News that Alaska's tuberculosis rate was the nation's highest in 2000 was neither good nor unexpected.
Dr. Beth Funk, head of TB control for the state Division of Public Health, describes the pattern in Alaska since about 1970: gradual progress, with occasional explosions like those in Anchorage (nine cases of the disease) and Dillingham (27 cases) in 2000. No surprise doesn't mean no action. ''I don't want to be cavalier about that and say it's just business as usual,'' Dr. Funk says.
Alaska Natives were first stricken with the disease in the 18th century, and in the first half of the 20th century TB was the leading killer in the state. We've turned a healthy corner since then, but there are still thousands of Alaskans, Native and non-Native, who carry the TB germ. In that we're not unusual. Health officials estimate a third of the world's population carries the germ.
Ninety percent of those infected will never suffer the disease; the body's own system keeps the germ at bay. Ten percent of those infected will contract the disease, and once they do, they can spread it through the air to others, particularly to those with whom they share close quarters -- family members, most often.
So how do we a keep ahead of a disease that most of us probably thought was already whipped?
The first need is awareness. TB tests should be routine; that way those infected can undergo preventive treatment to make sure they don't get the active disease. Because only those with the active disease can spread it, keeping the germ dormant could wipe out the disease.
Dr. Funk said the public health division is about to mail a TB handbook to doctors, nurses and clinics around the state to heighten awareness of TB and increase screening for it. TB's onset can be subtle; victims may mistake its symptoms for smoker's cough, flu or ordinary fatigue.
Dr. Funk also stressed the need for both the public and medical workers to understand the distinction between TB infection and the disease. Those who have only the infection cannot spread it and are not sick.
The second need is money, an investment in public health. Lawmakers last spring approved a third of the governor's $2.3 million ''Back to Basics'' public health initiative, which included money for TB control. Dr. Funk said in a few months the division will know if they have enough, and if not, what more they need.
The catch is the need for what health workers call ''Directly Observed Therapy.'' The course of treatments in both preventive care and for those with the disease is long -- from six to nine months -- and essential to complete. Skip a dose and you defeat the purpose -- in effect, you allow the TB infection a chance to mount its own defenses against the drugs attacking it. Directly Observed Therapy means that a health worker -- doctor, nurse, health aide, or village public safety officer with training -- witnesses the patient taking the medication to make sure he or she stays on course.
This is no place to skimp; if the division needs more help and fuller funding of the Back to Basics program, the Legislature shouldn't hesitate. Public health is a fundamental service. The payoff here is that we have a real chance to bury a disease instead of its victims.
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