Effect Measure

Immigrants and TB: not a threat

Immigrants traditionally get blamed for a country’s ills and historically they have been feared for their ability to bring disease as well. The recent cases of the traveling lawyer (and here, passim)and the Mexican businessman with TB raised concerns that tuberculosis would be brought to the US or other low TB incidence countries by immigrants or travelers from countries where TB was prevalent. Now a new study from Norway suggests this doesn’t happen:

Immigrants from countries with high rates of tuberculosis who move to countries of low TB incidence do not pose a public health threat to native citizens, according to researchers in Norway, who analyzed the incidence and genetic origins of all known cases of TB in the country between 1993 and 2005. Their results were reported in the first issue for November of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

After gathering all available cultures from the identified cases and eliminating samples suspected of being contaminated in the lab, the researchers examined 2,173 cases of TB in the country over 12 years. They tracked outbreaks among native-born citizens and immigrants, and analyzed the genetic strain of each confirmed case using cultures obtained through patient samples at 14 laboratories that service the entire country.

They found little evidence to support the belief that immigrants from countries with high TB incidence present a public health threat to non-immigrant natives in low-incidence countries. Instead, the researchers documented an increase in number of strains in immigrants, but a decrease in the number and incidence of native infections, suggesting that while immigrants from high-TB regions do bring with them more strains of TB, they do not significantly contribute to the spread of TB within native-born populations of low-incidence countries. (Infection Control Today)

During the twelve year study period there continued to be a lack of similarity between the infections among natives and those among immigrants. Nor was there any evidence of a clustering of a strain indicative of an outbreak. In ten imported cases TB was passed on to more than 5 cases within 5 years. This was not considered a significant threat to TB control. Said another way, indigenous TB can be eliminated without being seriously challenged by importation of cases from immigrants from high incidence areas.

So that’s the good news — for Norway. But the US isn’t Norway. We don’t have a national health system. The accompanying editorial by Dr. Kevin Schwartzman of McGill University in Montreal, who was not part of the study, noted that this was an important strength of the Norwegian success:

Ultimately, the strategies used to control TB are more important to public health than immigration. “The take-home message is not one of blame or stigmatization–quite the opposite,” said Schwartzman. “By ensuring access to TB care and public health programs for all, Norwegian authorities are controlling TB and preventing transmission.”

I know I am always harping on the importance to US health of a national health service. That doesn’t make it any less true. You can like it or not. Frankly I can afford some extra taxation more than I can afford TB.

But maybe that’s just me.


  1. #1 Jon Herington
    November 2, 2007

    I’m not sure how much of this is because of Norway’s exceptionally stringent TB legal regime, which includes compulsory detention on exposure (the dreaded “Q word”), compulsory treatment and a compulsory screening regime. No doubt the universal access to treatment is one of the major contributing factors, but I’m unsure how much noise there is here coming from some potentially ethically dubious laws.

    Perhaps better to look at a place like France, which has a much less stringent legal regime but also UHC.

  2. #2 herman
    November 2, 2007

    The global system for the control of TB is collapsing. WHO calls XDR-TB, Extreme Drug Resistant Tuberculosis,a grave public health threat.
    XDR-TB is defined as tuberculosis that is resistant to the two most important antituberculosis drugs (isoniazid and rifampin), along with two other drugs: a member of the fluroquinolone class and at least one of the 3 others (capremycin, kanamycin, and amikacin).
    XDR-TB is considered to be incurable. One or more cases of XDR-TB have been found in 28 countries. And an estimated two-thirds were from China, India, and Russia.
    In 1991 and 92 there were 36 cases of XDR-TB is New York City. And it cost the city a fortune to reduce those numbers.
    There is an estimated 6000 new cases of multi-drug resistant TB each year in South Africa, and the rate of treatment failure is about 10%. It was assumed most failures were due to extremely drug resistant TB, with a conservative estimate of 600 cases in South Africa.
    A situation may arise where the only treatment for some forms of TB will be isolation and surgery.
    If an epidemic of drug resistant TB were to arrive in the US, it would cost a fortune, since it is very expensive to treat drug resistant TB. And many people with TB are not detected, do not know they have it, and walk aroung spreading the disease.
    It is easy to spread XDR-TB through the airborne vector.
    All the infected individual has to do is cough.
    We need a national health care system now.

  3. #3 M. Randolph Kruger
    November 2, 2007

    Now Revere if you take the healthcare out of the situation and move it to the crime then that health situation drops like a rock. Drugs, crime, probably kill more illegal immigrants than TB does. The immigrants you are referring to are illegals for sure. All legal immigrants are healthy otherwise they wont be allowed out into the population.

