“Stopping TB requires a government program that functions every day of the year, and that's hard in certain parts of the world. And partly it's because of who tuberculosis affects: It tends to affect the poor and disenfranchised most.”
Tom Frieden, M.D., former director, Centers for Disease Control and Prevention, President and CEO, Resolve to Save Lives
“Kansas is experiencing one of the largest tuberculosis (TB) outbreaks ever recorded in the US, as public health powers at the state and federal level have been greatly curtailed.”
Melody Schreiber, freelance journalist, The Guardian, February 6, 2025
As I featured tuberculosis (TB) in a post less than a year ago, I would ordinarily consider it too soon to revisit the topic. (See, “’Leading Infectious Disease Killer in the World’: TB Regains the Title,” Germ Gems, April 10, 2024.) But, these aren’t “ordinary” times.
Right now, Kansas is experiencing a historic outbreak of TB—67 confirmed cases of active TB disease reported as of January 24, 2025. And, at the same time, science and public health are under siege. In today’s post, I provide a recap of the key features of TB and discuss the pivotal role public health organizations play in combatting “Public Enemy No. 1.”
TB: a recap. TB is a highly contagious respiratory tract infection caused by the bacterium Mycobacterium tuberculosis (aka the “tubercle bacillus). As a rule, the tubercle bacillus is transmitted from person-to-person by aerosols generated by coughing or sneezing.
TB is manifest in two clinical forms: pulmonary and extrapulmonary disease. The incubation period for TB can be anywhere from a few months to decades. The typical symptoms include:
a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody
weight loss
night sweats
high temperature (fever)
tiredness and fatigue
loss of appetite.
In addition to having some of these same symptoms, patients with extrapulmonary disease manifest signs and symptoms related to the sites of reactivation of latent tubercle bacilli (e.g. headache and confusion in the case of TB meningitis, abdominal pain in peritonitis, and chest pain in those with cardiac involvement).
BCG vaccine can help prevent TB in young children, and the disease can be cured with a combination of antibiotics. Nonetheless, according to the World Health Organization, in 2024, 10.3 million people were sickened by TB with 1.8 million deaths. In 2023, the Centers for Disease Control and Prevention (CDC), reported 9,633 cases of TB—the highest number reported since 2013— over 90% of which occurred among persons who identified as racial and ethnic minorities.
What happened in Kansas? We don’t know if the TB outbreak in Kansas represents something new or is part of the ongoing trend of rising cases of TB in the U.S.—a trend that has been going on for almost a decade. We do know, however, that in 2023, the Kansas state legislature “forbade state and county public health officials from mandating tests, isolation and closures due to infections disease.” (Schreiber, Melody, “Kansas reckons with large tuberculosis outbreak as health officials hamstrung,” The Guardian, February 6, 2025.) And we also know that an underlying public health system is essential to detecting and containing TB outbreaks at very early stages.
As David Dowdy, MD, PhD, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health said: “Tuberculosis outbreaks are often indications of weakness in public health infrastructure. When public health services weaken, one of the first things you will see is outbreaks of TB. That’s because we've been successful in keeping TB levels in the U.S. so low. An outbreak of 60 TB cases is a real signal of deteriorating capacity, compared to an outbreak of 60 cases of a more prevalent infectious disease—such as gonorrhea or even HIV—which would never rise to the same level of attention.” (Rosen, Aliza, “What the Tuberculosis Outbreak in Kansas Means for Public Health,” Johns Hopkins School of Public Health, February 6, 2025.)
Why hasn’t the CDC weighed in? In mid-January President Trump and his henchman Elon Musk shut down the CDC’s communication with everyone, including the general public—those it is meant to serve. Therefore, the CDC has not been able to provide us with its analysis of this outbreak. And, if TB is the proverbial canary in the coal mine, the public health status of the American public is in deepening trouble. To put it in the vernacular, we “ain’t seen nothing yet.”
What are your thoughts about the dismantling of the CDC, Dr. Peterson? Will it be necessary for physicans across the country to form a private information network?