For thousands of years it was the biggest health threat in the world – killing actors, poets, kings and emperors.
Previously called phthisis, consumption and even the White Plague, this deadly lung infection is today known as tuberculosis (TB).
Despite sweeping advances in medical care, the World Health Organization (WHO) still considers it the deadliest infectious disease on the planet, killing 1.25 million people in 2023 alone.
TB remains a relatively rare threat in the US, infecting several thousand of people annually and killing around 500 – far fewer than heart disease, cancer and dementia.
However, cases are on the rise in 80 percent of US states, and health officials nationwide are now sounding the alarm.
In September, three people in Maine tested positive for active TB, which means the bacteria responsible for the disease, Mycobacterium tuberculosis, is building up in their lungs.
Officials reported that there was no connection between the patients, suggesting they were all infected from different sources.
Just days later, Leesville Road High School in Raleigh, North Carolina, reported a TB case. It is unclear if the individual is a student or employee.
The lung infection tuberculosis is on the rise in the US, prompting urgent warnings from public health experts (stock image)
Meanwhile, Kansas health officials warned in January that the state was experiencing the ‘the largest documented outbreak in US history,’ with 67 people infected with active TB since the start of 2024, according to the latest figures.
Dr Raj Dasgupta, internal medicine physician and Chief Medical Advisor for Sleepopolis, told the Daily Mail: ‘Without strong public-health action, we’ll probably continue to see elevated numbers.’
Children, older adults and those with weaker immune systems are more vulnerable to the infection.
While the lung infection doesn’t always cause symptoms (then called inactive TB), about half of people with untreated active infections will die.
In the early stages, symptoms include a persistent and unexplained cough, sometimes coughing up blood or chest pain.
Patients may also suffer from unexplained weight loss, loss of appetite, fever and night sweats.
In later stages, patients may have severe breathing difficulties and extensive lung damage, and the infection may spread to other organs or the back, causing pain.
Deaths are most often due to respiratory failure caused by bacterial damage to the lungs.
Medical advancements like antibiotics have helped dramatically curb deaths.
Once killing as many as 20,000 Americans each year in the 1950s, according to data collected by the Centers for Disease Control and Prevention (CDC), deaths have declined to about 560 per year as of 2023.
TB was on a steady decline from 1993 until 2020, when the overall number of cases hit an all-time low of 7,170. But in 2021, that number jumped to 7,866.
Prevalence has gone up every year since.
The latest CDC data shows the US provisionally recorded 10,347 TB cases in 2024 – up eight percent from the year before and the highest tally since 2011, when there were 10,471 cases.
Pictured above are public health posters from the Work Projects Administration in the 1930s and ’40s on getting tested for tuberculosis
Compared to 2014, cases nationwide are up 10 percent, CDC data shows.
And experts have warned it is not just one area responsible for the increase. According to the data, TB infections are on the rise in 40 US states and have only declined in 10.
The District of Columbia is the only jurisdiction to report no change compared to 2014.
Maine has reported 28 cases so far this year compared to 39 during all of 2024, which showed a 179 percent increase from the 14 cases in 2014.
TB cases have risen the most – 187 percent – in Kansas compared to a decade ago. Maine has seen a rise of 179 percent from 2014 to 2024 (14 compared to 39, respectively), while North Carolina reported 250 cases last year compared to 195 in 2014 – a 22 percent increase.
California reported the most cases in both 2014 (2,145) and 2024 (2,100), and Texas had the second most with 1,269 in 2014 and 1,238 in 2024.
In New York, the state with the third-highest prevalence, cases have surged 73 percent over the last decade.
Across Idaho, Vermont and Wyoming, cases are up 100 percent compared to 2014.
Doctors and public health experts told the Daily Mail that the Covid pandemic is likely a main driver in TB’s surge, especially considering cases started going up in 2021.
‘In my opinion, early in the pandemic, a lot of clinics focused almost entirely on Covid, which meant TB testing and treatment often got pushed aside,’ Dasgupta said.
‘At the same time, masks and social distancing probably helped slow TB spread for a while.
‘Now that most people aren’t masking, and with those earlier delays in diagnosis, we’re seeing cases rise again.’
Mycobacterium tuberculosis bacteria, which cause tuberculosis, are pictured above (stock image)
The pandemic also forged a growing distrust of doctors and the medical establishment, which Dr Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Children’s Hospital, said has likely contributed to the rise of TB.
One JAMA study found the public’s general trust in physicians and hospitals dropped from 71.5 percent in April 2020 to 40 percent in January 2024. Experts have suggested the change is likely due to concerns over vaccine mandates and Big Pharma’s financial gains.
Nachman told the Daily Mail: ‘I believe the erosion of public health funding and the publicity around “medical myths” being true has led to people not seeing their medical providers and not following standard guidelines or even going back for follow-up care.
‘This translates into poor care for our population and delays in preventing TB infection from progressing to TB disease (meaning intrathoracic or lung disease).
‘This delay then translates into a person having an easily treatable infection to having a disease that transmits to their family and friends, leading to more cases of TB.’
The demographics of TB began to shift in 2001. That was the first year the CDC reported more non-US born citizen patients than US-born, meaning immigrants and travelers were the driving force behind infections.
Dasgupta said international travel and migration play a role as many of those cases were linked to folks who had recently come from places where TB is more common.
Pictured above is a chest X-ray showing signs of tuberculosis. Doctors told the Daily Mail that paying attention to early symptoms is key for preventing spread (stock image)
International travel further surged starting around 2021, after the height of the Covid pandemic, which Nachman said could have further driven the increase as Americans ventured abroad and foreign relatives made Stateside visits.
‘The longer you stay and come into contact with an infected adult, the more likely you are to get infected yourself,’ Nachman said.
Still, infections are linked to significant, long-term exposure over months or years, so one international trip abroad likely is not enough to bring TB back to the states, she added.
Tuberculosis can be prevented with the Bacillus Calmette-Guerin (BCG) vaccine. Though, due to the generally low risk, it is not routinely offered in the US – except for to children regularly exposed to people with active TB or healthcare workers in areas with increased spread.
‘It’s not recommended here because of its variable effectiveness against adult pulmonary TB and because it can interfere with TB skin test results,’ Dasgupta said.
In developing countries, the vaccine is administered to children younger than 16.
As cases rise, Dasgupta urged Americans to ‘pay attention to symptoms’ before they progress so antibiotics can be administered and potential spread can slow.
‘If you’ve had a cough for more than a couple weeks, or unexplained weight loss, fevers, or night sweats, get checked.
‘And if you are diagnosed, stick with treatment until the end. Stopping early can lead to drug resistance.’