Yes, tuberculosis remains a significant health problem worldwide, though it looks different depending on where you live

Tuberculosis (TB) has not disappeared. In 2023, the World Health Organization estimated that roughly 10 million people developed TB disease globally, and about 1.3 million died from it. In the United States, the picture is less severe but still present: the CDC reported over 8,000 TB cases in 2023, a number that has been rising after decades of decline. TB is no longer the leading infectious cause of death worldwide—that distinction now belongs to COVID-19—but it remains in the top ten and kills more people than any single bacterial infection.

The disease persists because the bacterium that causes it, Mycobacterium tuberculosis, spreads through the air when an infected person coughs or sneezes, and because many people carry the infection without symptoms. A person with latent TB infection—meaning they carry the bacteria but are not yet sick—cannot spread the disease and may never develop symptoms. But roughly 5 to 10 percent of people with latent TB will eventually develop active TB disease if left untreated. This hidden reservoir of infection means TB will continue to circulate as long as people with active disease go undiagnosed.

Key Takeaways

  • Tuberculosis still infects millions of people each year globally and kills more people than any other single bacterial infection.
  • In the United States, TB cases have been rising since 2020 after a long period of decline, with over 8,000 cases reported in 2023.
  • Most people infected with TB bacteria never develop symptoms, but about 5 to 10 percent of those with latent infection will eventually become sick without treatment.
  • Drug-resistant TB strains exist and are harder to treat, but standard TB drugs remain effective for most cases when taken as prescribed.

Why TB declined in wealthy countries but persists globally

In the early 1900s, TB was the leading cause of death in the United States and Europe. Antibiotics developed in the 1940s and 1950s made TB curable, and public health campaigns reduced transmission. By the 1980s, many wealthy countries thought TB was nearly conquered. But the disease never left poorer regions, where crowded living conditions, malnutrition, and limited access to diagnosis and treatment kept it alive.

Today, TB is concentrated in specific parts of the world. India, Indonesia, China, the Philippines, and Pakistan account for about half of all TB cases globally. Africa carries the highest burden relative to population size. In these regions, TB often coexists with HIV, which weakens the immune system and makes TB much more likely to develop in people who carry the latent infection. The combination of poverty, weak health systems, and other diseases creates conditions where TB spreads and thrives.

The rise of drug-resistant tuberculosis

A newer threat has emerged: TB bacteria that no longer respond to standard antibiotics. Drug-resistant TB develops when patients do not complete their full course of treatment, when drugs are poor quality, or when the bacteria naturally mutate. The most serious form, multidrug-resistant TB (MDR-TB), resists the two most powerful first-line drugs and requires longer, more toxic treatment with drugs that have worse side effects.

In 2023, the WHO estimated that roughly 450,000 people developed drug-resistant TB, with about 40,000 cases of the most severe form. These cases are concentrated in Eastern Europe, Central Asia, and parts of Africa and Asia. In the United States, drug-resistant TB remains rare—fewer than 2 percent of TB cases—but it is a growing concern in other countries. When drug resistance develops, treatment can take 18 to 20 months instead of 6 months, and success rates drop significantly.

Who is at highest risk for TB in the United States

TB in America is not evenly distributed. Certain groups face much higher risk. People born outside the United States account for about 70 percent of TB cases, particularly those from countries where TB is common. People living with HIV have a much higher chance of developing active TB if they carry the latent infection. Homeless individuals, people in prisons or jails, and those living in crowded shelters face higher exposure and transmission risk.

Healthcare workers, people who use drugs, and those with conditions like diabetes or chronic kidney disease also have elevated risk. Older adults who became infected decades ago, when TB was more common, may develop active disease later in life as their immune systems weaken. The recent rise in US TB cases has been driven largely by increases among foreign-born populations and in specific cities with larger immigrant communities.

