Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, is criticizing the Centers for Disease Control (CDC) for allowing refugees to enter the United States without screening and treatment for latent tuberculosis.
Seven of the agency’s own public health experts said such screening and treatment “would potentially save millions of dollars and contribute to United States TB elimination goals” in a research article published in December.
“Admitting people who might cause an epidemic makes no sense whatsoever from a public health standpoint,” Orient tells Breitbart News.
“It suggests that those who favor it do not care about the cost in suffering, death, and expense to Americans,” Orient says, adding she agrees with the public health experts currently or formerly employed at the CDC who concluded that screening of refugees for latent tuberculosis and successful treatment of those who test positive for the disease prior to their entry into the country is the proper public health policy for the United States.
But the political leadership at CDC does not appear to be following the screening and treatment recommendations of the study done by its own experts, and has not yet responded to inquiries from Breitbart News whether it plans to change course.
“If for humanitarian reasons we wish to help people fleeing persecution, there is still no need to release them into the general population of susceptible individuals. Officials who place politics above the health of Americans need to be held accountable and removed from positions of authority,” Orient says.
In a December 2015 study published at BMC Health, “a peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health,” seven public health professionals who at the time worked at the CDC’sDivision of Global Migration and Quarantine concluded that:
Implementing LTBI [latent tuberculosis infection] screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.
At least one of the authors of the study that recommended screening and treatment of U.S. bound refugees for latent tuberculosis infection is no longer affiliated with the CDC.
“Tuberculosis is one of the most lethal infectious diseases in history. It is easily transmitted, say on a public bus. Increasingly, it is becoming highly resistant to all our antibiotics,” Dr. Orient tells Breitbart News.
“The course of treatment is at best lengthy, and for resistant forms costly and toxic. Isolation of infected persons is essential to keep this plague from spreading. It is not even clear that treatment of latent infection in persons from regions where multiple-drug resistant TB is prevalent is even effective,” Orient adds.
Currently, however, the CDC does not screen or test the 70,000 refugees brought in to the U.S. annually under the federal refugee resettlement program country for latent tuberculosis infection. The refugees are tested for active tuberculosis, and allowed entry into the U.S. subsequent to what the CDC determines is successful treatment.
Even those refugees treated for active Multi Drug Resistant (MDR) tuberculosis, as shown in this video of Burmese refugees who have the disease being treated in a refugee camp in Thailand, are allowed to enter the United States despite recent studies that indicate that between 4 percent and 5 percent of those deemed successfully treated experience a recurrence of tuberculosis within 2 years.
The Minnesota Department of Health recently reported that
22 percent of resettled refugees in that state tested positive for latent tuberculosis, as opposed to 4 percent of the general population.
Other research indicates that anywhere from
20 percent to 49 percent of resettled refugees test positive for latent tuberculosis.
The CDC says that many resettled refugees are screened for latent tuberculosis within a month of their arrival in the United States, and encouraged to voluntarily participate in the 6 month to 9 month latent tuberculosis treatment regimens. Between 70 percent and 85 percent of those who participate successfully complete those latent tuberculosis treatment regimens, which means between 15 percent and 30 percent fail to complete those regimens.
More than
3 million refugees have been resettled in the United States since 1975, according to the Office of Refugee Resettlement (ORR), the department of Health and Human Services that operates the federal refugee resettlement program
Neither the CDC nor the ORR responded to inquiries from Breitbart News to get an estimate of the number of resettled refugees who are never screened for latent tuberculosis subsequent to their arrival in the United States.
Since 10 percent of those with latent tuberculosis develop active tuberculosis, the potential public health risk of the current policy is apparent to many public health experts, but not to the bureaucrats at the CDC and in a number of state and local health departments around the country.
Another arm of the federal government, the U.S. Preventive Services Task Force (USPSTF), however, recently issued a draft recommendation that is consistent with the findings of the December 2015 study about the importance of screening and treatment for latent tuberculosis population among “at risk” populations, which includes resettled refugees.
“The USPSTF recommends screening for latent tuberculosis infection (LTBI) in populations that are at increased risk,” the
draft recommendation concludes.
