Other countries, from many of which we've had a recent surge in immigration, have higher incidence rates, esp. among the urban and rural poor who have worse living conditions prior to immigration, worse living conditions than many Americans after immigration, and less access to health care, whether in the US or their countries of origin. Very often immigrants will go back to visit family/friends/etc. in their home countries for a while and pick it up, or new arrivals will spread it.
Incidence in the US has risen since the big groundswell of immigration started in what, 2019, and it's not a Trump/Biden "thing". Not a huge rate increase, but noticeable enough for the CDC to take note.
https://www.cdc.gov/tb-surveillance-report-2023/summary/national.html
And it's not just Alabama.
A nearby school district reported two cases recently--notice that they're siblings, TBs most easily spread from close, not casual, contact.
In 2021, Houston's incidence rate was the same as New York City's and lower than San Francisco, San Diego, and Los Angeles', so don't bother with the "yeah, that's backwards Texas." Unless you follow it up with "and backwards New York City and San Francisco and Los Angeles". Just sayin'.
The only person I've ever known with TB was in the late '70s or early '80s, and he was Mexican by citizenship. He was sick and had missed work intermittently for a while. Finally the disease was IDed, he was quarantined and we all had to have tuberculin skin tests. No idea how long he'd been infected--at least a month or so, given his sick days--but the dozen people that were his coworkers all tested negative, myself included. Then again, we worked for a small company in a large warehouse, not a confined office, and we had to pull the components for the kits we assembled, assemble them, shrink wrap the kits and then box them up for shipment.
I wouldn't be surprised if tuberculin skin tests weren't required at some point for public school students in some areas--there'd be an outcry, but I remember them every once in a while when I was a public school student back in the '60s and early-ish '70s. It's one of the ways "we" brought down the incidence rate decades ago.
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