New York City
Department of Health and Mental Hygiene
Annual Tuberculosis Summary 2023
Mission: The New York City (NYC) Department of Health and Mental
Hygiene (Health Department) aims to prevent the transmission of
tuberculosis (TB) and eliminate it as a public health problem in NYC.
Goals
Identify all people with
suspected or conrmed TB
disease and ensure their
appropriate treatment, ideally
on directly observed therapy.
1
Ensure that people at high risk
for progression from latent TB
infection (LTBI) to TB disease
complete treatment and do not
develop disease.
2
Core Activities
To fulll its mission and goals, the Health Department collaborates with health care
providers, laboratories, community partners, City and state agencies, and others to
ensure effective TB care and prevention in NYC through an integrated, dynamic model of
core activities and services.
Clinical Care
Laboratory
Testing
Contact
Investigation
Strategic Data Use
Treatment
Case
Management
Outbreak Detection
and Response
Reporting and
Surveillance
Medical
Consultation
Outreach and Education
Prepared by: Emily Bamforth, MPH; Misato Gbedemah, MPH; Jillian Knorr, MPH; Aminotu
Ogunyemi-Anderson, MPH; Anthony Romano, MPH; Jeanne Sullivan Meissner, MPH; Lisa Trieu, MPH
Additional Program Content Provided by: Joseph Burzynski, MD, MPH; Magali Calderon, MS;
Christine Chuck, MPA; Alice V. Easton, PhD; Teresa Mark, MPH; Herns Modestil, BS; Diana Nilsen, RN, MD;
Farah Parvez, MD, MPH; Marco Salerno, MPH; Abubaker Siddique, BS Vet. Sc., MS
Suggested Citation: New York City Department of Health and Mental Hygiene. Bureau of Tuberculosis
Control Annual Summary, 2023. Long Island City, NY. 2024
About This Report
This report provides TB surveillance data and summaries of core Health Department TB
program activities for calendar year 2023. These data reect the most complete information
available as of January 16, 2024. For additional details on the use of population data and
denitions in this report, see the Technical Notes (Page 36).
Contents
Introduction
Tuberculosis in New York City, 2023 ...................................................................................4
Letter From the Assistant Commissioner ............................................................................5
Core Activities
Surveillance and Reporting ..............................................................................................7-8
Clinical Care and Treatment .......................................................................................... 9-10
Medical Consultation .........................................................................................................10
Case Management ....................................................................................................... 11-12
Drug Susceptibility Testing and Whole Genome Sequencing...................................... 12-13
Outreach and Education .............................................................................................. 13-15
Funding and Administration...............................................................................................16
Research ............................................................................................................................16
Program Evaluation...................................................................................................... 16-17
Profile of Tuberculosis Cases, 2023
Tuberculosis Cases and Rates in New York City, 2023 .....................................................19
Overview: Tuberculosis in New York City............................................................................20
Demographic Characteristics....................................................................................... 21-22
Age and Gender............................................................................................................21
Birth in the United States and Race and Ethnicity ......................................................22
Country of Birth ............................................................................................................23
Tuberculosis in New York City Neighborhoods............................................................. 25-26
Clinical Characteristics ................................................................................................ 27-28
Disease Site and Comorbidities ...................................................................................27
Culture Status, Treatment Outcomes and Mortality ....................................................28
Drug Resistance.................................................................................................................29
Whole Genome Sequencing and New York City Clusters ..................................................30
Contact Investigation in Congregate Settings ...................................................................31
Appendix
Select Characteristics by Birth in the United States, 2022 to 2023 .......................... 33-34
Historical Tuberculosis Data, New York City ......................................................................35
Technical Notes..................................................................................................................36
New York City Health Department Chest Clinics ...............................................................37
3. Dened as resistance to at least isoniazid and rifampin. One person
was diagnosed with extensively drug-resistant (XDR) TB in 2023, dened
as resistance to at least isoniazid and rifampin plus a uoroquinolone
and either a second-line injectable anti-TB medication, bedaquiline
or linezolid. 4. In the 12 months before TB diagnosis. 5. Dened by
United Hospital Fund neighborhood designation (42). 6. Rates are
per 100,000.
There were 684 conrmed tuberculosis (TB) cases identied in New York
City (NYC) in 2023, an increase of 28% from 2022. This represents the
highest number of cases conrmed in NYC since 2011.
Tuberculosis in NYC, 2023
68
Number of countries of birth
represented among people with TB
89%
Percentage of TB cases among
people born outside the U.S.
19
Number of NYC neighborhoods
5
with a TB rate higher than the
2023 citywide rate
6
China 19%
U.S. 11%
Ecuador 7% Venezuela 4%
Mexico 5%Bangladesh 5%
Other 49%
13
Number of people diagnosed
with a multidrug-resistant
(MDR) TB
3
strain
684
Number of
TB cases
conrmed
7.8
TB rate per
100,000
people
28%
Most common country of birth among people with TB: Race and ethnicity among
people born in the U.S.
1
:
increase
1. Does not include people of multiple, other
or unknown races or ethnicities.
2. People for whom gender identity was listed only as
transgender are excluded from this gure.
Man 68% Woman 32%
TB cases by gender
2
:
Age in years among people with TB:
18 to 44 years 45%
45 to 64 years 24%
65 years and
older 27%
Birth to 17 years 4%
13%
Percentage of TB cases
among people with history
of homelessness
4
49%
Non-Hispanic
Black
45%
Age 18 to 44
Hispanic 24%
Non-Hispanic white 15%
Asian 8%
Non-Hispanic Black 49%
Other/Multiple 3%
Dear Colleagues,
Each year, we use World TB Day and the release of our Annual TB Summary as an opportunity
to reect on the challenges faced, strategies implemented and progress made in our ght
against TB.
In 2023, there were 684 conrmed cases of active TB disease in NYC, representing a 28%
increase compared with 2022 and the highest number of cases since 2011. Increases
were seen among various populations, including young children, people with a history of
homelessness, people born in the U.S. and people born in another country. Among those
with TB, there was an increase in patients with a drug-resistant strain, including strains
resistant to rifampin. These increases serve as both a sobering reminder of the impact of
this devastating disease and a galvanizing call to action.
This year we continued to face a number of challenges, including global shortages of
key TB medications, an inux of people from countries with a high burden of TB and the
resonating impact of the COVID-19 pandemic. The upward trend in TB cases in NYC is
consistent with an overall rise in the number of cases nationally, and we must be prepared
— globally, nationally and locally — to redouble our efforts through innovation, collaboration
and intensied investment.
In 2023, the NYC Health Department continued to pioneer advancements in TB care and
treatment. We worked closely with other agencies, health care providers and community-
based organizations to expand access to TB testing, treatment and care. Our core public
health infrastructure enabled us to quickly detect and respond to TB cases, interrupt TB
transmission and ensure access to state-of-the-art TB services, including video directly
observed therapy (vDOT), telehealth and new treatment options. Improvements in laboratory
methods allowed us to identify drug resistance more quickly, while new medications have
greatly improved the treatment of drug-resistant TB, allowing for shorter and better-tolerated
treatment regimens. In response to the rise in cases, we are increasing our capacity to
provide TB services and are strengthening collaborations to detect, treat and prevent TB.
Together, we can again bring TB rates to record lows and change the trajectory of TB in
NYC. Together, we can end TB.
Sincerely,
Joseph N. Burzynski, MD, MPH
Assistant Commissioner, Bureau of Tuberculosis Control
5
> Letter From the Assistant Commissioner
Core Activities
Core Activities
TB is an airborne, infectious disease caused by a bacteria. TB has two stages: active TB
disease and latent TB infection (LTBI). TB is treatable and preventable, but without effective
treatment, TB may lead to serious illness and death.
