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Tuberculosis: Refugees Produce 29 Percent of Active Cases in New Hampshire

The refugees resettled by the federal government in New Hampshire produced 29 percent of all diagnosed active tuberculosis (TB) cases in the state during 2014 and 2015, says the Centers for Disease Control.

Three contagious TB cases, or “active tuberculosis,” in New Hampshire were diagnosed in refugees in 2015, and four cases were diagnosed in refugees during 2014. During that two year period, a total of 24 cases of active TB were diagnosed in New Hampshire.

So seven of the 24 active cases, or 29 percent, were among refugees delivered by the federal government. The refugee population is less than one percent of the total state population.

New Hampshire does, however, have a much higher per capita rate of refugee TB compared to other states.

Between FY 2008 and FY 2015, 4,368 refugees were resettled in New Hampshire by the federal government. More than 80 percent of these refugees, or 3,497 out of 4,368, arrived from four high TB burden countries, according to the Department of State–Bhutan (2,239 refugees), the Democratic Republic of Congo (797 refugees), Burma (291 refugees), and Somalia (170 refugees).

Only Minnesota, where 33 percent of TB cases during this period, or 99 out of 297, were diagnosed in refugees, had a higher percentage than New Hampshire’s 29 percent among all 46 states for which the CDC reports data on immigration status upon first entry data for foreign-born cases of TB. (Arizona, Illinois, Virginia, and Washington do not report this data to the CDC.)

The national average, 4.5 percent, is significantly lower.

“In New Hampshire, based on our most recent 2015 data, a total of 13 cases of TB were reported to the NH Department of Health & Human Services, Division of Public Health Services (DPHS); 11 of these cases (85%) were among foreign-born persons,” a spokesperson for the New Hampshire Department of Health & Human Services told Breitbart News in an emailed statement.

New Hampshire’s percentage of foreign-born cases of TB in 2015 was 19 percent higher than the national average of 66 percent. In 1986, the national average of foreign-born cases of TB was only 22 percent.

“NH DPHS does not distinguish among categories of foreign-born because our public health interventions are not different; however, based on the most recent CDC surveillance report, (table 36), only 3 of these 11 foreign-born individuals diagnosed with TB in 2015 were refugees,” the spokesperson added.

Only two of the 13 cases of active TB in New Hampshire in 2015 were diagnosed in U.S.-born residents. Three cases were diagnosed in refugees, and six cases were diagnosed in foreign-born residents of New Hampshire whose immigration status upon initial arrival in the United States was something other than refugee.

Three of these six foreign-born residents of New Hampshire diagnosed with active TB in 2015 had an immigrant visa as their immigration status at first entry into the United States, according to the CDC publication Reported Tuberculosis in the United States, 2015. One arrived on a student visa, one arrived on an employment visa, and one arrived as an asylee/parolee.

Breitbart News asked the New Hampshire Department of Health & Human Services why such a high percentage of total TB in New Hampshire is diagnosed in refugees.

“When there are as few TB patients as in New Hampshire, proportions may seem high and reporting such may be misleading,” the spokesperson responded.

“The total number of TB diagnoses among our refugees is very low,” the spokesperson concluded.

But the pattern of high rates of active TB diagnosed among refugees in the state of New Hampshire is not a one-time “blip,” or data outlier, experienced only in 2015.

In 2014, for instance, four refugees resettled in New Hampshire were diagnosed with active TB out of a total of 11 cases diagnosed among New Hampshire residents, according to CDC data. Three U.S.-born residents of New Hampshire were diagnosed with active TB that year, while four foreign-born residents whose initial immigration status upon arrival was something other than refugee were also diagnosed.

In 2013, four out of the 15 cases of active TB diagnosed in New Hampshire, or 26 percent of all cases, were diagnosed in refugees. Ten cases were “other foreign-born” and one was U.S.-born. A stunning 93 percent of all cases of TB diagnosed that year in the state were foreign-born.

In 2012, one out of 9 cases of active TB diagnosed in New Hampshire, or 11 percent of all cases, wase diagnosed in a refugee. Nine cases were “other foreign-born” and none were U.S.-born. One hundred percent of all cases of TB diagnosed that year in the state were foreign-born.

Breitbart News asked the the New Hampshire Department of Health & Human Services if “NH DPHS does not distinguish among categories of foreign-born because our public health interventions are not different,” how then, did the CDC determine that “3 of these 11 foreign-born individuals diagnosed with TB in 2015 were refugees” if the state of New Hampshire did not provide this data on refugees to them.

The New Hampshire Department of Health & Human Services has not yet responded to that inquiry.

The  CDC states that data used in its annual publication Reported Tuberculosis in the United States is provided directly by the states:

Reporting areas (i.e., the 50 states, the District of Columbia (DC), New York City, Puerto Rico, and other U.S. jurisdictions in the Pacific Ocean and Caribbean Sea) provide information regarding tuberculosis (TB) cases to CDC’s National TB Surveillance System (NTSS) by using a standard case report form, Report of Verified Case of Tuberculosis (RVCT).

When asked if the state of New Hampshire has a plan to effectively deal with this refugee TB issue, the spokesperson for the New Hampshire Department of Health & Human Services did offer a response.

“TB is an important but treatable and curable disease. NH DPHS continues to comprehensively address management of TB in accordance with national guidelines through testing for and treating of TB infections; surveillance; and education of healthcare providers,” the spokesperson said.

“These strategies apply to all NH residents whether U.S.-born or foreign-born,” the spokesperson added.

Incoming New Hampshire Gov. Chris Sununu, the first Republican to hold that office in twelve years,  may want to consider establishing a new common sense TB control strategy: not resettling refugees from high TB burden countries in the state.

 

 

 

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