Alaska Department of Health Proposes to End Routine School Tuberculosis Screening Despite Record Infection Rates


Although Alaska’s TB infection rate is the highest in the country, the state health department is proposing to end routine screenings of all schoolchildren for the disease.

The suggested change is in a public notice posted on the Alaska Department of Health and Human Services website. Health experts say the proposed change is a way to better align with federal guidelines and make disease detection more effective.

Dr Benjamin Westley, an infectious disease specialist in Anchorage who regularly treats TB patients, said in an interview that the proposed change seemed “very appropriate” and reflected a change that has already been happening statewide since. several years.

“Frankly, school screening is just not a good way to find cases of TB,” Westley said. “In the 10 years that I have been (in Alaska), I have not been aware of any case of active tuberculosis that has been identified by school screening.

“The effective way to screen is to screen children who are at increased risk for tuberculosis,” he added.

National guidelines from the Federal Centers for Disease Control and Prevention recommend against universal screening for tuberculosis.

This is because “it is low yielding, an inefficient use of resources and can result in an unacceptable rate of false positive tests,” wrote Michelle Rothoff, medical epidemiologist with the Alaska Division of Public Health, in a document sent in response to email questions about the proposed change.

“A more targeted approach is recommended,” she wrote. “Most children in Alaska do not have risk factors for tuberculosis.”

Tuberculosis is one of the oldest infectious diseases in the world and remains one of the leading causes of death from infection worldwide, killing more than one million people a year. TB is spread through the air when a person with active TB coughs, sneezes or speaks.

Symptoms of active TB include a cough that lasts longer than three weeks, fever, night sweats, weight loss, and coughing up blood.

The majority of people with TB have a latent, non-contagious form of the disease and can live for decades without symptoms. Experts say the public health goal is to identify latent cases, which are much cheaper and easier to treat than active TB.

Alaska has long had one of the highest TB infection rates in the country. In 2020, the state recorded the highest TB infection rate in the country for the second year in a row, with 58 documented cases, according to a federal report released in March.

Although the nation as a whole saw a 20% reduction in tuberculosis incidence last year, Alaska’s rate remained as high in 2020 as it was in 2019, at 7. 9 cases per 100,000 people, the CDC report says.

The high rates in the southwest and northern areas of the state “are still due in part to the lingering effects of the historic high rates,” Rothoff said in a March statement.

In the most populous cities of Alaska, the prevalence of tuberculosis is low. According to Westley, there is an increased risk of false positives “if you test people who have virtually no chance of getting TB.”

Tuberculosis skin tests are not perfect, Westley said, and “it can be argued that one can cause as much hassle, damage and cost as any benefit when the prevalence is so low” in many. Alaskan communities.

In the Yukon-Kuskokwim Delta, a spokesperson for the region’s tribal health organization said in an email that the proposed changes appeared to be state best practices.

“In areas with a high prevalence of the disease, or in an epidemic environment, universal tests may discover previously unknown cases, ”wrote Tiffany Zulkosky, spokesperson for Yukon-Kuskokwim Health Corp. “However, this discovery can also be accomplished through contact tracing, targeted testing and village searches. We understand that currently children are screened based on symptoms and as part of case investigations, ”she wrote.

The proposed change “appears to align the standards of practice announced and in place for a few years,” she added.