Foreign-born residents fuel increase in TB rates


POSTED: Wednesday, March 25, 2009

Hawaii's tuberculosis rate continues to creep up, with most cases — 110 out of a total 124 last year — involving foreign-born residents, according to the state Health Department's Tuberculosis Control Program.

World Tuberculosis Day was observed yesterday, with Hawaii holding the nation's highest case rate at 9.6 per 100,000 population. It was twice the national average, the state Health Department reported.

Derrick Felix, public health adviser to the Health Department's Tuberculosis Control Program from the U.S. Centers for Disease Control and Prevention, said Hawaii had no multi-drug-resistance cases last year. These are cases resistant to Isoniazid and rifampin, two major drugs used to treat active TB.

But he said “;single drug resistant TB is common, especially among the clients we service.”; These cases increased from six in 2007 to 14 last year, he said.

Overall, the state's TB case rate has been slowly increasing since 2005, when there were 112 cases, Felix said. There were 114 cases in 2006 and 122 in 2007.

The tuberculosis bacillus was discovered on March 24, 1882, and was once the leading cause of death in the United States. Though many people think it's a disease of the past, it is a common infectious disease in many countries.

It has been decreasing overall in the U.S., but the number of cases is increasing among people born in countries where TB is common.

Tuberculosis usually attacks the lungs and can spread from person to person through sneezes, coughs, speaking or even singing.

The Health Department clinics last year read more than 55,000 tuberculin skin tests. Of those, it reported, 8.3 percent were positive. Most had latent TB infection and were offered nine months of antibiotics to prevent the infection from becoming an active disease.

Those with a latent TB infection have the bacteria in their body but their immune system protects them from getting sick. Those who don't go on medication develop the active disease later in life, Felix said.

When they have latent TB, they can't spread the infection to others, but they can if it becomes active.

Symptoms of active TB may include: a bad cough, chest pain, coughing up blood or sputum, weakness or fatigue, weight loss, no appetite, chills, fever and sweating at night.

The Tuberculosis Control Program expanded screening last fall to protect Hawaii from exposure to multi-drug-resistant TB after four deaths in Chuuk (formerly Truk), Federated States of Micronesia, Felix said. “;We welcomed all people from Chuuk to get services.”;

There are Chuukese patients in Hawaii with tuberculosis, but none was found as a result of the enhanced screening, he noted.

Felix said the state program continues to provide free services and do community outreach.

“;The key message is TB is preventable and curable if people take recommended treatment for nine months to prevent developing TB in the future.”;

Dr. Jessie Wing, CDC medical officer who was chief of the Tuberculosis Control Program, was reassigned by the CDC and left for Atlanta last month.

Dr. Glenn Wasserman, director of the Health Department's Communicable Disease Division, is acting chief of the tuberculosis program until a successor is recruited for Wing.

For more information about TB, call 832-5731 or see www.hawaii.gov/health/tb.