Tuberculosis came back in 2022, and the youngest rose fastest

US tuberculosis incidence fell gradually from 1993 to 2019, reaching **2.7
cases per 100,000**. Then it dropped to 2.2 in 2020 alongside the COVID-19
pandemic — a fall nobody believes was entirely real. **The proposed
explanations are delayed or missed diagnoses, changes in migration and travel,
and deaths among people susceptible to TB reactivation.**

**California reported the most cases (1,843); Alaska the highest incidence
(13.1).**

The age pattern is the finding

Highest incidence is still among people aged ≥65 (3.9), then 45–64
(2.9), 25–44 (2.7), 15–24 (1.9), ≤4 (1.1) and 5–14 (0.4).

But the changes run the other way:

That inversion matters. TB in an older adult is usually reactivation of an
infection acquired decades ago. TB in a child under five is almost always
recent transmission, because there has not been time for anything else.
The age group rising fastest is the one that reports on what is happening now,
and the age group falling is the one that reports on the past.

Birth origin

**73% of cases (6,009 of 8,248 with known birth origin) were among
non-US-born people**, against 72% in 2021.

**Among non-US-born people with TB in 2022, 16.5% (992) were recent
arrivals** — up — while the share who had been in the United States **more than
ten years fell from 50.2% to 46.9%.** The population is shifting towards people
diagnosed soon after arrival, which is what the reopening of travel looks like
in surveillance data.

Within that group, **more than 80% of cases were among Asian (2,632; 44%) or
Hispanic (2,194; 37%) people**. By incidence the order is different: **Native
Hawaiian or other Pacific Islander (27.8)**, Asian (22.0), Black (13.7),
Hispanic (10.1), American Indian or Alaska Native (4.3), White (3.4) — a
reminder that the largest count and the highest rate are not the same question.

The disparity the report names

**Higher TB incidence among American Indian or Alaska Native and Native
Hawaiian or other Pacific Islander people, compared with other groups,
represents an ongoing health disparity.** Among non-US-born people, the
largest single-year increase was 221% among AI/AN persons, followed by
NH/OPI (+20%), Hispanic (+13%) and White (+7%); incidence fell 12% among Black
and 7% among Asian people.

Where people were living

Rising shares of people diagnosed with TB in 2022 reported, compared with 2021:

• Experiencing homelessness in the preceding 12 months — 4.8%
• Residing in a correctional facility at diagnosis — 3.5%
• In a long-term care facility — 1.7%

4.7% of those with known HIV status were coinfected, up from 4.3%.

What follows

TB incidence appears to be returning to prepandemic levels, which is not
recovery so much as the end of an undercount. The response named is two-part
and in order: timely diagnosis and treatment to interrupt transmission, and
prevention through treatment of latent TB infection — the reservoir that
the 65-and-over line is drawing on.

Source: Centers for Disease Control and Prevention, MMWR.