As for the United States, a 1958 study indicated high exposure to NTM in the southeastern and Gulf Coast regions. Specifically, Edwards et al16 reported that 33% of 275,558 Navy recruits examined from these regions showed the highest positive skin tests to purified protein derivative-B, a mixture of antigens from the Battey bacillus now known as Mycobacterium intracellulare. More recently, Winthrop et al17 reported disease prevalence in Oregon between 2005 and 2006 to be 8.6 cases per 100,000. Other analyses conducted in Oregon showed the annualized period prevalence rate of NTM pulmonary disease to be 5.6 cases per 100,000 and 15.5 cases per 100,000 in people aged > 50 years.18 Adjemian et al19 reported that between 1997 and 2007, the annual prevalence of NTM lung disease significantly increased from 20 to 47 cases per 100,000 in individuals aged > 65 years. Among the states surveyed, Hawaii showed the highest prevalence at 396 cases per 100,000 followed by states in or near the southeast section of the country (eg, Florida, Louisiana, Oklahoma).19,20 Other states with high rates of NTM infections include California, New York, Wisconsin, Pennsylvania, and Texas.21 The increased prevalence appears to be more than just increased detection because a study of skin test positivity to purified protein derivative-B in two National Health and Nutrition Examination Survey cohorts showed that sensitization to M intracellulare significantly increased from 11.2% from 1971 to 1972 (approximately 1,500 subjects) to 16.6% from 1999 to 2000 (approximately 7,400 subjects).22 Given that natural disasters can disrupt ecosystems and cause widespread water-soil aerosolization, it is plausible that large-scale natural disasters contribute to the rise in NTM infections.