Morbidity and Mortality Weekly Report

1 Morbidity and Mortality Weekly Report Weekly / Vol. 71 / No. 12 March 25, 2022. Tuberculosis United States, 2021. Thomas D. Filardo, MD1,2; Pei-Jean Feng, MPH2; Robert H. Pratt2; Sandy F. Price2; Julie L. Self, PhD2. During 1993 2019, the incidence of tuberculosis (TB) in estimates were used to calculate national- and state-level TB. the United States decreased steadily; however, during the later incidence per 100,000 persons along with incidence stratified years of that period the annual rate of decline slowed (1) until by age groups. Persons with TB were grouped by self-reported 2020 when a substantial decline ( ) was observed. This race and ethnicity according to federal guidelines. Persons sharp decrease in TB incidence might have been related to who self-identified as Hispanic were categorized as Hispanic multiple factors coinciding with the COVID-19 pandemic, irrespective of self-reported race, persons not identifying as including delayed or missed TB diagnoses or a true reduc- Hispanic were categorized by self-reported race, and non- tion in TB incidence related to pandemic mitigation efforts Hispanic persons who reported more than one race were and changes in immigration and travel (2).

2 During 2021, a total of 7,860 TB cases were provisionally reported to CDC's 2021 vintage population estimates were used for 2021 and 2020. 2020 vintage National Tuberculosis Surveillance System (NTSS) by the population estimates were used for 2011 2019. 50 states and the District of Columbia (DC). National programs-surveys/popest/ incidence of reported TB (cases per 100,000 persons) rose during 2021 ( ) compared with that in 2020 ( ). but remained lower than the rate during 2019 ( ).*. During 2021, TB incidence increased among both INSIDE. and non persons. The increased TB incidence 447 Lessons Learned from Programmatic Gains in HIV. observed during 2021 compared with 2020 might be partially Service Delivery During the COVID-19 Pandemic . explained by delayed diagnosis of cases in persons with symp- 41 PEPFAR-Supported Countries, 2020.

3 Tom onset during 2020; however, the continued, substantial 453 Health Needs and Use of Services Among Children reduction from prepandemic levels raises concern for ongoing with Developmental Disabilities United States, underdiagnosis. TB control and prevention services, including 2014 2018. early diagnosis and complete treatment of TB and latent TB 459 Effectiveness of mRNA Vaccination in infection, should be maintained and TB awareness promoted Preventing COVID-19 Associated Invasive to achieve elimination in the United States. Mechanical Ventilation and Death . United States, March 2021 January 2022. Health departments in the 50 states and DC Report TB. 466 COVID-19 Associated Hospitalizations Among cases to CDC based on the Council of State and Territorial Adults During SARS-CoV-2 Delta and Omicron Epidemiologists' surveillance case definition, which includes Variant Predominance, by Race/Ethnicity and both laboratory and clinically verified cases.

4 For each case, Vaccination Status COVID-NET, 14 States, health departments electronically submit a Report of a verified July 2021 January 2022. TB case to CDC. midyear Census Bureau population 475 QuickStats * This Report is limited to National Tuberculosis Surveillance System data verified as of February 9, 2022. Updated data will be available in CDC's annual TB. surveillance Report later in 2022. Continuing Education examination available at Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report categorized as multiple races. midyear population estimates Hispanic, 2% as Native Hawaiian or other Pacific Islander from the Current Population Survey** were used to calculate (NH/OPI), 29% as White, and 1% as multiple races. From incidence by birth origin and race/ethnicity.

5 Percent changes 2020 to 2021, TB incidence decreased among in incidence were calculated using unrounded figures. Black persons and among NH/OPI persons A total of 7,860 TB cases were reported during 2021, 687 and increased among all other groups (including more than during 2020 (7,173) and 1,040 fewer than during AI/AN [ ], Asian [ ], Hispanic [ ], and White 2019 (8,900) (Table 1). From 2020 to 2021, TB incidence [ ] persons) (Table 2). Among non persons (cases per 100,000 population) rose , from to reported as having TB disease, <1% identified as AI/AN, 48%. , but remained lower than during 2019 ( ). as Asian, 12% as Black, 34% as Hispanic, 1% as NH/OPI, California reported the highest number of cases (1,750), and 4% as White, and 1% as multiple races. From 2020 to 2021, Alaska reported the highest incidence ( ).