The Health Department performs a variety of integrated activities to address and prevent
TB disease. These include surveillance, clinical care and treatment, medical consultation,
case management, directly observed therapy (DOT), contact investigation, coordination
of laboratory tests, outbreak detection and response, outreach and education, program
evaluation, and research. These activities support effective, patient-centered TB care,
response and prevention in NYC.
Surveillance and Reporting
Health care providers and laboratories are required to report to the Health Department:
1. All patients with conrmed TB disease
2. Anyone suspected of having TB disease
3. Children younger than 5 years of age with a positive test for TB infection and
related chest radiograph ndings and treatment information
4. Results of any blood-based test for TB infection, regardless of patient age
(laboratories only)
Medical providers in NYC must report these patients even though pathologists and
microbiologists are also required to report ndings consistent with TB. Reports must be
submitted using the Universal Reporting Form (URF) and must be received by the Health
Department within 24 hours of diagnosis or clinical suspicion, whether sent electronically,
by express or overnight mail, fax or telephone.
For more information about TB reporting requirements in NYC and to download related
forms, visit nyc.gov and search for TB reporting requirements. To download a URF,
visit nyc.gov and search for URF. For assistance, call 311 and ask for the Health
Department Bureau of Tuberculosis Control Surveillance Unit.
> Core Activities
7 New York City Health Department Annual Tuberculosis Summary, 2023
The Health Department reviews all submitted reports for completeness and timeliness and
determines whether patients are eligible for case management. The Health Department
maintains an electronic TB surveillance registry and case management system (Maven
version 6.3.1, Conduent Public Health Solutions, Florham Park, NJ) that has information for
all reported patients and individuals exposed to TB. These data are used to conduct case
management; ensure treatment completion; monitor trends; detect outbreaks; prepare
surveillance reports; report aggregated data to the New York State Department of Health
(NYSDOH) and the Centers for Disease Control and Prevention (CDC); identify reporting
and data quality issues; and inform programmatic decision-making.
TB Surveillance and Reporting in 2023:
•
684 TB cases were conrmed by the Health Department.
•
3,019 people with suspected TB disease were reported to the
Health Department.
•
112 children younger than 5 years of age with TB infection were reported
to the Health Department.
•
105 facilities reported at least one TB case; nearly half of all cases were
reported by one of 13 facilities.
> Core Activities
Figure 1: Initial reporter of conrmed TB cases veried in NYC by reporter type, 2023
Private hospital 47%
Public hospital 24%
Other 16%
Community provider 7%
Health Department chest clinic 6%
71%
of TB cases were
rst reported by
a hospital
8 New York City Health Department Annual Tuberculosis Summary, 2023
Clinical Care and Treatment
The Health Department is a leading provider of TB care in NYC. TB services are available
at three Health Department chest clinics located in the Bronx, Brooklyn and Queens.
Physicians working at the chest clinics are specialists in internal, preventive and pulmonary
medicine, and infectious disease.
The Health Department provides TB diagnostic services, including testing for TB infection
(using blood-based QuantiFERON-TB Gold Plus [QFT-Plus] test and tuberculin skin test
[TST]); sputum induction; laboratory tests; medical evaluation and chest radiographs;
treatment for TB disease and LTBI; and DOT for patients of all ages. Most patients evaluated
and treated at Health Department chest clinics are referred by NYC health care providers,
other health departments or social service providers. Health Department staff also refer
patients to other medical professionals for further evaluation and treatment of non-TB
related conditions.
Obtaining medications with limited availability for the treatment of multidrug-resistant
(MDR) TB: Health Department staff can assist with obtaining certain medications that
are available under limited circumstances, including pretomanid, bedaquiline, clofazimine
and delamanid. Clofazimine and delamanid require the submission of a Single Patient
Investigational New Drug application to the Food and Drug Administration (FDA) and to the
Health Department’s Institutional Review Board for approval.
For more information about these drugs or for help obtaining them, call the TB Provider
Hotline at 844-713-0559.
HIV testing services: Health Department staff provide opt-out rapid HIV testing services
to every eligible patient at Health Department chest clinics and refer patients who have
HIV infection to health care providers who specialize in HIV care. The Health Department
offers rapid HIV testing to contacts in household settings. Anonymous HIV testing services
are available at all chest clinics independent of need for TB services.
Evaluation of refugees and immigrants applying for permanent status: People who are
applying for permanent U.S. immigration status and refugee status are screened for TB
as part of their overseas medical examination. If the pre-immigration examination nds a
clinical diagnosis of TB, a Class A designation is given and the applicant is not allowed to
travel until treatment is completed or the patient is no longer infectious.
> Core Activities
9 New York City Health Department Annual Tuberculosis Summary, 2023
The CDC noties local jurisdictions of any immigrants and refugees who have been deemed
at risk of having TB but have been cleared for travel to that U.S. jurisdiction. The local
jurisdiction then reaches out to the individual to schedule an initial evaluation for TB in
the U.S. (within 30 days, as recommended by the CDC), and the clinical team endeavors
to complete domestic evaluations within 120 days. The majority of these individuals come
to a Health Department chest clinic for evaluation after arriving in NYC.
TB Clinical Care and Treatment in 2023:
•
325 (48%) patients conrmed with TB disease in 2023 received care at a Health
Department chest clinic.
•
25 patients with an MDR TB strain received treatment, care and case
management through the Health Department, including 13 patients newly
diagnosed with an MDR TB strain in NYC and 3 patients initially conrmed with
TB outside NYC.
•
23 patients received bedaquiline; 1 patient received clofazimine.
•
1,646 immigrants and refugees arriving in NYC with a Class B designation were
notied to the Health Department; 1,611 (98%) were eligible for evaluation;
915 (57%) were evaluated as of January 30, 2024.
Medical Consultation
Health Department TB medical consultants are physicians with many years of experience
treating TB disease and LTBI. They provide expert consultation to community providers
and others regarding TB diagnosis; hospital discharge planning; TB treatment (including
treatment of MDR TB, management of adverse reactions to TB drugs and treatment
completion); contact investigation; infection control; and other TB-related public health
concerns.
Recommendations are based on these physicians’ professional experience and Health
Department policies, which are informed by guidelines from the CDC, American Thoracic
Society (ATS), Infectious Diseases Society of America (IDSA), National TB Coalition of
America (NTCA) and the World Health Organization (WHO). TB medical consultants also
conduct TB rounds and give medical talks throughout NYC.
To get expert medical consultation about TB and LTBI, call the TB Provider Hotline at
844-713-0559.
> Core Activities
10 New York City Health Department Annual Tuberculosis Summary, 2023
Case Management
The Health Department provides case management activities for NYC residents diagnosed
with or suspected of having TB disease and their contacts, regardless of where the patient
receives their TB care.
Case management includes patient interviews, TB education, chart reviews, contact
investigation, DOT and coordination with community providers to ensure optimal TB
treatment and care. Health Department staff conduct home assessments to identify
contacts and to determine whether patients with infectious TB can be discharged from
the hospital. Health Department staff also coordinate with colleagues in other jurisdictions
to ensure continuity of care for patients with conrmed TB disease and contacts who work
or live outside NYC. Case managers perform monthly monitoring for treatment adherence
and locate patients who have signicant lapses in medical appointments or medication
and help them return to medical supervision.
DOT: DOT is the standard of care for patients with suspected or conrmed TB disease in
NYC, regardless of where they receive TB care. During DOT, a health care worker observes
a patient ingesting their anti-TB medications. The Health Department provides face-to-face
DOT services at all chest clinics and at homes, worksites and other locations as requested
by the patient. The Health Department also provides video DOT (vDOT), which facilitates
continuity of DOT outside traditional business hours and when patients travel. DOT is also
available through NYC Health + Hospitals Elmhurst, Kings County and Bellevue facilities.
