Alaska in 2016 had the nation's second-highest rate of tuberculosis, a challenge state officials say reflects both the enduring effects of the disease in rural Alaska and the social stigma associated with it.
The Alaska Department of Health and Social Services on Tuesday released a breakdown of tuberculosis infections reported across the state last year. Federal statistics show that Alaska's TB infection rate last year of 7.7 cases per 100,000 people – nearly three times the national average of 2.9 cases per 100,000 people – is behind only Hawaii.
Alaska's 2016 rate was down from 9.2 cases per 100,000 people in 2015, but in previous years Alaska has led the nation in infection rates.
Dr. Bruce Chandler, a medical officer with the Anchorage Department of Health and Human Services, said Tuesday many people are latent carriers of TB bacteria, but only a few suffer from the highly contagious respiratory disease those bacteria can cause.
"Most of us who get infected with tuberculosis never get infected with tuberculosis disease," Chandler said. "We see people who've just arrived from foreign countries, we see people who've been here for decades; TB doesn't discriminate."
A brief history of TB in Alaska, compiled by Chandler, who often works with state epidemiologists on the disease, says human remains found in Utqiagvik and on St. Lawrence Island suggest TB has had a presence in Alaska for at least 1,500 years.
An "epidemic" of TB, however, only arrived with European explorers and then American prospectors, beginning in the late 18th century.
"During that period, TB was a leading cause of death in the U.S. and in many European countries," Chandler wrote. "Tuberculosis rapidly spread among Alaska Native people, a susceptible population living under conditions ideal for TB transmission and dissemination, especially those with close contact to the incoming colonists."
Between 1900 and 1950, Alaska had some of the world's highest recorded rates of the illness. In 1934, TB was responsible for a third of Alaska Native deaths statewide, according to a review of death certificates conducted by the federal Office of Indian Affairs.
Regional and racial divides still exist in Alaska's TB infection rates: "Alaska Native people from the Northern and Southwest regions of Alaska, the areas devastated by TB half a century ago, continue to be disproportionately burdened with TB," Chandler wrote.
Of the 334 Alaskans diagnosed with TB from 2011 to 2015, 73 percent were Alaska Native, the report said.
Some problems remain in treating TB, Chandler wrote, including the stigma surrounding the contagious illness.
He called for public education as a "cornerstone" of destigmatizing TB, so physicians can treat both patients and those close to them who may also have been infected.
A vaccine for TB exists, but is generally used in North America only on confirmed patients, to prevent TB tests from falsely indicating people are infected.
Between 2010 and 2015, Alaska saw seven cases of worrisome "multiple-drug-resistant" TB; All seven involved people who were born in or had visited foreign countries, or had been living with such a person – a low rate Chandler said was a silver lining to the TB threat Alaska faces.
"The big worry is that someone with (multiple drug-resistant) TB would go on to infect many other people, and it would become a very big challenge to treat that infection," Chandler said.
TB outbreaks come with measurable, sometimes significant costs. A previous state study said containing a 2013 outbreak of TB in rural Alaska, which affected at least eight people in an unnamed Yukon-Kuskokwim Delta village, cost state and regional health groups more than $1 million.
Chandler said those costs, driven by the need to observe and treat patients with multiple drugs for at least six months, are borne by a broad cross-section of agencies.
"A lot of transport and effort by public health nurses here in Anchorage and in the regional hubs, plus the Native health corporation nurses and (state) aid – a lot of work goes into finding the cases and getting everyone treated," Chandler said. "They don't get enough credit for what they do."
Dr. Jay Butler, the state's chief medical officer, said in an email that two-thirds of Alaska's spending for treating TB outbreaks, roughly $900,000 during the 2016 fiscal year, is dependent on federal funds. Health officials are tracking proposed state and federal budget cuts that may directly or indirectly affect Alaska's Public Health Nursing program, which also helps fight TB infections.
"There's no contingency fund, there's no reserve fund," Butler said by phone Tuesday. "We do what we can with what we have."
Butler said anyone traveling to a foreign country where TB is common should be tested for the disease both before and after their return. Anyone who thinks they have been exposed should note when and where the exposure occurred when seeking medical help.
"The main thing that people can do to decrease their chances of contracting TB is to avoid close contact or spending prolonged time with persons who have active TB disease until they have received at least two weeks of treatment," Butler wrote. "If you think you have been exposed to someone with TB disease, you should contact your health care provider or local public health center (about) getting a TB skin test or TB blood test."
DHSS plans to release a full report on TB in Alaska, including a discussion of measures taken to control the disease, later this summer.