A WORD OF CAUTION ON THE INCREASE OF MULTI-DRUG RESISTANT TUBERCULOSIS IN HAWAI`I

HONOLULU—TB is a leading killer among infectious diseases worldwide. The World Health Organization estimates that about two million people die of TB each year. Without accelerated worldwide efforts, 70 million could die by the year 2020. This global epidemic is fueled by the spread of HIV/AIDS and the emergence of multi-drug resistance.

"The good news is that our case count decreased significantly in 2003, however, we must be cautious about the increase in the number of multi-drug resistant cases," said Dr. Jessie Wing, CDC Medical Officer and Chief of the Department of Health’s TB Control Program. "This increase has significant impact on the program due to the expensive medications and clinical needs of these challenging cases."

Although, drug resistant TB in Hawai`i decreased from 22 cases (in 2002) to 11 cases (in 2003), the number of multi-drug resistant cases increased from one in 2002 to four in 2003. All 11 drug resistant cases in 2003 were among foreign-born persons.

Multi-drug resistant TB cases represent the most challenging and expensive TB infections to treat and cure. TB disease is usually treated with a combination of antibiotics drugs that are relatively inexpensive, easy to administer orally, and can cure TB. However, when a patient is infected by or develops a resistant strain, the therapies available are much more expensive, inconvenient or in the case of daily injections, painful to administer. In some cases, treatment and monitoring of a multi-drug resistant case of TB can last many years.

Tuberculosis is an airborne disease caused by small bacteria. It usually affects the lungs, and these cases are most infectious. It may also infect other parts of the body. Individuals can be infected with TB when a person with TB disease of the lungs or throat coughs, sneezes, or sings spreading contaminated droplets. This type of transmission usually requires prolonged contact. Signs and symptoms of TB disease include cough, fever, night sweats, loss of appetite, weight loss and fatigue.

TB FACTS:

• In 2003, the United States reported 14,871 cases of TB, representing a TB case rate of 5.1 per 100,000 (Preliminary CDC data)
• In 2003, Hawai`i reported 117 cases of TB, representing a TB case rate of 9.3 cases per 100,000
• Hawai`i TB case rates fell 56.5% over the past decade from 21.4 cases per 100,000 in 1993 to 9.3 cases per 100,000 in 2003.
• Hawai`i TB case rates fell 21.8% over the past year from 11.9 cases per 100,000 in 2002 to 9.3 cases per 100,000 in 2003.

CASES BY COUNTY (2003):

• Honolulu: 96 new TB cases (10.7 cases/100,000)
• Hawaii: 10 new TB cases (6.5 cases/100,000)
• Maui: 8 new TB cases (6.0 cases/100,000)
• Kauai: 3 new TB cases (5.0 cases/100,000)

March 24^th marks World Tuberculosis Day. On this day in 1882, Robert Koch announced the discovery of the tuberculosis bacillus (TB). The yearly commemoration is intended to raise awareness of TB and stress the importance of TB control efforts.

The Department of Health TB Program returned to the Lanakila Health Center (LHC) in the summer of 2003 after a total renovation of the 13,000 sq. foot clinic. With the installation of a digital and network-integrated X-ray system and a negative air pressure system, the clinic is now a state-of-the-art facility. In 2003, the TB Program at LHC administered over 21,000 skin tests and 13,276 X-rays. The number of patients seeking TB services increased after the re-opening of the renovated clinic space. For more information on program services, please check the TB Program’s website at http://www.hawaii.gov/doh/resource/comm_dis/tb/.

Jason Nehal
CDC Public Health Advisor
Hawai`i Tuberculosis Control Program
Phone: (808) 832-5731
Email: jnehal@tb.health.state.hi.us

Dr. Jessie Wing
CDC Medical Officer
Hawai`i Tuberculosis Control Program Chief
Phone: (808) 832-5731
Email: jxwing@tb.health.state.hi.us