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TB Notes 1, 2007
Director's Letter
Highlights from State and Local Programs
  Maine’s Contact Investigation Course for Public Health Nurses: A Model for Regional Collaboration
  Washington State TB Program Hosts Regional Meeting
  Midwest TB Controllers Meeting
World TB Day “TB Awareness Walk”
TB Program Evaluation Toolkit Shared with Evaluators
Public Health Information Network Conference, September 2006
QuantiFERON-TB Gold Education: Responding to the National Need
TB Education and Training Network Updates
  TBETN Member Highlight
International Research and Programs Branch Update
  Oral Presentation at the 2007 IUATLD North America Region Conference
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  Release of 2005 TB Surveillance Report
  Update on Research Priorities of the TBESC
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TB Notes Newsletter

No. 1, 2007

Oral Presentation at the 2007 IUATLD North America Region Conference

Sekai Chideya, MD, of DTBE’s International Research and Programs Branch, developed an oral and poster presentation on the “Burden of Tuberculosis Disease Among Marshall Islanders Living in Arkansas—2000–2005” for the 2007 Conference of the International Union Against Tuberculosis and Lung Disease (IUATLD), North America Region. Her colleague on the study, Dr. Leonard Mukasa from the Arkansas Department of Health and Human Services, presented the study at the conference. A brief synopsis of the study is summarized below.

Although Native Hawaiians/Pacific Islanders (including Marshall Islanders) account for only 0.1% of the population of Arkansas (AR), Marshall Islanders represented 5.8% of all TB patients in the state during 2000–2005, and 40% of foreign-born patients in 2004. This talk will describe factors influencing TB transmission and barriers to care in Arkansas’ Marshall Islander community. Dr. Chideya and her team reviewed Arkansas’ surveillance data for all TB cases and collected patient data from medical records and interviews with Marshallese TB patients begun on treatment January 1, 2000–December 31, 2005. 

Of the 861 TB cases reported in Arkansas, 50 (5.8%) occurred in Marshallese patients; 46 (92%) of the 50 patients were born in the Marshall Islands, yet only three (8%) reported symptoms before U.S. entry. Most (68%) lacked health insurance, and at least 10 (20%) had a history of untreated or inadequately treated latent TB infection (LTBI). Among the 40 symptomatic patients, 26 (65%) had delayed diagnosis (>60 days from symptom onset to diagnosis), primarily due to patients not seeking medical attention, misunderstanding the U.S. health care system, and having language and transportation barriers.

Arkansas’ Marshall Islanders are disproportionately affected by TB compared to other racial/ethnic groups. Promptly identifying and treating LTBI, increasing access to medical insurance, and addressing social and infrastructure-related barriers to health care will be vital in improving prevention and control of TB and reducing health disparities in this population.

—Submitted by Bryan Kim, MPH
Div of TB Elimination


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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