TB Elimination: Now is the Time! 2007
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A Global Perspective on Tuberculosis
TB is one of the world’s deadliest diseases:
- One third of the world’s population are infected with TB.
- Each year, nearly 9 million people around the world become sick with TB.
- Each year, there are almost 2 million TB-related deaths worldwide.
- TB is the leading killer of people who are HIV infected.
What is TB?
TB is caused by bacteria called Mycobacterium tuberculosis.
When a person with active TB disease of the lung or throat coughs
or sneezes, tiny particles containing M. tuberculosis may
be expelled into the air. If another person inhales air that contains
these particles, the bacteria may enter the lungs causing infection.
However, not everyone infected with TB bacteria becomes sick.
As a result, two TB-related conditions can exist: latent TB
infection and active TB disease.
|A Person with Latent TB Infection
||A Person with Active TB Disease
|Usually has a skin test or blood test result indicating TB infection
||Usually has a skin test or blood test result indicating TB infection
|Has a normal chest x-ray and a negative
||May have an abnormal chest
positive sputum smear or culture
|Has TB bacteria in his/her body that are alive, but inactive
||Has active TB bacteria in his/her body
|Does not feel sick
||Feels sick and may have symptoms such as coughing, fever, and weight loss
|Cannot spread TB bacteria to others
||May spread TB bacteria to others
|Should consider treatment for latent TB infection to prevent active TB disease
||Needs treatment for active TB disease
TB Elimination: Now is the Time!
Many people think that tuberculosis (TB) is a disease of the
past — an illness that no longer threatens us today. One reason
for this belief is that, in the United States, we are currently
experiencing a decline in TB. We are at an all-time low in the
number of persons diagnosed with active TB disease.
That very success makes us vulnerable to complacency and neglect.
But it also gives us an opportunity to eliminate TB in this country.
Now is the time to take decisive actions, beyond our current
efforts, that will ensure that we reach this attainable goal.
The Price of Neglect
In the 1970s and early 1980s, the nation let its guard down and
TB control efforts were neglected. The country became complacent
about TB, and many states and cities redirected TB prevention and
control funds to other programs.
Consequently, the trend toward elimination was reversed and the
nation experienced a resurgence of TB, with a 20% increase in TB
cases reported between 1985 and 1992. Many of these were persons
with difficult-to-treat drug-resistant TB.
Back on Track Toward TB Elimination
The nation’s mobilization of additional resources in the
1990s has paid off:
- We are now at an all-time low in reported TB cases, with 14
consecutive years of decline.
- In 2006, there were 13,779 persons with TB disease reported
in the United States, declining from 14,080
cases in 2005.
- However, the decline in the number of cases from 2005
was 2.1% – one of the smallest declines in more than a decade.
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TB Continues to Lurk Beneath the Surface
There are an estimated 9 million to 14 million persons in the
United States infected with M. tuberculosis.
On average, without treatment, about 5-10% of infected
individuals will develop active TB disease at some point in their
Some underlying conditions increase the risk that latent TB
infection will progress to active TB disease — for example, the risk
is higher in persons with HIV infection or diabetes.
HIV and TB Coinfection
Because HIV weakens the immune system, persons with both latent
TB infection and HIV infection have a very high risk of
progressing to active TB disease.
It is crucial that persons with both latent TB infection and HIV
infection receive treatment, coordinated in consultation with
experts, for both of these conditions.
The Threat of Drug-Resistant TB
Drug resistance poses a serious threat to our ability to
treat and control TB, both in the United States and abroad.
Drug-resistant TB is extremely difficult and costly to treat.
Persons with drug-resistant TB are more likely to die of TB than
persons with drug-susceptible TB.
Multidrug-Resistant Tuberculosis (MDR TB)
- MDR TB is active TB disease caused by bacteria that are
resistant to the two drugs most commonly used for treatment
(isoniazid and rifampin).
- Forty-eight states and the District of Columbia have
reported diagnosing and caring for persons with MDR TB.
- It has been estimated that one MDR TB case can cost as
much as $1.5 million (direct medical expenses and
Extensively Drug-Resistant Tuberculosis (XDR TB)
- There has been a global emergence of XDR TB, a rare type
of MDR TB.
- XDR TB is resistant to almost all drugs used to treat
TB, raising concerns of an epidemic of virtually untreatable
- XDR TB has been found in every region of the world,
including the United States.
- XDR TB is much more expensive to treat (two times that
of MDR TB); there are also more side effects from the
medications, and the person is more likely to die.
The Burden of TB in Minorities
Disparities in TB persist among members of racial and ethnic
minority populations. In 2006, the majority (83%) of all
reported TB cases in the United States occurred in racial and
Several factors likely contribute to the burden of TB in
- Among people from countries where TB is common, TB
disease may result from an infection acquired in their
country of origin.
- Among racial and ethnic minorities, unequal distribution
of TB risk factors, particularly HIV infection, can also
increase the chance of developing the disease.
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The Global Challenge
In 2006, foreign-born persons accounted for 57% of all TB
cases diagnosed in the United States, as compared to 36% of all
TB cases in 1996.
The number of states with at least 50% of TB cases occurring
among foreign-born persons has increased from 9states in 1996 to 27
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Finishing the Job: What is Needed to Eliminate TB in the United
Maintaining Control: By strengthening current TB control, treatment,
and prevention systems, we ensure the ability to diagnose and provide
proper treatment to people with active TB disease. This will prevent
spread to others; as well as prevent the emergence of MDR TB and
Accelerating the Decline: By finding better methods of identifying
and treating latent TB infection and improving strategies for reaching
at-risk populations, we will speed our progress toward elimination.
Developing New Tools for Diagnosis, Treatment, and Prevention:
Through research to develop more effective methods of testing for
latent TB infection, better drugs to treat latent TB infection,
and an effective TB vaccine, we can find vital ways to stop the
progression from latent infection to contagious disease.
Engaging in Global TB Prevention and Control: In providing leadership,
contributing technical support, and forming international partnerships,
we improve global health. Worldwide control of TB is in the nation’s
Mobilizing Support for TB Elimination: By reaching leaders of
high-risk groups, we can work together to eliminate a disease that
burdens their communities.
Monitoring Progress: By assessing the impact of our elimination
efforts, we can continually monitor our progress and identify and
address any lapses in our efforts.
What You Can Do to Help
- Find out more about TB services in your area.
- Educate your community about TB.
- Ensure that efforts to eliminate TB continue.
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination Website
State TB Control Offices
TB Education and Training Resources Website
TB-Related News and Journal Items Weekly Update
World Health Organization
The World Health Organization is the United Nations
specialized agency for health.
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention