Family nurse practitioner Munira Maalimisaq, center, gives a vaccine education session at Inspire Change Clinic, a nonprofit health care center she leads in Minneapolis. Tuberculosis cases in the U.S. have been rising since 2021. (Photo courtesy of Munira Maalimisaq)
In Johnson County, Iowa, the number of tuberculosis cases has increased in recent years — and so has the cost of containing it.
The cost of contact tracing and surveillance, traveling each day to patients’ homes to ensure they take their meds or booking hotel rooms to quarantine patients, has surged from $17,000 in 2020 to $65,000 last year.
That doesn’t include $13,000 spent last year for language translation, as many of the cases were among the local immigrant communities, said Danielle Pettit-Majewski, director of the Johnson County public health department. She said the rise in spending is directly tied to the increase in diagnoses since 2020, with latent infections tripling, from 27 that year to 90 last year.
Last week, the state informed the county that the greater number of cases had made it too costly to help pay for the home visits, forcing the county to pay for them on its own.
“I was kind of dumbfounded,” Pettit-Majewski said. “It was surprising.”
Tuberculosis cases have been rising nationwide since 2021, and in 2024 — the most recent year for which data is available — they reached the highest level since 2011. Thirty-four states and the District of Columbia reported increases in TB case counts and rates from 2023 to 2024, according to the federal Centers for Disease Control and Prevention.
In 2024, there were 10,347 reported cases nationwide, up 8% from the 9,622 cases reported the year before.
The case numbers for 2025 won’t be released until the end of March. But the Trump administration’s immigration crackdown last year might have dissuaded some people from seeking care, perhaps leading to fewer recorded diagnoses, some TB experts say.
Some states, however, are reporting preliminary data to the National Tuberculosis Coalition of America that shows that the number of cases grew from 2024 and 2025 by between 10% and 20%, said Donna Hope Wegener, the coalition’s executive director.
“There are a number of [tuberculosis] program managers that are reporting double-digit increases,” Wegener said, adding that the cost of antibiotics to treat TB is rising. “These back-to-back increases that states are contending with are certainly alarming.”
In San Antonio, Texas, case numbers have been steady, but the local public health department is still struggling to cover treatment costs.
Tommy Camden, health program manager at the City of San Antonio’s tuberculosis clinic, said the city has proposed eliminating a full-time specialist position that assists with TB contact tracing, blood draws and home visits.
Whatever the 2025 numbers show, many public health agencies are struggling to keep up, especially as they also contend with a growing measles outbreak that so far has affected 26 states.
Tuberculosis is a bacterial infection with both active and latent stages. A person with active tuberculosis disease, which can be deadly, can spread the disease. A person with a latent infection can’t, but they can develop the disease at any point.
Consistent, daily antibiotic treatment for four to nine months, with no skipped doses, is crucial to knocking it out. Skipping doses can allow the germs to mutate into drug-resistant TB, which is one reason health agencies spend so much to ensure patients take their medication.
In the U.S., the disease disproportionately affects people born in countries where it’s more common, as well as Hispanic, Black, Asian American, Pacific Islander and Indigenous communities, according to the CDC.
Immigrant communities tend to be disproportionately affected, in part because the disease can spread more easily in multigenerational households and other crowded home and work settings. Poverty, a lack of access to health care because of language, transportation and cultural barriers, and the stigma around the disease also can make those communities more vulnerable, Pettit-Majewski explained.
These back-to-back increases that states are contending with are certainly alarming.
– Donna Hope Wegener, executive director of the National Tuberculosis Coalition of America
The California Department of Public Health says the cost of drugs to prevent a latent tuberculosis infection from turning into full-blown disease can be about $857 for what is usually three to four months of treatment. In contrast, diagnosing and treating one infected person who develops active tuberculosis disease can cost about $43,900.
While there is a vaccine for tuberculosis, it isn’t recommended for use in the U.S. because it can cause false positives in TB tests taken by skin sample. The vaccine also isn’t consistently effective against adult pulmonary tuberculosis.
Research has been underway for developing a new vaccine. But the Trump administration’s antipathy toward vaccines of all kinds is dampening investment in new products.
Immigration crackdown
Before the COVID-19 pandemic, tuberculosis was the world’s deadliest infectious disease, killing about 1.5 million people each year, according to the World Health Organization. It remains a leading infectious disease killer globally. Immigrants coming to the U.S. are screened for active TB and connected with treatment, and U.S. residents may be asked about travel abroad during routine checkups.
