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Vermont Hides Role of Refugees in Tripling of TB

The number of active tuberculosis cases in Vermont tripled last year, from two in 2014 to seven in 2015, according to the Centers for Disease Control (CDC).

Neither the Vermont Department of Health nor the U.S. Committee for Refugees and Immigrants-Vermont Refugee Resettlement Program, the local resettlement agency hired by the federal government, are admitting how much of this increase is from resettled refugees.

Internal emails from the Vermont Department of Health obtained by VermontWatchdog.org through a public records request, however, appear to confirm that at least two of the 2015 cases of active TB were diagnosed among recently resettled refugees.

Even more significantly, those internal emails appear to confirm that, halfway through 2016, there have been as many cases of active TB diagnosed among resettled refugees in Vermont — two — as there were in the entire population of the state in 2014.

The emails also reveal that the medical community in Vermont was largely unprepared for the tripling of active TB cases in 2015.

If confirmed, these four cases would represent a third-world level of TB among the 1,301 refugees who have resettled in Vermont over the past four years — a rate in excess of 100 active cases of TB per 100,000 — more than thirty times the rate of 3 per 100,000 in the United States.

The number of active TB cases among refugees in Vermont may be greater than four in the past year and a half, but no one in the politically-correct public health establishment of the Green Mountain State is talking.

Breitbart News asked Vermont Department of Health Spokesman Truman Bennett, University of Vermont Medical Center infectious disease specialist Dr. Walter Kemper Alston, Vermont Department of Health public health nurse Sydney White, and Vermont Refugee Resettlement Program Director Amila Merdzanovic to confirm or deny the existence of four cases of active TB among resettled refugees in Vermont in 2015 and 2016 identified in these internal Vermont Department of Health emails recently released to VermontWatchdog.org, as identified below, but none of these public health officials responded.

Alston and White are featured prominently in the internal emails of the Vermont Department of Health obtained by Vermont Watchdog as medical professionals responsible for the treatment of the refugees diagnosed with active TB.

The internal Vermont Department of Health emails appear to confirm the following four cases of active TB among recently resettled refugees in Vermont in the full calendar year of 2015 and the first six months of 2016:

One refugee diagnosed and treated by Sally Cook, of the Vermont Department of Health Tuberculosis Control Program, Deborah Kutzko of the University of Vermont Medical Center Infectious Disease Clinic, and Patricia Hennard, a nurse employed by the Vermont Department of Health, prior to August 2015.

A second refugee diagnosed with active TB , treated by Dr. Walter Kemper Alston and Dr. Portnip Kiatsimkul, both of the University of Vermont Medical Center, whose treatment began on December 31, 2015.

A third refugee, a patient of Dr. Christopher Huston of the University of Vermont Medical Center, whose husband had been treated for active pulmonary TB at a refugee camp prior to arriving in the US, with 3 children, age 13,11, and 7, who was diagnosed with active TB by a GeneXpert test on April 22, but who had already been started on the four drug protocol earlier in the month.

A fourth refugee, a patient of Dr. Krystine Speiss and Dr. Alston, both of the University of Vermont Medical Center, of whom Vermont Department of Health public health nurse Sydney White said on May 27 “Her CXR was OK so they plan to have her do daily INH/RIF/B6 for 9 months, no PZA or EMB. Kemper said she should self administer since she is extrapulmonary.”

On June 8, 2016, Sydney White emailed Sally Cook and Patricia Hennard of the Vermont Department of Health about this fourth resettled refugee patient:

“Just getting around to a quick update on her after seeing her yesterday…I wrote out all her appointments onto June/July calendars and went over them with grandson with the interpreter. He seemed to find this helpful, and had not been aware of all the appointments.”

“The barriers [to making appointments] are still a little clear after asking about them—it seems more like an issue of having a hard time keeping track or a language barrier when scheduling.”

The failure of the Vermont public health establishment to confirm or deny the diagnosis of active TB among these four refugees is inconsistent with the state’s long tradition of open and honest government.

The internal emails do confirm, however, that the taxpayers of the state of Vermont are paying for both the time of the health officials treating the refugees diagnosed with active TB and the drugs to treat them. The CDC says the cost of treating a patient with active TB over nine months is $17,000.

On May 27, Dr. Krystine Spiess emailed Sally Cook of the Vermont Department of Health about the treatment of one of these four refugees diagnosed with active TB.

“I did order INH 200mg qd and rifamping 450mg qd + B6 50mg qd at the UHC pharmacy. Dr. Alston told me to have it billed to the Health Department and that someone from your office could pick it up,” (emphasis added) the email read.

The emails also indicate that privately, the Vermont public health establishment considered the dramatic increase in TB cases among resettled refugees to be a cause for concern.

On January 15, Patricia Hennard of the Vermont Department of Health emailed Dr. Kiatsimkul of the University of Vermont Medical Center indicating to her that the treatment of active TB among refugees in Vermont had moved to a level that required focused attention from Vermont health professionals.

“I wanted to let you know about the monthly TB case conference call that is happening Tuesday morning…Sally Cook runs the calls at VDH and Kemper Alston is scheduled to attend as well. And I will be on as well,” Hennard wrote.

When Governor Peter Shumlin, a Democrat, was inaugurated in 2011, he promised that “making government more transparent” wold be one of his administration’s top priorities.

In fact, under Shumlin, public health reporting on refugees has been anything but transparent.

News that as many as four refugees in Vermont may have been diagnosed with active TB during the past eighteen months comes after the Vermont Department of Health told Breitbart News that no refugees arriving in Vermont in the five years between 2011 and 2015 were diagnosed with active TB.

