Estimated Rate of Reactivation of Latent Tuberculosis Infection in the United States, Overall and by Population Subgroup

Am J Epidemiol. 2014 Jan 15;179(2):216-25. doi: 10.1093/aje/kwt246. Epub 2013 Oct 18.


We estimated the rate of reactivation tuberculosis (TB) in the United States, overall and by population subgroup, using data on TB cases and Mycobacterium tuberculosis isolate genotyping reported to the Centers for Disease Control and Prevention during 2006-2008. The rate of reactivation TB was defined as the number of non-genotypically clustered TB cases divided by the number of person-years at risk for reactivation due to prevalent latent TB infection (LTBI). LTBI was ascertained from tuberculin skin tests given during the 1999-2000 National Health and Nutrition Examination Survey. Clustering of TB cases was determined using TB genotyping data collected by the Centers for Disease Control and Prevention and analyzed via spatial scan statistic. Of the 39,920 TB cases reported during 2006-2008, 79.7% were attributed to reactivation. The overall rate of reactivation TB among persons with LTBI was estimated as 0.084 (95% confidence interval (CI): 0.083, 0.085) cases per 100 person-years. Rates among persons with and without human immunodeficiency virus coinfection were 1.82 (95% CI: 1.74, 1.89) and 0.073 (95% CI: 0.070, 0.075) cases per 100 person-years, respectively. The rate of reactivation TB among persons with LTBI was higher among foreign-born persons (0.098 cases/100 person-years; 95% CI: 0.096, 0.10) than among persons born in the United States (0.082 cases/100 person-years; 95% CI: 0.080, 0.083). Differences in rates of TB reactivation across subgroups support current recommendations for targeted testing and treatment of LTBI.

Keywords: National Health and Nutrition Examination Survey; latent tuberculosis infection; reactivation tuberculosis; tuberculosis.

MeSH terms

  • Female
  • HIV Infections / complications
  • Humans
  • Latent Tuberculosis / complications
  • Latent Tuberculosis / epidemiology*
  • Male
  • Mycobacterium tuberculosis / physiology*
  • Nutrition Surveys
  • United States / epidemiology
  • Virus Activation*