2022 ARPE Contact Investigations Report

Purpose

This Aggregate Reports for Tuberculosis Program Evaluation (ARPE) report summarizes national contact investigation efforts related to tuberculosis (TB) cases diagnosed in 2022, as reported to CDC through August 20, 2024, and summary data from 2018-2021 as reported to CDC through August 20, 2024.

A line drawing of a network connecting individuals

About the report

Follow-up examination and treatment of contacts to patients with tuberculosis (TB) is a national TB prevention and elimination strategic priority in the United States.

Each year, TB programs report results of their contact investigation activities to CDC by entering the data into the Aggregate Reports for Tuberculosis Program Evaluation (ARPE) form via the National Tuberculosis Indicators Project performance-monitoring tool.

ARPE data provide the only national-level data on contact investigations and are reported in three categories:

  1. Sputum smear-positive
  2. Sputum smear-negative/culture-positive
  3. Other

The data are also used by awardees as a tool to evaluate and coordinate TB prevention activities.

Data summary

In 2022, there were 3,406 acid-fast bacillus (AFB) smear-positive and 1,682 AFB smear-negative, culture-positive cases for investigation in the United States. The number of sputum acid-fast bacillus (AFB) smear-positive TB cases identified in 2022 (3,406) was higher than the annual number identified in 2021 (3,227), 2020 (2,879), and 2018 (3,398) but lower than the number reported in 2019 (3,481).

Elicitation of contacts

The number of contacts increased in 2022 (33,576) as compared to 2021 (28,736) but remained below the numbers reported during the 2018-2020 period (35,918-53,783). The percentage of cases with contacts elicited in 2022 was 89.9% (3,061/3,406 cases) compared with annual percentages achieved during 2018-2021 (range: 91.8% - 94.5%), with all years falling below the 2025 National Performance Target of 100%.

Evaluation of contacts

Among the 33,576 contacts elicited to smear-positive cases in 2022, 24,339 (72.5%) were evaluated.

Evaluation of contacts to smear-positive cases in 2022 remained below the 2025 National Performance Target of 94%, as were performance levels achieved annually from 2018-2021 (range: 75.7% -78.7%).

Diagnosis and treatment of latent TB infection

Of those who were evaluated, 4,716 (19.4%) were diagnosed with latent TB infection. Among those diagnosed with latent TB infection, 76.2% (3,592) initiated treatment, of whom 79.7% (2,862) completed treatment. Latent TB infection treatment initiation and completion performance remains below the 2025 National TB Performance Targets of 92% and 93%, respectively.

Additionally, among persons diagnosed with latent TB infection and determined to be contacts of smear-positive TB cases in 2022, contacts choosing to stop treatment accounted for 33.6% of those not completing treatment, while contacts lost to follow-up accounted for 39.4%.

Appendix A: Sputum smear-positive TB cases

Appendix A. Counts and Indices for Investigation of Sputum Acid-fast Bacillus (AFB) Smear-Positive TB Cases, 2018-2022A

Table 1: Counts of Sputum AFB Smear-Positive Cases and Contacts
Cases and Contacts 2018 2019 2020 2021 2022
Cases for investigation 3,398 3,481 2,879 3,227 3,406
Cases, no contacts 187 193 206 266 345
Number of contacts 53,783 51,419 35,918 28,736 33,576
Evaluated 42,302 38,942 27,806 21,951 24,339
TB disease 352 345 351 395 396
Latent TB infection 6,044 5,587 4,290 4,518 4,716
• Started treatment 4,583 4,271 3,332 3,356 3,592
• Completed treatment 3,623 3,423 2,660 2,739 2,862
• Treatment outcome unknown/missing 366 283 290 259 293

Table 2: Reasons Contacts Stopped Latent TB Infection Treatment, Sputum AFB Smear-Positive Cases
Reason 2018 2019 2020 2021 2022
Contacts stopping treatment (n) 594 565 382 358 437
Active TB developed 6 (1.0%) 4 (0.7%) 2 (0.5%) 2 (0.6%) 9 (2.1%)
Adverse effect of medicine 51 (8.6%) 47 (8.3%) 40 (10.5%) 41 (11.5%) 27 (6.2%)
Contact chose to stop 256 (43.1%) 185 (32.7%) 119 (31.1%) 116 (32.4%) 147 (33.6%)
Contact lost to follow-up 190 (32.0%) 249 (44.1%) 158 (41.4%) 157 (43.8%) 172 (39.4%)
Contact moved (follow-up unknown) 35 (5.9%) 38 (6.7%) 29 (7.6%) 22 (6.1%) 50 (11.4%)
Death 4 (0.7%) 8 (1.4%) 7 (1.8%) 8 (2.2%) 8 (1.8%)
Provider decision 52 (8.7%) 34 (6.1%) 27 (7.1%) 12 (3.4%) 24 (5.5%)

