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TB Notes Newsletter

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No. 3, 2005

Second Meeting of the Pacific Island TB Controllers Association

In a previous issue of TB Notes (No. 2, 2004), we informed our partners of outcomes from the inaugural meeting of the Pacific Island TB Controllers Association (PITCA).  Building on that successful meeting, we held the second meeting on December 7-9, 2004, convening again in Honolulu. We report on the outcomes from the second meeting.

The second PITCA meeting provided another invaluable opportunity for regional staff, technical consultants, and supporting agencies to network and to discuss program and laboratory accomplishments since the inaugural meeting. In an effort to maximize the meeting’s effectiveness and to address other important public health issues for the region, this meeting was organized to allow for greater participation from regional staff and consultants from Pacific Island jurisdiction (PIJ) HIV/AIDS programs. As a result of this combined effort, participation in this second meeting was close to 100 persons, doubling last year’s attendance. Representation included staff from the six US-affiliated PIJs (American Samoa, Republic of the Marshall Islands, Federated States of Micronesia, Republic of Palau, Guam, and Commonwealth of the Northern Mariana Islands), the State of Hawaii TB Control Program and Public Health Laboratory, the State of California Microbial Diseases Laboratory, the Federal Aviation Administration, the Diagnostic Laboratory Services of Honolulu, the World Health Organization (WHO) Western Pacific Regional Office (WPRO), the Secretariat of the Pacific Community (SPC) TB Section, the US Health and Human Services (HHS) Region 9 Office of Pacific Health and Human Services, the CDC Office of Global Health, the CDC Division of HIV/AIDS Prevention, and DTBE. The Pacific Island Health Officers Association (PIHOA) again provided conference support.

During the first day of the meeting, participants were provided an overview of health-related activities support by the HHS Region 9 Office of Pacific Health and Human Services for the region. This was followed by an update on the status of TB and HIV in the region. Keeping in line with core conference activities, several partners provided updates regarding laboratory practices for TB and HIV, the newly established PIHOA regional laboratory initiative, shipping protocols, and International Airline Transportation Association (IATA) regulations. The first day provided an excellent opportunity to present certificates of appreciation from CDC Director Julie Gerberding, MD, to several partners (Dr. Edward Desmond, State of California, Microbial Disease Laboratory; Duain Muraoka, Courier Corporation of Hawaii; Thomas Goob, Diagnostic Laboratory Services; and Patsy Ideue, PIHOA) who have been instrumental in supporting key activities in the region that have led to improved TB control practices for these jurisdictions and their communities. The first day closed with several presentations focused on health education activities for TB and HIV programs.

During the entire second day as well as half of the third day, HIV/AIDS program representatives met separately while the TB participants broke into program and laboratory working groups to review area-specific activities. Laboratory session participants focused on discussions and exercises related to AFB-smear microscopy quality assurance, and set up a mini-laboratory for program staff to use to conduct basic smear microscopy. Program session participants were provided an update by representatives from WHO, SPC, and CDC regarding an agency collaborative training session held in Yap State, Federated States of Micronesia, in November 2004. This included a presentation from Dr. Zachary Taylor regarding a proposed protocol for treatment of TB patients in the Pacific region, based on a hybrid of WHO and CDC protocols and driven by the ability for PIJ TB programs to consistently use TB culture and susceptibility testing. Dr. Masae Kawamura gave a presentation on the role of the Advisory Council for the Elimination of TB (ACET) as well as on the proposed scope of training and medical consultation services available from the San Francisco Regional Training and Medical Consultation Center (RTMCC). Working sessions were held, during which program and laboratory participants from the PIJs as well as DTBE reported back on respective 2004 accomplishments and goals for 2005.

