CDC’s Tuberculosis Laboratory: The Nation’s TB Reference Lab

CDC's Tuberculosis (TB) Laboratory is the National TB Reference Laboratory, supporting all 50 U.S. states, the U.S. territories and the freely associated states. It has the special facilities and expertise needed to work safely with live TB bacteria, and it supports the goal of eliminating TB in three ways: clinical testing, applied research and technical assistance.

Image from CDC's page on tuberculosis laboratories.

Research

The lab's applied research aims to:

• improve detection of outbreaks;
• identify and describe how TB becomes drug-resistant;
• explore new approaches, such as host-directed therapies;
• make the best use of state-of-the-art technology.

Services for health departments

• Consultation and technical assistance for public health laboratories and TB programs.
• Drug susceptibility testing of Mycobacterium tuberculosis complex, from processed specimens or cultured isolates. Local health departments, licensed physicians' offices, labs and health care facilities may submit samples, but only through their state health department or another authorized facility.
• Molecular Detection of Drug Resistance (MDDR), which uses DNA sequencing to quickly find the mutations most often linked to resistance — including multidrug resistance — to the most effective first- and second-line drugs and to newer and repurposed drugs such as bedaquiline, clofazimine and linezolid.
• The Model Performance Evaluation Program, which assesses how well clinical, commercial and public health labs across the country perform TB drug susceptibility testing.
• The National TB Molecular Surveillance Center and the National Public Health Laboratory Drug Susceptibility Testing Reference Center for TB.

Tracking transmission

The lab supports CDC's TB investigations and surveillance. Combined with epidemiologic data, genotyping helps show which patients belong to the same chain of recent transmission. CDC contracts with a laboratory in Michigan to provide genotyping to U.S. TB programs, using whole genome sequencing.

Measuring lab performance

Under the CDC TB Elimination and Laboratory Cooperative Agreement, 58 state, local and territorial public health laboratories file an Annual Performance Report. CDC compiles the data into the Tuberculosis Laboratory Aggregate Report — its eighth edition published in 2026 — so labs can check progress toward national TB testing benchmarks and compare themselves with peers of similar size, methods or region.

Partners

CDC works with the Association of Public Health Laboratories to strengthen the national lab system through evaluation, education and training and by promoting best practices and new tools, and with public health labs and TB programs on patient care, genotyping and outbreak detection. It also offers a toolkit for investigating false-positive TB results and a continuity-of-operations toolkit for public health mycobacteriology labs.

Sources

Based on "Tuberculosis Laboratories," Centers for Disease Control and Prevention; a work of the United States government in the public domain.