It’s going undetected.
Tuberculosis (TB), often viewed as a disease of the past, may be regaining ground due to the disruptions caused by the COVID-19 pandemic, according to a new study. Researchers have found that although TB is most commonly found in prisons today—where confined spaces facilitate transmission—cases were significantly underdiagnosed during the pandemic. The decline in reported cases, particularly in prisons, does not reflect a true drop in infections but rather a decrease in detection and reporting.
Amy Zheng, a doctoral student at the Boston University School of Public Health and co-lead author of the study, emphasized the danger of undetected TB within correctional facilities. She noted that failure to diagnose TB in high-risk environments, like prisons, poses a threat not only to incarcerated individuals but also to the general public when inmates are released. The concern was underscored by a recent confirmed TB case at a high school near Chicago, reigniting public health awareness of the disease’s lingering presence.
The study analyzed data from nearly 5 million incarcerated individuals across 47 countries in Europe and the Americas from 2010 to 2022. Despite stable incarceration rates, TB diagnoses dropped dramatically—by up to 100% in parts of Central and North America and nearly 87% in Western Europe. This discrepancy suggests many cases may have gone undetected due to limited testing capacity during the pandemic. In contrast, TB cases in the general population initially declined in 2020 but rebounded in the following years, highlighting the unique detection gap within prisons.
The study also noted a sharp drop in TB reporting in several countries, including Slovakia, El Salvador, and Bulgaria. At the same time, global TB prevention efforts are facing major financial setbacks due to cuts in U.S. foreign aid, especially from the dismantling of USAID’s programs that previously played a critical role in global TB control. Researchers, including assistant professor Leonardo Martinez, warn that these funding reductions could derail progress made since 2000, which the World Health Organization credits with saving nearly 80 million lives.
Ultimately, the researchers stress that without renewed commitment and funding, the global goal of ending TB by 2030 is in jeopardy. They call for the international community to set new, achievable targets and seek alternative funding strategies to sustain progress in TB prevention and treatment—particularly within vulnerable populations like those in prisons.
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