GIFF JOHNSON
A plan for a mass screening of people on Ebeye for tuberculosis (TB) is anticipated for later this year as a first step in a new effort to reduce the level of TB in the Marshall Islands.
With the TB problem continuing at high rates for many years, health officials are looking at this major screening effort to reduce the problem by identifying more people with TB and treating them. If the program on Ebeye is successful, they will look to a similar strategy for Majuro, where about half the RMI’s population resides.
Ministry of Health officials have been working with the US Centers for Disease Control (CDC) and the World Health Organization to develop the plan.
“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 virtually overwhelmed by the ongoing burden of attempting to get control of the continuing high number of people with TB.
In 2014, RMI 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 RMI 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 US-affiliated islands. “The TB rate has dropped 20 percent over the last 15 years in US-affiliated Pacific islands,” he said. “This success is tempered by tremendously high rates — ‘rates’ that mean illness and deaths.”
From CDC’s perspective, the three TB “hotspots” in the Pacific are Ebeye, Majuro and Weno in Chuuk.
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. The Joint Economic Management and Financial Accountability Committee approved $732,300 for the screening program and non-communicable disease prevention at its meeting last week in Honolulu.
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 having diabetes triples the risk of TB changing from latent (no symptoms) to active illness. The fact that so many people are diabetic in Marshall Islands and other Pacific islands is driving up TB rates, he said. “Forty percent of people with TB got it because diabetes pushed it to active status,” he said.
Read more about this in the September 2, 2016 edition of the Marshall Islands Journal.