TB Rates Are Rising Again
There is well-known pattern to tuberculosis (TB) outbreaks: rising, bottoming out with interventions, creeping up again once it is a low public health priority. This pattern is so well known that an there is an epidemiologic adage to describe it: “The U-shaped curve of concern.”1
It is slowly happening again, but in 2019 the CDC dropped the longstanding recommendation to test healthcare workers annually for latent TB.2 At that time, the United States TB rate was 2.7 cases per 100,000 people. In 2020, the rate dropped to 2.2, possibly because COVID-19 demanded public health resources that might have been used to detect it, and travel and immigration declined.
After a small rebound in 2021, TB levels climbed to 2.5 cases per 1,000 people in 2022. There were more than 8,000 cases, and the CDC said TB was returning to pre-pandemic levels.
“Among non-U.S.-born persons with TB, the proportion who had recently arrived in the United States increased,” the CDC reported. “Higher TB incidence among American Indian or Alaska Native and Native Hawaiian or other Pacific Islander persons compared with other race and ethnicity groups represents an ongoing health disparity. TB diagnosis and treatment to interrupt transmission and prevention of TB through treatment of latent TB infection are critical to U.S. TB elimination efforts.”3
In a cautionary tale, two prison TB outbreaks in Washington state occurred after the facility dropped routine testing during COVID-19. “During 2021-2022, a total of 25 TB cases were reported among persons incarcerated in two Washington state prisons,” researchers reported. “An additional 244 resident-contacts and staff-member-contacts without known TB histories in five facilities received a diagnosis of latent TB infection.”4
If TB’s comeback continues, the conversation about testing workers annually for latent infection may be reopened. In any case, hospitals are free to do so under their own policies.
- Reichman LB. The U-shaped curve of concern. Am Rev Respir Dis 1991;144:741-742.
- Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis screening, testing, and treatment of U.S. health care personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep 2019;68: 439-443.
- Schildknecht KR, Pratt RH, Feng PI, et al. Tuberculosis — United States, 2022. MMWR Morb Mortal Wkly Rep 2023;72:297-303.
- Stalter RM, Pecha M, Dov L, et al. Tuberculosis outbreak in a state prison system — Washington, 2021-2022. MMWR Morb Mortal Wkly Rep 2023;72:309-312.
In 2020, the TB rate dropped to 2.2, possibly because COVID-19 demanded public health resources that might have been used to detect it, and travel and immigration declined. After a small rebound in 2021, TB levels climbed to 2.5 cases per 1,000 people in 2022. There were more than 8,000 cases, and the CDC said TB was returning to pre-pandemic levels.
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