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U.S. Tuberculosis Cases Rise as Foreign-Born Patients Triple 1986 Caseload Percentage

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Two-thirds of contagious tuberculosis carriers in the United States during 2015 were born overseas, up from one-fifth in 1986.

The government’s increased inflow of tuberculosis-carrying migrants appears to have reversed a 23-year decline of contagious tuberculosis cases inside the United States.

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The jump in foreign-born cases from 22 percent in 1986 to 66 percent in 2015 is caused by the federal government’s policy of accepting more tuberculosis-infected migrants from countries with large-scale contagions of the deadly and debilitating disease. The disease spreads when carriers cough or exhale the TB bacteria.

In 1986, about 5,000 of the estimated 22,725 cases of contagious TB, or ‘active TB,’ reported in the United States were diagnosed in foreign-born patients, according to the Centers for Disease Control. The data appears in the CDC’s May 10, 1996 MMWR Weekly Report, “Tuberculosis Morbidity — United States, 1995.”

In 2015, 29 years later, the percentage of foreign born cases of active TB in the United States has tripled to 66 percent. The total number of active TB cases have declined to 9,563 in 2015 because of large-scale public health programs, but the number of foreign-born cases has increased from 5,000 up to 6,335. That is up by almost 20 percent since 1986.

American-born active TB cases have declined from an estimated 17,725 in 1986 to 3,201 in 2015. That is down 80 percent since 1986.

But federal immigration policy is pushing up the nation’s contagious TB cases. In 2015, for the first time in 23 years, the number of active TB cases in the United States increased rather than declined. It rose by 1.7 percent from the 9,421 cases diagnosed in 2014.

Over the same 29 year period, the foreign-born population as a percentage of the total U.S. population has increased from 7.5 percent in 1986 (18 million out of a total population of 240 million) to an estimated 13.7 percent in 2015. That is an increase from the 13.2 percent in 2014, the last year for which there is complete data (42.5 million out of a total population of 322 million).

Of that 42.5 million, 11.2 million are illegals, 17.8 million are legal naturalized citizens, 11.7 million are legal permanent residents, and 1.9 million are legal temporary residents.

Of the 29.5 legal permanent & naturalized citizen residents, approximately 3 million arrived through the refugee resettlement program.

Of the 11 million illegal residents, very few have been tested for active or latent TB, and therapy treatment rates are unknown.

The 3 million refugees experience higher rates of testing for both active and latent TB than illegals, but their treatment rates are sporadic.

The increase in foreign born cases of active TB is attributable to several factors. A small part of that is due to migrants arriving with active TB, and then transmitting it within their arrival communities.

The largest part of the increase, however, appears to be due to the dramatically higher rate of latent TB infection among foreign born residents (which can range from 20 percent to 43 percent, depending on country of origin) compared to the general population, which has a four percent LTBI infection rate, and the greater likelihood those living in refugee communities will see their latent TB activate.

As Breitbart News reported previously:

The result, according to the Arizona Department of Health, has been an explosion in the number of active TB cases among foreign born who arrived here with latent TB:

“Most [of the] 222 cases of active tuberculosis infection (TB) …reported among Arizona’s refugee populations…[in] the past two decades …were caused by latent tuberculosis infections that became active after years or even decades of lying dormant,” according to the state’s Department of Health.

Foreign-born residents of the United States have been identified as a high risk population by the CDC because a number of them arrive from crowded refugee camps, engage in high risk behavior such as smoking, and have cultural traditions not consistent with successful completion of treatment therapy.

Numerous medical studies have reported on the link between high latent TB infection rates and the risk of active TB in refugee resettlement communities and other centers of migrant population. As Breitbart News reported previously:

A 2013 study by the University of California at San Diego’s Global Health Centerconcludes that “high latent TB infection rates among refugee resettlement communities like San Diego increase the risk of active TB.” . . .

The UC San Diego study found:

Our findings suggest that newly arrived refugees with LTBI have a considerable burden of clinical risk factors that increase their risk for reactivation of TB, which may contribute to the increased proportion of active TB among foreign-born populations in the United States if not prioritized for LTBI treatment. Efforts to ensure adequate LTBI treatment among high-risk refugees such as those documented in this study should be a public health priority. (emphasis added)

The researchers recommended that “public health departments that provide LTBI services to refugees with documented low treatment rates should consider programmatic changes to improve treatment acceptance.”

“We are not yet certain why TB incidence has leveled off, but we do know it indicates the need for a new, expanded approach to TB elimination,” the CDC’s Phillip LoBlue recently told the Star Tribune, adding that “[a] dual approach is needed: continue to find and treat cases of disease and evaluate their contacts, as well as identify and evaluate other high-risk persons for latent TB infection.”

While it is true that the rate of active TB among foreign born residents in the United States has declined slightly since 1986, the sheer volume of new foreign born migrants with high latent TB infection rates and much higher active TB rates does not bode well for the future decline in the overall number of active TB cases in the US.

According to the CDC, “[r]esuming declines in TB incidence will require more comprehensive public health approaches, both globally and domestically.”:

Resuming declines in TB incidence will require more comprehensive public health approaches, both globally and domestically. These include increasing case detection and cure rates globally, reducing TB transmission in institutional settings such as health care settings and correctional facilities, and increasing detection and treatment of preexisting latent TB infection among the U.S. populations most affected by TB. (emphasis added)

Public health policies, however, appear to be doing little to stop the trend of increases in the absolute number of foreign born TB cases in the US.

Despite the CDC’s urging to “increasing detection and treatment of preexisting latent TB infection among the U.S. populations most affected by TB,” resettlement agencies around the United States are not consistently testing and treating refugees for latent TB infections.


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