title: Islands of hope: building local capacity to manage an outbreak of multidrug-resistant tuberculosis in the Pacific.
abstract: A single case of multidrug-resistant tuberculosis (MDR-TB) can overwhelm the technical and financial capacity of small TB programs. In May 2008, the island state of Chuuk requested assistance for their first cases of MDR-TB. Second-line drugs and isolation rooms were unavailable, lab capacity was limited, and clinicians lacked experience. Delayed response caused prolonged transmission among household contacts. Several agencies responded with technical assistance and resources. Subsequent evaluations identified 16 additional MDR-TB cases and 124 infected contacts. Within six months, the local TB program gained remarkable capacity to manage MDR-TB cases and contacts, and greatly improve care for all TB patients. The Chuuk outbreak demonstrates the importance of establishing MDR-TB readiness in smaller jurisdictions and maintaining an essential TB control infrastructure.
authors.affiliation: Division of Public Health, Commonwealth of the Northern Mariana Islands. richard.brostrom@gmail.com
authors.forename: Richard
authors.initials: R
authors.lastname: Brostrom
authors.forename: Dorina
authors.initials: D
authors.lastname: Fred
authors.forename: Andy
authors.initials: A
authors.lastname: Heetderks
authors.forename: Mitesh
authors.initials: M
authors.lastname: Desai
authors.forename: Rinn
authors.initials: R
authors.lastname: Song
authors.forename: Maryam
authors.initials: M
authors.lastname: Haddad
authors.forename: Roylinne
authors.initials: R
authors.lastname: Wada
authors.forename: Sapna
authors.initials: S
authors.lastname: Bamrah
mesh_terms: D003140:Communicable Disease Control / Q000458:organization & administration; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D007391:International Cooperation; D008849:Micronesia / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000517:prevention & control*