Tuberculosis   
Annual Summary of Reportable Diseases

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria typically attack the lungs but can affect other body systems. Not everyone infected with TB bacteria becomes sick. As a result, two related conditions exist: latent TB infection (LTBI) and TB disease. In 2022, 132 tuberculosis cases (2.3 per 100,000 population) were reported. This represents a 1.5% decrease in the number of cases compared to 2021, when there were 134 newly reported cases. Despite the rebound in the number of new cases in 2021 from a low of 117 in 2020, the average TB case count in Minnesota from the last two years (2021-2022) was 133, compared to an average of 160 cases in the two years before the COVID-19 pandemic started (2018-2019). This follows a trend seen at the national level and most likely reflects the lingering effects of the pandemic. The TB incidence rate in Minnesota was slightly lower than the overall rate in the United States (2.5 per 100,000). Ten cases (8%) from 2022 have died as of October 2023, 9 (7%) due to TB disease. 

Twenty-two counties (25%) reported at least one case in 2022. The majority of TB cases (76%) occurred in the metropolitan area, primarily in Hennepin (33%) and Ramsey Counties (21%). Twenty-eight cases (21%) were from the other five metropolitan counties, and the remaining 24% of cases were reported from greater Minnesota. Among metropolitan area counties, the highest TB incidence rate in 2022 was reported in Ramsey County (5.1 per 100,000), followed by Anoka County (4.2 per 100,000) and Hennepin County (3.5 per 100,000). The combined TB incidence rate for the 7-county metropolitan area was 3.2 per 100,000, compared to 1.3 per 100,000 for all greater Minnesota counties. The two largest groups of new TB cases were those 25-44 (36%) and 65 years of age and older (20%) at time of diagnosis. Eight patients (6%) were less than 5 years of age when they were diagnosed. 

Most TB cases (83%) were identified only after seeking medical care for symptoms of disease. Targeted public health interventions identified a portion of the remaining 17% of cases, including contact investigations surrounding potentially infectious patients (8%), screening of new refugee arrivals (2%), and follow up to pre-immigration exams (1%). An additional 4% were identified through other targeted testing for TB, including employment screening, screening at medical visits and during immigration detention. The remaining four cases (3%) were diagnosed with active TB disease incidentally while being evaluated for another medical condition. 

TB incidence is disproportionately high among racial and ethnic minorities in Minnesota, as well as nationally. In 2022, 9 cases occurred among non-Hispanic whites, a case rate of 0.2 per 100,000. In comparison, among non-Hispanic persons of other races, 52 cases occurred among Black/African-born persons (11.9 cases per 100,000), 55 among Asian/ Pacific Islanders (17.4 cases per 100,000), and two cases among American Indian/ Alaska Native persons (2.9 cases per 100,000). Fourteen cases were Hispanic/ Latino persons of any race (4.4 cases per 100,000). The majority of Hispanic/Latino (79%), Asian/Pacific Islander (84%), and black/African-born cases (83%) were non-U.S.–born. 

In 2022, the percentage of TB cases in Minnesota occurring in persons born outside the United States was 76%, compared to 73% of TB cases reported nationally. The non-U.S.-born percentage among Minnesota cases has consistently been higher than the national average, but the gap in 2022 was smaller than usual. The 100 non-U.S.–born TB cases represented 26 different countries of birth; the most common region of birth among these cases was Sub-Saharan Africa (43% of non-U.S. born cases), followed by South/Southeast Asia (34%), East Asia/Pacific (12%), and Latin America (including the Caribbean) (11%). (Figure 6). 

Compared to the percentage of cases who have lived in areas of the world where TB is more common, individuals in other high-risk groups comprised smaller proportions of the cases. Note that patients may fall under more than one risk category. Fifty-one percent occurred in persons with certain medical conditions (not including HIV/ AIDS), which increase the risk for progression from latent TB infection to active TB disease (e.g., diabetes, COVID-19 infection, active smoking, prolonged corticosteroid or other immunosuppressive therapy, end stage renal disease). Two percent of cases were co-infected with HIV. Substance use (including excess alcohol use and/ or injection and non-injection drug use) during the 12 months prior to their TB diagnosis was reported by 9% of cases, and 2% reported experiencing homelessness during the 12 months prior to diagnosis. Two patients were in a congregate setting at time of diagnosis: one in an immigration detention center and another one in a long-term care facility. 

