Three Foreign-Born Cases of Multi-Drug Resistant TB in Nashville, Tennessee


NASHVILLE, Tennessee–Three foreign-born residents of Nashville, Tennessee were diagnosed with multi-drug resistant (MDR) tuberculosis (TB) in 2014 and 2015, according to the Tennessee Department of Health.

All told, in the six years between 2010 and 2015, seven cases of MDR TB were diagnosed in the state of Tennessee, including the three Nashville cases. The Tennessee Department of Health confirms that two of these seven cases of MDR TB were refugees, four were foreign-born but not refugees, and one was U.S.-born.

“One of those [two refugees] was diagnosed [with MDR TB] in 2013 and one was diagnosed in 2010. The one diagnosed in 2013 did not have a TB B-classification in 2007 upon arrival,” a spokesperson for the Tennessee Department of Health says.

The spokesperson did not add whether this refugee diagnosed with MDR TB in 2013 was tested for latent tuberculosis infection (LTBI) upon the initial medical screening that every refugee is supposed to undergo upon arrival in the United States.

As Breitbart News reported previously, 27 percent of refugees recently resettled in Tennessee have tested positive for LTBI, one of the highest rates in the country.

Four percent of the general population tests positive for LTBI. The rate at which those in the general population who test positive for LTBI develop active TB at some time in their life is ten percent.

The refugee diagnosed with MDR TB in 2013 developed the disease six years after arriving in the United States in 2007.

Several recent studies have indicated that the high rate of LTBI among resettled refugees poses a risk of active TB in resettlement communities because many refugees who develop TB do so as much as five or more years after their arrival in the country.

“The one [refugee diagnosed with MDR TB] in 2010 had a TB B1-classification upon arrival in 2010,” the spokesperson says.

Under the federal refugee resettlement program operated by the Office of Refugee Resettlement, all refugees are given overseas medical screenings as part of a program developed and supervised by the Centers for Disease Control (CDC) that supporters frequently describe as “stringent.”

When those screenings reveal health risks in a refugee, they receive specific classifications. Refugees diagnosed with active TB are given Class A classifications, meaning they are not allowed to be admitted to the United States, with one very big loophole.

Refugees diagnosed overseas with active infectious TB and are classified as Class A medical risks are permitted to resettle in the United States if they receive a medical waiver from the U.S. Citizenship and Immigration Service (USCIS) of the Department of Homeland Security.

Breitbart News has asked CDC to report on the number of refugees given Class A active tuberculosis classifications in their overseas medical screenings who have received medical waivers from the USCIS that allow them to enter the United States, but has not received a response.

Refugees who have abnormal chest x-rays but are sputum smear negative, or who have successfully completed the full regimen of treatment for active TB are classified as B1 medical risks with “active non-infectious tuberculosis,” using the CDC’s terminology, and are allowed to enter the United States without a waiver.

In the case of the one refugee who was diagnosed with MDR TB in 2010, it appears that refugee may have received a B1 “active non-infectious tuberculosis” classification overseas, but been diagnosed with MDR TB almost immediately upon arriving in the United States.

The spokesperson for the Tennessee Department of Health tells Breitbart News none of the three foreign-born cases diagnosed in Nashville in 2014 and 2015 were refugees, but refuses to provide either their country of origin or their immigration status. If not refugees, they were either illegal aliens, asylees, parolees, student visa holders, foreign tourists, or permanent legal residents.

“Due to the small number of persons with MDR TB in one county, we have determined providing information about the country of origin for each could contribute to their identification and could violate their protections under HIPAA,” the spokesperson tells Breitbart News.

The HIPAA excuse, a long legal stretch at best, is one often made by politically correct public health officials in an effort to conceal the immigration status of patients with TB or other infectious diseases.

Michael Evans of the Tennessee Office for Refugees (TOR), the subsidiary of Catholic Charities of Tennessee hired by the federal government as the resettlement agency in the Volunteer State, tells Breitbart News, “Because the Tennessee Department of Health does not directly track immigration status, the Tennessee Office for Refugees provided research support to TNDH staff.”

TOR has previously claimed that it does not monitor the medical status of resettled refugees and is unable to provide data on the number of refugees that have been diagnosed with active TB.

Breitbart News has asked both the Tennessee Department of Health and TOR to provide information on the number of refugees diagnosed with active TB over the past five years, but neither organization has done so.

