9 people hospitalized, 1 dead in California TB outbreak

By Lisa Marie Basile | Fact-checked by Barbara Bekiesz
Published May 9, 2024

Key Takeaways

  • City health officials in Long Beach, CA, declared a public health emergency due to a tuberculosis (TB) outbreak on May 2, 2024.

  • The outbreak stems from a small hotel, and it is thought that 170 people were “likely” exposed to TB. In total, 14 were identified as having TB—of those, nine were hospitalized and one died. 

  • Experts say TB can be contracted after prolonged exposure to someone with the disease; TB outbreaks require a high degree of vigilance and suspicion on the part of healthcare providers, as symptoms often mimic those of other diseases.

Long Beach, California’s City Health Officer, Anissa Davis, MD, declared a public health emergency May 2, 2024, after the city was made aware of a localized tuberculosis (TB) outbreak, according to a press release posted by the City of Long Beach Public Information Office.[] 

In an email to MDLinx, Jennifer Rice Epstein, public affairs officer of the Long Beach Department of Health and Human Services, said, “The city council ratified the emergency last night [May 7]. The numbers remain the same [as of May 8].”

About the May 2024 outbreak

TB is caused by the bacterium Mycobacterium tuberculosis, which mainly attacks the lungs (as well as other parts of the body). It is the 13th leading cause of death worldwide, according to the World Health Organization.[]

According to the Long Beach press release, the outbreak stems from a single room occupancy hotel in the city, where 14 people (as of April 29) were identified as having TB. Of the 14, nine were hospitalized and one has died as a result. HIPAA regulations prevent identifying details (both of the patients and the hotel) from being made public.

The city’s investigation suggests that an estimated 170 people were “likely” exposed to TB as a result of this particular outbreak, and their health department has reportedly performed symptom reviews, blood or skin tests, and chest x-rays for people who were exposed to TB. They expect the number of both cases and contacts to rise.

For this reason, elevating the circumstance to a public health emergency enables the local health department to better manage and control the outbreak. 

“The facility is a private hotel not operated by or contracted with the City of Long Beach,” the release clarifies. “People who were staying at the hotel at the time or could have otherwise been exposed have been or will be contacted by the Health Department.”

Who is most at risk?

City officials call the outbreak “isolated to a distinct population” with low risk to the general public.

“The population at risk in this outbreak has significant barriers to care including homelessness and housing insecurity, mental illness, substance use and serious medical comorbidities,” the release states.

Sarah Park, MD, an infectious disease physician and the medical director at Karius in Redwood City, CA, tells MDLinx, “TB is an airborne infectious disease, meaning it can spread through the air when an infected person coughs, sneezes, or speaks. However—unlike some other respiratory infections—TB spreads more with prolonged exposure to infected people you are with every day in close quarters or congregate within settings like the affected hotel in Long Beach.”

Outbreaks like these often occur in specific populations, too—including patients who are immunosuppressed, people who use drugs, healthcare workers, or unhoused populations, explains Fady Youssef, MD, a board-certified pulmonologist, internist, and critical care specialist at MemorialCare Long Beach Medical Center.

The CDC says incidences of TB have been rising. For 2023, the number of provisionally reported TB cases in the United States was 9,615, up from 8,895 in 2019—the most recent pre-pandemic year.[]

According to Dr. Park, “It's also important to note that most people who become infected with the TB bacteria do not go on to develop active disease. Their immune system contains the infection in a latent state [known as latent TB infection, or LTBI]. They should still receive preventive antibiotic treatment to ensure the infection does not reactivate later on, especially if their immune system is ever compromised.” It is thought that as many as 13 million Americans may have a LTBI.[]

Dr. Youssef says outbreaks could be rising due to people spending a lot more time indoors, homelessness, and immigration from endemic areas. According to the CDC, TB rates in 2023 were highest in people born outside the United States.[]

Both close and casual contacts are at increased risk of acquiring the disease from someone who has TB, Dr. Youssef says, but generally prolonged exposure over several hours increases the risk even more.

Detection challenges

Hallmark symptoms of TB include fever, fatigue, night sweats, and coughing or other respiratory symptoms, like chest pain. 

“Some of these symptoms can be missed because they're constitutional,” Dr. Youssef tells MDLinx. “In patients that have underlying disease, it is hard to tease out.”

Dr. Youssef recommends looking for evidence of fever, unclear cause of illness, and presence of risk factors—such as being immunocompromised, having a contact with TB, spending time in a correctional facility, or experiencing homelessness.

He says any healthcare provider with a high degree of suspicion should test their patient immediately.

Dr. Youssef adds that for healthcare workers who are at risk of exposure, implementing airborne precaution is key, as is involving public health authorities. Dr. Park remains optimistic. “The good news is that TB is treatable with antibiotics in most cases,” she says. “While the public and clinicians should remain aware and vigilant, we have effective tools to diagnose, treat, and ultimately control this outbreak.”

What this means for you

Long Beach, CA, declared a public health emergency due to a localized tuberculosis outbreak originating from a single room occupancy hotel, with 14 cases identified and one death. The outbreak primarily affects vulnerable populations such as the homeless, those with housing insecurity, and individuals with medical comorbidities. Health authorities are conducting investigations and implementing measures to control the spread, emphasizing the importance of early detection and treatment, especially among at-risk groups.

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