Thread: Disease risk posed by immigrants, travelers

Disease risk posed by immigrants, travelers

By ROBERT M. COOK
bcook@fosters.com


Sunday, March 8, 2009


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Tuberculosis has not been a major health concern in the United States since doctors developed effective medical treatments more than a half century ago.

But while the number of cases has declined in America, it remains a problem abroad, and drug resistant strains are developing that could find their way into the country through travel or immigration.

Dr. Elizabeth Talbot at Dartmouth Hitchcock Medical Center in Lebanon specializes in the study of infectious disease and tuberculosis. She said Thursday that multidrug-resistant strains from other parts of the world pose a concern.

"It can pose a great challenge to public health," she said.

In Southeast Asia, Africa and Eastern Europe, Talbot said many patients develop TB with varying degrees of drug resistance because of ineffective treatment, prevention and screening.

What often happens is a TB patient will get some treatment for TB, but it is discontinued or the drugs used are not the right quality, Talbot said. They end up developing resistance to those drugs, and the bacteria becomes even more powerful, she said.

Americans who travel abroad to countries with high TB rates are vulnerable and can bring it back with them, she said.

According to the Centers for Disease Control and Prevention in Atlanta, Ga., there were 13,299 reported TB cases in the U.S. in 2007, a 3.3 percent decrease from 2006. But 21 states, including California, Texas, Florida and New York, saw increased case counts in 2006. In a 2007 report about TB, the federal agency said the increase in immigrants from countries with higher TB rates could pose a health concern in the U.S.

The report notes that the highest incidences of TB in foreign-born U.S. residents originate in Mexico, the Philippines, India, Vietnam and China.

The number of TB cases in New Hampshire and Maine is small. New Hampshire, ranked 48th nationwide for TB cases, reported 11 in 2007, down from 17 in 2006. Maine, ranked 41st, reported 19 in 2007 and 16 in 2006, according to the CDC.

Chris Adamski, disease control chief at the New Hampshire Department of Health and Human Services, said state and federal protocols and procedures are sufficient to treat people with TB and preserve public health.

"We don't see clusters of tuberculosis. We see individual cases," Adamski said.

Most are people who are foreign-born and they tend to be very isolated cases, she said. The state's main concern is for people who are infectious, she added.

In those cases, she said, people would be in home isolation and get weeks of treatment with four drugs that fight the TB bacteria until doctors deem they are no longer infectious.

In an e-mail, Rachel Powell, CDC spokeswoman, wrote that the federal agency is concerned about the threat of multidrug-resistant TB.

"TB continues to exact a severe toll on many U.S. communities, notably on minorities and foreign-born individuals, who face much higher rates of disease than other populations," she wrote.

In 2007, she wrote a CDC report finding that foreign-born individuals accounted for 58 percent of TB cases and had a case rate almost 10 times higher than that of U.S.-born individuals.

Compared to whites, the rate of TB for blacks was eight times higher; the rate for Hispanics was seven times higher; and the rate for Asians was 23 times higher in 2007, Powell wrote.

"Multiple steps will be needed to accelerate progress toward TB elimination and to guard against a resurgence of the disease," she wrote.

Tuberculosis is caused by bacteria called Mycobacterium tuberculosis. It usually attacks the lungs. But TB bacteria can attack any part of the body, such as the kidney, spine and brain. If not treated properly, TB can be fatal.

TB was once the leading cause of death in the U.S. from the late 1800s to the 1950s. TB is spread through the air from one person to another.

The bacteria become airborne when a person with an active TB infection of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

Talbot said it was unlikely TB would become such a threat in the U.S. again.

But the U.S. must continue to take the threat of multidrug-resistant strains seriously and do more to screen as many immigrants and refugees as it can, she said.

The challenge is that while many immigrants and refugees go through official channels to enter the country, there are many who do not because they are students, seasonal workers on the H-1B VISA program, or illegal immigrants, she said.

Powell wrote in her e-mail that some of the CDC's recommendations to ensure TB remains in check call for improved screening procedures overseas for all immigrants and refugees before they enter the U.S.

The agency also called for strengthening the notification process to keep local health officials in the loop about immigrants or refugees who may be infected with TB.

"We must build the capacity of front line providers to diagnose individuals with TB and to ensure completion of treatment, which will help avert resistance," Powell wrote.

Talbot said health officials nationwide continue to work on developing better screenings, more effective drug treatments and strong health prevention practices so they can prevent the threat of multidrug-resistant TB from becoming a widespread problem here.

"This is a very active area of research right now," she said.

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If they are so worried about it why not advocate that people are immunized against it?

Just make it one more vaccination in the list of advisables.