The Epidemiology of Tuberculosis in Alaska
Alaska had some of the highest rates of tuberculosis (TB) ever seen anywhere in the world in the mid 20th Century. While a large amount of resources were mobilized to combat this disease, including 10% of Alaska's total budget one year, and the rate of TB declined precipitiously in the 1950's and 1960's, Alaska continues to have among the highest rates of tuberculosis in the country. This presentation will briefly review the history of TB in Alaska, present recent data, and discuss issues involved in the control of TB in Alaska.
METHODS:
Suspect and confirmed cases of active TB are required to be reported to the State of Alaska, TB Control Program. Raw data are collected, and reported to the Centers for Disease Control and Prevention through the Report of Verified Case of Tuberculosis (RVCT) system. The RVCT system currently consists of 49 items, and these were used to compile data for this presentation. Raw data submitted directly to the TB Control Program were used as well.
RESULTS:
Alaska had the highest rate of TB in the United States in 2012 (9.0/100,000), and preliminary data suggest that the rate for 2013 will be higher than in 2012. Native Alaskans in the Northern and Southwest regions of the State continue to bear a disproportionate burden. The percentage of TB cases in Alaska in foreign born individuals (~20%) is lower than the percentage of total TB cases in the United States in foreign born individuals (~60%). While Alaska has had multiple drug resistant cases of TB, these have not represented a significant proportion of the total TB. The rate of TB has declined markedly in Alaska compared to rates from the 1950's and 1960's, but a sawtooth pattern has been observed since 1990, with mild overall decrease.
CONCLUSIONS:
While progress has been made in controlling the rate of TB in Alaska over the past decades, much work remains to be done. Alaska faces significant challenges related to geography, health care infrastructure, health disparities, and a remarkable history of TB in Native Alaskans which continues to make TB control in Alaska a challenging job.