Tweet
Infectious Disease Threat from Travelers, Illegals
by Anthony L. Kimery
Sunday, 16 November 2008
Drug-resistant TB rise in Mexico border areas a concern
While new cases of tuberculosis (TB) in the United States declined sharply during the 15 years up until 2007, there are growing concerns over the sudden escalation of the disease, especially the drug-resistant forms of TB, some of which are highly contagious airborne strains of the disease. Last year there were more than 13,000 cases of TB reported in the United States, roughly the same as in 2006, which was the lowest number of infections since reporting began in 1953.
TB is the leading cause of infectious disease death among adults worldwide, and drug-resistant TB is rapidly becoming a particularly disturbing threat ? there were nearly 500,000 new cases in 2006. There's about 40,000 new cases of extensively drug-resistant TB (XDR-TB) every year, according to the World Health Organization.
For US public health and security officials, the rise of tuberculosis and its drug-resistant sibling in Ciudad Ju?rez, Mexico, the industrial city of 1.5 million on the other side of the Rio Grande River from El Paso, Texas, is especially alarming, particularly in the wake of at least two carriers having repeatedly crossed back and forth the border in 2007.
New cases of individuals diagnosed with tuberculosis along the Juarez-El Paso border increased six-fold in the last nine years, but it was only recently that emphasis was put on border surveillance and monitoring of this and other emerging and re-emerging infectious diseases among foreign visitors entering the country or caught illegally trying to cross the border.
This new focus is in response to two incidents last year involving individuals with TB who entered and exited the United States. One was a Mexican businessman from Juarez with drug-resistant TB ? and a prior history of non-adherence to treatment ? who crossed the US-Mexico border at the El Paso, Texas, land port of entry approximately 20 times (some reports say more than 70 times) during April and May 2007. His trips included multiple domestic airline flights within the US.
The other was an Atlanta attorney with drug-resistant TB. He also traveled in and out of the US in the spring of 2007 against advice from physicians - and past border security that was supposed to be on the lookout for him.
The explosion in TB cases in Juarez and along the US-Mexican border has especially become a concern of federal and state health authorities in light of the intensifying violent war between the Juarez and Tijuana cartels over control of the dwindling trafficking corridors into the United States.
(The January HSToday will feature an exclusive, in-depth report from the border on the cartels' warring and its impact on US security)
Of special concern to officials is that both cartels have begun to use ?expendible? indigent Mexicans to transport narcotics and humans across the border, which US officials say increases the threat that TB infected people may get into the US and begin infecting others, potentially igniting a TB epidemic.
These officials? greatest fear though is that some of these TB infected people may be carrying the drug-resistant form of tuberculosis, which if it began to spread could result in a serious TB medical crisis that could rapidly expand far beyond a localized, regional level.
As the Centers for Disease Control and Prevention (CDC) pointed out eight years ago, illegals with latent TB infection may not experience active disease until after they?re in the United States. And ?after a person with TB enters the United States, further transmission might occur, which contributes to TB morbidity in the United States directly from source patients and indirectly from their contacts,? CDC pointed out in January 2001.
US hospitals closest to the border where victims of cartel shootings and violence are taken for emergency medical care also are concerned about the possibility of receiving a drug-resistant TB-infected person, HSToday.us was told by authorities like James Valenti, president and CEO of the El Paso Hospital District, and National Foundation for Trauma Care Executive Director Connie Potter.
A 2001 CDC report stated that in 1999, Mexico was the country of origin for 23 percent of all foreign-born persons with TB, and that of TB cases among Mexican-born persons, three fourths were reported from the four US states bordering Mexico.
As Mexico?s cartel-controlled regions? societies and economies have begun to collapse, these statistics have grown worse.
"Extensively drug-resistant TB is a wake-up call. If we don't strengthen TB diagnosis and care, we're going to see escalation,? Dr. Ritu Banerjee, an infectious disease fellow at University of California San Francisco and an author of the recent study, "Extensively Drug-Resistant Tuberculosis in California, 1993?2006," told the Los Angeles Times last week.
?There is a growing concern among public health officials about a continuum of drug resistant TB infections, which means that the TB bacteria can no longer be killed by commonly used antibiotics. As a result, the drug resistant forms of the disease are more difficult to treat than ordinary TB and require as much as two years of multidrug treatment, or more in extreme cases,? states the new Trust for America?s Health (TFAH) report, ?Germs Go Global: Why Emerging Infectious Diseases Are a Threat to America.?
"Infectious diseases are not just a crisis for the developing world. They are a real threat right here, right now to America's economy, security, and health system," said TFAH Executive Director, Dr. Jeffrey Levi. "Infectious diseases can come without warning, crossing boarders, often before people even know they are sick. Americans are more vulnerable than we think we are, and our public health defenses are not as strong as they should be.?
TFAH?s report also states that the nation's defenses against emerging infectious diseases are insufficient, creating serious consequences for the US health system, economy, and national security.
Indeed, as HSToday.us has reported, newly emerging and re-emerging infectious diseases like drug-resistant TB are considered to be a growing threat to national security by the US Intelligence Community.
The number of individuals who have TB that is resistant to many of the most effective medications is increasing worldwide and these individuals have fewer options for effective treatment.?
