Kansas is experiencing one of the largest tuberculosis (TB) outbreaks ever recorded in the US, as public health powers at the state and federal level have been greatly curtailed.
Outbreaks like these may become more common and dangerous as officials’ efforts are hamstrung and their communications are limited, experts say.
“You can think of TB outbreaks like a canary in the coalmine of our public health infrastructure,” said David Dowdy, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.
“What causes them to happen is a weakening of our public health infrastructure.”
Since January 2024, there have been 67 active cases of tuberculosis identified in two counties in Kansas – more than the usual case count for the entire state in a year, despite the counties together representing less than 3% of the state’s population, according to US Census data from 2023.
“It’s definitely more than just a little blip,” said Dowdy. “It’s one of the largest outbreaks of tuberculosis that we’ve seen in the country in the past 30, 40, 50 years.”
The state has also detected at least 79 latent cases of TB, in which patients do not display active symptoms but may develop and spread active disease later.
The state is currently monitoring 384 people who are undergoing testing and treatment, officials in Kansas said.
Public health officials in Kansas and from the US Centers for Disease Control and Prevention (CDC) are “working together to mitigate the risk of TB in the community and ensure the safety of all individuals”, Jill Bronaugh, communications director for the Kansas department of health and environment, said in a statement.
But the risk to the general public remains low, she said.
“We are also working with schools and businesses to help prevent the spread of TB by supporting efforts to monitor symptoms and provide education,” Bronaugh said.
It is an uphill battle in a state that has seen public health powers sharply reduced in the wake of the pandemic.
The Kansas governor was banned from closing down businesses during public health emergencies in 2021. And the legislature forbade state and county public health officials from mandating tests, isolation and closures due to infectious disease in 2023.
Tuberculosis tends to spread when people spend a lot of time in crowded conditions such as prisons, jails and homeless shelters. These are also places where people frequently lack access to adequate healthcare, which can make infections more likely.
Other factors such as malnutrition, HIV/Aids and other immune-suppressing conditions put people at greater risk of getting sick.
But what really causes TB outbreaks is the inability for public health professionals to respond, Dowdy said.
“It’s not that we don’t know how to do it,” Dowdy said of treating TB patients and keeping the bacteria from spreading. “It’s about the conditions underlying this that enable these outbreaks to unfold.”
When there is a way to detect the first cases, and there are enough health workers to trace and test contacts and to support patients who test positive, outbreaks can be stopped before they even start.
But when the systems are incomplete or dismantled and there are not enough health workers or resources to go around, “it’s easier for these sorts of things to go undetected for a longer period of time”, Dowdy said.
“The people in Kansas are doing a good job with this. They just don’t have the resources they need,” he said.
At the national level, the Trump administration limited what the CDC and other federal health agencies can do by instituting a communications blackout in its first weeks.
The ban on external communications includes withholding the release of the Morbidity and Mortality Weekly Report (MMWR), a highly regarded epidemiological digest that updates the public and medical practitioners on emerging and continuing outbreaks, among other crises.
On Friday, hundreds of pages were also removed from health agency websites to comply with Donald Trump’s executive order to remove references to race, gender, sexual identity and disability, among other identities. Some of those pages have now been restored, sometimes with edits and omissions because of the order.
Outbreaks such as the one in Kansas speak to the importance of coordination between states and national entities like the CDC, Dowdy said.
“One can only see these sorts of events when you can look from a big-picture perspective, and that’s what our national agencies are there for, but we can only respond to them at a local level, which is what our state and local health agencies are there for,” he said.
“The importance of being able to coordinate between those and maintaining strength at both the national and the state and local levels really can’t be overstated,” Dowdy added. “Disruptions to those systems certainly increase the risk of outbreaks like this occurring.”
Internationally, the in effect dissolution of the US Agency for International Development (USAid) means global outbreaks of preventable illnesses such as TB could increase.
John Green, the author, YouTube star and TB advocate, said he had worked for months on a partnership with private donors, the Philippines and USAid on an $85m project to end TB in two regions of the Philippines.
“It could provide a blueprint for eliminating TB worldwide – except it’s … not happening,” he wrote in a post on Bluesky.
Global outbreaks are the major driver for TB cases in the US.
Although the Kansas outbreak is large, it accounted for less than 1% of all TB cases in the US last year. About two-thirds of cases are detected among people who were born outside of the US, pointing to greater transmission outside of the country.
The current outbreak in Kansas is happening in the same place as a different outbreak detected in 2021-22. Troublingly, the disease strain in that outbreak showed resistance to several TB treatments, known as multidrug-resistant (MDR) TB, which can make outbreaks more challenging to contain.
There is no sign that this cluster of cases shows resistance to treatments – but if MDR-TB were to spread, it might be more difficult to ascertain now.
MDR-TB outbreaks are often detected through notable spikes in CDC monitoring reports, which may be affected by the gag order on US health agencies.
The report on the 2021-22 outbreak in Kansas, for instance, was published in the now quiet MMWR.
