TB Cases In LA County Are Rising. Here's Why

After declining for over a decade, tuberculosis cases in Los Angeles County have ticked up each year since 2020.

Cases rose more than 18% in that time. The L.A. County Department of Public Health recorded 542 cases last year, compared to 458 in 2020.

“We are definitely one of the hotspots, in California and the United States,” said Dr. Julie Higashi, director of L.A. County’s tuberculosis control program.

How serious is this?

Tuberculosis may seem like a relic of the past in the U.S. and other wealthy countries, yet it still kills more people worldwide than any other infectious disease besides COVID-19 — with about 1.6 million people dying from TB annually.

“It’s the No. 1 infectious disease killer in the world. And a fourth of the world’s population is infected,” Higashi said.

Since 2020, TB rates have steadily crept up in L.A. County.

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Courtesy of the L.A. County Public Health Department

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Not everyone infected with the TB bacteria becomes sick or even knows they have it. Higashi said most of the people who test positive in L.A. have latent tuberculosis. That’s where the bacteria lives in the body without making the person sick, and they are not contagious. Health officials estimate more than 685,000 people in L.A. County have latent TB.

One in 10 develop active tuberculosis, with symptoms you’d associate with tuberculosis patients in movies, such as hacking, bloody coughs, wheezing breaths and a pale complexion. They can spread the bacteria by coughing, talking or even laughing. Both stages are treatable with antibiotics and curable, but it’s best to catch it early.

“About 80% of TB cases in L.A. County are preventable,” Higashi said.

Why are TB cases rising?

To explain the historically high numbers, Higashi points to L.A. County’s gigantic population of more than 10 million, as well as being an immigration center for people coming to the country.

“We have a lot of people traveling internationally, coming in and out of the country, we have a large population of people experiencing homelessness, a large incarcerated population,” she said.

Dr. Julie Higashi, director of L.A. County’s tuberculosis control program, calls TB "a disease of humanity."

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Jackie Fortiér / LAist

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Higashi blames the pandemic for the recent rise in cases, since reduced access to medical care may have prevented some infections from being identified. People are also now traveling internationally again, with many traveling from L.A. to Central and South American countries, as well as Southeast Asia, all parts of the world with high tuberculosis rates.

Higashi also noted that many people in L.A. County live “binational lives” and travel frequently to Mexico and other countries where the disease is endemic.

According to the Los Angeles County Department of Health, which divides the region into districts, the Alhambra, Central and South districts have the highest TB rates in Los Angeles County.

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Courtesy of the Los Angeles County Department of Public Health

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That’s why TB cases in the county are concentrated in areas with historically high immigrant communities in the Alhambra, Central and South areas. Public health focuses on their screening efforts in these areas.

What resources are available in LA?

Today, immigrants and those seeking asylum in the U.S. have to take a blood test that detects any tuberculosis infection, but in the past it was just an X-ray, which doesn’t show a case where the bacteria is dormant. In L.A. County, 67% of TB cases are in patients over 45 years old.

“Many people as they get older will reactivate if their immune system is disrupted by some other medical condition,” Higashi explained. “We really want to get to as many people as possible before the progression happens.”

The uptick in cases since 2020 is a reminder of how important tuberculosis screenings are, Higashi said.

She pointed to county-based clinics, as well as public health field teams that do contact tracing investigations that offer screenings and treatment. Doctors should also consider testing for tuberculosis if they have a vulnerable patient.

“We also have centralized program resources to support hospitals and other providers to find and treat tuberculosis. I think we’ve done a good job of finding and treating those cases proactively,” Higashi said.

March 24 is World TB Day. Four local landmarks — LA City Hall, the 6th Street bridge, Union Station and the entrance to LAX — will be lit red to raise awareness.