Just a short time after “Gone With the Wind star” Vivien Leigh appeared at Atlanta’s Loews Grand Theatre for the 1939 premiere of the legendary film, the British actress caught tuberculosis on a trip to North Africa. The airborne disease would ultimately claim her life in 1967. Yet by the 1960s, a cocktail of antibiotics helped people beat TB, working so well that many today have never heard of the disease.
“I can’t tell you how often, when I tell people I work on TB, they respond, ‘We still have that?’” Kenneth Castro, an infectious diseases expert at Emory University, told The Atlanta Journal-Constitution. “TB is not a disease of the past.”
Though the Loews Grand Theatre in downtown Atlanta is long gone, and TB – or consumption, as it was once called – conjures up scenes from Victorian novels rather than modern-day air travel, medical experts are warning that globally, more people have been infected with Mycobacterium tuberculosis than ever before. And this presents a risk for Atlanta and the U.S. as millions of Americans travel abroad and return through Hartsfield-Jackson International Airport, the world’s busiest.
“TB is the world’s deadliest infectious disease, briefly eclipsed by COVID-19. However, TB has reclaimed this top position as the pandemic has subsided,” Lisa George, a spokeswoman for the Centers for Disease Control, told the AJC.
Tuberculosis is a disease caused by bacteria that are spread from person to person through the air when someone coughs or sneezes or even just through talking. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine, according to the CDC.
Though the U.S. has one of the world’s lowest rates of TB, cases jumped 16% from 2022 to 2023, reaching 9,615 around the nation (2.9 cases per 100,000 persons) the CDC reported in March. TB rates had fallen in the U.S. for 27 years prior.
Foreign aid investments by the U.S., Europe, Japan, and others have helped developing countries fight TB. That notwithstanding, an estimated 10.6 million people become ill with TB every year, and 1.3 million people die from it worldwide – some 25,000 people per week.
Castro and others say that, in addition to the foreign aid investments, the U.S. needs to increase spending on contact tracing in this country to ensure everyone who might have been exposed to TB can be located and tested. He also advised more investment in rapid rests that can can pick up infections in their earlier stages and a telemedicine program to make sure that people who have treatment-resistant TB finish their antibiotics.
Drug-resistant TB is caused by tuberculosis organisms that are resistant to at least one first-line anti-TB drug, the CDC says. Multidrug-resistant TB is resistant to more than one drug. Treating and curing drug-resistant TB is complicated.
It could be a sound investment as record numbers of U.S. citizens travel abroad and could accidentally return home with the disease. The fact TB has a long incubation period means people do not necessarily know they have it until returning to the U.S.
About 22% of Americans plan to visit a foreign country in the next six months, the highest share ever recorded. In 2023, 89 million Americans traveled abroad, mostly to Mexico, Canada and Europe, according to the International Trade Administration.
Mexico is considered a moderate-incidence country for TB, according to the CDC. TB incidence in Mexico is lower than in Africa, Asia, and Eastern Europe, but incidence is several-fold greater than in the U.S.
“I have treated cases of TB in people returning from the Peace Corps, volunteers, soldiers, business people stationed overseas, and people coming to the U.S.,” Castro said.
While TB symptoms can include a cough, chest pain, fever and weakness, many people who have been infected develop what is called a latent TB infection. A latent infection requires treatment but doesn’t make the person sick and they can’t spread the disease to others unless the infection becomes active.
Most people in the U.S. who seek treatment have a latent form of TB that was most likely acquired outside of the U.S. Among people with TB whose place of birth was known, researchers said 76% occurred among those born outside the U.S. The rate was also highest among that group at 15 cases per 100,000, compared with a steady year-over-year rate of 0.8 per 100,000 among people born in the U.S.
People with latent TB do not have any symptoms and cannot spread TB. But if they do not get treatment, they may eventually develop active TB disease, which is then highly contagious according to the CDC.
For people whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is considerably higher than for persons with normal immune systems, the CDC says.
Carole D. Mitnick of Harvard Medical School said the jump in cases globally is linked to the redeployment of medical resources to fight Covid-19.
“Globally there were huge challenges during the pandemic because health facilities were effectively shuttered to people with anything other than Covid,” Mitnick told the AJC. “There’s probably a large backlog of cases.”
Though there is a quick test for TB, Mitnick said “it’s overpriced, and that limits access.”
The company that makes the quick test, Danaher Corporation, announced last September that it would drop the price of its Cepheid Xpert MTB/RIF Ultra test cartridge to $7.97. Still, NGO Doctors Without Borders/Médecins Sans Frontières (MSF) said the price should fall further.
Last month, during a week of events leading up to World TB Day, MSF held a protest at Danaher’s headquarters in Washington, D.C., demanding that the company lower the price to $5 for the tests, which are also used to diagnose HIV, hepatitis, sexually transmitted infections (STIs), and Ebola. MSF accused Danaher of profiteering after receiving at least $252 million in U.S. taxpayer funding to develop the tests. The machines are used throughout the U.S., the EU, Africa, and elsewhere, and deliver results in just hours.
Mitnick said governments should do more to prevent latent infection from becoming active disease.
Castro from Emory said he is urging policymakers to address chronic underfunding in U.S. public health infrastructure.
“We have the money in a crisis, but then when society thinks a situation is over, the resources disappear,” Castro said.
TB tips for travelers
In many countries, TB is much more common than in the United States. The Centers for Disease Control and Prevention recommends travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments (for example, clinics, hospitals, prisons, or homeless shelters).
Although drug-resistant versions of TB are occurring globally, they are still rare. HIV-infected travelers are at greatest risk.
Air travel itself carries a relatively low risk of infection with TB of any kind. Travelers who will be working in clinics, hospitals, or other health care settings where TB patients are likely to be encountered should consult infection control or occupational health experts.
Travelers who anticipate possible prolonged exposure to people with TB (for example, those who expect to come in contact routinely with clinic, hospital, prison, or homeless shelter populations) should have a TB skin test or a TB blood test before leaving the United States. If the test reaction is negative, they should have a repeat test 8 to 10 weeks after returning to the United States.
Source: The Centers for Disease Control and Prevention
Editor’s note: The headline has been corrected to reflect that TB is the deadliest disease in the world, not just in the U.S.
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