Kansas tuberculosis outbreak is America's largest recorded since the 1950s
370 comments
·January 26, 2025mhandley
Not being from the US, I find it odd that the article didn't mention anything about vaccination. Until 2005, pretty much everyone in the UK received the BCG vaccine. After that the TB rate fell too low to merit routine vaccination, but even today it's still given routinely in a few areas where the rate merits it, or if there's elevated risk of exposure via family from abroad, etc. Has vaccination in general become such a divisive topic in the US that articles about diseases for which we used to routinely vaccinate don't even mention that a vaccine is available and greatly reduces the risk of the most severe forms of TB, such as TB meningitis?
danw1979
Kind of related to your point… I remember my maternal Grandmother was looking after me one day and I’d either missed or skipped my earlier vaccination appointment in school (which, I think was a BCG or booster, it was in the early 1990s). She was raised by her maternal Grandmother after her mother died from TB when she was 2 years old. Her father died of… something infectious when she was teenager
(the oral history is obviously a bit sketchy, but she used to tell me her father also caught TB - cholera maybe ? - when he was removing bodies from the flooded Balham tube station in 1940 - https://www.ianvisits.co.uk/articles/75th-anniversary-of-the...)
Well, I got quite the scolding about missing my jabs and a stern lecture about how many awful diseases have been cured because of vaccination. I could never forget how emotional she was about it.
To people born in the early 20th century, seeing the effects first hand of the vaccination programmes of the mid 20th century (not to mention antibiotics) must have seemed miraculous. I think we’ve lived without these diseases for so long that some people (stupid, selfish people) simply think they don’t exist or pose a threat any more.
nobodyandproud
Tried-and-true vaccines are like plumbing or city infrastructure: Once established, it’s taken for granted and the true value can’t be intuited.
amluto
BCG, sadly, is not really in that category.
rightbyte
I think it was just some small anti-culture (like healing stones or whatever. Same people initially) that got dragged into the with us or against us political landscape of the US.
close04
> I think we’ve lived without these diseases for so long that some people (stupid, selfish people) simply think they don’t exist or pose a threat any more.
This is true beyond just vaccines. All too often hardships are forgotten, history is just old pictures and stories, and people who are too far disconnected from those real events and don't learn from history will just walk the same path, leading to the same hardships.
They all think that the world is better today so they're smarter or better than the old generations, that the world evolved so they're intrinsically prepared, so the pains of the past can't harm them. Ironically they're ignoring all the lessons and the tools that made the world better and are needed to keep it like that, and instead think things are better because they just are.
They'll skip any vaccines or support extremist regimes because they think the modern world is just immune to this, it's intrinsically and permanently "fixed". We have freedoms or don't get sick because we "just" have freedoms and don't get sick.
Having close family spending a lifetime paralyzed by the polio virus before a vaccine was widely available, or spending some of my life in the cold embrace of dictatorship really drove the point home for me about learning the lessons of history.
ksenzee
It’s a valid question, but I don’t think the current vaccine-unfriendly climate in the US is the reason why the BCG vaccine wasn’t mentioned. BCG wasn’t routinely given in the US even in the last half of the 20th century when vaccines were universally popular. I was surprised to learn a TB vaccine even existed when I started a public health−adjacent job in the 2000s. Our public health establishment just isn’t convinced it’s worth giving here.
Animats
The BCG vaccine does exist, but it's an 90 year old live-virus vaccine with short-term side effects. Because it's a live-virus "natural" vaccine, it can't be used on people who are immunocompromised or have HIV. There's work on more modern vaccines.[1] No big successes yet.
The safety record of the BCG vaccine, in terms of permanent harm, is pretty good. But a normal side effect is "The usual expected reaction to BCG vaccination is redness and/or a small lump at the injection site, followed by a small ulcer (open sore) a few weeks later (usually less than 1 cm in diameter). The ulcer may last from a few weeks to months before healing to a small flat scar."[2] Mass vaccination will have parents screaming "my perfect baby has an open sore from the vaccine" on Instagram, with pictures.
The classic live-virus smallpox vaccine has similar side effects, by the way, plus a death rate of 1-2 per million.
Huge political problem. Remember all the screaming about the COVID vaccines, which are pure RNA, can't replicate, and have fewer side effects.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3349743/#s6
[2] https://www.rch.org.au/uploadedFiles/Main/Content/immunisati...
gambiting
>>Mass vaccination will have parents screaming "my perfect baby has an open sore from the vaccine" on Instagram, with pictures.
