Tuberculosis was supposed to be a disease the United States had largely moved past. For nearly three decades, U.S. case counts fell consistently, reaching an all-time low of 7,174 in 2020 — a figure driven partly by pandemic disruptions in health care utilization, but broadly reflecting long-term progress in TB control.
That trend has reversed. In 2024, the Centers for Disease Control and Prevention confirmed 10,388 tuberculosis cases — the highest total since 2011 and a 14-year high that public health officials say reflects structural vulnerabilities that predated the pandemic and have been deepening since. Provisional 2025 data released March 23, 2026 shows a slight reduction to 10,260 cases — a 1% decline in cases and a 2% drop in the national rate to 3.0 per 100,000 — but the numbers remain sharply elevated compared to every year before the pandemic-era trough.
What concerns public health experts is not any single year's count but the direction and the infrastructure supporting the response.
Why This Matters
Tuberculosis is not a disease of the past in the United States. It is a present, active, and substantially underacknowledged public health challenge — one that disproportionately affects immigrant communities, older adults, people with diabetes, and residents of congregate settings including nursing homes, shelters, and correctional facilities.
Globally, TB remains the single deadliest infectious disease caused by a single organism — killing approximately 1.25 million people annually, according to the World Health Organization. The United States has maintained one of the world's lowest TB rates, but the consecutive years of post-pandemic case increases have signaled that the infrastructure required to sustain that record — contact tracing, latent infection screening, and consistent treatment support — is under pressure.
The practical consequence for communities is that more cases means more transmission, more hospitalizations, and more patients who need months of daily antibiotic therapy supported by public health workers. The cost of managing each case is substantial, and those costs scale with volume.
What We Know So Far
From the CDC's full-year 2024 TB surveillance report and the 2025 provisional data report:
- 2024 cases : 10,388 — the highest since 2011
- 2025 cases (provisional) : 10,260 — a 1% decline from 2024, but the fourth consecutive year above pre-pandemic baselines
- National rate 2025 : 3.0 cases per 100,000 population
- Proportion of cases in non-U.S.-born individuals : 77% (rate of 15.4 per 100,000 among foreign-born vs. 0.8 per 100,000 among U.S.-born)
- Largest share of cases in 2024 by state : California, Texas, New York, and Florida (collectively about 50% of all cases)
- Highest incidence rates per 100,000 : Alaska (12.3), New York City (9.8), Hawaii (8.1), California (5.3)
- Adults 65 and older : The only age group where TB rates increased from 2024 to 2025
- Recent transmission (2023–2024 combined) : 12% of genotyped cases linked to transmission within the past 2 years
Where the Risk Is Highest
The concentration of U.S. TB cases in four states — California, Texas, New York, and Florida — reflects both the high proportion of foreign-born residents in those states and the major international transportation hubs they contain. But the risk is not uniform within those states.
New York City's TB incidence rate of 9.8 per 100,000 is among the highest of any U.S. city, driven by the concentration of recent immigrants and the density of congregate housing and shelter populations where transmission can occur more readily. Alaska's rate of 12.3 per 100,000 is the highest of any state, reflecting the high proportion of Alaska Native residents — a population disproportionately affected by TB historically.
At the county level, the epidemiology is more granular. Johnson County, Iowa — far from the traditional TB burden states — has seen its case count rise substantially since 2020, with contact tracing and surveillance costs increasing from $17,000 in 2020 to $65,000 in 2025. This trajectory is not unique to Iowa; it reflects a pattern emerging in Midwestern and Southern counties with growing immigrant populations where TB programs have not always scaled to meet rising demand.
New Hampshire saw TB cases double from 12 to 24 between 2024 and 2025. North Dakota reported a 64 percent increase. These are small absolute numbers, but percentage growth rates of this magnitude in states not historically associated with high TB burden signal that transmission is reaching communities that may have lower provider awareness of the disease.
What Doctors and Experts Say
Dr. Michael Lauzardo, an infectious disease specialist at the University of Florida and director of the Florida TB Physicians Network, said immigration enforcement climate adds an important complicating factor to the data. "I think the numbers will be lower because people are afraid," he told Stateline in February 2026, referring to concerns that undocumented individuals at risk for TB may be avoiding medical care. "A lot of the people at risk for TB are not seeking care, I suspect."
That perspective is significant: if fear of immigration enforcement is deterring at-risk individuals from seeking TB diagnosis and treatment, the actual 2025 case count may understate the true burden — which is the opposite of the progress the slight numeric decline might appear to represent.
The CDC itself noted in its 2025 data release that "eliminating TB in the United States requires a dual approach that prioritizes addressing both active TB disease to stop TB transmission and latent TB infection (LTBI) to prevent future disease" — a statement that implicitly acknowledges the gap between the current resource environment and what elimination would require.
