Tuberculosis (TB) is still a threat to public health, the Centers for Disease Control and Prevention (CDC) reminded people ahead of World TB Day last week. Agency stats show that TB case rates increased by 5 percent in 2022, totaling 8,300 cases. This comes after a temporary decline in TB cases during the peak of the pandemic.

Centers for Disease Control and Prevention. TB is Still Here – New CDC Data Show U.S. Cases Increased Again in 2022. March 23, 2023.

 

“For the second year in a row, TB disease cases in the U.S. have continued to rise, with concerning increases among young children and other groups at increased risk for TB disease,” said Philip LoBue, MD, FACP, FCCP, Director of CDC’s Division of Tuberculosis Elimination in a CDC press release.

Centers for Disease Control and Prevention. TB is Still Here – New CDC Data Show U.S. Cases Increased Again in 2022. March 23, 2023.

 

Cases appear to cluster around vulnerable groups, including people from specific racial and ethnic groups, people who were incarcerated, and children under the age of 4. The rise in cases among young children is particularly concerning as young children can be prone to latent TB infection, where TB bacteria live inside the body without causing immediate symptoms but can activate later in life, according to the CDC.

Centers for Disease Control and Prevention. Latent TB Infection and TB Disease.

 

The data underscores the importance of testing and treating TB in vulnerable groups, according to the agency. 

 

“The message is loud and clear – TB is still here,” LoBue said. “Communities, providers, and public health partners must work together to make sure we are reaching the right people with testing and treatment, so we can prevent and stop the spread of TB.”

 

What’s driving TB trends?

 

“While there has been a recent slight rise in the number of cases of tuberculosis in the United States, and most notably in young children, this increase should be looked at in the context of all the health risks we face, " says David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA. “There are about 3 new cases of TB per 100,000 people per year in the United States. There have been over 300 deaths from covid per 100,000 people in the United States.”

Cutler attributes TB’s temporary hibernation to pandemic-induced mask-wearing and social distancing, as well as a roll back of in-person doctor visits where practitioners may have tested people for TB.

“There was less TB testing during the pandemic when many routine medical problems were not adequately addressed as attention focused on covid,” says Cutler. “People were locked down, travel was restricted, and masks were worn routinely.”

TB’s resurgence seems to have been influenced by the increases in social activities and decreases in mask-wearing that came after, he adds. Further, drug-resistant TB may have likewise influenced upward trends.

Centers for Disease Control and Prevention. Drug-Resistant TB.

 

He notes the importance of diagnosing TB cases early to avoid poor outcomes and deaths.

 

The importance of testing for TB

 

Testing for TB can be essential for disease detection and control.

To test for TB, practitioners can either rely on a blood test or a skin test. These tests can detect TB in early stages, including inactive or latent infection, so that people can get on top of treatment before the infection becomes active and harmful to the lungs. 

“The CDC has established guidelines for testing, treating and preventing spread of tuberculosis,” says Cutler. “Anyone exposed to a patient with active tuberculosis should be tested.” 

However, testing should be reserved for people exposed to the virus or otherwise in high risk groups, and not for everyone, due to the high risk that a test could produce a false positive result, Cutler adds.

The CDC recommends practitioners talk to vulnerable patients about the Think. Test. Treat. model, which prioritises conversations around early detection and detection of latent TB infection.

The model suggests patients and practitioners:

Think: Consider if they are at risk for TB infection?

• Evaluate whether or not they fall into a vulnerable group due to health status, racial identity, living scenario, or other factors.

• Test: If at risk or in a vulnerable group, administer one of two TB test options

  • TB blood test option: This is recommended for people who have received a TB vaccine. It measures the immune system reaction to TB-causing germs. 

  • TB skin test option: This option relies more heavily on observation. Using a small needle, the tester will apply testing material under the patient’s skin. A few days later, the patient will return for you to assess whether or not they have had a reaction. 

• Treat: If TB is detected, begin treating the patient even if they do not display symptoms.

 

 

Pushing back TB trends

 

Reversing TB trends may require doctors and patients to pay more attention to vulnerable groups, and increase screenings for latent infections. Following preventative health measures like ensuring people have access to clean environments and good healthcare may also help turn trends around.

“We need to pay more attention to all public health risks by recognising the factors which can lead to all diseases, test for disease when appropriate and provide access to care in order to prevent diseases like TB from spreading,” says Cutler.