Among Us V2023.2.9 Pc
Tommye Hope
For years, the United States has had one of the lowest tuberculosis (TB) rates in the world. In the first year of the COVID-19 pandemic, reported TB case counts dropped substantially, followed by increasing case counts every year since 2020.
Continued progress toward TB elimination will require strong public health systems that are capable of maintaining essential disease prevention and control activities and prepared to withstand the next pandemic or other large-scale crisis.
Approximately 85% of TB cases in the United States are attributed to reactivation of latent TB infection (LTBI) rather than recent transmission (2,4). Therefore, sustained transmission of TB in the United States leading to outbreaks is uncommon. Essential TB elimination activities include TB testing among populations at risk and treating persons with LTBI or TB disease. To prevent transmission and reduce morbidity, TB disease must be detected quickly; effective treatment must be initiated promptly; and all exposed persons identified, evaluated, and treated if infected (5). This approach led to a 66% reduction in TB cases and 73% reduction in the TB rate in the United States in the first 25 years of implementation (4).
TB prevention and control interventions are primarily conducted by staff members in state and local public health programs. The decades-long downward trend in TB in the United States and the high TB disease treatment completion rates (4) underscore the success of these TB programs. However, during the COVID-19 pandemic, TB programs were severely taxed with many staff members and activities diverted to the COVID-19 response (6). Timely diagnosis and treatment of TB disease also suffered because of pandemic-related disruptions in health care access and health care workers focusing on identifying persons with COVID-19, who often have symptoms similar to those of pulmonary TB (7). These factors, along with changes in migration volume (8), probably contributed to the decrease in the number of cases observed in 2020, and to the subsequent rise in case counts and rates since 2020. Identification of TB cases possibly increased after the pandemic because of renewed attention to infectious diseases other than COVID-19.
The U.S. TB case count increases in 2023 underscores the ongoing global TB-associated morbidity and mortality. Renewed progress toward TB elimination will require strong public health systems both domestically and globally that are responsive to health disparities, capable of maintaining essential disease prevention and control activities, and prepared to withstand the next pandemic or other large-scale crisis.
State and local health department personnel; Surveillance Team, Cynthia Adams, Shanita Clemmons, Stacey Parker, Jeanette Roberts, Katrina Williams, Peraton; Justin Davis, Maryam Haddad, Kimberly Schildknecht, Julie Self, Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC.
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After 27 years of declining U.S. tuberculosis (TB) case counts, the number of TB cases declined considerably in 2020, coinciding with the COVID-19 pandemic. For this analysis, TB case counts were obtained from the National TB Surveillance System. U.S. Census Bureau population estimates were used to calculate rates overall, by jurisdiction, birth origin, race and ethnicity, and age group. Since 2020, TB case counts and rates have increased each year. During 2023, a total of 9,615 TB cases were provisionally reported by the 50 U.S. states and the District of Columbia (DC), representing an increase of 1,295 cases (16%) as compared with 2022. The rate in 2023 (2.9 per 100,000 persons) also increased compared with that in 2022 (2.5). Forty states and DC reported increases in 2023 in both case counts and rates. National case counts increased among all age groups and among both U.S.-born and non-U.S.-born persons. Although TB incidence in the United States is among the lowest in the world and most U.S. residents are at minimal risk, TB continues to cause substantial global morbidity and mortality. This postpandemic increase in U.S. cases highlights the importance of continuing to engage communities with higher TB rates and their medical providers in TB elimination efforts and strengthening the capacity in public health programs to carry out critical disease control and prevention strategies.
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Note: The small number of counties that experienced no population change are categorized as having a population gain. From 2021 to 2022, nine counties had no change: four in the Midwest, three in the South, and two in the West. From 2022 to 2023, 12 counties had no change: four in Midwest, five in the South, and three in the West.
Sixty-two percent of counties, up from 60% in 2022, experienced positive net domestic migration in 2023. In addition, net domestic migration generally moderated among some of the counties with the largest amounts of net domestic in-migration and out-migration in 2022. The 10 counties with the largest net domestic in-migration were mostly in the South. In contrast, the top 10 counties with largest net domestic out-migration were mostly in large metro areas, with some experiencing considerably less net domestic out-migration in 2023 than in 2022.
In June, the Census Bureau is scheduled to release estimates of the July 1, 2023, population by age, sex, race and Hispanic origin for the nation, states, metropolitan and micropolitan statistical areas, and counties, and population by age and sex for the Commonwealth of Puerto Rico and Puerto Rico municipios. The data will be embargoed.
With each new release of annual estimates, the entire time series of estimates is revised for all years back to the date of the last census. All previously published estimates (i.e., old vintages) are superseded and archived on the FTP2 site.
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