Although Alaska’s tuberculosis infection rate is the nation’s highest, the state health department is proposing ending routine screenings of all schoolchildren for the disease.
The suggested change is in a public notice published on the Alaska Department of Health and Social Services website. Health specialists say the proposed shift is a way of aligning better with federal guidance and making disease detection more efficient.
Dr. Benjamin Westley, an infectious disease physician in Anchorage who regularly treats patients for TB, said in an interview that the proposed change seemed “quite appropriate,” and a reflection of a shift that has already been happening statewide for several years.
“Frankly, school screening just is not a good way of finding TB cases,” Westley said. “In the 10 years I’ve been (in Alaska), I’m not aware of any cases of active tuberculosis that have been identified through school screening.
“The effective way to do screenings is to screen kids that are at some increased risk of tuberculosis,” he added.
That’s because “it is low-yield, an inefficient use of resources, and may result in an unacceptable rate of false positive tests,” wrote Michelle Rothoff, a medical epidemiologist with the Alaska Division of Public Health, in a document sent in response to emailed questions about the proposed change.
“A more targeted approach is recommended,” she wrote. “Most children in Alaska do not have risk factors for TB.”
Tuberculosis is one of the world’s oldest infectious diseases and is still a leading cause of infectious death worldwide, killing more than a million people a year. TB spreads through the air when a person with active TB coughs, sneezes or talks.
Symptoms of active TB include a cough that lasts more than three weeks, a fever, night sweats, weight loss and coughing up blood.
The majority of people with TB have a latent, noncontagious form of the disease and can go decades without symptoms. Experts say the public health goal is to identify latent cases, which are far cheaper and easier to treat than active TB is.
Alaska has long had one of the highest rates of tuberculosis infection in the country. In 2020, the state recorded the nation’s highest rate of tuberculosis infections for the second consecutive year, with 58 documented cases, according to a federal report released in March.
Although the nation as a whole saw a 20% reduction in the incidence of TB last year, Alaska’s rate remained as high in 2020 as it was in 2019, at 7.9 cases per 100,000 people, the report from the CDC indicates.
High rates in the southwestern and northern regions of the state “are still due in part to the lingering effects of high historic rates,” Rothoff said in a March statement.
In Alaska’s most populous cities, the prevalence of TB is low. According to Westley, there’s an increased risk of false positives “if you test people who have virtually no chance of having tuberculosis.”
TB skin tests aren’t perfect, Westley said, and “an argument can be made that one could cause as much hassle and harm and costs than any benefit when there’s such a low prevalence” in many Alaska communities.
In the Yukon-Kuskokwim Delta, a spokesperson from the region’s tribal health organization said in an email that the proposed changes appeared to match statewide best practices.
“In areas of high disease prevalence, or in an environment of an outbreak, universal testing may uncover some previously unknown cases,” wrote Tiffany Zulkosky, Yukon-Kuskokwim Health Corp. spokeswoman. “However, that discovery can also be accomplished through contact tracing, targeted testing, and village sweeps. Our understanding is that currently children are screened by symptoms and as part of case investigations,” she wrote.
The proposed change “appears to be bringing into alignment the standards of practice that have been announced and in place for a couple of years,” she added.