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Eleven Refugees Diagnosed with Active Tuberculosis Around Akron, Ohio

CLEVELAND, Ohio–Eleven refugees have been diagnosed with active tuberculosis in Summit County, Ohio, over the past six years, Dr. Margo Erme, medical director of the Summit County Public Health Department tells Breitbart News.

The cases of active and communicable tuberculosis were in the county that holds Akron, with a population of 199,000. It is the largest city in Summit County, population 541,000.

The county lies immediately to the south of Cleveland and Cuyahoga County. Many of the delegates and members of the media attending the Republican National Convention held in Cleveland this week are staying at hotels in Summit County and are shuttled on buses thirty plus miles each way.

“From 1/1/2010 through 12/31/2015, 37 cases of tuberculosis (both pulmonary and extrapulmonary) were reported in Summit County,” Dr. Margo Erme, medical director of Summit County Public Health, tells Breitbart News in an email.

Of those, “16 were US-born” and “21 were foreign-born.” Of the 21 foreign-born, “10 did not come into the US on refugee status, 11 came into the US on refugee status,” Erme says.

In June, Summit County Public Health Commissioner Donna Skoda told the Summit County Public Safety Committee there has been a “huge uptick” in active tuberculosis cases in the county recently:

As Summit County Council’s Public Safety Committee looked at legislation that would authorize county officials to accept a grant of a little over $16,000 from the Ohio Department of Health to help pay for the treatment of individuals with tuberculosis (TB), they heard from Summit County Public Health (SCPH) Commissioner Donna Skoda that there has been a “huge uptick” in TB cases locally…

Many individuals have a latent TB infection, which SCPH treats for six to nine months to prevent them from developing TB disease, said Skoda.

Isolation can become necessary, she said, and five or six individuals in Summit County have had to be quarantined this year, said Skoda. Sometimes an individual can be isolated at home, but SCPH is responsible for a patient’s living expenses if he/she must be relocated.

“It’s difficult to confine someone that long. It’s just hard on them, as well. They’re cut off from everything,” she said.

Contrary to what some may think, the most problematic cases from SCPH’s perspective are not of foreign-born individuals but of domestic homeless persons, she said. If a TB sufferer is a homeless individual, SCPH pays for an extended-stay motel room, sometimes for three to four months, she said.

The total budget of the Communicable Disease Unit of SCPH is $400,000, with the state reimbursing just $16,000, said Skoda.

Across the state, the number of cases this year has been up. Currently, there are 14 TB cases SCPH is monitoring; usually, there are about six a year, said Skoda.

Medical director Erme offered more details on the foreign-born cases of active TB in Summit County.

“1o foreign-born developed TB within 5 years of arrival: 8 were in persons who came to US on refugee status, 2 were in persons who did not come to US on refugee status. . . of the 10 cases diagnosed [in foreign-born residents] within 5 years of arrival to the US: 9 were pulmonary cases (7 in persons who came to US on refugee status; 2 in persons who did not come to US on refugee status) and  1 was extrapulmonary (1 in person who came to US on refugee status),” Erme says.

Ohio, at least with data provided by this one county, now joins a number of other states that have reported recently resettled refugees diagnosed with active TB: Wisconsin (27), Louisiana (21), Vermont (17), Colorado (16), Florida (11), one county in Kentucky (9), Idaho (7), Indiana (4), one county in North Dakota (4), and one county in Tennessee (2).

Summit County has been an area with a significant number of resettled refugees for many years.

In 2013 510 refugees were resettled in the Akron/Summit County area by the International Institute of Akron, a local non profit that has been a refugee resettlement agency for several decades.  The vast majority of those refugees (401) came from Bhutan, a high burden TB country. 75 came from another high burden TB country, Burma.

In 2015, the International Institute of Akron resettled an additional 585 refugees in the Akron/Summit County area, with some coming from Iraq and Afghanistan, as well as Bhutan and Burma.

In February “a person associated with North High School” in Akron was diagnosed with active TB. A spokesperson from Summit County Public Health Department would not say whether the person was U.S.- born, a foreign-born refugee, or a foreign-born in another category.

In an unusual, but legal, arrangement, the local resettlement agency (the International Institute of Akron) has hired the Summit County Public Health Department to conduct the initial domestic medical screenings  (health assessments) of recently arrived refugees in the county.

Among the tests included in that initial screening are Tuberculosis Skin Tests or IGRA blood tests which indicate the presence of the tuberculosis bacterium.

Those who test positive for LTBI are at risk of developing active TB. Within the general population, about ten percent of those who test positive for LTBI ultimately develop active TB.

The activation rate among resettled refugees who test positive for LTBI may well be greater than seen in the general population, according to a 2013 UC San Diego study.

The reasons are numerous. Many resettled refugees who test positive for LTBI do not participate in the recommended treatment programs, which are voluntary. Among those who begin treatment, many fail to complete it.

In addition, many refugees live in circumstances that result in compromised immune systems, such as crowded refugee camps overseas or crowded living situations domestically.

The rate of LTBI among the general population is four percent. Worldwide, the rate is much higher, around 33 percent.

Many other states and counties around the country have publicly reported the  percentage of resettled refugees who test positive for LTBI: Vermont (35 percent), one county in North Dakota (29 percent), Tennessee (27 percent), Indiana (26 percent),  Minnesota (22 percent), and Texas (15 percent), among them.

A high rate of LTBI infection among resettled refugees appears to correspond to a higher rate of active TB in refugees resettled in a community or state. In Vermont, for instance, three cases of active TB have been diagnosed in refugees in the past seven months.

The Summit County Public Health Department refuses to provide information on the LTBI rates of refugees resettled in the county to Breitbart News, though it acknowledges it has the data.

“Because LTBI is not reportable, we do not keep track of the percentage of persons coming for their initial refugee screening exam who are diagnosed as latent tuberculosis infection. All we keep record of is the number of persons we start on latent tuberculosis in our clinic. Giving you this data is not a valid or accurate assessment of latent tuberculosis status of the refugees we see because we do not provide latent tuberculosis treatment to everyone–some refuse, some go to a private doctor, and all children go to a private doctor,” Summit County Public Health’s Erme tells Breitbart News.

But As Breitbart News reported previously:

Under the Refugee Act of 1980 [resettlement agencies are] required to “assure that refugees known to the agency as having been identified. . . as having medical conditions affecting the public health and requiring treatment [such as active and latent TB] report to the appropriate county or other health agency upon their resettlement in an area.” (8 US Code 1522 (4) (B) (D) and (7) (C) )

A spokesperson for the Ohio Department of Job and Family Services tells Breitbart News that 2,559 of the 3,043 refugees who arrived in Ohio in 2015, or approximately 84 percent, completed their initial domestic screenings within 90 days of arrival.

“It should be noted that totals from the first attachment don’t necessarily line-up with totals in the second. This could be due to a number of factors, such as screenings being done in the following fiscal year, refugees traveling to Ohio from other states or vice versa, or other reasons,” the spokesperson says.

Breitbart News has also asked the Department of Job and Family Services for data on the number of refugees arriving in Ohio who were diagnosed with active TB within five years of their arrival and the percentage of arriving refugees who test positive for LTBI but has not yet received a response to those inquiries.

Listen to Michael Patrick Leahy’s discussion of this article on Breitbart News Daily on SiriusXM:

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