By Aria Bendix -
NBC News
After declining for nearly three decades, tuberculosis cases in the United States increased every year between 2020 and 2022.
Cases have increased more than 15% in that time, though the disease remains less prevalent than it was before the pandemic.
The Centers for Disease Control and Prevention (CDC) recorded 8,300 cases of tuberculosis last year, up from nearly 8,900 in 2019.
Doctors treating tuberculosis patients blame the pandemic for the rise in cases, as reduced access to care may have prevented some infections from being identified or delayed diagnoses long enough for a latent infection to progress to disease. active.
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“The number of tests for tuberculosis has dropped across the board in this country because everyone is busy looking for coronaviruses,” says Richard Chaisson, director of the Johns Hopkins University Tuberculosis Research Center.
As a result, some more recent cases of active tuberculosis could have been prevented, Chaisson said.
Last week, a Maryland institute reported a new case, and a woman with tuberculosis in Washington has garnered attention since January because she has refused numerous orders to isolate or receive treatment.
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Other factors related to the pandemic may also have made it more difficult for the disease to spread, according to Dr. Priya Shete, an associate professor of medicine and epidemiology at the University of California, San Francisco.
Shete said it's possible that some "public health measures that protected our communities from COVID-19 also prevented people from spreading TB."
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Travel restrictions may also have temporarily limited transmission, Chaisson added.
Identify asymptomatic tuberculosis infections
Tuberculosis is caused by bacteria that can be spread through the air when a person with an active case coughs, sneezes, or talks.
Symptoms include a bad cough that lasts three weeks or longer, chest pain, or coughing up blood or phlegm, according to the CDC.
But as many as 13 million people in the US have latent infections, meaning the bacteria are inactive and the host is not contagious or symptomatic.
About 5% to 10% of those latent cases, if left untreated, will develop into active disease.
According to Dr. Luke Davis, an associate professor of epidemiology and medicine at the Yale School of Public Health, the uptick in cases since 2020, while likely a flicker in the overall downward trend, is a reminder of how important are tuberculosis screening tests.
“If we could get everyone at risk tested once, that would be a huge victory for public health,” he said.
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The US Preventive Services Task Force, an independent group of disease experts, published its latest set of guidelines for tuberculosis screening on Tuesday.
The recommendations are the same as previous ones from 2016: Higher-risk groups—including those in homeless shelters or correctional facilities and people who were born or previously lived in countries with a high prevalence of tuberculosis—should undergo to latent infection screening tests.
Davis said the recommendations are primarily a way to encourage screening and encourage insurance providers to cover costs.
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But right now, according to Shete, Medicare and Medicaid don't pay for latent TB screening.
To detect tuberculosis, doctors perform skin or blood tests, although the latter are more common.
The task force's recommendations do not specify how often testing should be done, but do note that testing annually is reasonable if the person is at ongoing risk of exposure.
Who is most vulnerable to tuberculosis?
Shete noted that immigrants in the US are disproportionately affected by tuberculosis, even though they are screened for latent infections before entering the country.
In 2020, more than 71% of all active TB cases in the US were among people born outside the country, according to CDC data.
More than half of the new cases that year were among people born in Mexico, the Philippines, India, Vietnam or China.
“Unfortunately, screening and testing of the millions of people at risk in immigrant communities estimated to be at risk for latent tuberculosis infection (LTBI) is lagging behind,” Shete and several colleagues wrote in an editorial. published Tuesday in JAMA magazine.
The editorial noted that about 80% of tuberculosis cases in the US occur in racial or ethnic minority groups.
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Tuberculosis is 70 times more common among non-US-born Asians than among US-born whites, according to CDC data.
Among US-born Asian Americans, TB cases increased more than 62% from 2021 to 2022.
“These communities are intertwined,” Shete noted.
“American-born Asian communities are sometimes within the same household as non-US-born Asian communities,” she noted.
Homeless shelters or correctional facilities also carry a higher risk of infection, since residents live in close proximity.
Tuberculosis was 11 times more common among the homeless than among the rest of the United States population as of 2016, according to an analysis published in 2021.
From 2021 to 2022, there was a nearly 61% increase in TB cases among correctional facility residents.
Chaisson said that could be due to reduced testing early in the pandemic.
But the US can reverse these trends, according to Davis.
"It's actually realistic to eliminate TB in the United States in our lifetime," he said.
"That's really what we should be working for," she said.