Though widely thought of as a disease of the past, tuberculosis, commonly referred to as TB, is still a problem in Alaska. For the third year in a row, the Last Frontier has come in first among U.S. states for its rate of new infections.
Rates of new infection are highest in rural Alaska, and Alaska Natives are most at risk for contracting the disease. New drug-resistant strains may play a factor in the general resurgence of TB in other parts of the world since the 1980s, but in Alaska, the illness's legacy is a big contributor to its present.
According to the Alaska Department of Health and Social Services, in 2013, Alaska had a new-case TB infection rate of 9.6 per 100,000 people. That's more than triple the nationwide rate of 3.0 per 100,000 people. And things are much worse in Southwest Alaska. For 2013, the Yukon-Kuskokwim region recorded a TB infection rate 700 percent higher than the rest of the state. And while the numbers -- especially those in rural parts of the state -- seem alarming, they probably shouldn't be.
Alaska reported 71 new infections of TB in 2013, compared to the 2,170 reported in California, which came in fourth on the list of highest rates of new TB infection. In 2013, according to an estimate from the U.S. Census Bureau, Alaska had just over 731,000 residents. California had more than 38 million. Since the rates are calculated per 100,000 people, the jumps in Alaska's numbers are often caused by just a few outbreaks -- not a widespread resurgence of the disease. While any new infection can be cause for concern for state health officials, the seeming rise in Alaska's infection rate isn't necessarily an indication of a new or growing problem.
"We are concerned when we see one case that leads to others," DHSS Infectious Disease Program Manager Dr. Michael Cooper said.
That happened in 2013. At one Y-K Delta village of fewer than 1,000 people -- DHSS has refused to name the village involved -- 17 people came down with the disease. Cooper said it was the biggest outbreak of TB anyone at his office could remember. The isolated geography of the region helped health officials stop the disease from spreading but also likely contributed to its growth in the unnamed village.
TB is an infectious disease that generally attacks lung tissue. Also known as consumption and the "white plague," TB was rampant across the developed world in the early- to mid-20th century. Rural Alaska was hit particularly hard by the illness between the 1940s and 1960s, with some rural parts of the state seeing one person in 10 with active TB.
Alaska Natives -- those most likely to live in rural and isolated villages -- were ravaged by the disease, with one in 30 residing in sanitariums throughout the country during the 1940s, and TB was the leading cause of death for all Alaskans until 1950.
TB spreads from person to person through the air -- by coughing, laughing, and sneezing. It can lie dormant in a victim, showing no symptoms for years following an infection -- a condition called latent TB. People with latent TB have a 5 to 10 percent chance of acquiring the active form of the disease within their lifetime.
In rural western and northern Alaska -- areas hardest hit by the disease in the mid-20th century -- many people have latent TB and don't know it, or haven't agreed to a months-long course of drug treatments that can significantly lower their risk of getting the active form of TB.
When it activates in one person in a small Alaska village, it can spread quickly. In many western and northern Alaska villages crowded homes, a lack of access to clean water and the scarcity of doctors and modern health centers have all contributed to the spread of TB. Such was the case in that village on the Y-K Delta last year.
But it takes a lot of close contact with an infectious person to get the disease.
"I have been doing TB work for over 35 years in Alaska and I still have not been infected," said Karen Martinek, a nurse epidemiologist with the Division of Public Health.
But tuberculosis is not just a disease of rural Alaska. Anchorage -- the state's largest metropolis -- saw 24 new cases of TB in 2013. That's more than double the 10 cases seen in 2012. When someone contracts active TB, the condition is reported to state and local health officials. During the six-month course of daily antibiotic treatment, the patient must takes the drugs under the direct observation of a health worker. And during the disease's two-week-long contagious period, people with active TB have to be separated from healthy family members.
That poses a problem for dealing with the disease among Anchorage's homeless population, estimated to be about 1,100 in 2013. The Anchorage Department of Health and Human Services provides temporary housing at two local motels for homeless people who contract the disease, especially when they are contagious to others around them.
"If they are infectious and we find they are primarily staying at the Brother Francis Shelter, we attempt to try to house them at our expense while they are infectious," DHHS nurse supervisor Wendy Walters said.
Last year, according to the municipality, eight homeless people were housed at either the Mush Inn or the Black Angus Inn. Both motels have, at one time or another, made the city's list of nuisance properties because of the number of emergency calls that require police response to their respective premises.
Despite the less-than-ideal conditions at the local motels, Anchorage health officers said they believe the program helps prevent TB from getting out of hand.
While the overall rate of TB infection has increased since 2011, state health officials said TB, though a constant presence in Alaska, isn't in danger of reaching former epidemic levels.
"The numbers, when you dig down and look at the cause of the increase, they are isolated village outbreaks that contribute to these," Cooper said. "Like a bush fire, once it's contained, it won't spread 200 miles down the Yukon River."
Contact Sean Doogan at sean@alaskadispatch.com.