To learn more about the Health Department DOT program or to enroll a patient,
call 311.
Contact investigation: The Health Department conducts TB contact investigations in
households, congregate settings (for example, worksites and schools) and other site types.
During contact investigations, Health Department staff identify and evaluate individuals
who were exposed to patients with infectious TB, ensure appropriate treatment for contacts
diagnosed with TB disease or LTBI, determine whether transmission occurred and assess
whether testing of additional contacts or other intervention is needed. When TB exposures
occur in health care facilities, epidemiologists at the Health Department provide technical
guidance and assist with contact investigation at the site as needed.
> Core Activities
11 New York City Health Department Annual Tuberculosis Summary, 2023
Social service referrals: Health Department staff identify and address obstacles to care
and unmet social service needs among patients and their families whenever possible.
These include concerns about nances, housing, food security, employment, school, health
insurance eligibility, access to health care services, immigration status, language barriers,
drug and alcohol use, and mental health issues. Patients are referred to a social worker
who facilitates referrals to social service resources.
Regulatory action: The Health Department has authority under the NYC Health Code to
require TB evaluation, DOT or involuntary hospitalization for patients with infectious TB who
are not adherent to evaluation, isolation or treatment recommendations and for patients
who pose a public health risk.
TB Case Management in 2023:
•
2,644 patients received case management services, including 684 patients with
newly conrmed TB disease, 1,499 patients with suspected TB disease, 351
patients with TB diagnosed before 2023 and 110 patients with TB initially
conrmed outside NYC.
•
429 eligible patients with conrmed TB disease were enrolled in DOT through
the Health Department or another health care provider; 47 were enrolled
exclusively in face-to-face DOT and 382 received some or all observations
through vDOT.
•
1,911 contacts were identied for 451 patients who were potentially infectious;
1,031 (54%) were evaluated as of January 25, 2024, and 265 (26%) had a new
positive TB test result.
Drug Susceptibility Testing and Whole Genome Sequencing
The NYC Health Code mandates that a portion of the initial isolate from all patients
with culture-positive TB be sent for drug susceptibility testing (DST) and whole genome
sequencing (WGS), performed at local, state and national public health laboratories.
DST: DST identies drug resistance in TB strains and informs clinical management and
treatment for patients with TB disease and their contacts. The NYC Public Health Laboratory
(PHL) performs phenotypic DST testing for rst-line and select second-line TB drugs.
Molecular-based laboratory tests are also used routinely at PHL, hospitals, commercial
laboratories and other public health reference laboratories. These tests rapidly conrm
the presence of Mycobacterium tuberculosis (M. tuberculosis) complex and can provide
> Core Activities
12 New York City Health Department Annual Tuberculosis Summary, 2023
information about the presence of mutations in specic genes that are known to predict
drug resistance, enabling earlier treatment of MDR TB and decreasing the amount of time
the patient is infectious.
Universal WGS: In NYC, WGS enables identication of the M. tuberculosis complex and
species within it; detection of genetic mutations associated with drug resistance; and
analysis of single nucleotide polymorphisms to characterize and compare TB strains. The
Health Department collaborates with the NYSDOH Wadsworth Center, PHL and CDC to
conduct WGS for all patients with a positive culture for M. tuberculosis.
NYS currently reports 19 mutations associated with resistance to 10 TB drugs. WGS
also helps the Health Department identify false positive laboratory results, assess TB
transmission and detect outbreaks. Possible instances of contamination and potential
false positive results are promptly and systematically investigated to ensure patients are
not placed on anti-TB medications unnecessarily. Cases among patients with similar TB
strains are investigated to identify and interrupt TB transmission.
TB Drug Susceptibility Testing and Whole Genome Sequencing in 2023:
•
539 out of 563 culture-conrmed TB cases had phenotypic DST results
available (96%); among culture-conrmed cases, molecular DST results were
available for 558 (99%) cases.
•
524 (93%) culture-conrmed TB cases had WGS results available.
•
16 instances of potential false positive laboratory results were
investigated; 7 (44%) investigations conrmed a false positive result.
Outreach and Education
The Health Department engages diverse stakeholders to advance efforts to detect, treat
and prevent TB throughout NYC. Educational materials developed by the Health Department,
the CDC and others are used to supplement staff training, which is delivered by experts
from the Health Department and at the Global TB Institute (GTBI) at Rutgers.
Health care providers: The Health Department conducts outreach to and collaborates
with health care providers and public health professionals throughout NYC, particularly
those serving in high TB burden neighborhoods. Health Department experts discuss TB
epidemiology, screening, testing, diagnosis and treatment through medical talks, case
management conferences and webinars. Health Department staff also provide clinical
> Core Activities
13 New York City Health Department Annual Tuberculosis Summary, 2023
> LTBI Action Kit: In 2023, the Health Department launched an LTBI
Action Kit promoting evidence-based best practices for the diagnosis
and treatment of LTBI. In conjunction with this launch, Health
Department staff educated more than 370 community health care
providers in high TB burden and TRIE (Taskforce on Racial Inclusion
and Equity) neighborhoods.
The toolkit contains provider- and patient-oriented resources to help
support identication, testing and treatment of LTBI. To access the
kit, visit nyc.gov/health and search for LTBI Action Kit.
consultation for health care providers across NYC. The Health Department co-sponsors an
annual medical conference in honor of World TB Day for health care providers and other
colleagues. Quarterly trainings on tuberculin skin testing are offered to physicians and
nurses from various organizations. In addition, Health Department staff regularly meet
with colleagues locally, nationally and internationally on matters related to TB policy and
practice.
Community partners: Communities with a high burden of TB are engaged as partners in
efforts to increase TB knowledge and inform TB care-seeking behavior. In partnership with
elected ofcials, community-based groups and others, the Health Department delivers
culturally and linguistically appropriate educational messaging through community events
and print and electronic media. Community partners also support TB screening and testing
efforts at health fairs and other testing events.
The Health Department also co-chairs the Coalition for a TB-Free NYC. The Coalition meets
on a quarterly basis to promote collaboration with partners to develop and implement
strategies that will lead to the prevention and elimination of TB in NYC. These partners
include TB patients and survivors, health care providers, government and nongovernmental
organizations, advocacy groups, schools of public health, educational organizations, policy
groups and community engagement groups.
For more information about TB community events and conferences and to sign up for
our TB newsletter, TB Action News, email [email protected]c.gov.
> Core Activities
14 New York City Health Department Annual Tuberculosis Summary, 2023
Educational materials: The Health Department offers a selection of tailored TB education
materials and other resources for patients, the general public and health care providers.
To access these materials, policy updates and other information about TB and TB services
in NYC, visit nyc.gov/health and search for tuberculosis or call 311.
Outreach and Education in 2023:
•
The Health Department tested 1,340 people for TB infection during 24
community health events conducted in collaboration with community partners.
Individuals with positive test results and those with TB symptoms were connected
to care in Health Department chest clinics and community health care settings.
•
The Health Department tested 3,232 people for TB infection in 65 shelter
settings in partnership with City and state agencies, social service agencies and
clinical service providers. People with positive test results and those with TB
symptoms were connected to care in Health Department chest clinics, public
hospitals and community health care settings.
•
Health Department staff partnered with colleagues in top TB reporting
facilities to conduct Grand Rounds presentations across NYC.
•
The Health Department hosted 4 meetings of the TB Coalition and launched a
multidisciplinary workgroup to discuss and address emergent clinical and care
access challenges among populations with high TB risk.
•
The Health Department partnered with the Stop TB Partnership to host a United
Nations High-Level TB Meeting Watch Party for community stakeholders and
others, including TB survivors and advocates.
