Data & Statistics
Current TB Epidemiology in Hawaii
Current TB Epidemiology in the U.S.
Here are some basic definitions that may be helpful in understanding the slides and statistics on this page:
Latent TB Infection (LTBI)
- Infected with TB bacteria but does not feel ill
- Has positive tuberculin skin test (TST): generally has induration of 10 mm or greater
- Usually has normal chest x-ray
- Not infectious
- Not reported to Department of Health (DOH)
Active TB Disease or TB Case
- Infected with TB bacteria and generally feels sick (usually: cough, fever, weight loss)
- Usually has positive tuberculin skin test (TST): generally has induration of 10 mm or greater
- Usually has abnormal chest x-ray (pulmonary cases)
- Potentially infectious
- Reported to Department of Health (DOH)
- A standardized measure used to compare how much disease there is in communities or groups of different sizes
- Usually expressed as: Number of cases/100,000 population
- Example #1: Hilo, Hawaii (zip code: 96720): 2 cases/42,916 population = Rate of 5 cases/100,000
- Example #2: Kapaa, Kauai (zip code: 96746): 2 cases/16,188 population = Rate of 12 cases/100,000
Case Rates and Numbers
The State of Hawaii to reports one of the highest annual tuberculosis (TB) case rates in the country. In 2015, Hawaii reported 127 total cases of TB, a rate of 8.9 new cases per 100,000 people and the second highest in the nation that year. Although TB rates have declined over the past decade, Hawaii’s 2015 rate was almost three times higher than the 2015 national TB case rate of 3.0 per 100,000 (Centers for Disease Control and Prevention (CDC), 2015).
Cases by County
Hawaii had an average of 121 reported TB cases over the past 10 years. In 2015, the City and County of Honolulu reported the highest number of TB cases in the state, with 98 cases of TB and an incidence rate of 9.8 cases per 100,000, accounting for 77% of the state’s TB morbidity. Maui County reported 17 new cases of TB, with an incidence rate of 10.3 cases per 100,000, the highest county rate in the State of Hawaii in 2015. Hawaii County reported 11 new cases of TB (incidence rate: 5.6 cases per 100,000), and Kauai County reported 1 new case of TB (incidence rate: 1.4 cases per 100,000).
Deaths from TB
TB deaths and death rates have decreased dramatically since 1920 when there were 531 TB related deaths and the death rate was 204 per 100,000. In 2015, there were 3 reported deaths attributed to TB in Hawaii, giving a TB mortality rate of 0.2 per 100,000. The latest national data show a TB mortality rate of 0.2 per 100,000, or 493 total TB deaths in the US in 2014 (CDC, 2015).
Cases by Age Group and Gender
The highest burden of TB disease continues to be among older adults. The largest group of new TB cases reported in 2015 in Hawaii were those 45 to 64 years of age; 29% (n=37) were in this age group. There were eight new cases of TB under 15 years of age. Additionally, there were about 20% more men diagnosed than women (n=71 vs. n=56). National data show that the majority of cases were male (60%) and age 25 and over (CDC, 2015).
Site of Disease
Seventy-two percent (n=92) of cases reported in Hawaii in 2015 were pulmonary TB, or TB affecting the lungs. Tuberculosis, however, is a systemic disease and can affect any area of the body. Eleven percent (n=11) of cases were exclusively extrapulmonary, or TB outside the lungs, while 17% (n=21) were both pulmonary and extrapulmonary. Overall, 89% of cases were either pulmonary or both pulmonary and extrapulmonary. National TB data show that a lower proportion, or 80%, of all cases reported in the US in 2015 were pulmonary or both pulmonary and extrapulmonary (CDC, 2015).
The percentage of TB cases in Hawaii with INH-resistant TB decreased from 5% in 2014 to 4% in 2015. In 2015, there were no multidrug-resistant TB cases (MDR TB) in Hawaii. MDR TB is defined by CDC as resistance to at least isoniazid (INH) and rifampin (RIF), isolates may be resistant to other drugs. The national MDR TB rate was 1.2% of all cases in 2015 (CDC, 2015). To prevent development of drug resistant TB, directly observed therapy (DOT) is the standard of care in Hawaii.
TB and HIV
In 2015, 96% of persons with TB in Hawaii reported HIV test results. The percentage of TB cases with HIV test results increased from 45% in 2006 to 96% in 2015. There were no new TB cases in Hawaii that were co-infected with HIV. TB-HIV co-infection remains less common in Hawaii than on the U.S. mainland.
The burden of TB disease in Hawaii is primarily among foreign-born persons from Asia and the U.S.-affiliated Pacific Islands. Persons from these TB endemic countries continue to immigrate and migrate to Hawaii with many immigrants arriving with active TB disease and latent TB infection (LTBI), impacting TB morbidity. Screening of foreign-born clients in state TB clinics in Hawaii in 2015 found that 20% had LTBI. If left untreated, these clients may be the TB cases of the future.
In 2015, 109 new TB cases, representing 86% of the state’s morbidity, were foreign-born. Among the foreign-born cases, the majority (63%) were born in the Philippines, followed by persons born in the Federated States of Micronesia (13%), Republic of the Marshall Islands (7%), Vietnam (5%), and China (3%). Note that the CDC counts persons born in the U.S. territories (i.e., Guam, American Samoa and Puerto Rico) and the Freely Associated States (i.e., Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau) as U.S.-born. Following CDC’s definition, Hawaii’s foreign-born percentage among new TB cases in 2015 was 66%. Similarly, 66% of the active TB cases reported in the U.S. in 2015 were foreign-born. This percentage has risen steadily since 1993 (CDC, 2015).
Trends in TB Cases and Percentage of Foreign-born Persons: Hawaii, 2006-2015
Countries of Birth of All Persons Reported with TB: Hawaii, 2015
Countries of Birth of Foreign-born Persons Reported with TB: Hawaii, 2015
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
The 2015 report of tuberculosis in the United States can be accessed at: http://www.cdc.gov/tb/statistics/reports/2015/pdfs/2015_surveillance_report_fullreport.pdf
This page last updated: December 1, 2016
Hawaii Tuberculosis Control Program
1700 Lanakila Avenue, Ground Floor
Honolulu, HI 96817
Phone: (808) 832-5731
Fax: (808) 832-5846
Hawaii State Department of Health · 1250 Punchbowl Street · Honolulu, HI 96813