Tuberculosis cases rise across most U.S. states as public health officials sound alarm

Tuberculosis, long one of the world’s deadliest infectious diseases, is increasing across much of the United States, public health officials said, with provisional Centers for Disease Control and Prevention data showing the highest U.S. case count in more than a decade.

The CDC reported 10,347 tuberculosis (TB) cases in the United States in 2024, an eight percent rise from 2023 and the largest total since 2011. The World Health Organization says TB remains the leading infectious-disease killer worldwide, accounting for about 1.25 million deaths in 2023.

Health departments in a majority of states have reported increases over the past decade. According to CDC analyses, TB cases have risen in 40 states and declined in 10, while the District of Columbia reported no change compared with 2014. California reported the most cases in both 2014 and 2024, with about 2,100 in 2024; Texas recorded roughly 1,238 cases in 2024. Some states reported much larger percentage increases over the last decade: Kansas infections are up 187 percent, Maine 179 percent and New York 73 percent. Idaho, Vermont and Wyoming each reported a 100 percent increase compared with 2014.

Local health officials have described recent clusters that underscore the spread. Kansas authorities warned in January of what they called the largest documented outbreak in U.S. history, reporting 67 people with active TB this year. In September, Maine officials reported three unrelated active TB cases in adults, and a school in Raleigh, North Carolina, publicly disclosed a case at Leesville Road High School; authorities did not identify whether the person was a student or employee.

TB is caused by the bacterium Mycobacterium tuberculosis and most commonly affects the lungs. The infection may be latent, with no symptoms, or active. When untreated, roughly half of people with active TB will die, typically from respiratory failure after bacterial lung damage, according to public health guidance. Early symptoms commonly include a persistent cough that can produce blood, chest pain, unexplained weight loss, fever and night sweats. Later stages can involve severe breathing difficulties and spread of infection to other organs or the spine.

Medical advances, including antibiotics, sharply reduced TB deaths in the United States over the 20th century. U.S. fatalities fell from as many as 20,000 annually in the 1950s to about 560 in 2023. Case counts also trended downward from the early 1990s until 2020, when the U.S. recorded a record low of 7,170 cases. The number of cases rose to 7,866 in 2021 and has increased each year since, according to CDC reporting.

In interviews and commentary provided to news outlets, public health experts cited multiple factors that likely contributed to the recent rise. Some experts pointed to disruptions from the COVID-19 pandemic that shifted clinical focus and resources toward SARS-CoV-2, delaying routine screening, diagnosis and treatment for TB.

"Without strong public-health action, we’ll probably continue to see elevated numbers," said Dr. Raj Dasgupta, an internal medicine physician and chief medical advisor for Sleepopolis. He said that early in the pandemic many clinics prioritized COVID-19 care and that reduced masking and social distancing as those measures eased may have allowed TB transmission to resume at higher levels.

Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Children’s Hospital, cited broader erosion in public trust and funding for public health as a contributing factor. "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," Nachman said. She said delays in diagnosis can allow a treatable infection to progress to active disease, increasing the risk of transmission to contacts.

The profile of TB in the United States shifted beginning in 2001, when the CDC first reported more cases among non–U.S.-born persons than among U.S.-born persons. Migration and international travel are factors in that trend, public health officials said, particularly because TB remains more common in many low- and middle-income countries. Experts noted that prolonged close contact with a person who has active pulmonary TB increases the risk of transmission; a single brief international trip is unlikely, by itself, to cause most U.S. infections.

Prevention and treatment options exist. The Bacillus Calmette-Guérin (BCG) vaccine is used in many countries to protect children but is not routinely administered in the United States because of its variable protection against adult pulmonary TB and because it can interfere with skin-test screening. In the U.S., BCG may be given to children who are continually exposed to people with active TB or to certain healthcare workers in high-risk settings.

Antibiotic regimens can cure most cases of TB when taken in full. Public health officials emphasize the importance of early detection and strict adherence to treatment to prevent progression and the development of drug-resistant TB. Dasgupta urged people to seek medical attention if they have a cough lasting more than two weeks or unexplained weight loss, fever or night sweats. "If you are diagnosed, stick with treatment until the end. Stopping early can lead to drug resistance," he said.

Globally, TB remains a major public health challenge despite advances in treatment. Historically referred to as phthisis, consumption or the White Plague, TB has afflicted societies for millennia. U.S. officials and infectious-disease experts said ongoing surveillance, renewed emphasis on diagnosis and treatment, and efforts to restore public health capacity will be critical to reversing the recent trends.

The CDC and state health departments continue to monitor case counts and contact investigations and are urging clinicians to consider TB in patients with compatible symptoms and epidemiologic risk factors.