> Core Activities
> Ongoing TB detection, care and prevention among newly arrived New Yorkers:
Since Spring 2022, NYC has experienced a sustained inux of individuals arriving from
other parts of the world, including individuals migrating through the U.S. southern
border, individuals arriving in conjunction with humanitarian parole programs and
individuals arriving with an overseas TB classication. Throughout 2023, the Health
Department continued to partner with health care providers, City and NYS agencies, social
service providers and community-based organizations to enhance and expand access to
TB testing, evaluation, treatment and care for these groups and to coordinate referrals to
medical care and other resources.
15 New York City Health Department Annual Tuberculosis Summary, 2023
Funding and Administration
The Health Department receives City, state and federal funding for TB care and control.
These funds support all TB prevention and control activities, from hiring staff to operating
Health Department chest clinics. Staff ensure that funds are allocated, monitored and
utilized efciently.
Research
Health Department staff actively participate in research, including epidemiologic studies,
implementation science and clinical research. This includes collaboration with the CDC
TB Trials Consortium, which conducts national and international studies to support the
development of TB treatment regimens. Health Department staff also participate in
professional organizations and TB advisory groups.
Conferences: NYC TB data and staff expertise are shared at meetings locally, nationally
and internationally. In 2023, these included: the National TB Coalition of America
(NTCA) Annual Conference; TB Medical Consultants Meeting; NYC Annual World TB Day
Conference; Conference of The Union North America Region; Council of State and Territorial
Epidemiologists (CSTE) Conference; American Public Health Association Conference; CDC
TB Trials Consortium (TBTC) Meeting; Mailman School of Public Health NYC Epi Forum.
Advisory groups: TB program staff participated in the following groups in 2023: Advisory
Council for the Elimination of TB; CDC/IDSA/ATS National MDR TB Guidelines Writing
Committee; CDC TB Education and Training Network; CDC TB Program Evaluation Network;
CDC TB Outbreak Detection Workgroup; CDC TBTC; CSTE; Maven Users Group; NTCA Board
of Directors; NTCA LTBI Reporting Workgroup; NTCA National Society of TB Clinicians;
NTCA Society for Epidemiology in TB Control; NTCA Survey Committee; International Union
Against TB and Lung Disease TB Contact Studies Consortium
Program Evaluation
The Health Department uses local, state and national performance indicators to assess
program impact. These indicators inform planning and policy decisions and help identify
> Core Activities
Publications in peer-reviewed journals by Health Department TB program
staff, 2023: For a complete list of staff publications from 2023, please scan
the QR code to the left.
16 New York City Health Department Annual Tuberculosis Summary, 2023
Indicator 2022
2025
target
Treatment and case management for persons with active TB
Initiated TB treatment within 7 days of specimen collection
2
88% 96%
Sputum culture conversion within 60 days of treatment initiation
3
64% 83%
Completed treatment within 365 days of initiation
4
88% 95%
Contact investigation
Eligible cases with contacts elicited
5
89% 100%
Eligible contacts evaluated
6
70% 94%
Eligible contacts who initiated treatment for TB infection
7
88% 92%
Eligible contacts who completed treatment for TB infection
8
78% 93%
1. Denitions for performance measures and national indicators are established by the CDC; the 2025 targets were set in 2020. For
details, visit cdc.gov/tb/programs/evaluation/indicators. Performance measures are reported for 2022 instead of 2023 to allow
sufcient time for follow-up. 2. Of TB patients with positive acid-fast bacilli (AFB) sputum-smear results who were alive at diagnosis.
3. Of TB patients with positive sputum culture results who were alive at diagnosis and have initiated treatment. Excludes patients who
died within 60 days of initiating treatment. 4. Excludes patients who never started on anti-TB medications, those who died or moved
outside the U.S. within 365 days of treatment initiation, those with any rifampin resistance, those with meningeal TB and children
14 years of age or younger with disseminated TB. 5. Of AFB sputum smear-positive TB patients. 6. Of contacts to AFB sputum smear-
positive TB patients counted in the year of interest. 7. Of contacts to AFB sputum smear-positive TB patients with newly diagnosed TB
infection. 8. Of contacts to sputum AFB smear-positive TB patients with newly diagnosed TB infection who started treatment.
Table 1: Select TB performance measures, national targets
1
and NYC outcomes for the
year 2022
> Core Activities
programmatic issues and areas for improvement. Performance indicators and targets are
developed in coordination with Health Department partners and funders, including the
CDC, NYSDOH and the NYC Mayor’s Ofce.
Reports include the quarterly report to NYSDOH, the CDC’s Annual Performance Report, the
CDC’s Aggregate Reports for TB Program Evaluation and the CDC’s National Tuberculosis
Indicators Project.
Cohort review: One of the Health Department’s primary tools for evaluating its TB program
is the quarterly cohort review process. Staff review case management activities, treatment
status and data quality for all patients with conrmed TB disease and their contacts four
to six months after TB diagnosis. Successes and challenges related to patient care and
case management are used to inform programmatic changes and identify training needs.
17 New York City Health Department Annual Tuberculosis Summary, 2023
Profile of TB Cases
0.0
10.0
20.0
30.0
40.0
50.0
60.0
0
500
1000
1500
2000
2500
3000
3500
4000
4500
84 86 88 90 92 94 96 98 00 02 04 06 08 10 12 14 16 18 20 22
Year
Figure 2: TB cases and rates,
1
NYC, 1984-2023
Number of cases
Rate per 100,000
Number of cases
Rate
7.8 per 100,0000
684 cases
There were 684 conrmed cases of active TB disease
identied in NYC in 2023, a 28% increase from 2022.
The NYC TB incidence rate was 7.8 per 100,000, more
than two and a half times higher than the national TB rate.
1. Rates are based on decennial census data.
2013-2023
Overall increase: 18%
Single-year increase
2022-2023: 28%
1992-2013
Overall decrease: 83%
Average annual
decrease: 7%
1984-1992
Overall increase: 139%
Average annual
increase: 12%
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
0
100
200
300
400
500
600
700
14 15 16 17 18 19 20 21 22 23
Overview: TB in NYC in 2023
There were 684 conrmed cases of active TB disease identied in NYC in 2023, a 28%
increase from 2022. This is the highest number of TB cases conrmed in NYC since 2011;
the 2023 TB rate of 7.8 per 100,000 is the highest TB rate in NYC since 2013.
Increases in the number of TB cases between 2022 and 2023 were observed among
both U.S.-born people and people born outside the U.S., among people with a history of
homelessness within 12 months prior to TB diagnosis, among most age groups, including
children younger than 18, and among individuals in the U.S. for less than one year prior to
TB diagnosis. The number of people with a rifampin-resistant TB strain more than doubled
between 2022 and 2023.
Figure 3: TB cases and rates,
1
NYC, 2014-2023
Year
Number of cases
Rate per 100,000
Number of cases
Rate
1. Rates are based on decennial census data.
Figure 4: Percentage point change for select characteristics among patients with
TB disease in 2023 compared with 2022, NYC
582 575 556 608 553 559 444 529 534 684
7.8
7.1
7.0
6.8
7.4
6.8
6.8
5.0
6.0
6.1
> Profile of TB Cases
Woman
Man
-3
+3
> 5 years
1-5 years< 1 year
-17
+6+8
Time in the U.S.
1
Social and Clinical
Characteristics
Diabetes
Homeless
history
-8
+8
Gender
45-64
18-440-17
-7
+11+2
Age Group
65+
-6
1. At time of TB diagnosis among individuals born outside the U.S.
HIV infection
+2
20 New York City Health Department Annual Tuberculosis Summary, 2023
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
14 15 16 17 18 19 20 21 22 23
0
50
100
150
200
250
300
350
400
450
500
Female Male
Demographic Characteristics
> Prole of TB Cases
1. Rates are based on NYC Health Department population estimates, modied from U.S. Census Bureau interpolated intercensal
population estimates, 2000-2022. Updated January 2024.
