Kansas’ response to TB outbreak challenged by lack of resources
Key takeaways:
- Sixty-seven cases and two deaths have been reported in an ongoing Kansas TB outbreak.
- Officials initially said it is the largest outbreak in U.S. history but clarified it is the largest over the span of 1 year.
An unprecedented yearlong outbreak of tuberculosis in Kansas has officials and residents concerned about lack of resources and additional cases that may occur under the radar.
For more than a year, the Kansas Department of Health and Environment (KDHE) has been responding to an ongoing tuberculosis outbreak that began in January 2024.
As of Jan. 31, 2025, 67 cases of active TB and two deaths associated with the outbreak have been reported, though KDHE told Healio that a total of 384 patients associated with the outbreak are at various stages of TB testing, diagnostics and treatment. The agency said that 35 patients have completed treatment and are considered cured, and “most” of the patients are no longer considered infectious to others or are isolating to avoid additional infections.
Initially, officials claimed this was the largest outbreak in U.S. history but have since specified it is the largest outbreak “over the span of 1 year” since CDC began reporting cases in the1950s.
“It is important to note that this outbreak is ongoing, therefore, cannot be compared to previous TB epidemics or outbreaks that have been tracked over many years and/or have been declared over,” the KSHD said in a statement.
The CDC told Healio that two other recent outbreaks were larger — a 2014-2017 outbreak during which 170 cases and more than 400 cases of inactive TB were detected and a 2021 nationwide outbreak 113 TB cases after the surgical implantation of contaminated bone allografts.
Although this outbreak is larger than what is typically observed in the United States, officials said the risk for the general public remains low. Despite this, however, concern from surrounding communities and health officials continues to grow as several factors have complicated the outbreak and outbreak response.
Thomas Moore, MD, FACP, FIDSA, clinical professor of medicine at the University of Kansas, Wichita, told Healio that this outbreak occurred “largely under the radar” because TB is generally not suspected in states that typically have a low number of cases.
“So, you get into a state like this, where TB has a very low number of cases — certainly less than 100 all year — and you have people who have developed pneumonia and respiratory [infections] in the winter months. Just playing the odds, the most likely explanation is going to be a bacterial pneumonia,” he said.
These patients are then treated with routine antibiotics that do not improve their condition, creating opportunities for additional exposures and infections to occur. He said it’s only after this that a TB diagnosis is made or suspected.
“The whole state is concerned about the outbreak, but I'm also getting a lot of calls from outlying communities wondering if somebody could be connected to the outbreak,” Moore said. “In general, it's an outbreak that's been hampered by both lack of resources from the on the state level ... and the public health department's ability to respond to outbreaks.”
Moore explained that legislation surrounding infectious disease outbreaks and response may have also contributed to continued transmission, including 2021’s Senate Bill 14, which he said “essentially banned” the governor from closing down businesses for a public health emergency.
These legislatures, Moore said, have “hamstrung the government, the governor and the public health department's ability to respond to outbreaks.”
“So, that's the setting for this outbreak,” Moore said.
References:
- Current tuberculosis outbreak in Kansas City, Kansas, metro area. https://www.coronavirus.kdheks.gov/CivicAlerts.aspx?AID=1436. Published Jan. 31, 2025. Accessed Feb. 10, 2025.
- Kansas register: Volume 40, Issue 3A, January 25, 2021: Senate Bill No. 14. https://sos.ks.gov/publications/Register/Volume-40/Issues/Issue%203A/01-25-21-48820.html. Published Jan. 25, 2021. Accessed Feb. 10, 2025.
Perspective
Back to TopThere has been broad media coverage about this outbreak in the past few weeks, both locally and nationally (including NBC nightly news), with one headline “Largest tuberculosis outbreak in U.S. history hits Kansas,” which has now been tempered. In TB outbreak investigations, media coverage is a double-edged sword. On the one hand, fear and anxiety to the general public may be promulgated by the news without proper context. On the other hand, people can learn that TB is still around, when and where they should seek medical attention, and that it can be successfully treated and prevented with effective medications.
What do we know about this outbreak? Compared with the 52 and 46 cases of active TB in Kansas reported to the CDC in 2022 and 2023, respectively, the 67 cases diagnosed in Wyandotte and Johnson counties from Jan. 1, 2024, through Jan. 31, 2025, is definitely an increase in incidence, albeit modest. Of note, looking at the epidemic curve on the KDHE website, the number of cases peaked in the summer of 2024, and only four cases have been reported so far in the past 4 months, with over 300 in various stages of evaluation and treatment. This has clearly been a significant problem in the Kansas City metro area, with a broad spectrum of illness and two deaths, and concern throughout the state, as noted by Dr. Moore. However, this accounts for less than 1% of cases of the approximate 9,000 cases in the U.S. that will be reported to and tabulated by the CDC in 2024 (9,615 in 2023). We do not yet know about the dynamics of this outbreak, ie, demographics and at-risk populations affected, and the proportion of cases that are due to recent local transmission vs. reactivation from prior latent TB infection. All isolates of Mycobacterium tuberculosis from newly diagnosed cases in the U.S. undergo genotyping by whole-genome sequencing by the CDC, and when linked to epidemiologic investigations, they are invaluable in elucidating chains of transmission, as occurred in the aforementioned outbreak in Atlanta’s homeless shelters and the nationwide epidemic due to contaminated bone allografts.
When will we learn more to better understand the Kansas TB outbreak? It may be later rather than sooner. In the current environment of federal government chaos, misinformation, xenophobia, serious threats to funding for medical research and public health, muzzling of the CDC and other future uncertainties, it is tough to say.
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