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Michigan’s Washtenaw County Refuses to Release Refugee Latent TB Infection Rates

The Washtenaw County Public Health Department in Michigan is refusing to release refugee latent tuberculosis (TB) infection rates, the Washtenaw County Freedom of Information Act (FOIA) Coordinator tells Breitbart News.

Ann Arbor, home to the main campus of the University of Michigan, is located in Washtenaw County.

On Friday, Washtenaw County released the following data to Breitbart News, which did not include requested latent TB infection rates:

Washtenaw County Public Health’s Refugee Health Screen Program completed screenings of 241 refugees between FY 2011 and FY 2015. The program screened 12 refugees in FY 2011, 31 in FY 2012, 78 in FY 2013, 66 in FY 2014, and 54 in FY 2015. The refugees came from Iraq, Syria, Iran, Afghanistan, Somalia, Ethiopia, and Jordan. The most common country of origin was Iraq. All screenings were completed withing 90 days of arrival, and most were done within 30 days.

Within this period, no refugees arrived with A1, B1, or B3 tuberculosis health risk classifications. The B2 classification [latent TB] is not reportable. No refugees were diagnosed with active tuberculosis.

“You’ve failed to include the most important information,” Breitbart News told Washtenaw County’s FOIA Coordinator. “How many of those refugees for whom you conducted initial domestic medical screenings tested positive for latent TB infection?”

Breitbart News noted that Ingham County, Michigan (Lansing) has provided latent TB infection (LTBI) data for refugees.

No other county in Michigan has provided data on LTBI rates among the more than 20,000 refugees who have arrived in the state during the six years between FY 2011 and FY 2016. The Michigan Department of Health and Human Services has also not provided that data on LTBI rates among arriving refugees in the state.

In contrast, several other states, routinely report LTBI among arriving refugees.  Minnesota, for instance, has been reporting that data annually since 2004.

LTBI rates among arriving refugees in states that report that data range from 12 percent in California to 35 percent in Vermont in recent years.

LTBI rates among the general population are approximately four percent. Of those, the Centers for Disease Control estimates that five to 10 percent develop active TB at some point in their lifetime.

A 2013 study by the University of California at San Diego concluded that high rates of LTBI among arriving refugees pose a risk of active TB to the general population because refugees have a higher activation rate than the general population.

The significance of LTBI among refugees as a risk factor for active TB in the population as a whole is one factor that may explain the extraordinarily high levels of active TB over the past two decades in Minnesota. In 2004, for instance, 40 percent of arriving refugees, and 55 percent of those arriving from Sub-Saharan Africa tested positive for LTBI. During the five years between 2010 and 2014, the Minnesota Department of Health reported that 296 refugees were diagnosed with active TB in the state.

Between 1993 and 2014, the percentage of active TB cases in Minnesota that were foreign-born increased from 50 percent to 87 percent.

In Ingham County, 22 percent of arriving refugees between FY 2011 and FY 2016 tested positive for latent TB infection, 5 were diagnosed with active TB and one was diagnosed with MDR TB.

“Latent TB infections aren’t reportable in Michigan, and individuals may be managed through our TB control program or by their medical provider. But the individuals we managed were not tracked by their refugee or non-refugee status so we do not have this specific information to provide,” the Washtenaw County FOIA coordinator responded.

Breitbart News reminded the Washtenaw County FOIA coordinator that according to the Refugee Act of 1980, the county and the resettlement agency have a duty to monitor the treatment of refugees identified with latent TB infection, and again requested answers to three questions about latent TB infection rates among refugees arriving in Washtenaw County:

1. How many refugees tested positive for latent TB infection in Washtenaw County during the period Washtenaw County Health Department conducted initial domestic medical screenings?

2. How many of those initiated treatment supervised by the county?

3. How many of those completed treatment supervised by the county?

“As I stated in my initial response to your Freedom of Information Act request sent on 10/21/16 at 9:43 am the Act is not intended to be a question and answer session,” the Washtenaw County FOIA Coordinator responded to Breitbart News.

“Further as I stated in my follow-up response reference latent TB, we do not have this specific information to provide for the reasons stated in my email of 10/21/16 at 10:26am,” the FOIA coordinator added.

Breitbart News had requested data for six years from FY 2011 to FY 2016, but only received partial data for the five years between FY 2011 and FY 2015.

“This communication is in response to your Freedom of Information Act Request subjected electronically on October 13, 2016, received October 14, 2016, pursuant to the Act a response is due today, October 21, 2016. Your request has been granted to the extent Washtenaw County Public Health has the information you are requesting,” the Washtenaw County FOIA Coordinator said:

The Washtenaw County Public Health Department, gathered the information they have available and prepared a summary of the information in order to respond to your request. The Freedom of Information Act is not intended to be a question and answer session; however, for this particular request a summary of the information was prepared. This does not set precedent for future requests.

According to the Department of State’s interactive website, 77 refugees arrived in Washtenaw County in FY 2015. Only 70 percent of those arrivals, or 54, consented to initial domestic medical screenings, a relatively low rate compared to the 87 percent rate experienced that same year in Ingham County, Michigan.

In September 2015, at the end of FY 2015, the Michigan Department of Health and Human Services ended the refugee health screening contract with Washtenaw County and awarded it to St. Joseph’s Hospital.

During FY 2016, the number of refugees resettled in Washtenaw County increased significantly to 177, of whom 62 were from Syria.

According to the FY 2017 resettlement plans for Washtenaw County from the two resettlement agencies that operate in Washtenaw County, the Lutheran Immigrant and Refugee Service (known as Samaritas in Michigan) and HIAS (formerly known as the Hebrew Immigrant Aid Society), a total of 400 refugees will be resettled in the county in this fiscal year, which began on October 1, more than double the number that arrived in FY 2016.

Samaritas intends to bring 100 refugees into the county from Iraq and Syria.

HIAS intends to bring 300 refugees into the county from Iraq, Iran, Syria, Afghanistan, Ukraine, Somalia, Eritrea, and Ethiopia.

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