Tuberculosis contact investigations in rural Alaska: a unique challenge

Alaska Natives suffered extraordinary rates of disease and death from tuberculosis (TB) during the first half of the 20th century. Although the epidemic was largely controlled in the 1960s, rates of TB among Alaska Natives remain higher than for other Alaskans, and village outbreaks of TB continue to pose major threats. In 2000, a contact investigation around a case patient with infectious TB involved eight villages in south-western Alaska and found 26 additional persons with TB disease and 48 people with newly positive TB skin tests. Rural Alaska brings unique challenges to TB contact investigations not seen elsewhere in the United States because many villages are accessible only by small aircraft or boat. To conduct an investigation, a public health nurse must fly into the village, bring food and water, and sleep at the village clinic or school. In spite of these obstacles, over the past 4 years contact investigations have been initiated for all TB cases with acid-fast bacilli smear-positive sputum, and the proportion of adequately examined contacts has increased from 51% to 75%. The Alaska TB Program plans to improve contact investigations through ongoing reports to regional public health centers and through a statewide training workshop.