Search

In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010-2019.We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States-persons historically grouped with NH/PI persons as one racial category-as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients.During 2010-2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents.

Sputum-culture confirmation guides tuberculosis (TB) diagnosis and patient management but has previously been reported to be low in the US-Affiliated Pacific Islands (USAPI). We evaluated factors associated with positive sputum-culture results by analyzing TB case surveillance and laboratory data, including sputa quality and quantity for diagnostic specimens from the USAPI. A lower proportion of sputum specimens were reported as culture positive from the USAPI (42%), compared with Hawaii (58%) and the United States (55%). Few (3%) sputa collected from TB patients in the USAPI had both optimal quality and quantity; 40% had optimal quality (mucoid), and 7% had optimal quantity (>5 mL). Suboptimal sputum specimen quality and quantity contributed to fewer sputum-culture positive results in the USAPI. Improving sputum collection and handling might lead to more culture positive results and ultimately improve patient care and TB control in USAPI.

BACKGROUND: Treatment of latent tuberculosis infection is an important strategy to prevent tuberculosis disease. In the USA, three tests are used to identify latent tuberculosis infection: the tuberculin skin test (TST) and two IFN-γ release assays (T-SPOT.TB and QuantiFERON). To our knowledge, few large studies have compared all three tests among people at high risk of latent tuberculosis infection or progression to tuberculosis disease. We aimed to assess test agreement between IFN-γ release assays and TST to provide guidance on their use in important risk groups. METHODS: In this observational cohort study, we enrolled participants at high risk of latent tuberculosis infection or progression to tuberculosis disease at ten US sites with 18 affiliated clinics, including close contacts of infectious tuberculosis cases, people born in countries whose populations in the USA have high (≥100 cases per 100 000 people) or moderate (10–99 cases per 100 000 people) tuberculosis incidence, and people with HIV. Participants were interviewed about demographics and medical risk factors, and all three tests were administered to each participant. The primary endpoints for this study were the proportions of positive test results by test type stratified by risk group and test concordance by risk group for participants with valid results for all three test types. The study is registered at ClinicalTrials.gov, NCT01622140. FINDINGS: Between July 12, 2012, and May 5, 2017, 26 292 people were approached and 22 131 (84·2%) were enrolled in the study. Data from 21 846 (98·7%) participants were available for analysis, including 3790 (17·3%) born in the USA and 18 023 (82·5%) born outside the USA. Among non-US-born participants overall, the RR comparing the proportions of TST-positive results (7476 [43·2%] of 17 306 participants) to QuantiFERON-positive results (4732 [26·5%] of 17 882 participants) was 1·6 (95% CI 1·6–1·7). The risk ratio (RR) for the comparison with the proportion of T-SPOT.TB-positive results (3693 [21·6%] of 17 118 participants) was 2·0 (95% CI 1·9–2·1). US-born participants had less variation in the proportions of positive results across all tests. The RRs for the proportion of TST-positive results (391 [10·9%] of 3575 participants) compared with the proportion of QuantiFERON-positive results (445 [12·0%] of 3693 participants) and T-SPOT.TB-positive results (295 [8·1%] of 3638 participants) were 0·9 (95% CI 0·8–1·0) and 1·3 (1·2–1·6), respectively. 20 149 (91·0%) of 21 846 participants had results for all three tests, including 16 712 (76%) non-US-born participants. Discordance between TST and IFN-γ release assay results varied by age among non-US-born participants and was greatest among the 848 non-US-born children younger than 5 years. 204 (87·2%) of 234 non-US-born children younger than 5 years with at least one positive test were TST-positive and IFN-γ release assay-negative. The proportion of non-US-born participants who were TST-negative but IFN-γ release assay-positive ranged from one (0·5%) of 199 children younger than 2 years to 86 (14·5%) of 594 participants aged 65 years and older (p(trend)

BACKGROUND: Immigrants to the United States from countries with a high burden of tuberculosis (TB) who have abnormal chest radiographs but negative sputum cultures during pre-immigration screening (TB Class B1) have a high risk of being diagnosed with TB disease within 1 year of arrival. METHODS: Using 2010–2014 national surveillance data, we compared proportions of Class B1 Filipino immigrants who received a diagnosis of TB disease within 1 year of arrival to Hawaii to proportions in other U.S. states (not including Hawaii) using chi-squared tests. RESULTS: In Hawaii, 40/1190 (3.4%) of Class B1 Filipino immigrants to Hawaii received a diagnosis of TB disease within 1 year of arrival compared with 220/16,035 (1.4%) nationwide (P < .01). CONCLUSIONS: During 2010–2014, the percentage of recent Class B1 Filipino immigrants in Hawaii with TB disease diagnosed within 1 year of arrival was over twice that as nationwide.

