Tuberculosis screening at a diabetes clinic in the Republic of the Marshall Islands
Abstract 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...
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Published in | Journal of clinical tuberculosis and other mycobacterial diseases Vol. 5; pp. 4 - 7 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier
01.12.2016
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Abstract | Abstract 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 27–86 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%–8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged ≤ 50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0–9.7, p = 0.05). 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. |
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AbstractList | SETTINGTuberculosis (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. OBJECTIVEEvaluate the rate of active and latent TB in a Pacific Island DM clinic. DESIGNIn one DM clinic on the island of Ebeye, 213 adult patients aged 27-86 years completed tuberculin skin testing and TB work-up between April 2010 and March 2012. RESULTSScreening 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%-8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged ≤ 50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0-9.7, p = 0.05). CONCLUSIONThe 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. 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 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. Evaluate the rate of active and latent TB in a Pacific Island DM clinic. In one DM clinic on the island of Ebeye, 213 adult patients aged 27-86 years completed tuberculin skin testing and TB work-up between April 2010 and March 2012. 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%-8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged ≤ 50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0-9.7, p = 0.05). 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. Abstract 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 27–86 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%–8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged ≤ 50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0–9.7, p = 0.05). 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. |
Author | Montgomery, D Gajitos, M.L Trinidad, R.M Thein, C.C Morello, M.I Chorba, T Brostrom, R Heetderks, A |
AuthorAffiliation | b Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, United States a Ministry of Health, Ebeye, Marshall Islands d Kwajalein Atoll Healthcare Bureau, Kwajalein, Marshall Islands c Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, United States |
AuthorAffiliation_xml | – name: c Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, United States – name: a Ministry of Health, Ebeye, Marshall Islands – name: d Kwajalein Atoll Healthcare Bureau, Kwajalein, Marshall Islands – name: b Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, United States |
Author_xml | – sequence: 1 fullname: Trinidad, R.M – sequence: 2 fullname: Brostrom, R – sequence: 3 fullname: Morello, M.I – sequence: 4 fullname: Montgomery, D – sequence: 5 fullname: Thein, C.C – sequence: 6 fullname: Gajitos, M.L – sequence: 7 fullname: Heetderks, A – sequence: 8 fullname: Chorba, T |
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Cites_doi | 10.2337/diacare.27.7.1584 10.1073/pnas.0511240103 10.1093/cid/cir939 10.5588/ijtld.11.0503 10.1016/S2213-8587(14)70110-X 10.1016/j.meegid.2011.10.013 10.1111/tmi.12462 10.1378/chest.09-2350 10.1079/PHN2002364 10.1016/S1473-3099(09)70282-8 10.1111/tmi.12468 10.1111/j.1365-3156.2010.02632.x 10.1093/aje/kwn075 10.1371/journal.pone.0055423 |
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Keywords | Tuberculosis Diabetes Pacific Islands Bi-directional screening |
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