Chanda Hesson, a nurse consultant who is part of the Alaska Department of Health’s tuberculosis team, holds up a souvenir mini flashlight on Wednesday that is imprinted with the slogan: “Think. Test. Treat. TB Alaska.” Hesson had just finished a presentation that day to the Alaska Public Health Association. She updated the status of tuberculosis in Alaska. (Photo by Yereth Rosen/Alaska Beacon)
Alaska’s rates of tuberculosis inched up in the past year, continuing the state’s long pattern of having the nation’s highest or nearly highest rates of this respiratory disease, according to preliminary figures.
The rate of tuberculosis in 2024 was 12.8 per 100,000 people, up from the 2023 rate of 10.5 per 100,000, according to preliminary figures presented at this week’s annual summit of the Alaska Public Health Association in Anchorage. Final figures for the year are expected in August.
The association is the Alaska affiliate of a national organization that represents public health workers.
If confirmed,the tuberculosis rate in 2024 will have been the third highest in three decades. The highest rate over that period was in 2000, at 17.2 per 100,000, and the second highest was in 2022, when a spike in cases drove the statewide rate to 13 per 100,000.
In comparison, the national rate in 2023 was 2.9 per 100,000 people, according to the U.S. Centers for Disease Control and Prevention. Alaska’s rates have generally hovered in recent years at about three times the national average, according to state and federal data.
Chanda Hesson, an Alaska Department of Health nurse consultant who is part of the state’s tuberculosis team, described the preliminary results for 2024 in a presentation Wednesday at the public health summit.
Case numbers dipped in southwestern Alaska, traditionally the region with the highest rates, Hesson said. But there was a notable increase in Anchorage, where the 2024 rate hit 7.2 per 100,000 people, according to the preliminary figures, she said. In comparison, the 2023 rate in the state’s largest city was 3.1 per 100,000 in 2023, according to the Division of Public Health’s epidemiology section.
History reflected in Alaska’s modern tuberculosis cases
Alaska’s tuberculosis history is traumatic, and that history continues to shape the way the disease spreads and is addressed today, Hesson said in her presentation.
In the first half of the 20th century, tuberculosis rates were much higher across the nation than they are now, but Alaska’s rates were some of the highest in the world, a legacy of introduction by explorers and settlers from elsewhere, according to the epidemiology section. Up to the middle part of the century, tuberculosis was the leading cause of death in Alaska, according to the epidemiology section. At that point, Alaska’s case rate was about 10 times the national rate, according to state records.
At that time, there was a “huge disparity,” with the state’s Native population hardest hit, Hesson said. That disparity continues. “Not much has changed as far as the disproportionate rates of active disease,” she said.
What has changed is the efficacy of treatment. Rates in Alaska and the nation started a sharp decline in the 1950s as new remedies were developed, the statistics show.
While Lower 48 tuberculosis cases tend to be among foreign-born residents who come from countries with high rates of the disease, Alaska’s cases are linked to past outbreaks and epidemics, even some that swept through long ago, as Hesson explained it.
People who acquired infections that were passed down from earlier generations living in the same ancestral areas can harbor them for decades without outward signs, Hesson said. But latent infections can be activated, particularly in older years when immune systems are weaker, she said. And those activations can result in “incredibly high rates in some of the villages,” in large part because of rural Alaska’s crowded housing conditions.
It can be challenging for state and local health officials to provide care to everyone in close contact with a person with a newly activated infection, Hesson said.
“At some point, when you have a small community, everybody becomes a contact in some way,” she said. “What we’re fighting against years of exposure, 100 years of exposure, for people who are never treated and then reactivate.”
Tuberculosis care in Alaska also requires sensitivity to the emotional trauma surrounding the way health officials treated past epidemics, Hesson said. In the past, officials sometimes whisked patients away to distant hospitals, without much explanation or communication to family members, she said. Today’s style of care, in contrast, is much more locally focused and communicative, she said.
Alaska is not the only state with relatively high rates of tuberculosis.
Hawaii’s rates tend to be high as well, compared to the rest of the nation, Hesson said. That state’s history of isolation and exposure has parallels to Alaska’s history, she said.
The District of Columbia has also had some very high tuberculosis rates in recent years, compared to the national average, according to CDC data.
In Kansas, an ongoing outbreak has killed two people so far and sickened dozens more.
Education and awareness are central to the World Health Organization’s annual Tuberculosis Awareness Day, coming up on March 24. Although President Donald Trump used an executive order to pull the U.S. out of the WHO, there are Tuberculosis Awareness Day events scheduled elsewhere in the country, in California and Michigan, for example.
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