Tuberculosis has been climbing in the United States since the pandemic, driven by missed diagnoses, stalled public health work and the activation of long-hidden infections. Officials are seeing more confirmed cases year over year, and the pattern has raised alarm because TB is both preventable and treatable when caught early. This piece walks through the scale of the rise, why it happened, who is at risk and what the medical community is urging patients and providers to do now.
Last year saw more than 10,600 confirmed TB cases in the U.S., roughly three people per 100,000, the latest federal data show, marking the highest annual count since 2013. The increase comes after a dip in 2020 when testing and screenings collapsed with the arrival of COVID. Even though U.S. rates remain far below the global average, the steady climb is a clear signal that systems for detection and care need attention.
Tuberculosis is a bacterial infection that most often targets the lungs but can appear in many organs. It spreads through airborne particles released when an infected person coughs, speaks or sneezes, so lung disease is especially worrisome for community transmission. TB is curable with the right mix of antibiotics, but only if patients are diagnosed and complete the full treatment course.
“The COVID-19 pandemic effectively disrupted TB surveillance and treatment programs across the country,” the doctor said. “What we’re seeing now is largely a rebound effect – latent TB infections that went undetected or untreated during the pandemic are now activating.” Those words capture the central public health problem: missed care during a global crisis has left a backlog of infections now surfacing as active disease.
Two big drivers behind the trend are a return to international travel and increased migration from regions where TB is more common. Local health departments also suffered staffing losses and reduced capacity that have not fully recovered, leaving contact tracing and prevention programs stretched. That combination has made it harder to catch latent cases before they progress and to manage outbreaks when they occur.
Experts estimate that roughly one in four people worldwide has been infected with the TB bacteria, but only about 5% to 10% will ever develop active disease. A latent infection does not spread to others, while active pulmonary TB can. Symptoms to watch for include a persistent cough, chest pain, fatigue, weight loss, fever and night sweats, and in severe cases patients may cough up blood.
“TB can affect any organ of the body, but it causes disease in the lung in over 80% of cases,” Masae Kawamura said, noting the danger posed by coughing as the mechanism of airborne spread. She added that “Often, there are minimal symptoms for a long time, and people mistake their occasional cough with allergies, smoking or a cold they can’t shake off.” That subtlety means many people delay care until the illness is advanced.
Detection usually begins with a skin or blood test to detect infection; imaging and sputum testing confirm active disease. Standard treatment is a daily antibiotic regimen for four to six months, commonly including isoniazid, rifampicin, pyrazinamide and ethambutol. Incomplete treatment can breed drug-resistant TB, which is much harder and costlier to treat and requires longer, more complex regimens.
“The good news is that TB is both preventable and treatable,” the doctor said. “People who are at higher risk – including those born in or traveling frequently to high TB-burden countries, individuals living in crowded conditions, or those who are immunocompromised – should speak with their doctor about TB testing.” High-risk groups also include people with diabetes, those who are malnourished, tobacco users, people who drink heavily, and young children. The U.S. Preventive Services Task Force recommends targeted screening for increased-risk populations rather than blanket testing of everyone.