By site of disease, 61% of cases had pulmonary disease exclusively. Another 14% had both pulmonary and extrapulmonary sites of disease, and 24% had extrapulmonary disease exclusively. Among the 51 patients with an extrapulmonary site of disease, the most common sites were lymphatic (41%), followed by pleural (25%), and musculoskeletal (16%). Extrapulmonary disease is generally more common among persons born outside the United States, as seen in cases reported nationally as well as in Minnesota. However, in 2022, the difference between the two groups was much smaller than in previous years. Thirty-nine percent of non-U.S.– born cases in Minnesota had at least one extrapulmonary site of disease, compared with 38% of U.S.-born cases. 

Of 103 culture-confirmed TB cases with conventional drug susceptibility results available, 13 (13%) were resistant to at least one first-line anti-TB drug (i.e., isoniazid [INH], rifampin, pyrazinamide, or ethambutol), including 11 cases (11%) resistant to at least INH. There were three new cases of multidrug-resistant TB (MDR-TB, or resistance to at least INH and rifampin) reported in 2022, making up 3% of culture-confirmed cases.

• For up to date information see: Tuberculosis (TB)

In 2021, 134 tuberculosis (TB) cases (2.4 per 100,000 population) were reported. This represents a 15% increase in the number of cases compared to 2020, when there were 117 newly reported cases. Despite this rebound in the number of new cases in 2021, it was still 9% below the case count in 2019. This followed a similar trend seen at the national level, most likely reflecting lingering effects of the COVID-19 pandemic. This could be due to a combination of factors, including delayed diagnosis or misdiagnosis of TB from shifting resources in public health and underutilization of healthcare services, together with a true decrease in TB incidence from COVID-19 mitigation strategies during the pandemic. The TB incidence rate in Minnesota was the same as the overall rate in the United States. Fourteen cases (10%) from 2021 have died as of March 2023, 11 (8%) due to TB disease. 

Twenty-six counties (30%) reported at least one case in 2021. The majority of TB cases (76%) occurred in the metropolitan area, primarily in Hennepin (24%) and Ramsey Counties (30%). Thirty cases (22%) were from the other five metropolitan counties, and the remaining 24% of cases were reported from greater Minnesota. Among metropolitan area counties, the highest TB incidence rate in 2021 was reported in Ramsey County (7.3 per 100,000), followed by Anoka County (3.6 per 100,000). The combined TB incidence rate for the 7-county metropolitan area was 3.3 per 100,000, compared to 1.3 per 100,000 for all greater Minnesota counties. 

The largest groups of new TB cases were those 25-44 and 45-64 years of age at time of diagnosis (28% each), followed by cases 65 years of age and older (20%). Eight patients (6%) were <5 years of age when they were diagnosed. 

Most TB cases (79%) were identified only after seeking medical care for symptoms of disease. Targeted public health interventions identified a portion of the remaining 21% of cases, including contact investigations surrounding potentially infectious patients (9%) and screening of new refugee arrivals (2%). An additional 6% were identified through other targeted testing for TB, including employment screening and other medical examinations for immigration purposes. The remaining five cases (4%) were diagnosed with active TB disease incidentally while being evaluated for another medical condition. 

TB incidence is disproportionately high among racial and ethnic minorities in Minnesota, as well as nationally. In 2021, 11 cases occurred among non-Hispanic whites, a case rate of 0.2 per 100,000. In comparison, among non-Hispanic persons of other races, 56 cases occurred among blacks/African-born persons (12.8 cases per 100,000), 52 among Asians or Pacific Islanders (16.5 cases per 100,000), and one case among American Indian or Alaska Native persons (1.5 cases per 100,000). Fourteen cases were Hispanic/Latino persons of any race (4.4 cases per 100,000). The majority of Hispanic/Latino (79%), Asian/Pacific Islander (79%), and black/African-born cases (96%) were non-U.S. born. 

