Tuberculosis Cases Surge in U.S. Post-Pandemic as Experts Warn of 'Rebound Effect' and Global Health Risks

Tuberculosis, a once-widespread disease that terrorized 18th- and 19th-century Europe and earned the grim nickname “the white plague,” is making an alarming comeback in the United States. New data from the Centers for Disease Control and Prevention (CDC) shows that reported cases surged to more than 10,600 in 2024—marking the third consecutive annual increase and the highest total since 2013. Public health officials attribute the rise to a combination of pandemic-related disruptions in surveillance and care, a resurgence in international travel, increased migration from high-burden regions, and the delayed activation of previously undiagnosed latent infections. While U.S. rates remain far below global averages, the uptick signals a potential public health challenge that experts say demands renewed attention and resources.

• U.S. tuberculosis cases reached 10,600 in 2024, the highest since 2013, driven by pandemic disruptions and travel resurgence.
• The disease, historically known as 'the white plague,' spreads through airborne particles and can remain latent for years before becoming active.
• Latent TB infections that went undetected during the pandemic are now activating, causing a 'rebound effect' in cases.
• Global TB rates are approximately 40 times higher than in the U.S., with 131 cases per 100,000 people worldwide.
• Failure to complete antibiotic treatment can lead to drug-resistant TB, which is harder and more expensive to treat.

How the Pandemic Disrupted TB Control and Created a Rebound Surge

The COVID-19 pandemic triggered an unprecedented disruption in tuberculosis control efforts across the United States. Routine screenings, contact tracing, and follow-up care for TB patients were scaled back or paused as healthcare systems pivoted to manage surges in coronavirus cases. Many public health programs, already underfunded, faced staffing shortages and redirected resources. According to Dr. Renuga Vivekanandan, a professor at Creighton University School of Medicine and Chief Medical Officer of CHI Health Physician Enterprise Midwest, the decline in 2020 cases—when reported TB cases fell to their lowest level in decades—was not a sign of progress, but of missed detection.

The Hidden Cost of Underdiagnosis During COVID-19

“The COVID-19 pandemic effectively disrupted TB surveillance and treatment programs across the country,” said Dr. Vivekanandan, who is board-certified in internal medicine and infectious diseases. “What we're seeing now is largely a rebound effect—latent TB infections that went undetected or untreated during the pandemic are now activating.” She emphasized that this phenomenon is not unique to TB; similar rebounds have been observed in other infectious diseases as healthcare systems recover from the pandemic’s shadow.

The CDC’s provisional 2025 data, released last week, shows a slight decrease to 10,260 reported cases in 2025—a 1% drop that experts caution should not be interpreted as a sustained downward trend. The agency notes that many states are still rebuilding TB program capacity, and understaffing persists in local and state health departments.

TB in the U.S.: Rates Remain Low, But Rising Trends Demand Vigilance

Despite the recent increase, tuberculosis remains relatively rare in the United States compared to much of the world. In 2024, the U.S. recorded approximately three TB cases per 100,000 people, according to CDC data. By contrast, the World Health Organization (WHO) estimates that the global average is about 131 cases per 100,000—nearly 40 times higher. The countries with the highest TB burdens include India, Indonesia, China, the Philippines, and Pakistan, where factors such as poverty, overcrowding, malnutrition, and limited access to healthcare fuel transmission.

The Role of International Travel and Migration in Domestic Spread

Public health officials also point to the resurgence of international travel and increased migration from regions where TB is endemic as key drivers of the U.S. uptick. As travel restrictions eased and global mobility rebounded post-pandemic, so too did the risk of importing TB cases. “Another factor is a return to international travel and increased migration from countries where TB is more prevalent,” Dr. Vivekanandan noted. While most imported cases are detected and treated early, they can seed new outbreaks if not properly managed.

Understanding Tuberculosis: From Latent Infection to Active Disease

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and primarily affects the lungs, though it can infect other organs including the kidneys, spine, brain, and skin. The disease spreads through airborne particles expelled when an infected person coughs, speaks, or sneezes. Not everyone exposed to the bacteria develops active illness. In fact, about 25% of the global population is estimated to carry a latent TB infection—meaning the bacteria are present but dormant and not causing symptoms. Of those, roughly 5% to 10% will go on to develop active, contagious TB over their lifetime.

The Silent Progression: Why TB Is Often Missed

One of the most dangerous aspects of tuberculosis is its ability to remain asymptomatic for long periods. “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,” said Dr. Masae Kawamura, a former TB control director in San Francisco and a clinician who serves on the board of Vital Strategies, a global public health organization. The subtle onset—fatigue, mild weight loss, low-grade fever, or night sweats—often leads to delayed diagnosis, increasing the risk of transmission.

