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BACKGROUND: The Republic of the Marshall Islands (RMI) is a high-incidence area for Mycobacterium tuberculosis. Marshallese can travel freely to and from the United States. Screening for either active tuberculosis (TB) or latent TB infection is not required upon U.S. entry. Despite establishment of an outreach team in 2002 and a satellite clinic in 2011, TB control among Marshallese in Arkansas remains challenging; approximately 40% of the estimated 10,000 Marshallese residing in Northwest Arkansas have been screened. A TB outbreak with 22 cases was identified in 2014, surpassing total case count of 4 from the three previous years combined (2011–2013).
METHODS: Data from Arkansas’ TB Registry were merged with the Centers for Disease Control and Prevention’s (CDC) TB Genotyping Information Management System. We performed a descriptive analysis of all clinical and culture confirmed TB diagnoses among Arkansas’ Marshallese residents during 2014.
RESULTS: Twenty-two TB cases, divided into 2 genotype clusters, were identified in 2014. Of 22 patients, 12 (55%) were aged ≤18 years; 6 of these children were U.S. born and never traveled outside of the United States. Of the 16 patients born in RMI, 9 (56%) developed TB within one year of arrival. 50% of the 10 culture confirmed cases were smear positive/cavitary disease.
CONCLUSIONS: Evidence of both local TB transmission and delayed diagnosis after immigration indicates the need for screening the remaining 6,000 Marshallese immigrants for TB. Quick, systematic identification of immigrant arrivals and linkage to screening, followed by therapy administration and monitoring for elimination of TB infection among this population, can aid TB prevention and control efforts in Arkansas communities.