Eighty-Two Percent of TB Cases in Nebraska Are Foreign-Born

July 20, 2009 photo shows Dr. David Ashkin examining an x-ray belonging to patient Oswaldo Juarez at A.G. Holley State Hospital in Lantana, Fla.
AP Photo/Lynne Sladky

Eighty-two percent of the active tuberculosis (TB) cases diagnosed in Nebraska in 2014, that’s 31 out of 38, were foreign-born, according to the Nebraska Department of Health and Human Services.

Only six percent of the 1.9 million residents of the Cornhusker State are foreign-born.

2014’s 38 active TB cases represented an 80 percent increase in active TB cases in the state in one year, up from 21 in 2013.

The number of U.S. born cases of active TB in the state actually declined from 8 in 2013 to 7 in 2014. But the number of foreign-born cases of active TB in Nebraska more than doubled in one year, from 13 in 2013, to 31 in 2014. According to the Centers for Disease Control, only 61.9 percent of the active TB cases in 2013, or 13 out of 21, were foreign-born.

The Tuberculosis Program Report 2014, published by the Nebraska Department of Health and Human Services, explains the role the state’s foreign-born population played in this increase in active TB in the state and the difficulties involved in dealing with that population when it comes to TB control:

Although Nebraska has an overall low incidence of TB, the cases continue to be difficult to treat because of the high percentage of foreign-born population that comprise Nebraska’s TB morbidity and also because of the complexity of the cases. The language and cultural barriers of the foreign-born population require a tremendous amount of public health resources to ensure a successful TB treatment outcome.

The report also offers this warning to Nebraskans about the risk posed by multi-drug resistant TB:

Nebraska has not yet seen an increase in multi-drug and extensive drug-resistant diseases that have become more frequent around the world, but we realize that the global burden of TB is not far away from Nebraska’s borders.

Though the number of active TB cases declined slightly to 33 in 2015, that number represented a much higher incidence of active TB than the state has seen for several years. Breitbart News has been unable to obtain the percentage of active TB cases in Nebraska that were foreign-born in 2015 that were foreign-born.

Sixty-six percent of the 9,563 active TB cases diagnosed in the United States in 2015 were foreign-born. Thirteen percent of the population of the United States, or 42 million out of 322 million, were foreign-born. Only 22 percent of active TB cases diagnosed in 1986 were foreign-born.

One possible explanation for this disproportionate share of TB cases in Nebraska that are foreign-born could be the high incidence of TB within the countries of origins among the approximately 120,000 foreign-born residents of the state.

A number of those foreign-born residents are from Mexico, a high TB burden country, but a number also come from other high burden TB countries.

The Tuberculosis Program Report 2014 for Nebraska provides this country by country breakdown for the foreign-born cases of active TB diagnosed in 2014:

Foreign-born persons have a higher risk for exposure to or infection with tuberculosis, especially those that come from areas that have a high TB prevalence such as Asia, Africa, Latin America, Eastern Europe and Russia. Many persons from these regions now reside in Nebraska.

In 2014, 31 of the cases reported were among the foreign born. The percentage of foreign born cases was 82% for 2014. The distribution by country of origin is as follows:

9 from Mexico, 4 each from Vietnam and Somalia, 3 from Sudan, 2 each from Guatemala, Kenya and Myanmar [Burma]  and 1 each from Korea, Togo, Indonesia, Nepal [refugees from Bhutan are Nepalese]  and the Philippines.

The number of foreign-born cases for 2014 compared to the population yields a case rate of approximately 27.4 per 100,000 foreign-born people compared to a case rate of 0.4 per 100,000 U.S.-born people.

The case management activities around each of the foreign-born cases require a higher level of public health resources. The foreign-born population often needs resources for basic health care services, transportation and interpretation. The Health Department must have an understanding of cultural beliefs.

When providing services to the different populations, there are great challenges to both the state and local health departments as they work to maintain high standards in completion of therapy rates and complete contact investigations.

