Tuberculosis cases rise again in the U.S.—and drug resistance is growing

Tuberculosis never fully disappeared from the United States, but for three decades it seemed to be slowly retreating. That long decline has stalled and reversed, with national case counts climbing again and drug resistance becoming a more pressing concern. The trend has left specialists warning that a disease often dismissed as a relic of the past is quietly regaining ground and exploiting cracks in the public health system.

The resurgence is still modest compared with global hot spots, yet it is persistent, geographically widespread, and increasingly shaped by social inequities and treatment gaps. Rising numbers of multidrug-resistant infections, while still relatively rare, add a layer of complexity that makes every missed diagnosis and every broken treatment course more dangerous for the wider community.

After decades of decline, the numbers are moving the wrong way

For nearly thirty years, reported tuberculosis cases in the United States fell steadily as better drugs, coordinated public health programs, and improved living conditions pushed infection rates down. According to federal surveillance data, that trend ended in the early 2020s, when case counts began to climb again. The executive commentary on recent national surveillance describes how the long downward trajectory flattened, then reversed, as health departments emerged from the first years of the COVID era.

The same analysis notes that the overall TB case rate in the United States has now risen above the levels recorded immediately before the pandemic. Nor is that shift confined to a handful of hot spots. A separate breakdown of reporting areas shows that from 2023 to 2024, increases in TB were widespread, with 39 of 52 jurisdictions reporting higher case counts. The pattern suggests a national phenomenon rather than a cluster of isolated outbreaks.

Provisional data for 2025 hint at a slight easing, with one analysis noting that the number of reported U.S. tuberculosis cases fell by 1 percent from 2024 to 2025, according to CDC data. Even so, case totals remain higher than they were in the late 2010s, and public health officials emphasize that a modest year-to-year dip does not erase the structural drivers that pushed incidence up in the first place.

How the COVID era disrupted TB control

Experts increasingly point to the COVID period as a turning point for tuberculosis control. One analysis of U.S. trends explains that the rise in TB cases can be attributed in part to the strain on prevention efforts as resources were redirected to the COVID 19 response, with contact tracing, clinic staffing, and outreach programs all affected, according to researchers. Staff who once focused on TB were reassigned, and routine screening in high-risk settings slowed or stopped.

During mandatory shutdowns, people were less likely to visit clinics, and some who had symptoms stayed home or delayed care. Reporting from one national broadcast outlet describes how during mandatory shutdowns people were less likely to be tested or started on treatment, and some patients already on therapy had difficulty accessing medications between 2021 and 2023. Interruptions like these can allow latent infections to progress and can also foster drug resistance when treatment courses are not completed as prescribed.

Public health cuts also played a role. A report focused on pediatric care notes that after declining during the pandemic, tuberculosis rose again in the U.S., and that Public health cuts have contributed to weakened TB programs at the same time that vaccines are not used commonly in the United States. When clinic hours shrink and outreach workers vanish, the disease has more room to spread before anyone notices.

Who is getting sick, and where

The recent increase is not evenly distributed. Federal surveillance shows that in 2024, 866 cases, or 9 percent of all reported TB cases in the country, were attributed to recent transmission rather than reactivation of old infections, according to federal estimates. Those cases cluster in specific communities and settings, including homeless shelters, correctional facilities, and crowded housing.

Specialists at a leading respiratory hospital describe how, over the past few years, there has been an increase in the number of TB cases in the U.S., and how that change is especially visible in urban centers and among people living with HIV, diabetes, or other conditions that weaken the immune system. One clinician there notes that Over the past several years, the rise has been steady rather than explosive, which can make it harder for the public to appreciate the risk.

Recent analyses also highlight geographic variation. Academic researchers report that in 2023, nine states recorded substantial increases in TB incidence, particularly among the U.S.-born population, according to their review. That finding challenges the common assumption that TB in the United States is almost entirely imported and suggests that local transmission chains are playing a larger role than many policymakers had assumed.

Drug resistance is still rare, but it is not standing still

Alongside the rise in total cases, clinicians are watching patterns of drug resistance with growing concern. Federal surveillance of drug-resistant disease notes that, despite the increase in overall tuberculosis disease case counts in 2023, the number and percentage of isoniazid-resistant and multidrug-resistant cases remained relatively stable, according to the What to know summary. That stability is reassuring in the short term, but it does not eliminate the risk that resistance could expand if treatment systems falter.