T-SPOT®.TB (T-SPOT) is an interferon-gamma release assay (IGRA) used to detect infection with Mycobacterium tuberculosis based on the number of spot-forming T-cells; however, delays in sample processing have been shown to reduce the number of these spots that are detected following laboratory processing. Adding T-Cell Xtend (XT) into blood samples before processing reportedly extends the amount of time allowed between blood collection and processing up to 32 hours. In this study, paired blood samples from 306 adolescents and adults at high risk for latent tuberculosis (TB) infection (LTBI) or progression to TB disease were divided into three groups: 1) early processing (∼4.5 hours after collection) with and without XT, 2) delayed processing (∼24 hours after collection) with and without XT, and 3) early processing without XT and delayed processing with XT. The participants' paired samples were processed at a local laboratory and agreement of qualitative and quantitative results were assessed. The addition of XT did not consistently increase or decrease the number of spots. In groups 1, 2, and 3, samples processed with XT had 13% (10/77), 28.0% (30/107) and 24.6% (30/122), respectively, more spots while 33.8% (26/77), 26.2% (28/107), and 38.5% (47/122) had less spots compared with samples processed without XT. The findings suggest that XT does not reliably mitigate the loss of spot-forming T-cells in samples with processing delay.

T-SPOT.TB (T-SPOT) is an interferon gamma release assay (IGRA) used to detect infection with Mycobacterium tuberculosis based on the number of spot-forming T cells; however, delays in sample processing have been shown to reduce the number of these spots that are detected following laboratory processing. Adding T-Cell Xtend (XT) into blood samples before processing reportedly extends the amount of time allowed between blood collection and processing up to 32 h. In this study, paired blood samples from 306 adolescents and adults at high risk for latent tuberculosis (TB) infection (LTBI) or progression to TB disease were divided into three groups: (i) early processing (∼4.5 h after collection) with and without XT, (ii) delayed processing (∼24 h after collection) with and without XT, and (iii) early processing without XT and delayed processing with XT. The participants’ paired samples were processed at a local laboratory and agreement of qualitative and quantitative results was assessed. The addition of XT did not consistently increase or decrease the number of spots. In groups 1, 2, and 3, samples processed with XT had 13% (10/77), 28.0% (30/107), and 24.6% (30/122), respectively, more spots, while 33.8% (26/77), 26.2% (28/107), and 38.5% (47/122) had fewer spots than samples processed without XT. The findings suggest that XT does not reliably mitigate the loss of spot-forming T cells in samples with processing delay.

Nontuberculous mycobacteria (NTM) respiratory infections represent a growing public health problem in many countries. However, there are limited published epidemiologic studies for the Western Pacific region. We reviewed respiratory specimens submitted to Diagnostic Laboratory Services in Hawaii, USA, for culture of Mycobacterium tuberculosis during August 2007-December 2011 to determine the NTM isolation rate. We observed a statistically significant increase in the rate of specimens with NTM isolated in respiratory culture (adjusted rate ratio per year 1.65, 95% CI 1.54-1.77; p

