Test solution shortage puts most TB screening on hold

The state Department of Health is temporarily allowing students, teachers, health care workers and others to attend school and go to work without the required tuberculosis clearance but said it believes the public will not be at an increased risk of contracting the disease.

A nationwide shortage of tuberculosis testing solution forced the department to suspend the clearance requirement beginning Thursday, DOH said.

"We looked carefully at the data before we made the proposal to the health director, and we determined that there’s really no appreciable risk by temporarily suspending screening," said Richard Brostrom, tuberculosis control branch chief at the Department of Health. "We will continue to screen identified high-risk groups."

Brostrom said the state usually administers about 1,000 tuberculin skin tests a week and keeps a 10-week supply of test solution on hand but that the state now only has enough to administer 100 to 200 tests a week until August.

DOH spokeswoman Janice Okubo said, "What we’re most concerned about is making sure employers and schools know that we’re suspending this requirement. We don’t want to see anyone restricted from school or work because they’re not able to get the TB clearance."

Other states have also curtailed routine testing due to the shortage, Brostrom said.

Adequate supplies of the testing solution could be available in a few months, he said, but the state is working on a plan if production delays continue longer than anticipated.

Availability of the Tubersol and Aplisol purified protein derivative solutions has been limited since November, Brostrom said.

Brostrom said he was told by the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration that manufacturers claimed the shortage stems from a "supply-and-demand issue."

Until supplies return to normal, state clinics will administer TB tests only to specific high-risk groups, such as people with symptoms of active TB disease.

Hawaii typically sees 120 cases of TB a year.

Brostrom said hospitals statewide have also been affected.

"We’re not aware of any hospital that has normal (TB testing) supplies," he said.

Laura Lott, a Kaiser Permanente spokes­woman, said, "We are in the same boat as everybody else. We do have very limited supplies of those two (TB testing) solutions, and the small supply we have we’re going to save for those at highest risk. The standard screening requirements, the testing that usually takes place, we’re going to postpone that."

Hawaii Pacific Health, Hawaii’s largest health care provider, is also suspending routine testing for staff.

"In light of (Thursday’s) Department of Health announcement, we have temporarily suspended TB testing of new and current staff and physicians until we are notified that the TB test requirement has been reinstated," Susan Kuni­take, director of employee health and wellness at HPH, said in an email to the Star-Advertiser. "However, any employee who is considered at risk for TB or pre­sents with potential issues will be given a complete examination and a chest X-ray."

Hawaii Pacific Health normally administers about 250 TB tests a month to new and current employees.

Compared with the rest of the United States, Hawaii has higher rates of TB "because of its position as an Asian crossroad and mostly as a factor of our high rates of immigration into the state," Brostrom said.

In 2011, Hawaii had a rate of 8.9 new TB cases per 100,000 people, compared with the national rate of 3.4 cases per 100,000, according to the DOH.

DOH said it will issue a public notice when the suspension is lifted and institute a grace period for people who were unable to obtain TB clearance due to the shortage.