More recent data show that in 2024, drug resistance continued to be rare among TB cases in the United States, with 115 cases of multidrug-resistant tuberculosis recorded, including a small number classified as pre-extensively drug resistant and 5 as extensively drug resistant. Each of those cases requires longer, more toxic, and more expensive treatment than standard infections, and each one poses a higher risk of ongoing transmission if therapy is incomplete.

Clinicians emphasize that even when resistant strains represent a tiny fraction of total cases, they can consume a disproportionate share of clinic time and public health resources. One infectious disease specialist quoted in a university profile explained that Even the people who do not die of the disease are often hospitalized and can have long-term problems from having TB. Those burdens are amplified when the bacteria involved are resistant to first-line drugs.

Why the resurgence puzzles experts

Public health agencies have clear theories about the forces behind the uptick, yet some aspects remain difficult to untangle. One detailed report on the recent rise notes that tuberculosis was once a disease in decline in the United States but that a resurgence in cases has left health officials puzzled about why the rebound has been so persistent, according to Tuberculosis. The same analysis asks, Could the COVID 19 pandemic be a factor, and concludes that the pandemic has played a central role in disrupting care and surveillance.

Specialists at a major respiratory center echo that view. They describe how clinicians have been asking what is behind the recent rise in tuberculosis cases, and point to a combination of delayed diagnoses, social displacement, and chronic conditions such as diabetes that increase susceptibility, as explained in what’s behind their patients’ infections. At a population level, one physician at a New York academic center argues that the single most effective intervention to prevent TB is to identify and treat latent infection in people who are at higher risk, especially within entire communities where exposure is concentrated, according to their explanation.

Some of the puzzle comes from the timing. TB case counts initially dipped during the first year of COVID, which suggested that transmission might have fallen. Later analyses now argue that much of that early decline reflected missed diagnoses and underreporting rather than a true reduction in infection, as described in provisional data for the United States. As clinics reopened and surveillance caught up, the apparent surge may have been, in part, a delayed accounting of cases that would otherwise have been detected sooner.

Global context and the role of U.S. funding

The U.S. resurgence is unfolding against a global backdrop where tuberculosis remains one of the leading infectious killers. Data from the Global Tuberculosis Programme show that TB incidence worldwide remains high, with millions of new cases annually, according to global TB incidence estimates. Drug-resistant strains are more common in some high-burden countries, which increases the risk that resistant organisms will spread across borders.

Many global TB efforts depend heavily on U.S. financial aid. One review of international programs notes that Manyglobal TB initiatives rely on sustained funding from the United States, and that cuts or shifts in those commitments can ripple through screening and treatment programs abroad. At the same time, domestic surveillance data show that more than 10,300 health agencies reported TB cases in 2024 and that they recorded over 10,300 TB cases, including people with active disease and others with latent TB who had no visible symptoms.

Those figures highlight a feedback loop. As long as TB remains entrenched globally, the United States will continue to receive people who were infected elsewhere, including some who harbor resistant strains. Meanwhile, if the U.S. allows its own domestic programs to weaken, local transmission will add to the burden and create new opportunities for resistance to emerge at home.

Outbreaks, local clusters, and the “outbreak 2025” narrative

Alongside national statistics, local outbreaks have drawn attention and sometimes alarm. One widely circulated explainer notes that when people talk about the Tuberculosis Outbreak 2025, they are usually referring to a collection of regional clusters rather than a single nationwide explosion of cases, as Tuberculosis Outbreak coverage makes clear. The same analysis stresses that, even though this is not a doomsday scenario, infection control practices in hospitals, nursing homes, and shelters remain essential and need to be strengthened.

State and local health departments have reported outbreaks linked to homeless encampments, long-term care facilities, and workplaces where ventilation is poor and people spend long hours together in close quarters. These clusters often reveal gaps in screening and follow-up. Once an outbreak is detected, contact investigations can identify dozens or even hundreds of people with latent infection who will need months of preventive treatment to keep them from developing active disease.

What needs to happen next

Experts who track tuberculosis in the United States argue that the current moment is a warning rather than an inevitability. The Key Highlights from recent federal commentary emphasize that, although TB rates have risen above pre-pandemic levels, the absolute numbers remain low compared with many other countries. That creates a window in which aggressive case finding, consistent treatment, and renewed investment in public health infrastructure could still push incidence back down.

Specialists at leading TB centers stress several priorities. First, clinicians should maintain a high index of suspicion for TB in patients with persistent cough, weight loss, fevers, or night sweats, especially if they have risk factors such as homelessness, incarceration, HIV infection, or recent travel to countries with higher incidence, as described by In theclinical experience of TB specialists. Second, health departments need stable funding to restore contact tracing, directly observed therapy, and community outreach that were scaled back during COVID.