NEW YORK (AP) — The number of U.S. tuberculosis cases in 2023 were the highest in a decade, according to a new government report.

Forty states reported an increase in TB, and rates were up among all age groups, the Centers for Disease Control and Prevention said Thursday. More than 9,600 cases were reported, a 16% increase from 2022 and the highest since 2013.

Cases declined sharply at the beginning of the COVID-19 pandemic, but have been rising since.

Most U.S. TB cases are diagnosed in people born in other countries. Experts say the 2023 number is in part a combination of a surge in TB cases internationally — the World Health Organization said TB was behind only COVID-19 in infectious fatal diseases worldwide in 2022. And there are also increases in migration and post-pandemic international travel.

But other factors are also at play, including other illnesses that weaken the immune system and allow latent TB infections to emerge.