That's so weird to me given that literally everyone where I'm from(Poland) has this on their left arm. Nothing to post on Instagram about. It's as universal as having a belly button - not having a vaccine scar on your arm would be the thing to post about if anything.
_heimdall
> the COVID vaccines, which are pure RNA
This is misleading. Vaccines, including those for covid, generally include adjuvants to stimulate the immune system [1]. While I understand the point your making here, the covid vaccines were not syringes with pure RNA in them.
xyzzy123
An interesting aside to this is the MIS BAIR study in Melbourne, which is looking at whether the BCG vaccine reduces the incidence of food allergies, eczema and asthma. https://www.mcri.edu.au/research/projects/misbair
lazide
Yeah, when it’s dress/tank top weather, you can see what part of the world people grew up in by the upper-left-arm scar.
[https://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/...]
BeetleB
The US medical community never accepted the effectiveness of that vaccine. They don't think it does a good job at prevention and it makes it harder to detect as anyone whose had that vaccine treats positive with the skin test.
ksenzee
All of the above, as well as the fact that the incidence of TB is already so low that the vaccine could cause more harm than it prevents.
poulpy123
I just checked and it's not mandatory anymore in France, which probably absurd because there is a surge of tuberculosis due to migration and international travel
Yeul
In the Netherlands people who travel to non Western countries can get their vaccinations.
There's an old Dutch fort in Ghana with a graveyard. Prior to modern medicine white people dropped like flies in Africa.
exe34
natural selection also applies to memes. memes that cause their host to fail to raise children to reproductive age will get weeded out, but it can take many generations.
netman21
Largest in recorded history is a bit of hyperbole. In the 1800s something like 80% of all Americans had the TB bacillus and of those that came down with TB a huge percentage died.
SecretDreams
Hopefully we can course correct before we have to relearn lessons from the 1800s.
hinkley
Maybe if we learned about the 1800’s in school things would be going better now.
lazide
We learned that we’ve progressed and that we’re totally different people now, so obviously we can’t end up with the same problems if we’re stupid about it. (/s, kinda)
At least smallpox has been eradicated (except for potentially some bio weapons labs), so hopefully our stupidity won’t bring that back.
cjfd
[flagged]
cushychicken
I agree, the emphasis probably should be on “recorded”, not “largest”.
raffraffraff
I assumed that the emphasis is correctly on "outbreak", ie: a single statistically significant increase, as opposed to a progressive increase over centuries (which is what led to the huge numbers in the 19th century)
odyssey7
That’s pretty much what I was looking for in clicking on the article, by what logic or rationale they made that statement.
lolinder
Yeah, the phrase they were looking for is "largest on record", or more precisely "largest in the CDC's records".
"Recorded history" has a very specific definition that places it in contrast with "prehistory": it's the time period in which we have written records of any sort, as opposed to the time period in which there is no surviving writing. That both phrases have "record" in them doesn't make them synonymous.
hinkley
Largest means a very different thing when the us population is 40 million versus 400m.
What’s a heinous tragedy in one could be an existential threat in the other.
boringg
How are you going to get people to click on the article without hyperbole?
levocardia
How can this possibly be America's largest TB outbreak in history? TB was killing thousands of people per year in America in the 1800s.
ceejayoz
> She noted that the Centers for Disease Control and Prevention started monitoring and reporting tuberculosis cases in the U.S. in the 1950s.
dang
Ok, we've put the CDC up there instead. Thanks!
Edit: actually let's put the 1950s up there instead. I think there's more information that way.
ceejayoz
Appreciate it, thanks.
declan_roberts
But surely our disease experts know about the past outbreaks and their impact and wouldn't say something patently untrue like the headline.
lanternfish
"Recorded history" in the title refers to the period of history where the agency has been recording the numbers. It might not be the best phrasing, but it's not strictly untrue; the underwritten thesis (TB is on the rise) is still supported by the evidence.
dang
They don't write the headlines.
PhoenixReborn
The crucial word in the headline is "recorded". I doubt that record-keeping in the 1800s was as comprehensive as it is today.
Additionally, from the article:
> the CDC started monitoring TB in the US in the 1950s.
lolinder
Eh, "recorded history" is totally the wrong phrase.
When we say "recorded history" we don't mean "the window of time in which we have detailed records up to our modern standards", we specifically mean "the window of time in which we have records of any sort", contrasted with "prehistory".
The phrase they were looking for is "largest on record" or even better "largest since 195X".
> For broader world history, recorded history begins with the accounts of the ancient world around the 4th millennium BCE, and it coincides with the invention of writing.
