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Basic Definitions
Current TB Epidemiology in Hawai`i
Current TB Epidemiology in the US

Basic Definitions Here are some basic definitions that may be helpful in understanding the slides and statistics on this page: Latent TB Infection (LTBI) Active TB Disease, or TB Case Case Rate

Current TB Epidemiology in Hawai`i

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Case Rates and Numbers Cases by County Deaths from TB Cases by Age Site of Disease Drug Resistance TB and HIV/AIDS Effects of Immigration

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Case Rates and Numbers
The State of Hawai`i continues to report one of the highest annual tuberculosis (TB) case rates in the country. In 2009, Hawai`i reported 117 total cases of TB, a rate of 9.0 new cases per 100,000 population. Although TB rates have declined over the past decade, Hawai`i's 2009 rate was more than double the national TB case rate of 3.8 per 100,000 (Centers for Disease Control and Prevention (CDC), 2010).

TB Case Rates: HI vs. US, 1995-2009
Reported TB Cases: HI, 1930-2009

Cases by County
The City and County of Honolulu continues to report the highest number of TB cases in the state, with 83 cases of TB and an incidence rate of 9.1 cases per 100,000, accounting for 70.9% of the state's TB morbidity in 2009. Maui County reported 16 new cases of TB (incidence rate: 11.0 cases per 100,000), Kaua`i County reported 10 new cases of TB (incidence rate: 15.5 cases per 100,000), and Hawai`i County reported 8 new cases of TB (incidence rate: 4.5 cases per 100,000).

TB Cases by County: HI, 2009

Deaths from TB
In 2009, there were four reported deaths attributed to TB in Hawai`i, giving a TB mortality rate of 0.3 per 100,000. The latest national data show a TB mortality rate of 0.2 per 100,000, or 644 total TB deaths in the US in 2006 (CDC, 2009).

TB Deaths and Death Rates: HI, 1920-2009

Cases by Age
The largest group of new TB cases reported in 2009 in Hawai`i were those 45 to 64 years of age; 37.6% (n=44) were in this age group. There were two new cases of TB under 10 years of age. National data show that cases were generally younger at TB diagnosis: 33% of all new cases in 2008 in the US were from 25 to 44 years of age (CDC, 2009).

TB Cases by Age at Diagnosis: HI, 2009

Site of Disease
Eighty-five percent (n=99) of cases reported in Hawai`i in 2009 were pulmonary TB, or TB affecting the lungs. Tuberculosis, however, is a systemic disease and can affect any area of the body. Fifteen percent (n=18) of cases were exclusively extrapulmonary, or TB outside the lungs. National TB data show that a lower proportion, or 80%, of all cases reported in the US in 2008 were pulmonary (CDC, 2009).

TB Cases by Major Site of Disease: HI, 2009

Drug Resistance
The percentage of TB cases in Hawai`i with primary drug resistance increased from 11.3% in 2008 to 13.7% in 2009. There were three primary multidrug-resistant TB cases (MDR-TB) in Hawai`i, defined by CDC as resistance to at least isoniazid (INH) and rifampin (RIF) in initial isolates, accounting for 2.6% of all cases in 2009. The national MDR-TB rate was 1.0% of all cases in 2008 (CDC, 2009). To prevent development of drug resistant TB, an initial four-drug regimen is usually recommended for newly diagnosed cases with directly observed therapy (DOT) (CDC, 2000).

Proportion of Primary Drug Resistant Cases: HI, 2005-2009
TB Cases with Primary Drug Resistance: HI, 2009

TB and HIV/AIDS
TB-HIV co-infection remains less common in Hawai`i than on the US mainland. In 2009, there was one new TB case in Hawai`i, or 0.9% of all cases, co-infected with HIV. In comparison, an estimated 6% of all TB cases diagnosed in the US in 2008 were co-infected with HIV (CDC, 2009).

TB-HIV Co-infected Cases: HI, 2000-2009

Effects of Immigration
Immigration, primarily from Asia and the neighboring Pacific Islands, continues to have a major impact on Hawai`i's TB morbidity. Many immigrants arrive with latent TB infection (LTBI), and some may develop active TB. Screening of non US-born clients in state TB clinics in Hawai`i in 2009 found that 19% had LTBI.

In 2009, US Customs and Border Protection officially admitted over 4,200 new immigrants to Hawai`i, 80.7% of whom were from the Philippines. In the same year, 100 new TB cases, representing 85.5% of the state's morbidity, were in non US-born individuals. Persons born in the Philippines accounted for the majority of Hawai`i's non US-born cases, making up 62.0% of this group, followed by persons born in the Federated States of Micronesia (10.0%) and the Republic of Marshall Islands (8.0%).

In comparison, only 59% of the active TB cases reported in the US in 2009 were non US-born, although this percentage has steadily increased from 47% in 2000 (CDC, 2010). [Please note: the CDC counts persons born in the US territories (such as Guam, American Samoa and Puerto Rico) and the Freely Associated States (FAS) - Republic of Marshall Islands, Federated States of Micronesia, and Palau - as US-born.] Following CDC's definition, Hawai`i's non US-born percentage among new TB cases in 2009 was 70.1%.

Proportion Non US-Born TB Cases: HI vs. US, 2000-2009
TB Cases by Place of Birth: HI, 2009
TB Cases from Pacific Jurisdictions: HI, 2005-2009
Non US-Born TB Cases: Length of US Residence at TB Diagnosis: HI, 2009

Current TB Epidemiology in the US

For the most current national TB data, visit the Centers for Disease Control and Prevention, Division of Tuberculosis Elimination website: http://www.cdc.gov/tb/default.htm