Large Tuberculosis Outbreaks — United States, 2017–2023

During 2017-2023, based on an analysis of national genomic and tuberculosis (TB) case surveillance data, 50 large TB outbreaks (10 or more related TB cases in a 3-year period) involving 1,092 cases were identified in 23 states. Compared with 61,993 other persons who received a diagnosis of TB during this period, persons included in large outbreaks were more frequently U.S.-born (79% versus 26%), and a higher percentage reported substance use (27% versus 12%), homelessness (9% versus 5%), and incarceration (11% versus 3%). Approximately one fourth of these large outbreak-related cases were identified through contact tracing; these cases less commonly had clinical markers of highly infectious disease (23%) than did large outbreak-related cases identified through other methods (including evaluation associated with symptoms, targeted testing, or incidental findings) (61%), suggesting that contact tracing might have facilitated earlier diagnosis. Among the 50 large outbreaks, 34 (68%) were primarily associated with family or social networks, and 13 (26%) were primarily associated with congregate settings. Maintaining state and local public health capacity for outbreak detection, prevention, and response is essential, even in low-incidence jurisdictions. Effective outbreak responses must overcome barriers to diagnosis and treatment associated with homelessness and substance use and include efforts to build trust with affected communities. Procedures to promptly identify and isolate persons with infectious TB remain critical in congregate settings.