Cases of tuberculosis, a disease that has long been a scourge in Alaska, spiked in the state in 2022, possibly because of a lapse in detection and treatment linked to the COVID-19 pandemic, health officials reported.
Alaska had 96 identified cases of active tuberculosis in the year, according to preliminary figures, a total that was about two-thirds higher than the totals for each of the prior three years, said a bulletin released Thursday by the state Division of Public Health’s epidemiology section.
The strain on health services caused by the COVID-19 pandemic likely delayed diagnoses and treatment of tuberculosis, as has been the case with many other diseases, the bulletin said. There are other potential factors, too, like overcrowded living conditions and weakened immune systems, the bulletin said.
There may not be a single reason for the big increase in cases in 2022, said Michelle Rothoff, a physician with the Alaska Division of Public Health who contributed to the bulletin. “It’s probably a combination of all those things,” she said.
The rise in tuberculosis cases is a worldwide phenomenon, Rothoff noted, and as in Alaska, the higher prevalence of this old disease is linked to medical system strains caused by the new disease, COVID-19. Tuberculosis deaths increased in 2020 for the first time since 2005, and the disruption is considered a setback in the global effort to control the disease, according to the World Health Organization.
Unlike many other respiratory diseases, which can spread quickly among contacts, tuberculosis spreads through “prolonged, ongoing sharing of airspace,” Rothoff said. Typically, that involves a limited number of people within households rather than casual contact among large numbers of people, she said. That means that the social distancing and other COVID-19 control efforts wound up reducing the spread of influenza and other respiratory diseases did not do much to stop the spread of tuberculosis, she said.
A particular challenge of tuberculosis and reason for its persistence in Alaska and elsewhere is its tendency to remain latent for long periods in infected people.
“They may not get sick right away, and they may not get sick ever,” Rothoff said. “It can kind of lay in that latent state for years or decades.” While latent, tuberculosis is not contagious, she said, but “people may not know they have it until they get tested for some reason.”
A latent infection is treatable, and in fact “much, much easier” to treat than an active infection, she said. Treatment generally requires medication that is administered for three to four months, while a treatment of an active infection requires multiple medicines administered for at least six months and possibly as long as a year, she said. “Our goal is always to find people when they have latent infections,” she said.
Generations ago, tuberculosis took a staggering toll on Alaska, particularly among Indigenous people. Alaska in the first half of the 20th century had some of the world’s highest rates of tuberculosis and tuberculosis death rates ever recorded in the world.
Probably introduced to Alaska during the Russian period, tuberculosis spread as both settlement by outsiders and the resulting poverty and overcrowding among Natives increased in tandem, according to Alaska physician and historian Robert Fortuine. “By 1900 tuberculosis was already exacting a terrible toll in Alaska. Over the following half-century, however, the disease was to increase yet further and even pose a serious threat to the survival of the Alaska Native peoples,” Fortuine wrote in his landmark book, Chills and Fever: Health and Disease in the Early History of Alaska.
The crisis spurred a massive public-health response, and tuberculosis rates were much reduced. Still, Alaska has the highest rates of all states, typically two to three times the national rate since 2010, according to the Division of Public Health.
Rates have been and continue to be highest among Alaska Natives and, by geographic regions, highest in Northern and Western Alaska.
Because of tuberculosis infections’ latency, Alaska’s history with the disease has medical effects on the present.
Some Alaskans who were children during the first half of the 20th century when deadly epidemics swept through the state are now elders, and any latent tuberculosis infection they may have acquired then could become activated now, Rothoff said. “It’s just created this huge reservoir of latent TB infections,” she said.
Alaska’s tuberculosis history has other carryover effects that could be hampering modern-day detection and treatment, she said.
“In communities in Alaska that have been affected by TB for generations, usually there is some awareness, but unfortunately, there is a lot of fear and stigma,” she said. People sick with the disease were sometimes shunted off to special hospital wards and isolated, for example.
There can also be an opposite effect in places with a lot of history with the disease – a minimization of it, because it is thought to be so common, she said.
Meanwhile, to people who are new to Alaska, the disease may seem like an anachronism. That makes ongoing public education necessary, she said.
“In Alaska, TB is still very much with us,” she said.
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