranked 5-year rate of TB cases by country of birth in the United States.
Percentage of TB Cases Among Non-U.S.–born Persons 

by Years Since Initial Arrival in the United States at 

Diagnosis, 2020 (N=5,127)

10%

18%

13%

16%

32%

11%

<1 year

1–4 years

5–9 years

10–19 years

≥20 years

Unknown/

Missing

32%
Percentage of TB Cases Among Non-U.S.–born Persons 

by Years Since Initial Arrival in the United States at 

Diagnosis, 2020 (N=5,127)

28%

13%

9%

7%

8%

6%

6%

4%

9%

11%

<5 years

5–9 years

10–14 years

15–19 years

20–24 years

25–29 years

30–34 years

35–39 years

≥40 years

Unknown/Missing
Percentage of TB Cases Among Non-U.S.–born Persons 

by Year Since Initial Arrival in the United States at 

Diagnosis, 2020 (N=5,127)

Percentage of cases

Years*in the United States

* Years since arrival was missing/unknown for 585 cases (11.4%).

~1/3 of cases occurred 20+ 

years after U.S. arrival

0%

2%

4%

6%

8%

10%

<1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 80
0

2,000

4,000

6,000

8,000

10,000

12,000

2011 2014 2017 2020 Year

TB Cases by Race/Ethnicity,* United States, 2011–2020

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

Black/African American

Native Hawaiian/ Other Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Hispanic/Latino
TB Cases by Race/Ethnicity,* United States, 2011–2020

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

0%

20%

40%

60%

80%

100%

2011 2014 2017 2020

Year

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

Black/African American

Native Hawaiian/ Other Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Hispanic/Latino
Asian

36%

Hispanic/Latino

30%

Black/African 

American

20% White

11%

Percentage of TB Cases by Race/Ethnicity,*

United States, 2020 (N=7,174)†

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

†Percentages are rounded. Percentages of unknowns/missing are <1% and are not displayed in graph.

American Indian/Alaska Native, 1%

Native Hawaiian/Other Pacific Islander, 2%

Multiple race, 1%
Cases per 100,000 persons

0

5

10

15

20

25

2011 2014 2017 2020

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

Native Hawaiian/Other 

Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Black/African American

Hispanic/Latino

TB Incidence Rates by Race/Ethnicity,*

United States, 2011–2020
TB Cases Among U.S.-born Persons by Race/Ethnicity,*

United States, 2011–2020

0

1,000

2,000

3,000

4,000

2011 2014 2017 2020

Year

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

Black/African American

Native Hawaiian/ Other Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Hispanic/Latino
TB Incidence Rates Among U.S.-born Persons by 

Race/Ethnicity,* United States, 2011–2020

0

1

2

3

4

5

6

7

2011 2014 2017 2020 Year

Cases per 100,000 persons

Native Hawaiian/

Other Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Black/African American

Hispanic/Latino

*All races are non-Hispanic; multiple race indicates two or more races reported for a person but does not include persons of Hispanic or Latino origin.
TB Cases Among Non-U.S.–born Persons by 

Race/Ethnicity,* United States, 2011–2020

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2011 2014 2017 2020

Year

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

Black/African American

Native Hawaiian/ Other Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Hispanic/Latino
TB Incidence Rates Among Non-U.S.–born Persons by 

Race/Ethnicity,* United States, 2011–2020

0

10

20

30

40

50

2011 2014 2017 2020 Year

Native Hawaiian/Other 

Pacific Islander

American Indian/Alaska Native

Asian

Multiple Race

White

Black/African American

Hispanic/Latino

*All races are non-Hispanic; multiple race indicates two or more races reported for a person but does not include persons of Hispanic or Latino origin. Cases per 100,000 persons
TB Incidence Rates Among Non-U.S.–born and U.S.-born 

Persons by Race/Ethnicity,* United States, 2011–2020

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

† Non-U.S-born American Indian/Alaska Native are not displayed because some years have zero cases, which cannot be displayed in a log-scale graph.

0

1

10

100

2011 2014 2017 2020

Year

2011 2014 2017 2020

American Indian/

Alaskan Native

Asian

Black/

African American

Hispanic or Latino

Multiple races

Native Hawaiian/

Other Pacific Islander

White

Year

Cases per 100,000 Persons

Non-U.S.–born† U.S.–born
Percentage of TB Cases by Origin and Race/Ethnicity,*

United States, 2020†

Non-U.S.–born persons

(N=5,127)

U.S.-born persons 

(N=2,018)

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

† Percentages are rounded. Percentages of unknowns/missing are <1% and are not displayed in graphs.

