Introduction to

Tuberculosis
(TB)

December 2023
This Slide Deck Covers the
Following Topics about
Tuberculosis (TB):
1. What is Tuberculosis (TB)?

2. How TB spreads

3. Inactive TB Infection and TB Disease

4. Risk Factors

5. TB Testing

6. Treatment

7. TB Elimination
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What is Tuberculosis
(TB)?
Tuberculosis (TB)

• TB is spread from person to person through the air

• TB is a disease caused by bacteria called Mycobacterium
tuberculosis. The bacteria, or TB germs, usually attack the
lungs. However, TB germs can attack any part of the body
such as the kidney, spine, or brain
• Pulmonary TB is TB in the lungs
• Extrapulmonary TB is TB in places other than the lungs, such as the
kidney, spine, or brain

• Not everyone infected with TB germs becomes sick

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TB is the one of the World’s Top Causes of Death due
to Infectious Disease

• TB is not a disease of the past

• Too many people in the United States still suffer from TB
• Approximately 10.6 million cases were reported worldwide in 2022
• In 2022, there were 8,331 cases of TB disease in the United States
• After decreasing considerably in 2020, TB cases increased in 2021
and 2022, but remain lower than in 2019

• TB is a serious disease that can cause a person to become very sick if

not treated with medicine

• Treatments are available to prevent and cure TB

5
Progress Toward TB Elimination,
United States, 1982-2022

6
TB Impacts People from
All Over the United States

https://www.cdc.gov/tb/topic/basics/personalstories.htm
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Anyone Can Get TB

8
How TB Spreads
TB Spreads
Through the Air
TB spreads from person
to person when someone
with active TB disease
coughs, speaks, or sings

10
TB Is NOT Spread by

Sharing Saliva from

toothbrushes kissing

Shaking Touching bed Sharing food,

someone’s hand linens or toilets drink, or utensils

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Inactive TB
and TB Disease
Two TB-Related Conditions

Inactive TB
• People with latent TB infection or inactive TB
• Do not feel sick, do not have symptoms, and cannot spread
TB germs to others
• Can have inactive TB for years
• Have a small amount of TB germs in their bodies that are
alive but inactive
• Inactive TB can develop into TB disease

TB Disease
• If TB germs become active and multiply, inactive TB can turn
into TB disease
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Not Everyone Who Is Infected with TB Becomes Sick
Person with Person with
Inactive TB TB Disease
Has a small amount of TB germs in their Has a large amount of active TB
body that are alive but inactive germs in their body

Cannot spread TB germs to others May spread TB germs to others

Has no symptoms and does not feel sick,

Feels sick and has symptoms such as a
but may become sick if the germs become
cough, fever, and/or weight loss
active in their body

Usually has a positive TB skin test or TB Usually has a positive TB skin test or TB
blood test result indicating TB infection blood test result indicating TB infection

Has a normal chest x-ray and a negative May have an abnormal chest x-ray, or
sputum smear positive sputum smear or culture

Needs treatment for inactive TB infection to

Needs treatment for active TB disease
prevent TB disease
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Untreated Inactive TB Can
Lead to TB Disease

• If the immune system can’t stop TB germs from growing,

they become active (multiplying in your body); this is called
TB disease
• Most people diagnosed with TB disease in the United States
become sick after living with inactive TB for years

• It is estimated that up to 13 million people in the United

States have inactive TB

• Inactive TB treatment is 90% effective in preventing the

development of TB disease

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Tuberculosis (TB) Disease: Only the Tip
of the Iceburg

There are two types of TB conditions: latent TB infection and TB disease.

People with TB disease are sick from active TB germs. They usually have
symptoms and may spread TB germs to others.
People with latent TB infection do not feel sick, do not have symptoms, and cannot
spread TB germs to others.
But, if their TB germs become active, they can develop TB disease.
Millions of people in the U.S. have latent TB infection Without treatment, they are
at risk for developing TB disease.

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Possible TB Disease Symptoms

Night Sweats Fever Chills

Weakness
Weight loss No appetite
or fatigue

Cough lasting Coughing up

Pain in blood or sputum
longer than
the chest (phlegm from inside
3 weeks the lungs)

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People with TB Disease Are Sick
and Can Spread TB Germs

• TB disease is a serious condition and can lead to death if

not treated

• TB disease can almost always be treated and cured with medicine

• A person with TB disease typically requires the following:

X-rays 4-6 months of medicine

Lab tests Follow up and testing of close contacts

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Public Health Workers Are Responsible
for Finding People Exposed to TB

• A person who was exposed to someone with contagious TB

disease is considered a TB contact

• Persons exposed to someone with TB can include family

members, roommates or housemates, close friends,
coworkers, classmates, and others

• People with TB disease can spread TB germs to those around

them

• The local health department will conduct a contact

investigation by following up and testing those who have been
close to someone with TB
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Risk Factors
Who Is at Higher Risk for Becoming
Infected with TB Germs?

Anyone can get TB

Some people have a higher risk of getting infected

with TB:
• People who have contact with someone who has infectious TB disease
• People who were born in or who frequently travel to countries where TB
disease is common, including Mexico, the Philippines, Vietnam, India,
China, Haiti, Guatemala, and other countries with high rates of TB

• Health care workers and others who work or live in places at high risk for
TB transmission, such as homeless shelters, jails, and nursing homes

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 Since 2010, the Majority of U.S. TB Cases Occur
in Persons Born Outside of the United States*

*Percentages are rounded; data from 2022 22

 Countries of Birth Among Non-U.S.-born
Persons with TB, United States 2022*

*Percentages are rounded 23

 Reported TB Cases by Race/Ethnicity,*
United States, 2022 (N=8,331) †

* All races are non-Hispanic; multiple race indicates two or more races reported for a person but does not include persons of Hispanic/Latino origin.
†
Excludes unknown/missing values 24
Who Is at Risk for Developing TB Disease?