As many as 10,000 of the foreign-born residents of the state originally came as part of the refugee resettlement program and work primarily in low wage jobs in the burgeoning local meat-packing industry. Recently, the countries of origin for those refugees, the number of which increased from 764 in FY 2012 to 997 in FY 2013 to 1,076 in FY 2014, have had high rates of TB.

The vast majority of these new arrivals came from countries with high burdens of TB. Six hundred and sixty-two refugees in FY 2012  and 785 refugees in FY 2013 came from two such countries, Burma and Bhutan. Nine hundred and forty-eight refugees in FY 2014 came three countries–Burma, Bhutan, and Iraq.

Earlier refugees arrived from Somalia and Sudan.

Breitbart News has requested refugee health data on arriving refugees during the five year period beginning in 2011 and 2015 from the Nebraska Department of Public Health and the State Refugee Coordinator. That request includes the following:

1.Number of B1, B2, and B3 Tuberculosis health risk notifications, by year, for arriving refugees.
2.Number of refugees who successfully complete domestic medical screenings within 90 days of arrival.
3.Number of refugees who were medically screened and tested positive for latent tuberculosis infection (LTBI).
4. Number of refugees who were medically screened that tested positive for LTBI who successfully completed medical treatment.
5.Number of refugees who were medically screened and were diagnosed with active tuberculosis at initial medical screening.
6.Number of refugees who were diagnosed with active tuberculosis within 5 years of initial arrival in the United States.
7. Number of refugees who were diagnosed with multi-drug resistant tuberculosis within 5 years of initial arrival in the United States.

Though they acknowledged the receipt of our request, they said they would not be able to provide us with that information in the three days between our request and the publication of this story. They gave no indication when they would be able to provide that data.

Breitbart News has obtained some or all of this refugee health data from more than a dozen other states, but a number of states have either refused to provide the data or have simply not responded.

Unlike fourteen states where the refugee resettlement program is operated by voluntary agencies [VOLAGs] under the statutorily questionable Wilson Fish alternative program, the state of Nebraska continues to participate in that program. According to the Nebraska Department of Health and Human Services, “Three refugee resettlement agencies operate in Nebraska: Catholic Social Services, Lutheran Refugee Services, and Refugee Empowerment Center,” all under the supervision of the state of Nebraska, as well as the Office of Refugee Resettlement.

The Omaha World Herald reported recently, that many small towns in Nebraska, like Lexington, have been transformed permanently by the arrival of a meatpacking plant and the accompanying influx of foreign-born workers:

Lexington’s long history with immigrants makes it an unusual place for what some see as a cultural clash. Ever since a meatpacking plant opened here in 1990, the central Nebraska community of 10,000 has been a magnet for Hispanics, Vietnamese and other immigrants seeking jobs and a better life.

The town, which is now 60 percent Hispanic, has long had a welcome center to help new arrivals get acclimated. Thirty-two languages are spoken at local schools.

“Diversity’s not a new issue for this community,” said Barry McFarland, a former school administrator who now helps run a family-owned winery in Lexington.

African Muslims, mostly from war-torn Somalia, started arriving in the mid-2000s. Census estimates put the number of Somalis in Lexington at 769 in 2014 — a 40 percent increase from 2000. Local Somalis and those who work with them say there actually may be 1,500 or more living in the community.

Across Nebraska, census estimates show 2,100 Somali-born residents clustered in Omaha and Lincoln, and near meatpacking plants in Grand Island and Madison, as well as Lexington. . .

At the sprawling Tyson Foods facility on the south end of town, many of the plant’s 2,700 workers are Muslim. Their religion requires short prayers five times a day, and the plant has made accommodations for that, according to a corporate spokesman. . .

There have been cultural clashes before for Muslims in Nebraska. In 2008, dozens of workers at Grand Island’s JBS Swift & Co. meatpacking plant walked out in protest over a lack of accommodations for prayer times during Ramadan, the Muslim holy month. After the plant proposed a schedule shift, non-Muslims staged counterprotests over the special treatment.

As the foreign-born population of Nebraska continues to grow, the Cornhusker State is likely to see an increase in the number of associated public health and cultural problems that growth brings.


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