In 2021, the percentage of TB cases in Minnesota occurring in persons born outside the United States was 81%, compared to 71% of TB cases reported nationally. The 108 non-U.S.–born TB cases represented 33 different countries of birth; the most common region of birth among these cases was Sub-Saharan Africa (50% of non-U.S. born cases), followed by South/ Southeast Asia (31%), Latin America (including the Caribbean) (10%), East Asia/Pacific (8%), and Eastern Europe (less than 1%). (Figure 7). 

Compared to the percentage of cases who have lived in areas of the world where TB is more common, individuals in other high-risk groups comprised smaller proportions of the cases. Note that patients may fall under more than one risk category. Fifty percent occurred in persons with certain medical conditions (not including HIV/ AIDS), which increase the risk for progression from latent TB infection to active TB disease (e.g., diabetes, COVID-19 infection, active smoking, prolonged corticosteroid or other immunosuppressive therapy, end stage renal disease). One percent of cases were co-infected with HIV. Substance use (including excess alcohol use and/or injection and non-injection drug use) during the 12 months prior to their TB diagnosis was reported by 3% of cases, and one percent reported experiencing homelessness during the 12 months prior to diagnosis. 

By site of disease, 65% of cases had pulmonary disease exclusively. Another 9% had both pulmonary and extrapulmonary sites of disease, and 26% had extrapulmonary disease exclusively. Among the 47 patients with an extrapulmonary site of disease, the most common sites were lymphatic (45%), followed by peritoneal (19%) and musculoskeletal (19%). Extrapulmonary disease is generally more common among persons born outside the United States, as seen in cases reported nationally as well as in Minnesota. Thirty-eight percent of non-U.S.–born cases in Minnesota had at least one extrapulmonary site of disease, compared to only 23% of U.S.-born cases. 

Of 94 culture-confirmed TB cases with drug susceptibility results available, 10 (11%) were resistant to at least one first-line anti-TB drug (i.e., isoniazid [INH], rifampin, pyrazinamide, or ethambutol), including 9 cases (10%) resistant to at least INH. There were 4 new cases of multidrug-resistant TB (MDR-TB, or resistance to at least INH and rifampin) reported in 2021, making up 4% of culture-confirmed cases.

• For up to date information see: Tuberculosis (TB)

In 2020, 117 tuberculosis (TB) cases (2.1 per 100,000 population) were reported. This represents a 21% decrease in the number of cases compared to 2019, when there were 148 new cases. This significant drop in newly reported TB cases was in line with the 20% decrease seen nationally in 2020. Many factors are thought to have contributed to the decline in both Minnesota and the United States: a true decrease in TB incidence due to COVID mitigation strategies and changing immigration and travel patterns, combined with an increase in missed and delayed diagnoses of TB due to decreased health care utilization and focus on COVID-19 by providers and clinics during the pandemic. The TB incidence rate in Minnesota was slightly lower than the overall rate in the United States, which was 2.2 per 100,000 in 2020. Ten cases (9%) from 2020 have died as of March 2022, 6 (5%) due to TB disease.

Seventeen counties (20%) reported at least 1 case in 2020. The majority of cases (81%) occurred in the metropolitan area, primarily in Hennepin (38%) and Ramsey Counties (27%). Twenty cases (17%) were from the other five metropolitan counties, and the remaining 19% of cases were reported from greater Minnesota. Among metropolitan area counties, the highest TB incidence rate in 2020 was reported in Ramsey County (5.6 per 100,000), followed by Hennepin County (3.5 per 100,000). The combined TB incidence rate for the other metropolitan counties (excluding Hennepin and Ramsey Counties) was 1.5 per 100,000, and 0.9 per 100,000 for all greater Minnesota counties. 

The largest group of new TB cases were those 25-44 years of age at time of diagnosis (34%), followed by cases 65 years of age and older (25%). Three (3%) were <5 years of age when they were diagnosed. 

Most TB cases (88%) were identified only after seeking medical care for symptoms of disease. Targeted public health interventions identified a portion of the remaining 12% of cases, including contact investigations surrounding potentially infectious patients (5%). An additional 3% were identified through other targeted testing for TB. The remaining five cases (4%) were diagnosed with active TB disease incidentally while being evaluated for another medical condition. 

