Tuberculosis is uncommon in the United States but far from gone. In 2023, the country reported 9,633 cases of active TB disease, an incidence rate of 2.9 cases per 100,000 people. That number ticked up again in 2024 to 10,388 cases. After declining for roughly three decades, TB rates have been climbing steadily since 2020, making 2023 the highest case count in a decade.
Those numbers represent active disease, the kind that causes symptoms and can spread to others. A much larger group of people carry the TB bacteria without being sick. The CDC estimates that up to 13 million people in the United States have latent TB infection, and more than 80% of active TB cases in the country develop from these longstanding, untreated latent infections reactivating years or even decades later.
Where TB Cases Are Concentrated
TB is not evenly spread across the country. A handful of states account for a disproportionate share of cases, largely because they have larger immigrant populations, more international travel, or denser urban areas where transmission is easier. In 2024, the states with the highest incidence rates were Alaska (12.3 per 100,000), Hawaii (8.1), California (5.3), New Jersey (3.6), and Massachusetts (3.6). California alone reported over 2,100 cases in 2024, roughly one-fifth of the national total.
By contrast, many rural and low-population states see only a handful of cases per year. If you live in the rural Midwest, for instance, your likelihood of encountering TB is considerably lower than if you live in a major coastal city.
Who Gets TB in the US
The demographic picture of TB in America is striking. In 2024, 77% of all TB cases occurred in people born outside the United States. The incidence rate among non-US-born individuals was 15.7 per 100,000, compared to just 0.8 per 100,000 for US-born individuals. Many of these cases stem from latent infections acquired in countries where TB is far more prevalent, with the bacteria reactivating after the person has lived in the US for years.
Among US-born individuals, the highest incidence rates in 2024 appeared in young children under age 5 (1.3 per 100,000) and adults 65 and older (1.0 per 100,000). Young children are vulnerable because their immune systems are still developing, while older adults may have weaker immunity or carry latent infections from decades past. The lowest rate was in school-age children between 5 and 14 (0.3 per 100,000).
Certain medical conditions also raise the risk significantly. In 2020, roughly 22.5% of TB patients in the US had diabetes, and about 4.8% were living with HIV. Both conditions weaken the immune system’s ability to keep latent TB bacteria in check, making reactivation more likely.
Congregate Settings and Outbreaks
TB spreads through the air, which means close, prolonged contact in enclosed spaces creates the highest risk. Homeless shelters, correctional facilities, and long-term care homes are classic settings for transmission. In 2023, 324 people who were residents of a correctional facility at the time of diagnosis were reported with TB, accounting for about 3.6% of all US cases among those 15 and older. Crowded living conditions, limited ventilation, and barriers to healthcare access make these environments particularly vulnerable to outbreaks.
Drug-Resistant TB
Most TB in the US responds to standard antibiotic treatment, but a small percentage does not. In 2023, 8.5% of cases showed resistance to at least one first-line drug at initial diagnosis. Of those, 100 cases (1.4% of the total) were classified as multidrug-resistant TB, meaning the bacteria resist the two most important frontline antibiotics. Drug-resistant TB requires longer, more complex treatment with medications that often carry more side effects.
The burden of drug resistance falls unevenly. Among non-US-born patients, 9.2% had some level of resistance, including 94 of the 100 MDR cases nationally. Among US-born patients, resistance rates were lower at 5.8%, with only 6 MDR cases.
Why Cases Are Rising Again
The recent uptick is partly a correction after the COVID-19 pandemic disrupted TB detection. During 2020 and 2021, fewer people visited clinics, fewer screenings were performed, and public health resources were diverted to COVID response. Some cases that would have been caught earlier went undiagnosed, leading to delayed presentations and continued transmission. As screening and surveillance returned to normal, those missed cases began showing up in the data. Immigration patterns and global travel resuming after pandemic restrictions also contributed to the increase.
The US set a goal in 1989 to reach TB elimination, defined as fewer than 1 case per million people per year. At the current rate of 2.9 per 100,000 (or 29 per million), the country remains roughly 29 times above that threshold. Progress has stalled, and some researchers have raised concerns that without more aggressive investment in finding and treating latent infections, elimination will remain out of reach for decades.
Active TB vs. Latent Infection
The distinction between latent and active TB is important for understanding the numbers. If you have latent TB, the bacteria are alive in your body but dormant. You feel fine, have no symptoms, and cannot spread it to anyone. Without treatment, roughly 5% to 10% of people with latent TB will develop active disease at some point in their lives, with the risk highest in the first two years after exposure and in people with weakened immune systems.
Active TB typically affects the lungs and causes a persistent cough lasting three weeks or more, fever, night sweats, and unintentional weight loss. It is contagious and requires a multi-drug antibiotic regimen lasting at least six months. Latent TB can be treated with shorter courses of medication to prevent it from ever becoming active, which is why screening programs for people at higher risk are a cornerstone of TB control in the US.
With an estimated 8.6 to 12.6 million people carrying untreated latent infections, this reservoir of potential future cases represents the biggest challenge to reducing TB in the United States. Each year, a fraction of those millions will progress to active disease, sustaining the case counts even in the absence of new transmission.