No TB outbreak
in prisons, says state
health division chief

A positive tuberculin test
differs from active TB

By Helen Altonn
Star-Bulletin

Contrary to some reports, Hawaii's prisons haven't had a tuberculosis outbreak, says Dr. Philip Bruno, state Health Department's Communicable Division chief.

He said the Centers for Disease Control became concerned after hearing several hundred inmates here have tuberculosis, which isn't true.

He said only four cases of infectious TB have been identified since Jan. 1. Three were inmates; one, an employee.

The first was a federal prisoner at Halawa Correctional Facility who was transferred to a prison in California and diagnosed with TB there, Bruno said. Active TB was identified in two other inmates when they were screened upon admittance to the Oahu Community Correctional Center, he said.

After federal authorities notified the state Department of Public Safety of the Halawa case, it asked the Health Department for help in screening the population, Bruno said.

Both Halawa and OCCC inmates and employees have since been screened, he said. The active TB cases do not appear related, and no new ones have been picked up, he said.

Wesley Mun, health care administrator in the Department of Public Safety, said about 400 inmates at the two prisons have had positive tuberculin skin tests since Jan. 1.

There is a big difference between a positive tuberculin test and an active case of TB, Bruno and Mun stressed.

A positive test only indicates past exposure to the tuberculosis bacteria, Bruno said. A chest X-ray is done to determine if the person has infectious TB.

Mun said X-rays of inmates with positive skin tests are being done at Lanakila Health Center and should be completed this week.

Bruno said the prevalence of Hawaii inmates with positive tuberculin tests is about the same as the 14 percent to 25 percent in mainland facilities.

Of all people with positive skin tests, he said about 10 percent will have active TB in their lifetime, depending on their immune system and other medical and nutritional factors.

State Health Director Bruce Anderson pointed out that tuberculosis is not spread by food, water or touch but is an airborne infection.

"TB transmission requires prolonged exposure to an infectious individual within a confined area," he said.

Bruno said the concern is that someone in the prison populations with HIV infection or another immunological problem might contract TB. That could cause a serious infection that could spread to other people and cause a large outbreak, he said.

"It's a problem in all prisons throughout the country," he said. But the Public Safety Department has a good screening program, he said. "They're right on top of it."

Bruno noted that Hawaii has the highest incidence of TB in the country, largely because of foreign arrivals. But the disease is curable with modern antibiotics, he said.

Last year, according to the Department of Health, there were 181 TB cases -- 15.2 per 100,000 population -- and 80 percent were foreign-born people.

In 1940, 717 new TB cases were recorded, or 170 per 100,000 population.

Seven deaths from TB were reported last year and 10 in 1997, compared with 257 in 1940.

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State program
delivers therapy

By Helen Altonn
Star-Bulletin

Medications are being delivered personally to Hawaii residents with tuberculosis in a special state Department of Health program.

The federally funded "directly observed therapy program" is being conducted in cooperation with the U.S. Centers for Disease Control, said Dr. Philip Bruno, Communicable Disease Division chief. He said paramedical assistants deliver the proper medications and dosage to patients at home or work, following certain schedules.

Since many people with TB are foreign-born, he said assistants are hired who represent the same cultural background and speak the same language as the patient. They observe the patient taking the medication and ask if there are any problems, Bruno said.

Patients also are seen monthly in the TB clinic, he said.

The state treats about 60 percent of all tuberculosis cases in Hawaii, Bruno said. Private physicians handle the other 40 percent.

He said the state works with private physicians in the directly observed therapy program and will provide services to patients who want them. Of 181 TB cases in Hawaii last year, Bruno said 120 were in the special therapy program.

Anyone with TB symptoms should see their physician for an evaluation, Bruno said.

Symptoms include a cough lasting more than three weeks, chest pain, coughing up blood, fever, weight loss and night sweats.