Alaska leads the nation in TB, and its immunization system will stop tracking TB tests

VacTrAK, Alaska's immunization records system, will stop tracking tuberculosis tests when it moves to a new software vendor in mid-2027, the Alaska Immunization Program told health care providers Monday.

After the switch, clinics will no longer be able to manage their TB test inventory or submit the tests they give through VacTrAK, according to the program's October newsletter. The newsletter does not say where providers should record those tests instead.

The change comes in the state with the nation's highest tuberculosis rate. Alaska ranked first among states in 2023 and again in 2024, according to the state TB program. The 2024 rate, 12.3 cases per 100,000 people, was about four times the national rate. State health officials also say estimates of recent TB transmission, meaning cases from infections picked up recently rather than years earlier, are higher in Alaska than anywhere else in the country.

Seventy-seven Alaskans were diagnosed with active TB last year, according to provisional state figures. That is down from 91 in 2024, but above the 58 cases a year the state recorded from 2019 through 2021.

Where TB hits hardest

Most of those cases were in Southwest Alaska. The region, home to about 41,000 people, had 46 of the state's 77 cases last year, according to the state's 2025 infectious disease report. Anchorage, with about seven times as many people, had 17.

American Indian and Alaska Native people made up 77% of Alaska's TB cases in 2024, at a rate of 61 cases per 100,000, according to the state's 2024 TB summary. A study by CDC and Alaska epidemiologists found that from 2010 to 2020, the age-adjusted TB rate among American Indian and Alaska Native people in Alaska was 21 times the rate among American Indian and Alaska Native people in other states. Housing in Native communities in Alaska showed more signs of substandard conditions than in Native communities in other states, the researchers found.

State health officials consider TB in young children a marker of recent transmission. Children 14 and younger made up 14% of Alaska's cases in 2024 and 30% in 2023. In 2024, 40% of cases had a known link to another active case.

People experiencing homelessness had a TB rate of 186 per 100,000 in 2024. Anchorage's public health nurses screen for TB at homeless shelters, work that a $2.77 million state grant for the city's public health nursing program would keep going, Alaska News reported in August.

A long history

A 1934 review of death certificates found a TB death rate of 655 per 100,000 among Alaska Native people, and TB caused 35% of all Native deaths, according to a 2017 history by the state Section of Epidemiology. In 1945, one in five deaths in Alaska was from TB, and it was the territory's leading cause of death until 1950. "Tuberculosis is the Alaskan scourge," a 1954 survey report on Alaska's health to the U.S. Department of the Interior declared.

The epidemic drove the creation of the 200-bed Mt. Edgecumbe Hospital in Sitka, which opened in 1950, the 400-bed Alaska Native Hospital in Anchorage, which opened in 1953, and regional hospitals and clinics around the state, the history says. Public health nurses and village "chemotherapy aides," now known as community health aides, helped find and treat cases.

New TB drugs and a coordinated public health campaign brought rates down sharply. Alaska's TB rate fell from 99 cases per 100,000 in 1960 to 12 in 1990. The 2024 rate was about where it stood in 1990.

Many Alaskans in urban areas are unaware of the state's ongoing TB problem, the 2017 history said. "We must think TB to find TB," it warned.

Finding infections before they spread

Most people infected with TB never develop active disease. For most, the lifetime risk is 5% to 10%, and people with latent infection cannot spread it. Finding those infections with a skin test or a blood test, and treating them, can keep them from becoming active TB later. Diagnosing and treating "Alaska's large reservoir of people with TB infection" is "a crucial component of TB control and elimination," the state TB program wrote in 2023. The program and its partners treated 227 people for TB infection in 2024.

Active TB is curable, but treatment typically takes four to nine months of multiple drugs. For decades, Alaska's standard of care has been directly observed therapy, in which a trained worker watches the patient take each dose.

The program's 2024 summary lists areas for improvement. That year, 67% of the contacts of patients whose sputum tested positive on a smear, a sign they are more infectious, were examined, against a national target of 94%. Of those patients, 82% started treatment within seven days of a sputum sample being collected, against a target of 96%. Six people died during treatment that year. The program listed geography, access to health care, treatment adherence, stigma and "public health staffing and resource limitations" among its challenges.

The state has tallied what one outbreak cost. When TB spread through a Yukon-Kuskokwim Delta village of fewer than 1,000 people in 2013, 17 people were found with active TB within five months. The youngest was 11 months old. Sixty more were found with latent infections. Nurses made 11 trips to the village to place skin tests and screen residents. The response cost an estimated $1.1 million and about 10,900 hours of state staff time, the state calculated.

The new system

VacTrAK combines the vaccines a person gets from different providers into a single record, and Alaska requires providers to report every vaccine they give to it within 14 days. As of the end of 2024, it held about 1.67 million active patient records and 17.6 million vaccinations, according to the state's request for proposals for its replacement.

The state's request for proposals, issued in August 2025, called for the new system to go live by July 1, 2026. Neither the request nor its list of required features mentions tuberculosis tests. In April, the state announced it intended to award the contract to Health Management Systems Inc., chosen from nine bidders that included STChealth, the system's longtime vendor, according to the state's procurement notice.