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Multi-Drug Resistant TB Spikes 75 Percent in Massachusetts

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The number of cases of very dangerous, multi-drug resistant (MDR) tuberculosis (TB) reported in Massachusetts spiked 75 percent in 2015, to seven cases, up from four in 2014, according to the Massachusetts Department of Public Health.

In 2015, 87 percent of the 192 cases of active TB diagnosed in Massachusetts (167 out of 192) were foreign-born, a rate significantly higher than the foreign-born rate across the country that year, which was 66 percent.

The Massachusetts Department of Public Health provided no information on how many of the seven cases of MDR TB in 2015 and four cases in 2014 were foreign-born. However, of the 9,421 cases of active diagnosed in the United States in 2014, 91 were classified as MDR. 88 percent of those cases (80 out of 91) were foreign-born. The CDC did not report how many of those foreign-born cases of MDR TB were resettled refugees.

Active TB can be successfully treated at a cost of $17,000 per patient over the course of six to nine months with a four drug regimen that has been the standard medical protocol for over fifty years.

MDR TB, in contrast, has a much lower survival rate, and is treated at a cost of $150,000 per patient over twenty to twenty-six months.  A 2012 study published by the Institute of Medicine found that “globally the treatment success rate for MDR TB is only about 60–65 percent.”

In 2014, the rate of MDR TB in Massachusetts, a state with a population of 6.8 million, was one out of every 1.7 million residents.

In 2015, the rate of MDR TB in Massachusetts jumped to one out of every 972,000 residents.

Those rates are sharply higher than the rates across the country, where one out of every 3.5 million residents were diagnosed with MDR TB in 2014.

The Centers for Disease Control has not yet reported the number of MDR TB cases diagnosed in the United States in 2015, but partial information obtained by Breitbart News from 16 states, which report a combined total of 64 cases of MDR TB in 2015, suggest that there may be an increase of MDR TB cases nationwide when the CDC finally reports those numbers.

The high incidence of foreign-born cases of active TB in Massachusetts, coupled with the the dramatic spike in MDR TB there in 2015, combine to suggest that the Bay State may have a special TB control problem that requires specific attention to foreign-born residents.

Publicly, at least, state officials do not appear to be focused in that area.

Last month, the Massachusetts Department of Health reported that students at a Brookline day care were exposed to someone diagnosed with active TB.

Tiny World Child Care, where the exposure took place, says it specializes in bilingual Spanish-English education for children age 1 to 5.

The Massachusetts Department of Health, however, would not say whether the person who exposed the children to active TB was U.S.-born or foreign-born.

One mother of a child attending the day care, ironically a lecturer of public health at Boston University, downplayed the risk the identification of a case of active TB in someone who came in contact with her child at Tiny World Child Care:

Parents received an email from Tiny World Child Care on Monday, warning them that their young children may have been exposed to tuberculosis.

No information about the patient is being released, but DPH is notifying anyone who may have been exposed. They are recommending and offering tuberculosis testing.  Any positive results would be followed up with preventative treatment.

“DPH is monitoring the situation, and working closely with local officials and the Tiny World Child Care community,” said Scott Zoback, Interim Director of Communications for the Department of Public Health. “Tuberculosis is preventable and treatable, and transmission of TB in these cases is very uncommon.”

“It is a really scary disease, but I am not terribly concerned,” Katy Quissell, a parent and a public health [lecturer] at Boston University, who dropped her daughter off at the center Tuesday.

“Kids tend to not be as contagious and they do not spread it as easily as adults do.”

Quissell still plans on bringing her daughter to the doctor.

“She is going to have a chest X-ray and she’s going to have, probably, the skin TB test done to see,” she told WBZ-TV. . .

“When I talked to the Department of Health, they said that it was an active TB infection, otherwise they wouldn’t have gone through all of this.“ Quissell said. “I don’t think that there is really any extreme threat.”

Quissell displayed a remarkable nonchalance about the health danger experienced by a child exposed to a person with active TB, particularly since she is in the final stages of completing a Phd. in Public Administration and Global Health Policy at American University. She recently co-authored an academic paper, “Sustaining effectiveness over time: the case of the global network to stop tuberculosis.”

The Massachusetts Department of Health reported that “In 2015, seven cases of TB were diagnosed in children under 15 years of age (4% of cases, incidence rate <1 per 100,000 children <15 years old). Two of the seven children (29%) were born in the U.S.”

Massachusetts is one of fourteen states that have withdrawn from the federal refugee resettlement program. In those states, the Office of Refugee Resettlement has hired a voluntary agency (VOLAG) to resettle refugees under the statutorily questionable Wilson Fish alternative program.

In Tennessee, which, like Massachusetts, has withdrawn from the federal refugee resettlement program, the Tennessee General Assembly is proceeding with a lawsuit to end the operation of the federal refugee resettlement program there on Tenth Amendment grounds.

Massachusetts Gov. Charlie Baker has indicated in the past his support for the federal refugee resettlement program and does not intend to follow Tennessee’s lead. In November, “[he] said Massachusetts will not do anything to halt its participation in refugee resettlement programs as he seeks to learn more about the screening of individuals fleeing war in the Middle East,” according to Mass Live:

“The state’s role in this is as a collaborator, and I have no intention of having Massachusetts walk away from its commitment and its participation in refugee resettlement programs,” Baker told reporters after an economic development announcement in Lynn on Monday. “But I am very interested in knowing a lot more about how the feds deal with situations that involve governments in countries that for the past 10 years have basically been broken.”

The Swampscott Republican explained why he did not sign onto a letter from other Republican governors to President Barack Obama.

“I’m interested in ensuring that Massachusetts maintains its standing as a welcoming community, and I’ve tried very hard to be a nonpartisan participant in political dialogue,” Baker said. He said, “I don’t see how elevating this and making it even more partisan than it is already really helps solve the problem. I just want to solve the problem.”


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