Tuberculosis often sounds like a disease of the past, but recent federal data tell a different story. The United States reported 10,260 tuberculosis cases in 2025, a figure that remains well above pre pandemic levels even after a slight decline from the year before.
Not everyone infected with tuberculosis bacteria actually gets sick. The distinction matters because it separates latent TB infection, sometimes called inactive TB, from active TB disease. People with latent infection carry the bacteria without symptoms and cannot spread it to others. Active TB disease is different entirely, marked by a large bacterial presence in the body, the ability to spread the infection to others, and physical symptoms that can include coughing, fever and unexplained weight loss.
How tuberculosis spreads
Tuberculosis moves through the air, not through surface contact. When someone with active pulmonary or laryngeal TB coughs, speaks or sings, they release infectious bacteria that can remain suspended in the air for hours depending on the environment. Infection occurs when another person inhales those bacteria, which then travel through the nose or mouth into the lungs.
Whether that exposure actually leads to infection depends on several factors, including the exposed person’s immune status, how infectious the person with TB disease is, environmental conditions like ventilation and airflow, and how long and how closely the two people were in contact.
Who tuberculosis affects most
Left untreated, roughly 5% of people infected with TB bacteria develop active disease within the first two years, and another 5% develop it at some point later in life. Progression from latent infection to full disease can happen at any point, though it is most common within the first two years after exposure or among people with weakened immune systems due to conditions like diabetes, cancer or HIV.
According to the latest CDC surveillance data, people born outside the United States account for the vast majority of domestic TB cases, with a rate roughly 19 times higher than that of U.S. born individuals. One third of all cases occur among adults between 25 and 44. Notably, adults 65 and older were the only age group where case counts rose from 2024 to 2025, a trend public health officials attribute in part to decades old infections reactivating as immune systems weaken with age.
Diagnosis and treatment
Anyone showing symptoms of TB disease, or testing positive on a TB blood test or skin test, should undergo a full medical evaluation. That process typically includes a review of medical history, a physical examination, TB specific testing, a chest radiograph and laboratory analysis of clinical samples to confirm an active infection.
Treatment benefits both the individual and the broader community. Completing a full, correctly administered treatment regimen cures nearly all patients, minimizes the risk of death or long term disability, reduces the chance of spreading the bacteria to others and helps prevent the development of drug resistant strains. Because roughly 80% of U.S. TB cases trace back to untreated latent infections, treating latent TB before it progresses remains one of the most effective tools available for controlling the disease.
Why elimination remains out of reach
Health care providers are required to report all confirmed or suspected TB disease cases to state or local health departments, a system that has tracked the disease nationally since 1953. Despite a 56% drop in cases and a 68% drop in the national incidence rate since 1989, tuberculosis has posted year over year increases for four consecutive years, with the majority of U.S. jurisdictions reporting rising case counts in the most recent full year of data. For a disease many assume has been eliminated, the numbers suggest otherwise.
This is general health information and is not a substitute for medical advice. Anyone concerned about tuberculosis exposure or symptoms should consult a healthcare provider or local health department.
