Ten of the approximately 8,000 refugees who were resettled in Colorado by the federal government between 2011 and 2015 were diagnosed with active tuberculosis shortly after their arrival, according to the Tuberculosis in Colorado: 2015 report published by the state’s Department of Public Health and Environment.
A number of other states have also reported refugees have arrived with active TB, as Breitbart News reported previously. Four refugees with active TB were resettled in Indiana in 2015, and eleven refugees with active TB were resettled in Florida in the three years from 2013 to 2015.
The recent increase in the number of active TB cases reported in the United States is driven by increases in the foreign born population with high rates of active and latent TB, as Breitbart News reported last week:
Two-thirds of contagious tuberculosis carriers in the United States during 2015 were born overseas, up from one-fifth in 1986.
The government’s increased inflow of tuberculosis-carrying migrants appears to have reversed a 23-year decline of contagious tuberculosis cases inside the United States.
The jump in foreign-born cases from 22 percent in 1986 to 66 percent in 2015 is caused by the federal government’s policy of accepting more tuberculosis-infected migrants from countries with large-scale contagions of the deadly and debilitating disease. The disease spreads when carriers cough or exhale the TB bacteria.
In 1986, about 5,000 of the estimated 22,725 cases of contagious TB, or ‘active TB,’ reported in the United States were diagnosed in foreign-born patients, according to the Centers for Disease Control. The data appears in the CDC’s May 10, 1996 MMWR Weekly Report, “Tuberculosis Morbidity — United States, 1995.”
In 2015, 29 years later, the percentage of foreign born cases of active TB in the United States has tripled to 66 percent. The total number of active TB cases have declined to 9,563 in 2015 because of large-scale public health programs, but the number of foreign-born cases has increased from 5,000 up to 6,335. That is up by almost 20 percent since 1986.
American-born active TB cases have declined from an estimated 17,725 in 1986 to 3,201 in 2015. That is down 80 percent since 1986.
But federal immigration policy is pushing up the nation’s contagious TB cases. In 2015, for the first time in 23 years, the number of active TB cases in the United States increased rather than declined. It rose by 1.7 percent from the 9,421 cases diagnosed in 2014.
Over the same 29 year period, the foreign-born population as a percentage of the total U.S. population has increased from 7.5 percent in 1986 (18 million out of a total population of 240 million) to an estimated 13.7 percent in 2015. That is an increase from the 13.2 percent in 2014, the last year for which there is complete data (42.5 million out of a total population of 322 million).
High latent TB infection (LTBI) rates among resettled refugees are well documented, in addition to these cases of active TB.
Over the five years between 2011 and 2015, the latent TB infection rate of the 1,500 out of 8,000 refugees resettled in Colorado who had been flagged for TB in overseas medical screenings ranged from 27 percent to 41 percent. The Colorado Department of Public Health and Environment tells Breitbart News that it may take another week to provide LTBI infection rates for all 8,000 of these resettled refugees.
At least eight other states, in compliance with the Refugee Act of 1980, have reported LTBI infection rates among newly arrived refugees: Vermont (35 percent), Indiana (26 percent), Minnesota (22 percent), Florida (20 percent for TST test, 6 percent for blood test ), Arizona (18 percent), Utah (18 percent), Texas (15 percent), and California (12 percent).
Foreign born residents of the United States who have entered the country with LTBI contract active TB at a rate higher than American born residents, where LTBI infection rates average four percent, many times less than the world wide rate, which, according to some estimates, is around 33 percent.
“The increase in foreign born cases of active TB is attributable to several factors. A small part of that is due to migrants arriving with active TB, and then transmitting it within their arrival communities,” Breitbart News reported recently, adding:
The largest part of the increase, however, appears to be due to the dramatically higher rate of latent TB infection among foreign born residents (which can range from 20 percent to 43 percent, depending on country of origin) compared to the general population, which has a four percent LTBI infection rate, and the greater likelihood those living in refugee communities will see their latent TB activate. . .
Foreign-born residents of the United States have been identified as a high risk population by the CDC because a number of them arrive from crowded refugee camps, engage in high risk behavior such as smoking, and have cultural traditions not consistent with successful completion of treatment therapy. . .
A 2013 study by the University of California at San Diego’s Global Health Centerconcludes that “high latent TB infection rates among refugee resettlement communities like San Diego increase the risk of active TB.” . . .
The UC San Diego study found:
Our findings suggest that newly arrived refugees with LTBI have a considerable burden of clinical risk factors that increase their risk for reactivation of TB, which may contribute to the increased proportion of active TB among foreign-born populations in the United States if not prioritized for LTBI treatment. Efforts to ensure adequate LTBI treatment among high-risk refugees such as those documented in this study should be a public health priority. (emphasis added)
The researchers recommended that “public health departments that provide LTBI services to refugees with documented low treatment rates should consider programmatic changes to improve treatment acceptance.”
Breitbart News will soon report on additional cases of active TB among recently resettled refugees in several other states.