Fig. 3.-Bacterial bronchiectasis and bronchiolitis in 46-year-old...
Two Dead, Dozens Sickened In Kansas Tuberculosis Outbreak
CNN —
A wave of tuberculosis cases hitting the Kansas City, Kansas, metro area has caused dozens of illnesses and at least two deaths, according to the state health department.
Cases related to the outbreak were first reported in January 2024, and there were two reported TB deaths last year associated with this outbreak, Jill Bronaugh, a spokesperson for the Kansas Department of Health and Environment, said Tuesday.
"This outbreak is still ongoing, which means that there could be more cases," Bronaugh said in an email. "We are working with and following the guidance of the CDC."
As of Friday, there have been at least 67 people treated for confirmed active TB infections in the outbreak, and there have been 79 confirmed latent cases, in which TB is detected in the body but it's not causing disease and making people sick.
TB germs are spread from person to person through prolonged contact with someone who has an active infection. People with latent infections cannot spread TB bacteria to others, but if the bacteria becomes active, latent infection can develop into TB disease.
"TB is an infectious disease that most often affects the lungs and is caused by a type of bacteria. It spreads through the air when infected people cough, speak, or sing," Bronaugh said. "While there is a very low risk of infection to the general public in these communities, KDHE is working to ensure that patients are receiving appropriate treatment, which will limit the ability to spread this disease and prevent additional cases from occurring."
The state health department has not said what caused the outbreak. Affected local health departments are working with each patient to identify possible close contacts and conduct TB testing at no cost, according to the state agency's website.
The US Centers for Disease Control and Prevention said Tuesday that four of its staffers are on-site to help with the response to the outbreak, including contact tracing, testing and screening.
People who test positive will be further screened to determine whether they have active TB disease or a latent TB infection, "which will help determine the best treatment," according to the state health department. The disease is curable and often treated with a standardized course of drugs that usually includes antibiotics.
"Treatment will be provided through the patient's local health department, and it will be provided for free if the person is uninsured or the treatment isn't covered by health insurance," according to the state health department's website. "Health department staff will remain in touch with patients throughout treatment to help them stay on course and address any questions or concerns they may have."
The National Association of County and City Health Officials has been closely monitoring news about the tuberculosis outbreak in Kansas, but concern remains that there is little information being shared at the national level while federal health agencies have been ordered to pause communications.
"Information exchange really matters and helps to shape and guide these outbreaks, and we're having a lull in that right now, which makes it concerning if we're missing out on any important updates or things that could impact how people are addressing disease, the spread of it, what to look for and how to stop it," Lori Tremmel Freeman, the association's CEO, said Tuesday.
Nationally, tuberculosis case counts in the United States increased in 2023 among all age groups and in most reporting jurisdictions, according to a report released last year by the CDC. The numbers of reported cases rose slightly from 8,320 in 2022 to 9,615 in 2023, and the rate of TB rose from 2.5 cases per 100,000 people in 2022 to 2.9 in 2023. But the report emphasizes that the United States has "one of the lowest TB rates in the world" and that most US residents are at "minimal risk" for TB.
Anyone can get tuberculosis, but people have a higher risk of being exposed to TB germs if they were born in or frequently travel to countries where the disease is common; if they live in large group settings where TB may be more common, such as homeless shelters, prisons or jails; or if they work in places where TB may be more likely to spread, such as hospitals, homeless shelters, correctional facilities and nursing homes.
Get CNN Health's weekly newsletterEach year, about 10 million people around the world fall ill with the disease, even though it is preventable and curable, and about 1.5 million people die, making it "the world's top infectious killer," according to the World Health Organization.
Along with screening, TB can be prevented with protocols such as vaccination and making sure people who are infected finish their course of treatment. The vaccine is not generally used in the United States because of its low TB incidence rate.
People infected with TB bacteria have up to a 10% lifetime risk of becoming sick with the disease, according to WHO, and those with compromised immune systems – such as people living with HIV or diabetes or those who use tobacco – have a higher risk of falling ill.
Correction: In a previous version of this report, Kansas health officials said the ongoing TB outbreak is the largest in the United States since the 1950s. The CDC said Tuesday that there have been at least two US outbreaks that were larger.
The Tuberculosis Outbreak In Kansas Is Alarming. Here's What The CDC Has To Say
A yearlong outbreak of tuberculosis in the Kansas City, Kansas area 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," said Dr. Dana Hawkinson, an infectious disease doctor at the University of Kansas Health System. But the high case counts in this outbreak were a "stark warning," he said.
The outbreak has killed two people since it started in January 2024, Kansas state health department spokeswoman Jill Bronaugh said. Health officials in Kansas say there is no threat to the general public.
What is tuberculosis?TB is caused by bacteria that lives in the people's lungs and spreads through the air when they talk, cough or sing. It is very infectious, but only spreads when a person has symptoms.
