Tuberculosis Outbreaks

Tuberculosis Outbreaks 2023

Tuberculosis (TB) is an ancient disease caused by Mycobacterium tuberculosis (MTB) that spreads through the air and affects people's lungs. "Consumption" and "Phthisis" were terms historically used to describe TB, which was responsible for one in four deaths in the 19th century. Some people are infected with TB but are not sick, have a latent tuberculosis infection (LTBI) and can become ill in the future. An estimated 10.6 million people fell sick with TB in 2022, and 1.3 million people died from TB in 192 countries and areas, according to the World Health Organization (WHO) 2023 Global TB Report, published on November 7, 2023. In 2022, most people who developed TB were in the WHO Regions of South-East Asia (46%), Africa (23%), and the Western Pacific (18%), with smaller proportions in the Eastern Mediterranean (8.1%), the Americas (3.1%) and Europe (2.2%). In 2020, almost two-thirds of TB cases in children worldwide were either not reported or went undiagnosed and untreated, according to the WHO.

The WHO announced on September 22, 2023, that leaders at the United Nations General Assembly's High-Level Meeting on Tuberculosis have approved a Political Declaration with new targets for the next five years to advance the global efforts towards ending the TB epidemic. The WHO recommends TB preventive treatment for people with HIV, those with bacteriologically confirmed pulmonary TB household contacts, and clinical risk groups.

World TB Day was celebrated on March 24, 2023, with the theme 'Yes! We can end TB!' The theme encourages faster uptake of new World Health Organization (WHO) 2030 recommendations. The report, Ready Next Time - Beating TB Today and Preparing for Pandemics Tomorrow, was published in March 2023. The WHO posts estimated TB rates for each country and territory.

Tuberculosis Tests

As of November 3, 2023, the U.S. Centers for Disease Control and Prevention (CDC) recommends testing persons at increased risk for TB infection as part of routine health care using TB blood tests, when possible, and if a diagnosis of LTBI is made, prescribing a short-course treatment regimen. Among 3,647 healthcare providers, approximately 53% reported routinely testing non–U.S.-born patients for TB in 2023. On October 30, 2023, The Lancet published an assessment of the diagnostic accuracy of the Cepheid Mycobacterium tuberculosis Host Response prototype cartridge (MTB-HR) in children with presumptive tuberculosis. This candidate test measures a three-gene transcriptomic signature from fingerstick blood. MTB-HR differentiated children with culture-confirmed tuberculosis from those with unlikely tuberculosis with a sensitivity of 59·8% (95% CI 50·8–68·4). TB testing is expected to reach $2.7 billion in 2027 at a CAGR of more than 6%.

Tuberculosis in Children

Each year, an estimated 1.2 million incident cases of tuberculosis occur in children younger than 15 years, and approximately 25% of these children will die from tuberculosis in low-income and middle-income countries. In the United States, the Centers for Disease Control and Prevention (CDC) reported 202 cases of TB in children ages four and younger in 2022, an increase from 160 cases in 2021. Philip LoBue, MD, FACP, FCCP, Director of CDC's Division of Tuberculosis Elimination, stated on March 23, 2023, "The message is loud and clear – TB is still here. TB disease cases in the U.S. have continued to rise for the second year, with concerning increases among young children and other groups at increased risk for TB disease." Published in February 2023, author Leonardo Martinez, assistant professor of epidemiology at Boston University School of Public Health, commented, "These results suggest that prevention of tuberculosis disease (vaccination) in the first few years of life may have substantial long-term health benefits, particularly lung health, through childhood."

Tuberculosis Outbreaks U.S.

In 2022, about 73% of reported TB cases occurred in the U.S. among non–U.S.-born persons, and the CDC estimates that up to 13 million persons in the U.S. have LTBI. The U.S. CDC reported on March 23, 2023, that TB cases increased by 5% in 2022, with 60 U.S. states, the District of Columbia, and territories provisionally reporting 8,300 TB cases. On October 5, 2023, H.R. 1776 was filed to require the U.S. Agency for International Development (USAID), which leads the U.S. Government's global TB Strategy 2023–2030 efforts, to coordinate with federal agencies to update and implement programs for the global prevention, treatment, and eradication of tuberculosis. The bill also would authorize USAID to contribute to the WHO and other international organizations for such initiatives. Since 2000, TB incidence has decreased by 25% in USAID's TB priority countries, and mortality has reduced by 41%, saving about 1 million lives.

Alabama - As of July 31, 2023, people who worked or worked with the poultry industry in Colbert, Franklin, Lawrence, or Lauderdale counties are being asked to take TB tests. Seven confirmed or suspected TB disease cases have been identified in individuals who have worked in one or more poultry plants. The Alabama Department of Public Health cautions that these individuals may have been or currently be at risk for contracting TB.

Alaska - The CDC reported 96 TB cases in 2022, an increase of 70% (58) from 2021. Alaska reported the highest TB incidence (13.1). "We have this silent endemic disease that continues to linger, and it's going to take a lot of time and effort," Dr. Anne Zink, the state's chief medical officer, stated.

