2016
DOI: 10.15585/mmwr.mm6533a7
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Notes from the Field: Cluster of Tuberculosis Cases Among Marshallese Persons Residing in Arkansas — 2014–2015

Abstract: During early September 2014, the Arkansas Department of Health identified an increased number of tuberculosis (TB) cases among a unique population in a well-circumscribed geographical area in northwest Arkansas. The Compact of Free Association Act of 1985 (Public Law 99-239, amended in 2003 by Public Law 108-188) established the Republic of the Marshall Islands (RMI) as an independent nation, and persons from the RMI can travel freely (with valid RMI passport) to and from the United States as nonimmigrants wit… Show more

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Cited by 8 publications
(5 citation statements)
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“…15,16 Additionally, several large tuberculosis clusters with a high proportion of children have been reported in the freely associated states of the Marshall Islands and the Federated States of Micronesia, and among Marshallese people living in the USA. 18,19 However, rates of tuberculosis among US-born children by parental country of birth and among children and adolescents in US territories and freely associated states have not been systematically reported. Additionally, detailed analyses of national estimates of tuberculosis disease counts and incidence rates among children and adolescents were last published in 2010 and 2007, respectively.…”
Section: Introductionmentioning
confidence: 99%
“…15,16 Additionally, several large tuberculosis clusters with a high proportion of children have been reported in the freely associated states of the Marshall Islands and the Federated States of Micronesia, and among Marshallese people living in the USA. 18,19 However, rates of tuberculosis among US-born children by parental country of birth and among children and adolescents in US territories and freely associated states have not been systematically reported. Additionally, detailed analyses of national estimates of tuberculosis disease counts and incidence rates among children and adolescents were last published in 2010 and 2007, respectively.…”
Section: Introductionmentioning
confidence: 99%
“…Under the Compact of Free Association, the people of the Marshall Islands can freely travel, live, and work in the United States, where they experience language, cultural, and economic barriers when accessing healthcare that can lead to infection, delayed diagnosis, and prolonged infectiousness with implications for community transmission ( 34 , 35 ). Despite the high incidence of TB in the Marshall Islands, persons from that country are not required to undergo screening for LTBI or active disease upon arrival to the United States ( 36 ). Screening those persons for TB may help in early diagnosis and treatment, thereby reducing the burden of TB in Arkansas and among NHPI persons.…”
Section: Discussionmentioning
confidence: 99%
“…Given the high risk for sputum smear positive PTB and elevated TB risk among 0–14-year-olds, TB transmission appears to play a role in driving TB incidence among NHPI persons. Hence, to curtail the disproportionate TB burden for NHPI persons, mitigation strategies should focus on active case finding in addition to LTBI screening of adults to disrupt chains of transmission ( 36 ). Curtailing the TB epidemic will also require ramping up contact tracing based on contact disclosure from TB patients, who often hesitate to name contacts because of stigma around TB in their communities ( 40 ).…”
Section: Discussionmentioning
confidence: 99%
“…There are ~ 30,000 Marshallese immigrants residing in the US, with the largest communities in Arkansas, Hawaii, Oregon, Washington, California, and Oklahoma [ 47 ]. Clinicians working in areas with large Marshallese populations should be aware of the high incidence of TB to provide appropriate care [ 48 ].…”
Section: Discussionmentioning
confidence: 99%