In January of last year, the Kansas Department of Health and Environment reported an outbreak of tuberculosis (TB) cases, which now has become one of the largest outbreaks ever recorded in US History since the Centers for Disease Control and Prevention (CDC) started tracking cases in the 1950s. As of Friday, January 24th, 2025, 67 people were being treated as confirmed cases of TB. As of February 13th, the outbreak has claimed the lives of two individuals.
However, the CDC reports that, until now, a 2015 TB outbreak and another in 2021 have been larger than the current contingency.
Pulmonary tuberculosis (TB) is a serious infection caused by the bacterium Mycobacterium tuberculosis (MTB) is an airborne disease spread person-to-person through extended and prolonged contact with someone who has active TB. It affects primarily the lungs but may spread to other organs. Tuberculosis (TB) is the leading global infectious cause of death.
Worldwide, 2–3 billion people are infected with TB and around 2–3 million people die from TB disease and related complications yearly. The mycobacteria can live dormant within a patient for many years, those exposed to Mtb often develop latent TB infection (LTBI) and have a 5–10% lifetime risk of progressing to active TB. Some of the symptoms presented by patients with pulmonary TB are Persistent Cough (lasting more than three weeks, often with phlegm or blood) – Chest Pain – Shortness of Breath – Fever and Chills – Night Sweats – Unintentional Weight Loss – Loss of Appetite – Fatigue and Weakness.
Pulmonary tuberculosis is diagnosed through a combination of a medical history evaluation, clinical evaluation, laboratory tests, and imaging. The key diagnostic methods include Chest X-ray showing lung abnormalities such as cavities, infiltrates, or nodules. Tuberculin Skin Test (TST) Measures immune response but does not differentiate between active and latent TB. Interferon-Gamma Release Assay (IGRA): A blood test for TB infection, used mainly for latent TB detection, Gene-Xpert is a real-time PCR-based rapid molecular assay. Sputum Culture, however, is the most definitive test.
The R0, in other words, the basic reproduction number, is a mathematical term that indicates how contagious an infectious disease is. Pulmonary TB’s R₀ is approximately 1–4 (for reference, Measles has an R₀ of 12-18).
Tuberculosis surpassed COVID-19 as the highest cause of infectious disease mortality worldwide in 2023. Although tuberculosis cases dropped to their lowest level in 2020 since the CDC began recording statistics (which doesn’t surprise me because everything was labeled as COVID), they have been trending up since then. 2023 recorded the highest number of Tuberculosis cases since 2013. The CDC, however, reported lower TB cases in 2024 than in 2023.
There are a couple of reasons behind this increase, I believe. Before explaining the first reason it’s important to give context. In 2023, non-US-born individuals represented 76% of the confirmed TB cases in the United States, 22% of which were diagnosed within the first year of their arrival in the United States.
Throughout my career in global migration medicine as a Panel Physician (i.e. Immigration Doctor), I have extensively researched global infectious disease patterns specifically pulmonary tuberculosis, particularly those emanating from Latin American migrants to the United States. This leads me to my first reason.
The recent increases in levels of TB are in part caused by the mass migration of persons, particularly from high-risk and high-propensity regions of the world (South Asia, Africa, & Latin America). Border officials encountered 11 million unauthorized migrants attempting to enter the US between October 2019 and June 2024. Mass and uncontrolled migration is a public health risk. It can be argued that the recent rise in unusual infectious diseases coincides with the increased influx of foreigners beginning at the turn of the decade.
The data supports this claim. As demonstrated in the graphs above migration is a key factor in the spread and propagation of tuberculosis in the United States. Title 42 which is part of the Public Health Service Act of 1944 aimed at preventing the spread of communicable diseases in the United States. As COVID-19 cases rose in the U.S., then-CDC Director Dr. Robert Redfield enacted Title 42 to seal the land borders with Canada and Mexico for migrants seeking asylum from March 20, 2020, to May 11, 2023. Migration is a social phenomenon that impacts public health.
The tuberculosis vaccine, also known as the Bacille Calmette-Guérin (BCG) vaccine, is used to “protect” against tuberculosis (TB) and related complications. Approximately 180 countries routinely administer this vaccine with the exception of the United States, Canada, Australia, New Zealand, the United Kingdom, the Netherlands, Ireland & Iceland. In fact, in these first five countries, for authorized immigrants, a medical examination including TB screening is required.
