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• In 2022, 1,843 new TB cases were reported, a five percent increase compared with 1,750 in 2021. 
• California’s annual TB incidence was 4.7 cases per 100,000 persons; nearly double the national incidence rate of 2.5. 
• Despite case increases in 2021 and 2022, TB cases remained 13% lower compared with 2019 (before the COVID-19 pandemic) when there were 2,110 TB cases reported. ​
• Medical and societal costs of TB reached $217 million in California in 2022.
• TB cases were reported in 45 of California's 61 (74%) local health jurisdictions. Of all jurisdictions, 20 (33%) jurisdictions reported 1–4 cases.
• The vast majority of TB cases (86%) were attributable to progression of LTBI to active TB, while an estimated 3% of cases were in persons who arrived in California from outside the United States with active TB disease, and another 11% resulted from recent transmission.
• In 2022, there were 5 new TB outbreaks and 15 ongoing outbreaks in 7 jurisdictions, each involving at least 4 persons.
• More than 2 million Californians (6% of the population) have LTBI. Without treatment LTBI can progress to active TB.

​TB kills more than 200 Californians each year

• ​In 2020, 226 (13% of TB cases) people with TB died; the highest proportion since 1993.
• During 2018–2020, 681 people with TB (12% of TB cases) died. Of those, 22% died before receiving TB treatment.
  

​People born outside the United States bear the largest burden of TB

• Nearly half (49%) of California’s TB cases occurred in Asian* persons, and 40% of cases occurred in Hispanic persons.​
  
• Rates of TB among people born outside the U.S. that are Asian,* Black,* or Hispanic were many times higher than White* people born in the U.S. These disparities for Asian* and Hispanic people increased in 2022.
  
• Rates in each non-U.S​.-born racial and ethnic group were higher than among U.S.-born persons in the same group. Among U.S.-born people, Asian*, Black*, and Hispanic persons had higher rates than White* persons

Diabetes and other conditions that increase TB risk are common

• 41% of people with TB had diabetes mellitus, end stage renal disease, HIV infection, or another condition that can increase the risk of progression from latent to active TB disease.
• The most common comorbidity was diabetes mellitus, occurring in 31% of cases.
• HIV infection increases the risk for active TB disease, as well as for death with TB.
• In 2022, 88% of patients with TB were tested for HIV. Of those tested, 74 (4.5%) were HIV-positive. The proportion of cases with HIV has ranged from 3.2% to 4.6% since 2013.
• Amon​g 45 people with HIV who had a known CD4 count, 82% had a CD4 count under 200, indicating advanced HIV infection. ​

TB affects children

• TB in children is an indication of recent transmission particularly when it involves children under 5 years old. These young children are also vulnerable to the most severe forms of TB such as disseminated TB and TB of the central nervous system (CNS).
• In 2022, there were 28 cases of TB among children under 5 years old.
• During 2016-2020, the most recent period with complete data, 2 children under 5 years died.

Multidrug-Resistant TB continues

• ​Multidrug-resistant (MDR) TB is TB resistant to the two most potent first line drugs, isoniazid and rifampin. According to CDC, extensively drug-resistant (XDR) TB is MDR TB additionally resistant to fluoroquinolones and injectables, bedaquiline, or linezolid.
• In 2022, there were 18 (1.0%) MDR TB cases in California, an increase from 11 cases (0.6%) during 2021. During 2017-2022, four XDR cases were reported.
• The proportion of TB cases in California that are MDR has remained constant (1–2%) since drug susceptibility data began being systematically collected in 1993.

TB can be prevented with LTBI treatment

• More than 2 million Californians have LTBI. Approximately 1.8 million were born outside the U.S., of whom only 20% are aware of their LTBI and only 12% have been treated. 
• Because an estimated 86% of cases occur because of progression from LTBI, treating LTBI will prevent many TB cases in California.
• The U.S. Preventive Services Task Force recommends testing and treating for LTBI (USPSTF LTBI Screening webpage)
• Risk assessment tools are available for use by medical providers to identify persons at risk for LTBI for testing and treatment (CDPH Risk Assessment webpage).
• Guidelines recommending shorter treatment for LTBI are available for California (CTCA LTBI Guidelines [PDF]) and the U.S. (CDC LTBI Guidelines webpage).​​​