Health and Me

Rachel V Thomas

CDC Flags Surge in US Tuberculosis Outbreaks, Cases Double Since 2017

The US has witnessed 50 large tuberculosis outbreaks (defined as 10 or more related cases in three years) across 23 states from 2017 through 2023, according to a new report by the Centers for Disease Control and Prevention.

The latest Morbidity and Mortality Weekly Report showed that the numbers, primarily involving U.S.-born persons, have more than doubled in recent years and disproportionately affected socially and economically vulnerable populations.

The outbreaks accounted for 1,092 of the 61,993 cases reported during the period. Two-thirds of large outbreaks occurred within family and social networks. Persons with TB in large outbreaks reported substance use, homelessness, and incarceration more often than did other persons with TB.

The numbers also show a sharp increase from the 24 identified from 2014 to 2016, suggesting that transmission within family and social networks is an ongoing issue, despite the US having one of the lowest TB incidence rates in the world. 

“Approximately 80 per cent of large outbreak-related cases occurred among US-born persons. The identification of large outbreaks in approximately one-half of US states, including many with TB incidence below the national average, indicates that maintaining public health capacity for TB outbreak prevention, detection, and response remains critical even in jurisdictions with low TB incidence,” said corresponding author Kala M. Raz, from the Division of Tuberculosis Elimination, CDC

Notably, the report showed that people involved in the large outbreaks differed from other TB patients. The differences include: 

<ul><li>Nearly 80 per cent of cases were among US-born people, compared to 26 per cent in non-outbreak TB cases </li><li>Substance use was more common (27 per cent vs 12 per cent) </li><li>Around 9 per cent were homeless, compared to 5 per cent in non-outbreak cases </li><li>Over 11 per cent had been incarcerated, vs 3 per cent in non-outbreak TB </li><li>More cases were seen in children under 15 (15 per cent vs 3 per cent) </li><li>Higher share among adults aged 25–44 (40 per cent vs 29 per cent) </li><li>Fewer cases in adults 65+ (8 per cent vs 26 per cent) </li><li>About two-thirds of outbreaks spread within families or social circles </li><li>Around one-quarter occurred in group settings like workplaces, prisons, care homes, universities, and shelters </li><li>Outbreaks were reported in 23 states, including those with lower TB rates </li><li>Large outbreaks made up 1.7 per cent of total TB cases (2017–2023) </li></ul>

The CDC report calls for maintaining public health capacity for TB outbreak detection, prevention, and response, even in areas with low TB incidence.

Importantly, they pressed for national genomic surveillance to help prevent and control outbreaks at the local levels. 

They also emphasize the need for targeted public health strategies focused on populations at increased risk, particularly those experiencing housing instability, substance use, or incarceration.

Tuberculosis (TB) is a bacterial infection that primarily affects the lungs but can spread to other parts of the body. It is transmitted through the air when an infected person coughs or sneezes. Without proper treatment, TB can be fatal.

Persistent cough that lasts more than three weeks 

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The US has witnessed 50 large tuberculosis outbreaks (defined as 10 or more related cases in three years) across 23 states from 2017 through 2023, according to a new report by the Centers for Disease Control and Prevention. The latest Morbidity and Mortality Weekly Report showed that the numbers, primarily involving U.S.-born persons, have more than doubled in recent years and disproportionately affected socially and economically vulnerable populations. The outbreaks accounted for 1,092 of the 61,993 cases reported during the period. Two-thirds of large outbreaks occurred within family and social networks. Persons with TB in large outbreaks reported substance use, homelessness, and incarceration more often than did other persons with TB. The numbers also show a sharp increase from the 24 identified from 2014 to 2016, suggesting that transmission within family and social networks is an ongoing issue, despite the US having one of the lowest TB incidence rates in the world. “Approximately 80 per cent of large outbreak-related cases occurred among US-born persons. The identification of large outbreaks in approximately one-half of US states, including many with TB incidence below the national average, indicates that maintaining public health capacity for TB outbreak prevention, detection, and response remains critical even in jurisdictions with low TB incidence,” said corresponding author Kala M. Raz, from the Division of Tuberculosis Elimination, CDC  What Are The Key Finding? Notably, the report showed that people involved in the large outbreaks differed from other TB patients. The differences include: Nearly 80 per cent of cases were among US-born people, compared to 26 per cent in non-outbreak TB cases Substance use was more common (27 per cent vs 12 per cent) Around 9 per cent were homeless, compared to 5 per cent in non-outbreak cases Over 11 per cent had been incarcerated, vs 3 per cent in non-outbreak TB More cases were seen in children under 15 (15 per cent vs 3 per cent) Higher share among adults aged 25–44 (40 per cent vs 29 per cent) Fewer cases in adults 65+ (8 per cent vs 26 per cent) About two-thirds of outbreaks spread within families or social circles Around one-quarter occurred in group settings like workplaces, prisons, care homes, universities, and shelters Outbreaks were reported in 23 states, including those with lower TB rates Large outbreaks made up 1.7 per cent of total TB cases (2017–2023)  How To Control The CDC report calls for maintaining public health capacity for TB outbreak detection, prevention, and response, even in areas with low TB incidence. Importantly, they pressed for national genomic surveillance to help prevent and control outbreaks at the local levels.  They also emphasize the need for targeted public health strategies focused on populations at increased risk, particularly those experiencing housing instability, substance use, or incarceration. What Is Tuberculosis? Tuberculosis (TB) is a bacterial infection that primarily affects the lungs but can spread to other parts of the body. It is transmitted through the air when an infected person coughs or sneezes. Without proper treatment, TB can be fatal. What Are The Symptoms? Persistent cough that lasts more than three weeks Fever Night sweats Unexplained weight loss.