California - Contra Costa Health announced on November 2, 2023, that it recommends that anyone who has spent time inside California Grand Casino in Pacheco since 2018 consider a TB test after recent genetic testing revealed ten related cases among staff and customers at the casino over the past five years. In 2022, the California Health Department reported 1,843 TB cases, up from 1,750 in 2021, a 3% year-over-year increase. Four new TB outbreaks and 14 ongoing outbreaks in 7 jurisdictions, each involving at least four persons, contributed to California's high number of TB cases. As of 2022, over 2 million Californians (6%) had LTBI. Los Angeles (524) and San Diago (208) reported the most TB cases in California.

Florida - In 2022, Florida confirmed 536 TB cases. In 2021, 500 tuberculosis cases were reported in Florida, representing a 21% increase from 2020 (412). Again, Miami-Dade County led the state.

New York - New York City has confirmed about 500 cases of active tuberculosis as of October 2023, an increase of roughly 20% from the same time in 2022. Data for New York indicates 714 TB cases in 2022, an increase from 683 in 2021. TB was diagnosed in every New York City neighborhood, with Flushing, Queens, having the highest rate, 22.4 per 100,000—more than three times higher than the city's overall rate. In 2022, 88% percent of TB cases were among persons born outside of the U.S., and 8% of persons diagnosed with TB died before or during treatment. Commissioner Ashwin Vasan explained in April 2023, "Many people who recently arrived in NYC have lived in or traveled through countries with high rates of TB."

Nebraska - The Douglas County Health Department (DCHD) confirmed a tuberculosis disease case at Westview YMCA, Omaha, Nebraska, on November 9, 2023. DCHD is investigating more than 500 possible exposures that may have happened at the facility's drop-in daycare. Those potential exposures would have occurred from late spring into late October 2023. Douglas County had 15 cases through September 2023. It had 15 confirmed TB cases in 2022.

Texas - Recent data indicates TB rates are accelerating in certain cities (Dallas, Ft. Worth, Hidalgo County, Houston, San Antonio) in 2023. Additionally, 69% of people diagnosed with TB in Texas were non-U.S. born. In 2022, 1,097 TB cases were reported in Texas, a 9.9% increase. 7,415 Texans were exposed to TB, and 50 Texans died of TB, the second most in any state. Harris Country (Houston) reported the most TB cases (267) in Texas. In 2021, 998 TB patients were reported throughout Texas, representing an increase of 12.5% from 2020. In 2019, Texas' 32 border counties had an average TB incidence nearly triple the national rate.

Tuberculosis in Canada

In 2021, 1,904 active TB cases were reported in Canada. The corresponding incidence was 5.0 active TB cases per 100,000 population—estimates of TB burden in 2021.

Tuberculosis Europe

The European Centre for Disease Prevention and Control (ECDC) reported in August 2023 that tuberculosis cases fell across 30 European countries in 2021. In 2021, a total of 33,527 TB cases were reported by all EU/EEA countries. Romania accounted for 23.8% of all TB cases reported in 2021. The ECDC stated the EU/EEA is not on track to reach the goal of ending the TB epidemic by 2030.

Tuberculosis India 2023

The Government of India's Central TB Division, within the Ministry of Health & Family Welfare, will lead BCG vaccination efforts in 2023. In 2020, compared to 2019, there was a 15.4% decrease in TB death totals, with 28 out of India's 36 states showing a decline. While total deaths increased in 2021 compared to 2020, reductions did occur in 2021 compared to 2019. In addition, deaths by TB for individuals living with HIV decreased by 16.0% across India. The WHO's Global TB Report 2022 indicates that India's TB incidence was 210 per 100,000 in 2021.

Tuberculosis in Mexico

Data indicates 31,000 TB cases (1,900 children) in Mexico in 2022. The U.S.-Mexico Binational Committees for Tuberculosis.

Tuberculosis United Kingdom

The UKSHA published the National quarterly report of TB provisional data on October 26, 2023. In the first three quarters of 2023, there was an 8.1% increase in TB notifications compared with the same period in 2022 (3,628 versus 3,402). The most significant number of TB notifications continued in London, with the most significant increases in the North East, Yorkshire and the Humber, and West Midlands. TB notification rates in England increased by 7% in 2021 compared with 2020. In 2021, TB incidence in England was 7.8 per 100,000 (4,425 people), with London reporting 1,569 cases. The London TB Register shows that the rate of TB diagnosis is increasing. England was not on target to reduce TB incidence by 90% from 2015 to 2035. The BCG vaccine is no longer offered to children in secondary schools in the UK. It was replaced in 2005 with a targeted program for babies, children, and young adults at higher risk of TB.

Tuberculosis Uzbekistan

The Republic of Uzbekistan has one of the five highest TB rates in the European region, with an estimated 62 cases of pulmonary TB per 100,000 people in 2021, and has one of the 30 highest MDR and RR-TB rates globally.