Ingham County, Michigan: One Refugee Diagnosed With Multi-Drug Resistant TB; 22 Percent Have Latent TB

One of the 3,554 refugees resettled in Ingham County, Michigan (Lansing) during the six years beginning October 1, 2010 and ending on September 30, 2016 (FY 2011 to FY 2016) has been diagnosed with multi-drug resistant (MDR) tuberculosis (TB), the Ingham County Health Department tells Breitbart News.

MDR TB is a very dangerous and expensive to treat type of TB that is a growing world wide problem and has recently become a public health issue in the United States as well.

In addition to to the one case of MDR TB diagnosed among refugees in Ingham County, four additional cases of active TB were diagnosed among refugees in Ingham County during this six-year period, the Ingham County Health Department says.

Previously, Breitbart News reported that the Michigan Department of Health and Human Services (MDHHS) confirmed that eighteen refugees have been diagnosed with active TB in the state of Michigan during the five years between FY 2011 and FY 2015. A nineteenth case of active TB among refugees was reported in March 2016 by the Oakland County Health Department.

In response to a FOIA request from Breitbart News, MDHHS said that no refugees had been diagnosed with MDR TB in the state during the five years between FY 2011 and FY 2015.

Breitbart News has asked Ingham County Health Department whether the case of the refugee with  MDR TB was diagnosed in FY 2016, which would be consistent with the MDHHS report, or during the five years between FY 2011 and FY 2015, which would be inconsistent with the MDHHS report, but has not yet received a response to that question.

Breitbart News has documented that at least 468 refugees in fifteen states have been diagnosed with active TB during the past six years.

Active TB costs $17,000 to treat with a four-drug regimen over a nine month period and has a virtually 100 percent cure rate. In contrast MDR TB costs $150,000 to treat over a two year to two and a half year time period and has only a 60 percent cure rate.

In 2015, there were 9,563 cases of active TB in the United States, 66 percent of which were foreign-born. In 2014, there were 91 cases of MDR TB in the United States, 88 percent of which were foreign-born.

Several other states have reported cases of MDR TB among refugees, including Wisconsin (6) and Tennessee (2).

The Centers for Disease Control has yet to report the MDR TB rates in the United States for 2015.

Seven percent of the 3,554 refugees who arrived in Michigan during the six year period beginning in FY 2011 (October 1, 2010) and ending in FY 2016 (September 30, 2016), or 263, did not consent to initial domestic medical screenings within 90 days of their arrival, while 93 percent, or 3,291, completed their initial domestic medical screenings.

All domestic medical screenings of arriving refugees in Ingham County are conducted by the Ingham County Health Department, which has been contracted by the Michigan Department of Health and Human Services to perform this task.

Twenty-two percent of the 3,291 refugees who were resettled in Ingham County, Michigan and completed domestic medical screenings during the six years beginning October 1, 2010 and ending on September 30, 2016 tested positive for latent tuberculosis infection (LTBI), the Ingham County Health Department tells Breitbart News.

As a point of comparison, LTBI rates among refugees arriving in other states vary from 12 percent in California to 35 percent in Vermont.

Seven percent of the 3,554 refugees who arrived during this period, or 263, did not consent to initial domestic medical screenings within 90 days of their arrival.

Of the 3,291 refugees who completed medical screenings in Ingham  County during this five year period, “100% are initiated on treatment,” the Ingham County Health Department says.

“87 – 90 % successfully complete the treatment,” the department adds.

This means that at least 329 refugees who tested positive for LTBI in Ingham County have not completed treatment, and are at risk of activating their latent condition into active TB. All told, 592 of the 3,554 refugees who arrived in Ingham County during these six years either were never tested for LTBI or tested positive for it and never received treatment.

As Breitbart News reported previously, a 2013 study at the University of California at San Diego concluded that refugees with LTBI have a much higher likelihood of activating than the general population. Consequently, high rates of LTBI among refugees pose a risk of active TB to the general population of communities in which they are resettled.

Four percent of the general population tests positive for LTBI, and only five to ten percent of those develop active TB over their life time, according to the CDC.

Ingham County is now the only county in the entire state of Michigan that has made public the LTBI rates of arriving refugees.

The Michigan Department of Health and Human Services (MDHHS) has told Breitbart News that it does not track this data and has no legal obligation to do so, despite the clear requirements for such record keeping and monitoring outlined in the Refugee Act of 1980.

When asked what, if any, of this data it makes available on a regular basis MDHHS, a spokesperson for Ingham County told Breitbart News, “All active tuberculosis cases are reported to MDHHS in MDSS (Michigan Disease Surveillance System).”

The spokesperson gave no indication that the county shares refugee latent TB data with MDHHS, but noted that “Health department staff meet with MDHHS quarterly to discuss TB cases.”

Kent County (whose county seat is Grand Rapids, another center for refugee resettlement) is the only other county in the state where the local health department conducts the domestic medical screenings of arriving refugees.

The Kent County Health Department has refused to provide Breitbart News with the refugee health data that Ingham County Health Department has provided. Instead, after more than a month of email exchanges, the Kent County Health Department has told Breitbart News to file a Freedom of Information Act request to obtain the required data.

The Kent County Health Department has also refused to offer an explanation for the huge uptick of 22 foreign-born cases of TB reported in 2011 in the public health region of Michigan in which Kent County is the county with the largest population.

In Washtenaw County (Ann Arbor), the Washtenaw County Health Department’s contract to perform initial domestic medical screenings of refugees was terminated by MDHHS in September 2015. Screenings for arriving refugees in the county are now conducted by St. Joseph’s Hospital.

Washtenaw County Health Department tells Breitbart News that is collecting refugee health data for the period of time it conducted that service, but has not yet made it available.

In three large counties in the Detroit area-Oakland, Macomb, and Wayne County—MDHHS has hired the Arab American and Chaldean Council to conduct initial domestic medical screenings of arriving refugees, but that organization has apparently not provided latent TB refugee data to the health departments in those counties, as it is required to do by the Refugee Act of 1980.

Neither the Wayne County Health Department nor the Arab American and Chaldean Council have responded to Breitbart News requests for comment.

Representatives for Macomb County and Oakland County tell Breitbart News they have not received latent TB refugee latent TB data—either at the individual level or the aggregate level—from the Arab American and Chaldean Council.

“The Oakland County Department of Health and Human Services is unable to share refugee health data because it is on record as having never received any refugee health information from the MDHSS-contracted health screening vendor, the Arab American and Chaldean Council (ACC) or from MDHHS itself,” a spokesperson for Secure Michigan, a local grassroots organization, tells Breitbart News.

“Oakland County residents are at risk without access to this public health data, particularly given the fact that Oakland County has received over 11,000 refugees since FY 2008 and, according to their annual plans, federal vendors place refugees in jobs where infections are easily spread such as commercial food preparation,” the spokesperson adds.

L. Brooks Patterson, the County Executive in Oakland County, has said he intends to sue the federal government to end the placement of refugees within the county for its failure to comply with the consultation clause of the Refugee Act of 1980.


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