EDIT: Downvote away, but I'd be interested to hear from someone who believes that "recorded history" is not incorrect and confusing usage here, with an explanation rather than a drive by vote.
hedora
Largest in CDC records. US government records existed before 1950.
loeg
No I agree with you, the 1800s were part of recorded history.
DFHippie
If you read the article, it appears they've only been keeping records in Kansas since the 50's. And I think the headline is wrong: it's the biggest in Kansas's records. I could be mistaken about that.
thrance
The article states that they only started recording in the 1950s.
WarOnPrivacy
From the article:
An tuberculosis outbreak in Kansas has become the largest in recorded history in the US....the CDC started monitoring TB in the US in the 1950s.
"This is mainly due to the rapid number of cases in the short amount of time. There are a few other states that currently have large outbreaks that are also ongoing."
People with an active infection feel sick and can spread it to others, while people with a latent infection don't feel sick and can't spread it. It is treatable with antibiotics.
State public health officials say there is "very low risk to the general public."ceejayoz
> It is treatable with antibiotics.
Treating it casually has led to widespread resistance.
https://en.wikipedia.org/wiki/Multidrug-resistant_tuberculos...
https://en.wikipedia.org/wiki/Extensively_drug-resistant_tub...
> People with an active infection feel sick and can spread it to others, while people with a latent infection don't feel sick and can't spread it.
https://www.who.int/teams/global-tuberculosis-programme/tb-r...
"Analysis of data from 14 countries in Africa and Asia suggests that about two thirds of global TB transmission may be from asymptomatic TB (95% prediction interval: 27–92%)."
JoBrad
On top of it being more resistant, we haven’t made very many new medicines to fight it in the last ~50 years.
eth0up
>Treating it casually has led to widespread resistance.
I have long suspected this as part of why the subject isn't much discussed, despite being more prevalent than most realize.
The elephant here is (aside from latent infection) the atypically long duration of treatment, which can exceed 6 months and is harsh. Many, even otherwise responsible people, will founder before the proper end of treatment and this, I think, is what terrifies health professionals - so much, that it almost seems to be avoided.
It's probably time we start looking a bit harder for "natural" or alternate treatments. Some in medical journals, are under scrutiny, but inconclusive.
Edit: I also think we'll be finding more about latent infections being involved in an array of other ailments, especially when mixed with the ultra prevalent EBV. And EBV is involved in a lot.
Fomite
"It's probably time we start looking a bit harder for "natural" or alternate treatments. Some in medical journals, are under scrutiny, but inconclusive."
Antibiotics are found in, and derived from, nature.
tbrownaw
> It's probably time we start looking a bit harder for "natural" or alternate treatments.
Is the idea that a different label would lead to higher compliance rates?
AngryData
What kind of natural treatments? Because tuberculosis has been a massive problem from the start of human civilization up until the advent of antibiotics, and they tried every natural medicine and treatment under the sun because of how long people can end up living with it before dieing, and they accomplished pretty much nothing in stopping it. In fact it continued to get worse throughout that entire time, at one point being the cause of death for 25% of Europeans.
scythe
>It's probably time we start looking a bit harder for "natural" or alternate treatments. Some in medical journals, are under scrutiny, but inconclusive.
We are looking, quite hard, in fact. Mycobacterium tuberculosis is among the most studied microörganisms.
Like HIV, it is notable particularly for being able to defeat the attempts of the immune system cells to kill it, and it in fact infects and reproduces within macrophages. Medical researchers have done a lot to understand how this is possible and we (as in humanity) have identified several enzymes and related biomolecules which seem to be crucial to this process, which we might be able to inhibit with a targeted drug.
However, all of this scientific research has the usual problem that it is very difficult and expensive. In order to inhibit the enzyme, the drug must be absorbed by the body, and then make its way into the macrophages, and then it still must be active, and have no other toxicity to the host. It is easy to say "just inhibit isotuberculosinol synthase", but it is much harder to do.
As I understand it, this is also the reason why treating tuberculosis requires such long courses of antibiotics. When treating a normal infection, we are basically just killing most of the pathogens, and we hope that the immune system will mop up the rest. In the case of M. tuberculosis, the drugs have to kill all of the bacteria, which is why multidrug therapy is basically always used and the patient must continue treatment long after symptoms seem to have disappeared. Even when patients have recovered, they are always considered to be at risk of still having latent tuberculosis, which is why hospital screenings often feature a question like "have you ever had a positive test for tuberculosis?"
BeetleB
> The elephant here is (aside from latent infection) the atypically long duration of treatment, which can exceed 6 months and is harsh. Many, even otherwise responsible people, will founder before the proper end of treatment and this, I think, is what terrifies health professionals - so much, that it almost seems to be avoided.
