US tuberculosis cases nearing pre-pandemic levels, CDC data shows

By Jacqueline Howard, CNN

Tuberculosis cases reported in the United States appear to be returning to levels seen before the Covid-19 pandemic, according to a new report from the US Centers for Disease Control and Prevention.

The US incidence of tuberculosis, or TB, increased slightly last year after a substantial 20.2% decline in 2020 and a 9.8% increase in 2021, according to the data published in the CDC’s Morbidity and Mortality Weekly Report on Thursday, just a day ahead of World Tuberculosis Day.

“TB incidence increased during 2022, compared with that during 2020 and 2021,” CDC researchers wrote in the report. Now, the incidence “appears to be returning to prepandemic levels among U.S.-born and non-U.S.-born populations.”

Before the pandemic, the incidence of reported tuberculosis decreased gradually in the United States from 1993 through 2019, falling to 2.7 cases per 100,000 people in 2019 and then to 2.2 in 2020, CDC data showed.

The researchers noted that during the pandemic, many tuberculosis diagnoses may have been missed, misdiagnosed or delayed.

In 2021, tuberculosis incidence rebounded to 2.4 cases per 100,000 and increased even more to 2.5 in 2022, according to the CDC. Last year, 8,300 cases were reported in the United States, compared with 7,874 cases in 2021.

American Indian, Alaska Native, and Native Hawaiian or other Pacific Islander communities appear to be the most affected, according to the CDC, with incidence rates 10 times higher than among White people. A rise in cases has also been seen among young children and people who have newly arrived from outside the country.

Compared with 2021, the largest increase in tuberculosis incidence last year was among children 4 and younger and people 15 to 24. Adults 65 and older were the only age group that had a decrease, the data showed.

Higher proportions of TB cases also are among people experiencing homelessness or living in correctional or long-term care facilities, according to the CDC.

Washington state recently had its largest tuberculosis outbreak in 20 years.

Another report published Thursday in the MMWR described how a total of 25 tuberculosis cases were identified among people incarcerated at two Washington prisons in 2021 and 2022.

“An additional 244 resident-contacts and staff-member-contacts without known TB histories in five facilities received a diagnosis of latent TB infection,” the researchers wrote, meaning they were infected but had no symptoms.

Between 2014 and 2020, no tuberculosis cases had been reported within the Washington prison system.

Tuberculosis is a bacterial infection, usually in the lungs, that can cause coughing, chest pain and fever — characterized by coughing up blood or mucus.

Tuberculosis disease is curable, often treated with a standardized course of drugs that usually includes antibacterial medicines. It can also be prevented with protocols such as screening, vaccination and making sure people who are infected finish their course of treatment.

Each year, about 10 million people fall ill with the disease, even though it is preventable and curable, and about 1.5 million people die, making it “the world’s top infectious killer,” according to the World Health Organization. TB is one of the leading causes of death for people with HIV worldwide.

There has also been a global rise in tuberculosis.

“The Covid-19 pandemic and conflicts in many countries have severely disrupted services to prevent, detect and treat TB. As a result, WHO last year reported an increase in TB deaths for the first time in more than a decade,” WHO Director-General Tedros Adhanom Ghebreysus said Thursday.

Tedros added that world leaders are scheduled to meet in New York in September to discuss the state of tuberculosis and efforts to end the global TB epidemic by 2030.

“We believe that meeting should be a turning point in the fight against TB, if leaders make real and lasting commitments to invest in the response to TB,” he said. “Ending TB by 2030 is an extremely ambitious target.”

On Thursday, WHO released a “flagship initiative” document outlining the effort to fast-track progress toward ending tuberculosis between 2023 and 2027. The initiative includes a call to action for nations and providers to accelerate the rollout of new WHO-recommended oral treatment regimens for drug-resistant tuberculosis, which the agency calls “a pressing public health concern.”

“2023 is our chance to push forward the agenda towards ending TB,” Dr. Tereza Kasaeva, director of WHO’s Global Tuberculosis Programme, said in a news release Thursday.

“WHO is pressing for firm political commitment at the highest level, strong multisectoral collaboration including beyond health, and an effective accountability system. We need everyone — individuals, communities, societies, donors and governments — to do their part to end TB,” she said. “Together, yes, we can end TB.”

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