Harris County’s TB Rate Is Nearly Double the Nation’s. What Houston Parents Can Do.

Texas already has one of the highest tuberculosis rates in the country, and Harris County’s is higher still. A recent Harris County Public Health report shows 5.5 active TB cases per 100,000 people in 2024, compared with 4.1 across Texas and 3.1 nationally that same year. With a new school year on the horizon and classrooms built around close contact, it makes sense to ask what this means for your family.

Earlier this year, we shared what Houston families need to know about tuberculosis. The good news hasn’t changed. TB is preventable, treatable, and curable when caught early. Dr. Neelima Kale, a board-certified family medicine physician and Legacy Community Health’s Senior VP of Clinical Services, offers additional insight here on the questions Houston parents are asking most.

How does TB actually spread in a school setting?

TB is airborne, but it doesn’t move the way a cold or the flu does. The bacteria travel through tiny droplets when a person with active TB disease coughs, sneezes, sings, or speaks, and spreading it usually takes prolonged close contact in an enclosed space.

That means everyday school interactions are not the threat parents often picture. “Casual contact like passing someone in the hallway, shaking hands, or sharing utensils does not spread TB,” says Dr. Kale, who hears this confusion often. A quick brush past in a crowded hallway or a shared snack at lunch won’t put your child at risk.

What does matter is time spent together in close quarters like classrooms, buses, and locker rooms. The county report also flagged five ZIP codes (77032, 77002, 77011, 77074, and 77009) with TB rates well above the county average.

Four are in or next to neighborhoods Legacy serves through our Southwest, East End, Fifth Ward, and Montrose clinics. The risk to any one child is still low, but knowing how the disease moves helps you act early.

What do parents most often get wrong about TB?

The biggest misconception, according to Dr. Kale, is that TB is a disease of the past. When people picture it at all, they tend to imagine old TB sanitariums and the deaths once called consumption. “In reality, TB is very much present, and the case count is rising,” she says.

Another common mix-up is what a positive test means. A positive screening result usually points to TB exposure. Exposure is common, it often causes no symptoms at all, and it is still important to complete the recommended preventive treatment. As Dr. Kale explains, “While you do need treatment, you are not contagious and will feel perfectly healthy.”

Active TB disease is different and much less common. It does cause symptoms and needs a more involved course of treatment.

What symptoms should parents watch for?

Most coughs and bouts of fatigue at this age turn out to be a common virus, Dr. Kale notes, not TB. Active TB disease looks different. Watch for the following.

• A cough that lasts two weeks or longer, especially one that produces mucus
• Coughing up blood or chest pain when coughing
• Night sweats that soak through pajamas or sheets
• Unexplained fevers and chills without an obvious illness
• Weight loss or loss of appetite that isn’t tied to a growth change
• Ongoing tiredness or weakness that doesn’t improve with rest

A child can have active TB without showing every symptom. What matters is the combination and the time frame. If there’s a cough that won’t let up after two weeks, especially with weight loss or night sweats, please bring it up with your family physician.

When should you bring your child in?

Sooner is better than later. If symptoms fit the pattern, or if your child may have spent prolonged time with someone diagnosed with active TB, don’t wait.

When a worried parent comes in, a clinician starts with the story, asking for a timeline of the illness and weighing risk factors like recent travel or possible exposures to decide whether testing makes sense. With a school exposure notice, what matters is the nature of the contact. “Was it the kid sitting next to your child for several weeks, or someone they may have passed in the hallway?” Dr. Kale says.

Testing is straightforward. It starts with a skin test or blood test, and if results come back positive, the next step is a chest X-ray and follow-up.

Dr. Kale also offers perspective. A positive test doesn’t necessarily mean active TB, and even active cases are very treatable. Harris County Public Health also offers free TB testing for people identified as close contacts of an active case, so cost shouldn’t be a barrier to getting answers.

What proactive steps can families take right now?

You don’t need to overhaul your routine to keep your child safer this school year. A few habits go a long way.

• Keep well-child visits up to date. A family physician who sees your child regularly catches changes faster.
• Talk about hygiene without making it scary. Handwashing, covering coughs, and staying home when sick still matter.
• Pay attention to lingering symptoms. Trust your gut when something isn’t resolving the way it should.
• Know your family’s risk factors. Recent international travel, a weakened immune system, or close contact with someone who has TB are worth mentioning at your next visit.

Where can Legacy help?

Legacy Community Health was built on the idea that healthcare should reach families before a problem becomes a crisis. That’s what Health Beyond Care means to us. It shows up in our clinics, in our school-based health care program, and in the trusted relationships we build with families across Houston over years, not single visits.

If you have questions about TB testing, want to schedule a back-to-school checkup, or need a primary care home for your child, our team is ready to help. You can also reach the Houston Health Department’s TB Control program at 832-393-4799.

Sources: Axios Houston | Houston Public Media | Houston.com | Legacy Community Health