The fear is overblown. I've known multiple people do the 9 month treatment and none had issues. One person had tingling sensation and that was resolved by an increase in vitamin intake after consulting with a neurologist.
They were in their early to mid thirties. Most problems occur when older people take the medication.
Spooky23
Yeah… understatement with respect to TB is pretty scary. There’s a limited set of effective antibiotics, some strains are resistant, and some drugs have severe side effects.
You have to be a little suspicious of some of this — folks are looking for political reasons for scary disease outbreaks.
3eb7988a1663
I had a TB scare last year. Coworker was exposed to a confirmed case. Got tested, and we all turned up negative. I then asked if I could get a TB vaccine, but was told no, because it makes the TB visual assessment test useless. So, to aid future potential diagnoses, I need to be able to be infected by the genuine article.
ksenzee
That’s one reason the BCG vaccine isn’t given in the US, but it’s also because the data on whether it’s effective in adults is really inconsistent. It seems to vary based on geography (maybe distance from the equator? they’re not sure). If we were going to administer it routinely, it would be for infants, where the data is better.
throwup238
Can confirm. I got the vaccine in the Soviet Union as a kid and tested positive in the US for school admission and when volunteering with special kids. It’s a huge pain in the ass every time because doctors insist on a course of antibiotics that is particularly hard on the liver or kidneys so I have to spend significant time fighting them and getting an exception from administration.
BeetleB
That's silly. There's a globule test that doesn't give a false positive for vaccinated people. Perhaps it's more recent than when you last had to go through this?
classichasclass
Quantiferon is the test you're thinking of, and is now preferred for most individuals, even those who haven't had BCG.
- TB physician since 2006
throwup238
What’s the name for that test?
I last had one in the late 2000s
Havoc
Is the CDC still a thing or did an executive order defund them too?
malfist
They were ordered to halt all publications, cancel trainings and not communicate with state health departments
api
What is the supposed rationale for this? Or is this just a general ideological purge of the government?
This is going to be a crazy four years, if it’s only four.
jltsiren
It could be ideological, or it could be a common mistake people with a business background make in the government.
For the average for-profit company, the actual business the company does has no value beyond its ability to generate profits. The damage a disruption causes today can always be offset with higher expected profits in the future.
But for many government departments, the day-to-day business is the entire point. Any disruption can easily cause irrevocable damage. Even when the net outcome is positive, the gains often cannot offset the damage, because they go to different people.
malfist
Rationale is probably the same that the current president used to claim there'd be no covid 19 if we didn't test for it
lenerdenator
I'm going to guess that the rationale is a combination of:
1) state's rights
2) anti-science
3) a number of people in the administration (very possibly including Trump himself) thinking that the CDC is an example of "the deep state" that conspired to keep him from winning in 2020
But, hey, Joe made groceries more expensive and the administration didn't kiss enough rear on the left side of the Dems to get Kamala elected, so, here we are.
twright
Since losing in 2020 the various think tanks and groups that make up the right-wing have settled on a unified, frightening, vision of what the US government should look like equipped with (extremely dubious) legal rhetoric and reason to back it up. Most notable of these is Project 2025 by the Heritage Foundation[1] which is a keyhole glimpse into the chaos of this last week and in the years to come. The section relevant to this action is chapter 14 which describes each HHS division as maligned, woke, and in need of reform.
A less nuanced answer is the HHS/CDC made Trump look bad in handling the COVID-19 pandemic and so they’re now ordered to say nothing about anything ever again.
[1]: https://static.project2025.org/2025_MandateForLeadership_FUL...
ikiris
it might make the admin look bad if they say bad things happened.
macinjosh
The freeze will be lifted once RFK Jr. is approved by the Senate. The purpose is to stop progressive ideologues in the agencies from doing things in protest of their new boss.
gigatexal
If RFK jr becomes HHS lead and is able to push anti-vax policies this could only get worse.
metadat
Is there public reporting for actions taken by the current American Presidential Presidency?
It would be useful and highly informative to be able to visit a single page to see daily/quarterly/bi-annual/annual diffs of which efforts habe received signoff.
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CHB0403085482
To me, TB is ultimate test of character. Stopping TB means you care for your common man:
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John Green, author of "The Fault in Our Stars", "Turtles All the Way Down", "The Anthropocene Reviewed", and other fine books is releasing a book called "Everything is Tuberculosis." If you are interested in the topic or just like to read well-written prose, I recommend joining me in pre-ordering it.