TB Threat in Marshall Islands Requires More Action

MIJ: TB Threat - Public Health Emergency - three of 10 Marshallese with drug resistant TB have died

TB challenge gets a parliamentary focus in the Marshall Islands - frustration with the current law that requires them to go to court to quarantine patients

Moves to forcibly quarantine TB patients in Marshall Islands - few people who could contract drug resistant TB have refused to take their medication

Marshalls Seeks Quarantine in TB Outbreak Minister of Health is asking the parliament to amend a law

MORE:

• U.S. Interior Gives Marshall Islands 1.4M to Fight TB - Tony Babauta, Assistant Secretary of the Interior for Insular Areas, signed yesterday a $1,456,932 grant that will be used to combat an outbreak of multiple drug resistant tuberculosis in the Marshall Islands.

THREAT: Underlining the health threat of drug resistant TB, three of 10 Marshallese with drug resistant TB have died, including one of two discovered in recent months, according to a recent report from the US Centers for Disease Control. The report, based on a CDC investigation conducted in November at the request of the Ministry of Health, shows six patients were on Ebeye and four on Majuro. The drug resistant problem first developed in 2004. CDC’s investigation estimated there are 480 people who had contact with the active drug resistant TB patients, and of those, 168 were “anticipated” to be infected.
CDC describes the outbreak of drug resistant TB as “a public health emergency.” “This threat is an emergency,” said Assistant Attorney General Rosania Bennett at Tuesday’s hearing on a TB-related bill. “It can impact us all as it’s hard to monitor and cure.”

HEARING: The threat of drug resistant tuberculosis in the Marshall Islands has prompted Parliament’s health committee to consider a law ammendment to allow public health officials to order the quarantine of patients.The recommendation was made during a public hearing on Thursday, considering legislation to increase the authority of health officials to detain people who are a threat to public health and prevent the spread of communicable diseases.During the meeting, Public Health Director Dr Kennar Briand said in other countries, people who pose a public health risk can be detained in jail, and asked why not take the next step if a person refuses treatment.

TREATMENT: The country’s TB-Leprosy Director, Dr Kennar Briand says three patients have died from the disease, three are still receiving treatment, there is one suspected case, and two unconfirmed historical cases. He says they are also trying to interview several-hundred people who may have been in contact with TB patients. Dr Briand says a few people who could contract drug resistant TB have refused to take their medication for a variety of reasons. “Same reasons why people in the Pacific don’t want to take drugs. They believe its magic, they believe they can use local medicines, same reasons, some people don’t want to bother taking it.”

QUARANTINE: Introducing the legislation, Health Minister Amenta Matthew said the current system requiring public health officials to take a person to court requires a lengthy and difficult process that does not adequately prevent spread of contagious diseasesThe Marshall Islands has confirmed 10 drug-resistant TB cases, and overall has the highest rate of TB in the Pacific at over 190 per 100,000 population. The rate in the United States is four per 100,000. Drug resistant TB has developed as a "result of non-compliance to medications due largely to patients’ refusal to take their medicines regardless of efforts by the Public Health physicians to conduct home visits and counseling," she said. "Currently, there are patients who continuously move around the community with TB disease posing the threat of exposing others to the disease."

GRANT: Babauta pointed out that this is not the first occurrence of drug resistant TB in the Freely Associated States. “I am increasingly concerned that given the free migration privileges of FAS citizens to the U.S., outbreaks such as this demands quick and immediate action by FAS leaders, the federal government and U.S. jurisdictions most visited by FAS citizens,” he said. “Containment and cure should be our priority to ensure that FAS and U.S. citizens are protected. In the recent past there has been a similar outbreak in the Federated States of Micronesia and I anticipate that the lessons learned will provide an excellent model for the Marshalls to follow and provide a similar outcome of success."