Multidrug-resistant tuberculosis (MDR-TB), defined as TB caused by Mycobacterium tuberculosis resistant to at least isoniazid (INH) and rifampin (RMP), threatens communities throughout the world. MDR-TB prevalence is increasing, with some countries reporting over 20% MDR-TB among new TB cases.1 To compound the situation, only 48% of individuals with MDR-TB receive adequate treatment by international standards. Worldwide, MDR-TB mortality remains high, as 11–20% of treated individuals and 25–40% of untreated individuals die of the disease.2–5 Although MDR-TB strains of M. tuberculosis were thought to be less transmissible,5,6 person-to-person transmission resulting in primary MDR-TB disease in contacts has been well demonstrated.7,8 Rapid identification, isolation, and appropriate treatment of patients with infectious MDR-TB is essential to cure disease and interrupt further transmission. However, the appropriate management of infected MDR-TB contacts is less clear. INH and RMP, the standard treatment for drug-susceptible latent tuberculous infection (LTBI), are likely ineffective against MDR-TB strains. To prevent progression to TB disease, several experts recommend that persons with LTBI undergo treatment based on the susceptibility results of the source case.9–11 Fluoroquinolones (FQs) are highly effective against drug-resistant M. tuberculosis and are often recommended in combination with other medications.9 However, some FQ-based combination MDR LTBI treatment regimens have been poorly tolerated.11–13 Furthermore, animal studies have suggested adverse effects on bone and cartilage development, resulting in a reluctance to use FQs in pediatric patients.14 MDR-TB experts have suggested that the benefits of using FQs outweigh the risks when treating pediatric MDR-TB patients or treating MDR-TB contacts for LTBI (MDR LTBI).15,16 As studies reporting MDR-TB outcomes have focused on TB disease,17–19 previous articles have highlighted the need for studies to demonstrate tolerability, feasibility, safety and efficacy of treatment for MDR LTBI.20 We describe our experience in providing MDR LTBI treatment following two simultaneous MDR-TB outbreaks in the Federated States of Micronesia (FSM). Our study followed the treatment of contacts with LTBI after exposure to infectious MDR-TB patients. The purpose of the study was to describe the tolerability and safety of the FQ-based regimens, to examine the operational feasibility of LTBI treatment in a resource-poor setting, and to observe whether treatment lowered the risk of progression to TB disease.

The current tuberculosis (TB) case reporting system for the United States, the Report of Verified Case of TB (RVCT), has minimal capture of multidrug-resistant (MDR) TB treatment and adverse events. Data were abstracted in five states using the form for 13 MDR TB patients during 2012–2015. The Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems were used to evaluate attributes of the form. Unstructured interviews with pilot sites and stakeholders provided qualitative feedback. The form was acceptable, simple, stable, representative, and provided high-quality data but was not flexible or timely. For the 13 patients on whom data were collected, the median duration of treatment with an injectable medication was 216 days (IQR 203–252). Six (46%) patients reported a side effect requiring a medication change and eight (62%) had a side effect present at treatment completion. A standardized MDR TB supplemental surveillance form was well received by stakeholders whose feedback was critical to making modifications. The finalized form will be implemented nationally in 2020 and will provide MDR TB treatment and morbidity data in the United States to help ensure patients with MDR TB receive the most effective treatment regimens with the least toxic drugs. Keywords: Drug resistance, Surveillance, Tuberculosis

Setting: Tuberculosis (TB) and diabetes mellitus (DM) are prominent public health problems in the Republic of the Marshall Islands, a small island nation with high rates of tuberculosis and diabetes. Objective: Evaluate the rate of active and latent TB in a Pacific Island DM clinic. Design: In one DM clinic on the island of Ebeye, 213 adult patients aged 27â86 years completed tuberculin skin testing and TB work-up between April 2010 and March 2012. Results: Screening for TB led to the diagnosis of 77 patients with TB infection and 11 patients with TB disease. From these data, the prevalence of TB disease among DM patients in the clinic exceeded 5% (95% CI 2.2%â8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged â¤50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0â9.7, p=â0.05). Conclusion: The experience at the Ebeye Diabetes Clinic demonstrates that screening DM patients for TB can identify significant rates of TB infection and TB disease, and should be considered for other settings with a high background TB incidence. Further assessment of TB risks should explore age, gender, and level of diabetes control. Keywords: Tuberculosis, Diabetes, Pacific Islands, Bi-directional screening

The South Pacific Territory of Wallis and Futuna has a high burden of non-communicable diseases (NCD): 18% of adults have diabetes mellitus (DM) and 87% are classified as overweight or obese.To characterise the burden of additional World Health Organization (WHO) recognised NCD risk factors, such as smoking, obesity, high blood pressure, eating less than five fruit or vegetable servings per day and a sedentary lifestyle, among adults with DM.Re-analysis of cross-sectional data from a 2009 national survey. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Of 487 adults sampled, 87 (18%) had DM. Nearly 99% of individuals with DM had at least one additional NCD risk factor, and 62% had three or more concurrent NCD risk factors. Individuals with DM were more likely to be obese (OR 1.66, 95%CI 1.01-2.74) and had a much higher prevalence of high blood pressure (OR 3.02, 95%CI 1.87-4.86).DM is rarely identified in the absence of other NCD risk factors. We recommend an integrated approach to the management of DM and other NCD risk factors in routine care rather than a disease-specific approach.