The top five countries with the highest incidence of tuberculosis (TB) are: India, Indonesia, China, Philippines & Pakistan.
The esteemed Dr. Paul Farmer, a Harvard-trained doctor and a tuberculosis expert, was known as "the man who would cure the world" (who rarely wore a mask). He dealt with the toughest TB cases in the world and did so much for humanity. He used to say “Medicine should be viewed as social justice work in a world that is so sick and so riven by inequities.” Which is a fundamentally Biopolitikal statement.
It is interesting to note that countries where routinely the BCG vaccine is applied to “protect” from Tuberculosis, have the highest incidence of TB cases, whereas those who don’t—have the lowest. The key to avoiding infections and/or complications with infections will be strengthening immune systems, through appropriate medical care adequate nutrition, supplementation, and obviously with efficient Biopolitikal initiatives.
Tuberculosis is undoubtedly an aggressive infectious disease. Still, the fact that the outbreak is occurring at this time and behaving the way it is—is indicative of a much larger underlying problem that we have discussed in this publication previously—the immunocascade. Immune-suppressing conditions exacerbate a person’s possibility of being infected with TB. In fact, according to a recent article published in Fortune—the U.S. is battling its worst flu season in at least 28 years. Our weakened immune system post-COVID operation is leading to all these sorts of infections.
How many people you know are having a hard time getting rid of a “common cold” or have been coughing lately?
From what we have seen in previous outbreaks of TB in the United States, such as the one in 2015 in Atlanta, Georgia, the uniting factor behind the reported cases of TB is that they existed within the same vicinity, in this case, a homeless shelter. There is no evidence of this being the case in the Kansas outbreak. Interestingly, the outbreak was reported a year after the first case was discovered. According to statements from the Kansas Department of Health and Environment, most cases were identified during July of last year, according to their epidemiological data.
It seems as though the case with this outbreak is not prolonged proximity, as we have seen in previous outbreaks. I believe that the cause could be the increased immunosuppression we are seeing currently. Strengthening immune systems will be key to public health safety over the next couple of years. Freedom of information will also be key in this age of outbreaks. The public does not trust the messaging from official sources, partially because it has been so unreliable over the last few years. A rise in trusted messengers (Doctors and scientists) must occur. Individuals with access to the true information and the expertise surrounding these issues must speak up.
The age of the singular source is over. Information spaces and popular opinion are now the Wild West. Reinstating trust through accountability and transparency will be key to solving these public health issues. Issues such as these. Those in which we understand the root causes, but only a select few dare to speak about it.
We know that post-COVID operation, immune systems are far more vulnerable. Although it may be inconvenient to some, we understand that immigration is a public health issue as well.
The truth of the matter is that the United States is reporting some of the highest rates of cases of TB in its history and globally there has been a consistent increase for the past three years consecutively. As medical professionals, it’s going to be important going into the future, to stress the importance of issues such as these. Health is now the number one commodity, if you are well you can have many aspirations but if you are sick—your only aspiration is to get well.
FIN
Biopolitiks by Dr. Alejandro Diaz
About Me (Dr. Alejandro Diaz)
I am a Pediatric Allergist / Immunologist and Global Health Expert with extensive international experience, most recently named Chief of Pediatric Medicine at The Wellness Company. I have delivered conferences in over 27 countries around the globe on topics of medicine, migration, biosecurity, and related topics. This includes prestigious venues such as the White House, the US Capitol, the Romanian Parliament, the European Parliament in Brussels, the Mexican Senate of the Republic, the United Nations in Geneva, Japanese Parliament, among others.
My career encompasses diverse roles in healthcare including private practice, health systems, and advisory positions for medical service companies, governments, and government entities worldwide.
"Although it may be inconvenient to some, we understand that immigration is a public health issue as well."
Amen. This is one of those well-known, yet not well-known facts. Way, way back in the 1970s, my husband was diagnosed through a routine, employer requested (he was a public bus system driver) TB skin test, as testing positive. The reason was that he came into contact daily with lots of people, many of whom had not had access to a healthy life or good health care. Long story short, he was intolerant to the TB drug available at the time, told by his doctor not to worry, just drink more milk (an old school remedy for TB) and get more sunshine. He was fine after that, never had an x-ray that showed any problems, and life went on. So, exposure to people carrying TB will increase the level of diagnoses, but doesn't necessarily pose a threat.
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