Tuberculosis still a threat in Hawai’i, state officials say

Tuberculosis is still found on all the islands in Hawai’i, with four new cases diagnosed on Kaua’i last year, for an incidence rate of 6.5 cases for every 100,000 residents, according to state Department of Health statistics.

Last month, state DOH officials joined others around the world in marking World Tuberculosis Day, commemorating the day in 1882 when Robert Koch announced the discovery of the tuberculosis (TB) bacillus, state DOH leaders said in a press release.

The yearly commemoration is marked by events worldwide intended to raise awareness of TB and stress the importance of TB control efforts.

TB is a disease that is commonly seen in the lungs, and is spread from person to person through the air.

When a person with active TB disease in the lungs or throat coughs, sneezes, speaks or sings, tiny drops containing mycobacterium tuberculosis may be spread into the air.

If another person breathes in these drops, there is a chance that they will become infected with TB.

Two forms of TB exist, both of which are treatable and curable:

  • Latent TB infection, when a person has TB bacteria in their body but the body’s immune system is protecting them and they are not sick. Someone with latent TB infection cannot spread the infection to other people;
  • Active TB disease, when a person becomes sick with TB because their immune system can no longer protect them. Someone with active TB disease may be able to spread the disease to other people.

Hawai’i usually leads the nation in having the highest state rate of TB, with 8.8 cases per 100,000 in 2005 (or 1.8 times the national rate).

Although many people believe that TB is a disease of the past, it is still a leading killer among infectious diseases worldwide, and is prevalent in the Philippines.

A new diagnostic test, QuantiFERON-TB Gold, received final approval for use in the United States by officials with the U.S. Food and Drug Administration last year.

Leaders of Hawai’i’s DOH TB Control Program were innovative, moved forward, and secured special state funding to implement this new blood test.

This major shift in methodology from tuberculin skin testing (TST) to a new generation of lab-based diagnostic tests will revolutionize the screening, improve the specificity of TB testing, and reduce the number of false positive tests, state DOH officials said.

Currently, the QuantiFERON-TB Gold test is being used in Honolulu for targeted populations, and will be more readily available once funding increases to accommodate the volume of testing that Hawai’i conducts annually.

“With the introduction of these new diagnostic tools, we are updating our TB screening in Hawai’i, there-by allowing the program to focus testing and treatment of latent TB infection on persons at highest risk for progression to active TB disease,” says Dr. Jessie Wing, state DOH TB program chief.

In 2005, professionals at DOH clinics placed and read over 50,000 tuberculin skin tests statewide. Among these, 17.8 percent were positive.

Most of these persons had latent TB infection, and were offered treatment of antibiotics within nine months to prevent progression to active TB disease.

In 2005 there were 112 cases of active TB disease reported to DOH leaders in Hawai’i, with O’ahu reporting the highest number of TB cases in the state.

The total number of new TB cases reported decreased 3.4 percent from 2004 (116 active TB cases) to 2005 (112 active TB cases).

Case rates have decreased 46 percent from 1995 (16.3 TB cases/100,000 population) to 2005 (8.8 TB cas-es/100,000 population).

Total active TB cases reported statewide in 2005 were 112 (8.8 cases/100,000 population), broken down in the other counties as follows:

  • City & County of Honolulu: 83 new TB cases (9.2 cases/100,000);
  • Hawai’i: 12 new TB cases (7.4 cases/100,000);
  • Maui: 13 new TB cases (9.4 cases/100,000).

In 2005, some 73.2 percent of the state’s TB cases were detected in foreign-born residents, compared with 54 percent foreign-born TB cases reported nationally in 2004.

For more information on tuberculosis, contact the Hawaii Tuberculosis Control Program at 1-808-832-5737, or visit the Department of Health Web site at http://www.hawaii.gov/health/tb.

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