4%

1%

2%

28%

36%

24%

5%

Native Hawaiian/ 

Other Pacific Islander

American Indian/ 

Alaska Native

Multiple Race

White

Hispanic/Latino

Black/

African American

Asian

1%

1%

4%

13%

32%

48%

0%
Percentage of TB Cases by Origin and Race/Ethnicity,*

United States, 2020†

Non-U.S.–born persons§

(N=5,127)

U.S.-born persons

(N=2,018)

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

† Percentages are rounded. Percentages of unknowns/missing are <1% and are not displayed in graphs.

§ American Indian/Alaska Native accounted for no cases among non-U.S.–born persons (not visible).

4%

1%

2%

28%

36%

24%

5%

Native Hawaiian/ 

Other Pacific Islander

American Indian/ 

Alaska Native§

Multiple Race

White

Hispanic/Latino

Black/African 

American

Asian

1%

1% 4%

32% 13%

48%
TB Incidence Rates* by Origin and Race/Ethnicity,†

United States, 2020

Non-U.S.–born persons

(N=5,127)

U.S.-born persons 

(N=2,018)

*Cases per 100,000 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.

3.6

0.2

6.5

0.3

2.0

1.2

1.2

Native Hawaiian/ 

Other Pacific Islander

American Indian/ 

Alaska Native

Multiple Race

White

Hispanic/Latino

Black/African 

American

Asian

15.6

33.5

2.8

15.5

8.1

22.1

White

Hispanic/Latino

Black/African 

American

Asian

0.0
TB Cases by Age Group, 

United States, 1993–2020

0

5,000

10,000

15,000

20,000

25,000

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

≥65 years

45–64 years

25–44 years

15–24 years

5–14 years

0–4 years

Year

Number of cases
0

5

10

15

20

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

≥65 years

45–64 years

25–44 years

15–24 years

5–14 years

0–4 years

TB Incidence Rates by Age Group, 

United States, 1993–2020

Cases per 100,000 persons

Year
TB Cases Among U.S.-born Persons by Age Group, 

United States, 1994–2020

0

4,000

8,000

12,000

16,000

1995 2000 2005 2010 2015 2020

≥65 years

45–64 years

25–44 years

15–24 years

5–14 years

0–4 years

Year

Number of cases
TB Incidence Rates* Among U.S.-born Persons by Age 

Group, United States, 1994–2020

0

4

8

12

16

1995 2000 2005 2010 2015 2020

≥65 years

45–64 years

25–44 years

15–24 years

5–14 years

0–4 years

Cases per 100,000 persons

Year

*Population Source: U.S. Census Bureau, Current Population Survey Basic Monthly: https://data.census.gov/mdat/
TB Cases Among Non-U.S.–born Persons by 

Age Group, United States, 1994–2020

0

2,000

4,000

6,000

8,000

1995 2000 2005 2010 2015 2020

0–4 years 5–14 years 15–24 years 25–44 years 45–64 years ≥65 years

Number of cases

Year
TB Incidence Rates* Among Non-U.S.–born Persons by 

Age Group, United States, 1994–2020

0

10

20

30

40

50

60

70

1995 2000 2005 2010 2015 2020

≥65 years

45–64 years

25–44 years

15–24 years

5–14 years

0–4 years

Cases per 100,000 persons

Year

*Population Source: U.S. Census Bureau, Current Population Survey Basic Monthly: https://data.census.gov/mdat/
Percentage of TB Cases by Birth Decade, 

United States, 1993–2020

0%

20%

40%

60%

80%

100%

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

2010s

2000s

1990s

1980s

1970s

1960s

1950s

1940s

1930s

Percentage of cases 

1920s

Year
Percentage of TB Cases by Sex and Age Group, 

United States, 2020

Males (N=4,346) Females (N=2,828)

63%

65%

58%

56%

44%

49%

37%

35%

42%

44%

56%

0–4 years (N=165) 51%

5–14 years (N=152)

15–24 years (N=690)

25–44 years (N=2,110)

45–64 years (N=2,174)

≥65 years (N=1,882)

Age Group
Pediatric TB Cases by Age Group, 

United States, 1993–2020

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Number of cases

<1 year

1–4 years

5–9 years

10–14 years

Year
Pediatric TB Incidence Rates* by Age Group, 

United States, 1993–2020

0

1

2

3

4

5

6

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

<1 year

1–4 years

5–9 years

10–14 years

Cases per 100,000 persons

Year

*Population Source: U.S. Census Bureau, Current Population Survey Basic Monthly: https://data.census.gov/mdat/
Percentage of Pediatric TB Cases by Age Group, 

