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U.S. Department of Health and Human Services


Core Curriculum on Tuberculosis, 2000

Chapter 3
Epidemiology of TB in the United States

Risk Groups

The following persons are at higher risk for exposure to or infection with M. tuberculosis:

  • Close contacts of persons known or suspected to have TB (i.e., those sharing the same household or other enclosed environments)
  • Foreign-born persons, including children, from areas that have a high TB incidence or prevalence (e.g., Asia, Africa, Latin America, Eastern Europe, Russia)
  • Residents and employees of high-risk congregate settings (e.g., correctional institutions, nursing homes, mental institutions, other long-term residential facilities, and shelters for the homeless)
  • Health care workers who serve high-risk clients
  • Some medically underserved, low-income populations as defined locally
  • High-risk racial or ethnic minority populations, defined locally as having an increased prevalence of TB (e.g., Asians and Pacific Islanders, Hispanics, African Americans, Native Americans, migrant farm workers, or homeless persons)
  • Infants, children, and adolescents exposed to adults in high-risk categories
  • Persons who inject illicit drugs; any other locally identified high-risk substance users (e.g., crack cocaine users)

Persons who are at higher risk of developing TB disease once infected with M. tuberculosis include

  • Persons with HIV infection
  • Persons who were recently infected with M. tuberculosis (within the past 2 years), particularly infants and very young children
  • Persons who have medical conditions known to increase the risk for disease if infection occurs, e.g., diabetes, end-stage renal disease (see Transmission and Pathogenesis)
  • Persons who inject illicit drugs; other groups of high-risk substance users (e.g., crack cocaine users)
  • Persons with a history of inadequately treated TB

An estimated 10 to 15 million persons in this country are infected with M. tuberculosis. TB disease may develop in these persons at some time in the future. Efforts to control TB through the prompt identification and treatment of persons with infectious TB can reduce the number of newly infected persons who are added to this population. Targeted testing of high-risk populations for TB infection and providing treatment for infection are crucial to achieving the nation's goal of eliminating TB. However, testing should not be given preference over higher priority TB prevention and control activities, such as identifying and completely treating all persons who have active TB, and conducting prompt contact investigations to identify persons who may have recently been infected and providing appropriate evaluation and treatment (see Testing for TB Disease and Infection,  and Community TB Control).


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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