Table 3: Contact Investigation Evaluation Indices, Sputum AFB Smear-Positive Cases
Evaluation Indices (%) 2018 2019 2020 2021 2022
Contact elicitation (%) 94.5% 94.5% 92.8% 91.8% 89.9%
Contacts per case (N, Average) 15.8 14.8 12.5 8.9 9.9
Contact evaluation (%) 78.7% 75.7% 77.4% 76.4% 72.5%
TB disease (%) 0.8% 0.9% 1.3% 1.8% 1.6%
Latent TB infection (%) 14.3% 14.3% 15.4% 20.6% 19.4%
Latent TB infection treatment initiated (%) 75.8% 76.4% 77.7% 74.3% 76.2%
Latent TB infection treatment completed (%) 79.1% 80.1% 79.8% 81.6% 79.7%

Figure 1: Proportion of TB patients with contacts elicited

View Larger
A bar chart depicting the number of sputum AFB smear-positive U.S. TB cases with contacts elicited from 2018 to 2022.
The percentage of cases with contacts elicited in 2022 was 89.9% (3,061/3,406 cases) compared with annual percentages achieved during 2018-2021 (range: 91.8% - 94.5%), with all years falling below the 2025 National Performance Target of 100%.

National objective

Increase the proportion of TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited to 100.0% by 2025.

Sputum AFB smear-positive TB Cases with contacts elicited = Number of sputum AFB smear-positive TB cases for investigation - Number of sputum AFB smear-positive TB cases with no contacts.

Indicator

Percent of sputum AFB smear-positive TB cases with contacts elicited

Cohort

Sputum AFB smear-positive TB cases are counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.

Data sources

ARPEs (Contacts) fields, a1 (Sputum smear+ Cases for Investigation), b1 (Sputum smear + Cases with No Contacts)

Calculation

[(Number of sputum AFB smear-positive TB cases with contacts elicited) / Cohort] x 100.

Figure 2: Evaluation of contacts

View Larger
A bar chart depicting the number of U.S. contacts to sputum AFB smear-positive TB cases examined from 2018 to 2022.
Evaluation of contacts to smear-positive cases in 2022 remained below the 2025 National Performance Target of 94%, as were performance levels achieved annually from 2018-2021 (range: 75.7% -78.7%).

National objective

Increase the proportion of contacts to sputum AFB smear-positive TB cases who are examined for infection and disease to 94.0% by 2025.

Contacts are counted as evaluated if they have been tested and examined to the point where a final determination of diagnosis is either latent TB infection or TB disease.

Indicator

Percent of contacts to sputum AFB smear-positive TB cases examined for infection and disease

Cohort

Contacts to sputum AFB smear-positive TB cases counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.

Data sources

ARPEs (Contacts) fields, c1 (Number of Contacts to Sputum smear+ Cases), d1 (Contacts to Sputum smear + Cases Evaluated)

Calculation

[Number of contacts to sputum AFB smear-positive TB cases evaluated / Cohort] x 100.

Figure 3: Latent TB infection treatment initiation

View Larger
A bar chart depicting the number of U.S. contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who started treatment from 2018 to 2022.
Of those who were evaluated, 4,716 (19.4%) were diagnosed with latent TB infection. Among those, 76.2% (3,592) initiated treatment. Latent TB infection treatment initiation performance remains below the 2025 National TB Performance Target of 92%.

National objective

Increase the proportion of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who start treatment to 92.0% by 2025.

Indicator

Percent of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who started treatment. Contacts are counted as having started treatment after taking the first dose of a treatment course.

Cohort

Contacts to sputum AFB smear-positive TB cases who have newly diagnosed latent TB infection, counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.

