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TB Notes 1, 2000
Introduction
Where We've Been and Where We're Going: Perspectives from CDC's Partners in TB Control
Changes I've Seen
TB Control in New York City: A Recent History
Not by DOT Alone
Baltimore at the New Millennium
From Crickets to Condoms and Beyond
The Denver TB Program: Opportunity, Creativity, Persistence, and Luck
National Jewish: The 100-Year War Against TB
Earthquakes, Population Growth, and TB in Los Angeles County
TB in Alaska
CDC and the American Lung Association/ American Thoracic Society: an Enduring Public/Private Partnership
The Unusual Suspects
The Model TB Prevention and Control Centers: History and Purpose
My Perspective on TB Control over the Past Two to Three Decades
History of the IUATLD
Thoughts about the Future of TB Control in the United States
Where We've Been and Where We're Going: Perspectives from CDC
Early History of the CDC TB Division, 1944-1985
CDC Funding for TB Prevention and Control
Managed Care and TB Control - A New Era
Early Research Activities of the TB Control Division
The First TB Drug Clinical Trials
Current TB Drug Trials: The Tuberculosis Trials Consortium (TBTC)
TB Communications and Education
TB Control in the Information Age
Field Services Activities
TB's Public Health Heroes
Infection Control Issues
A Decade of Notable TB Outbreaks: A Selected Review
International Activities
The Role of CDC's Division of Quarantine in the Fight Against TB in the U.S.
The STOP TB Initiative, A Global Partnership
Seize the Moment - Personal Reflections
 
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This is an archived document. The links are no longer being updated.

TB Notes 1, 2000

TB in Alaska

by Robert Fraser, MD
Former Alaska TB Controller

TB is probably a relatively new disease in the Alaska population that was introduced by early explorers and other newcomers to the territory of Alaska. One of Captain Cook's mates died of TB at the time of his voyage in 1786 to Alaska. By the early part of the 20th century, TB was widespread in the villages of Alaska, and treatment options were very limited. Attempts at isolating individual family members in the home was the major treatment available. In the late 1940s a small TB hospital was opened in Skagway. In the early 1950s coordinated efforts by the Bureau of Indian Affairs and the territory of Alaska were directed to this major public health problem.

Image 1: Picture of a plane and snow mobile. By the mid-1950s most Alaskan communities had "bush" air service, which enabled portable x-ray facilities to be taken into communities.

In a large land area like Alaska with poor transportation, case finding was a major challenge. In the early 1950s the territory of Alaska operated three health boats that visited coastal communities and communities along the Yukon River. These ships carried x-ray facilities, a physician, a dentist, and public health nurses. By the mid-1950s most communities had "bush" air service, which enabled portable x-ray facilities to be taken into communities and chest x-rays taken. Hospital facilities also improved with the availability of the facilities at the old naval base in Sitka, which was turned over to the Bureau of Indian Affairs, and the construction of a new hospital facility for the Bureau of Indian Affairs, which opened in Anchorage in 1953. At the same time, medication effective against M. tuberculosis became available, with streptomycin available in 1946, PAS in 1947, and INH in 1953. These treatment modalities permitted the effective treatment of TB.

In the mid-1950s the TB reactor rate among children in rural Alaska was about 50% in school enterers and approached 90% in the third grade. Deaths from TB in some years approached 500, and thousands of residents of Alaska awaited hospitalization for treatment of their disease. The initial studies using INH to prevent TB were effectively carried out in a number of villages in the Bethel area of Alaska, demonstrating better than 80% effectiveness in preventing the development of TB in infected individuals. The results also raised the possibility of treating people with active disease outside of the hospital. Subsequently most patients with TB had been treated in Alaska with either no hospitalization or short hospitalization followed by outpatient treatment.

As the incidence of TB fell, supervision of the infected individuals in smaller communities was possible using traveling x-ray technicians and the identification of problem communities was done on the basis of tuberculin testing. Tuberculin testing programs were implemented in selected age groups in the schools. Review of immigrants coming to Alaska from Southeast Asia and South America allowed public health personnel to identify and treat active disease, thus minimizing the spread of TB into Alaska.

Effective treatment of TB has increasingly required directly observed therapy, or DOT, for successful management of the disease. Many communities in Alaska have few tuberculin reactors among school age children, but there still remains a significant reservoir of individuals who have had TB infection in the past and who may potentially develop disease, posing a challenge for public health. How to identify new cases of TB at a time when concern for the disease has diminished and how to provide direct administration of medication to infected individuals in remote areas are continuing challenges.

As Alaska enters a new century, there is a potential to eliminate TB from the population and there is also the potential that the disease will remain a chronic problem. The new century will pose new challenges with diminished public awareness of TB, and with HIV infections in rural communities complicating the problem.

 


Released October 2008
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