United States, 2020 (N=317)

<1 year

14%

1–4 years

38%

5–9 years

20%

10–14 years

28%
Pediatric TB Cases by Origin of Birth, United States, 

1993–2020

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Number of cases

U.S.-born

Non-U.S.–born* 

Year

*Non-U.S.–born refers to persons born outside the United States or its territories or not born to a U.S. citizen
Pediatric TB Incidence Rates* by Origin of Birth, 

United States, 1994–2020

*Population Source: U.S. Census Bureau, Current Population Survey Basic Monthly: https://data.census.gov/mdat/

†Non-U.S.–born refers to persons born outside the United States or its territories or not born to a U.S. citizen

0

5

10

15

20

25

30

1995 2000 2005 2010 2015 2020

 U.S.-born

Non-U.S.–born†

Year

Cases per 100,000 persons
Pediatric TB Cases Among U.S.-born Children by 

Parent/Guardian Status, United States, 2011–2020

0

100

200

300

400

500

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Number of cases

U.S.-born with parents/guardians with unknown origin

U.S.-born with U.S.-born parents/guardians*

U.S.-born with Non-U.S.–born parents/guardians†

Year

*U.S.-born guardian defined as born in the United States or U.S. territories

†At least one parent/guardian was non-U.S.–born.
60%

31%

9%

U.S.-born 

parents/guardians*

Parents/guardians with 

unknown origin

Non-U.S.–born 

parents/guardians†

Percentage of Pediatric TB Cases Among U.S.-born Children 

by Parent/Guardian Status, United States, 2020 (N=254)

*U.S.-born guardian defined as born in the United States or U.S. territories

†At least one parent/guardian was non-U.S.–born
TB Cases by Case Verification Criteria, 

United States, 1993–2020

0

5,000

10,000

15,000

20,000

25,000

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Number of cases

Positive Culture

Positive NAA* Test

Positive Smear

Clinical Case

Provider Diagnosis

*NAA=nucleic acid amplification Year
Percentage TB Cases by Case Verification Criteria,

United States, 2020 (N=7,174)

Positive Culture, 

79%

Positive NAA* Test, 3%

Positive Smear, <1%

Clinical Case, 13%

Provider Diagnosis, 4%

*NAA=nucleic acid amplification
Percentage of TB Cases by Site of Disease, 

United States, 2020

Pulmonary 

Involvement*

79% Extrapulmonary 

Only

21%

*Any pulmonary involvement which includes cases that are pulmonary only and both pulmonary and extrapulmonary. 

Patients may have more than one disease site but are counted in mutually exclusive categories for surveillance purposes. 

25%

<1%

4%

4%

7%

9%

16%

35%

Other

Laryngeal

Meningeal

Genitourinary

Peritoneal

Bone & Joint

Pleural

Lymphatic
0%

20%

40%

60%

80%

100%

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Percentage of cases

HRZE† Other 4+ drug regimen Not on a 4+ drug regimen

Year

Percentage of TB Cases* by Initial Drug Regimen, 

United States, 1993–2020

*In persons alive at diagnosis

†HRZE=isoniazid, rifampin, pyrazinamide, and ethambutol
Percentage of TB Cases,* by Initial Drug Regimen, 

United States, 2020 (N=7,174)

HRZE†

83%

Other 4+ drug regimen

Not on a 4+ drug regimen

*

In persons alive at diagnosis

†HRZE=isoniazid, rifampin, pyrazinamide, and ethambutol

6%

11%
DOT=directly observed therapy; SA=self-administered therapy.

*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.

†Data available through 2018 only. 

Percentage of TB Cases by Mode of Treatment 

Administration,* United States, 1993–2018†

Percentage of cases

0%

20%

40%

60%

80%

100%

1993 1998 2003 2008 2013 2018

DOT only DOT + SA SA only

Year
Percentage of TB Cases by Mode of Treatment 

Administration,* United States, 2018 (N=8,738)

Directly observed therapy 

(DOT), 61%

DOT + SA,

34%

Self-administered therapy (SA) 

*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.

5%
0%

20%

40%

60%

80%

100%

1993 1998 2003 2008 2013 2018

Percentage of cases

Completed in ≤1 year Completed Did Not Complete

Year

*Data available through 2018 only. Among all patients who were alive at diagnosis and started on TB therapy and therapy ≤ 12 months indicated.

†National goal: for patients with newly diagnosed TB disease for whom ≤12 months of treatment is indicated, 95% complete treatment within 12 months.

