Decline of the Tuberculosis Epidemic in Alaska

Abstract

T HERE can bie little doubt that tuberculosis was epidemic among Alaskan natives during the first half of the present century (1-4). Although the pattern of spread will probably never be known, the disease appears to have been introduced by white visitors and immigrants (5) and to have followed in their wake as they sailed Alaska's coasts and floated down her rivers. Thus the disease probably came first to the Aleutian Islands, the southern coast, and the southeastern panhandle with the explorers and fur traders some time in the latter part of the 18th century. The search for gold and whales late in the 19th century provided additional opportunities for the introduction of tuberculosis into the interior and along the northwest coast. When the disease arrived in the delta of the Yukon and Kuskokwim Rivers is not known, but it seems likely that the epidemic peak came later in this area than elsewhere in Alaska. In any event, the first systematic examination of Alaskan natives for tuberculosis, a tuberculin survey conducted from 1948 to 1951, indicated that the tuberculosis problem was most serious along the lower Yukon and Kuskokwim Rivers (6). The prevalence of tuberculin reactors among native children, standardized for age, was 32 percent in southeastern Alaska and the Aleutian Islands, 56 percent in the interior and on the northwest coast, and an astounding 75 percent in the Yukon-Kuskokwim delta. In the 1950's, tuberculosis continued to be the major health problem of Alaskan natives and was particularly serious in the delta, region. From 1953 to 1956, the average annual tuberculosis mortality rate in that area was 282 per 100,000, and as recently as 1957, 30 perceint of adults ha,d X-ray evidence of past or present pulmonary tuberculosis (7). In spite of the severity of the tuberculosis epidemic along the lower Yukon and Kuskokwim Rivers, a situation which has few rivals in medical literature, there is evidence that the disease is at last being brought under control. Not only have tuberculosis mortality and case rates fallen sharply, but even more significant for the future of tuberculosis control, there has been a marked decrease in the risk of acquiring new infections. So dramatic is this reduction that children whose parents were decimated by tuberculosis may well live to s,ee it become a rare disease.