6 Eighteen states TB incidence decreased among non Black and DC reported the same number or fewer TB cases during persons and among non NH/OPI per- 2021 than during 2020; the remaining 32 states reported more sons and increased among all other non groups cases during 2021 than 2020. (including Asian [ ], Hispanic [ ], and White [ ]. During 2021, 71% of TB cases occurred among persons). Compared with TB incidence in 2020, incidence non persons, the same proportion as in 2020 during 2021 declined among children aged 4 years, and 2019. Incidence (cases per 100,000 population) among among children and adolescents aged 5 14 years, and persons increased from in 2020 to in among persons aged 15 24 years. Incidence increased 2021 and among persons from in 2020 among adults aged 25 44 years ( ), 45 64 years ( ), to in 2021 (Figure).

7 Among persons reported and 65 years ( ). as having TB disease, 4% identified as American Indian or During 2021, among non persons reported as Alaska Native (AI/AN), 6% as Asian, 33% as Black, 25% as having TB, (507 of 5,456) received a diagnosis <1 year Persons with missing race or ethnicity data are excluded from calculations ** Persons born in the United States or a territory or elsewhere to at least of proportions. Percent change is not reported for non AI/AN persons because one citizen parent are categorized as All other persons are categorized as non there were no reported cases during 2020. The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, Atlanta, GA 30329-4027.

8 Suggested citation: [Author names; first three, then et al., if more than six.] [ Report title]. MMWR Morb Mortal Wkly Rep 2022;71:[inclusive page numbers]. Centers for Disease Control and Prevention Rochelle P. Walensky, MD, MPH, Director Debra Houry, MD, MPH, Acting Principal Deputy Director Daniel B. Jernigan, MD, MPH, Deputy Director for Public Health Science and Surveillance Rebecca Bunnell, PhD, MEd, Director, Office of Science Jennifer Layden, MD, PhD, Deputy Director, Office of Science Leslie Dauphin, PhD, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff ( Weekly ). Charlotte K. Kent, PhD, MPH, Editor in Chief Martha F. Boyd, Lead Visual Information Specialist Ian Branam, MA, Brian A. King, PhD, MPH, Executive Editor Alexander J. Gottardy, Maureen A.

9 Leahy, Acting Lead Health Communication Specialist Jacqueline Gindler, MD, Editor Julia C. Martinroe, Stephen R. Spriggs, Tong Yang, Shelton Bartley, MPH, Leslie Hamlin, Paul Z. Siegel, MD, MPH, Associate Editor Visual Information Specialists Lowery Johnson, Amanda Ray, Mary Dott, MD, MPH, Online Editor Quang M. Doan, MBA, Phyllis H. King, Health Communication Specialists Terisa F. Rutledge, Managing Editor Terraye M. Starr, Moua Yang, Will Yang, MA, Teresa M. Hood, MS, Lead Technical Writer-Editor Information Technology Specialists Visual Information Specialist Leigh Berdon, Glenn Damon, Soumya Dunworth, PhD, Tiana Garrett-Cherry, PhD, MPH, Srila Sen, MA, Stacy Simon, MA, Morgan Thompson, Technical Writer-Editors MMWR Editorial Board Timothy F. Jones, MD, Chairman Matthew L. Boulton, MD, MPH William E.

10 Halperin, MD, DrPH, MPH Carlos Roig, MS, MA. Carolyn Brooks, ScD, MA Jewel Mullen, MD, MPH, MPA William Schaffner, MD. Jay C. Butler, MD Jeff Niederdeppe, PhD Nathaniel Smith, MD, MPH. Virginia A. Caine, MD Celeste Philip, MD, MPH Morgan Bobb Swanson, BS. Jonathan E. Fielding, MD, MPH, MBA Patricia Quinlisk, MD, MPH Abbigail Tumpey, MPH. David W. Fleming, MD Patrick L. Remington, MD, MPH. 442 MMWR / March 25, 2022 / Vol. 71 / No. 12 US Department of Health and Human Services/Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report TABLE 1. Tuberculosis disease case counts and incidence, by state 50 states and the District of Columbia, 2019 2021. No. of TB cases* TB incidence . jurisdiction 2019 2020 2021 2019 2020 2021. Total 8,900 7,173 7,860 Alabama 87 72 92 Alaska 58 58 58 Arizona 183 136 129 Arkansas 64 59 69 California 2,111 1,706 1.