Tuberculosis in the United States: Spread, Causes, and Solutions
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a highly infectious bacterial disease that primarily affects the lungs but can also target organs like the kidneys, spine, or brain. Once a leading cause of death in the United States, TB cases had declined significantly due to robust public health measures.
However, in 2025, a concerning outbreak has emerged, with 10,312 cases reported in the first three quarters alone, surpassing the 9,624 cases for all of 2023. This resurgence has raised alarms about its causes and the best strategies to curb its spread. While multiple factors contribute, mass immigration from high-TB-burden countries is a significant driver. Addressing this outbreak requires immediate medical interventions and long-term policy adjustments to safeguard public health.
The 2025 Outbreak and Potential Causes
TB spreads through airborne transmission when an infected person coughs, sneezes, or speaks, releasing bacteria into the air. In 2025, non-U.S.-born individuals account for 78% of TB cases, with hotspots in states like California, Texas, and New York. Migrants from high-TB-prevalence regions, such as sub-Saharan Africa, South Asia, and Central America, often carry latent TB infection (LTBI), which can remain dormant for years before progressing to active, contagious TB. Recent data shows that non-U.S.-born individuals have TB incidence rates up to 15 times higher than U.S.-born populations, with a spike in cases within the first year of arrival.
Mass immigration, both legal and illegal, has been linked to the 2025 outbreak. Reports from early 2025 highlight that relaxed border policies and inconsistent health screening protocols have facilitated TB spread. For example, in California, 87% of TB cases this year are tied to LTBI reactivation among foreign-born individuals, with nearly half occurring more than 15 years after arrival.
Undocumented migrants often bypass screening, and even legal immigrants with LTBI are admitted without mandatory treatment. Compounding the issue, disruptions in TB control programs during the COVID-19 pandemic and global TB increases have strained U.S. public health systems, but migration remains a key factor due to higher TB burdens in migrants’ countries of origin.
Short-Term Solutions: Medical Treatment
Immediate action to curb the 2025 TB outbreak relies on aggressive screening, diagnosis, and treatment. The U.S. uses interferon-gamma release assays (IGRAs) and chest X-rays to screen for TB, particularly among immigrants and refugees. Those diagnosed with active TB require a six-to-nine-month regimen of multiple antibiotics, often administered through directly observed therapy (DOT) to ensure compliance. For LTBI, shorter preventive treatments (three to four months) can reduce the risk of progression to active TB. The CDC estimates that up to 13 million people in the U.S. have LTBI, making widespread screening urgent.
For high-risk groups, such as newly arrived immigrants and those in detention facilities, rapid screening at entry points has proven effective. In 2025, pilot programs in border states have detected asymptomatic TB cases through radiographic screening, with 82% of cases in detention centers identified this way. Treatment costs remain high, averaging $22,000 per active TB case and up to $200,000 for multidrug-resistant TB (MDR-TB). Programs like the CDC’s 2025 TB Emergency Response Fund provide free treatment to improve access, but challenges persist, particularly among migrants with limited healthcare access or distrust of authorities.
Long-Term Solutions: Enhanced Vetting and Slower Immigration
While medical interventions address the immediate crisis, long-term TB control requires addressing root causes through immigration policy reform. Current screening for legal immigrants and refugees, mandated by the U.S. Department of State, includes chest X-rays for adults and TB tests for children from high-burden countries. However, these measures miss undocumented migrants, and legal entrants with LTBI are often admitted without follow-up. Strengthening vetting by mandating TB testing for all entrants, including temporary visitors and undocumented migrants, could reduce LTBI cases entering the U.S.
Slower, more controlled immigration would allow health authorities to manage screening and follow-up more effectively. In 2025, only 68% of at-risk immigrants completed post-arrival TB evaluations, down from 71% in prior years, due to overwhelmed health systems. Expanding mandatory LTBI treatment before granting residency could prevent reactivation, as could improving coordination with local health departments. Models like Minnesota’s 2025 TB Task Force, which ensures treatment access for all migrants regardless of status, show promise. Additionally, scaling up community-based screening and culturally sensitive outreach can boost compliance without stigmatizing vulnerable populations.
Balancing Health and Ethics
Tighter vetting and slower immigration must balance public health with ethical considerations. Coercive measures or restrictive policies risk alienating migrants, many of whom face socioeconomic challenges or limited healthcare access in their home countries. Voluntary screening, informed consent, and non-identifying TB clinics, like those piloted in Texas in 2025, can mitigate harm while protecting communities. The World Health Organization emphasizes that TB control in low-incidence countries hinges on addressing migrant health equitably.