Under the Refugee Act of 1980, TOR is required by law to both report and monitor illnesses such as LTBI, active TB, and MDR TB diagnosed among refugees to the county public health departments in which those cases are diagnosed.

To date, TOR has not fully complied with that requirement.

As Breitbart News reported previously, public health directors in Davidson County and Shelby County (Memphis is another refugee resettlement community in the state) have said that TOR has not reported any of this data – LTBI, active TB, or MDR TB – to them.

Nashville, in Davidson County, is the leading refugee resettlement community in the state. In 2015, 1,162 of the 1,601 refugees resettled in the Volunteer State were placed in Nashville.

MDR TB is a very dangerous form of active TB. Only 60 percent of those diagnosed with the disease survive, according to one medical expert who specializes in tuberculosis.

In contrast to active TB, which can be successfully treated over 9 months with four standard drugs at a cost of $17,000 per patient, MDR TB takes 20 to 26 months to treat at a cost of $150,000 per patient.

In 2014, there were only 91 MDR TB cases in the entire United States, out of a total of 9,421 cases of active TB. Worldwide, however, there were 480,000 cases of MTB TB out of a total of 9 million cases of active TB.

Breitbart News asked Nashville Mayor Megan Barry what specifically she plans to do to limit the health risk to Nashville residents from foreign-born MDR TB.

Mayor Barry has not yet responded.

With a population of 644,000 and at least two confirmed cases of MDR TB in 2015, Nashville, Tennessee appears to have the highest rate of MDR TB of any county in the country: one case for every 322,000 residents during the year.

Across the country in 2014 the 91 MDR TB cases were diagnosed out of a total United States population of 323 million, or one case for every 3.5 million residents during the year.

Breitbart News asked the three members of Congress who represent the metropolitan Nashville area–Rep. Jim Cooper, Rep. Marsha Blackburn, and Rep. Diane Black–to comment, but none have yet responded.

Their challengers, however, readily offered their views on the news that Nashville has developed such a high rate of MDR TB.

“Rep. Diane Black and her Democratic allies in Washington, like Rep. Jim Cooper, have combined to pass budgets bringing refugees into Tennessee and the United States that now have apparently contributed to making Nashville, Tennessee the multi-drug resistant TB capital of America,” former State Rep. Joe Carr, who is challenging Rep. Black for the GOP nomination in the Sixth Congressional District, tells Breitbart News.

Stacy Ries Snyder, who is running for the GOP nomination to take on Rep. Jim Cooper in the Fifth Congressional District this fall, tells Breitbart News, “Jim Cooper, who has served in Congress for 26 years and represents Nashville/Davidson County, should be out in front of this issue since these refugees affect his district more than any other in Tennessee. He is either uninterested or unable to protect the citizens of his district.”

“There are refugees being allowed into this country unfettered – we don’t know who they are or even if they have contagious diseases. We must re-institute an Ellis Island type of inspection station where those with diseases can either be treated or some returned to their native country. Until such an inspection station is instituted, there needs to be a moratorium on refugees until we can find out who is in this country and in what state of health they are,” Snyder says.

“As a Catholic, I am extremely disturbed by the knowledge that Catholic Charities is helping to bring in these refugees and failing to protect the American populace in the meantime. They are doing this in violation of the Refugee Act of 1980 which allowed States to opt out-which Tennessee did. Catholic Charities is not operating under laws, it is operating under regulations that circumvent the people’s voice to its own government,” she adds.

Big John Smith, who is competing with Snyder for the GOP nomination in the Fifth District, tells Breitbart News, “it’s very puzzling to me why our federal government seems hell-bent to bring immigrants into our country from places where TB infections are common, if not rampant.”

“At Ellis Island, individuals were admitted to America after a medical screening.  Those
policies were designed to protect Americans, to keep them safe.  Our life boat will sink and all will perish if our earlier American policies are not resurrected, ” Smith adds.

“In my town of Nashville, the local office of refugee resettlement with its sister organization, Catholic Charities,  have been very sly in concealing which of its current immigrants are infected.  Catholic Charities is paid for each person entering America through their crowded offices,” Smith adds.

“What is unfair to Nashvillians and Tennesseans in general is that it is they who will have to bear the costs for housing, medical care, food stamps, earned income tax rebates and the thousands of dollars spent every year for a people with no education and few marketable skills. These policies are so costly and unfair to the people in my own community as they struggle to keep their own families fed and housed,” Smith concludes.

