US Funding To Target Tuberculosis 'Hot Spots' In Pacific Region

$700 million will support mass screening of Ebeye Islanders in the Marshall Islands

By Giff Johnson

MAJURO, Marshall Islands (Marianas Variety, Sept 5, 2016) – The United States government has approved over $700 million to target one of three tuberculosis “hot spots” in the U.S.-affiliated Pacific island area.

A mass screening of the population of 12,000 on Ebeye Island to detect and treat tuberculosis or TB is anticipated for later this year as a first step in a new effort to reduce the high rate of TB in the Marshall Islands.

Despite ongoing treatment efforts by local health workers, the TB situation in the Marshall Islands remains problematic. Marshall Islands health officials and representatives of the U.S. Centers for Disease Control see this major screening effort as a way to dramatically reduce the problem on Ebeye. If the program on Ebeye is successful, they will look to a similar strategy for Majuro, where half the country’s 55,000 population resides and TB is rampant.

A U.S. Centers for Disease Control official said the three TB “hot spots” in the U.S.-affiliated Pacific are Ebeye, Majuro and Weno, the capital of Chuuk state in the Federated States of Micronesia.

Ministry of Health officials have been working with the U.S. Centers for Disease Control and the World Health Organization to develop the plan for a mass screening at Ebeye Island.

“We won’t stop TB with this screening,” said Dr. Richard Brostrom, who is TB Medical Officer for the Pacific Region, Branch Chief of the Hawaii TB Program for CDC. “But the aim is to decrease the level by 30 percent of more. The number one enemy of TB is organization.”

Getting a better handle on the problem through the mass screening program will “give the TB program an opportunity to focus on prevention following the intensive screening,” said Brostrom.

This would allow for more effective public health TB follow up focus in home and work places. Right now, public health TB program are swamped with the ongoing burden of attempting to get control of the continuing high number of people with TB.

In 2014, the Marshalls reported a TB prevalence rate of 466 per 100,000 population, the highest in the Pacific and one of the highest levels in the world.

In light of high rates of TB in the Marshall Islands and also the Federated States of Micronesia, the public may not realize that the TB situation has improved in recent years.

Brostrom made the point that “there has been measured, modest success” in the TB situation in U.S.-affiliated islands. “The TB rate has dropped 20 percent over the last 15 years in U.S.-affiliated Pacific islands,” he said. “This success is tempered by tremendously high rates — ‘rates’ that mean illness and deaths.” TB is still a “devastating” problem for the Pacific islands, he added.

During a recent CDC-supported meeting of health officials from around the region held in Majuro, island health leaders looked at how to accelerate progress in addressing both TB and leprosy problems. A major challenge is that these needs are competing for limited health funding with a host of other important public health needs, including diabetes.

But the recent approval of $732,300 for the Ebeye TB screening program and related preventive health work will allow the plan to move forward.

The proposal for a mass screening on Ebeye to be done in a six-week period is likely to happen later this year, said Health Minister Kalani Kaneko. Both Kaneko and Brostrom said key to the screening is being ready to treat the expected new cases that will be identified through screening on Ebeye.

The Ebeye screening “will be done in six weeks of concentrated effort,” said Brostrom. “If we can demonstrate it is successful, then we will bring it to Majuro.”

Brostrom said there have been “modest improvements” in the TB situation since 2009. “We need to accelerate progress,” he said. “We have no choice. We can’t maintain the status quo. Everyone wants to take the next step.”

Health officials also hope that reducing TB levels in the Marshall Islands will have a positive impact on Hawaii, where tens of thousands of islanders from the U.S.-affiliated Pacific area now live. Hawaii averaged 119 new TB cases a year, 2005-2014. The number increased nearly 20 percent in 2014 to 136, compared to 115 the previous year.

The state said that over 90 percent of the TB cases identified in 2014 were in “foreign-born persons,” with 60 percent of the cases among people from the Philippines. The Federated States of Micronesia accounted for eight percent and the Marshall Islands contributed four percent of the TB cases identified in Hawaii in 2014.

A Hawaii state Tuberculosis Control Program report for 2005-2014 shows that of the 168 cases of TB from citizens of U.S.-affiliated Pacific islands over that 10-year period, over half (88) were from the Federated States of Micronesia and second largest number (64) came from Marshall Islands. Other islands contributed small numbers to the total: American Samoa 7, Guam 5 and the CNMI 4. Zero cases were recorded from Palau over the 10 years.

Marianas Variety
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