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Basic Definitions
Current TB Epidemiology in Hawai`i
Current TB Epidemiology in the US

Basic Definitions Here are some basic definitions that may be helpful in understanding the slides and statistics on this page: Latent TB Infection (LTBI) Active TB Disease, or TB Case Case Rate

Current TB Epidemiology in Hawai`i

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Case Rates and Numbers Cases by County Deaths from TB Cases by Age Site of Disease Drug Resistance TB and HIV/AIDS Effects of Immigration

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Case Rates and Numbers
The State of Hawai`i continues to report one of the highest annual tuberculosis (TB) case rates in the country. In 2006, Hawai`i reported 115 total cases of TB and a rate of 8.9 new cases per 100,000 population. Although TB rates have steadily declined since 1992, Hawai`i's 2006 rate was still higher than the national TB case rate of 4.6 per 100,000 (Centers for Disease Control and Prevention (CDC), 2007).

TB Case Rates: HI vs. US, 1990-2006
Reported TB Cases: HI, 1930-2006

Cases by County
The City and County of Honolulu continues to report the highest number of TB cases in the state, with 95 cases of TB and an incidence rate of 10.4 cases per 100,000, accounting for 82.6% of the state's TB morbidity in 2006. Maui County reported 9 new cases of TB (incidence rate: 6.4 cases per 100,000), Hawai`i County reported 7 new cases of TB (incidence rate: 4.1 cases per 100,000), and Kaua`i County reported 4 new cases of TB (incidence rate: 6.3 cases per 100,000).

TB Cases by County: HI, 2006

Deaths from TB
TB death rates in Hawai`i are generally low. In 2006, there was one reported death due to TB in Hawai`i, a TB mortality rate of 0.1 deaths per 100,000. (To be ruled a TB death, the deceased patient's record must be reviewed by a TB Control Program physician who then determines that the death was caused by TB disease). The national TB mortality rate was 0.2 deaths per 100,000, or 646 total TB deaths in the US in 2005 (CDC, 2007).

TB Deaths and Death Rates: HI, 1920-2006

Cases by Age
The largest group of new TB cases reported in 2006 in Hawai`i were those 45 to 64 years of age; 30.4% (n=35) were in this age group. There were no new cases of TB under 10 years of age. National data show that cases were generally younger at TB diagnosis: 34% of all new cases in 2006 in the US were from 25 to 44 years of age (CDC, 2007).

TB Cases by Age at Diagnosis: HI, 2006

Site of Disease
Eighty-seven percent (n=100) of cases reported in Hawai`i in 2006 were pulmonary TB, or affecting the lungs. Tuberculosis, however, is a systemic disease and can affect any area of the body. Thirteen percent (n=15) of cases were exclusively extrapulmonary, or outside the lungs.

TB Cases by Major Site of Disease: HI, 2006

Drug Resistance
The percentage of TB cases in Hawai`i with primary drug resistance increased from 6.3% in 2005 to 12.2% in 2006. The number of primary multidrug-resistant TB cases (MDR TB), as defined by CDC as resistance to at least isoniazid (INH) and rifampin (RIF) in initial isolates, remained at zero in 2006. The national MDR TB rate was 0.9% of all cases in 2006 (CDC, 2007). To prevent development of drug resistant TB, an initial four-drug regimen is usually recommended for newly diagnosed cases with directly observed therapy (DOT) (CDC, 2000).

TB Cases with Primary Drug Resistance: HI, 2006
TB Cases with Primary Multidrug Resistance: HI, 2002-2006

TB and HIV/AIDS
TB-HIV co-infection remains less common in Hawai`i than on the US mainland. In 2006, there was one TB case in Hawai`i co-infected with HIV, or 0.9% of all cases. In comparison, an estimated 7% of all TB cases diagnosed in the US in 2005 were co-infected with HIV (CDC, 2007).

TB-HIV Co-infected Cases: HI, 1996-2006

Effects of Immigration
Immigration, primarily from Asia and the neighboring Pacific Islands, continues to have a major impact on Hawai`i's TB morbidity. Many immigrants arrive with latent TB infection (LTBI), and some may develop active TB. Screening of non US-born clients in state TB clinics in 2006 found that almost 40% had LTBI.

In 2006, US Customs and Border Protection officially admitted over 3,700 new immigrants to Hawai`i, 70.4% of whom were from the Philippines. In the same year, 101 new TB cases, representing 87.8% of the state's morbidity, were in non US-born individuals. Persons born in the Philippines accounted for the majority of Hawai`i's non US-born cases, making up 63.4% of this group, followed by those born in the Federated States of Micronesia (8.9%) and China (5.9%).

In comparison, only 56.6% of all the active TB cases reported in the US in 2006 were non US-born, although this percentage has steadily increased from 36% in 1996 (CDC, 2007). Please note: the CDC counts persons born in the US territories (such as Guam, American Samoa and Puerto Rico) and the Compact of Free Association (COFA) nations - Republic of Marshall Islands, Federated States of Micronesia, and Palau - as US-born. Following CDC's definition, Hawai`i's non US-born percentage decreases to 77.4%.

Proportion Non US-Born TB Cases: HI vs. US, 1996-2006
TB Cases by Place of Birth: HI, 2006
TB Cases from Pacific Jurisdictions: HI, 2002-2006
Non US-Born TB Cases: Length of US Residence at TB Diagnosis: HI, 2002-2006

Current TB Epidemiology in the US

For the most current national TB data, visit the Centers for Disease Control and Prevention, Division of Tuberculosis Elimination website: http://www.cdc.gov/tb/default.htm