77 More Active TB Cases Among Sub-Saharan Migrants to Minnesota in 2015, Half of All in State

Seventy-seven migrants to Minnesota from Sub-Saharan Africa were diagnosed with active TB in 2015, according to the Minnesota Department of Health (MDH).

Slightly more than half of the cases of active TB diagnosed in Minnesota in 2015, or 77 out of 150, were born in Sub-Saharan Africa. The number of active TB cases in Minnesota increased from 147 in 2014 to 150 in 2015, according to the Centers for Disease Control.

Less than 1.5 percent of Minnesota’s residents, or 81,971 of the state’s 5.5 million population, were born in Sub-Saharan Africa, according to the Census Bureau.

“The most distinguishing characteristic of the epidemiology of TB disease in Minnesota continues to be the large proportion of cases occurring among persons born outside the United States,” the MDH reported, adding that 60 percent of the 129 foreign-born cases of TB diagnosed in Minnesota in 2015 (77) were born in Sub-Saharan Africa:

In 2015, the percentage of TB cases in Minnesota occurring in foreign-born persons was 86%, compared to 66% of TB cases reported nationally. The 129 foreign-born TB cases reported in Minnesota represented 26 different countries of birth; the most common region of birth among these patients was Sub-Saharan Africa (60% of foreign-born cases), followed by South/ Southeast Asia (22%), East Asia/Pacific (10%), and Latin America (including the Caribbean) (6%) (Figure 7). All 6 U.S.- born pediatric TB cases (<15 years of age at diagnosis) had at least one foreign-born parent or guardian. These second-generation children appear to experience an increased risk of TB disease that more closely resembles that of foreign-born persons.

Among the foreign-born TB cases, 19% were diagnosed with TB within the first 12 months after arriving in the United States, and an additional 12% were diagnosed 1 – 2 years after arrival. These cases most likely acquired TB infection prior to immigrating and started progressing to active TB disease shortly after arrival. Of the 16 cases ≥15 years of age who arrived as immigrants or refugees and diagnosed in Minnesota within 12 months of arriving in the U.S., only 4 had any TB-related condition noted in their pre-immigration medical examination reports. These findings highlight the need for clinicians to have a high index of suspicion for TB among newly arrived foreign-born persons, regardless of the results of medical exams performed overseas.

Previously, Breitbart News reported that 296 refugees resettled in the state in the five years between 2010 and 2014 were diagnosed with active TB, according to the Minnesota Department of Health (MDH). During those five years, 161 residents of Minnesota born in Somalia, which is in Sub-Saharan Africa, were diagnosed with active TB. Almost all migrants to the United States from Somalia have arrived through the federal refugee resettlement program.

Minnesota has the largest Somalian community in the United States, estimated to be between 40,000 and 70,000.

As the MDH reported:

In 2015, 150 tuberculosis (TB) cases (2.7 per 100,000 population) were reported. This represents a 2% increase in the number of cases compared to 2014 (147), but a 37% decrease in the number of cases since 2007, when the highest number (238) in the past decade was reported. As seen in most years, Minnesota’s TB incidence rate in 2015 was lower than the national rate of 3.0 cases per 100,000 population. Two (1%) of the cases died due to TB related causes. . .

The vast majority (87%) of TB cases reported in Minnesota in 2015 were identified as a result of individuals seeking medical care for symptoms of disease. Various targeted public health interventions identified a portion of the remaining 13% of cases. Such methods of case identification are considered high priority, core TB prevention and control activities; they included TB contact investigations (3%), follow-up evaluations resulting from abnormal findings on pre-immigration exams performed overseas (3%), and domestic refugee health assessments (2%). An additional 3% were identified through other means (e.g., other immigration medical exams, occupational screening or other targeted testing for TB). Five (3%) cases were diagnosed with active TB disease incidentally while being evaluated for another medical condition.

At least eight cases of active TB were diagnosed among refugees upon their arrival in Minnesota in 2015, bringing the total number of cases of active TB among refugees in Minnesota over the past six years to at least 304. That also increases the number of active TB cases diagnosed among refugees over the past six years in the fifteen states in which Breitbart News has been able to obtain data to 476, broken down as follows:

Minnesota (304), Wisconsin (27)Nebraska (21)Louisiana (21), Michigan (19)Vermont (17)Colorado (16), Florida (11), Ohio (11 in one county)Idaho (7), Kentucky (9 in one county)North Dakota (4 in one county),  Indiana (4), California (3), and Tennessee, where two refugees have been diagnosed with the very dangerous, multi-drug resistant (MDR) TB.

Three cases of active TB (two percent) were diagnosed among refugees in Minnesota in 2015 at their initial “domestic refugee health assessment,” and five cases (three percent) were diagnosed among refugees as part of “follow-up evaluations resulting from abnormal findings on pre-immigration exams performed overseas.” Those refugees arrive in the United States with A1, B1, B2, or B3 tuberculosis health risk classifications.

It is not clear how many of the 129 foreign-born cases of active TB diagnosed in Minnesota in 2015 came into the United States as refugees and were diagnosed subsequent to their initial domestic medical screening but within ten years of their arrival.

Based on past experience in Minnesota, that number is likely to account for a majority of the 129 cases of foreign-born TB diagnosed in Minnesota in 2015.

“The majority of those [296] refugees [diagnosed with active TB between 2010 and 2014] actually developed TB disease after being in Minnesota at least five years, and many had been in the US at least 10 years, so these are not new arrivals to the US,” a spokesperson for the MDH told Breitbart News last week.

Breitbart News contacted the MDH to confirm how many of the 77 Sub-Saharan migrants to the state diagnosed with active TB in 2015 were refugees.

“The information that is available is on our website. We do not have additional analysis or cross-tabulated information to share at this time,” a spokesperson for the MDH tells Breitbart News.


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