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The Honolulu Advertiser
Posted on: Saturday, March 25, 2006

TB cases fall, but state still vigilant

By Beverly Creamer
Advertiser Staff Writer

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Over the past decade, Hawai'i has seen a decline in the number of active tuberculosis cases, with 112 last year nearly 28 percent below the state average according to state health officials.

And there have been no cases of the far more dangerous multi-drug-resistant TB.

"This is the lowest number in several years," said Dr. Jessie Wing, chief of the tuberculosis control program of the state Department of Health. "We've averaged 155 cases a year over the past 11 years."

This is good news in a state that often leads the nation in its rate of TB per 100,000 population.

But this year, Hawai'i dropped behind Alaska and the District of Columbia. While Hawai'i's rate is 8.8 percent, Alaska's is 9 percent and D.C.'s is 10.2 percent.

"We're in good shape, but the message is we have to be vigilant," said Wing, speaking yesterday on the nation's observance of World Tuberculosis Day.

With the national incidence of multidrug-resistant TB increasing more than 1 percent last year the first increase in a decade Hawai'i health officials are constantly watchful.

They also are using new testing techniques to identify the disease more quickly and accurately.

"In taking care of drug-resistant cases, you have to make sure you get the proper workup and get proper medications to the patient," said Wing. "And if you have Directly Observed Therapy (which involves health workers visiting patients' homes every day for six months to dispense antibiotics), you use that."

Nationally the number of multidrug-resistant cases rose last year from 113 to 128, raising concern among officials at the national Centers for Disease Control and Prevention. The proportion of extensively drugresistant cases those resistant to at least five drugs also has risen.

But even nondrug-resistant cases need precise and careful follow-up, said Wing, and Hawai'i has been using an effective surveillance, screening and treatment regimen since the mid-1990s, when the state began to see a new and growing threat of increasing TB cases, particularly among new immigrants.

As a result, the number of new cases has been declining steadily.

The successful therapy Hawai'i uses involves direct daily contact with patients. About half the patients stop by the Lanakila Health Center each morning to take their antibiotics, said Wing. With the other half, medical workers take the antibiotics directly to the patients' homes and watch while they consume the medicine.

"This is the recommended therapy for all patients," said Wing. "We get 100 percent of our patients on it."

The power of this face-to-face therapy involves the certainty that patients get the medication for the required six months to kill the active bacterium. Drug resistance has arisen through the improper use of antibiotics and failure to ensure this kind of follow-through, officials say.

Wing said more than 80 percent of the state's cases are found in immigrants from Asian and Pacific countries where TB is still prevalent.

"If they come from a TB-prevalent area, they could bring that with them," Wing said. "In our screening, that's what we're finding."

Statistics show that of the TB cases among the foreign-born, 52 percent are among immigrants from the Philippines; 8 percent from the Compact of Free Association areas of the Marshall Islands, Micronesia and Palau; 5.4 percent from Japan; 5 percent from Vietnam; and 4 percent from Indonesia.

Wing said more patients are now being treated in their countries of origin before coming to the United States. However, those from the Pacific nations are not required to be tested for TB because of their legal status, and 8 percent of the TB cases this year were among people from Free Association nations.

Of the 2,000 immigrants who entered the state in 2005, 300 came in under Class A and Class B status, which means they have either active or inactive TB. Few were in the active category, said Wing, but the state follows up with both, evaluating their cases and putting the people on daily antibiotic therapy.

"Ninety-six percent are evaluated and treated," she said. That's one of the highest percentages in the country, she said.

Those with inactive TB were offered nine months of antibiotic treatment to prevent the disease from becoming active. Those who don't get treatment generally have left the state, or may be pregnant.

Follow-up screening is now starting to be done with a new technique called QuantiFERON-TB Gold that's replacing the skin test with a blood test that has fewer false positives. So far, it has been used in a little more than 100 people.

Over the past year, the state Health Department has mainly screened 50,000 people through TB skin-testing. This includes schoolchildren, healthcare workers, food handlers and residents of care homes.

Reach Beverly Creamer at bcreamer@honoluluadvertiser.com.