Mar. 25, 2022 -- Tuberculosis cases in the U.S. increased 9.4% in 2021 after falling about 20% in 2020, according to a new study published in the CDC’s Morbidity and Mortality Weekly Report.

At the same time, 2021 rates are still about 13% lower than before the pandemic.

“Timely evaluation and treatment of TB and latent tuberculosis infection remain critical to achieving U.S. TB elimination,” the study authors wrote.

The research team analyzed CDC data to understand trends in tuberculosis cases. Between 1993-2019, tuberculosis rates in the U.S. decreased steadily, though the rate of decline slowed in more recent years.

In 2019, there were about 2.7 cases per 100,000 people, which fell to 2.2 in 2020 and rose to 2.4 in 2021. In total, 7,860 tuberculosis cases were reported in 2021, up from 7,173 in 2020 but lower than 8,900 in 2019.

Tuberculosis cases increased for both U.S.-born and non-U.S.-born people between 2020 and 2021, the researchers found. About 71% of cases in 2021 were identified in people not born in the U.S., which was similar to previous years. Among the non-U.S.-born population, 9% of cases were diagnosed within one year of immigrating to the U.S., as compared with 9.7% in 2020 and 15.6% in previous years.

California reported the highest number, with 1,750 cases, and Alaska reported the highest incidence, with 7.92 cases per 100,000 people. Eighteen states reported the same number or fewer cases in 2021 than in 2020, and 32 reported more cases.

Several factors likely played into the tuberculosis trends during the past few years due to the pandemic, the researchers wrote. Travel restrictions and safety protocols may have led to fewer cases. A strained health care system may have also led to missed or delayed diagnoses, they wrote, as well as misdiagnoses since tuberculosis and COVID-19 share similar respiratory symptoms.

Tuberculosis trends at the state level appear to be similar. In Minnesota, for instance, cases increased from 2.05 per 100,000 people in 2020 to 2.35 in 2021 but remained below the 2019 rate of 2.62.

“There is a true decrease in TB incidence due to COVID-19 mitigation and from changes in immigration patterns and travel to the U.S. during the pandemic,” Sarah Gordon, supervisor of the state’s Tuberculosis Control Program, told CNN.

“There is a decline from misdiagnosis or delayed diagnosis of TB due to providers not initially screening for TB or from patients less likely to seek medical care during the pandemic,” she said.

The pandemic also likely led to a decrease in tuberculosis testing due to an overwhelming focus on testing for the coronavirus.

“Throughout the COVID-19 pandemic, staff and resources have been diverted from the public health infrastructure to COVID-19 response efforts,” the TB Elimination Alliance told CNN.

Tuberculosis is a bacterial infection, usually found in the lungs, that can cause coughing, chest pain and fever. It spreads through the air when people cough, sneeze or spit. Before the COVID-19 pandemic, tuberculosis was considered the world’s top infectious killer, according to WHO data, adding up to more than 1 million deaths annually.

The WHO celebrated World Tuberculosis Day on March 24, noting that tuberculosis death rates are at the highest point in 10 years. In its 2021 Global Tuberculosis Report, the WHO found that global tuberculosis deaths increased from 1.2 million 2019 to 1.3 million in 2020, which marked the first time that deaths had risen since 2005.

Earlier this week, the WHO called for an “urgent investment” of resources to fight against tuberculosis, especially since ongoing conflicts across Eastern Europe, Africa and the Middle East have exacerbated the spread of infection. The WHO is now particularly focused on potential transmission in Ukraine.

“Given that Ukraine has a high burden of drug-resistant TB, WHO is proactively supporting efforts to enable access to TB care services for the people with TB, refugees and displaced populations at risk,” the WHO said in a statement.

Show Sources

CDC: “Tuberculosis — United States, 2021.”

CNN: “US tuberculosis rates went up more than 9% in 2021 after plummeting early in pandemic, study shows.”

WHO: “Health topics: Tuberculosis.”

WHO: “Global Tuberculosis Report 2021.”

WHO: “On World TB Day, WHO calls for increased investments into TB services and research.”

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