Data Sources

ARPEs (Contacts) fields, f1 (Contacts to Sputum smear+ Cases with Latent TB Infection), g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment)

Calculation

[Number of contacts diagnosed with latent TB infection who started treatment/ Cohort] x 100.

Figure 4: Latent TB infection treatment completion

View Larger
Bar chart depicting treatment completion for U.S. contacts to sputum AFB smear-positive TB cases who have started treatment for latent TB infection from 2018 to 2022.
Among the 3,592 contacts who initiated treatment for latent TB infection, 79.7% (2,862) completed treatment. Latent TB infection treatment completion performance remains below the 2025 National TB Performance Target of 93%.

National objective

For contacts to sputum AFB smear-positive TB cases who have started treatment for latent TB infection, increase the proportion who complete treatment to 93.0% by 2025.

Indicator

Percent of contacts to sputum AFB smear-positive TB cases who complete treatment.

Cohort

Contacts to sputum AFB smear-positive TB cases with newly diagnosed latent TB infection and have started treatment are counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.

Data sources

ARPEs (Contacts) fields, g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment), h1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Completed Treatment)

Calculation

[Number of contacts diagnosed with latent TB infection who completed treatment / Cohort] x 100

Figure 5: Number of contacts to AFB-smear positive TB cases

View Larger
A bar chart depicting the number of U.S. contacts to sputum AFB smear-positive TB cases by examination and treatment disposition in 2022
U.S. contacts to sputum AFB smear-positive TB cases by number of contacts elicited, examined, diagnosed, and treated in 2022

Appendix B: Sputum smear-negative, culture positive TB cases

Appendix B. Counts and Indices for Investigation of Sputum AFB Smear-Negative, Culture-Positive TB Cases, 2018-2022B

Table 4: Counts of Sputum AFB Smear-Negative, Culture-Positive Cases and Contacts
Cases and Contacts 2018 2019 2020 2021 2022
Cases for investigation 1,903 1,784 1,343 1,434 1,682
Cases, no contacts 258 257 207 251 270
Number of contacts 13,589 12,679 8,829 8,128 9,830
Evaluated 10,713 9,908 6,927 6,267 6,944
TB disease 72 63 64 78 82
Latent TB infection 1,428 1,147 901 866 1,004
• Started treatment 958 747 567 524 620
• Completed treatment 744 606 413 427 477
• Treatment outcome unknown/missing 40 33 91 39 66

Table 5: Reasons Contacts Stopped Latent TB Infection Treatment Sputum AFB Smear-Negative, Culture-Positive Cases
Reason 2018 2019 2020 2021 2022
Contacts stopping treatment (n) 174 108 63 58 77
Active TB developed 4 (2.3%) 2(1.8%) 0 (0%) 0 (0%) 0 (0%)
Adverse effect of medicine 21 (12.1%) 12 (11.1%) 12 (19.0%) 5 (8.6%) 1 (1.3%)
Contact chose to stop 71 (40.8%) 38 (35.2%) 25 (39.7%) 21 (36.2%) 29 (37.7%)
Contact lost to follow-up 54 (31.0%) 42 (38.5%) 20 (31.7%) 25 (43.1%) 37 (48.0%)
Contact moved (follow-up unknown) 10 (5.7%) 6 (5.6%) 2 (3.2%) 3 (5.2%) 5 (6.5%)
Death 2 (1.1%) 4 (3.7%) 2 (3.2%) 3 (5.2%) 0 (0%)
Provider decision 12 (7.0%) 4 (3.7%) 2 (3.2%) 1 (1.7%) 5 (6.5%)

Table 6: Contact Investigation Evaluation Indices Sputum AFB Smear-Negative, Culture-Positive Cases
Evaluation Indices (%) 2018 2019 2020 2021 2022
Contact elicitation (%) 86.4% 85.6% 84.6% 82.5% 83.9%
Contacts per case (N, Average) 7.1 7.1 6.6 5.7 5.8
Contact evaluation (%) 78.8% 78.1% 78.5% 77.1% 70.6%
TB disease (%) 0.7% 0.6% 0.9% 1.2% 1.2%
Latent TB infection (%) 13.3% 11.6% 13.0% 13.8% 14.5%
Latent TB infection treatment initiated (%) 67.1% 65.1% 62.9% 60.5% 61.8%
Latent TB infection treatment completed (%) 77.7% 81.1% 72.8% 81.5% 76.9%

Appendix C: Other*

Appendix C. Counts and Indices for Investigation of Other* Cases, 2018-2022C

* Other: Contact investigations not captured in investigating sputum acid-fast bacillus (AFB) smear-positive or sputum AFB smear-negative, culture-positive. For example: Associate-contact or source-case investigations done because of a child with TB disease.

