TUBERCULOSIS CONTROL BRANCH

Tuberculosis in California: 2025 Snapshot

Tuberculosis disease (TB) is an illness caused by the bacteria Mycobacterium tuberculosis. TB usually affects the lungs and spreads through the air when a person sick with TB coughs. Not everyone infected with the bacteria becomes sick. People that have been infected but are not sick have latent tuberculosis infection (LTBI). People with LTBI can become sick with TB disease in the future if they do not take treatment for LTBI.

2,150 people had TB disease in California in 2025

In 2025, 2,150 people were reported to have TB compared with 2,109 in 2024.
California's annual TB incidence was 5.4 cases per 100,000 persons; substantially higher than the national incidence rate (3.0 per 100,000 in 2025).
The number of cases in 2025 was the highest reported since 2013. Except during the COVID-19 pandemic (2020-2022), the number of TB cases has remained consistently 2,000-2,200 cases since 2012 despite steady declines in the preceding 20 years when cases fell nearly 60% from 5,382 cases in 1992.
TB cases were reported in 45 (74%) of California's 61 local health jurisdictions (LHJs); 21 (34%) LHJs reported 1–9 cases.
The vast majority of TB cases (83%) were attributable to progression of LTBI to TB disease meaning that they might have been prevented with testing and treatment for LTBI. An estimated 7% of cases were in persons who arrived in California with TB disease, and another 10% resulted from recent transmission.
The costs and consequences of TB in California are substantial. Medical and societal costs of TB reached $303 million in California in 2025.
(Costs calculated using data from Oh et al. BMC Res Notes 2017 and methods adapted from Castro et al. Int J Tuberc Lung Dis. 2016.)

TB kills more than 200 Californians each year

The percentage of people with TB who die has been significantly increasing. In 2010, 8.4% of people with TB died. In 2023, the most recent year with complete outcome data, 279 (13.2%) people with TB died. Of those who died, 67 (24%) died before receiving treatment for TB.

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

Birthplace of Persons with TB Disease, California, 2025

The TB rate among people born outside the U.S. (16.0 per 100,000) was 12 times higher than the rate among U.S.-born persons (1.3 per 100,000).
Nearly three-quarters of TB in people born outside the U.S. occurred more than 5 years after U.S. arrival; over half occurred more than 20 years after arrival.
Among the five most frequent countries of birth outside of the U.S., the TB rate was highest among people born in the Philippines (46.1 per 100,000) and Vietnam (36.1 per 100,000), followed by India (21.0 per 100,000), China (13.6 per 100,000) and Mexico (12.2 per 100,000).

Severe disparities by race, ethnicity, and place of birth

TB Incidence Rates by Birthplace, Race, and Ethnicity, California 2025

Nearly half (46%) of California’s TB cases occurred in non-Hispanic Asian persons, and 42% of cases occurred in Hispanic persons.
Rates of TB among people born outside the U.S. who are non-Hispanic Asian, non-Hispanic Black, or Hispanic were many times higher than non-Hispanic White people born in the U.S.
In each racial and ethnic group, TB rates were higher in non-U.S.-born than U.S.-born people. Among U.S.-born people, non-Hispanic Asian, non-Hispanic Black, and Hispanic persons had higher rates than non-Hispanic White persons.

Diabetes and other conditions that increase TB risk are common

42% of people with TB had diabetes, end stage renal disease, HIV infection, or another condition that can increase the risk of progression from latent to TB disease or complicate treatment for TB and LTBI.
The most common comorbidity was diabetes mellitus, occurring in 31% of cases.
More than one-third of adults with TB were reported to be current or former smokers.
HIV infection increases the risk for TB disease, as well as for death with TB disease.
In 2025, 106 (4.9%) people with TB also were living with HIV, a substantial increase from 2024 when 74 (3.5%) people had both TB and HIV. In 2025, 88% of patients with TB were tested for HIV, similar to the prior 10 years when 88-91% were tested.
Among 75 people with HIV who also had a known CD4 count, 65% had a CD4 count less than 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 2025, there were 35 cases of TB among children under five years old. This is an increase compared with the five years prior to 2025 when there were 23-27 cases of TB in this age group.
Of the 35 children younger than 5 years with TB in 2025, four (11%) had CNS TB.

TB affects older people

TB occurs more frequently in older people. Nearly 40% of TB disease occurred in people 65 and older in 2025. This group also had the highest rate of TB disease, 12 per 100,000 compared with 6 per 100,000 in people aged 45-64 years.
TB is more likely to result in death when it occurs in older people. One-third of people 80 years and older with TB disease die and nearly 20% of people who are 65-79 years old with TB disease die.

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, the most potent second-line drugs.
In 2025, there were 27 (1.3%) MDR TB cases in California, an increase from 22 cases (1.0%) during 2024. During 2021-2025, 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 Outbreaks

In 2025, there were six new TB outbreaks and nine ongoing outbreaks in 10 jurisdictions, each involving at least four persons.

TB can be prevented with LTBI treatment

More than 2 million Californians are estimated to have LTBI. Based on data from 2011-2012, only 23% are aware of their LTBI and only 13% have been treated.
The majority of people with LTBI (1.8 million) likely acquired their infection while living outside the U.S.
An estimated 83% of TB disease cases occur because of progression from LTBI. This means that testing for and treating LTBI will prevent many TB disease cases in California.
Laboratories are required to report to CDPH the results of interferon gamma release assays (IGRAs) which are blood tests for LTBI. Since reporting started in 2019, 3.4 million people have been tested and more than 408,000 people have tested positive.
An estimated 8.2% of IGRA tests in California have been positive.
AB 2132, a new law that took effect in 2025, requires adult patients receiving primary care services to be offered a TB test if TB risks are identified, followed by provision or referral for appropriate follow-up care.
CDPH has created a set of TB resources and tools for providers.
CDPH has released a comprehensive report on LTBI in California (2022) (PDF, 4.8 MB).
The U.S. Preventive Services Task Force recommends testing and treating for LTBI for persons at increased risk of LTBI.
Risk assessment tools are available for use by medical providers to identify persons at risk for LTBI for testing and treatment.
National guidelines recommend shorter treatment for LTBI (CDC LTBI Guidelines webpage), (NTCA/NSTC LTBI Clinical Recommendations).