Back in May, KTVU confirmed a tuberculosis outbreak at Archbishop Riordan High School in San Francisco. It began in January, resulting in 247 cases with seven active and the rest latent. While tuberculosis is treatable, the disease is still serious. The high school mediated treatment for any students that tested positive for latent or active TB, and everyone moved on. Now TB appears to have found a new foothold, this time at Crazy Horse strip club on Market Street. The Department of Public Health received their first reports earlier this month and is conducting contact tracing.
TB or not TB—that is the concern.
San Francisco is no stranger to diseases from around the globe. The world-class port of call has seen yellow fever, bubonic plague and obviously, tuberculosis, or TB for short. TB in the Bay Area is not a recent phenomenon. Like the flu, smallpox, and syphilis, TB came with colonization and immigration. The illnesses hitched a ride with every wagon, train, and ship destined for the prosperous region. We their descendants are better equipped to handle infectious disease, but not much wiser (looking at you, anti-vaxxers). Pathogens cannot discriminate—vectors are vectors.
TB spreads via airborne particles released when a person with an active infection talks, coughs, sneezes, laughs, or sings. It isn’t caused by a virus but a bacteria, Mycobacterium tuberculosis. TB remains viable on hard surfaces or suspended in the atmosphere for hours. It thrives in damp, cramped, poorly ventilated areas.
Tuberculosis worms are bright pink, so if you stay away from all things fuchsia, you should be alright (Kidding!).
Worse, it is common for someone to get infected with TB and present asymptomatically. In this case, the person cannot spread the disease. That’s called a latent tuberculosis infection, the diagnosis most Archbishop Riordan students received. Up to 10% of those cases progress to an active infection, the communicable stage. Latent TB is more likely to activate within the first two years of infection. Seven Archbishop Riordan students presented with the active variation.
Some people are more susceptible to TB infection than others. Diabetes, HIV/AIDS, autoimmune disorders, kidney failure, cancer and chemotherapy, or smoke inhalation can activate a latent TB infection.
Getting the TB-jeebies
Today, US immigration officials screen for active tuberculosis infections when people immigrate to the States. That said, latent cases can surpass tests and deliver a false negative. Vaccination rates vary worldwide, meaning two individuals from the same country could have wildly different immunization records. That’s especially true in the United States, where we gatekeep healthcare and spread misinformation about lifesaving vaccines. I’m curious what newcomers make of our strong, ambivalent feelings towards vaccination, the kind of messages we send.
In another cruel twist of epidemiology, Mycobacterium tuberculosis multiplies slowly. You might test negative one week and positive the next. Those suspected of exposure should repeat tests throughout TB’s lengthy incubation period of ten weeks or more. TB infections in the US are still rare compared to rates in more disadvantaged countries, but the gap is shrinking.
Active tuberculosis cases generally declined in San Francisco from 2015 through the pandemic years, hitting an all-time low in 2022. More recent data from SF.gov however says there were 9.3 active cases per 100,000 people last year. 2025 recorded 78 new active TB cases overall. While that suggests improvement from 91 new active cases in 2024, 2025’s figures still exceeded the national rate by triple.
Crazy Horse Gentleman’s Club on Market Street. Creative commons.
As of October 2026, SF has recorded 41 active cases of tuberculosis. That includes 39 tallied in June, and two more reported at Crazy Horse. A stripper with tuberculosis was the basis for Baz Luhrmann's Moulin Rouge (2001). Now it’s sort of a reality, right here in San Francisco. Aren’t we the lucky ones?
At first blush, the city seems to be on track for a reduction in TB cases compared to 2025. Then again, one more outbreak could tip the scales. It doesn’t help that Trump has cut federal funding for Medicaid, placing further strain on hospitals and clinics already limping by. In San Francisco, the rainy season is near, heralding the onslaught of the holiday/respiratory infection season. It’s the most wonderful time of the year—for RFK to blame immigrants for illnesses even we barely vaccinate for.
The Department of Public Health told the Chronicle, “These efforts are ongoing and at this time, the risk to the general public is low. If this status changes, we will let the public know.”
