The lowest tuberculosis rate ever recorded is not fast enough

9,029 new tuberculosis cases in the United States in 2018 — a **0.7%
decrease** from 2017 — and an incidence of 2.8 per 100,000, down 1.3%.

Both are the lowest ever reported. Cases have declined steadily since 1993.

And that is the problem.

The arithmetic of elimination

**A recent model predicted that the U.S. TB elimination goal will not be
attained in the 21st century without greatly increased investment in
detection and treatment of latent TB infection.**

A 1% annual decline compounds slowly. Getting from 28 per million to under 1
that way takes longer than the century has left, which is why "lowest ever
recorded" and "not on track" are both true.

Why latent infection is the lever

**The rate among non-US-born people was more than 14 times that among
US-born people**, and **non-US-born people accounted for roughly two-thirds of
cases.**

Read that together with the recommendation and the mechanism becomes clear.
Most US TB is not recent transmission inside the country — it is **latent
infection, acquired elsewhere, reactivating years later.** Nothing done to
stop people passing TB to each other in the United States touches that
reservoir.

Which is why every recommendation in this report points at the same place:
identify, test and treat populations at high risk for latent TB infection.
Treating latent infection is the only intervention that empties the reservoir
before it produces a case.

Enhanced surveillance, detection, and treatment is the stated requirement —
with the emphasis on finding infections in people who are not ill, which is
the hardest kind of public health programme to fund and to explain.

Source: Centers for Disease Control and Prevention, MMWR.