A retrospective cohort study was conducted to evaluate the screening of adult TB patients for diabetes (DM) using glycated haemoglobin (HbA1C) in Ebeye, Republic of the Marshall Islands. Of 62 patients registered between July 2010 and December 2012, 28 (45%) had DM. The only significant difference in baseline characteristics between those with and those without DM was higher age in those with DM. Two-month sputum smears and cultures were also not different between the two groups. Despite the limited sample size, this study shows that screening TB patients for DM in Ebeye is feasible and worthwhile and that it should be continued.Une étude rétrospective de cohorte a été réalisée afin d'évaluer le dépistage du diabète (DM) chez des patients tuberculeux adultes grâce à l'hémoglobine glycosylée (HbASe llevó a cabo un estudio retrospectivo de cohortes con el fin de examinar la detección sistemática de la diabetes mellitus (DM) en los pacientes adultos con diagnóstico de tuberculosis (TB), mediante la determinación de la hemoglobina glucosilada (HbA

The steadily growing epidemic of diabetes mellitus poses a threat for global tuberculosis (TB) control. Previous studies have identified an important association between diabetes mellitus and TB. However, these studies have limitations: very few were carried out in low-income countries, with none in Africa, raising uncertainty about the strength of the diabetes mellitus-TB association in these settings, and many critical questions remain unanswered. An expert meeting was held in November 2009 to discuss where there was sufficient evidence to make firm recommendations about joint management of both diseases, to address research gaps and to develop a research agenda. Ten key research questions were identified, of which 4 were selected as high priority: (i) whether, when and how to screen for TB in patients with diabetes mellitus and vice versa; (ii) the impact of diabetes mellitus and non-diabetes mellitus hyperglycaemia on TB treatment outcomes and deaths, and the development of strategies to improve outcomes; (iii) implementation and evaluation of the tuberculosis 'DOTS' model for diabetes mellitus management; and (iv) the development and evaluation of better point-of-care diagnostic and monitoring tests, including measurements of blood glucose and glycated haemoglobin A(1c) (HbA(1c)) for patients with diabetes mellitus. Implementation of this research agenda will benefit the control of both diseases.

Background In the Federated States of Micronesia and then the Republic of the Marshall Islands (RMI), levofloxacin pharmacokinetics were studied in children receiving directly observed once-daily regimens (10 mg/kg, age >5 years; 15-20 mg/kg, age ≤5 years) for either multidrug-resistant tuberculosis disease or latent infection after multidrug-resistant tuberculosis exposure, to inform future dosing strategies. Methods Blood samples were collected at 0 (RMI only), 1, 2 and 6 hours (50 children, aged 6 months to 15 years) after oral levofloxacin at >6 weeks of treatment. Clinical characteristics and maximal drug concentration (Cmax) of levofloxacin, elimination half-life and area under the curve from 0 to 24 hours (AUC0-24 hours × μg/mL) were correlated to determine the optimal dosage and to examine associations. Population pharmacokinetics and target attainment were modeled. With results from the Federated States of Micronesia, dosages were increased in RMI toward the target Cmax for Mycobacterium tuberculosis, 8-12 µg/mL. Results Cmax correlated linearly with per-weight dosage. Neither Cmax nor half-life was associated with gender, age, body mass index, concurrent medications or predose meals. At levofloxacin dosage of 15-20 mg/kg, Cmax ≥8 µg/mL was observed, and modeling corroborated a high target attainment across the ratio of the area under the free concentration versus time curve to minimum inhibitory concentration (fAUCss,0-24/MIC) values. Conclusions Levofloxacin dosage should be 15-20 mg/kg for Cmax ≥8 µg/mL and a high target attainment across fAUCss,0-24/MIC values in children ≥2 years of age.

Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.En santé publique, la recherche opérationnelle (RO) vise à identifier des stratégies, des interventions, des outils et des connaissances susceptibles d'améliorer la qualité, la couverture, l'efficacité ou la performance de systèmes de santé. L'attention a récemment été attirée sur le manque de capacités en recherche opérationnelle des programmes de santé publique dans toutes les îles du Pacifique malgré des investissements considérables dans leur mise en œuvre. Ce manque de réflexion critique pourrait empêcher le personnel des programmes de santé de comprendre pourquoi les objectifs ne sont pas totalement atteints et entraver des progrès à long terme en santé publique. L'Union Internationale contre la Tuberculose et les Maladies Respiratoires (L'Union) a collaboré avec les agences du Pacifique pour offrir des cours de RO basés sur un modèle de formation élaboré par L≈os;Union et Médecins Sans Frontières Bruxelles-Luxembourg en 2009. Le premier a débuté en 2011 en collaboration avec l'Université nationale de Fidji, le Ministère de la santé de Fidji, l'Organisation Mondiale de la Santé et d'autres partenaires. L'Union et le Secrétariat de la Communauté Pacifique ont organisé un deuxième cours pour les participants des autres îles du Pacifique en 2012 et un cours supplémentaire destiné aux participants Fidjiens a commencé en 2013. Douze participants ont été enrôlés dans chacun des trois cours. En ce qui concerne les deux cours terminés avant la fin de 2013, 18 participants sur 24 ont terminé leur RO et soumis leurs articles avant la date limite. A ce jour, 17 articles ont été publiés. Cet article décrit le contexte, l'organisation et les résultats des cours du Pacifique ainsi que les innovations, adaptations et défis.La meta de la investigación operativa en salud pública consiste en estudiar las estrategias, las intervenciones, los instrumentos o los conocimientos que fortalecen la calidad, la cobertura, la eficacia y el desempeño de los sistemas de salud. En tiempos recientes, se ha llamado la atención sobre la falta de capacidad de realizar investigación operativa en los programas de salud pública en todas las Islas del Pacífico, pese a una inversión considerable en la ejecución. La falta de una reflexión crítica permanente impide que el personal del programa de salud comprenda las razones por las cuales no se cumple a cabalidad con los objetivos y dificulta además el logro de beneficios a largo plazo en materia de salud pública. La Unión Internacional contra la Tuberculosis y las Enfermedades Respiratorias (La Unión) ha colaborado con entidades del Pacífico a fin de llevar a cabo cursos de investigación operativa, con base en un modelo de capacitación elaborado por La Unión y Médicos Sin Fronteras de Bruselas y Luxemburgo en el 2009. El primero de estos cursos comenzó en el 2011, en colaboración con la Universidad Nacional Fiji, el Ministerio de Salud de Fiji, la Organización Mundial de la Salud y otros asociados. La Unión y la Secretaría de la Comunidad del Pacífico organizaron un segundo curso dirigido a participantes de otros países y territorios de las Islas del Pacífico en el 2012 y en el 2013 comenzó un nuevo curso, destinado a participantes de las Islas Fiji. Cada uno de los tres cursos contó con 12 participantes. En los dos cursos terminados antes del fin de 2013, 18 de los 24 participantes completaron la investigación operativa, presentaron sus artículos dentro del término previsto en el curso y hasta la fecha, se han publicado 17 artículos científicos. En el presente artículo se describen el contexto, los procedimientos y los resultados de los cursos de las Islas del Pacífico y se comentan además las innovaciones, las adaptaciones y las dificultades encontradas.

Mentorship is a key feature of operational research training courses run by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières. During the recent South Pacific paper writing module, the faculty discussed 'hands-on' mentorship (direct technical assistance) vs. 'hands-off' mentorship (technical advice). This article explores the advantages and disadvantages of each approach. Our collective experience indicates that 'hands-on' mentorship is a valuable learning experience for the participant and a rewarding experience for the mentor. This approach increases the likelihood of successful course completion, including publishing a well written paper. However, mentors must allow participants to lead and take ownership of the paper, in keeping with a first author position.Le tutorat est un élément clé des cours de formation à la recherche opérationnelle organisés par l'Union Internationale Contre la Tuberculose et les Maladies Respiratoires et Médecins sans Frontières. Lors du récent module consacré à la rédaction d'articles dans le Pacifique Sud, la faculté a discuté des mérites comparés du tutorat pratique (assistance technique directe) et du tutorat moins actif (conseil technique). Cet article explore les avantages et inconvénients de chaque approche. Notre expérience collective montre que le tutorat pratique est un outil d'apprentissage précieux pour le participant et une expérience gratifiante pour le tuteur. Cette approche accroit les chances que le cours soit suivi jusqu'à la fin, notamment la publication d'un article bien écrit. Les tuteurs doivent cependant laisser les participants conduire la rédaction de l'article et se l'approprier, en accord avec leur position de premier auteur.La tutoría es una de las características principales de los cursos de capacitación en investigación operativa de la Unión Internacional Contra la Tuberculosis y Enfermedades Respiratorias y Médicos Sin Fronteras. Durante un reciente módulo en el Pacífico Sur sobre la redacción de artículos científicos, el cuerpo docente analizó las modalidades de tutoría ‘práctica’ (asistencia técnica directa) y tutoría ‘teórica’ (asesoría técnica). En el presente artículo se examinan las ventajas y desventajas de cada enfoque. Según la experiencia colectiva de los autores, la tutoría ‘práctica’ representa una valiosa vivencia de aprendizaje para los participantes y una experiencia enriquecedora desde el punto de vista de los tutores. Este enfoque favorece la finalización exitosa del curso, que incluye la publicación de un artículo científico bien redactado. Es importante que los tutores permitan que los participantes lideren y se apropien del artículo, en conformidad con la posición de autor principal.