TB incidence is disproportionately high among racial and ethnic minorities in Minnesota as well as nationally. In 2020, 6 cases occurred among non-Hispanic whites, a case rate of 0.1 per 100,000. In contrast, among non-Hispanic persons of other races, 52 cases occurred among blacks/African-born persons (12.3 cases per 100,000), and 47 among Asians or Pacific Islanders (15.3 cases per 100,000). Twelve cases were Hispanic/Latino persons of any race (3.8 cases per 100,000). The majority of Hispanic/Latino (92%), Asian/ Pacific Islander (91%), and black/ African-born cases (94%) were non-U.S. born. 

In 2020, the percentage of TB cases in Minnesota occurring in persons born outside the United States was 90%, compared to 72% of TB cases reported nationally. The 105 non U.S.-born TB cases represented 27 different countries of birth; the most common region of birth among these cases was Sub-Saharan Africa (47% of non-U.S. born cases), followed by South/Southeast Asia (34%), Latin America (including the Caribbean) (10%), and East Asia/Pacific (7%). Patients from other regions (North Africa/Middle East and Eastern Europe) accounted for the remaining 2% of cases (Figure 6). 

Compared to the percentage of cases who have lived in areas of the world where TB is more common, individuals in other high risk groups comprised smaller proportions of the cases. Note that patients may fall under more than one risk category. Forty-eight percent occurred in persons with certain medical conditions (not including HIV/AIDS) that increase the risk for progression from latent TB infection to active TB disease (e.g., diabetes, active smoking, prolonged corticosteroid or other immunosuppressive therapy, end stage renal disease). Two percent of cases were co-infected with HIV. Substance use (including excess alcohol use and/or injection and non-injection drug use) during the 12 months prior to their TB diagnosis was reported by 3% of cases. One percent reported being homeless during the 12 months prior to diagnosis, and 1% were residents of long-term care facilities at time of diagnosis. 

By site of disease, 44% of cases had pulmonary disease exclusively. Another 15% had both pulmonary and extrapulmonary sites of disease, and 40% had extrapulmonary disease exclusively. Among the 65 patients with an extrapulmonary site of disease, the most common sites were lymphatic (46%), followed by peritoneal (14%). Extrapulmonary disease is generally more common among persons born outside the United States, as seen in cases reported nationally as well as in Minnesota. Fifty-seven percent of non U.S.-born cases in Minnesota had at least one extrapulmonary site of disease, compared to only 42% of U.S.-born cases. 

Of 90 culture-confirmed TB cases with drug susceptibility results available, 12 (13%) were resistant to at least one first-line anti-TB drug (i.e., isoniazid [INH], rifampin, pyrazinamide, or ethambutol), including 10 cases (11%) resistant to at least INH. There were 3 new cases of multidrug-resistant TB (MDR-TB, or resistance to at least INH and rifampin) reported in 2020, making up 3% of culture-confirmed cases.

• For up to date information see: Tuberculosis (TB)

In 2019, 148 tuberculosis (TB) cases (2.6 per 100,000 population) were reported. This represents a 14% decrease in the number of cases compared to 2018, when there were 172 new cases. The TB incidence rate in Minnesota was lower than the overall rate in the United States, which was 2.7 per 100,000 in 2019. The TB case count has decreased 38% since 2007, when 238 cases were reported, and has remained under 200 since 2009. Seven cases (5%) from 2019 have died, all due to TB disease.

Twenty-four counties (28%) had at least 1 case in 2019. The majority of cases (73%) occurred in the metropolitan area, primarily in Hennepin (36%) and Ramsey Counties (20%). Twenty-six cases (18%) were from the other five metropolitan counties, and the remaining 27% of cases were reported from greater Minnesota. Among metropolitan area counties, the highest TB incidence rate in 2019 was reported in Ramsey County (5.3 per 100,000), followed by Hennepin County (4.2 per 100,000). The combined TB incidence rate for the other metropolitan counties (excluding Hennepin and Ramsey Counties) was 2.0 per 100,000, and 1.6 per 100,000 for all greater Minnesota counties.