Year
Rate per 100,000
13.4
9.6
7.9
1.5
Figure 7: TB cases by gender,
1
NYC, 2023
Number of cases
Woman Man
32% 68%
1. Persons for whom gender identity was listed only
as transgender are excluded from this gure. See the
Technical Notes (Page 36) for more information.
Figure 6: TB cases by age group in
years, NYC, 2023
217
466
45%
of TB cases in 2023
occurred among
people between
the ages of
18 and 44
Age 0-17
Age 18-44 Age 45-64 Age 65+
Age 0-17 4%
Age 18-44 45%
Age 45-64 24%
Age 65+ 27%
Figure 5: TB rates by age group in years,
1
NYC, 2014-2023
21 New York City Health Department Annual Tuberculosis Summary, 2023
0.0
1.0
2.0
3.0
4.0
14 15 16 17 18 19 20 21 22 23
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
0
100
200
300
400
500
600
700
14 15 16 17 18 19 20 21 22 23
> Profile of TB Cases
Figure 8: TB cases and rates
1
by birth in the U.S.,
2,3
NYC, 2014-2023
1. Rates are based on one-year American Community Survey data for the given year or the most recent available data. 2. U.S.-born
includes individuals born in the U.S. and U.S. territories. 3. Excludes cases with unknown country of birth.
Year
Number of cases
Rate per 100,000
Figure 9: TB rates
1
by race and ethnicity
2
among patients born in the U.S.,
3,4
NYC,
2014-2023
Year
Rate per 100,000
1. Rates are based on one-year American Community Survey Public Use Microdata Sample data for the given year or the most
recent available data. 2. Data shown do not include patients with multiple, other or unknown race and ethnicity. 3. U.S.-born
includes individuals born in the U.S. and U.S. territories. 4. Excludes cases with unknown country of birth.
Non-Hispanic Black
Non-Hispanic white
Asian
Hispanic
3.1
1.7
1.2
0.6
U.S.-born rate
U.S.-born cases
Non-U.S.-born rate
Non-U.S.-born cases
1.4
72
18.9
608
22 New York City Health Department Annual Tuberculosis Summary, 2023
NYC TB rate per
100,000: 36.5
Median age (years): 67
Median years in the
U.S.: 17
129 cases
China
Top Five Countries of Birth by NYC TB Burden and Incidence,
1-3
2023
Country Number of NYC TB cases
China
4
................................................ 129
U.S.
5
...................................................... 72
Ecuador ................................................51
Bangladesh ..........................................36
Mexico ..................................................31
Country NYC TB rate per 100,000
Bhutan ..................................................340.7
Guinea .................................................. 233.9
Senegal ................................................223.6
Venezuela ............................................. 157.7
United Republic of Tanzania .................. 98.6
Figure 10: Tuberculosis cases, rates
1
and select characteristics by patient country of birth,
2-5
NYC, 2023
Country of Birth
The ve most common countries of birth among patients with TB disease in 2023 accounted for
47% of all cases identied. Patient characteristics and TB risk factors differ by country of birth.
68
Number of countries of birth represented
among patients with TB disease in 2023
10
Median number of years in the U.S.
among non-U.S.-born TB patients
NYC TB rate per
100,000: 1.4
Median age
(years): 42
72 cases
United States
NYC TB rate per
100,000: 39.4
Median age (years): 32
Median years in the
U.S.: 2
51 cases
Ecuador
NYC TB rate per 100,000
1.4 to 10.0
40.1 to 340.7 Rate not available
20.1 to 40.0 No NYC TB cases
10.1 to 20.0 Birth country of at least one
NYC patient with MDR TB
6
1. Rates are based on one-year American Community Survey sample data. 2. Four cases in 2023 were among patients who had unknown
country of birth. 3. There were 10 countries for which rate could not be calculated due to insufcient population data. 4. China includes
individuals born in mainland China, Hong Kong, Taiwan and Macau. 5. U.S.-born includes individuals born in the U.S. and U.S. territories.
6. MDR TB is dened as resistance to at least isoniazid and rifampin.
NYC TB rate per
100,000: 18
Median age (years): 46
Median years in the
U.S.: 17
31 cases
Mexico
NYC TB rate per
100,000: 33.9
Median age (years): 56
Median years in the
U.S.: 8
36 cases
Bangladesh
23 New York City Health Department Annual Tuberculosis Summary, 2023
Figure 11: TB rates
1
by neighborhood,
2
NYC, 2023
TB in NYC Neighborhoods
Table 2: Proportion of TB cases and rates
1
by birth in the U.S.
2,3
and area-based
poverty level of patient residential neighborhood,
4
NYC, 2023
1. Rates are based on 2017-2021 American Community Survey data. 2. U.S.-born includes individuals born in the U.S. and
U.S. territories. 3. Four cases in 2023 had unknown country of birth and two had an unknown ZIP code. 4. Area-based poverty
level is based on 2017-2021 American Community Survey data on the proportion of ZIP code residents living below the federal
poverty level. Cases were assigned to a ZIP code based on their residence at time of TB diagnosis.
Area-based poverty
level
4
U.S.-born
rate
%
U.S.-born
Non-U.S.-
born rate
% non-
U.S.-born
Total
NYC rate
% of all
cases
Very high (30 to 100%) 2.2 21% 22.9 14% 9.3 15%
High (20 to < 30%) 1.8 25% 18.4 17% 8.0 18%
Medium (10 to < 20%) 1.0 31% 18.0 47% 8.0 45%
Low (< 10%) 1.1 23% 17.0 22% 6.8 22%
At or below provisional national rate (1.4 to 2.9)
Above citywide rate (7.9 to 23.5)
At or below citywide rate (3.0 to 7.8)
Rate per 100,000
TB rate per
100,000: 23.5
106 cases
West Queens
TB rate per
100,000: 16.1
19 cases
Sunset Park
TB rate per
100,000: 14.4
36 cases
Flushing-
Clearview
> Profile of TB Cases
25 New York City Health Department Annual Tuberculosis Summary, 2023
7.5
2.2
4.5
7.1
6.2
10.6
10.6
8.8
7.2
3.6
2.7
7.1
5.6
16.1
9.1
5.2
7.9
10.2
8.3
6.3
6.3
4.5
6.7
10.7
2.3
4.4
11.7
5.3
5.2
9.2
8.2
12.2
11.2
23.5
14.4
7.7
6.7
11.4
8.2
9.7
8.9
5.4
2.6
5.6
3.1
2.1
1.5
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 22.0 24.0
Bronx (103)
Kingsbridge-Riverdale (2)
Northeast Bronx (9)
Fordham-Bronx Park (18)
Pelham-Throgs Neck (18)
Crotona-Tremont (22)
Highbridge-Morrisania (22)
Hunts Point-Mott Haven (12)
Brooklyn (187)
Greenpoint (5)
Downtown-Brooklyn Heights-Park Slope (7)
Bedford Stuyvesant-Crown Heights (24)
East New York (11)
Sunset Park (19)
Borough Park (30)
East Flatbush-Flatbush (15)
Canarsie-Flatlands (16)
Bensonhurst-Bay Ridge (21)
Coney Island-Sheepshead Bay (24)
Williamsburg-Bushwick (14)
Manhattan (101)
Washington Heights-Inwood (12)
Central Harlem-Morningside Heights (12)
East Harlem (12)
Upper West Side (5)
Upper East Side (9)
Chelsea-Clinton (18)
Gramercy Park-Murray Hill (7)
Greenwich Village-SoHo (4)
Union Square-Lower East Side (17)
Lower Manhattan (5)
Queens (279)
Long Island City-Astoria (22)
West Queens (106)
Flushing-Clearview (36)
Bayside-Little Neck (7)
Ridgewood-Forest Hills (17)
Fresh Meadows (11)
Southwest Queens (23)
Jamaica (31)
Southeast Queens (19)
Rockaway (7)
Staten Island (13)
Port Richmond (4)
Stapleton-St. George (4)
Willowbrook (2)
South Beach-Tottenville (3)
Figure 12: TB cases and rates
1
by neighborhood,
2
NYC, 2023
3
Notes (Figures 11 and 12):
1. Rates are based on NYC Health Department
population estimates, modied from U.S. Census
Bureau interpolated intercensal population estimates,
2000-2022. Updated January 2024.
