Top 5 Takeaways

1. Increase in TB Incidence: Reported TB incidence increased by 9.4% in 2021 compared to 2020, but it remained lower than the pre-pandemic levels of 2019.
2. Impact of COVID-19 Pandemic: The sharp decline in TB cases in 2020 was likely due to factors related to the COVID-19 pandemic, including delayed or missed diagnoses and reduced transmission due to mitigation efforts.
3. Demographic Variations: TB incidence increased among both U.S.-born and non–U.S.-born persons in 2021, with significant increases among certain racial and ethnic groups.
4. Advanced Disease Indicators: There was an increase in the prevalence of smear positivity, particularly among non–U.S.-born persons, indicating more advanced pulmonary disease and potential delays in diagnosis.
5. Public Health Implications: Timely evaluation and treatment of TB and latent TB infection are critical to achieving TB elimination in the U.S., and awareness campaigns like “Think. Test. Treat TB” are essential.

Original Article Author and Citation

Corresponding Author

Thomas D. Filardo, rhx1@cdc.gov

Suggested Citation

Filardo TD, Feng P, Pratt RH, Price SF, Self JL. Tuberculosis — United States, 2021. MMWR Morb Mortal Wkly Rep 2022;71:441–446. DOI: http://dx.doi.org/10.15585/mmwr.mm7112a1

Summary

The article discusses the trends in tuberculosis (TB) incidence in the United States for the year 2021. After a significant decline in TB cases in 2020, likely due to the COVID-19 pandemic, TB incidence increased by 9.4% in 2021. However, the incidence was still lower than in 2019. The increase in TB cases was observed among both U.S.-born and non–U.S.-born persons, with notable variations across different racial and ethnic groups. The report emphasizes the importance of timely diagnosis and treatment of TB and latent TB infection to achieve TB elimination in the U.S.

Methods

Health departments in the 50 U.S. states and the District of Columbia report TB cases to the CDC based on the Council of State and Territorial Epidemiologists’ surveillance case definition, which includes both laboratory and clinically verified cases. Midyear U.S. Census Bureau population estimates were used to calculate national- and state-level TB incidence per 100,000 persons, stratified by age groups, race, and ethnicity. Incidence by birth origin was also calculated using midyear population estimates from the Current Population Survey.

Discussion

The increase in TB incidence in 2021 compared to 2020 may be partially explained by delayed diagnosis of cases with symptom onset during 2020. The COVID-19 pandemic likely contributed to disruptions in health care access and delayed TB diagnoses. The report highlights the need for continued TB control and prevention services, including early diagnosis and complete treatment of TB and latent TB infection. The CDC’s “Think. Test. Treat TB” campaign aims to raise awareness among communities at risk and their health care providers.

Conclusion

The main takeaways from the report are the increase in TB incidence in 2021 following a sharp decline in 2020, the impact of the COVID-19 pandemic on TB diagnosis and reporting, and the importance of timely evaluation and treatment of TB and latent TB infection. Public health efforts must focus on maintaining essential TB activities to achieve TB elimination in the United States.

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