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Active TB Increases in Minnesota; 90 Percent Foreign-Born, 11 Refugees Diagnosed Overseas Before Arrival

The number of active tuberculosis (TB) cases diagnosed in Minnesota increased 12 percent in 2016 to 168, up from 150 one year earlier, according to the Minnesota Department of Health’s (MDH) Tuberculosis Prevention and Control Program’s Quarterly Surveillance Report, October 1, 2016 – December 31, 2016.

Ninety percent of these 168 cases  (152 of 168) were foreign-born, significantly higher than the national 2016 average of 67.9 percent of active TB cases that were foreign-born.

Fourteen of these 168 cases, or 9 percent were diagnosed within the first year in the United States of the  2,635 refugees who were resettled in Minnesota in FY 2016. The majority of these refugees came from two high TB burden countries: 1,195 came from Somalia, and 653 came from Burma, according to the State Department’s interactive website.

Eleven of these 14 cases of active TB in refugees were actually diagnosed in pre-immigration exams overseas before their arrival in Minnesota – a remarkable situation that would have either violated U.S. law or required the granting of a waiver by the United States Citizenship and Immigration Services (USCIS) office within the Department of Homeland Security, since active TB is a “Class A” health risk which is prohibited entry to the U.S. without such a waiver.

Three of these 14 cases of active TB in refugees were diagnosed during the refugee health exams conducted after their arrival in the United States.

Breitbart News asked USCIS to explain why these 11 refugees diagnosed with active TB during overseas medical examinations and classified as “Class A” health risks were allowed to enter the United States, but has not received a response.

“The [overseas] medical examination determines whether the applicant has an inadmissible condition of public health significance (a Class A condition) or has a health-related condition that is admissible but that might require extensive medical treatment or follow-up (a Class B condition). Applicants with Class A (inadmissible) conditions can only enter the United States if they are granted a waiver,” a 2013 Centers for Disease Control (CDC) report noted:

Applicants who have Class A conditions include those who 1) have a communicable disease of public health significance, 2) do not have documentation of having received vaccinations against vaccine-preventable diseases, 3) have a physical or mental disorder with associated harmful behavior, or 4) abuse or are addicted to drugs. (42 USC 252, 8 USC 1182, and 8 USC 1222 provide for the physical and mental examination of applicants in accordance with regulations prescribed by the HHS Secretary.) The communicable diseases of public health significance include tuberculosis, syphilis, chancroid, gonorrhea, granuloma inguinale, lymphogranuloma venereum, Hansen disease (leprosy) . . . (emphasis added)

Eight of the 168 cases of active TB diagnosed in Minnesota during 2016 were of the extremely dangerous Multi-drug resistant (MDR) strain; that is they are resistant to two of the four drugs usually used to effectively treat active TB, INH and rifampin.

“The introduction of MDR TB to the United States represents a serious public health threat, since its successful treatment is uncertain and very expensive. Active TB can usually be treated successfully in six to nine months at a cost of $17,000 per patient, according to the Centers for Disease Control (CDC), but MDR TB treatment costs more than $150,000 per patient and can take between 20 and 26 months,” as Breitbart News reported previously:

The six to nine month treatment regimen for active TB, which has been standard practice in the United States for some 50 years, involves a combination of four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol.

Over the past several decades, new strains of TB have developed around the world which are resistant to at least two of these four drugs, hence the term MDR TB. Treatment for MDR TB begins only after the patient is observed to be resistant to the standard four drug protocol. Subsequent to diagnosis, a number of expensive “second level” drugs are added to the patient’s treatment regimen.

In 2016, the eight cases of MDR TB diagnosed in Minnesota accounted for 1.9 percent of the 168 cases of active TB diagnosed in the state.

“In 2016, a total of 9,287 new tuberculosis (TB) cases were reported in the United States; this provisional* count represents the lowest number of U.S. TB cases on record and a 2.7% decrease from 2015,” the Centers for Disease Control (CDC) reported in March:

Minnesota was one of the few states where the number of active TB cases increased in 2016 , and one of only 12 states that reported “incidence higher than the national incidence.”

State-specific TB incidence in 2016 ranged from 0.2 cases per 100,000 persons in Wyoming to 8.3 in Hawaii (median state incidence = 1.9). Twelve states (Alaska, Arkansas, California, Florida, Georgia, Hawaii, Maryland, Minnesota, New Jersey, New York, North Dakota, and Texas) and DC reported incidence higher than the national incidence. . .

Among 9,287 TB cases reported in 2016, U.S.-born persons accounted for 2,935 (31.6%) cases, and 6,307 (67.9%) cases occurred among foreign-born persons; 45 (0.5%) cases occurred among persons whose national origin was not known (Table 2). TB incidence among U.S.-born persons (1.1 cases per 100,000) decreased 8.4% from 2015 (Figure). Incidence among foreign-born persons (14.6 cases per 100,000) decreased 3.2% from 2015, but was approximately 14 times the incidence among U.S.-born persons

The refugee community in Minnesota, and particularly the Somali refugee community, has been at the center of several recent public health issues in the state.

“During the five years between 2010 and 2014, 732 cases of active TB were diagnosed in Minnesota. Of these, 81 percent, or 593, were foreign-born. Of foreign-born cases, 50 percent, or 296, were refugees, according to ‘The Epidemiology of Tuberculosis in Minnesota, 2010-2014,’ a report published by the Minnesota Department of Health,” Breitbart News reported previously.

“Twenty-nine percent of the 593 foreign-born cases of active TB diagnosed in Minnesota, or 161, were attributed to Somali born migrants. Almost all Somali migrants to the United States have arrived under the federal refugee resettlement program,” Breitbart News noted.

In April, 29 out of 34 cases of measles diagnosed in a record outbreak in Minnesota were identified within members of the state’s Somali community.

Also in April, two doctors and one other person were arrested in Michigan on charges of performing illegal female genital mutilation procedures on Somali girls transported from Minnesota.

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