Top 5 Takeaways

  1. Second Outbreak in Recent Years: This report covers the second outbreak of TB related to bone allografts in recent years, with 36 recipients affected.
  2. Initial Detection and Response: The outbreak was initially detected following two TB cases in different states, leading to a rapid public health response that prevented 53 additional procedures using the implicated allografts.
  3. Laboratory Analysis and Results: Whole-genome sequencing confirmed the bone allograft as the transmission source, with 5 out of 36 recipients diagnosed with laboratory-confirmed TB disease.
  4. Significance of Findings: The outbreak highlights the limitations of current testing methods for Mycobacterium tuberculosis in donor tissues and underscores the need for more comprehensive testing, including culture-based methods.
  5. Public Health Implications: Emphasizes the necessity for improved donor screening, informed consent processes, and post-implant monitoring to reduce the risk of tissue-derived TB transmission.

Original Article Author and Citation

Corresponding Author

Jonathan M. Wortham,

Suggested Citation

Wortham JM, Haddad MB, Stewart RJ, et al. Second Nationwide Tuberculosis Outbreak Caused by Bone Allografts Containing Live Cells — United States, 2023. MMWR Morb Mortal Wkly Rep 2024;72:1385–1389. DOI:


The article discusses a tuberculosis (TB) outbreak in the United States in 2023, linked to bone allografts containing live cells. This second recent outbreak affected 36 recipients and was similar to a 2021 outbreak involving 113 patients. Rapid public health interventions prevented further distribution and implantation of the implicated allografts.


The outbreak was detected following TB diagnoses in two patients who underwent spinal surgeries with bone allografts from the same deceased donor. Investigations involved whole-genome sequencing, which showed a close genetic relationship between the TB cultures from surgical recipients and the unused product, confirming the source of the outbreak.


The discussion highlights the limitations of nucleic acid amplification testing and the need for more sensitive culture-based tests. The report emphasizes the importance of reviewing donor information and excluding donors with sepsis or signs of TB. It also notes the lower rate of symptomatic TB disease in the 2023 outbreak compared to 2021, possibly due to prompt treatment and lower contamination levels.


The report concludes that there is an urgent need for improved donor screening and testing methods to prevent tissue-derived Mycobacterium tuberculosis transmission. It calls for better informed consent processes and routine post-implant monitoring of tissue allograft recipients to enhance transplant tissue safety.


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