Cough in a Cannery Worker, Southeast Alaska, July 2015

BACKGROUND:  Alaska has one of the highest rates of tuberculosis (TB) in the United States. Approximately 25,000 people work seasonally in Alaska every year; 70% are non-residents, and many are foreign born from high TB incidence countries.  We present a case of active TB in a non-resident seafood industry worker in remote Alaska in July 2015 who was subsequently found to be co-infected with AIDS. We describe the logistics of the response.

METHODS:  The Alaska TB Program worked with State Public Health Nursing (PHN) and local health care providers to interview the individual, arrange for transport for diagnostic testing, process sputa specimens, and to arrange for isolation.  Contacts were identified with the help of the employer, and nurses from the TB program and PHN traveled to the site to further investigate.  Medical records were obtained from the patient's out of state hospital facility.  The Alaska State Public Health Laboratory performed TB specimen testing.

RESULTS:   The patient was smear positive (4+), with pulmonary (cavitary) and miliary TB.  Unknown to his employer, he was receiving care in his home state for AIDS; he was non-compliant with his therapy.  His last CD4 count from out-of-state records was under 50 cells/mm³. The patient was immediately started on 4 drug therapy for TB while in Alaska.  Due to his infectiousness and the need for an air Medevac to depart his remote location, complicated logistics were arranged for the individual to travel directly to his home state instead of to a larger Alaska city for further care. No active cases of TB were identified from his close contacts at the seafood processing plant, and the end of the season occurred before 8-week follow up testing for TB infection could be performed to assess for any skin test converters.  One hundred and one contacts were screened.  Of the 84 skin tests placed, 31 had positive results.  All individuals with positive skin tests were flown to Juneau for radiography and sputa collection.  No active cases of TB were identified.

CONCLUSIONS:  This case report highlights the risk of TB in seasonal seafood workers in rural Alaska, many of whom are foreign-born from high TB incidence countries.  Close coordination and collaboration between private companies and local, state and federal agencies, as well as good communication between state agencies is critical in logistically challenging TB situations such as this.  Medical screening of seasonal seafood workers is challenging, and coordination of care is important.