More than 9,000 People in the U.S. Got Tuberculosis Last Year. Who Were They?

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The ratio of tuberculosis cases comparing immigrants to native-born Americans is more than 2:1. Standardizing these numbers paints an even starker picture. The incidence of tuberculosis is almost 15 per 100,000 immigrants, while it is only 1 per 100,000 native-born Americans. The good news is that tuberculosis is curable, and the disease is in decline all over the world.

A new CDC report says that, in 2017, there were 9,093 new cases of tuberculosis in the United States.

Like most other infectious diseases, tuberculosis never "went away." It's still with us, but it's mostly under control in developed countries. Elsewhere, it's a different story. According to the World Health Organization, tuberculosis is the #9 leading cause of death worldwide, killing an estimated 1.3 million people in 2016. That's worse than HIV/AIDS.

Tuberculosis has a very strange history, detailed nicely by Michael Barrett in an essay for Aeon. Because tuberculosis destroys the lungs and, hence, a person's ability to breathe, patients become pale. Tuberculosis, therefore, became known as the "white plague." Europeans in the 1800s viewed it as a romantic, almost sexy way to die. Dr. Barrett notes that "[f]ashion-conscious, healthy women starved themselves and chemically whitened their skin" to appear as if they were dying of tuberculosis.

Today, we don't think of tuberculosis as romantic, and the people who die from it aren't glamorized. In the United States, the disease is mostly limited to immigrants (from countries where tuberculosis is prevalent) as well as the homeless and people who live in close contact with others (such as in prison). The following graph from the CDC depicts the trends in new tuberculosis infections in the U.S.:

As shown, the ratio of tuberculosis cases comparing immigrants to the native-born is more than 2:1. Standardizing these numbers paints an even starker picture. The incidence of tuberculosis is almost 15 per 100,000 immigrants, while it is only 1 per 100,000 native-born Americans.

There are a few additional points worth considering. First, the vast majority of immigrants do not have tuberculosis. Second, as an advanced country, the U.S. is perfectly capable of managing tuberculosis infections because it is curable. And third, despite the rise of multidrug-resistant strains of tuberculosis, the good news is that the disease is in decline all over the world.

May biomedical science march on!

Source: Stewart RJ, Tsang CA, Pratt RH, Price SF, Langer AJ. "Tuberculosis — United States, 2017." MMWR 67(11): 317–323. Published: 23-March-2018. DOI: 10.15585/mmwr.mm6711a2.