Old disease poses
new global threat

Tuberculosis strikes about
8 million people a year, with
some new strains drug-resistant

By Helen Altonn

World Tuberculosis Day is being observed today in Hawaii and around the world with the old disease posing new threats to public health.

No big events are planned here to mark the day that Robert Koch announced the discovery of the TB bacillus in 1882, perhaps because of the war, said John Hunter, program director of the American Lung Association of Hawaii.

However, the association wants the public to be aware that TB is still an urgent threat, "and even more from the increasingly global point of view of Hawaii and the United States."

Hawaii consistently has had the highest, or second-highest, TB case rate in the nation per 100,000 population because of a large immigrant population.

Dr. Jessie Wing, chief of the state Department of Health's TB Control Program, said Friday that Hawaii's case rate had stabilized, slipping to 148 cases last year from 150 in 2001.

But she expressed concern about a rise in drug-resistant TB cases, to 22 last year from 12 in 2001. Twenty were among foreign-born people.

Douglas Yee, American Lung Association of Hawaii president and Hawaii member of the National Institutes of Health Directors' Council of Public Representatives, said tuberculosis anywhere in the world is a concern for Hawaii.

"The ability to pass the disease through an airborne system is frightening."

Many Americans think TB is a disease of the past, but about 8 million new cases occur each year, with about 2 million deaths, he said. One-third of the world's population -- 2 billion people -- is infected with TB, he said.

Yee cited "troubling signs that we have yet to truly conquer this ancient disease," particularly with Hawaii as a Pacific hub:

>> More than three-fourths of all cases reported nationally last year occurred in minorities and poverty-stricken areas, creating racial and ethnic disparities in TB rates.

>> More than half of the TB cases in the United States last year were foreign-born, a dramatic increase. In Hawaii, 82 percent of cases last year were foreign-born, compared with 49 percent in the United States., according to the Hawaii TB Control Program.

>> Multidrug-resistant TB cases have increased substantially in the country, although the overall number of cases has declined.

Senate Health Chairwoman Rosalyn Baker (D, Honokohau-Makena) said legislators recently told federal health officials visiting from Washington, "Some decisions Congress and the federal administration are making are impacting us in an unintended and adverse way."

She said additional federal resources are needed to deal with people coming here because of the Compact of Free Association or immigration laws from areas where TB is common and there is no screening.

Hunter noted that Hawaii's TB rate fell to 11.9 cases per 100,000 last year from a high of 23.45 cases per 100,000 in 1992, but Hawaii is one of only two states "still in double digits."

The Centers for Disease Control was making headway toward abolishing tuberculosis until the early 1990s when states redirected money to other programs. Hawaii's numbers peaked in 1992-93, Yee pointed out. He said Hawaii's TB Control Program "does heroic work, but it must do so with ever-diminishing resources."

Wing said no money was requested this year from the Legislature for tuberculosis. "All this stuff is really breaking the past two weeks," she said.

She said she will work with the lung association and Hawaii Thoracic Society to issue an alert to physicians early this week with new national treatment guidelines for TB and drug-resistant strains.

State Health Department
U.S. Centers for Disease Control

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