After three consecutive years of rising tuberculosis cases in the United States — which saw the case count climb from 9,622 in 2023 to a 14-year high of 10,395 in 2024 — public health officials had hoped 2025 would mark a turning point. The CDC's provisional tuberculosis data for 2025, released March 23, 2026, delivered mixed news: the national total dropped slightly to 10,260 confirmed cases, a 1 percent decline in cases and 2 percent decline in the national rate to 3.0 per 100,000 population. That marginal improvement, however, comes against a backdrop that public health experts are calling structurally fragile — and four states reported increases significant enough to demand attention.
The most striking state-level change came in New Hampshire, where TB cases doubled from 12 to 24 — a 100 percent increase in a single year. North Dakota saw a 64 percent increase. Colorado rose 32 percent. These are not large-population states by national standards, but double-digit percentage jumps in consecutive years signal that the infrastructure for TB detection, contact tracing, and treatment is under pressure.
For context, the United States recorded its lowest-ever TB case count in 2020 at 7,174 cases — a figure heavily influenced by pandemic-era reductions in healthcare utilization and reporting. Since 2021, the trend has been consistently upward. The 2025 total of 10,260 is 43 percent higher than the 2020 low, confirming that the pandemic-era trough was not a genuine improvement in TB control but a reporting artifact that masked an underlying resurgence.
Who Is Getting Tuberculosis in America
The demographic portrait of U.S. TB in 2025 reinforces longstanding patterns with one notable new development. Approximately 77 percent of U.S. TB cases are diagnosed in people born outside the United States, with a corresponding rate of 15.4 cases per 100,000 — nearly 20 times the rate of 0.8 per 100,000 among U.S.-born individuals. This distribution reflects both the global burden of TB in countries of origin and the fact that many individuals with latent TB infection — acquired before U.S. arrival — progress to active disease years later.
The new development is the trajectory for older adults. Adults 65 and older are the only age group showing an increase in TB rates in 2025, with 2,632 cases compared to 2,518 in 2024. This matters for several reasons. Older adults often acquired TB infection decades earlier and are now experiencing reactivation due to immune system weakening, concurrent chronic illness, or immunosuppressive medications. They are also more likely to present with atypical symptoms, meaning diagnosis is frequently delayed.
System Strain and Prevention Gaps
The Stateline reporting consortium documented in February 2026 that public health agencies across multiple states are struggling to keep up, contending simultaneously with TB surveillance and a growing measles outbreak, with some TB programs facing budget cuts and workforce reductions that directly undermine contact tracing capacity. In San Antonio, a city health department proposal to eliminate a full-time TB specialist position was reported — a move that would remove a dedicated role responsible for contact tracing, blood draws, and home visits in one of Texas's largest metropolitan areas.
Effective TB control requires both treatment of active disease and treatment of latent TB infection — the phase in which the bacterium is present but not yet causing symptoms or transmissibility. The CDC's dual approach to TB elimination emphasizes latent TB treatment as the key to preventing future active cases. Without adequate testing of high-risk populations, contact tracing of confirmed cases, and completion of treatment regimens — which for latent TB range from 3 to 9 months — the structural conditions for ongoing elevated case counts remain in place.
TB is spread through the air when a person with active, untreated TB disease coughs, sneezes, or speaks. It cannot be transmitted through casual contact, sharing food, or touching surfaces. Symptoms of active TB include a persistent cough lasting three or more weeks, chest pain, coughing up blood or sputum, fatigue, unintended weight loss, fever, and night sweats. Anyone experiencing these symptoms — especially individuals born outside the U.S., those in close contact with a confirmed TB case, or older adults with prior TB exposure — should seek testing from their healthcare provider.
Frequently Asked Questions
Q: How many tuberculosis cases were reported in the U.S. in 2025?
A: 10,260 provisional cases, down 1% from 10,395 in 2024 — but still the fourth consecutive year above pre-pandemic levels and well above the 2020 low of 7,174.
Q: Which states saw the biggest TB increases in 2025?
A: New Hampshire (100% increase, from 12 to 24 cases), North Dakota (up 64%), and Colorado (up 32%) saw the most significant percentage increases.
Q: Who is most at risk for tuberculosis in the United States?
A: People born outside the U.S. (77% of cases), adults 65 and older, individuals with HIV, people taking immunosuppressive medications, residents of congregate settings, and people who have spent time in high-burden TB countries.
Q: Is tuberculosis contagious through everyday contact?
A: TB spreads through the air via respiratory droplets when a person with active disease coughs or sneezes. It cannot spread through surfaces, food, water, or brief casual contact. Prolonged close contact with an active case is required for transmission.
Q: What are the symptoms of active tuberculosis?
A: Persistent cough lasting 3 or more weeks, chest pain, coughing up blood or phlegm, fatigue, unintended weight loss, fever, chills, and night sweats.
