Published ahead of print on November 7, 2007, doi:10.1164/rccm.200701-057OC
Am. J. Respir. Crit. Care Med., Volume 177, Number 3, February 2008, 348-355
A more recent version of this article appeared on February 1, 2008
Submitted on January 11, 2007
Accepted on November 6, 2007
Prevalence of Tuberculosis Infection in the U.S. Population
Diane E Bennett1*, Jeanne M Courval2, Ida Onorato1, Tracy Agerton1, Judy Daugherty Gibson1, Lauren Lambert1, Geraldine McQuillan1, Brenda Lewis1, Thomas R Navin1, and Kenneth G Castro1
1 NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA,
2 RTI International, Atlanta, GA, USA
* To whom correspondence should be addressed. E-mail: bennett{at}who.int.
Rationale: The goal for U.S. tuberculosis elimination is a tuberculosis disease incidence of <1 per million U.S. population by 2010, which requires that the latent tuberculosis infection (LTBI) prevalence be less than 1% and decreasing.
Objective: To estimate the prevalence of LTBI in the U.S. population
Methods and measurements: Interview and medical examination, including tuberculin skin testing (TST), of 7386 individuals conducted in 1999-2000 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the civilian noninstitutionalized U.S. population. LTBI was defined as a TST measurement of  10 mm. Associations of age, race/ethnicity, sex, poverty, and birthplace were assessed. Results among the 24-74 year-old subgroup were compared to NHANES 1971-72 data.
Main results: Estimated LTBI prevalence was 4.2%; an estimated 11 213 000 individuals had LTBI. Among 25-74 year-olds, prevalence decreased from 14.3% in 1971-72 to 5.7% in 1999-2000. Higher prevalences were seen in the foreign-born (18.7%), non-Hispanic blacks/African-Americans (7.0%), Mexican-Americans (9.4 %) and individuals living in poverty (6.1%). 63% of LTBI was among the foreign-born. Among the U.S. born, after adjusting for confounding, LTBI was associated with non-Hispanic African-American race/ethnicity, Mexican-American ethnicity, and poverty. 26% of persons with LTBI had been diagnosed, and only 13% treated.
Conclusions: In addition to basic tuberculosis control measures, elimination strategies should include targeted evaluation and treatment of individuals in high-prevalence groups and enhanced support for global tuberculosis prevention and control.
Key words: tuberculosis infection
epidemiology
tuberculin testing
United States
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