Tuberculosis, once called the “white plague” for the pallor it left on its victims, is staging a comeback in the United States. The CDC recorded 10,388 TB cases nationally in 2024, a 7.9% jump from the prior year and the highest count in over a dozen years. The agency’s annual surveillance report ties the spike to a post-pandemic rebound effect, with disrupted diagnoses and stalled treatments during COVID-19 now feeding a backlog of active infections that public health systems are scrambling to contain. The full scope of those changes is detailed in the CDC’s most recent surveillance report, which frames the new numbers as a warning that past gains are no longer guaranteed.
A Decade of Progress Reversed in Two Years
TB case counts and incidence rates in the United States had been falling for nearly three decades before the pandemic broke that trajectory. The CDC’s executive commentary on the 2024 data puts the national incidence rate at 3.1 per 100,000 people, a 6.9% increase over 2023. That rate may sound small in absolute terms, but it represents a sharp reversal for a disease that public health officials had been steadily pushing toward elimination targets.
The increases were not isolated to a handful of hotspots. Federal analysts noted widespread jurisdiction-level increases across the country, suggesting the rebound is systemic rather than driven by a single outbreak or region. The 2024 report also includes, for the first time, new estimates of recent TB transmission and descriptions of large outbreaks, signaling that the agency views the current trajectory as materially different from the slow, predictable declines of the pre-pandemic era. In other words, the U.S. is no longer simply coasting downhill on decades of progress; it is climbing back up a curve that once seemed firmly under control.
What the Rebound Effect Actually Means
The phrase “rebound effect” can sound abstract, but the mechanism is straightforward. During the worst of the COVID-19 crisis, clinics diverted staff and resources to pandemic response. Routine TB screening slowed. People with latent infections, who carry the bacterium without symptoms and are not contagious, missed the window for preventive treatment. Some of those latent cases have since progressed to active, transmissible disease.
The CDC’s technical notes for the 2024 report explain how surveillance lags, reporting changes, and jurisdictional differences can affect year-over-year comparisons, but the overall direction is clear: more people are getting sick, and more of them are spreading the infection before being identified. When health systems are stretched, people with early TB symptoms (persistent cough, fever, weight loss) may wait longer to seek care or be misdiagnosed, lengthening the period during which they can infect others.
This pattern is not unique to the United States. The global report from the World Health Organization documents the same dynamic worldwide, with COVID-era disruptions in diagnosis and treatment creating backlogs that are now showing up as elevated case counts. Globally, TB remains the leading cause of death from a single infectious agent. A total of 1.23 million people died from tuberculosis in 2024, including 150,000 among people with HIV, underscoring that the U.S. surge is part of a broader, post-pandemic reset, rather than an isolated anomaly.
Kansas City Outbreak Tests Local Response
One of the clearest examples of the rebound playing out in real time is the tuberculosis outbreak in the Kansas City area. The state health department in Kansas has been running expanded testing, case investigations, and contact tracing to identify and isolate active infections connected to a cluster first detected in 2024. Officials there have emphasized that TB is treatable and that early identification is critical to stopping transmission chains.
The agency’s public guidance draws a careful line between active TB disease, which is contagious and requires immediate multi-drug treatment, and latent TB infection, where the bacterium is present but dormant. That distinction matters for the broader public. A positive TB skin test or blood test does not necessarily mean someone is sick or contagious. But when active cases cluster in a community, the contact-tracing net widens fast, and the strain on local health departments grows. The Kansas City response illustrates a challenge that many jurisdictions now face: outbreak-level surges layered on top of a national trend that was already moving in the wrong direction.
Surveillance Gaps May Mask the Full Picture
One underexamined dimension of the current surge is whether the official numbers capture the full scope of the problem. The CDC’s detailed tables for 2024 break down cases by state, demographics, risk factors, clinical characteristics, drug susceptibility, and outcomes. They also document the ongoing revision of the Report of Verified Case of Tuberculosis (RVCT) system and the uneven pace at which jurisdictions have adopted the updated framework.
That unevenness raises a practical question. If some states and counties are slower to implement revised reporting standards, their case counts may lag behind reality. Rural areas, which often have fewer public health workers per capita and less access to TB-specific diagnostic infrastructure, could be particularly affected. The national figure of 10,388 cases may therefore represent a floor rather than a ceiling. Provisional 2025 data from the CDC already show the upward trend continuing, with case counts tracked by birth origin and jurisdiction through preliminary figures that lack the full methodological rigor of the finalized annual report. If anything, the finalized 2025 tally may reveal that the rebound has further accelerated.
Why the U.S. Does Not Use the TB Vaccine
A question that surfaces whenever TB cases rise is why the United States does not routinely administer the BCG vaccine, which is standard in many countries with higher TB burdens. The answer is partly epidemiological and partly diagnostic. BCG offers its strongest protection against severe forms of TB in young children, such as meningitis and disseminated disease, but is less reliable at preventing pulmonary TB in adults—the form most responsible for transmission. In a country with relatively low incidence, public health officials have long judged that targeted screening and treatment of latent infection offer more impact than universal vaccination.
There is also a practical downside: BCG can interfere with traditional tuberculin skin tests, producing false-positive results that complicate efforts to identify who truly has latent infection. In a system that depends heavily on those tests to guide preventive therapy, widespread BCG use could blur the line between vaccinated and infected populations. For that reason, U.S. guidelines reserve BCG primarily for rare, high-risk situations rather than routine childhood immunization.
What Needs to Happen Next
Public health experts argue that reversing the current trend will require a renewed focus on the basics: testing, prompt treatment, and support for patients to complete lengthy drug regimens. The CDC’s testing campaign urges clinicians to “think TB” when patients present with compatible symptoms or risk factors, to “test” using recommended diagnostics, and to “treat” both active disease and latent infection to prevent future cases.
That approach is resource-intensive. Treating active TB typically requires at least four antibiotics taken for six months or longer, and drug-resistant cases can demand even more complex regimens. Patients may need social support (housing, transportation, food assistance) to stay on therapy long enough to be cured and to prevent the emergence of resistance. At the same time, expanding latent TB treatment among people at elevated risk, including close contacts of active cases and individuals from countries with higher TB incidence, is essential to shrinking the pool of future patients.
The rebound in TB is not yet a crisis on the scale of the early 20th century epidemics that earned it the “white plague” moniker. But the recent data send a clear message: without sustained attention, investment, and vigilance, diseases once thought to be fading into the past can reassert themselves quickly. The United States still has the tools to drive tuberculosis back down. Whether it does so will depend on how seriously policymakers, clinicians, and communities take the warning embedded in the latest case counts, and how quickly they act on it.
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*This article was researched with the help of AI, with human editors creating the final content.