National 

Goal†:

95%

Percentage of TB Cases by Completion of TB Therapy,

United States, 1993–2018*
Percentage of TB Cases by Reason Therapy Stopped, 

United States, 2018* (N=8,738)

Completed 

Therapy

87%

Did Not Complete 

Therapy

13%

3%

<1%

1%

1%

7%

Unknown†

Adverse Event

Refusal

Lost to Follow-Up

Died

*Data available through 2018 only. Among all patients who were alive at diagnosis and started on TB therapy. 

†Unknown includes cases in persons reporting reason therapy stopped as other, missing, unknown, or moved.

Outcomes for patients who 

did not complete therapy
TB Cases by Isoniazid Resistance and Origin of Birth, 

United States, 1993–2020

0

200

400

600

800

1,000

1,200

1,400

1,600

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Number of cases

Year

U.S.-born

Non-U.S.–Born
Cases and Percentages of MDR TB by History of TB, 

United States, 1993–2020

0%

1%

2%

3%

0

100

200

300

400

500

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Number of cases

Percentage of cases

Year

 No previous TB

 Previous TB

 Percentage MDR with no previous TB*

*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.
Percentage of HIV Coinfection by Age among Persons 

with TB, United States, 2011–2020

0%

2%

4%

6%

8%

10%

12%

2011 2014 2017 2020

Percentage of cases

 All ages

25–44 years

45–64 years

Year
Percentage of Selected Risk Factors Among Persons 

with TB by Origin of Birth, United States, 2020

23%

9%

7%

14%

10%

16%

26%

9%

4%

Diabetes mellitus Non-HIV immunosuppression Contact with infectious TB

Total

U.S.-born

Non-U.S.–born 
Percentage of Social Risk Factor Among Persons Aged 

≥15 Years with TB, United States, 2020

1%

2%

3%

4%

7%

9%

Injection drug use

Residing in long-term care facility

Residing in correctional facility

Experiencing homelessness

Noninjection drug use

Excess alcohol use
*Correctional facilities include federal prisons, state prisons, local jails, juvenile correctional facilities, other correctional facilities, or unknown type of 

correctional facility.

Number and Percentage of Correctional Facility* 

Residents Among Persons Aged ≥15 Years with TB, 

United States, 1993–2020

0%

1%

2%

3%

4%

5%

6%

0

200

400

600

800

1,000

1,200

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Percentage of cases

Number of cases

Year

 Number of TB cases

 Percentage of TB cases
Five States with the Highest Percentages of TB Cases Diagnosed 

Among Correctional Facility* Residents Aged ≥15 Years, 

United States, 2020 

*Correctional facilities include federal prisons, state prisons, local jails, juvenile correctional facilities, other correctional facilities, or unknown type.

Idaho

20%

New Hampshire

8%

Arizona

17%

New Mexico

11%

Texas

8%

0–1.1% >1.1–5.9% >5.9%
TB Cases Among Correctional Facility* Residents Aged 

≥15 Years by Type of Facility, United States, 1993–2020 

*

Includes Immigration and Customs Enforcement (ICE) detention centers, tribal jails operated by Indian reservations, police lockups (temporary holding 

facilities for person who have not been formally charged in court), military stockades and jails, or federal park facilities

0

200

400

600

800

1,000

1,200

1993 1996 1999 2002 2005 2008 2011 2014 2017 2020

Number of cases

Year

Federal Prison State Prison

Local Jail Juvenile Correction Facility

Other* Unknown
Percentage of TB Cases Among Persons Aged ≥15 Years, 

by Primary Occupation, United States, 2020 (N=6,156) 

23%

14%

15%

4%

1%

<1%

38%

Unemployed

Retired

Not Seeking Employment

Healthcare Worker

Migrant Worker

Correctional Employee

Other
Percentage of TB Cases by Status

and Cause of Death, United States, 2018*(N=9,006)

Alive, 91%

Dead, 9%

Cause of death

* Data available through 2018 only.

15%

33%

27%

6%

11%

8%

At diagnosis

During therapy/disease

TB cause of 

death

TB not cause 

of death

Unknown 

cause of death
Percentage of Sputum Culture Conversions Documented, 

United States, 2018*(N=5,087)

Documented 

88%

Not 

Documented

11%

7%

1%

4%

10%

17%

22%

39%

Unknown

Refused

Lost to follow-up

Could Not Produce

Other

Sputum Not Collected

Died

Reasons sputum culture 

conversion not documented

*Data available through 2018 only; among persons who were alive at diagnosis and had a positive sputum culture.
National TB Genotyping Surveillance Coverage*

United States,† 2004–2020

0%

20%

40%

60%

80%

100%

2004 2008 2012 2016 2020

Percentage of culture 

confirmed TB cases genotyped

Year

*

Includes culture-confirmed TB cases with at least one genotyped isolate.

