Tuberculosis: Is Alarming Outbreak Cause For Worry In NH?

NEW HAMPSHIRE — A yearlong tuberculosis outbreak in the Kansas City metropolitan area has sparked concern as cases of the highly contagious disease exceed the national level in a majority of states, including New Hampshire.

To be clear, public health officials say the threat to the general public of sometimes fatal tuberculosis remains low, even in the two metropolitan Kansas counties where 67 active tuberculosis infections have been reported as of Jan. 24, including two that were fatal.

Another 79 people in the area have latent, or inactive, TB infections associated with the outbreak that began last January, according to Kansas public health officials.

Centers for Disease Control and Prevention surveillance information is limited in that it only reflects tuberculosis cases as of the end of 2023, when 9,633 active cases were reported nationwide, occurring at a rate of about 2.9 cases per 100,000 population. Active tuberculosis infections increased 15 percent from 2022 and were at their highest level since 2013.

In the Granite State, the rate per 100,000 people was less than 1.5 cases. In the past decade, there have been 125 cases. In 2023, New Hampshire had 14 cases.

Of the 50 U.S. states, New York City and the District of Columbia, 42 jurisdictions reported increases in both cases and the incidence of cases, according to the CDC.

As in past years, the four most populous U.S. states — which combined represent about a third of the U.S. population — reported half (50.6 percent) of all U.S. tuberculosis disease cases in 2023: California (21.9 percent), Texas (12.9 percent), New York, including New York City (9.3 percent), and Florida (6.5 percent).

TB rates — the incidence per 100,000 people — above the national average of 2.9 were: Alaska (10.5); Hawaii (8.1), California (5.4), New York, including New York City (4.6), Texas (4.1), District of Columbia (4.0), New Jersey (3.7), Maryland (3.3) and Massachusetts (3.2).

The infections in the Kansas City area, all reported since 2024, are in two Kansas counties — mostly Wyandotte, but also Johnson. Despite the high concentration of cases, there is “very low risk to the general public, including the surrounding counties,” according to the Kansas Department of Health and Environment.

The yearlong outbreak has taken local experts aback, even if it does not appear to be the largest outbreak of the disease in U.S. history as a state health official claimed last week.

“We would expect to see a handful of cases every year,” Dr. Dana Hawkinson, an infectious disease doctor at the University of Kansas Health System, told The Associated Press. But the high case counts in this outbreak were a “stark warning,” he said.

Kansas Department of Health and Environment spokesperson Jill Bronaugh told The Topeka Capital-Journal last week the outbreak is concerning “due to the rapid number of cases in the short amount of time.”

“This outbreak is still ongoing, which means that there could be more cases,” Bronaugh said.

Here’s what you need to know:

What Is Tuberculosis?

Tuberculosis is caused by bacteria that live in people’s lungs and spread through the air when they talk, cough or sing. Once a person is infected with TB, it can take two forms — the highly contagious type at the center of the Kansas City outbreak, or latent, or inactive, tuberculosis.

The CDC estimates about 13 million people nationwide have inactive tuberculosis. The bacteria hibernate in their lungs or elsewhere in their bodies but do not cause symptoms and can’t be spread. Symptoms may develop at any time, at which point TB becomes contagious again.

In active TB, the person has a long-standing cough and sometimes bloody phlegm, night sweats, fever, weight loss and swollen glands.

Roughly a quarter of the global population is estimated to have TB, but only about 5 percent to 10 percent of those develop symptoms.

What’s The Latest In Kansas?

In Kansas, a provisional 2024 count showed 79 active TB cases and 213 latent cases in the two counties. However, not all the 2024 cases are linked to the outbreak and Bronaugh did not respond to The AP’s requests for clarification.

The situation is improving, though: “We are trending in the right direction right now,” Ashley Goss, deputy secretary at the Kansas health department, told the state Senate’s Committee on Public Health and Welfare on Jan. 21.

How Is Tuberculosis Treated?

TB is treated with antibiotics over the course of several months. A vaccine is available, but generally not recommended in the United States because the risk of infection is low and getting the vaccine can interfere with the test doctors use to diagnose the disease.

Is Kansas Outbreak Largest In U.S. History?

Kansas health officials called the outbreak “the largest documented outbreak in U.S. history” since the U.S. Centers for Disease Control and Prevention began counting cases in the 1950s.

But a spokesperson for the CDC on Tuesday refuted that claim, noting at least two larger TB outbreaks in recent history.

In one, the disease spread through Georgia homeless shelters. Public health workers identified more than 170 active TB cases and more than 400 latent cases from 2015 to 2017. And in 2021, a nationwide outbreak linked to contaminated tissue used in bone transplants sickened 113 patients.

TB Much Bigger Problem Worldwide

TB is a leading cause of infectious disease death worldwide, and has been on the rise.

In 2023, the bacteria killed 1.25 million people globally and infected 8 million, the highest count since the World Health Organization started keeping track.

While tuberculosis was a much bigger danger in the U.S. in earlier generations, it has been trending back up in recent years. In 2023 there were more than 9,600 cases nationwide, the highest in a decade, according to the CDC.

The Associated Press contributed reporting.