Why are TB Cases on the Rise?
After almost 30 years of decline, tuberculosis rates have been increasing, with an increase of 16% just in 2023. Once referred to as consumption — a deadly disease that afflicted Charles Dickens characters — national TB cases are now at their highest since 2012, according to the Centers for Disease Control and Prevention.
Tuberculosis, a disease caused by bacteria spread through the air, is classified in two ways: latent or inactive.
Not everyone with TB germs becomes sick; the infection can live in a person’s body for years without any telltale signs. In fact, patients with inactive TB don’t spread germs to others, nor do they show signs of having the disease.
TB symptoms typically include:
- a persistent cough
- blood in cough sputum
- pain in the chest
- fever for more than two weeks
- unexplained weight loss and night sweats
In a recent Morbidity and Mortality report, the CDC put the number of 2023 cases at 9,616, a spike of 1,295 from 2022. What’s more, 40 states, including Florida, reported a jump in TB cases. Florida accounted for 6% of the U.S. cases, behind California, Texas and New York. Case counts increased across the board — in other words, among both U.S.-born and foreign-born. They also increased in all age groups.
These statistics suggest a need for better outreach and more timely diagnosis.
Catherine V. Boulanger, M.D., an infectious disease specialist with the University of Miami Health System, puts the numbers in perspective: The U.S. has a lower rate than most other countries.
What’s more, “even with the higher numbers, we are well below where we were in the 1990s,” she says. “Back then, it [tuberculosis] was big, primarily because of HIV, and we simply didn’t have the infrastructure [for diagnosis and treatment] in place.”
The current figures are likely affected by the COVID-19 pandemic. The restraints on the public health system caused by the epidemic may have resulted in delays in diagnosis and treatment. In 2020, TB cases dropped, likely because people weren’t going to doctors. However, case counts have been rising ever since. In 2020, Florida reported 412 TB cases, compared to 591 in 2018. By 2021, TB cases numbered 500, followed by a reported 535 the following year.
Miami-Dade continues to be the Florida county with the highest number of cases, making up 21% of the state total. The only other county that comes close is Broward, with almost 10% of total cases. Dr. Boulanger isn’t surprised. Miami has a large foreign-born population.
According to the CDC report, 76% of TB cases last year were among non-U.S. born people, an increase of 18% for this demographic. In Florida, according to the state’s Department of Health, cases are from people born in Haiti (21%) Central America (20%), South America (14%) and Cuba (7%). The CDC noted that during this time the number of TB cases among non-US born persons within one year of arrival in U.S. doubled.
Nationally, the CDC reports that about 85% of U.S. cases are not due to recent transmission.
Rather, they’re a result of latent TB being reactivated. It is estimated that as many as 13 million Americans have latent TB. Most concerning has been the increase in cases among U.S.-born persons aged 5–14 years and non-U.S.–born persons aged 0–4 years, which is due to recent transmission instead of reactivation.
A chest x-ray will appear normal in latent TB patients, but a TB blood test or TB skin test will pick up the condition. As with an active TB infection, the individual needs treatment to prevent the disease from developing into full-blown TB
Those with active TB feel sick and do show symptoms. They are contagious. People with weakened immune systems or HIV/AIDS are at a higher risk of catching it. Left untreated, complications from TB can lead to pleurisy, lung damage, cardiac problems and even death.
There’s good news, however. “We have medicines for TB that cure the disease,” Dr. Boulanger says. “The disease is highly treatable. The key is to take and finish all of your medicine.”
There are about a dozen antibiotics that can cure the infection, but depending on the treatment, it can take 4, 6, or 9 months.
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post.
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Tags: Dr. Catherine Boulanger, mycobacterium tuberculosis, tb treatment
