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State puts routine TB screening on hold

Posted: March 13, 2013 - 11:14pm

KODIAK — In the 1940s and 1950s, medical ships cruised the waters of southwest Alaska, trying to end an epidemic of tuberculosis that infected as many of 90 percent of the regions population.

Doctors now face shortages of tuberculosis detection and treatment medicines even as the aftershocks of that 70-year-old epidemic infect Alaskans anew.

“What we’re having to do due to the national shortage is to ask people to put on hold some of the routine screening of at-risk people,” said Dr. Michael Cooper, Alaska’s deputy state epidemiologist.

Alaska has the highest tuberculosis rates in the country, partly due to the mid-20th century epidemic, Cooper explained.

Five to 10 percent of “cured” tuberculosis patients experience recurring cases of the disease later in life. “We get these flare-ups out in the villages,” he said. “Before you know it, they’ve spread it.”

Tuberculosis, also known as consumption, is a bacterial infection that develops in the lungs and spreads through coughs and sneezes from infected people. Left untreated, it can result in permanent lung damage and death.

The most common way to detect tuberculosis is a skin test that involves a small injection. The injection typically creates a red spot on the arm, and in people who have tuberculosis, that spot will turn hard within a day or two.

A product called Tubersol is the most common chemical used in tuberculosis testing, but increased demand and production problems at the plant that creates Tubersol have caused a nationwide shortage.

“The State of Alaska is unable to secure more Tubersol at this time, although product availability is expected to improve as early as late March,” the Alaska Section of Epidemiology stated in a public health alert email late last week.

The email recommends deferring regular screening and prioritizing people at higher risk or who may have tuberculosis.

Similar alerts have been issued by public health agencies in North Carolina, Pennsylvania and elsewhere.

An alternative skin test chemical, Aplisol, has become hard to get due to rising demand.

Blood tests can detect tuberculosis, but those are more complicated and require longer to develop, Cooper said.

The state’s remaining supply of Tubersol is being closely held. It isn’t being shipped out upon request. “We’ve been kind of proactive in terms of prioritizing what we do have,” he said. “Fortunately, this is happening at a time when most of the routine school screening has been done.”

Some Alaska hospitals and clinics keep supplies of testing materials on-hand and have not begun rationing. Karen Leatherman, a spokeswoman for Providence Kodiak Island Medical Center, said Kodiak’s hospital hasn’t changed its policies.

“For the testing part of it, we haven’t had any problems getting supplies,” she said.

A more serious problem is a shortfall in the primary drug used to treat tuberculosis.

In December, the Centers for Disease Control and Prevention issued an alert stating that manufacturing of isoniazid, the principal drug used to treat tuberculosis, had been interrupted due to production problems.

“U.S. INH production has been interrupted, and stocks are dwindling,” the alert stated.

Alternatives to isoniazid have been similarly troubled by a shortage of a principal ingredient and by increased demand, according to the CDC.

If the United States is seeing a spike in tuberculosis cases, that hasn’t happened in Alaska, Cooper said.

In 2011, Alaska had 9.3 tuberculosis reports per 100,000 people. The national average was 3.4 cases per 100,000 people.

Figures for 2012 have not yet been released, but Cooper said Alaska’s figures will be right around 2011 levels.

While treatment and testing have not ended or been curtailed by the drug shortages, Cooper said, the state is preparing alternative plans if the shortage drags on through the summer and fall.

“We’re preparing for the worst and hoping for the best,” he said.

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