A Five-Year Review of Tuberculosis Trends, Determinants, and Policy Responses in California (2020–2025)

Tuberculosis (TB) remains a significant public health challenge for California, being the state with the highest TB case count in America. The following narrative literature review analyses TB trends in California between 2020 and 2025. It reviews peer-reviewed articles, surveillance reports and epidemiological databases to summarize current evidence for the structural determinant factors of TB disease burden in the state and policy response to TB. Deep racial and ethnicity disparities, foreign-born populations as the primary case reservoir and social determinants such as homelessness, incarceration, diabetes and Human Immunodeficiency Virus (HIV) co-infection characterized the distribution of TB in California. The COVID-19 pandemic disrupted TB surveillance and resulted in a historic 19% single-year decline, followed by consecutive increases in reported cases, with preliminary 2025 surveillance data suggesting a continued rise. An excess of approximately 200 TB cases between 2020-2023 caused by diagnostic delays, surveillance disruptions and post-pandemic rebound indicates a rebound-diagnosis phenomenon following pandemic delays. Preliminary evidence suggests that excess cases were concentrated among working-aged Hispanic adults, those foreign-born or patients with comorbid diabetes and HIV. TB control measures concentrated on expansion of screening and treatment therapy of latent tuberculosis infection (LTBI) in primary care settings, commitment to the California TB elimination Plan and implementing culturally tailored outreach schemes. Addressing gaps that remained by previous policies have centered around LTBI cascade engagement, reimbursement structure, provider education and resilience to external factors. To reverse setbacks and accelerate progress for TB control in California during the pandemic era, this review identified prioritized research areas for strengthened TB control.