The largest group of new TB cases were those 25-44 years of age at time of diagnosis (42%), followed by cases 45-64 years of age (22%). Two percent of new cases were less 5 years of age when they were diagnosed.

Most TB cases (85%) were identified only after seeking medical care for symptoms of disease. Various targeted public health interventions identified the majority of the remaining 15% of cases. Such case identification methods are high priority core prevention and control activities, and include contact investigations (6%) and follow-up evaluations of individuals with abnormal findings on preimmigration exams where infectious TB disease had been ruled out (<1%). An additional 4% were identified through other screening (e.g., other immigration medical exams, employment screening, and other targeted testing for TB). Six cases (4%) were diagnosed with active TB disease incidentally while being evaluated for another medical condition.

TB incidence is disproportionately high among racial and ethnic minorities in Minnesota as well as nationally. In 2019, 11 cases occurred among non-Hispanic whites, a case rate of 0.2 per 100,000. In contrast, among non- Hispanic persons of other races, 72 cases occurred among blacks/African-born persons (17.7 cases per 100,000), and 54 among Asian/Pacific Islanders (17.9 cases per 100,000). Eleven cases were Hispanic persons of any race (3.6 cases per 100,000). The majority of Hispanic (100%), Asian (94%), and Black cases (89%) were non-U.S. born.

In 2019, the percentage of TB cases in Minnesota occurring in persons born outside the United States was 88%, compared to 71% of TB cases reported nationally. The 130 non U.S.-born TB cases represented 25 different countries of birth; the most common region of birth among these cases was Sub-Saharan Africa (49% of non- U.S. born cases), followed by South/ Southeast Asia (35%), Latin America (including the Caribbean) (9%), and East Asia/Pacific (4%). Patients from other regions (North Africa/Middle East, and Eastern Europe) accounted for the remaining 4% of cases (Figure 6).

Compared to the percentage of cases who have lived in areas of the world where TB is more common, individuals in other high risk groups comprised smaller proportions of the cases. Note that patients may fall under more than one risk category. Thirty-eight percent occurred in persons with certain medical conditions that increase the risk for progression from latent TB infection to active TB disease (e.g., diabetes, prolonged corticosteroid or other immunosuppressive therapy, end stage renal disease). The next most common risk factor was substance abuse (including excess alcohol use and/or injection and non-injection drug use) during the 12 months prior to their TB diagnosis (3%). Three percent of cases were co-infected with HIV. Three percent reported being homeless during the 12 months prior to diagnosis, 1% were residents of long-term care facilities, and 1% were in a correctional facility at time of diagnosis.

By site of disease, 53% of cases had pulmonary disease exclusively. Another 18% had both pulmonary and extrapulmonary sites of disease, and 28% had extrapulmonary disease exclusively. Among the 69 patients with an extrapulmonary site of disease, the most common sites were lymphatic (46%), followed by musculoskeletal (25%). Extrapulmonary disease is generally more common among persons born outside the United States. Forty-eight percent of non U.S.- born cases in Minnesota had at least one extrapulmonary site of disease, compared to only 39% of U.S.-born cases.

Of 123 culture-confirmed TB cases with drug susceptibility results available, 17 (14%) were resistant to at least one first-line anti-TB drug (i.e., isoniazid [INH], rifampin, pyrazinamide, or ethambutol), including 13 cases (11%) resistant to at least INH. There were 6 new cases of multidrug-resistant TB (MDR-TB, or resistance to at least INH and rifampin) reported in 2019, making up 5% of culture-confirmed cases.

• Find up to date information at>> Tuberculosis (TB)

In 2018, 172 tuberculosis (TB) cases (3.1 per 100,000 population) were reported. This represents a 3% decrease in the number of cases compared to 2017, when there were 178 cases. The TB incidence rate in Minnesota has typically been lower than the overall rate in the United States, but Minnesota’s rate in the last few years has been higher than the national rate (2.8 per 100,000 in 2018). Despite the higher TB case counts and rates in Minnesota recently, the TB case count has decreased 28% since 2007, when 238 cases were reported, and has remained under 200 since 2009. Four (2%) cases from 2018 died, 1 of whom died due to TB disease.