When TB Turns Severe: Symptoms and Complications

As TB progresses, symptoms intensify. Patients may experience persistent coughing—sometimes with blood—chest pain, and profound weakness. In advanced cases, the disease can damage the lungs so severely that breathing becomes difficult. Dr. Kawamura warned that TB can affect any organ, but lung involvement occurs in over 80% of cases. “This is dangerous because it causes cough, the mechanism of airborne spread,” she explained. Without treatment, TB is fatal in about half of those infected.

Who Is Most at Risk of Tuberculosis in the U.S.?

While the overall risk of TB in the U.S. remains low, certain groups face significantly higher vulnerability due to exposure, health status, or living conditions. These include individuals born in or frequently traveling to high-burden countries, people living in crowded or congregate settings (such as homeless shelters or long-term care facilities), and those with weakened immune systems—whether from HIV, chemotherapy, or organ transplants. Other high-risk populations include people with diabetes, malnutrition, or substance use disorders (notably tobacco and excessive alcohol), as well as infants and young children, whose immune systems are still developing.

Diagnosis and Treatment: A Long Road to Recovery

Detecting TB typically involves a two-step process: first, a screening test (either a tuberculin skin test or a blood test known as an interferon-gamma release assay) to check for latent infection, followed by confirmatory testing if active disease is suspected. Imaging (such as chest X-rays) and sputum analysis are used to diagnose active pulmonary TB. The standard treatment regimen lasts four to six months and involves a combination of antibiotics, including isoniazid, rifampicin, pyrazinamide, and ethambutol. Completion of the full course is critical to prevent relapse and the development of drug-resistant strains.

The Threat of Drug-Resistant TB

One of the most pressing challenges in TB control is the rise of antibiotic resistance. When patients do not complete their prescribed treatment—or when access to care is inconsistent—the bacteria can mutate into drug-resistant forms. Multi-drug-resistant TB (MDR-TB) does not respond to the two most powerful first-line antibiotics, isoniazid and rifampicin, and requires longer, more complex, and costlier regimens. In some cases, extensively drug-resistant TB (XDR-TB) emerges, leaving patients with limited or no effective treatment options. “Failure to take the complete course of medications can cause the bacteria to become drug-resistant,” Dr. Vivekanandan cautioned. “Drug-resistant TB is more difficult and costly to treat and requires longer, more complex medication regimens.”

Public Health Response: Screening, Prevention, and Policy Gaps

The U.S. Preventive Services Task Force (USPSTF) currently recommends targeted TB screening only for high-risk populations, rather than universal screening for the general population. This approach prioritizes efficiency and cost-effectiveness but may miss some cases, particularly among newly arrived immigrants or travelers from high-burden regions. Public health experts argue for expanded access to latent TB treatment, which can prevent progression to active disease—a strategy known as “treatment as prevention.”

The Role of State and Local Health Departments

Local and state TB control programs are the frontline defense against transmission. These programs conduct contact tracing, provide directly observed therapy (DOT) for patients who may struggle with adherence, and offer social support such as housing assistance and transportation vouchers to ensure treatment completion. However, many programs remain understaffed and underfunded, with capacity still not fully restored since the pandemic. “Local and state public health TB programs became understaffed during the pandemic, and that capacity hasn't fully recovered,” Dr. Vivekanandan said.

Global Context: Why TB Remains a Top Infectious Killer

Despite advances in medicine, tuberculosis remains one of the world’s deadliest infectious diseases. In 2022, the WHO reported approximately 10.6 million new cases and 1.3 million deaths globally. The disease thrives in conditions of poverty, poor ventilation, and limited healthcare access. It disproportionately affects marginalized communities, including Indigenous populations, prisoners, and refugees. Global efforts such as the WHO’s End TB Strategy aim to reduce TB deaths by 95% and new cases by 90% by 2035, but progress has been uneven, particularly in low-income countries.

Looking Ahead: What Can Be Done to Reverse the Trend?

To curb the rising tide of TB in the U.S., experts advocate for a multi-pronged approach: restoring and expanding public health infrastructure, increasing screening for high-risk groups, accelerating latent TB treatment, and improving access to care for underserved populations. They also emphasize the importance of public awareness campaigns to reduce stigma and encourage early symptom recognition. “Identifying and treating latent infection is one of the most powerful tools we have for protecting both individual patients and the broader community,” Dr. Vivekanandan said. “The good news is that TB is both preventable and treatable—when detected early and managed properly.”

How to Protect Yourself and Your Community

While the average American faces low risk, individuals in high-risk groups should take precautions. The CDC advises speaking with a healthcare provider about TB testing if you fall into any of the following categories: born in or frequently travel to high-burden countries, live in crowded conditions, have a weakened immune system, or have chronic health conditions like diabetes. Early diagnosis and treatment can prevent severe illness and stop transmission. Additionally, practicing good ventilation, avoiding close contact with people who have prolonged coughs, and seeking medical evaluation for persistent respiratory symptoms are simple yet effective steps.