What the Evidence Shows — and What It Does Not
The 2025 provisional decline of 1% in TB cases does not represent a meaningful reversal of the post-pandemic upward trend. The 2025 total remains 43% higher than the 2020 low of 7,174 — and that 2020 low was itself shaped by pandemic disruptions in health-seeking behavior, not genuine disease control progress.
The rise in TB rates among adults 65 and older specifically — the only age group that increased from 2024 to 2025 — is clinically important. Older adults are more likely to have been infected with TB decades ago and to experience reactivation as their immune systems weaken. This age-specific trend suggests that screening and treatment of latent TB infection in older populations is an underutilized intervention.
The CDC's 2024 surveillance report included, for the first time in several years, estimates of recent TB transmission — finding that 12% of genotyped 2023–2024 cases were attributable to transmission within the prior two years. Domestic transmission, while still a minority of the total case burden, is not negligible.
MedicalDaily Evidence Check
- Data source : CDC National Tuberculosis Surveillance System (provisional 2025 data released March 23, 2026; full 2024 report released December 2025)
- 2024 confirmed cases : 10,388 (14-year high)
- 2025 provisional cases : 10,260 (slight decline, still above all pre-pandemic years)
- What it found : Sustained above-baseline TB activity; rising rates in older adults; geographic spread into historically lower-burden states
- Key limitation : 2025 data are provisional and may increase when finalized; data may undercount true burden among individuals not seeking care
- What readers should know : High-risk individuals should discuss TB testing with their provider; latent TB infection is treatable and prevents future active disease
Who Faces the Greatest Risk?
According to CDC epidemiological data:
- People born outside the United States, with a TB rate nearly 20 times higher than U.S.-born individuals
- Adults 65 and older, who are experiencing rising TB rates
- People living with HIV (5% of 2024 cases)
- People with diabetes (22% of 2024 cases, the most commonly reported medical risk factor)
- Individuals taking medications that suppress immune function (corticosteroids, TNF-alpha inhibitors, cancer chemotherapy)
- Residents of congregate settings, including nursing homes, homeless shelters, and correctional facilities
- Individuals with a history of residence in or extended travel to high-TB-burden countries
Symptoms and Warning Signs to Watch For
Active pulmonary TB typically produces:
- A persistent cough lasting three weeks or longer
- Coughing up blood or mucus
- Chest pain
- Unintended weight loss
- Fever and night sweats
- Extreme fatigue
- Loss of appetite
TB outside the lungs (extrapulmonary TB) can affect the lymph nodes, spine, kidneys, or brain, and may produce symptoms specific to the affected organ.
A persistent cough in a person with any of the risk factors above — particularly recent immigration, prior residence in a high-burden country, or known TB contact — warrants evaluation. TB is diagnosed through a skin test (tuberculin skin test), blood test (IGRA), chest X-ray, and, if active disease is suspected, sputum culture.
What You Can Do Now
- If you are in a high-risk group, ask your primary care provider about TB testing. The IGRA blood test (QuantiFERON-TB Gold) is the preferred test for most adults and does not require a return visit for reading.
- If you have been prescribed treatment for latent TB infection (a positive test with no active disease symptoms), complete the full course of preventive therapy. Latent TB is curable and the treatment prevents future active disease.
- If you develop a cough lasting more than three weeks and you have any risk factors, do not assume it is a chronic respiratory condition — request evaluation that includes TB testing.
- Employers and facility administrators at nursing homes, shelters, and correctional facilities should review their TB screening protocols for new residents and staff.
- Health care providers working with immigrant communities should incorporate TB screening into intake assessments.
Cost and Access: What Patients Should Know
TB testing, latent TB treatment, and active TB treatment are provided at no cost to patients through state and local TB control programs in the United States, regardless of immigration status. This is a fundamental component of U.S. TB policy — because untreated active TB spreads, cost barriers to TB care create public health risk for everyone.
Local TB clinics can be located through state health department directories or by calling the county health department.
For active TB patients, treatment spans 4 to 9 months of daily antibiotics. Many programs offer directly observed therapy (DOT), in which a public health worker visits the patient daily to confirm medication is taken — a proven strategy for ensuring completion rates and preventing drug-resistant TB.
What Happens Next
The CDC will release its full-year 2025 TB surveillance report later in the fall of 2026, which will include more granular state-level, demographic, and genotyping data. The provisional figures released in March are subject to upward revision as additional reports are processed.
Public health officials are watching the 2026 trend closely. Several states reported preliminary 2025 figures to the National Tuberculosis Coalition of America suggesting their case counts grew between 10% and 20% from 2024, which would indicate the provisional decline is not uniform across the country.
The Bottom Line
Tuberculosis is not a historical footnote in the United States. With case counts at their highest levels in over a decade and a public health infrastructure under pressure from competing demands and funding constraints, the conditions for sustained domestic TB transmission are more present than at any point in recent memory. The risk is concentrated but not invisible: major cities, immigrant communities, older adults, and people with immune-compromising conditions carry the heaviest burden. TB testing is free through public health programs, and latent infection is curable — making early identification the most powerful tool available.