Twenty-seven (31%) counties had at least 1 TB case in 2018. The majority (70%) of cases occurred in the metropolitan area, primarily in Hennepin (31%) and Ramsey (20%) Counties. Thirty-three (19%) were from the other 5 metropolitan counties. The remaining 30% of cases were reported from Greater Minnesota, representing a 3% increase from 2017. Among metropolitan area counties, the highest TB incidence rate in 2018 was reported in Ramsey County (6.2 per 100,000), followed by Hennepin County (4.3 per 100,000). The TB incidence rate for all Greater Minnesota counties combined was 2.0 per 100,000.

The largest group of new TB cases was the 25-44 year age group at time of diagnosis (42%), followed by cases 65 years and older (18%). Two percent of new cases were less than 5 years of age when they were diagnosed.

Most (78%) TB cases were identified only after seeking medical care for symptoms of disease. Various targeted public health interventions identified the majority of the remaining 22% of cases. Such case identification methods are high priority core prevention and control activities, and include contact investigations (6%) and follow-up evaluations of individuals with abnormal findings on pre-immigration exams where infectious TB disease had been ruled out (3%). An additional 9% were identified through other screening (e.g., other immigration medical exams, employment screening, other targeted testing for TB). Six (3%) cases were diagnosed with active TB disease incidentally while being evaluated for another medical condition.

TB incidence is disproportionately high among racial and ethnic minorities in Minnesota, as it is among cases reported nationally. In 2018, 12 cases occurred among non-Hispanic whites, a case rate of 0.3 per 100,000. In contrast, among non-Hispanic persons of other races, 97 cases occurred among blacks/African-born persons (24.9 cases per 100,000), and 52 among Asian/ Pacific Islanders (17.5 cases per 100,000). Ten cases were Hispanic persons of any race (3.3 cases per 100,000). One case was reported as multi-racial. The majority of Hispanic (60%), Asian (90%), and black cases (91%) were non-U.S. born.

In 2018, the percentage of TB cases in Minnesota occurring in persons born outside the United States was 83%, compared to 70% of TB cases reported nationally. The 142 non U.S.-born TB cases represented 30 different countries of birth; the most common region of birth among these cases was Sub-Saharan Africa (61% of non-U.S. born cases), followed by South/ Southeast Asia (26%), East Asia/ Pacific (7%), and Latin America (including the Caribbean) (4%). Patients from other regions (North Africa/Middle East, and Eastern Europe) accounted for the remaining 1% of cases (Figure 7).

Individuals in other high risk groups comprised smaller proportions of the cases. Note that patients may fall under more than one risk category. Twenty-seven percent occurred in persons with certain medical conditions that increase the risk for progression from latent TB infection to active TB disease (e.g., diabetes, prolonged corticosteroid or other immunosuppressive therapy, end stage renal disease). The next most common risk factor was substance abuse (including alcohol abuse and/ or injection and non-injection drug use) during the 12 months prior to their TB diagnosis (6%). Three percent of cases were coinfected with HIV. Two percent reported being homeless during the 12 months prior to diagnosis, 2% were residents of long-term care facilities, and 1% were in a correctional facility at time of diagnosis.

By site of disease, 47% of cases had pulmonary disease exclusively. Another 14% had both pulmonary and extrapulmonary sites of disease, and 38% had extrapulmonary disease exclusively. Among the 90 patients with an extrapulmonary site of disease, the most common sites were lymphatic (51%), followed by musculoskeletal (18%). Extrapulmonary disease is generally more common among persons born outside the United States, as seen in cases reported nationally as well as in Minnesota. Fifty-six percent of non U.S.-born cases in Minnesota had at least one extrapulmonary site of disease, compared to only 33% of U.S.-born cases.

Of 130 culture-confirmed TB cases with drug susceptibility results available, 25 (19%) were resistant to at least one first-line anti-TB drug (i.e., isoniazid [INH], rifampin, pyrazinamide, or ethambutol), including 16 (12%) cases resistant to at least INH. There were 7 new cases of multidrug-resistant TB (MDR-TB, or resistance to at least INH and rifampin) reported in 2018, making up 5% of culture-confirmed cases.

• For up to date information see>> Tuberculosis (TB)

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