Previously, the Vermont Department of Health confirmed to VermontWatchdog.org that 35 percent of refugees resettled in Vermont during this time period tested positive for latent TB infection (LTBI), the highest rate of any state to report data to date.

The combination of these two facts suggests that refugees who arrived in Vermont with LTBI subsequently developed active TB.

This would be consistent with a 2013 study by UC San Diego that high rates of LTBI among recently resettled refugees poses a health risk of active TB within resettled refugee communities.

According to the internal emails obtained by VermontWatchdog.org, the resettled refugee diagnosed with active TB in December 2015 resettled in Vermont in 2013.

But the Vermont Department of Health was unsure if she and her family had been tested and treated for LTBI at their original domestic medical screening in 2013.

On January 12, Sally Cook emailed public health nurses Sydney White and Patricia Hennard of her concern that the Vermont Department of Health had not followed up on whether LTBI tests had been administered to the second patient and her family upon the initial domestic medical screening when they arrived in Vermont in 2013.

“So far, I have found the [redacted] had a negative Quantiferon on 12/27/13 thru the ID clinic for his initial exam,” Cook wrote.

“The other 3 we should be able to find on their DHA [Domestic Health Assessment] forms, but I can’t find the 2013 folder up here…Now the only other detail is, you’ll probably have to call the provicer if they had a + [positive] test [for LTBI], to find out if they completed LTBI treatment or not. We don’t have completion info on a lot of them, unfortunately,” Cook added.

Between 2012 and 2015, a total of 1,301 refugees arrived in Vermont: 312 in 2015, 317 in 2014, 322 in 2013, and 350 in 2012.

The majority of these refugees—905, or 69 percent—came from Bhutan, a small country near Nepal with high rates of active and latent TB infection. A significant minority of these refugees—127 or 9 percent—came from Somalia, and another 95—7 percent—came from Iraq.

Both Bhutan and Somalia have very high rates of active and latent TB infection.

Vermont will soon see more refugees.

On Tuesday, the Rutland Board of Aldermen refused to put the question of the resettlement of 100 Syrian refugees in the community up for approval in a public referendum by a 6 to 4 vote. Mayor Christopher Louras had secretly negotiated with the Department of State to arrange this resettlement.

A certified petition requesting such a public referendum received more than a thousand signatures.

A picture also emerges from the internal Vermont Department of Health emails obtained by VermontWatchdog.org of a small medical community overwhelmed by the medical and logistical requirements of treating refugees diagnosed with active TB, many of whom do not speak English or have a basic familiarity with modern health care systems.

At an August 2015 meeting of officials with the Vermont Refugee Resettlement Program, the UVM Medical Center Infectious Disease Clinic, and the Vermont Department of Health, Sally Cook, Patty Hennard, and Deborah Kutzko, all of whom “have recently been involved with client [presumably a refugee, given the audience] who has active tuberculosis” spoke to the meeting “to ensure that people know the health department is a source of information to help with concerns about TB.”

“We rarely have TB in the state, usually latent TB, so there is confusion about the difference between active and latent tuberculosis and its risks,” the documents presented at the meeting stated.

“We worry about the people who have the infectious disease, not the ones that have come in contact with them,” the document added.

On April 25, 2016, nurse Sydney White emailed Sally Cook of Vermont Dept of Health about the patient:

“She got her first dose today. She seems with it, and I don’t get the impression there will be adherence issues. The ‘father’ with TB was in fact her husband, she says he was treated 9 months in [redacted]. Her treatment was interrupted in [REDACTED] because her child was having health issues so she just kind of fell off with it.”

That same day, Sally Cook emailed Dr. Alston about the patient:

“Looks like the case’s husband was treated for pansusc. pulmonary TB in the refugee camp with documentation of standard treatment. One of the 3 kids had a + TST overseas and +QFT at UPeds and is/was started on 9 months INH.”

The children were 13, 11, and 7.

Nurse Patricia Hennard with the Vermont Department of Health emailed Sally Cook, Nancy Thayer, and Sydney White on April 26, 2016 concerning her treatments of the patient with active TB:

“She also informed me that she has two new family members arriving from [redacted] on April 28, 2016 to live with them. This is her husband’s other brother and his wife.” Hennard said there was an “ unsure plan for her husband, who was pos TB in past and was [redacted].”

“Home visit for DOT [Direct Observed Therapy] set up for tomorrow at 10:00 am. Using phone interpreter. Still need to identify incentives possible food or gas card or both???” Hennard asked.

On April 29, 2016, Dr. Amee Patrawalla of the Rutgers University Global Tuberculosis Institute emailed Dr. Chris Hutson, who was apparently the doctor treating the recently resettled refugee diagnosed with active TB earlier that month, that the patient’s TB “may have reactivated from immunosuppression.”

This email suggests that the patient had been previously treated for active TB, had been deemed “cured,” and yet allowed to resettle in Vermont.

On May 10, 2016 Sydney White emailed Sally Cook to inform her that the resettled refugee diagnosed with active TB “got her first dose of the BIW regimen today,” and that “she informed me today that she plans to visit her brother in NY sometime this July.”

White did not express concern that an active TB patient who had not completed her treatment was allowed to travel outside the state of Vermont, presumably because the patient had been diagnosed with extrapulmonary TB.
Vermont is one of fourteen states that have withdrawn from the federal refugee resettlement program.

In those states, the federal government hires a voluntary agency (VOLAG) to resettle refugees under the statutorily questionable Wilson Fish alternative program.

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