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TB Notes 2, 2006
Highlights from State and Local Programs
  An Outbreak Response in a Rural, Southwest Missouri County Jail
  No Reported TB Cases in Wyoming in 2005
  Suffolk County (New York) Targeted TB Testing and Treatment Program Among the Foreign-born, 2000–2004
  The Changing Epidemiology of TB in Connecticut, 2000-2004
  Molecular Genotyping of Mycobacterium tuberculosis in Connecticut
  Third Annual Conference on TB in the U.S. Pacific Islands: Meeting Highlights, Challenges, and Solutions for Addressing the Disparities
  "Update: Tuberculosis Nursing" Workshop in Hawaii
  Lessons Learned in the Process of Evaluation – Illinois
  TB Education and Targeted Testing of Garfield County, Colorado, WIC Clients
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TB Notes Newsletter

No. 2, 2006


Third Annual Conference on TB in the U.S. Pacific Islands: Meeting Highlights, Challenges, and Solutions for Addressing the Disparities

Based on available surveillance data, the average tuberculosis (TB) case rate in the U.S.-affiliated Pacific Islands (USAPIs) is 51.1 per 100,000; this is 10 times higher than the overall U.S. rate. The USAPIs include the U.S. territories of Guam and American Samoa, the Commonwealth of the Northern Marianas Islands, and three U.S.-affiliated nations: the Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands. The U.S.-affiliated nations have Compacts of Free Association with the United States; under these compacts, the countries are fully sovereign in domestic and foreign affairs, but give responsibility for their health, education, defense, and other essential operations to the United States. As such, the USAPIs are among the recipients of CDC cooperative agreement funding for TB control program activities. These jurisdictions deal with many challenges such as highly mobile populations, limited health care resources, variable economic and social conditions, and locations separated by vast expanses of ocean. The map of the USAPIs shown here has been superimposed on a map of the United States to illustrate the distances between the islands. In addition, through agreements with the United States, USAPI citizens are able to immigrate to the United States without the usual overseas screening for health conditions that is required of those permanently resettling from other foreign countries. Given the disproportionately high TB rates among USAPIs, the DTBE Field Services and Evaluation Branch (FSEB) is working with partners to implement program and laboratory improvements in this region.

Map of U.S. and  U.S. Pacific Islands

From December 6 to 8, 2005, more than 80 nurses, laboratory technicians, clinicians, and other public health officials gathered at what has become an annual meeting to address the growing threat of TB in the USAPI jurisdictions. This conference provides an invaluable opportunity for those on the front lines to come together and formulate strategies that will work in their communities. Meeting attendees from CDC, the TB control programs in the USAPIs and the State of Hawaii, the World Health Organization (WHO) Western Pacific Regional Office, HHS Region 9, HHS Office of the Pacific, the State of California Microbial Disease Laboratory, the University of Hawaii, and the Pacific Island Health Officers Association gathered to review the latest trends; conduct hands-on training in patient management, surveillance, and TB laboratory quality assurance testing; and identify solutions to the challenges of sustaining effective TB control programs in the region. Among proposed solutions, an important factor will be the maintenance of the WHO DOTS strategy and CDC enhancements, such as high-quality laboratory testing and expert TB medical consultation.  

Another major theme of the conference was the need for culturally appropriate TB health education materials. This is especially important in many of the Pacific Islands, where many islanders have their own local language and a considerable proportion of the people do not read. Mr. Terry Sasser, a resident of the Marshall Islands and founder of the organization Mission Pacific, shared information about using multimedia to empower communities. In many of the remote, isolated communities in the Pacific Islands, media tools such as locally produced videos provide a critical means for outreach and empowerment. Mr. Sasser is currently collaborating with DTBE and the Republic of the Marshall Islands National TB Program to develop a video regarding TB for Marshallese communities.

Since TB is one of the most common opportunistic diseases for people infected with HIV, the link between TB and HIV/AIDS was another critical topic. While the numbers of HIV/TB-coinfected persons in the region are low, DTBE will continue to work with USAPI TB programs and HIV/AIDS organizations in the region to strengthen the availability of HIV testing for TB patients. Conference materials are available at

Prior to this year’s regional meeting (December 1–2), the San Francisco Regional Training and Medical Consultation Center collaborated with faculty from DTBE, the National Jewish Medical and Research Center, the California Department of Health Services, and the Commonwealth of the Northern Mariana Islands to provide training for approximately 40 clinicians and other medical professionals who treat TB patients in this region. In collaboration with the University of Hawaii School of Medicine and the Pacific Association for Clinical Training (a HRSA-funded project), a training DVD was developed. Information regarding this DVD can be obtained at

For more information about TB control activities in the USAPIs, please contact Subroto Banerji (404-639-8065 or or Andy Heetderks (404-639-8130 or in DTBE’s Field Services and Evaluation Branch.

—Submitted by Maggie Kelly, Subroto Banerji,
Andy Heetderks, Gregory Andrews, and Zach Taylor 
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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