2. Dened by United Hospital Fund designation (42).
3. Parentheses indicate the number of TB cases
among people residing in each neighborhood at time
of TB diagnosis.
Healthy People 2025 goal (1.0 per 100,000)
2023 provisional national rate (2.9 per 100,000)
2023 citywide rate (7.8 per 100,000)
Rate per 100,000
> Profile of TB Cases
26
0
5
10
15
20
25
30
19 20 21 22 23
0
5
10
15
20
25
30
19 20 21 22 23
Clinical Characteristics
In 2023, 82% of TB cases involved a pulmonary site of disease, and 82% of people with TB
disease had a positive culture. Between 2022 and 2023, the overall proportion of patients
with diabetes decreased from 27% to 19%.
Figure 13: TB cases by
disease site, NYC, 2023
1. Categories are not mutually exclusive.
Table 3: Disease site among TB cases with
extrapulmonary disease,
1
NYC, 2023 (257)
Disease site # of cases Percentage
Any extrapulmonary site 257 -
Lymphatic 99 39%
Pleural 91 35%
Bone/joint 19 7%
Meningeal 15 6%
Genitourinary 12 5%
Peritoneal 5 2%
Laryngeal 3 1%
Other 60 23%
Pulmonary
disease only 62%
Both pulmonary and
extrapulmonary
disease 19%
Extrapulmonary
disease only 18%
Figure 14: Select comorbidities among patients with TB disease by birth in the U.S.,
1,2
NYC, 2019-2023
1. U.S.-born includes individuals born in the U.S. and U.S. territories. 2. Excludes cases with unknown country of birth.
3. There were 115 patients in 2023 with an unknown HIV status.
Year
Proportion of cases
HIV Infection
3
Overall proportion, 2023: 6%
Non-U.S.-born U.S.-born
Year
Diabetes
Overall proportion, 2023: 19%
Proportion of cases
> Profile of TB Cases
27 New York City Health Department Annual Tuberculosis Summary, 2023
0
2
4
6
8
10
12
14
0
10
20
30
40
50
60
70
14 15 16 17 18 19 20 21 22 23
Figure 17: Number and proportion of patients with TB who died
1
before or during
treatment, NYC, 2014-2023
Died prior to TB treatment completion Died prior to TB treatment initiation
Proportion of all NYC TB patients who died
Figure 15: Proportion of culture-conrmed TB cases among all cases, NYC, 2023
Culture positive 82%
Case conrmed without positive culture 18%
1. Treatment outcomes are reported for 2022 instead of 2023 to allow sufcient time for follow-up. 2. A death is dened as any
patient who died prior to or during TB treatment, regardless of the cause of death.
Figure 16: Treatment outcomes for TB cases counted in 2022,
1,2
NYC (534)
84%
of all patients
with TB disease in
2022 completed
treatment
Year
Number of patients
Proportion of all NYC patients
1. A death is dened as any patient who died prior to or during TB treatment, regardless of the cause of death.
Completed treatment 84%
Died 9%
Currently on treatment 2%
Lost to follow-up 2%
Moved outside U.S. 2%
Refused treatment 1%
Treatment discontinued < 1%
> Profile of TB Cases
28 New York City Health Department Annual Tuberculosis Summary, 2023
0
2
4
6
8
10
12
14
16
14 15 16 17 18 19 20 21 22 23
Table 4: Detection of resistance to select TB medications by test type,
1
NYC, 2023
INH RIF EMB PZA FLQ
2
INJ
3
Number of patients with a molecular test
4
530 578 523 522 530 523
> Number with mutation detected (%) 52 (10) 21 (4) 14 (3) 8 (2) 6 (1) 2 (< 1)
Number of patients with a phenotypic test 485 489 484 453 80 75
> Number with resistance detected (%) 55 (11) 16 (3) 12 (3) 34 (8) 8 (10) 2 (3)
Number of patients with any drug
susceptibility test conducted
548 587 546 540 530 523
> Number with resistance detected (%) 58 (11) 21 (4) 15 (3) 35 (7) 9 (2) 2 (< 1)
1. Categories are not mutually exclusive. 2. Fluoroquinolones include levooxacin, moxioxacin, ciprooxacin and ooxacin.
3. Injectables include kanamycin, capreomycin and amikacin. 4. Molecular tests include GeneXpert MTB/RIF, pyrosequencing,
Sanger sequencing and whole genome sequencing.
Abbreviations: INH - isoniazid; RIF - rifampin; EMB - ethambutol; PZA - pyrazinamide; FLQ - uoroquinolones; INJ - injectables
Figure 18: Multidrug resistance
1
among TB cases, NYC, 2014-2023
1. MDR TB is dened as resistance to at least isoniazid and rifampin. 2. XDR TB is dened as resistance to at least isoniazid and rifampin
plus a uoroquinolone and either a second-line injectable anti-TB medication, bedaquiline or linezolid.
Multidrug-resistant TB (MDR TB)
1
Extensively drug-resistant TB
(XDR TB)
2
Number of cases
Year
Drug Resistance
Molecular-based tests that rapidly detect mutations associated with drug resistance are
now being used routinely in hospitals, commercial laboratories and public health reference
laboratories in NYC. In 2023, 13 patients were newly diagnosed with MDR TB, dened as
a TB strain resistant to both isoniazid and rifampin, two of the most effective TB drugs. Of
these, one person was newly diagnosed with XDR TB.
10
5
15
11
13
12
7
9
8
> Profile of TB Cases
13
29 New York City Health Department Annual Tuberculosis Summary, 2023
Whole Genome Sequencing and NYC Clusters
The Health Department uses WGS to characterize TB strains and assess transmission.
Cases are reviewed, prioritized and assigned for epidemiologic investigation. A difference
of ve single nucleotide polymorphisms (SNPs) or less between isolates is considered
suggestive of possible recent transmission and prompts further investigation.
Figure 19: TB cases by WGS availability and high-quality SNP analysis results, NYC,
2023 (684)
≥ 6 SNPs from any other TB case
1
65%
Culture positive, WGS not available 6%
0-5 SNPs from at least one other TB case
1
12%
Culture negative 18%
1. May include cases veried outside NYC with WGS
results in the NYS Wadsworth laboratory database.
Characteristic n (percentage)
Male 56 (70%)
U.S.-born 19 (24%)
Non-U.S.-born 61 (76%)
> Most common countries of birth among patients born
outside the U.S.
China (26%), Ecuador (25%),
Mexico (7%), Peru (5%), Guatemala (5%)
> In the U.S. for > 5 years 32 (52%)
Median age (range) 34 (1-70)
Most common borough of residence at diagnosis
Queens (44%), Brooklyn (35%),
Bronx (10%)
Pulmonary site of disease 73 (91%)
Sputum smear positive 41 (51%)
History of homelessness
2
11 (14%)
Nearest neighbor counted by NYS 6 (8%)
Known contact to a TB case 8 (10%)
Table 5: Characteristics of patients whose isolate has less than or equal to ve SNP
differences from at least one other TB case,
1
NYC, 2023 (80)
1. May include cases conrmed outside NYC with WGS results in the NYS Wadsworth laboratory database. 2. In the 12 months
before TB diagnosis.