How TB is diagnosed and treated today

Modern TB diagnosis relies on several methods. A tuberculin skin test (also called a Mantoux test) involves injecting a small amount of TB protein under the skin and checking for a reaction after 48 to 72 hours. An interferon-gamma release assay is a blood test that measures immune response to TB antigens and is often more specific. A chest X-ray can show signs of TB in the lungs. The most definitive test is a sputum smear or culture, where a sample of mucus from the lungs is examined under a microscope or grown in a lab to identify the bacteria.

Treatment for drug-susceptible TB is straightforward: a combination of four antibiotics taken daily for two months, followed by two antibiotics for four more months. The drugs are inexpensive and widely available. Success rates exceed 85 percent when patients complete the full course. The challenge is not the drugs themselves but ensuring people take them consistently, which is why public health programs use directly observed therapy—a healthcare worker watches the patient take each dose—in many settings. For drug-resistant TB, treatment is longer, more complex, and more difficult to tolerate.

What prevents TB from spreading

TB prevention works at two levels. Primary prevention stops infection from happening in the first place through good ventilation, isolation of people with active TB, and the BCG vaccine, which is used in many countries but not routinely in the United States because TB rates here are low. Secondary prevention targets people who already carry latent TB and gives them medication to prevent the infection from becoming active disease. Drugs like isoniazid or rifapentine, taken for several months, reduce the risk of developing active TB by about 60 to 90 percent.

Public health departments in the United States identify people with active TB through reporting requirements and conduct contact investigations to find others who may have been exposed. Close contacts—people who spent significant time with the sick person in enclosed spaces—are tested and offered preventive treatment if they have latent TB. This approach has helped keep TB rates low in many US communities, though it requires sustained funding and coordination.

Why TB remains a concern despite being curable

TB is curable, but that does not mean it is controlled. The disease persists because of gaps between what medicine can do and what actually happens in the real world. In wealthy countries, diagnosis and treatment are available, but some people do not seek care or complete treatment. In poorer countries, diagnosis is often delayed or missed entirely, and treatment may be interrupted by cost, side effects, or lack of access to consistent medication.

The COVID-19 pandemic disrupted TB services globally, delaying diagnoses and treatments. Climate change and conflict create conditions that favor TB spread. And as long as TB circulates in any part of the world, the risk of new cases appearing elsewhere remains. International travel and migration mean TB does not respect borders. This is why the WHO and global health organizations continue to prioritize TB control: not because the disease is incurable, but because the conditions that allow it to spread are still widespread.

Frequently Asked Questions

Can you catch TB from someone who has latent TB?

No. Latent TB means the person carries the bacteria but is not sick and cannot spread it. Only people with active TB disease in the lungs or throat can transmit the infection through coughing or sneezing. A person with latent TB poses no transmission risk to others.

Is TB still deadly if you get treated?

TB is curable with antibiotics, and treatment success rates exceed 85 percent in most settings. Death from TB is now rare in countries with good healthcare access. However, delays in diagnosis, incomplete treatment, or drug-resistant strains can lead to serious complications or death, which is why early detection and completing the full course of medication matter.

Can you get TB more than once?

Yes, though it is uncommon. If you recover from TB and are cured, you can still become infected again if exposed to someone with active disease. However, people who have had TB may have some immune protection that makes reinfection less likely than in someone who has never had the disease.

Is the TB vaccine available in the United States?

The BCG vaccine is not routinely given in the United States because TB rates are low and the vaccine is less effective in preventing TB in adults. It is used in many other countries where TB is more common. The CDC recommends BCG only for specific groups at very high risk, such as healthcare workers in settings with drug-resistant TB.

Why has TB increased in the US after declining for so long?

TB cases in the US began rising in 2020 after decades of decline. Contributing factors include disruptions to TB control programs during the COVID-19 pandemic, increases in homelessness and incarceration, and higher rates among foreign-born populations from countries where TB is more common. Sustained funding for TB prevention and control programs remains important to reverse this trend.