Mobile unit to expand TB testing
Hawaii's high rate originates mostly with the foreign-born
The Hawaii Tuberculosis Control Program is waiting for a mobile X-ray unit to arrive so it can take screening services to communities.
"We will go where we are needed instead of expecting people to come here (to the Lanakila clinic)," said Dr. Jessie Wing, chief of the state Department of Health's TB Control Program.
"We can't expect folks to come on the bus to see us," Wing said.
She was hoping the mobile unit -- the same as one as on Air Force One -- would arrive from the mainland in time for World Tuberculosis Day observances tomorrow.
Tuberculosis, an infectious disease caused by a bacteria that usually attacks the lungs, remains a leading killer worldwide, even though many people think it has been wiped out.
Hawaii, with a large immigrant population, continues to have one of America's highest TB rates. Last year, it had 8.9 cases per 100,000 population.
It crept up a little, Wing said, noting the rate was 8.8 in 2005. "Nationally it has gone down. I wish we had tracked with that."
But Hawaii's TB case rates have dropped 36.9 percent in the past 10 years -- from 14.1 cases per 100,000 population in 1997 to last year's 8.9 cases, the Health Department reported.
Nearly 80 percent of Hawaii's new TB cases last year were foreign-born, compared with 55 percent foreign-born cases reported nationally in 2005.
Luckily, Hawaii had no multi-drug-resistant (MDR) or XDR (extensively drug-resistant) tuberculosis cases last year, Wing said.
But they are being reported in Asia and other parts of the world, she noted. "It's a matter of time, unfortunately."
The U.S. Centers for Disease Control and Prevention is trying to help Pacific islands control their TB situation, said Wing, a CDC medical officer.
CDC brings TB controllers together annually from throughout the Pacific to help them with control efforts, and they are brought to Hawaii for laboratory and other training, she said.
"If we don't help, they're not going to do any better. We do need to take care of the Pacific and Asia," she said.
State administrative rules are being updated to include new blood tests for TB infection and base screenings on risk assessment of the disease rather than classification of the patient, Wing said.
The QuantiFERON-TB GOLD blood test is being used in some places as a replacement for the skin test. Another more sensitive blood test, called Elispot-T-Spot, is expected to be approved by the Food and Drug Administration this year, Wing said.
Her program is working with many partners for community outreach, she said. They co-sponsored free TB tests Monday at the Kalihi Valley Health Center in recognition of World Tuberculosis Day.
Free screenings also are planned by the TB unit at the Next Step Project-Kakaako Homeless Shelter.
For more information about tuberculosis, call 832-5737 or visit www.hawaii.gov/ health/tb.
Not all who test positive are infectious
Hawaii's TB clinics read almost 50,000 tuberculin skin tests last year, of which 14.4 percent were positive, the state Department of Health reported.
Most had latent TB infection, meaning the bacteria was in their body but their immune system was protecting them and they were not sick. They were treated with antibiotics for nine months to prevent the infection from becoming an active disease.
Those with the latent infection cannot spread it to others. Those with the active disease can spread it through the air by coughing, sneezing, talking or even singing.
The total number of new TB cases in the islands increased 2.7 percent from 112 cases in 2005 to 115 last year, the TB Control Program reported.
The 115 active cases included 95 in Honolulu, seven on the Big Island, nine in Maui County and four on Kauai.