Once it infects a person, TB can take two forms. In "active" TB, the person has a long-standing cough and sometimes bloody phlegm, night sweats, fever, weight loss and swollen glands. In "latent" TB, the bacteria hibernates in the person's lungs or elsewhere in the body. It does not cause symptoms and does not spread to others.
Roughly a quarter of the global population is estimated to have TB, but only about 5% to 10% of those develop symptoms.
How big is the tuberculosis outbreak in Kansas?As of Jan. 24, 67 people are being treated for active TB, most of them in Wyandotte County, Bronaugh said. Another 79 have latent TB.
The state's provisional 2024 count shows 79 active TB cases and 213 latent cases in the two counties where the outbreak is happening, Wyandotte and Johnson. Not all of those are linked to the outbreak and Bronaugh did not respond to requests for clarification.
The situation is improving, though: "We are trending in the right direction right now," Ashley Goss, deputy secretary at the Kansas Department of Health and Environment, told the state Senate's Committee on Public Health and Welfare Jan. 21.
Is the Kansas tuberculosis outbreak the 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.
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 U.S. Because the risk of infection is low and getting the vaccine can interfere with the test doctors use to diagnose the disease.
TB is a much bigger problem outside of the U.S.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.
12 Facts About Tuberculosis, The Victorian "Robber Of Youth"
Since January 2024, 67 cases of tuberculosis (with two fatal) have been found in and around Kansas City, Kansas. Public health officials reported another 79 latent cases, in which people carried the bacterium that causes the disease but did not get sick or become infectious. No one is sure why cases are occurring in this area—and why now.
Tuberculosis may seem like a historic disease: A scourge of overcrowded, unsanitary European cities of the 19th century, a plot point in La Bohème or Jane Eyre, and an inspiration for mournful paintings by Edvard Munch and Claude Monet. But TB is the world's deadliest infectious disease (after it was briefly displaced by COVID-19). According to the World Health Organization, 1.25 million people died from TB in 2023 and another 10.8 million were infected.
Now might be a good time to brush up on 12 key facts about tuberculosis.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which divides every 18 to 24 hours. This is slow for bacteria, but what it lacks in speed it makes up for in durability. The cell wall of M. Tuberculosis is thick with lipids, which give it a waxy coat that allows it to withstand dry conditions and some mild disinfectants.
Tuberculosis may be as old, or older, than humans. A scanning electron microscope image of 'M. Tuberculosis.'National Institute of Allergy and Infectious Disease, Flickr // CC BY 2.0With a few exceptions, humans and other primates are the only animals susceptible to TB, indicating that M. Tuberculosis evolved with humans. Some genetic evidence indicates that a bacterium that could be an ancestor to M. Tuberculosis infected our hominin ancestors three million years ago.
Evolutionary biologists think that, in a Darwinian escalation, the hominins that survived the tuberculosis bacterium probably passed on genes that were more resistant to it, but the bacterium adapted to spread among those more-resistant humans.
It spreads only through air.Tuberculosis spreads when an infected person coughs, speaks, or sings, releasing germs that someone else inhales. That is the only known mode of transmission. TB germs are not spread by shaking hands, sharing food, touching the linens and clothes of an infected person, or even through kissing.
Tuberculosis primarily attacks the lungs. Various apparatuses promised to eradicate symptoms of tuberculosis, such as catarrh (buildup of phlegm in the airways).Fototeca Storica Nazionale./GettyImagesTuberculosis mainly affects the lungs, where it can trigger coughing, chest pain, and buildups of blood and phlegm. The disease can also impact the brain, spine, and larynx, as well as lymph nodes and kidneys. Other symptoms might include fatigue, weight loss, chills, fever, headache, back pain, hoarseness, sweating at night, and swelling beneath the skin.
Most cases are latent.After a few million years of adapting to M. Tuberculosis, most people who encounter the bacterium do not get sick; their immune system fights it off before it takes root. By some estimates, 25 percent of the world population has latent tuberculosis infection. Latent TB is also not contagious.
Immunocompromised people are especially at risk for developing active tuberculosis. According to a World Health Organization report, tuberculosis is a factor in 30 percent of the world's AIDS-related deaths.
Tuberculosis is documented in ancient evidence from around the world. An illustration of England's Charles II touching a patient to heal the "king's evil" (a.K.A. Scrofula, a form of tuberculosis).Print Collector/GettyImagesAncient artifacts show that no part of the globe has ever been free of tuberculosis. Egyptian mummies from 2400 BCE have skeletal deformities typical of the disease. Peruvian mummies indicate it was in the Americas before the arrival of Europeans. Descriptions of a TB-like disease have been found in 3300-year-old documents from China and 2300-year-old papers from India.
In the King James Bible, "consumption" is listed among the manifestations of God's retribution against the Egyptians. It is a translation of the Hebrew word schachepheth, a "wasting disease" that was probably TB.
In ancient Greece, Hippocrates described phthisis, a fatal disease among young adults, defined by lung lesions. The philosopher Isocrates was among the first to theorize it was contagious.
