Why doesn’t the public know more about the troubling tuberculosis outbreak in eastern Kansas?

The Kansas Department of Health and Environment (KDHE) is tracking 384 individuals with suspected tuberculosis in the Kansas City metro area — at least 67 have an active infection, and two have died. While Kansas public health officials called it the largest U.S. concentration of the disease since recording began in the 1950s, the U.S. Centers for Disease Control and Prevention has refuted this, citing two larger episodes in the past.

But the relative size of the outbreak is irrelevant. Kansas numbers continue to grow, and Dr. William Schaffner, infectious disease professor at the Vanderbilt School of Medicine, confirmed with Today.com: “It’s a substantial outbreak of tuberculosis.” Kansas state health agency spokesperson Jill Bronaugh said: “It is important to note that this outbreak is ongoing, therefore, cannot be compared to previous TB epidemics or outbreaks.”

Despite this, virtually nothing is known about the Kansas outbreak of a disease that recently surpassed COVID-19 as the leading infectious-disease cause of death in the world. The term “outbreak” typically refers to a common source of infection with resulting local spread. In this case, there is virtual silence from the CDC and local public health officials on demographic details that in the past would have been mandatory reporting: age, sex, race, risk factors, outbreak epicenter and how spread occurred. Although those numbers are obviously available, neither the CDC nor the KDHE has released pertinent information about the affected populations. “Of course, that’s intriguing and we would like to know that from a public health point of view,” Schaffner said.

Health officials say the risk to the general public is low, which is reassuring but not completely true, as they know. Tuberculosis, spread by air, is not as contagious as COVID-19, and no risk of transmission exists unless people are exposed to an infected patient, especially in closed spaces or at close quarters, by breathing the same air. There may be no need for widespread quarantines or other elaborate precautions, but an infected patient waiting for a hot dog on the concourse at the AFC championship game in Kansas City would have presented a risk to other fans.

The reason more information is not being released may be political. Wyandotte and Johnson counties, which comprise a large part of the Kansas City metropolitan area, have the greatest number of reported tuberculosis cases, and both counties have significant immigrant populations, primarily from Mexico, Latin America and Southeast Asia. In 2023, 75% of the tuberculosis in the U.S. occurred in non-U.S.-born residents. Until more information is available, a reasonable speculation — and it remains speculation — is that this outbreak occurred primarily in immigrants.

If that proves true, both Democrats and Republicans are complicit in withholding information from the public. Hoping to control what goes out, the administration of President Donald Trump has placed a temporary embargo on the publication of the leading CDC scientific journal Morbidity and Mortality Weekly Report (MMWR), the outlet where tuberculosis details would ordinarily be disseminated publicly. MMWR had published weekly since 1960 — until the last two weeks. Whatever its political ramifications, silencing the MMWR undercuts public health awareness about all manner of risks. An outbreak in an immigrant population has important implications for screening of new arrivals and other immigration policies.

There is no good rationale for health officials failing to identify an outbreak in immigrants, if that’s the situation here. CDC fear of a high-handed reaction from the White House would be a weak excuse. Schaffner is correct that the information is important as health officials try to halt the spread of TB, even if disclosure could be misinterpreted as demonizing immigrants and be “weaponized” against them. Studies paid for by taxpayers belong to the public. It is improper and anti-scientific to withhold the findings, no matter how distressing they are.

Historian John Green has just completed a book on the history of tuberculosis, “Everything is Tuberculosis.” He writes that tuberculosis has been around for 3 million years, and in 2022, it killed more people worldwide than malaria, typhoid, cholera, homicide and war combined. Since 1990, tuberculosis rates in the U.S. had been dropping, the result of aggressive control programs and anti-tuberculous drugs. Beginning in 2020, rates have risen every year. It is still not a major threat in the U.S. but soon might be.

Whatever the truth of what’s happening in Kansas, federal and state health officials owe the media and citizens a truthful explanation. Each passing day of virtual silence heightens suspicions — fair or not — that someone is playing politics with a lethal disease.

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Dr. Cory Franklin is a retired intensive care physician and the author of “ The COVID Diaries 2020-2024: Anatomy of a Contagion as it Happened.”

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