Understanding Tuberculosis (TB): Symptoms, Risks, and Infection Control Guidelines

Tuberculosis (TB) is an infectious disease caused by a bacteria called Mycobacterium tuberculosis. Mycobacterium tuberculosis is generally found in the lungs but can attack any part of the body, such as the brain, kidneys, or spine.

Types of TB

There are two types of TB: active and latent (inactive). Active TB disease is very contagious and can cause symptoms such as coughing, fever, and fatigue. Other symptoms can include coughing for more than three weeks, coughing up mucus or blood, unintentional weight loss, night sweats, or chills. The disease is spread through the air when an infected person coughs, sneezes, speaks, or sings. TB can linger in the air for several hours and doesn’t require close contact to transmit. It is not spread by shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, or kissing. If not treated, TB disease can be fatal. People with active TB disease are most likely to spread TB germs to people they spend time with every day or for prolonged periods.

TB can live in the body without making one sick. This is called latent TB infection. Latent TB is not contagious and typically causes few or no symptoms. Most people with latent TB never experience symptoms, however, without treatment one in 10 people with latent TB will develop TB disease.

Cases of TB in U.S.

As of December 14, 2024, there were 8,040 cases of TB in the United States. The states with the most TB cases in 2024 were California, New York, and Texas. The U.S. has one of the lowest rates of TB in the world. However, there is an ongoing outbreak of TB in two counties in Kansas. As of January 31, 2025, there have been 67 cases of active TB and two deaths in these counties. This is one of the largest outbreaks of TB in the U.S. in the past 30-40 years. It should be noted that this outbreak has been going on for at least a year, possibly longer.

TB Vaccine

There is a vaccine for TB but, in the U.S., it is not routinely recommended for healthy children due to the low risk of TB infection. However, the vaccine may be considered for certain high-risk individuals, such as those with HIV or who have been exposed to TB. The vaccine can give a false positive TB skin reaction.

Be sure to tell your health care provider if you had the vaccine.

TB Infection Control Plan

Healthcare facilities must have a written TB infection control plan. The plan includes ways for prompt detection of infectious patients: through medical histories, being aware of the symptoms, education for all employees, and ways to manage the patients and/or healthcare workers who have suspected or confirmed TB disease.

Screening for TB in New Hires

As part of the TB infection control plan, the CDC guidelines recommend that all newly hired employees who are at risk of exposure be screened for TB disease, unless they have a previous positive tuberculin skin test or have been treated for latent TB disease or TB disease. Newly hired employees must complete a TB risk assessment, symptom screening, and be offered a TB test. The TB test is either a two-step tuberculin skin test (TST) or a blood assay TB test (BAMT). If the worker tests positive, they should be further evaluated to exclude a diagnosis of TB disease.

The CDC does not recommend annual TB testing for healthcare workers unless there is a known exposure or there is ongoing transmission in the healthcare setting. State and local regulations may differ to meet local needs and should always be followed.

Exposure to TB

If a healthcare worker has a known exposure to TB, they should report the incident to the safety officer. A worker who tested negative previously should be tested immediately and test again 8-10 weeks after the exposure. The same type of test (TST or BAMT) that was done at hire, should be used for any follow-up testing. This will produce consistency in the testing. Because local needs may be different than these recommendations, the local health department must be contacted immediately for guidance.

A worker who had a previous positive TB test result does not need to be re-tested. They would be screened for symptoms. If asymptomatic, evaluate for TB disease. Again, local needs may differ, contact the local health department for further recommendations and guidance.

If you are in a facility that provides treatment for patients with TB, there are additional precautions necessary. These are called transmission-based precautions and can be found in the CDC guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities.