The “White Plague” Is Back: Why Washington Cases Are Soaring

Tuberculosis (TB), once called the “white plague,” is making a comeback in the United States, and Washington state is seeing the effects. The CDC reported 10,260 TB cases nationwide in 2025 (provisional data). This is a slight 1% drop from 2024, but the numbers are still higher than before the pandemic, after nearly 30 years of steady decline. Health officials say TB, which mainly affects the lungs, is still the world’s deadliest infectious disease. Early cases are often missed because the symptoms can mimic those of the flu, RSV, or a lingering cold.

In Washington, the increase has been even more noticeable.

The state had 257 TB cases in 2024, a 17.4% rise from 2023 and the highest number since 2007. Provisional numbers for 2025 show 264 cases, keeping the rate at 3.3 per 100,000 residents, which is a bit higher than the national average. Most cases are found in urban counties such as King, Pierce, Spokane, and Snohomish, but reports have also been made from other areas, including Central Washington.

TB symptoms usually appear slowly and can include a lasting fever, chills, night sweats, unexplained weight loss, tiredness, loss of appetite, a cough that won’t go away, chest pain, and coughing up blood or mucus. When diagnosis and treatment are delayed, antibiotic-resistant strains can develop, making treatment harder. Experts believe the rise in cases is linked to disruptions in screening and care during the pandemic, more international travel and migration, and the reactivation of latent TB infections. About 200,000 people in Washington are estimated to carry the bacteria without symptoms. While TB does not spread easily from person to person in the U.S., certain groups are at higher risk, including older adults, people with weakened immune systems, and those born in countries where TB is more common.

In North Central Washington, the Chelan-Douglas Health District and other providers continue to monitor cases and trace contacts. TB can be prevented and treated with the right antibiotics if caught early, but it is important to finish the full course to avoid resistance. Anyone in Washington who has ongoing respiratory symptoms or classic TB warning signs should contact their healthcare provider for testing. Strong local public health programs are still our best protection against this disease.