People at high risk for developing TB disease generally fall into two categories:
• Those who have been recently infected with TB germs
• Those with medical conditions that weaken the immune system, such as:

HIV infection Diabetes Specialized treatment for rheumatoid Organ transplants Severe kidney
arthritis or Crohn’s disease disease

Head or neck cancer Substance abuse Medical treatments such Silicosis Low body weight
as corticosteroids
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TB Testing
Two Types of Tests Can Be Used
to Diagnose TB Infection

• TB blood test or
• TB skin test
OR

If either test is positive, • Medical examination

further tests are done to
confirm a diagnosis of
TB disease: • Chest x-ray

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TB Blood Test

Blood is drawn and sent to a lab for analysis.

•
Positive blood test: A person likely has been infected with
TB germs. Additional tests are needed to determine if the
person has inactive TB or TB disease.

•
Negative blood test: A person’s blood did not react to the
test and inactive TB, or TB disease is not likely.

The TB blood test is also known as an Interferon-Gamma Release

Assay (IGRA).
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TB Skin Test

The TB skin test, also called the Mantoux tuberculin skin test
(TST), requires two visits with a health care provider

On the first visit, a test is placed On the second visit, the test is read

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People Vaccinated with BCG
Can Still Get TB Disease

Bacille Calmette-Guérin (BCG)

• Is a vaccine for TB disease
• The TB vaccine is not widely used in the United States
• Is often given to infants and small children in countries
where TB is more common
• Protects against severe forms of active TB in children
• Protection from TB goes away as people get older

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TB Blood Tests Are Preferred for People
Who Have Received the TB Vaccine (BCG)

• The TB vaccine (BCG) may cause a positive TB skin test

• The TB vaccine does not affect TB blood tests results
• TB blood tests give more accurate results in people who
have received the TB vaccine
• Anyone who has received the TB vaccine should receive
a TB blood test instead of a TB skin test

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Treatment
Treatment for Inactive TB Can Prevent the
Development of TB Disease

• People with inactive TB will not feel sick

• As long as TB germs remain in the body, they can become active,
multiply, and make someone sick with TB disease

• People with inactive TB

• Should take medicine to prevent the development of TB disease,
even though they don’t feel sick

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Treatment for Inactive TB

Compared to treatment for TB disease, inactive TB treatment

Is shorter

Is less costly

Has fewer side effects

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Treating TB Disease Protects Your Health and
the Health of Others

• People with TB disease can pass TB germs to their family,

friends, and others around them if they don’t take TB
medicine the right way
• People with TB disease need to take several medicines when
they start treatment
• After taking TB medicine for several weeks, a doctor will be
able to tell TB patients when they are no longer able to spread
TB germs to others
• Most people take TB medicine for at least 4 months to
be cured

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Directly Observed
Therapy (DOT)

• Is the most effective strategy for ensuring

that patients stay on track with their treatment
• A health care worker will meet with the
patient to watch them swallow each dose of
the prescribed drugs
• During DOT visits, the health care worker will
check in with the patient to:
• answer questions
• make sure the treatment is working
• watch for side effects

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Video Directly Observed Therapy
(vDOT)

• Alternative method to in-person DOT

• The health care worker meets with the patient
remotely using a video-enabled device to
observe them taking their medication
• Can be done live (synchronous) or recorded
(asynchronous)
• Gives patients more flexibility and autonomy
as they complete their treatment
• Facilitates patient monitoring outside of
normal clinic hours, during an emergency, or
when patients are traveling

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TB Elimination
 Together We Can Work Toward
TB Elimination in the United States

1. Strengthen current TB programs to

diagnose and treat TB disease.

2. Increase efforts to identify and treat

inactive TB infection.

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Health Care Providers and Communities Need
to “Think TB!”

Protect the health and well-being of community members

at higher risk for TB:
• Know who is most at risk for TB
• Recognize the signs and symptoms of TB
• Test and treat patients who are at high risk for TB
• Be aware of latest TB research and shortest treatment
options
• Encourage conversations about TB and how it affects the
community to reduce stigma

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Key Partners
in TB Elimination
• Health care workers in doctors’
offices and hospitals, community
health centers, and academic
institutions
• State and local health
departments
• Community organizations
• Communities at higher risk for TB
• TB survivors

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Think. Test.
Treat TB
• CDC’s Think. Test. Treat TB
campaign aims to reach those most
at risk for inactive TB infection and
their health care providers to
encourage TB testing and get closer
to the elimination of TB
• Think. Test. Treat TB is the first
national multilingual communications
campaign to increase testing for
inactive TB infection, a major health
disparity among Asian Americans

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 Resources
CDC TB website:
www.cdc.gov/tb/
State & Local TB Control Offices:
www.cdc.gov/tb/links/tboffices.htm

Find TB Resources:
https://findtbresources.cdc.gov

TB Centers of Excellence:
https://www.cdc.gov/tb/education/tb_coe/default.htm
Facebook:
www.facebook.com/CDCTB/

Twitter:
www.twitter.com/cdc_tb
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 43