"Because 2006 data revealed that more than half of TB cases occurred among foreign-born persons, CDC has committed to collaborating with national and international public health organizations to achieve the following goals:
• Improve overseas screening of immigrants and refugees by systematically monitoring and evaluating the screening process.
• Strengthen the current notification system that alerts public health departments about the arrival of immigrants or refugees who have suspected TB to enhance the evaluation and treatment of these persons.
• Improve the coordination of TB control activities between the United States and Mexico to ensure completion of treatment among TB patients who cross the border.
• Test recent arrivals from high-incidence countries for latent TB infection and monitor treatment completion.
• Survey foreign-born TB patients in the United States to determine opportunities for the improvement of prevention and control interventions.
Presumably the TB "hotspots" correlate with areas with high proportion of foreign born;
Despite an overall reduction in TB cases the situation remains of concern;
"According to the National Health and Nutrition Examination Survey (NHANES), a group of health surveys conducted each year involving populations across the country, more than 11 million persons in the United States have latent TB. An estimated 5%–10% of persons with latent TB will eventually have active disease. If left untreated, TB disease causes death in approximately half of the persons who have active TB. In addition, HIV-infected persons who also have TB disease are more likely to die, even with treatment."
