‘White Plague’ Tuberculosis Cases Rising in US Since Pandemic

A potentially deadly disease known as “the white plague” has been steadily increasing across the United States since the COVID-19 pandemic, according to health officials. Tuberculosis (TB), which earned its ominous nickname from the pale appearance of those affected, has shown a concerning upward trend over the past three years.

After an initial decline in 2020 during the early stages of the COVID pandemic – likely due to underdiagnosis and reduced screenings – TB cases have risen annually. The Centers for Disease Control and Prevention reports that more than 10,600 cases were confirmed in 2024, approximately three people for every 100,000 population. This marks the third consecutive annual increase and represents the highest annual case count since 2013.

Despite this concerning trend, the U.S. rate remains relatively low compared to global figures. The World Health Organization estimates the global average at approximately 131 cases per 100,000 people – about 40 times higher than in the United States.

Dr. Renuga Vivekanandan, professor at Creighton University School of Medicine and VP and CMO of CHI Health Physician Enterprise Midwest, explains that the rise was foreseeable. “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 added, noting that increased international travel and migration from countries with higher TB prevalence have also contributed to the uptick.

This resurgence has strained public health resources. “Local and state public health TB programs became understaffed during the pandemic, and that capacity hasn’t fully recovered,” Dr. Vivekanandan said.

TB is a bacterial infection primarily targeting the lungs, though it can affect other organs. The disease spreads through airborne particles released when an infected person coughs, speaks, or sneezes. While approximately 25% of people have likely been infected with TB bacteria at some point, only 5% to 10% develop active disease.

People with latent infections carry the bacteria in an inactive state. Though not contagious at this stage, latent TB can progress to active disease in some individuals. Only those with active TB in the lungs or throat can transmit the infection to others.

Symptoms of active TB include persistent cough, chest pain, fatigue, weight loss, weakness, fever, and night sweats. In more severe cases, patients may cough up blood. The disease can also affect other parts of the body including the kidneys, spine, skin, and brain.

“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,” noted Dr. Masae Kawamura, a former TB control director in San Francisco and tuberculosis clinician who serves on the board of directors of Vital Strategies.

Several factors increase TB risk, including birth or frequent travel to high-burden countries, living in crowded conditions, and having a compromised immune system. Other high-risk groups include people with diabetes, those who are malnourished, tobacco users, and those who consume excessive alcohol. Babies and children are particularly vulnerable.

Diagnosis typically involves skin or blood tests to detect infection, followed by imaging or sputum (mucus) testing to confirm active disease. Treatment consists of a regimen of antibiotics taken daily for four to six months. Common medications include isoniazid, rifampicin, pyrazinamide, and ethambutol.

Completing the full course of treatment is critical. “Failure to take the complete course of medications can cause the bacteria to become drug-resistant,” Dr. Vivekanandan warned. Drug-resistant TB requires longer, more complex, and costly treatment regimens. Left untreated, TB proves fatal in approximately half of cases.

“The good news is that TB is both preventable and treatable,” Dr. Vivekanandan emphasized. “Latent TB, which causes no symptoms and is not contagious, can be treated and cured before it ever progresses to active TB. Identifying and treating latent infection is one of the most powerful tools we have for protecting both individual patients and the broader community.”

The U.S. Preventive Services Task Force currently recommends TB screening only for populations at increased risk rather than for the general population.