“Populations that are at increased risk for LTBI based on increased prevalence of active disease and increased risk of exposure include persons who were born in, or are former residents of, countries with increased tuberculosis prevalence and persons who live in, or have lived in, high-risk congregate settings (such as homeless shelters and correctional facilities),” the draft recommendation
continues.
Crowded refugee camps in countries like Kenya, where many Somali refugees live prior to their entrance to the United States, are also “high-risk congregate settings.”
The U.S. Preventive Services Task Force, was
founded as part of the federal government in 1984 as “an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.”
The Agency for Healthcare Research and Quality “convene[s] the Task Force and . . . provide[s] ongoing scientific, administrative, and dissemination support to the Task Force.”
“The USPSTF recommends screening for latent tuberculosis infection (LTBI) in populations that are at increased risk,” the draft recommendation
concludes.
“In 2014, among persons of known national origin, 66.5% of all active tuberculosis cases in the United States were among foreign-born persons, and the case rate among foreign-born persons was 13.4 times higher than among U.S.-born persons (15.3 vs. 1.1 cases per 100,000 persons),” the draft recommendation continues.
“The World Health Organization (WHO) recently updated its list of countries with a high burden of tuberculosis to include the top 20 countries with the highest absolute numbers of cases, plus an additional 10 countries with the most severe burden in terms of case rate per capita,” the draft recommendation adds.
A number of countries on that list are also on the CDC’s list of “[t]he top ten countries of refugee origin [which includes] Afghanistan, Iraq, Somali, DR Congo, Myanmar, Colombia, Sudan, Vietnam, Eritrea, and China.”
All ten of these countries had dramatically higher tuberculosis morbidity rates in 2014 than the United States, according to the World Health Organization.
That year, there were only 0.1 deaths from tuberculosis for every 100,000 residents of the United States.
The Democratic Republic of Congo, in contrast, experienced 69 deaths from tuberculosisfor every 100,000 residents, a rate more than 690 times greater than the rate in the United States.
Myanmar (Burma) experienced 53 deaths from tuberculosis for every 100,000 residents, a rate more than 530 times greater than the rate in the United States.
Afghanistan experienced 44 deaths from tuberculosis for every 100,000 residents, a rate more than 440 times greater than the rate in the United States.
China experienced the lowest tuberculosis mortality among the top ten countries of refugee origin in 2014—2.8 deaths per 100,000—but even that rate was 28 times greater than the rate in the United States.
Somalia, another of the ten leading countries of origins for resettled refugees in the U.S. had the second highest rate of tuberculosis mortality of the ten leading countries of origins for resettled refugees in the U.S.—67 tuberculosis deaths per 100,000—or more than 670 times greater than the rate in the United States.
Somalia is one of the top countries of origins for resettled refugees who settle in the states of Minnesota, North Dakota, and Tennessee.
In 2015, 26 percent of the 518 refugees resettled in North Dakota came from Somalia.
Some 45 percent of the 2,338 refugees who resettled in Minnesota during 2015 were from Somalia. 40 percent were from Burma.
The first evidence of a possible linkage between resettled refugees from Somalia to tuberculosis outbreaks in the United States came in Emporia, Kansas in 2007, as NewsMaxreported:
The incidence of a Somali meat packer in Kansas who died from tuberculosis has officials calling for better health screening for the waves of unskilled immigrant workers flooding smaller American communities.
In the wake of the January death at a Tyson Foods plant in Emporia, Kan., public health officials found 160 cases of latent TB among the facility’s 500 Somali workers, according to the Topeka Capital-Journal.
Local officials say the case represents only a small part of the growing problem of foreign-born, unassimilated communities with high rates of communicable diseases such as TB and HIV. Many say they need help from Washington, which has been silent on the issue for too long.
Similarly, the health risk to the general public in communities that have become centers for refugee resettlement has also been known since 2007. In that year, Ft. Wayne , Indiana experienced a huge public health problem with resettled refugees arriving from Burma with high rates of latent tuberculosis.
The failureof the political leadership at the CDC to implement the common sense, practical recommendations put forward by its own experts to conduct screening and treatment of refugees for latent tuberculosis infection overseas before they come to the United States is just the most recent indication of the terribly negative impact the politicization of public health is having on the health of American citizens.
EPA
AFP
