Provisional 2025 Tuberculosis Data, United States

10,260 TB cases were provisionally reported in 2025 (rate 3.0 per 100,000), down 1% in case count and 2% in rate from 2024. Non-U.S.–born persons accounted for 7,858 cases (77%) with a rate of 15.4/100,000; U.S.-born persons had 2,252 cases (22%) with a rate of 0.8/100,000. Twenty-six states plus DC reported declines year-over-year while a few states saw increases (e.g., California +2% cases, Texas +1%); notable large declines include Kansas (-46%) and Wyoming (-100%). Data are provisional, reported to the National Tuberculosis Surveillance System as of Feb 12, 2026.

Analysis

The public-health signal should be read less as a single-disease story and more as a demand-shift across three linked markets: diagnostics (screening kits and lab throughput), niche antimicrobials (especially for drug-resistant TB), and state/federal public-health procurement. Capacity constraints in reagent manufacturing and single-source IGRA tests create an asymmetric opportunity for incumbents with scale: a modest policy nudge (updated screening guidance or targeted funding) can translate into outsized order-book visibility within a 3–12 month window.

A second-order effect is the age-structure and care-setting concentration of cases. Older cohorts and institutional settings imply longer diagnostic cascades, more inpatient stays, and higher use of combination therapies — this favors vertically integrated players that supply both diagnostics and therapeutics, and creates short-term margin tailwinds for large national labs able to reprice episodic testing. Conversely, it increases downside for payors and providers exposed to outbreaks in long-term care if reimbursement or utilization management tightens.

Policy, not biology, is the main near-term catalyst. Congressional appropriations, CDC guideline shifts, or state-level screening mandates can move procurement cycles quickly; conversely, improvements in rapid point-of-care assays or a breakthrough vaccine would reprice the addressable market over 1–3 years. Tail risks that could reverse the thesis include a data revision/export ban on certain reagents, a sudden oversupply from low-cost competitors, or a localized MDR-TB cluster that forces emergency contracting favoring specialized drug makers rather than broad-based diagnostics winners.

Key Decisions for Investors

• Long QGEN (Qiagen) — 6–12 month horizon: buy QGEN equity or a 6–9 month call spread sized 2–4% of healthcare allocation. Rationale: dominant IGRA reagent/IP and short reagent lead times create upside if screening guidance or state contracts expand. Risk: single-product concentration and pricing pressure from public tenders; position should be hedged with a 20–30% trailing stop.
• Long DGX (Quest Diagnostics) — 3–12 month horizon: buy stock or 9-month calls (conservative size). Rationale: national lab footprint captures increased screening throughput and higher-margin reflex testing in institutional outbreaks. Reward: 15–40% upside if testing volumes rebase; risk: Medicare rate pressure and margin compression — cap position at 3% of portfolio.
• Long RHHBY or ABT (Roche / Abbott diagnostics exposure) — 6–18 months: buy Roche ADRs or Abbott equity selectively. Rationale: reagent manufacturing scale and diversified diagnostics franchises hedge single-test concentration, benefiting from reagent supply tightness. Risk/reward: defensive upside in supply-constrained scenario; downside if low-cost competitors undercut prices.
• Event/special-situation: small allocation to GSK (vaccine upside) or JNJ (specialized antimicrobial exposure) — 12–36 months: buy equity or LEAP calls (small size 1–2% portfolio). Rationale: any positive clinical readout or regulatory push for TB vaccines/drugs will rerate these names in a way not correlated with diagnostics. Risk: binary clinical/regulatory outcomes; position size should reflect binary payoff structure.