Table 7: Counts of Contacts, Other Cases
Contacts 2018 2019 2020 2021 2022
Number of contacts 10,667 8,309 5,627 8,014 9,493
Evaluated 8,837 6,207 4,292 6,029 7,510
TB disease 69 66 65 80 91
Latent TB infection 820 796 514 742 811
•  Started treatment 577 551 343 423 563
•  Completed treatment 493 457 282 338 452
•  Treatment outcome unknown/missing 18 24 12 30 31

Table 8: Reasons Contacts Stopped Treatment for Latent TB Infection, Other Cases
Reason 2018 2019 2020 2021 2022
Contacts stopping treatment (n) 66 70 49 55 80
Active TB developed 1 (1.5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Adverse effect of medicine 9 (13.6%) 14 (20.0%) 6 (12.2%) 4 (7.3%) 2 (2.5%)
Contact chose to stop 18 (27.3%) 27 (38.6%) 18 (36.7%) 25 (45.4%) 42 (52.5%)
Contact lost to follow-up 26 (39.4%) 21 (30.0%) 19 (38.8%) 22 (40.0%) 28 (35.0%)
Contact moved (follow-up unknown) 5 (7.6%) 5 (7.1%) 4 (8.2%) 3 (5.5%) 5 (6.25%)
Death 1 (1.5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Provider decision 6 (9.1%) 3 (4.3%) 2 (4.1%) 1 (1.8%) 3 (3.75%)

Table 9: Contact Investigation Evaluation Indices, Other Cases
Evaluation Indices (%) 2018 2019 2020 2021 2022
Contact evaluation (%) 82.8% 74.7% 76.3% 75.2% 79.1%
TB disease (%) 0.8% 1.1% 1.5% 1.3% 1.2%
Latent TB infection (%) 9.3% 12.8% 11.9% 12.3% 10.8%
Latent TB infection treatment initiated (%) 70.4% 69.2% 66.7% 57.0% 69.4%
Latent TB infection treatment completed (%) 85.4% 82.9% 82.2% 79.9% 80.3%

Resources

Aggregate Reports for Tuberculosis Program Evaluation (ARPE)
ARPE provides national summaries of TB prevention activities carried out by TB programs in the U.S.
ARPE Follow-Up and Treatment of Contacts of TB Patients Form
This form helps TB programs evaluate testing and treatment of contacts to TB patients.
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Content Source:
Division of Tuberculosis Elimination; National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention; Centers for Disease Control and Prevention
  1. Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico, and eight large city jurisdictions (Los Angeles, CA; San Francisco, CA; San Diego, CA; Chicago, IL; Baltimore, MD; New York City, NY; Philadelphia, PA; Houston, TX). Missouri, Kansas, Nebraska, and the Virgin Islands did not report in 2018. Virgin Islands and Vermont did not report in 2019. Vermont did not report in 2020. Data shown in tables and figures are up to date as of August 20, 2024.
  2. Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico, and eight large city jurisdictions (Los Angeles, CA; San Francisco, CA; San Diego, CA; Chicago, IL; Baltimore, MD; New York City, NY; Philadelphia, PA; Houston, TX). Missouri, Kansas, Nebraska, and the Virgin Islands did not report in 2018. Virgin Islands and Vermont did not report in 2019. Vermont did not report in 2020. Data shown in tables and figures are up to date as of August 20, 2024
  3. Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico, and eight large city jurisdictions (Los Angeles, CA; San Francisco, CA; San Diego, CA; Chicago, IL; Baltimore, MD; New York City, NY; Philadelphia, PA; Houston, TX). Colorado, Idaho, Indiana, Kansas, Maine, Massachusetts, Nebraska, New Hampshire, and the Virgin Islands did not report 2018-2022 data. DC and New Mexico did not report 2018-2020 data. Alaska did not report 2018-2021 data. Montana did not report 2019-2022 data. Missouri did not report 2018 data. Mississippi did not report 2020 data. Data shown in tables and figures are up to date as of August 20, 2024.