Michigan still sees tuberculosis cases, but public health efforts keep numbers low

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Capital News Service

LANSING – Tuberculosis continues to be a health problem in Michigan, but officials say the infectious disease is largely under control in the state.

Numbers from the federal Centers for Disease Control and Prevention, or CDC, show a 5% national increase in cases in 2022, with figures in Alaska, Nevada, South Carolina and Washington state higher than their pre-pandemic numbers; according to a 2023 report.

Newly updated data from the Michigan Department of Health and Human Services shows 149 people were diagnosed with tuberculosis in the state last year, while 2022 saw 120 reported cases in Michigan.

The counties with the most cases were Wayne, Oakland and Macomb. 

Tuberculosis is commonly transmitted through the air from one person to another, according to the CDC.

“It’s transmitted through close personal contact,” said Kellie Brunner, the director of health promotions at the American Lung Association. “You’ve got folks in homeless shelters, folks who are incarcerated, any time you have a fairly large number of people in a small area.”

Brunner said that the disease is primarily transmitted through talking, coughing and singing close to one another.

Once infected, the primary symptoms are a serious cough that lasts three weeks or longer, chest pains or coughing up blood or sputum (phlegm from deep inside the lungs), according to the CDC.

According to Health and Human Services, the state’s numbers are nothing to be anxious about. 

“A lot of people in the United States think that TB is long gone, and that’s because of people in public health who work very hard every day to keep it in check,” Brunner said.

According to Brunner, Michigan is in the lowest incident rate category in the country, with 1.5 cases per 100,000.

“Michigan’s doing a great job – they just have to keep doing it,” Brunner said.

Shona Rodriguez, a department TB epidemiologist, said that, historically, cases have been decreasing overall in Michigan.

“It depends on what years we’re looking at,” Rodriguez said. “We actually saw a 12% decline in cases from 2021 to 2022. But we did see a 24% increase from 2022 to 2023.” 

Rodriguez said that the numbers aren’t alarming, despite the rising number of cases in the 2022-23 period.

“Even if we see an increase in one given year, it’s not necessarily something to be concerned about,” Rodriguez said.

The most significant reason for the fluctuations year to year is that cases can take a while to diagnose, according to Rodriguez.

“For TB, the course of treatment is fairly long,” said Peter Davidson, the department’s TB control manager. “The average time is six months to treat someone.”

The extended process of acquiring symptoms and then being properly diagnosed can create fluctuations in data, Rodriguez said. “It doesn’t necessarily reflect more people having TB in that given year. It just reflects when they got to the correct provider who told them they had TB.” 

Rodriguez said the slight increase nationwide in 2022 may have partially been due to the number of undiagnosed cases and infected individuals who didn’t seek care in 2020 and 2021 due to the COVID-19 pandemic. 

Some population groups, including immigrants, may be more susceptible than others, according to Rogriguez.

“If you look at just the straight-up numbers and rates of TB, there is more TB in other countries,” Rodriguez said. “So it would make sense that someone arriving to the U.S., born in another country, might have a higher risk.” 

Rodriguez said most cases are among people born in the U.S. rather than any group of immigrants.

Another primary reason for susceptibility lies in social and lifestyle factors that may suppress an individual’s immune system, like drug abuse, Rodriguez said.

At the state level, Health and Human Services contracts with a team of expert physicians available for consultations.

Davidson said the department provides services for infected patients. “We refer to them with the catchphrase’ ‘incentives or enablers.’”

Such services are an incentive for those who are infected to stay engaged with their treatment and assist them in overcoming barriers that may disrupt treatment, he said. 

Housing is a major barrier because illness may prevent them from working full-time, Davidson said.

“In fiscal year 2023, we spent almost $71,000 in patient support that would have been a combination of housing, food assistance, groceries and utilities,” Davidson said.

Understanding risk factors is a major way for people to avoid infections and seek treatment, according to Davidson and Rodriguez.

“We can assess trends a little bit better,” Rodriguez said. “We have to look at TB as a whole.” 

Tuberculosis cannot be looked at on an individual scale and must be viewed from a wider perspective, according to Davidson.

“TB is a community disease. It may look like it’s just individual people, but everyone is connected to someone else, and TB hits communities,” Davidson said. “It affects their social and family network. That’s something we’re trying to push more on the messaging.”

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