A retrospective cohort study was performed in Pohnpei, a small Pacific Island, to evaluate the feasibility and results of screening adult diabetes (DM) patients for tuberculosis (TB) and latent tuberculous infection (LTBI) using a symptom screen, tuberculin skin testing and chest radiography. Of 79 patients, 65 (82%) completed screening. Two (3%) patients with active TB and 16 (25%) with LTBI were referred for anti-tuberculosis treatment and isoniazid preventive therapy, respectively. It is feasible and worthwhile to screen diabetes patients for TB, but a number of changes are needed to improve both the screening process and the diagnostic yield.Une étude rétrospective de cohorte a été réalisée à Pohnpei, un petit îlot du Pacifique, afin d'évaluer la faisabilité et les résultats du dépistage de patients adultes avec une diabète (DM) à la recherche d'une tuberculose (TB) ou d'une infection tuberculeuse latente (LTBI) grâce à un arbre de décision basé sur les symptômes, sur un test cutané à la tuberculine et sur une radiographie pulmonaire. Parmi 79 patients, 65 (82%) ont achevé le dépistage. Deux (3%) patients avaient une TB active et 16 (25%), une LTBI ; ces patients ont été référés pour traitement de TB ou traitement préventif par isoniazide, respectivement. Il est donc faisable et utile de dépister les patients DM à la recherche d'une TB, mais la procédure de dépistage doit être améliorée grâce à différentes modifications afin d'obtenir de meilleurs résultats en termes de diagnostic.En Pohnpei, una pequeña isla del Pacífico, se llevó a cabo un estudio retrospectivo de cohortes con el propósito de evaluar la factibilidad y los resultados de una detección sistemática de la enfermedad tuberculosa y la infección tuberculosa latente (LTBI) en los pacientes adultos con diagnóstico de diabetes (DM), mediante un cuestionario de síntomas, la prueba cutánea de la tuberculina y la radiografía de tórax. Se incluyeron 79 pacientes, de los cuales 65 completaron el plan de detección (82%). Se estableció el diagnóstico de tuberculosis (TB) activa en dos pacientes (3%), en 16 pacientes el de LTBI (25%) y los pacientes se remitieron a fin de suministrarles el tratamiento antituberculoso y el tratamiento preventivo con isoniazida, respectivamente. Se demostró que es factible y útil practicar la detección de la TB en los pacientes con DM, pero es preciso establecer una serie de modificaciones con el fin de mejorar el mecanismo de detección sistemática y aumentar el rendimiento diagnóstico.

A single case of multidrug-resistant tuberculosis (MDR-TB) can overwhelm the technical and financial capacity of small TB programs. In May 2008, the island state of Chuuk requested assistance for their first cases of MDR-TB. Second-line drugs and isolation rooms were unavailable, lab capacity was limited, and clinicians lacked experience. Delayed response caused prolonged transmission among household contacts. Several agencies responded with technical assistance and resources. Subsequent evaluations identified 16 additional MDR-TB cases and 124 infected contacts. Within six months, the local TB program gained remarkable capacity to manage MDR-TB cases and contacts, and greatly improve care for all TB patients. The Chuuk outbreak demonstrates the importance of establishing MDR-TB readiness in smaller jurisdictions and maintaining an essential TB control infrastructure.