> Profile of TB Cases
30 New York City Health Department Annual Tuberculosis Summary, 2023
Figure 20: Contact investigations in health care settings
1
by site type, NYC, 2023 (147)
Contact Investigation in Congregate Settings
The Health Department investigates TB exposures in residential and nonresidential
congregate settings in NYC to identify and evaluate contacts, ensure appropriate treatment
for contacts with TB disease or LTBI, determine if transmission has occurred and assess
whether testing of additional contacts or other interventions may be warranted. The number
of investigations in congregate settings more than doubled from 2022 to 2023. In 2023,
63% of investigations in congregate settings occurred in shelter settings.
1. Excludes health care-associated investigations. 2. Proportion calculated among investigations where transmission could be
assessed. 3. Contacts eligible for testing are dened as contacts without a known history of TB disease or documented positive test
for TB infection who were alive after diagnosis of the infectious TB patient to whom they were exposed.
Table 6: Contact investigation outcomes in congregate settings
1
by number of exposed
contacts and site type, NYC, 2023 (76)
≥ 15 exposed
contacts
< 15 exposed
contacts
Total
n (%) n (%) n (%)
Non-shelter settings
Number of sites 6 22 28
Likely transmission
2
1 17 2 9 3 11
Total number of contacts identied 215 143 358
Contacts eligible for testing
3
211 98 140 98 351 98
Contacts tested 182 86 120 86 302 86
Contacts with a positive TB test result 11 6 18 15 29 10
Shelter settings
Number of sites 4 44 48
Likely transmission
2
1 25 19 43 20 42
Total number of contacts identied 74 201 275
Contacts eligible for testing
3
74 100 197 98 271 99
Contacts tested 38 51 121 61 159 59
Contacts with a positive TB test result 7 18 61 50 68 43
> Profile of TB Cases
Acute care facilities
1
77%
1. Includes hospitals and acute care clinics.
Home health care services 16% Dialysis centers 1% Long-term care facilities 5%
31 New York City Health Department Annual Tuberculosis Summary, 2023
Appendix
Characteristics
2022 2023
U.S.-born
1
Non-
U.S.-born
Total
2
U.S.-born
1
Non-
U.S.-born
Total
2
n % n % n % n % n % n %
Total 57 - 476 - 534 - 72 - 608 - 684 -
Age group
0-17 7 12 6 1 13 2 9 13 16 3 25 4
18-44 18 32 162 34 180 34 29 40 281 46 311 45
45-64 19 33 145 31 165 31 17 24 143 24 161 24
65+ 13 23 161 34 174 33 17 24 168 28 187 27
Gender
Woman 21 37 166 35 187 35 24 33 192 32 217 32
Man 36 63 307 65 344 65 48 67 415 68 466 68
Transgender 0 0 1 < 1 1 < 1 0 0 1 < 1 1 < 1
Race and ethnicity
Non-Hispanic white 9 16 12 3 21 4 11 15 26 4 38 6
Non-Hispanic Black 29 51 46 10 75 14 35 49 100 16 135 20
Hispanic 16 28 126 27 142 27 17 24 194 32 211 31
Asian 3 5 270 57 274 52 6 8 258 42 266 39
Multiple or other 0 0 18 4 18 3 2 3 28 5 31 5
Time in the U.S. (at time of reporting)
< 1 year n/a n/a 46 10 46 10 n/a n/a 108 18 108 18
1-5 years n/a n/a 89 19 89 19 n/a n/a 155 25 155 25
> 5 years n/a n/a 332 71 332 71 n/a n/a 331 54 331 54
Borough of residence 14 17 225 47 239 43 16 19 231 44 247 40
Manhattan 7 12 46 10 53 10 15 21 85 14 101 15
Bronx 15 26 71 15 86 16 8 11
95 16 103 15
Brooklyn 24 42 112 24 137 26 23 32 163 27 187 27
Queens 11 19 232 49 243 46 23 32 254 42 279 41
Staten Island 0 0 13 3 13 2 2 3 11 2 13 2
Neighborhood poverty
3
Low (< 10%) 7 12 116 24 123 23 16 22 133 22 150 22
Medium (10 to < 20%) 13 23 226 47 239 45 22 31 286 47 308 45
High (20 to < 30%) 17 30 78 16 96 18 18 25 104 17 125 18
Very high (30 to 100%) 20 35 56 12 76 14 15 21 84 14 99 14
Table 7: Select demographic, social and clinical characteristics among patients with
conrmed TB disease by birth in the U.S.,
1
NYC, 2022-2023
> Select Characteristics by Birth in the U.S., 2022 to 2023
33 New York City Health Department Annual Tuberculosis Summary, 2023
Characteristics
2022 2023
U.S.-born
1
Non-
U.S.-born
Total
2
U.S.-born
1
Non-
U.S.-born
Total
2
n % n % n % n % n % n %
Total 57 - 476 - 534 - 72 - 608 - 684 -
Homeless
4
7 12 21 4 28 5 5 7 84 14 89 13
Employed
4,5
13 26 175 37 188 36 21 33 186 31 207 31
Health care worker
4,5
0 0 6 3 6 3 2 10 9 5 11 5
Respiratory smear
positive ever
6
24 51 236 59 261 58 33 52 287 58 321 58
Sputum smear positive 23 96 215 91 239 92 31 94 270 94 302 94
Culture positive 48 87 410 86 459 86 59 82 500 83 563 83
Pulmonary only site of
disease
30 53 313 66 344 64 47 65 377 62 427
62
Extrapulmonary only site
of disease
9 16 73 15 82 15 9 13 116 19 126 18
Both pulmonary and
extrapulmonary disease
18 32 90 19 108 20 16 22 115 19 131 19
Cavities present on chest
X-ray ever
6
11 23 66 16 77 17 13 21 79 16 92 16
Rifampin resistance
7
0 0 10 2 10 2 3 4 17 3 21 3
Multidrug resistance
8
0 0 8 2 8 2 2 3 11 2 13 2
Extensive drug resistance
9
0 0 0 0 0 0 0 0 1 < 1 1 < 1
History of TB disease 3 5 35 7 38 7 1 1 34 6 35 5
HIV infection 6 11 18 4 24 4 6 8 32 5 38 6
Diabetes 14 25 128 27 143 27 9 13 123 20 133 19
1. U.S.-born includes individuals born in the U.S. and U.S. territories. 2. Totals may not equal the sum of U.S.-born and
non-U.S.-born due to missing country of birth data. 3. Area-based poverty level is based on 2017-2021 American Community Survey
data on the proportion of ZIP code residents living below the federal poverty level. Cases were assigned to a ZIP code based on their
residence at TB diagnosis. 4. In the 12 months before TB diagnosis. 5. Among patients 18 years of age and older. 6. Percentage is
among patients with a pulmonary site of disease. 7. Percentage is among patients with susceptibility testing performed for rifampin.
8. MDR TB is dened as resistance to at least isoniazid and rifampin. Percentage is among patients with susceptibility testing
performed for isoniazid and rifampin. 9. XDR TB is dened as resistance to at least isoniazid and rifampin plus a uoroquinolone and
either a second-line injectable anti-TB medication, bedaquiline or linezolid. Percentage is among patients with susceptibility testing
performed for isoniazid, rifampin, any uoroquinolone and any second-line injectable anti-TB medication.
