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January 25, 2024

Increased tuberculosis among Pacific Islander communities

Actions requested

  • Hospitals and clinics: Please distribute to primary care providers, emergency and urgent care providers, pulmonologists, and infectious disease specialists.
  • Health care providers:
  • Consider tuberculosis (TB) in adult and pediatric patients with compatible clinical symptoms such as cough that lasts 2-3 weeks or longer, unexplained weight loss, fever, night sweats and/or abnormal radiographic findings.
  • Exercise higher consideration for TB in patients from Pacific Islander (PI) communities, including persons born in the Pacific Islands or the U.S. (Pacific Island regions include Federated States of Micronesia and Republic of the Marshall Islands).
  • For patients with compatible symptoms from PI communities, perform the following steps to rule out TB disease:
    • Physical exam
    • Chest x-ray
    • IGRA (i.e., QuantiFERON or T-SPOT)
    • If radiographic findings of the chest images (chest x-ray and/or chest CT) are suggestive of TB disease, collect 3 sputum samples on three different days, ideally first in the morning.
  • Report suspected or confirmed cases of active TB, particularly before initiating TB treatment, to the county health department within 24 hours. King County TB reporting line is 206-744-4579, option 2. Both pulmonary TB and extrapulmonary TB disease are reportable. Do not wait for culture confirmation to report the case.


The Pacific Northwest has been experiencing higher than normal diagnoses of TB disease among people from Pacific Islander communities in recent years. On average, 5 cases of TB disease are diagnosed in Washington each week and an estimated 200,000 people in Washington are infected and at risk of developing disease.

Be aware of persons with increased risk of infection or developing TB disease, including:

  • Close contacts of a person with active TB disease
  • Persons who have history of residence or travel to a place with an elevated TB rate. This includes any country other than the United States, Canada, Australia, New Zealand, or a country in western or northern Europe (Refer to table below for TB-endemic countries and territories).
  • Children younger than 5 years of age who have a positive TB test
  • Persons who have a history of latent tuberculosis infection (LTBI), especially those who were in contact with patients with active TB within the past 2 years
  • Persons who have lived or worked in a shelter, correctional facility, long-term care facility or other congregate setting
  • Persons with HIV
  • Persons with diabetes mellitus
  • Persons who are immunocompromised

TB-endemic countries and territories based on 2019 incidence per 100,000 population (adapted from WHO global list of high burden countries for TB, TB/HIV, and MDR/RR-TB), 2021-2025):

Incidence Category Countries included, by WHO region
Severely endemic (≥500 new and relapse cases per 100 000 population per year)

Africa: Central African Republic, Gabon, Lesotho, South Africa

South-East Asia: Democratic People's Republic of Korea

Western Pacific: Philippines

Highly endemic (300–499 new and relapse cases per 100 000 population per year)

Africa: Angola, Congo, Democratic Republic of the Congo, Eswatini, Guinea- Bissau, Liberia, Mozambique, Namibia, Zambia

South-East Asia: Indonesia, Myanmar, Timor-Leste

Western Pacific: Kiribati, Marshall Islands, Mongolia, Papua New Guinea

Endemic (100–299 new and relapse cases per 100 000 population per year)

Africa: Botswana, Burundi, Cameroon, Chad, Côte d'Ivoire, Equatorial Guinea, Ethiopia, Gambia, Ghana, Guinea, Kenya, Madagascar, Malawi, Nigeria, Sao Tome and Principe, Senegal, Sierra Leone, South Sudan,
Uganda, United Republic of Tanzania, Zimbabwe

Americas: Bolivia (Plurinational State of), Haiti, Peru

Eastern Mediterranean: Afghanistan, Djibouti, Pakistan, Somalia Europe: Greenland, Kyrgyzstan

South-East Asia: Bangladesh, Bhutan, India, Nepal, Thailand

Western Pacific: Cambodia, Lao People's Democratic Republic, Micronesia (Federated States of), Nauru, Northern Mariana Islands, Tuvalu, Viet Nam