Table 1. Tuberculosis in the US-Affiliated Pacific Islands, 2004

Jurisdiction

2004
Cases
2004
Case Rate
Population

US Pacific Basin1

163

41.4

394,000

Commonwealth of the Northern Mariana Islands

55

70.5

78,000

Guam

51

30.7

166,100

Republic of the Marshall Islands

41

74.0

55,400

Federated States of Micronesia2 -- Yap State3

8

71.4

11,200

Republic of Palau

5

24.2

20,700

American Samoa

3

4.8

62,600

Hawaii4

116

9.2

1,262,840

United States4

14,511

4.9

293,655,404

  1. Pacific Basin denominator excludes population estimates for the FSM states Chuuk, Kosrae, Pohnpei
  2. CDC TB case reporting from FSM this year was limited to Yap State and thus reflects an undercount for FSM
  3. Denominator data for Yap State obtained from www.fsmgov.org/info/people.htm
  4. Provisional TB surveillance data for 2004, CDC, DTBE

The afternoon of the third day allowed for HIV/AIDS and TB representatives to regroup and update each other on the activities from the last day and half. This was an excellent opportunity for staff of these disease-specific programs to come out of historically established working “silos,” and allowed each program within the PIJs to not only hear about activities and accomplishments but also to set the framework to allow for increased collaboration within the PIJ HIV/AIDS and TB programs. Prior to concluding this workshop, Dr. Taylor presented accomplishment awards on behalf of DTBE and Dr. Castro to the PIJ TB program and laboratory staff to recognize program and laboratory accomplishments in 2004. 

One of several important accomplishments in 2004 involves the reporting of TB cases from the PIJs to CDC TB surveillance system. Unlike the US jurisdictions, the six PIJs report TB case data to multiple health agencies: CDC, SPC (www.spc.int), and the WHO WPRO (www.wpro.who.int). Several of the PIJs implement the WHO DOTS protocol, which is also supported by the SPC, while other PIJs implement a more US-based approach. The WHO protocols, developed for resource-challenged programs, are different from the CDC/ATS/IDSA guidelines. As a result, the collection and reporting of TB surveillance data is not always as uniform across the PIJ programs as it is in the US jurisdictions.

During 2004, a total of 163 confirmed cases were reported in this region. This reflects case reports received from all PIJs with the exception of the States of Kosrae, Chuuk, and Pohnpei, which are part of the Federated States of Micronesia. The US Pacific Basin TB case rate (41.4/100,000) is 9 times greater that the reported US case rate (4.9) and exceeds by 5 times the TB rate of Hawaii, the closest US jurisdiction. The TB rate ranged from 4.8 in American Samoa to 74.0 in the RMI. Among the 163 cases reported in the PIJs in 2004, five patients (3%) were diagnosed with multidrug-resistant (MDR) TB, the most dangerous form of TB disease.

The PIJ TB control programs are an important component of our domestic TB control and prevention agenda. Given this disparity in TB rates among PIJs when compared to US jurisdictions with similar case counts or similar populations, the DTBE Field Services and Evaluation Branch (FSEB) has initiated program and laboratory improvement efforts to intensify TB control in these regions which are challenged not only owing to their geographical separation from the United States but also to the limited health care resources available in these PIJs as compared to the US jurisdictions.

The FSEB PIJ TB improvement project includes

  1. Providing technical assistance to collaboratively develop the respective national TB programs (DOT, surveillance, patient management, contact investigation, treatment protocols, and program evaluation with performance indicators);
  2. Improving and sustaining local laboratory capacity (AFB-smear microscopy);
  3. Supporting off-island reference laboratory testing (culture and sensitivity testing);
  4. Fostering regional networking;
  5. Collaborating with other Pacific-focused partners such as WHO, SPC, the Pacific Regional Laboratory Initiative (www.pihoa.org), HHS Region 9 Office of Pacific Health and Human Services, HHS Health Attaché for the PIJs, State of Hawaii TB Program and Laboratory Services, State of California Microbial Diseases Laboratory, and the Francis J. Curry Regional Training and Medical Consultation Center.

To continue supporting the need for regional networking, PIHOA and CDC are collaborating with HHS, San Francisco RTMCC, SPC, WHO, and the State of California to plan a third PITCA meeting December 6–8, 2005, and a separate training workshop for PIJ TB clinicians, scheduled for December 1–2, 2005, in Honolulu, Hawaii. For information regarding this proposed meeting, please contact Subroto Banerji (sbanerji@cdc.gov) or Andy Heetderks (aheetderks@cdc.gov) or send an e-mail to pitca@cdc.gov.

—Submitted by Subroto Banerji, MPH, PHA
Andy J. Heetderks, MPH, Team Leader
Gregory W. Andrews, Section Chief, and
Zachary Taylor, MD, Branch Chief
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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