Table 7 (continued): Select demographic, social and clinical characteristics among
patients with conrmed TB disease by birth in the U.S.,
1
NYC, 2022-2023
> Select Characteristics by Birth in the U.S., 2022 to 2023
34 New York City Health Department Annual Tuberculosis Summary, 2023
Year
Number of
TB cases
Rate per
100,000
Cases with
positive
culture
Cases with
positive sputum
smear
Multidrug-
resistant
cases
2
Deaths
attributable
to TB
3
Death rate
per 100,000
1900 11,997 349.0 9,630 280.2
1910 32,065 672.7 10,074 211.3
1920 14,035 249.7 7,915 140.8
1930 11,821 170.6 4,574 66.0
1940 9,005 120.8 3,680 49.4
1950 7,717 97.8 2,173 27.5
1960 4,699 60.4 824 10.6
1970 2,590 32.8 432 5.5
1980 1,514 21.4 143 2.0
1990 3,506 47.9 3,384 256 3.5
1991 3,653 49.9 3,462 1,826 385 245 3.3
1992 3,755 51.3 3,401 1,855 437 200 2.7
1993 3,151 43.0 2,784 1,529 289 166 2.3
1994 2,941 40.2 2,433 1,280 183 133 1.8
1995 2,408 32.9 1,996 1,001 114 94 1.3
1996 2,013 27. 5 1,693 873 84 67 0.9
1997 1,705 23.3 1,383 708 57 55 0.8
1998 1,528 20.9 1,232 611 38 52 0.7
1999 1,436 19.6 1,124 571 31 49 0.7
2000
1,311 16.4 1,043 516 24 44 0.5
2001 1,232 15.4 938 454 25 33 0.4
2002 1,071 13.4 819 436 29 30 0.4
2003 1,132 14.1 865 428 22 34 0.4
2004 1,036 12.9 793 395 19 31 0.4
2005 983 12.3 745 378 24 21 0.3
2006 947 11.8 705 354 24 18 0.2
2007 909 11.4 707 379 9 16 0.2
2008 886 11.1 685 339 11 18 0.2
2009 757 9.5 539 281 9 25 0.3
2010 705 8.6 511 265 11 26 0.3
2011 684 8.4 501 264 16 32 0.4
2012 652 8.0 495 271 18 15 0.2
2013 650 8.0 473 258 7 17 0.2
2014 582 7.1 454 243 10 31 0.3
2015 575 7. 0 444 240 5 20 0.2
2016 556 6.8 448 225 11 21
0.2
2017 608 7.4 504 261 15 15 0.1
2018 553 6.8 421 230 13 20 0.2
2019 559 6.8 461 254 12 24 0.2
2020 444 5.0 366 212 6 22 0.3
2021 529 6.0 441 239 9 Not available Not available
2022 534 6.1 459 241 8 Not available Not available
2023 684 7.8 563 304 13 Not available Not available
Table 8: TB cases and rates
1
by select characteristics, NYC, 1900-2023
> Historical TB Data, NYC
1. Rates are based on decennial census data. 2. MDR TB is dened as resistance to at least isoniazid and rifampin. 3. Data on TB
deaths are obtained from the Health Department Ofce of Vital Statistics. Deaths recorded in a given year may include cases
diagnosed in a previous year.
35
Technical Notes
• Data for 2023 are preliminary and reect the most complete information available as of January 16, 2024, unless
otherwise noted.
• Data prior to 2023 have been updated since the release of the 2022 report. Data for these years reect the nal
numbers and may differ from ofcial estimates presented in previous reports.
• TB became a reportable disease on January 19, 1897. From 1920 to 1940, only cases of pulmonary TB were
reportable. Beginning in 1978 the TB case denition was amended to consider people who had veried TB disease
12 or more months before their current diagnosis as incident cases of TB disease.
• Data on patient gender are presented as woman, man and transgender. In future reports, more expansive categories
of gender identity will be used to reect changes in data collection.
• In all tables presenting data by birth in the U.S., column sums may not equal applicable totals due to missing or
unknown data.
• In all tables where data are presented by geography, column sums may not equal applicable totals due to missing or
unknown data.
• The sum of proportions do not always equal 100% due to rounding.
• All rates presented in this report are calculated per 100,000 population. Reported rates for earlier years may differ from
previous reports due to corrected data and changes in the denominators used to calculate rates. The sources of
denominator data are indicated throughout the report.
• The Health Department calculates population estimates based on modied U.S. Census Bureau interpolated
intercensal estimates. Data are modied to account for population undercounts in northwest Queens and southern
Brooklyn because of erroneously deleted housing units and housing units mislabeled as vacant. Population
estimates are updated as new data become available. Therefore, rates may differ from previously reported rates.
• U.S.-born refers to patients born in the 50 states, Washington, D.C., or U.S. territories and outlying areas, including
American Samoa, Baker Island, Guam, Howland Island, Jarvis Island, Johnston Atoll, Kingman Reef, Midway Island,
Navassa Island, Northern Mariana Islands, Palmyra Atoll, Puerto Rico, U.S. Minor Outlying Islands, U.S. Pacic Islands,
U.S. Virgin Islands and Wake Island. All others with a known country of birth are considered non-U.S.-born.
• Area-based poverty is dened using patients’ ZIP code of residence at the time of TB diagnosis. Poverty level by ZIP code
is based on the most recent ve-year sample data from the American Community Survey, which measures the proportion
of residents living below the federal poverty level in that census tract. The federal poverty level is a measure of income
used by the U.S. government to determine eligibility for subsidies, programs and benets. The U.S. Department of Health
and Human Services updates the poverty guidelines each January. Patients with addresses outside NYC, addresses
unable to be geocoded to a ZIP code or addresses located in ZIP codes where poverty level could not be determined
were not assigned to a poverty level.
• The geographic distribution of cases is presented by the 42 United Hospital Fund neighborhoods. These neighborhoods
consist of adjoining ZIP codes that approximate NYC Community Planning Districts and contain an average of 200,000
individuals.
• Data presented on HIV status reect information as collected by the Health Department. Misclassication of HIV status
may occur if a patient refused to disclose known status or refused to be tested for HIV while under care for TB disease.
• Data on TB deaths are obtained from the Health Department Ofce of Vital Statistics. Deaths recorded in a given year
may include cases diagnosed in a previous year.
• Product names are provided for identication purposes only; their use does not imply endorsement by the Health
Department.
36 New York City Health Department Annual Tuberculosis Summary, 2023
13
The Health Department provides a
variety of TB services, including:
• Testing for TB infection using the
latest generation blood-based
QFT-Plus test and TST
• Sputum induction
• Chest radiographs
• Medical evaluation
• Treatment for TB disease and LTBI
• DOT services, including vDOT
Additional clinical services provided at
each chest clinic include:
• Outpatient medical and nursing care
• Phlebotomy services
• Social services referrals
• HIV education and testing regardless
of person’s need for TB care
• TB evaluation for newly arrived
immigrants and refugees referred
by the CDC
To make an appointment at an NYC Health
Department chest clinic or to refer a
patient, call the individual clinic or 311.
Eligible patients can be referred to one of three NYC Health Department chest clinics
for TB testing, radiography, sputum induction and treatment as needed. All chest clinic
services, including medication, are provided at no cost to the patient and regardless of
immigration or insurance status.
295 Flatbush Ave. Ext.
Fourth Floor
Brooklyn, NY 11201
718-249-1468
Fort Greene
34-33 Junction Blvd.
Second Floor
Jackson Heights, NY
11372
718-396-5134
Corona
NYC Health Department Chest Clinics
1309 Fulton Ave.
First Floor
Bronx, NY 10456
718-838-6876
Morrisania
37 New York City Health Department Annual Tuberculosis Summary, 2023
3.24