Tuberculosis — an infection many people think of as a disease of the past or a problem “somewhere else” — is quietly rising again in the United States. After decades of progress, health departments are now seeing more cases, new school-based exposures, and worrying signs that we’ve let our guard down against the world’s deadliest infectious disease.


In this guide, we’ll walk through what’s happening with TB in the US, what the recent high school outbreak in San Francisco tells us, and how testing, treatment, and simple awareness can dramatically reduce risk without panic or stigma.


Health workers reviewing chest X-rays related to a tuberculosis case investigation
Public health teams are investigating more tuberculosis exposures in community settings, including schools and shelters.

Tuberculosis in the US: A “Solved” Problem That Isn’t

Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis, discovered in 1882. Despite effective antibiotics, TB still kills more people globally each year than any other infectious disease, including HIV and malaria, according to the World Health Organization.


In the US, TB rates fell steadily for decades. But recent CDC surveillance data show:

  • Reported TB cases have increased for multiple consecutive years after the Covid-19 pandemic dip.
  • A growing share of cases are being detected late, when people are sicker and more infectious.
  • Clusters are showing up in congregate settings — homeless shelters, jails, and, occasionally, schools.

“TB never really went away. It just became less visible. When systems are strained and screening is disrupted, TB is one of the first infections to slip through the cracks.”
— US infectious disease specialist, 2025 conference panel


What Happened at a San Francisco High School?

In the fall of 2025, a student at Archbishop Riordan High School in the San Francisco Bay Area sought care for a persistent cough. Initially, it looked like an ordinary respiratory illness. But further evaluation revealed something less expected in a US teenager: active pulmonary tuberculosis.


Local health officials launched a contact investigation — a standard public health process where people who shared airspace with an infectious patient are notified, offered testing, and, if needed, preventive treatment. Dozens of students and staff underwent blood tests and chest X-rays. A few tested positive for TB infection, though not for active disease.


For families, the emotional impact was significant: fear of infection, confusion about what “latent TB” means, and frustration that TB was not on anyone’s radar. For experts, it was a warning sign that quiet gaps in screening and awareness can suddenly surface in the most everyday places: a classroom, a bus, a locker room.


Students walking in a school hallway, representing TB exposure investigations in schools
School outbreaks are rare but highlight how easily tuberculosis can spread in shared indoor air.

Why Is Tuberculosis Rising Again in the US?

No single factor explains the recent uptick in TB, but several overlapping trends are important:

  1. Pandemic disruptions to care.
    During Covid-19, routine health visits dropped, and many TB clinics were repurposed. Fewer people were screened, and some missed early diagnosis — leading to more advanced disease later.
  2. Global TB burden and travel.
    Most TB cases in the US occur in people born in countries where TB is more common. International travel, migration, and global inequities in TB control all shape US trends.
  3. Crowded and unstable housing.
    People experiencing homelessness, incarceration, or living in crowded housing are more likely to both acquire and transmit TB due to prolonged indoor exposure.
  4. Underlying health conditions.
    Conditions that weaken the immune system — such as diabetes, HIV, certain cancers, and immune-suppressing medications — increase the risk that a latent TB infection progresses to active disease.
  5. Complacency and low awareness.
    Because TB has been relatively rare in the US, many clinicians and patients don’t consider it until symptoms are advanced.

“TB is a slow-burn crisis. It doesn’t make headlines like a new virus, but it quietly exploits every weakness in our health and housing systems.”
— Public health researcher, TB surveillance report briefing

How TB Spreads — and What “Latent” Really Means

TB is an airborne disease. When someone with active TB in their lungs coughs, speaks, sings, or laughs, tiny droplets containing bacteria can linger in the air, especially in enclosed, poorly ventilated spaces. Close, prolonged contact is usually needed for transmission.


One of the most confusing parts of TB is the difference between latent TB infection and active TB disease:

  • Latent TB infection (LTBI)
    The bacteria are in the body, but the immune system is keeping them “asleep.” People feel well, have no symptoms, are not contagious, and may never become sick. This can only be found with a TB blood test or skin test.
  • Active TB disease
    The bacteria are multiplying and causing damage, often in the lungs. Symptoms can include:
    • Cough lasting three weeks or more
    • Chest pain or trouble breathing
    • Fever, night sweats, or unexplained weight loss
    • Fatigue and loss of appetite
    People with active pulmonary TB can spread it to others.

Medical infographic style illustration comparing healthy lungs and lungs affected by tuberculosis on a screen
TB infection can stay silent for years before becoming active disease — early detection allows preventive treatment.

Getting Tested for TB: Who Should Consider It and What to Expect

Testing for TB in the US is targeted — not everyone needs it. The CDC recommends testing people at higher risk of infection or progression to disease, including:

  • People who have had close contact with someone with infectious TB
  • People born in or who frequently travel to countries where TB is common
  • Residents and workers in high-risk settings (shelters, correctional facilities, some healthcare settings)
  • Individuals with immune-suppressing conditions or treatments

Common tests include:

  1. TB blood test (IGRA)
    A single blood draw; results typically in 1–3 days. Often used in adults because it requires only one visit and is not affected by BCG vaccination.
  2. TB skin test (TST)
    A small amount of fluid is injected under the skin of the forearm; the site is checked 48–72 hours later. Requires two visits.