† Includes 50 states and the District of Columbia.

National 

Goal:

100%
Definitions for TB Genotyping

in 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

* MIRU-VNTR=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 U.S. GENType designations.
860

215

85

41

22

11

11

8

27

2 cases

3 cases

4 cases

5 cases

6 cases

7 cases

8 cases

9 cases

10+ cases

Number of County-based TB Genotype Clusters* by 

Cluster Size, United States, 2018–2020

* Genotype clusters are 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.
TB Genotype Clusters by TB GIMS* Alert Levels,†

United States, 2018–2020 (N=1,280)

* TB GIMS=Tuberculosis Genotyping Information Management System

† Alert levels are determined by the log likelihood ratio (LLR) statistic 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.

High Alert

5%

Medium Alert

23%

No Alert

72%
Genotyped TB Cases Estimated to be Attributed to Recent 

Transmission, United States, 2019–2020 (N=12,242)

Recent 

transmission*

12%

Not recent 

transmission§

88%

8% 

4%

Limited recent 

transmission 

Extensive recent 

transmission†

* A TB case is designated as attributed to recent transmission if a plausible source case can be identified in a person who i) has the same M. tuberculosis genotype, ii) has 

an infectious form of TB disease, iii) resides within 10 miles of the TB case, iv) is 10 years of age or older, and v) was diagnosed within 2 years before the TB case.

† A TB case is designated as attributed to extensive recent transmission when the criteria above for recent transmission are met, and furthermore the case belongs to a 

plausible transmission chain of six or more cases. Otherwise, the case is designated as attributed to limited recent transmission.

§ Cases not attributed to recent transmission may be misclassified in children <5 years old or indeterminate in persons with a recent U.S. arrival due to limitations of the 

plausible-source case method. 
Genotyped Cases Estimated to be Attributed to Limited and 

Extensive Recent Transmission, United States, 2017–2020

n=589 

(34%)

n=502

(33%)

n=1,123

(66%) n=1,025

(67%)

0

400

800

1,200

1,600

2,000

2017–2018 2019–2020

Cases Attributed to

Recent Transmission

*

n=1,712

n=1,527

* A TB case is designated as attributed to recent transmission if a plausible source case can be identified in a person who i) has the same M. tuberculosis genotype, ii) 

has an infectious form of TB disease, iii) resides within 10 miles of the TB case, iv) is 10 years of age or older, and v) was diagnosed within 2 years before the TB case.

† A TB case is designated as attributed to extensive recent transmission when the criteria above for recent transmission are met, and furthermore the case belongs to 

a plausible transmission chain of six or more cases. Otherwise, the case is designated as attributed to limited recent transmission.

Limited recent transmission 

Extensive recent transmission†
Percentages of TB Cases Estimated to be Attributed and Not 

Attributed to Recent Transmission, by Origin of Birth,* 2019–2020

* Cases with unknown origin of birth not shown (n=27).

† A TB case is designated as attributed to recent transmission if a plausible source case can be identified in a person who i) has the same M. tuberculosis genotype, ii) has an infectious form of TB disease, 

iii) resides within 10 miles of the TB case, iv) is 10 years of age or older, and v) was diagnosed within 2 years before the TB case.

§ Cases not attributed to recent transmission may be misclassified in children <5 years old or indeterminate in persons with a recent U.S. arrival due to limitations of the plausible-source case method.

25%

92% 75%

Non-U.S.–born U.S.-born

Recent transmission†

8%

Not recent transmission§

Recent transmission†

Not recent transmission§
73

Percentage of TB Cases Estimated to be Attributed to Recent 

Transmission by Race/Ethnicity, United States, 2017–2020

2017–2018 2019–2020

Native Hawaiian/ 

Other Pacific Islander

American Indian/ 

Alaska Native

White

Hispanic/Latino

Black/African 

American

Asian

40%

24%

20%

13%

13%

7%

45%

34%

20%

12%

13%

7%
74

Percentage of TB Cases Estimated to be Attributed to Extensive 

Recent Transmission by Race/Ethnicity, United States, 2017–2020

2017–2018 2019–2020

American Indian/ 

Alaska Native

White

Hispanic/Latino

Black/African 

American

Asian

24%

7%

8%

4%

4%

2%

22%

18%

7%

4%

3%

3%

Native Hawaiian/ 

Other Pacific Islander
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.

Division of Tuberculosis Elimination 

National Center for HIV, 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/