Tuberculosis Cases & Costs Rising in Johnson County, Iowa
The resurgence of tuberculosis (TB) is placing a growing strain on public health resources, particularly at the local level. In Johnson County, Iowa, the cost of containing the disease has risen sharply in recent years, mirroring a national trend. Even as TB was once considered a disease of the past in many parts of the world, increasing cases and associated expenses are forcing health departments to reassess budgets and strategies.
Rising Costs of Containment in Johnson County
Johnson County’s Public Health Department has seen the cost of TB contact tracing and surveillance climb significantly. Expenses surged from $17,000 in 2020 to $65,000 last year, a nearly fourfold increase. This rise isn’t simply about identifying more cases; it reflects the intensive work required to manage each one. That work includes daily visits to patients’ homes to ensure medication adherence and, in some instances, covering the cost of hotel rooms for quarantine. A substantial portion of the increased spending, around $13,000 last year, is attributed to language translation services, as many of the new cases are occurring within the county’s immigrant communities.
The financial pressure is compounded by a recent decision from the state level. Johnson County was informed that the growing number of cases had made state financial assistance for home visits unsustainable, shifting the full cost of these essential services onto the county. Danielle Pettit-Majewski, director of the Johnson County public health department, expressed surprise at this development, calling it “kind of dumbfounded” and “surprising.”
A National Trend: TB Cases on the Rise
Johnson County’s experience isn’t isolated. Nationwide, TB cases have been increasing since 2021. Data from the Centers for Disease Control and Prevention (CDC) show that in 2024, there were 10,347 reported cases, an 8% increase from the 9,622 cases reported in 2023. This represents the highest number of TB cases recorded since 2011. Thirty-four states and the District of Columbia all reported increases in TB case counts and rates between 2023 and 2024. The case numbers for 2025 won’t be available until the end of March, but experts are closely monitoring the situation.
The increase in cases is particularly concerning since it follows years of decline. TB is caused by bacteria (Mycobacterium tuberculosis) that most often attack the lungs, but can similarly affect other parts of the body. Transmission occurs through the air when a person with active TB disease coughs, speaks, sings, or sneezes. We find two TB-related conditions: latent TB infection and active TB disease. In latent TB infection, the bacteria are present in the body but inactive and cause no symptoms. People with latent TB infection are not infectious. However, if left untreated, latent TB infection can progress to active TB disease. Active TB disease causes symptoms and can be spread to others.
Understanding Latent TB Infection and Active Disease
The rise in diagnoses since 2020 includes a tripling of latent infections in Johnson County, from 27 in 2020 to 90 last year. This increase in latent cases is a key indicator, as it suggests a larger pool of individuals who could potentially develop active TB disease in the future. While people with latent TB infection don’t sense sick and can’t spread the disease, they require treatment to prevent progression to active disease.
It’s important to note that a TB vaccine is not currently available in the United States. The Bacillus Calmette-Guérin (BCG) vaccine is used in many countries with high TB prevalence, but its effectiveness varies, and it’s not routinely recommended in the U.S. Because of its limited impact on preventing TB in people who have been exposed.
Factors Contributing to the Resurgence
Several factors are likely contributing to the increase in TB cases. Vaccine hesitancy and rising exemption rates for other communicable diseases are creating an environment where infectious diseases can spread more easily. Disruptions to healthcare access during the COVID-19 pandemic may have led to delays in diagnosis and treatment. Some experts also suggest that changes in immigration policies may be playing a role, potentially discouraging individuals from seeking care. The Mercury reports that some TB experts believe the Trump administration’s immigration crackdown last year might have dissuaded some people from seeking care, leading to fewer recorded diagnoses.
Public Health Response and Surveillance
The Iowa Tuberculosis (TB) Control Program, part of the Iowa Department of Health & Human Services, is responsible for minimizing the spread of TB within the state. The program collaborates with clinicians and local public health agencies to promote effective diagnosis and treatment. The program publishes annual data on active TB cases, broken down by county, and incidence rates. This data is crucial for tracking trends and identifying areas where interventions are needed. You can find the latest data on the Iowa HHS website: https://hhs.iowa.gov/health-prevention/disease-information/tuberculosis
The CDC also maintains national surveillance systems to monitor TB trends and provide guidance to state and local health departments. The CDC’s Division of Tuberculosis Elimination works to prevent the spread of TB through research, technical assistance, and funding for state and local programs. More information can be found on the CDC website: https://www.cdc.gov/tb/index.htm
What Comes Next: Ongoing Evaluation and Adaptation
The situation with TB is dynamic, and public health agencies are continuously evaluating the data and adapting their strategies. The Johnson County Health Department is currently focusing on internal cost-shifting and identifying savings to address the increased financial burden. However, they are prepared to request additional funding from the county supervisors if an outbreak occurs. Nationally, the CDC is likely to continue monitoring TB trends closely and providing guidance to state and local health departments. Further research is needed to understand the underlying causes of the resurgence and to develop more effective prevention and treatment strategies. Individuals concerned about potential exposure to TB should consult with a healthcare professional.
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