Uptick in tuberculosis cases across the Yukon-Kuskokwim Delta forces in-school testing

A red and white building
Yukon-Kuskokwim Health Center (Greg Kim/KYUK)

The Yukon-Kuskokwim Health Corporation is dispatching health teams to multiple villages in the Y-K Delta this month to test school age kids for tuberculosis. Case counts are trending above average this year. The situation has been further complicated by the coronavirus pandemic and the repeal of a state law that required in-school testing.

St. Mary’s school principal Teresa Paukan said that the community opted for school-wide testing last month after a student tested positive. The testing trend found second case of tuberculosis.

“We would have never found out about that positive case if we didn’t get [testing] into the school,” Paukan said.

Last month, the Alaska Department of Health and Social Services ended statewide in-school testing for TB in order to “comply with national guidelines.” The CDC no longer recommends in-school testing for TB because the agency says that doing so is not an efficient way to track down active cases of the illness. According to the state, in-school testing didn’t turn up any cases of TB between 2014 and 2019.

But Evelina Achee, the nurse manager at Bethel’s Public Health Center, said that she has found cases in the Y-K Delta with in-school testing.

“It seemed to me that when we went out to the communities and to the villages and tested in schools, we always found TB cases,” Achee said.

This year, cases are trending above average. That’s according to YKHC. The organization is working with school leaders, and teams have already visited three schools. They’re trying to complete testing before schools close at the end of the month.

The coronavirus pandemic has complicated the effort to track and treat TB. At the Public Health Center in Bethel, most of the full-time nursing positions are unfilled. Achee said that nurses are burned out. There’s only two full-time nurses in Bethel managing TB cases in the region. Six remote nurses are helping them.

“I have never had this before where we had such very low capacity,” Achee said. “And then a surge of TB, and it’s like since we’re losing so many nurses that it’s even harder for us,” she said.

Michelle Rothoff is a family physician with Alaska’s Tuberculosis Program.

”TB is already a difficult thing to diagnose,” she said, and the coronavirus pandemic has caused further complications — COVID-19 delayed medical care for some people and diverted resources away from public health that would otherwise be available to combat TB.

“I’ve seen some estimates that it’s kind of set back the global fight against TB by about 10 years, and I think that’s true in Alaska as well,” Rothoff said.

Tuberculosis is caused by a bacteria that targets the lungs, but it can affect other parts of the body. An active case will turn up a positive test result. So will latent cases, where the bacteria remains dormant in the body.

“So it’s not causing symptoms and it’s not infectious to others, and people can remain in that state for years, to decades, to their entire lives,” Rothoff said.

The state only reports active cases of TB, and there were 58 in 2020. However, an additional 287 people were treated for latent TB. So far in 20202, preliminary state data shows that over 30 cases of active TB have been identified in Alaska this year. About two-thirds of those cases are in the Yukon-Kuskokwim Delta.

Paukan in St. Mary’s said that she will continue to support testing in her school.

“I think it’s very important, especially being in a smaller community where everyone is so close knit and in close contact with each other at school and at home,” Paukan said.

The incidence rate for tuberculosis in Alaska is nearly four times the national average. Health officials are urging people throughout the Y-K Delta to report all cases of TB. It’s also important to follow a full course of treatment if you are diagnosed with any form of tuberculosis.

Correction: This story originally stated that only one traveling public health nurse is managing TB cases in the region. That information is incorrect. There’s two full-time public health nurses in Bethel managing TB cases in the region. Six remote nurses are helping them. Also, this story originally stated that in-school testing had detected between 30 to 80 TB cases in the region so far this year. That information is incorrect. Instead, between 30 to 80 is the range of TB workload that Bethel Public Health Nursing is currently managing. 

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