Impact of the COVID-19 pandemic on tuberculosis epidemiology in California, Florida, New York, and Texas.

RATIONALE: The United States experienced a considerable decline in tuberculosis (TB) incidence in 2020 following the COVID-19 pandemic.

OBJECTIVES: While TB rates have since returned to near prepandemic levels, analyzing the pandemic's impact offers insight into TB epidemiology in the United States.

METHODS: Focusing on California, Florida, New York, and Texas-the 4 states with the highest TB incidence-we explored 3 potential mechanisms of pandemic-related disruption on TB epidemiology: (1) reduced immigration, (2) reduced Mtb transmission (through social distancing and other behavior changes), and (3) delays in care-seeking. We used data on the volume of nonimmigrant arrivals and new permanent residents, Google mobility and US transit data, and data on the volume of emergency department visits and cancer screenings to inform the magnitude of these effects at the state level, adapting previously developed state-specific transmission models. We then estimated the impact of each mechanism and projected future TB incidence through 2032.

MEASUREMENTS AND MAIN RESULTS: Disruptions to migration and care-seeking across all 4 states were considerable but short-lasting, with 70% to 90% reductions in the first 4 months of the pandemic that returned to prepandemic levels by 2021. In contrast, transmission disruptions were moderate but more prolonged, with mobility still 10% to 20% lower than prepandemic in 2022. No statistical evidence was identified to favor models emphasizing immigration and transmission vs access to care.

CONCLUSIONS: Revised projections for pandemic-related disruptions did not substantially differ from prepandemic projections beyond 2024. Future declines in TB incidence in the 4 states are likely to be small without additional interventions.