Wednesday, March 23, 2005

TB Higher Among Immigrants to US

Though tuberculosis infection rates are at an all time low in the general US population, infection rates are significantly higher among illegal immigrants and rising in states with large immigrant populations.

Infection rates for Asians were 20 times as great as those of whites, and rates for blacks and Hispanics were 8 times as great as those of whites, the centers said. The overall number of cases, 14,511, was the lowest since recording began, in 1953.

The high rates for Asians "are a reflection of immigration patterns and TB rates in the countries of origin," said Dr. Kenneth Castro, director of the tuberculosis control division at the C.D.C. China and India have the most cases in the world, and there are relatively high rates in Vietnam and the Philippines.

More than half the cases in the United States were in people born overseas and probably first infected there, Dr. Castro said.

The higher rates for Hispanics and blacks reflect a combination of high rates in Mexico and the disproportionate rate of incarceration, homelessness and drug abuse among those populations, Dr. Castro said.

Though the number of TB cases remains low, immigrants are bringing new and more virulent strains of TB into the US, a potential threat to the general population.

Cases of multi-drug-resistant tuberculosis, the most dangerous kind, also continued to decline. Only 114 people had drug-resistant strains in 2003, the last year they were measured; 86 of them were born abroad.

Getting patients to complete treatment regimens has become so difficult - especially among immigrants - that physicians are resorting to "incentives" to lure the infected individuals to their offices so that treatment can continue. Failing to complete a treatment regimen can contribute to the development of drug resistant strains of TB and thus adds to the threat facing the general population.

Also, [Dr. Castro] said, local clinics are more sophisticated at enticing patients to report daily for six to nine months to take their pills while a nurse watches. Some clinics offer sandwiches or vouchers for fast-food restaurants, some pay transportation costs, and some send workers to shelters for the homeless, subway platforms or other places where the homeless congregate.

"By making sure that people complete their therapy, you minimize drug resistance," Dr. Castro said.

In previous decades, people with infectious diseases like TB were properly quanantined by the health authorities until they ceased to be infectious. This vital safeguard was jettisoned by public officials for reasons of political correctness, but in the case of individuals whose life circumstances clearly indicate that they cannot be trusted to complete the treatment regimens on their own, shouldn't quarantine be considered?

Resistant strains can also be picked up from other victims.

Dr. Castro cited two recent outbreaks of such tuberculosis in high schools in Georgia and California, each from strains circulating abroad. "To me, that shows the importance of the U.S. being involved in controlling TB overseas," he said. "It's enlightened self-interest."

Enlightened self-interest for the US might also mean controlling our border and preventing people from illegally entering the US (and thus avoiding the medical screening that applies to legal immigrants). But Congress and the White House clearly don't consider that a priority - no matter what damage illegal immigration does to the general population.

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