Thread: TB scare in S.C. puts immigrants' health in spotlight

131 EXPOSED IN GREENVILLE
TB scare in S.C. puts immigrants' health in spotlight

FRANCO ORDOÑEZ AND AMES ALEXANDER
fordonez@charlotteobserver.com

The number of workers exposed to tuberculosis at a Greenville, S.C., chicken plant has grown to 131, but state health officials cautioned Tuesday only one is suspected of having an active form of the infectious disease.

The S.C. Department of Health and Environmental Control began testing employees at the House of Raeford Farms plant late last month after the agency was told about the infected worker. So far, 286 employees who have been in contact with the worker have been tested.

The percentage of positive cases is believed to be high because many of the plant's employees come from other countries where the disease may be more prevalent, said agency spokesman Thom Berry.

While not considered an immediate threat to Greenville residents, the number of infected workers reflects a concern about a growing health threat: immigrants increasingly carrying TB to the U.S.
"It's become more of an imported disease," said Dr. Jason Stout, an infectious disease specialist at Duke University who serves as one of North Carolina's tuberculosis consultants.

House of Raeford employs about 650 workers at its Greenville plant who process chicken for stores and fast-food restaurants. Many of the workers live in small neighborhoods surrounding the plant.

Foreign-born residents accounted for 55 percent of TB cases nationwide in 2005 -- the last year for which statistics were available. The greatest number of foreign born cases, 25 percent, or 1,942 cases, came from Mexico, followed by the Philippines, Vietnam, and India. In 1993, foreign-born residents made up 29 percent of reported TB cases.

Every year, thousands of illegal immigrants come to the Carolinas to work in poultry, construction and other industries. But undocumented workers are not the only ones entering the United States without being tested for TB. While refugees receive the tests, many immigrants traveling on tourist, business and student visas do not, according to experts.

"That is a major problem," said Carol Pozsik, CEO of the National TB Controllers Association.

House of Raeford Farm officials did not respond to calls to discuss the cases. It's unclear how many of the infected workers are still employed at the plant. Health officials said there's no risk to other employees as long as the cases are inactive.

They also say the strain found in the poultry worker is "very treatable" -- unlike the drug-resistant form contracted by Andrew Speaker, the Atlanta lawyer who made news last month by traveling internationally and sneaking back into the country with the disease.

Disease characteristics

Tuberculosis primarily affects the lungs, but can also spread to the kidneys or spinal column. The disease, which can be fatal, is transferred from person-to-person and cannot be transmitted to food.While cases of the disease have been declining nationally for years, the rate of decline has been slowing in recent years, according to the Atlanta-based Centers for Disease Control and Prevention.

The House of Raeford worker suspected of having an active case has not been identified.

Berry said the 131 workers whose skin tests were positive did not necessarily have active cases of tuberculosis. Sixty of those workers were given chest examinations that showed no signs of active tuberculosis. Two others had inconclusive results and are receiving further tests. They hope to test the remaining workers soon.

More than 60 percent of line workers in the chicken industry are Hispanic. And experts say most of the workers probably entered the U.S. already infected.
They point out chicken plants are a natural environment for aerosolized TB germs. Pozsik said the high use of water and steam in a plant allows TB to remain aerosolized, exposing more workers to infection.

However, fewer than 5 percent of those who test positive on skin tests for TB are active carriers of the disease, Duke's Stout said. Even those who have active TB generally can't transmit the disease to others unless they share a confined space for a prolonged period of time.

"The average population should not be concerned unless they work with these folks, live with them, or interact with them," Pozsik said. "They should not be worried. It's really about sharing the same air over time. That is the secret."

Prevention urged

Pozsik, the former head of S.C. Department of Health and Environmental Control TB control program, says health departments encourage people to get treatment to prevent the spread of a dangerous disease. Illegal immigrants often are reluctant to seek medical attention, however, fearing exposing themselves could lead to their deportation.

"One of our problems is when they get frightened and they leave," Pozsik said. "And if they do get sick and break down we haven't had the chance to treat them with the disease."

The health department will not ask patients their residency status or report illegal immigrants who seek treatment to immigration authorities, spokesman Berry said.

She said infected immigrants are more likely to become active in the first two years of immigrating to the U.S. when their stress levels are high due to residency status fears, questions about health care, and the uncertainty of living in a new community.

"This puts stress on their immune system," she said. "Any kind of worry and they go from infected to disease much more easily."

Tuberculosis Statistics

Nationally, the TB rate among Hispanics in the United States -- 9.2 for every 100,000 people -- was about eight times higher than that for whites, according to the Centers for Disease Control and Prevention.

African Americans, at a rate of 10.1 for every 100,000 people, are more likely to have tuberculosis than Hispanics, as are Asians, at a rate of 25.5.

