Health risks of resettlement include rising rates of tuberculosis infection

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FARGO, N.D. (Valley News Live): The Centers for Disease Control and Prevention reports the rates of tuberculosis infections are rising for the first time in nearly 20 years, and the evidence points to people coming from overseas to the United States. Our own investigation has found that everyone, U.S. born or foreign born, who lives in a refugee resettlement area is at risk for contracting tuberculosis.

The CDC reports refugees are not required to be vaccinated before coming to the United States. TB being brought by refugees to the U.S. is an issue the Minnesota Department of Health is working to fix. It’s the leading cause of death from infectious disease worldwide and the most common risk factor? Being from a country where TB infection is widespread.

Nearly a quarter of all TB cases in Minnesota last year were in people from Somalia. As our own investigation progress, we found that many people in Fargo don’t actually know a whole lot about this disease. So what does this mean for your health?

Documents obtained by the group “Judicial Watch” in April contained emails from the CDC, reading in part “We might as well plan on many of these kids having TB”. It’s from a 2014 operation where top federal health officials were sent to the southern U.S. border to stem the tide of unaccompanied children crossing into the country. Tuberculosis is caused by bacteria that primarily affects the lungs and is then spread through the air.

On page three of the Minnesota Refugee Health Quarterly from April of this year has the headline “TB Continues to Affect Refugee Communities”. There’s even a pie chart, breaking down all of Minnesota’s 150 TB cases. Over a quarter were from Somalian refugees.

In North Dakota, there were nine active cases in 2015, six of which were in Cass County. But there were 355 latent-TB cases reported. Latent-TB or LTB means you’re infected with the TB bacteria, but your immune system is able to contain it. You show no signs of actually being sick. But according to the North Dakota Department of Health, if you get rundown, say a severe cold for example, that bacteria could become active again, making you a threat to infect others.

"I don't know if it’s a big enough deal to panic but maybe just some screening or some precautionary measures?" suggests Ryan Keel.

"Maybe we could set up some sort of vaccination right at the border then if they want to come over we can vaccinate them. Help them right off the bat,” said Brandon Brown.

The ND DoH also said many cases go unreported. A CDC official said days ago that across the board screening is not recommended for everyone coming to the U.S. Along with the CDC, an article in the New England Journal of Medicine says those who are screened overseas and who show abnormal results are forwarded to local public health department where the refugee is only encouraged to follow up. But over a quarter of those referred for follow up just don’t show, and there’s nothing requiring them to undergo treatment.

Reporter Bradford Arick pressed the ND DoH if the active and latent-TB cases were from refugees. They replied that they “don’t have that information”, but they track where the infected individual was born in an effort to prove that they majority if cases are from foreign born individuals.

“I think it's better to do that screen and make sure everyone has that vaccination to spread that disease,” said Charitha Hettiarachchi, a student at NDSU.

Charitha Hettiearachchi said he and his family had to undergo many vaccinations before coming to the United States years ago, but he wasn’t sure about TB, and he was surprised when I told him about how deadly it is worldwide, describing the threat it poses to the Fargo community.

Reporter Bradford Arick reached out to Lutheran Social Services of North Dakota, the resettlement agency running the operation in this state. LSS was asked if TB is a threat to refugee populations and the general public, and if the ND DoH is targeting them for the job they’re trying to do. They replied in part that “We know active TB condition is an inadmissible condition to enter the United States and all of our refugees are properly screened prior to the admission, we do not see active TB as a health risk.” LSS specifically singled out active TB in their response, despite the CDC and state health agencies reporting latent TB as an area of concern.

Does this mean you need to run out and get a TB test? Apparently one east coast doctor thinks so, as one viewer told me their doctor insisted on a test since Fargo is a resettlement area. It probably wouldn’t hurt and the more informed you are about your own health is never a bad thing.

Furthermore this store had ignited much discussion on the Valley News Live social media sites. Many of those criticizing this report are not even from the viewing area, and may or may not be affiliated with organizations pushing an agenda.

Here is the full response from LSS ND:

One third of the world's population is infected with TB. (http://www.cdc.gov/tb/statistics/) This condition is referred as Latent TB Infection. While there are billions infected, only the ones with active TB disease ( Tuberculosis as we understand) can spread the disease.
All refugees being admitted the the United States Refugee Resettlement process must undergo a thorough medical screening process. Please See CDC's Overseas TB Screening Protocol: http://www.cdc.gov/immigrantrefugeehealth/pdf/tuberculosis-ti-2009.pdf. Any refugees diagnosed with active TB cannot be admitted for US Refugee Resettlement Process until the condition is fully treated and resolved.

After refugees arrive to ND, they are subjected to further screening including TB screening. Please see CDC's domestic refugee screening guideline http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/tuberculosis-guidelines.html. All of ND's medical providers who provide medical screening for new refugees must adhere to these protocols. Because of these precautions taken before and after a refugee is admitted, and the presence of a rigorous collaborative partnerships among the Dept of State, CDC, and the International Organization of Migration to medically screen refugees, LSSND is confident that refugees undergo most comprehensive medical exam compared to anyone immigrating to the United States. LSSND works very closely with Fargo Cass Public Health, Grand Forks Public Health, and Bismarck-Burleigh Public Health Units to make sure refugees obtain any assistance if needed especially when it comes to Latent TB or Active TB, and prepare for any situations as they arise. LSSND has not encountered any issues due to the existing partnerships and collaboration it has with medical providers, and Public Health Units when it comes to Latent TB/ Active TB.

Since we know Active TB condition is an inadmissible condition to enter United States, and all of our refugees are properly screened prior to the admission, we do not see active TB as a health risk among new refugees or general population.

Foreign-born population also comprises of other immigrants on temporary visas, immigrants joining families, and International students other than refugees, and TB-testing is required for many jobs, and for schooling purposes. We have a good working relationship with NDDoH, and have not encountered any issues pertaining to active TB disease among refugees.

Many refugees are vaccinated with BCG-vaccines in their home country with high prevalence of TB. BCG vaccination generally is not recommended for use in the United States. Please see CDC's recommendation for the vaccination use: http://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm

LSSND is familiar and content with the policies and procedures that's in place from NDDoH for new refugees, but is unfamiliar with processes involving other immigrants, and international students for LTB treatment.

Click the links next to this story to view previous reporting on the impact of refugee resettlement to the FM area. Also available are links to various publications and websites used when researching this topic.