The CDC report provides a sobering backdrop to the challenge of curbing the spread of TB that members of parliament grappled with in public hearings while considering legislation to increase the authority of health officials to detain people who are a threat to public health.
Following a public hearing earlier last week, the parliament’s health committee on Thursday recommended passage of an amendment to give the director of public health authority to order quarantine of patients to prevent spread of communicable diseases.
But public health director Dr. Kennar Briand in the public hearing asked, “Why not go the next step (if a person refuses treatment)?”
He said in other countries, people who pose a public health risk can be detained in jail, which the amendment does not address.
Speaking from experience, Briand said even though there are court orders, hostile patients refuse to take their medicine and run away from the hospital.
Government officials expressed their frustration with the current law that requires them to go to court to quarantine patients with communicable diseases who will not follow treatment prescribed.
“We’ve been involved with a case against an infectious patient in the courts and it’s taken weeks to decide whether the patient is a threat or danger to the public,” said Attorney General Frederick Canavor, Jr.
The Marshall Islands has the highest TB rate in Pacific islands affiliated with the United States at more than 190 per 100,000 population.
The U.S. rate is about four per 100,000.
The CDC report obtained this week describes the outbreak of drug resistant TB as a public health emergency.
This threat is an emergency, said Assistant Attorney General Rosania Bennett at a public hearing on the amendment to increase the public health director’s authority to quarantine patients. It can impact us all as it’s hard to monitor and cure.
CDCs 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.
The CDC report offers a window into the difficulty of tracking TB patients and people who came into contact with them who are highly mobile — including several who moved to the United States.
CDC reported that it has notified the health authorities in five U.S. states where Marshall Islanders with TB and their contacts moved so they can provide follow up evaluations, and CDC is working with the Ministry of Health to ensure that U.S. states gets notified within one week when a TB patient or contact moves to the U.S.
None of the Marshall Islands patients so far identified with drug resistant TB are children ages ranged from 27 top 68. Nine of the 10 had diabetes, and the CDC report indicates that people with diabetes are two to four times more likely to develop TB.
CDC said that a nurse who contracted drug resistant TB did not follow infection control procedures, and one patient ³was not effectively isolated because unprotected visitors, including this health care worker, slept in the room with her during her infectious period.
