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A potentially deadly disease known as “the white plague” has been rising in the U.S. since the pandemic, health officials have warned.
Tuberculosis (TB) gets its nickname from the pale appearance of those affected with the disease.
After a dip in 2020 with the onset of COVID – likely due to underdiagnosis and reduced screenings, according to health experts – cases of TB have increased every year since.
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More than 10,600 cases were confirmed in 2024, which is around three people for every 100,000, per the latest available data from the Centers for Disease Control and Prevention.
This marks the third consecutive annual increase, and the total 2024 case count is the highest annual number since 2013.
Despite the recent increase, TB rates in the U.S. remain relatively low compared to many parts of the world, as the global average is about 131 cases per 100,000, per the World Health Organization. That’s approximately 40 times higher globally compared to the U.S.
TB is a curable bacterial infection that targets the lungs, but can also infect other organs, according to Johns Hopkins. It is spread through airborne particles released when an infected person coughs, speaks or sneezes.
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Renuga Vivekanandan, MD, professor at Creighton University School of Medicine and VP and CMO of CHI Health Physician Enterprise Midwest, said the rise in tuberculosis cases in the U.S. is concerning, but noted that it was foreseeable.
“The COVID-19 pandemic effectively disrupted TB surveillance and treatment programs across the country,” the doctor, who is board-certified in internal medicine and infectious diseases, told Fox News Digital.
“What we’re seeing now is largely a rebound effect – latent TB infections that went undetected or untreated during the pandemic are now activating.”
Another factor is a return to international travel and increased migration from countries where TB is more prevalent, according to Vivekanandan.
The uptick has also strained healthcare systems. “Local and state public health TB programs became understaffed during the pandemic, and that capacity hasn’t fully recovered,” the doctor said.
Symptoms of disease
While around 25% of people have likely been infected with the TB bacteria, about 5% to 10% will go on to develop active disease, according to health agencies.
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A person with a latent infection has been infected with the tuberculosis bacteria, but the bacteria are inactive in the body. While latent-stage TB is not contagious, it can develop into active disease in 5% to 10% of people.
Only people with active TB disease in the lungs or throat can spread the infection.
Those who get sick with TB may experience mild symptoms, including coughing, chest pain, fatigue, weight loss, weakness, fever and night sweats, per the CDC. In some cases, however, the disease can also affect the kidneys, spine, skin and brain.
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“TB can affect any organ of the body, but it causes disease in the lung in over 80% of cases,” Masae Kawamura, M.D., a former TB control director in San Francisco and a tuberculosis clinician, previously told Fox News Digital. “This is dangerous because it causes cough, the mechanism of airborne spread.”
“TB can affect any organ of the body, but it causes disease in the lung in over 80% of cases.”
In more severe cases, patients may cough up blood, noted Kawamura, who serves on the board of directors of Vital Strategies, a global public health organization.
“Often, there are minimal symptoms for a long time, and people mistake their occasional cough with allergies, smoking or a cold they can’t shake off,” she added.
Risk factors, treatment and prevention
“The good news is that TB is both preventable and treatable,” Vivekanandan said.
“People who are at higher risk – including those born in or traveling frequently to high TB-burden countries, individuals living in crowded conditions, or those who are immunocompromised – should speak with their doctor about TB testing.”
Other high-risk groups include people who have diabetes, are malnourished, use tobacco and/or drink excess amounts of alcohol. Babies and children are also more vulnerable to the disease.
Doctors typically use a skin or blood test to detect TB infection, followed by imaging or sputum (mucus) testing to confirm active disease, per the CDC.
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The disease is treated with antibiotics that are taken every day for four to six months, the CDC states. Some of the most common include isoniazid, rifampicin, pyrazinamide and ethambutol.
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Failure to take the complete course of medications can cause the bacteria to become drug-resistant, which means it does not respond to standard antibiotics. Drug-resistant TB is more difficult and costly to treat and requires longer, more complex medication regimens, according to experts.
If TB goes untreated, it is fatal in about half of its victims.
“Latent TB, which causes no symptoms and is not contagious, can be treated and cured before it ever progresses to active TB, which is infectious,” Vivekanandan said.
“Identifying and treating latent infection is one of the most powerful tools we have for protecting both individual patients and the broader community.”
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The U.S. Preventive Services Task Force recommends screening only for populations at increased risk rather than for the general population.
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