Hawaii DoH Notified Of Multi-Drug-Resistant TB Cases

Ruzanna Harutyunyan's picture

The Hawai‘i State Department of Health (DOH) was notified this week of five multi-drug-resistant tuberculosis (MDR TB) cases that have resulted in four deaths in Chuuk, Federated States of Micronesia. The government of Chuuk requested assistance from the U.S. Centers for Disease Control and Prevention (CDC) after their initial concerns of MDR TB cases and deaths.

MDR TB signifies that the two primary drugs used to treat active TB are not effective in patients who have this form of TB. Instead, doctors must use other drugs that extend treatment times and costs of therapy. Drug resistance can occur when patients do not complete a full course of therapy. The World Health Organization and World Health Organization and CDC advocate very close monitoring of patients with active tuberculosis, usually with direct observation of the patient taking the medication until they are cured.

MDR-TB is a major global problem whose magnitude is greatly underestimated because developing countries where this may be occurring do not have TB laboratory capability to identify MDR-TB which takes advanced diagnostic tests. The Pacific Island TB Controllers Association and CDC have been working to improve diagnostic, treatment, and public health for TB in the countries in the Pacific during the past several years. This helped to identify the cases in Chuuk, which often go unrecognized in other parts of the world.

In the United States, the prevalence of drug-resistant TB fell to 1 percent between 1997 and 2006, from 2.4 percent in 1993, according to CDC. Since 1995, the prevalence of drug-resistant tuberculosis among foreign-born individuals has been about 1.5 percent, about three times as high as in American-born patients with TB. Hawai‘i has had at most one MDR TB case per year.

The DOH is forming a TB task force to maintain Hawai‘i’s very low rates of MDR TB, to continue to reduce its high rate of tuberculosis, and to effectively coordinate health care of MDR TB cases. MDR TB is treatable particularly when identified early and appropriate medications are administered. The DOH TB Control Branch at Lanakila provides free screening for persons at risk, and free treatment for any person with latent or active TB.


The TB task force will include representation from public and private partners in health care, community clinics, CDC, Health and Human Services, the Honolulu Quarantine Station, regional airlines, the Pacific Islands Health Officers Association, Nations of Micronesia, military, and other government, community and Pacific partners.

TB facts:

* TB is a disease that is commonly seen in the lungs and can be spread from person-toperson through the air. When a person with active TB disease in the lung or throat coughs, sneezes, speaks, or sings, tiny drops containing M. tuberculosis may be spread into the air. If another person inhales 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 occurs 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 occurs 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.

* Multi-drug-resistant TB (MDR TB) is active TB with drug resistance to Isoniazid (INH) and rifampin, two of the four front-line drugs used to treat TB. MDR usually requires treatment with second-line medications for 18-24 months.