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Drug resistant TB in Marshalls since 2004

By Giff Johnson MAJURO, Marshall Islands (Yokwe, Feb. 6, 2010) - Underlining the health threat of drug resistant TB, three of 10 Marshallese with drug resistant TB have died, including one of two discovered in recent months, according to a recent report from the US Centers for Disease Control.

The report, based on a CDC investigation conducted in November at the request of the Ministry of Health, shows six patients were on Ebeye and four on Majuro. The drug resistant problem first developed in 2004.

CDC’s investigation estimated there are 480 people who had contact with the active drug resistant TB patients, and of those, 168 were "anticipated" to be infected.

CDC describes the outbreak of drug resistant TB as "a public health emergency."

"This threat is an emergency," said Assistant Attorney General Rosania Bennett at Tuesday’s hearing on a TB-related bill. "It can impact us all as it’s hard to monitor and cure."

As debate swirled in Nitijela this week over bill 65 to give the Ministry of Health power to quarantine people who are deemed a health threat to the public, the CDC report offers a window into the difficulty of tracking TB patients and people who came into contact with them who are highly mobile -- including several who moved to the United States. CDC reported that it notified the relevant state health authorities where Marshallese TB patients and contacts moved for follow up evaluations, and CDC is working with the Ministry of Health to ensure that US states get notified within one week when a TB patient or contact moves to the USA. "At least seven household contacts of ‘Patient A’ had relocated to the state of Washington before clinical evaluations were completed," CDC reported. "Four household contacts of ‘Patient E’ were in Oklahoma. Because ‘Patient E’ may have still had infectious multi-drug resistant TB other contacts were possible in Tennessee. Two other patients with confirmed multi-drug resistant TB had also relocated to the US (California and Hawaii)." None of the patients getting drug resistant TB are children -- ages ranged from 27 top 68, and nine of the 10 had diabetes. One of those exposed was a nurse who was caring for a patient. The CDC said that people who are diabetic are "two-to-four times" more likely to develop TB.

CDC noted that the nurse who contracted drug resistant TB did not follow infection control procedures, and Patient A "was not effectively isolated because unprotected visitors, including this health care worker, slept in the room with her during her infectious period."

CDC made 17 recommendations for diagnosing, treating and managing TB in the RMI, including that all TB patients receive direct observation treatment (DOT) -- nurse providing the daily pill and watching the patient take it -- assign each DOT worker no more than 15 patients, and establish standard for patients who do not take their medication and use legal interventions to isolate and detain patients who do not cooperate with DOT.

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