Many immigrants might be reluctant to seek care amid the Trump administration’s immigration crackdown, said Dr. Michael Lauzardo, a University of Florida associate professor at the division of infectious diseases and global medicine and director of the Florida TB Physicians Network.
“I think the numbers will be lower because people are afraid,” Lauzardo said of the soon-to-be-released 2025 data. “A lot of the people at risk for TB are not seeking care, I suspect.”
Munira Maalimisaq, a family nurse practitioner in Minneapolis, said such fear has been rampant across immigrant communities in her area. After President Donald Trump was elected, a health care center where she worked had to drop a routine question on patient intake forms that asked where a patient is from, because people were scared to answer it. The question was meant to assess exposure to TB in countries where it’s more common.
“That was a big barrier, because people would just not answer that question, or would not even want to engage and say ‘yes’ or ‘no,’” said Maalimisaq, CEO of a nonprofit health care center in Minneapolis, Inspire Change Clinic.
She said such fear could cause more active cases later on, as people with latent TB may not get diagnosed or get care — increasing the risk that they’ll develop the disease and become contagious.
“The whole thing delays seeking care,” she said. “If I don’t get screened for it, there’s no way that my provider is going to diagnose me.”
In Iowa, Pettit-Majewski said she hopes that Johnson County residents won’t be scared to seek care.
“If you are a Johnson County resident, you are our neighbor, and it is our responsibility to keep you safe and healthy — and we take that very seriously,” said Pettit-Majewski. “We want to make sure that folks are able to get the best care, regardless of immigration status, regardless of where you came from.”
People in detention or correctional facilities also are disproportionately at risk of infection. In recent weeks, two tuberculosis cases cropped up at a U.S. Immigration and Customs Enforcement facility in El Paso, Texas. Last year, California, Alaska and Arizona also saw cases at ICE detention facilities.
ICE didn’t respond to Stateline’s questions about the recent two cases at the El Paso facility. On a recent visit to the detention center, Democratic U.S. Rep. Veronica Escobar, who represents El Paso, said she saw agents go into a community pod, which can hold between 30 to 70 detainees, without protective attire.
“I was about to walk into a pod with the ICE agents, and the security guard said, ‘No, no, ma’am, you don’t want to walk in there. They’ve not been tested for TB yet,’” Escobar told Stateline.
“But I did see contractor staff coming in and out of the pod, and so I asked, ‘Why are they not wearing [personal protective equipment]? Why aren’t they wearing a mask?’ And my concerns were pretty much dismissed, and I was told it’s their choice and they don’t have to if they don’t want to.”
Cuts to public health funding
Earlier this month, the Trump administration told Congress it intends to rescind $600 million in public health funds to four Democratic-led states: California, Colorado, Illinois and Minnesota. Many of the grants targeted HIV, and some also targeted tuberculosis.
The four states have sued to stop the cuts, arguing that the administration is targeting them with “devastating funding cuts to basic public health infrastructure based on political animus and disagreements about unrelated topics such as federal immigration enforcement.”
A federal judge has temporarily halted the cuts, saying the administration’s statements suggest “hostility to what the federal government calls ‘sanctuary jurisdictions’ or ‘sanctuary cities.’” An agency action, U.S. District Judge Manish S. Shah said, can’t be honored “if it is arbitrary or capricious.”
One of the California grants affected is a grant to the Tuberculosis Elimination Alliance, a partnership of community-based organizations that conduct outreach and education about tuberculosis.
The group received notice Feb. 11 that its grants were ending — putting in jeopardy $100,000 the alliance distributes to groups serving high-risk communities across California, Illinois, Washington state, the District of Columbia and U.S. island territories.
One of the largest tuberculosis outbreaks in recent weeks occurred at a San Francisco Bay Area high school, where latent TB was detected in more than 200 students and staff.
“It’s just such a scary and confusing time for our communities,” said Chibo Shinagawa, associate director of infectious diseases at the Association of Asian Pacific Community Health Organizations, which leads the Tuberculosis Elimination Alliance.
“The instability, the uncertainty right now — it’s such a disruption to public health, to the trust we’ve built in our communities.”
Stateline reporter Nada Hassanein can be reached at [email protected].
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes NC Newsline, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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