In the Middle Ages, Europe was afflicted by scrofula, a strain of tuberculosis that affects the cervical lymph nodes. In France and England, it was widely believed that a king's touch could heal it; in 1712, Queen Anne was the last English monarch to offer this service. Charles X, one of the post-Revolution exiled kings of France, attempted to revive the practice.
Its spread accelerated after the Industrial Revolution.For reasons that are obvious in retrospect, the industrial revolution accelerated the spread of tuberculosis, then often called the "white plague," as populations crammed into cities to work in poorly ventilated plants and factories.
In some parts of Western Europe in the 18th century, the TB mortality rate was 900 deaths per 100,000 inhabitants per year. An outbreak in the late 1830s killed one in three English tradespeople, according to the 1952 account The White Plague: Tuberculosis, Man, and Society. Upper-class Britons died of a rate of about one in six.
In 1793, the Scottish pathologist Matthew Baille described the lung abscesses of the disease as "tubercles," from the Latin word tuberculum, meaning "small swelling." Forty years later, German physician Johann Lukas Schönlein wrote of tuberculosis, creating the common name for the disease.
It was called "the robber of youth"—and inspired works of art. An illustration of poet John Keats.Print Collector/GettyImagesDuring the peak of tuberculosis in Western Europe, its fatalities tended to be young. Older people were mostly exempt from the back-breaking factory labor and cramped working peoples' tenements that acted as breeding grounds for TB, and those who survived into old age then tended to have healthier immune systems.
For these reasons, TB was also called "the robber of youth," a sentiment that spilled into the work of artists and writers. Edvard Munch suffered from the disease as a child and his sister, Johanne Sophie, died of it at age 15, inspiring his painting The Sick Child. Claude Monet painted his wife and muse, Camille, on her deathbed from TB at age 32. Edgar Allan Poe's mother and wife both died of TB in their twenties, which probably determined his whole vibe. Percy Bysshe Shelley, Robert Louis Stevenson, and John Keats (the last of whom died of TB at age 25) all wrote about the ubiquitous disease. By the end of the 19th century, tuberculosis even had a gothic, Romantic quality because of its association with virginal youth and with artists.
TB patients tried to regain their health at sanitariums.In 1854, botany student Hermann Brehmer published a doctoral dissertation asserting that "tuberculosis is a curable disease." He wrote about how his symptoms improved after travelling through the Himalayan Mountains.
This was one instigator of the sanitarium movement, founded on a belief that sunlight, bed rest, nutrition, and the fresh air of high altitudes—the opposite of cramped, smoky factories—could treat, and maybe cure, tuberculosis. Country houses and work hospitals across the U.S. And Europe were repurposed. In the 1920s, architects began designing specialty buildings with large open windows and plentiful balcony and porch space to increase exposure to sunlight and fresh air. These institutions had the added desired effect of quarantining tuberculosis patients away from the general population.
In the U.S., sanitariums sprouted up at a brisk pace. In 1904, there were 115 TB sanitariums with about 8000 beds. By 1923, there were 656 institutions with upwards of 66,000 beds and, by 1953, the number had grown to 839 with 136,000 beds.
The more luxurious sanitariums catered to wealthier clients and the poor and middle class crowded into shabbier ones. Some patients were shipped there for the rest of their lives, while others demonstrated their recovery through sometimes grueling exercise regimens and eventually returned to regular society.
Antibiotics truly ended the age of widespread tuberculosis. Technicians produce tuberculosis treatment.Hulton Deutsch/GettyImagesPublic health initiatives and improved socioeconomic conditions decreased deaths from tuberculosis in the early 20th century. In 1900, the TB death rate in the U.S. Was 194 per 100,000 persons. By 1945, the rate had decreased to 40 per 100,000 persons.
But nothing did more to diminish the threat of TB than antibiotics. Penicillin was discovered in 1928 and refined and mass-produced over the next decades. In 1945, the drug streptomycin was first used to treat TB, followed by isoniazid, ethambutol, and rifampin.
By the 1980s, tuberculosis was measured in new cases, not deaths. The rate of new diagnoses in the U.S. Was just 9.4 per 100,000 people in 1984, with similar rates across Europe and more modest, but still substantial, decreases in developing countries.
Today, tuberculosis is most common in countries with underdeveloped medical infrastructure. North Korea, Mongolia, Myanmar, Indonesia, the Philippines, Papua New Guinea, several sub-Saharan African countries, and a few Pacific Island nations are the only places with case rates of more than 300 per 100,000 people.
Many TB strains are becoming antibiotic-resistant.Public health officials hoped that antibiotics would eradicate tuberculosis. However, true to its evolutionary tenacity, the disease has mutated into strains of drug-resistant TB, defined as infections that persists after treatment by at least one common antibiotic.
The Centers for Disease Control and Prevention reported that, in 2023, 8.5 percent of cases of TB in the U.S. Were resistant to the medication isoniazid and 1.4 percent were resistant to multiple drugs.
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