Two simultaneous outbreaks of multidrug-resistant tuberculosis--Federated States of Micronesia, 2007-2009.

In July 2008, CDC responded to a request from the Federated States of Micronesia (FSM) to investigate the first documented cases of multidrug-resistant tuberculosis (MDR TB) in Chuuk State. Compared with drug-susceptible TB disease, MDR TB is resistant to at least isoniazid and rifampin, the two most effective TB medications, making treatment more difficult and outcomes more likely fatal. Second-line TB drugs for treating MDR TB were not available in FSM, and during December 2007-June 2008 four patients with MDR TB had died, including a child aged 2 years. This report describes the investigation by the World Health Organization (WHO) and CDC, which initially identified five confirmed cases in two distinct clusters, characterized by two distinct geographic locations, genotypes, and drug-susceptibility patterns. Extensive transmission has occurred among household contacts; 16 (8%) of the 205 contacts identified have confirmed or suspected MDR TB disease, and 124 (60%) have latent TB infection. Among 21 confirmed and suspected cases of MDR TB identified as of March 13, 2009, 10 have been in persons aged <15 years. With the death of a child aged 4 years in November 2008, a total of five persons have died of MDR TB. Multiple U.S. government agencies and other organizations are assisting local health authorities with resources to procure second-line TB drugs, ensure directly observed therapy (DOT), and identify and evaluate contacts. These simultaneous and continuing outbreaks demonstrate how a lack of basic TB control activities can allow the emergence and spread of drug-resistant TB.