From 2005 to 2006, the number of foreign-born TB cases in North Carolina increased about 22 percent -- from 110 to 134, according to the N.C. Division of Public Health.

http://www.charlotte.com/112/story/166608.html

August 10, 2006, Rep. Marsha Blackburn, TN had a field hearing on Health Care/Immigration in Brentwood, Tennessee

She received from me a 10 page report on Tennesee which included this information:

Health threats nationwide reported by WorldNetDaily and physicians at leading medical institutions such as:

New Jersey TB Clinic
Bellevue Hospital,
Spring 2006 issue of Journal of American Physicians and Surgeons
The Washington Post
Virginia Department of Health
name Chagas, Leprosy, Dengue Fever, Polio, Malaria and a deadly
drug-resistant form of Tuberculosis as diseases almost totally eradicated in America and now being brought in by illegal immigration.

Their reports tie these outbreaks as "totally tied to illegal immigration".

IT IS VERY DIFFICULT TO GET UPDATED STATS ON ILLEGALS AND DISEASES THEY BRING IN MOST STATES.

This concerns REFUGEES ALLOWED into the U.S., but SHOULD include the illegals.

By Elizabeth Cohen

Refugee illnesses often misdiagnosed in U.S.

ATLANTA, Georgia (CNN) -- Monykuch Deng is 5, but you'd never know it to look at him. In fact, he's the size of a 3-year-old.

As Monyjuch runs around his family's apartment outside Atlanta, Georgia, he's constantly hiking his pants up around his thin frame. Monykuch usually isn't very hungry and often skips dinner, his mom explains.

"He drink milk in small cup and not eat too much," said his mother, Rachel Bol. "When he eats he say, 'I have a bad stomach ache. My stomach is not OK.' "

For months after Monykuch's arrival last September from Sudan, doctors didn't recognize what was wrong with the exceptionally small, skinny child. Finally, a doctor accustomed to taking care of refugees figured it out: Monykuch was severely malnourished because of an intestinal parasite.

Dr. Carlos Franco, the doctor who made the diagnosis, says this isn't the first time he's caught a disease other doctors have missed.

"Not everyone is trained in these particular diseases in these particular populations," said Franco, assistant professor of medicine at Emory University School of Medicine.

As more and more refugees flee to the United States -- 20,000 had arrived this year through the end of May -- experts in refugee health care say U.S. doctors need to learn more about how to diagnose their often unique physical and emotional problems. (Interactive: The World's Refugee Crisis )

Franco said sometimes U.S. doctors also miss hepatitis B. Since children are vaccinated against the disease in the United States, doctors here aren't used to seeing it and often don't think to screen for it. Untreated hepatitis B can lead to cirrhosis of the liver and liver cancer.

Dr. Richard Adair, who treats about 1,000 refugees in Minnesota, added another disease to the list: tuberculosis. He said the disease often looks very different in young refugees.

"American doctors are used to seeing TB in older people, who acquired it when Franklin Roosevelt was president," said Adair, a clinical professor of internal medicine at the University of Minnesota. "In older people, it's a disease of the lungs....In younger people it can be in the lymph nodes, abdominal cavity and brain, so it's sometimes harder to recognize."

But refugee health experts said perhaps the most misdiagnosed illnesses are emotional ones. "TB and malaria are peanuts compared to the amount of chronic depression these people experience over time," said Dr. Richard F. Mollica, professor of psychiatry at Harvard Medical School and director of the Harvard Program in Refugee Trauma at Massachusetts General Hospital.

"Some refugees are tortured, some experience trauma," he said. "They had to give up everything to come to the U.S. They had to learn a language, get a job, and function in the U.S. The stress is enormous." (Impact Your World: How to help )

Mollica has followed refugee patients for 25 years, and found that these psychiatric issues become physical issues.

"Look at a study we did of Cambodians who settled in Long Beach, California. The rates of chronic depression 25 years later are 25 percent," he said. "People would say, 'Well of course -- these people lost their home. They had to flee to the U.S.' What's new is that we know it's killing people."

He said many studies have recently found a link between depression and heart disease, stroke, and diabetes. "I can list hundreds and hundreds of patients who have this problem," he said.

Catching depression early is crucial, but Mollica said many U.S. doctors miss it. He explained that while American patients may be well-versed in talking about their feelings, refugees often don't verbalize emotional issues and instead will tell their doctors about the physical manifestations of depression. "If a Cambodian says to me he has dizziness, headache, and extreme fatigue, that means to me they're seriously depressed," he said. "They're not going to walk in looking like the middle-class Caucasian person doctors are used to seeing,"

For now, Monykuch is on medication for the parasite, which is fairly easy to remedy once it's identified. However, the months before his illness was diagnosed have cost him precious developmental time. "If you take 10 months in the life of a child who is 5 years of age, those are 10 months that you would have had to promote better growth and better development," said Franco.

Elizabeth Cohen is a CNN Medical News correspondent.

http://www.cnn.com/2007/HEALTH/06/20/re ... index.html