Tuberculosis makes a comeback in the US with children most at risk, CDC warns

Tuberculosis rates are increasing in the US, according to official data.

The Centers for Disease Control and Prevention (CDC) warned that 2.5 over every 100,000 Americans contracted the bacterial infection in 2022. This is up from 2.4 per 100,000 in 2021, but still below the pre-pandemic rate of 2.7.

Experts warned that case declines during the pandemic were not because of fewer infections but because of illness going unrecorded during a time many avoided testing. 

Now that those anti-Covid mitigation measures have largely been consigned to history, rates of severe bacterial infection are on the rise, particularly in children four and younger.

Last year, the World Health Organization (WHO) warned global cases were rising for the first time in 20 years. UK officials also recorded a recent increase in TB cases. 

In 2022, 6,009 of of 8,248 TB cases occurred among non–US-born persons, mostly of Asian or Hispanic heritage. A higher overall TB incidence among American Indian or Alaska Native and Native Hawaiian or other Pacific Islander persons compared with other racial groups represents an ongoing health disparity

The disease is considered to be serious by health officials. It is an infection of the —usually of the lungs — that occurs when a person breathes in the bacteria mycobacterium tuberculosis.

It can also infect the brain, kidneys and spine.

The bacteria that cause tuberculosis are spread from person to person through tiny droplets in the air released in coughs and sneezes. 

People with HIV/AIDS and those with weakened immune systems have a higher risk of catching tuberculosis than people with typical fully-functional immune systems. 

It used to be one of the deadliest diseases in the world, with earliest known cases at the start of recorded human history.

The bacterial infection was a deadly foe for much of the world until the 1900s, when the emergence of treatments such as streptomycin and para-aminosalicylic acid were discovered.

Still, the disease is highly deadly if left untreated and is still a nuisance in the developing world, where the medication is not as accessible.

Tuberculosis is most common in sub-Saharan Africa, Eastern Europe, and Asia and is classically associated with malnutrition, poverty, and overcrowding. 

In areas of the world where people can be screened and diagnosed early and treated for the infection, treatment success can be near 90 percent. 

But in low-income countries in Africa and Asia, the prognosis is grimmer. 

Ninety-six percent of the children who die from tuberculosis never accessed treatment.

There is a TB vaccine, called the Bacillus Calmette–Guérin shot, but it is rarely used because of how little a threat TB is to people in the developed world.

But, officials warn the threat it poses could slowly rise coming out of the Covid pandemic. 

The CDC reported 8,300 new TB cases in America last year. This is up from 7,874 the year prior, a 29 percent increase.

Young people were affected most, with cases among people 15 to 24 increasing 23 percent, the CDC said in its Morbidity and Mortality Weekly Report.

The WHO warned last fall that the number of confirmed cases of TB in 2021 had reached 10.6 million, an increase of nearly five percent from the previous year.

This may be less of a year-over-year rise in bacterial infections and instead reflect a decrease in cases being reported in 2021.

The CDC cites delayed or missed doctors appointments during the pandemic as one of the reasons cases dropped in 2021.

Because of lockdowns and other Covid mitigation measures, many people avoided the doctors office when they would have went to seek care otherwise.

This phenomenon also led to other interesting statistical trends, such as a drop in overall cancer diagnosis — but a jump in late stage cases. 

Around 80 percent of US TB cases are a result of what doctors call ‘latent’ infections.

This is when the bacteria is lying dormant in a person’s body, but eventually ‘wakes up’ to cause infection. 

Incidence among older adults aged 25 to 44 increased slightly less markedly at about seven percent, while that rate increased about one percent among 45 to 64-year-olds. 

Only seniors 65 and older saw a decreased rate of TB cases of nearly two percent.

The lower incidence rate of TB among seniors could be attributed to the infection’s high rate of mortality.

Higher incidence among young children may reflect recent TB transmission in the US. 

Almost three-quarters of all new TB cases in the US in 2022 were detected in people who were not born in the country.

Recent TB outbreaks in two Washington state prisons illustrate the risk that TB poses to people living in close quarters.

No cases were reported in the prison system from 2014 to 2020, but from 2021 to 2022, 25 cases were reported among incarcerated persons.

The ongoing outbreak in Washington, the largest one there in 20 years, also reflects the dire consequences of delayed diagnostics during the Covid pandemic, when an already-limited testing infrastructure and workforce shifted to focus almost exclusively on Covid detection.

Over 600 children under the age of 15 die from TB every day – nearly a quarter million each year. 

Most of the deaths occur among children under the age of 5, according to Unicef.