Tuberculosis on the Rise: Here's What to Know About the Disease

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Over the past few years, we have experienced isolation, mask-wearing, and significant behavioral changes in response to a declared pandemic.

As that emergency fades into the "new normal" of our post-COVID-19 world, the mass migration of people to Western countries is setting the stage for something potentially worse.

The escalating influx of individuals from various regions has led to an unprecedented situation at the U.S. border, raising concerns about the introduction of tuberculosis (TB) and other infectious diseases not widespread in the United States.

New U.S. Centers for Disease Control and Prevention data published in March show that tuberculosis cases rose by 5 percent in 2022 to 8,300 cases in the United States.

Tuberculosis on the Rise

By the time the bacterium that caused tuberculosis was identified in 1882, the disease was killing an estimated 1 in 7 people in the United States and Europe. TB remains the leading cause of infectious disease globally as an airborne disease transmitted through coughing and sneezing.

The rise of drug-resistant TB poses challenges for effective treatment, with more than a half-million cases reported in the past year. Additionally, TB infection after COVID-19 has become more prevalent, raising concerns about potential outbreaks in the post-pandemic world.

Prompt treatment is crucial for individuals with active TB, Dr. Sarah Lee, chief resident for emergency medicine at Northwell Staten Island University Hospital in New York, told The Epoch Times. Symptoms such as coughing up blood, night sweats, fever, and weight loss can worsen without intervention.

"Without proper treatment, about two-thirds of people with active TB will die," she added.

New York City Health Commissioner Dr. Ashwin Vasan recently announced that the continuing arrival of migrants bused north from states on the southern border is bringing several diseases, most notably TB.

So far this year, the five boroughs of New York City have reported a TB rate more than twice (pdf) the national average, with Queens experiencing the highest number of cases. Specifically, the Flushing neighborhood of Queens has been severely affected, with a TB infection rate more than three times higher than the city-wide average, primarily affecting recent immigrants.

In a letter (pdf) to doctors and health care administrators, Vasan notes that a significant number of individuals who have recently arrived in NYC have either resided in or traveled through countries with high rates of TB. To address this issue, Vasan requested that all individuals who have recently arrived in the city from these countries and haven't undergone TB screening be promptly assessed.

In 2022, nearly 90 percent of TB cases in the city occurred among individuals born outside the United States, and almost 80 percent of TB-infected people who were born in the United States were non-Hispanic black or Latino, according to the NYC Department of Health.

Identification, Treatment Are Key

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, stressed the importance of accessible diagnostics, such as chest X-rays.

Clear X-rays indicate latent infection, treatable with medication. In the case of active infection, doctors obtain a sputum sample to check for antibiotic resistance.

“We can identify, because we’re in the U.S., what the resistance factors for antibiotics are,” Nachman said. Those resistances can be to rifampin or multiple drugs.

There is a range of new-generation TB medicines available, including bedaquiline and delamanid, to effectively treat multidrug-resistant TB in the United States, she added.

“So I want to say that the dangerous part is closing our eyes and not looking for it, as opposed to identifying and treating it.”

Neglected or incomplete treatment of patients with multidrug-resistant TB can lead to its spread in the community, making the disease more difficult—and potentially impossible—to treat.

In the United States, treatment for TB is free for the uninsured because TB is a declared public health hazard.

“You don’t need to pay for your meds; you don’t need to pay for anything,” Nachman said. “We can get you in and get you treated and get you on meds.”

TB Vaccine Isn't Perfect Solution

An easy solution to rising rates of TB in the United States should be vaccination against infection, according to Nachman. A vaccine, bacille Calmette-Guerin (BCG), has long been available against TB.

The vaccine isn’t effective against intra-thoracic TB and only “somewhat effective” against miliary TB, a potentially fatal form of the condition, which can lead to disseminated TB or TB meningitis, Nachman said.

“So people thinking, 'I’ve got a BCG vaccine, I’m not going to get pulmonary TB,' ... actually, you will,” she said. “We don’t have anything better.”

The complexity of the TB bacteria makes it difficult to determine which antibodies or components can offer protection.

Another problem, according to Nachman, is that TB is primarily transmitted through close and ongoing household contact rather than casual encounters. She emphasized that the risk of spreading TB is significantly higher in overcrowded living conditions.