The Department of Health presentation from October 2015, “MDR in NDR: Nashville’s Trio of Multidrug-Resistant TB Cases,” by Ben Katz, MPH, of the Tennessee Tuberculosis Elimination Program offered a description of each of the three foreign-born patients who were diagnosed with MDR TB.

Patient 1 in Nashville was a 44-year-old, foreign-born male who “presented to local hospital with cough and abnormal chest x-ray,” on May 15, 2015.

Two weeks later, on June 2, “Molecular detection of drug resistance (MDDR) showed INH, EMB, and PZA mutations.”

Patient 2 in Nashville was a a 47-year-old, foreign-born female who had a “Previous diagnosis 2011 with treatment.” On March 30, 2015, she had a “TST placed.” On April 3, that test revealed the presence of TB. That same day she “[r]eported night sweats, weight loss, fatigue, and cough.”

Patient 3 in Nashville was a 28-year-old, foreign-born female who “[r]eported TB treatment overseas” between February 2013 and February 2014 “with Isoniazid, Rifampin, and Ethambutol.”

On April 14, 2014, two months after completing a year of treatment for active TB overseas, Patient 3 “[s]ought care related to lump in neck and related medical complaints,” in Nashville.

On May 29, 2014, Patient 3’s “[b]iopsy reported MTb probe positive.”

As of October 7, 2015, more than one year later, Patient 3 was still undergoing treatment.

Tennessee is one of fourteen states that have withdrawn from the federal refugee resettlement program. In those states, the federal government has hired contractors, voluntary agencies (VOLAGs), to resettle refugees under the statutorily questionable Wilson Fish alternative program.

In April, the Tennessee General Assembly passed Senate Joint Resolution 467 declaring its intent to sue the federal government on Tenth Amendment grounds for its operation of the refugee resettlement program in the Volunteer State.

In July Tennessee Attorney General Herb Slatery gave the state legislature the green light to proceed with the litigation, though he said he would not personally represent the state in the proceedings.

“This news of two refugees with MDR TB in Tennessee underscores the need for judicial relief through our Tenth Amendment lawsuit. Inconsistent data and conflicting reports indicate unacceptable risk when it comes to the health and safety of our citizens,” State Senate Majority Leader Mark Norris (R-Collierville), the sponsor of SJR 467, tells Breitbart News.

An attorney familiar with the federal refugee resettlement program agrees.

“Recent articles detailing cases of refugee arrivals with TB including those of greatest concern, being active and multi-drug resistant, highlight the need for meaningful accountability and transparency on the part of the federal resettlement contractors who bring refugees to our communities,” the attorney tells Breitbart News.

“VOLAG (volunteer agency resettlement agency) accountability has been discussed in Congress repeatedly since the passage of the Refugee Act of 1980 and unfortunately, not much has changed.  The federal program continues to operate with sanctioned secrecy, including the concealment of resettlement plans prior to the start of the fiscal year and other information that has serious implications for public health,” the attorney adds.

“This secrecy surrounding the whole refugee program must be unveiled,” State Rep. Terri Lynn Weaver (R-Lancaster), the main sponsor of SJR 467 in the Tennessee House tells Breitbart News.

“We want to know who, how many and where these refugees are coming from. It is wrong to put our state in danger of epidemic proportions that will only escalate that could be prevented if we knew the truth,” Weaver adds.

The Tennessee General Assembly is expected to hire the Thomas More Law Center, which has said it will represent the state at no cost, to litigate the case on its behalf in federal court.


Rep. Diane Black provided this statement to Breitbart News late Friday morning:

With each passing day, the case against continuing our broken refugee resettlement program grows. President Obama’s own Secretary of Homeland Security admitted previously that terrorists could ‘exploit’ this system, and now we see very clearly how it is threatening our public health right here in Tennessee. That is why I’ve fought at every turn to combat this dangerous practice, whether it was cosponsoring a bill to halt refugee resettlement altogether, voting for House-passed legislation to strengthen refugee screening, or voting against last year’s omnibus bill that allowed the program to continue on, unabated.  President Obama and Hillary Clinton like to frame this as a matter of compassion and goodwill, but there’s nothing compassionate about endangering American citizens to help seal a political legacy. The compassionate and responsible thing to do is to enact a full moratorium on refugee resettlement until these safety concerns are fully addressed.


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