If either test suggests infection, your clinician may order a chest X-ray and, if needed, sputum (phlegm) tests to see whether TB is active or latent.



Modern TB Treatment: Effective, but It Requires Commitment

TB treatment today is far more effective than it was decades ago, but it isn’t a “quick course” like many other antibiotics. Most people can be cured if they take the right medicines for the full duration recommended by their healthcare team.


Treatment for Latent TB Infection

The goal is to prevent latent TB from progressing to active disease. Common evidence-based regimens include:

  • Once-weekly pills for 3 months (often a combination of isoniazid and rifapentine)
  • Daily rifampin for 4 months
  • Daily isoniazid (sometimes with another drug) for 6–9 months

Your clinician will choose a regimen based on your age, other medications, and underlying health conditions.


Treatment for Active TB Disease

Most people with drug-susceptible TB take a combination of several antibiotics for 4–6 months or longer. During the first weeks of treatment, public health nurses often provide “directly observed therapy” (DOT) or video-enabled check-ins to support adherence and monitor side effects.


“When I was diagnosed with TB, I felt scared and ashamed. Working with the county TB nurse changed everything — she broke down the plan, checked in weekly, and made the long treatment feel manageable.”
— Former TB patient, US, de-identified case account


Common Barriers to TB Control — and How to Overcome Them

Rising TB in the US is not just a microbiology problem; it’s also about access, stigma, and trust. Some of the most persistent obstacles include:

  • Stigma and fear.
    TB has long been associated with poverty, crowded housing, and marginalization. People may fear being blamed or isolated, which can delay testing and treatment.
  • Cost and insurance worries.
    Many TB services in the US are provided at low or no cost through public health departments, but people often don’t know this and avoid care.
  • Long treatment durations.
    Months of medications can be overwhelming, especially for people juggling work, caregiving, or unstable housing.
  • Language and immigration concerns.
    Some individuals worry that TB diagnoses will affect immigration status or lead to discrimination, even though public health programs are focused on care, not enforcement.

Strategies that have helped patients and communities include:

  1. Partnering with trusted community clinics and organizations for TB education and testing.
  2. Using interpreters and culturally appropriate materials to explain latent vs. active TB.
  3. Offering flexible appointment times, reminder systems, and medication delivery.
  4. Publicly framing TB as a solvable medical condition — not a moral failing.

Community health worker talking with a patient at a clinic, representing TB outreach and support
Community health workers and public health nurses play a key role in overcoming stigma and supporting TB treatment.

Practical Steps to Protect Yourself and Your Community

You don’t need to become a TB expert to make a real difference. A few evidence-based steps, especially for those in higher-risk settings, help keep communities safer:

  • Know your risk.
    If you’ve lived in or frequently travel to countries with higher TB rates, or work in congregate settings, ask your clinician whether TB screening makes sense for you.
  • Take persistent symptoms seriously.
    A cough that lasts more than three weeks, especially with weight loss, fever, or night sweats, deserves medical evaluation — particularly if you have TB risk factors.
  • Respond to exposure notices promptly.
    If you get a letter from a school or health department about TB, follow the instructions for testing. These programs are designed to protect you and are usually free.
  • Support those in treatment.
    If a friend, family member, or coworker is being treated for TB, offer practical help (rides, reminders, emotional support). With proper treatment, the vast majority become non-infectious within weeks and can fully recover.
  • Advocate for healthy environments.
    Improving ventilation in schools, shelters, and workplaces can reduce the spread of many respiratory infections, including TB.

Person consulting with a healthcare provider while looking at medical information on a tablet
Simple actions — timely testing, completing treatment, and supporting public health guidance — are powerful tools against TB.

The Science and Policy Landscape: Why TB Still Lags Behind

Even though we’ve known the cause of TB for more than 140 years, progress has been uneven. Compared with other major diseases, TB research has historically been underfunded, leading to:

  • Slow development of shorter, less toxic treatment regimens
  • Limited vaccine options — the current BCG vaccine offers only partial protection and is not routinely used in the US
  • Gaps in rapid, affordable diagnostics in many parts of the world

In recent years, however, there has been renewed momentum. Global initiatives are pushing for:

  1. Shorter, all-oral regimens for both drug-susceptible and drug-resistant TB
  2. New vaccine candidates in clinical trials
  3. Expanded use of rapid molecular tests that can detect TB and resistance markers within hours

For the US, this global progress matters. TB anywhere can eventually affect TB everywhere. Strengthening TB control worldwide — alongside targeted domestic efforts — is one of the most effective long-term strategies for keeping US rates low.



Looking Ahead: Staying Vigilant Without Living in Fear

TB’s resurgence in the US — from high school exposures to rising national case counts — is a reminder that infectious diseases don’t vanish just because we stop talking about them. But it’s also a story of tools that work when we choose to use them: modern diagnostics, effective treatments, and public health systems that can move quickly when a case appears.


If TB touches your life — through a school notice, a positive test, or a loved one’s diagnosis — know this: you’re not alone, and you’re not powerless. Asking questions, seeking timely care, and supporting others through treatment are all meaningful acts that protect your community.


The world’s deadliest infectious disease doesn’t have to stay that way. By combining science, compassion, and steady attention, the US can reverse this uptick and continue the unfinished work of making TB a rarity — not a rising threat — for the next generation.