I recently finished what might be one of the greatest video games of all time in Red Dead Redemption 2. For those of you unfamiliar with this particular title, it showcases the rough and tumble outlaw with a heart of gold (if you play the character that way) Arthur Morgan. Spoiler Alert!!! The final chapters of this game lead to the main character receiving the terrible news of a Tuberculosis infection. An infection that in that time almost always led to death. In fact, it's been the cause of over a billion deaths in the last 200 years.

I only bring this up because Tuberculosis has recently reappeared in the mainstream news specifically in Great Britain where cases seem to be rising exponentially, which led me to investigate our own country. I was surprised by what I found on this so called "old world" disease, and how it's still affecting, and infecting, us today right in Iowa and Illinois.

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Throughout history, the disease tuberculosis has been known as consumption, phthisis, and the White Plague, and although it often seems like a disease from the history books, recent data shows it’s making a "comeback" of sorts, with cases rising here in Illinois, Iowa, and across the U.S. Health officials are now watching TB carefully, especially since it can be tough to treat once it takes hold in a community, and since the discovery of antibiotic-resistant strains. Although TB is less common in the U.S. than in many other parts of the world, new cases are a reminder that TB hasn’t disappeared.

According to recent article, in 2023, the World Health Organization (WHO) reported that TB cases worldwide reached a new record, with 8.2 million people newly diagnosed—an increase from 7.5 million cases in 2022. In the U.S., TB remains relatively rare, with about 8,000 cases last year, but over 13 million people carry what’s known as latent TB, meaning they’re infected but not sick. These people aren’t contagious, but about 1 in 10 may develop active TB, which can then spread to others and cause death if untreated.

Credit: Canva
Credit: Canva
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In the Midwest, Illinois, Iowa, and Wisconsin have seen mixed changes in TB rates. Illinois, for example, had a significant increase in TB cases from 2021 to 2022, jumping by over 17% from 254 to 298 cases. Iowa saw an even sharper rise of 22%, going from 49 cases to 60. Wisconsin was the exception, with cases dropping by 21%. Even so, the upward trends in Illinois and Iowa are catching attention, as they contribute to the broader increase in TB cases across the U.S.

Credit: CDC
Credit: CDC
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Just how big was the increase across the nation? A rise of 5.9 percent in cases and a rise of 5.5 percent in incidence rates. For those of you wondering, "Cases" simply refers to the total number of individuals diagnosed with a disease within a given population, while "incidence rate" represents the number of new cases of a disease that develop within a specific population over a defined period of time, essentially calculating the rate at which new cases occur, making it a more dynamic measure than just the raw number of cases.

Credit: CDC
Credit: CDC
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Why is TB Rising Again?

There’s no single answer to why TB is back on the rise, but there are a few key factors which have contributed. For one, the number of people moving or traveling between countries means TB can spread to areas that haven’t seen many cases before. In addition, drug-resistant strains of TB are becoming more common, making the disease harder to treat effectively. In Illinois, for example, health officials are now seeing more cases resistant to the usual antibiotics, requiring longer, more intensive treatments to combat the disease.

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And while we often think of TB as a curable disease, it still claims lives. Globally, over 1.25 million people died from TB in 2023, according to the World Health Organization, showing just how challenging it can be to control, even with treatment options available. Food for thought, four U.S. states combined reported half of all U.S. TB cases in 2022:

  • California (22.2%)
  • Texas (13.2%)
  • New York, including New York City (8.6%)
  • Florida (6.4%)

These states are also the most populous states in the United States, but only represent about a third of the total U.S. population.

Credit: CDC
Credit: CDC
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How TB Spreads and Why It’s Dangerous

TB is caused by a bacterium, Mycobacterium tuberculosis, which usually affects the lungs. It’s contagious, spreading through the air when someone with active TB coughs or sneezes, although it’s not as easily caught as the flu or COVID-19. Early symptoms include a persistent cough lasting three weeks or longer, chest pain, and coughing up blood. People with active TB are most contagious, but there’s also a form called latent TB, which can sit quietly in someone’s body without causing any symptoms. About 10% of people with latent TB may eventually develop active TB, which is why doctors recommend treatment for high-risk individuals.

Credit: Tuberculosis. (2024, October 18). In Wikipedia. https://en.wikipedia.org/wiki/Tuberculosis
Credit: Tuberculosis. (2024, October 18). In Wikipedia. https://en.wikipedia.org/wiki/Tuberculosis
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TB also places a big financial strain on families, especially those in low- and middle-income countries, where families often spend more than 20% of their income on TB treatment. The financial impact is also substantial, as treatment for active TB can require months of antibiotics, doctor visits, and even hospital care for more serious cases.

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The CDC is aiming to keep TB under control in the U.S., with a goal to eventually eliminate it, which they say is possible. One important focus is treating people with latent TB, especially those at higher risk of developing the disease, to prevent them from getting active TB later. Health officials say it’s also crucial to educate communities, especially those more vulnerable to the disease, so they know when to seek care and can help stop the spread.

And there’s hope on the horizon: new vaccines and diagnostic tools are in the works, including a promising blood test that could help identify people with latent TB. Advances like these could be game-changers in stopping TB before it spreads. For now, the main focus is on managing active cases and treating latent infections.

Rising TB rates across the country and in our local area should be a wake-up call, especially as drug-resistant strains make it harder to treat and cure. Local health agencies, doctors, and communities will need to work together to spot cases early, offer timely treatment, and spread awareness. With the right approach, TB doesn’t have to remain a risk—but it will take a collective effort to ensure it stays controlled.

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