CDC History of Tuberculosis Control - Medical and Public Health ...

on preventive therapy. In addition, the Public
Health Programs and Services Division of the
Department of Health Services has continued
to undergo extensive reorganization, redirection
of priorities, and change of leadership.
The 20 th century has clearly ended with a
period of constant change. One can only
predict that the new century will continue in
the same mode, possibly as the norm. In the
meantime, the number of TB cases continues
to decline, to an all-time low by the turn of
the century. Hope, tempered by the reality of
a huge problem with TB in the world as a
whole, suggests that the goal of elimination of
TB can be reached in Los Angeles County
during the early decades of the 2000s.
TB in Alaska
by Robert Fraser, MD
Former Alaska TB Controller
TB is probably a relatively new disease in the
Alaska population that was introduced by
early explorers and other newcomers to the
territory of Alaska. One of Captain Cook’s
mates died of TB at the time of his voyage in
1786 to Alaska. By the early part of the 20th
century, TB was widespread in the villages of
Alaska, and treatment options were very
limited. Attempts at isolating individual
family members in the home was the major
treatment available. In the late 1940s a small
TB hospital was opened in Skagway. In the
early 1950s coordinated efforts by the Bureau
of Indian Affairs and the territory of Alaska
were directed to this major public health
problem.
TB Control at the Millennium
22
In a large land area like Alaska with poor
transportation, case finding was a major
challenge. In the early 1950s the territory of
Alaska operated three health boats that visited
coastal communities and communities along
the Yukon River. These ships carried x-ray
facilities, a physician, a dentist, and public
health nurses. By the mid-1950s most communities
had “bush” air service, which enabled
portable x-ray facilities to be taken into communities
and chest x-rays taken. Hospital
facilities also improved with the availability of
the facilities at the old naval base in Sitka,
which was turned over to the Bureau of Indian
Affairs, and the construction of a new hospital
facility for the Bureau of Indian Affairs, which
opened in Anchorage in 1953. At the same
time, medication effective against M. tuberculosis
became available, with streptomycin available
in 1946, PAS in 1947, and INH in 1953.
These treatment modalities permitted the
effective treatment of TB.
In the mid-1950s the TB reactor rate among
children in rural Alaska was about 50% in
school enterers and approached 90% in the
third grade. Deaths from TB in some years
approached 500, and thousands of residents of
Alaska awaited hospitalization for treatment
of their disease. The initial studies using INH
to prevent TB were effectively carried out in a
number of villages in the Bethel area of
Alaska, demonstrating better than 80% effectiveness
in preventing the development of TB
in infected individuals. The results also raised
the possibility of treating people with active
disease outside of the hospital. Subsequently
most patients with TB had been treated in
Alaska with either no hospitalization or short
hospitalization followed by outpatient treatment.
As the incidence of TB fell, supervision of the
infected individuals in smaller communities
was possible using traveling x-ray technicians
and the identification of problem communities
was done on the basis of tuberculin testing.
Tuberculin testing programs were imple-