In part two of this report, we will examine the Government Accountability Office?s audit of border and port disease surveillance, and actions taken by the Department of Homeland Security and Department of Health and Human Services in response to two persons known to have TB who were able to enter and exit the country.
by Anthony L. Kimery
Sunday, 16 November 2008
Drug-resistant TB rise in Mexico border areas a concern
While new cases of tuberculosis (TB) in the United States declined sharply during the 15 years up until 2007, there are growing concerns over the sudden escalation of the disease, especially the drug-resistant forms of TB, some of which are highly contagious airborne strains of the disease. Last year there were more than 13,000 cases of TB reported in the United States, roughly the same as in 2006, which was the lowest number of infections since reporting began in 1953.
TB is the leading cause of infectious disease death among adults worldwide, and drug-resistant TB is rapidly becoming a particularly disturbing threat ? there were nearly 500,000 new cases in 2006. There's about 40,000 new cases of extensively drug-resistant TB (XDR-TB) every year, according to the World Health Organization.
For US public health and security officials, the rise of tuberculosis and its drug-resistant sibling in Ciudad Ju?rez, Mexico, the industrial city of 1.5 million on the other side of the Rio Grande River from El Paso, Texas, is especially alarming, particularly in the wake of at least two carriers having repeatedly crossed back and forth the border in 2007.
New cases of individuals diagnosed with tuberculosis along the Juarez-El Paso border increased six-fold in the last nine years, but it was only recently that emphasis was put on border surveillance and monitoring of this and other emerging and re-emerging infectious diseases among foreign visitors entering the country or caught illegally trying to cross the border.
This new focus is in response to two incidents last year involving individuals with TB who entered and exited the United States. One was a Mexican businessman from Juarez with drug-resistant TB ? and a prior history of non-adherence to treatment ? who crossed the US-Mexico border at the El Paso, Texas, land port of entry approximately 20 times (some reports say more than 70 times) during April and May 2007. His trips included multiple domestic airline flights within the US.
The other was an Atlanta attorney with drug-resistant TB. He also traveled in and out of the US in the spring of 2007 against advice from physicians - and past border security that was supposed to be on the lookout for him.
The explosion in TB cases in Juarez and along the US-Mexican border has especially become a concern of federal and state health authorities in light of the intensifying violent war between the Juarez and Tijuana cartels over control of the dwindling trafficking corridors into the United States.
(The January HSToday will feature an exclusive, in-depth report from the border on the cartels' warring and its impact on US security)
Of special concern to officials is that both cartels have begun to use ?expendible? indigent Mexicans to transport narcotics and humans across the border, which US officials say increases the threat that TB infected people may get into the US and begin infecting others, potentially igniting a TB epidemic.
These officials? greatest fear though is that some of these TB infected people may be carrying the drug-resistant form of tuberculosis, which if it began to spread could result in a serious TB medical crisis that could rapidly expand far beyond a localized, regional level.
As the Centers for Disease Control and Prevention (CDC) pointed out eight years ago, illegals with latent TB infection may not experience active disease until after they?re in the United States. And ?after a person with TB enters the United States, further transmission might occur, which contributes to TB morbidity in the United States directly from source patients and indirectly from their contacts,? CDC pointed out in January 2001.
US hospitals closest to the border where victims of cartel shootings and violence are taken for emergency medical care also are concerned about the possibility of receiving a drug-resistant TB-infected person, HSToday.us was told by authorities like James Valenti, president and CEO of the El Paso Hospital District, and National Foundation for Trauma Care Executive Director Connie Potter.
A 2001 CDC report stated that in 1999, Mexico was the country of origin for 23 percent of all foreign-born persons with TB, and that of TB cases among Mexican-born persons, three fourths were reported from the four US states bordering Mexico.
As Mexico?s cartel-controlled regions? societies and economies have begun to collapse, these statistics have grown worse.
"Extensively drug-resistant TB is a wake-up call. If we don't strengthen TB diagnosis and care, we're going to see escalation,? Dr. Ritu Banerjee, an infectious disease fellow at University of California San Francisco and an author of the recent study, "Extensively Drug-Resistant Tuberculosis in California, 1993?2006," told the Los Angeles Times last week.
?There is a growing concern among public health officials about a continuum of drug resistant TB infections, which means that the TB bacteria can no longer be killed by commonly used antibiotics. As a result, the drug resistant forms of the disease are more difficult to treat than ordinary TB and require as much as two years of multidrug treatment, or more in extreme cases,? states the new Trust for America?s Health (TFAH) report, ?Germs Go Global: Why Emerging Infectious Diseases Are a Threat to America.?
"Infectious diseases are not just a crisis for the developing world. They are a real threat right here, right now to America's economy, security, and health system," said TFAH Executive Director, Dr. Jeffrey Levi. "Infectious diseases can come without warning, crossing boarders, often before people even know they are sick. Americans are more vulnerable than we think we are, and our public health defenses are not as strong as they should be.?
TFAH?s report also states that the nation's defenses against emerging infectious diseases are insufficient, creating serious consequences for the US health system, economy, and national security.
Indeed, as HSToday.us has reported, newly emerging and re-emerging infectious diseases like drug-resistant TB are considered to be a growing threat to national security by the US Intelligence Community.
The number of individuals who have TB that is resistant to many of the most effective medications is increasing worldwide and these individuals have fewer options for effective treatment.?
In part two of this report, we will examine the Government Accountability Office?s audit of border and port disease surveillance, and actions taken by the Department of Homeland Security and Department of Health and Human Services in response to two persons known to have TB who were able to enter and exit the country.