    I wonder what the life expectancy is for a illegal who is working in a meat factory, or one that is doing a job for 1/2 of what they should be getting paid if they werent illegal? The study is fine. I liked it. But I wouldnt pay one red cent for an illegal to receive healthcare other than enough to pack them up and deport them back into their country. America is becoming a dumping ground for an unwanted work force.

    40 million people in this country pay NO taxes now other than consumptive. Add in another 20 million in under 20 years and you’ll not be paying a bit more in taxes, you’ll be paying it all in as taxes. They of course will pay nothing because they are poor and you are rich. Between Social Security, Medicare and all the gimme programs the projection is that we are going to sink like a rock. Forget the military Revere. The giveaway people will ensure that we dont have one. If we do we will have to take the tax rate for our kids and grandkids and Social Security recipients to 75% unless EVERYONE pays taxes and even then it will be very dicey as we roll money over and over. Its paper, we will just print some more and when we do, inflation will skyrocket. You’ll make more paper and spend more paper in taxes and thats when we start to sink.

    Oh, you’ll bring up the military and their budgets. Military budgets come and go and until the last war is fought, you have to have one. Peacetime/wartime… still have to have it in varying degrees. Carter gutted the military as did Clinton…..See what happens when you do that? It leads to what we have now both directly and indirectly.

    No spendable income means no economy, you’ll get paid in paper and they’ll tax that paper. If they dont take paper one day we will be in trouble. As for those immigrants the people you refer to are illegals and they are actively trying to get the right to vote. Once they do, they’ll vote people in that ensure they never, ever have to pay taxes. Same thing will happen under UHC.

    HIV came in with the Haitians. Pink Eye thought eradicated from the US came back in too. Along with drug resistant Gonorrhea, Syphilis, TB. The graphs are all out there and they do show a rise then fall after each immigration as public health steps in to stave it off. S. Florida had HUGE increases in just about every communicable disease and especially TB after the Cuban boatlift. But those are communicable, crime is a bug of choice. Their murder rate rose, burglaries, robberies…. Its all about perspective. I dont know if you are overrun by Mexicans as we are down here but they have blown the county budget for the year and had done so by August. Now its on emergency funding from the state and even thats about to run out. So whats the answer? Tax more? How about deportation instead. Put them on a plane for Mexico. One ER visit is twice to three times as much as that ticket. .

    How about running their butts back to their various countries instead of telling us we HAVE to do something about them? What a concept….

    “Everything is free in America…..” West Side Story 1961.

  4. #4 jen_m
    November 2, 2007

    I wonder – in STD modeling and intervention strategy, there’s this idea of assortative and dissortative sexual mixing. Under some circumstances, people who have a lot of sexual encounters with a lot of different partners will tend mostly to have sex with people who are similar in their sexual behavior, and people who have only a few partners will tend to have sex with people similar to them, so you’ll end up with two populations with very different STD patterns. Where the groups come in contact, there’s a population that can be targeted for interventions.
    Under other circumstances, where people with a lot of partners have sex with people who have just a few, the intervention target might need to be pretty different.

    All of which is to say, apart from the whole socialized medicine issue, I wonder whether the way that Norway’s immigrant population from high-TB regions interacts with the rest of the population is more assortative or more dissortative, and whether immigration mostly works similarly in other Western countries. If new immigrants mostly stick to their own group, there’s not as much opportunity for infection of presumably immunonaive Norwegians.

    (A side-note to Mr. Kruger – You are muddling together two questions, the issue of tax evasion and the issue of illegal immigration. Undocumented workers who pull a paycheck without employer knowledge do have income taxes pulled from that check if the employer is following the law. If a person is being paid “under the table”, regardless of immigrant status, both he and his employer are in the wrong.)

  5. #5 herman
    November 2, 2007

    World food supply may soon go into decline. This may cause infectious diseases, including tuberculosis, to increase.
    The Germany based Energy Watch Group has just issued a report stating world production of conventional oil peaked in 2006, and supplies will now drop by 3% per year.
    In the developed countries it takes 10 calories worth of energy from fossil fuels put into a farm in the form of fertilizers, pesticides, and transportation fuel to get one calorie back in the form of food.
    As oil becomes more expensive, third world countries will not have the money to buy sufficient oil to maintain food production at present levels. What has allowed the world population to grow to over 6 billion is oil to produce food. Without that oil, food production will crash, and an estimated 3 billion people will die of starvation.
    This drop in the food supply will cause a massive invasion of legal and illegal immigration to developed countries like the US.
    Without sufficient food, a person’s immune system weakens, making that person vulnerable to diseases like TB.
    Since the world system to control TB is already near collapse, a crash downward in the world food supply will only make the situation regarding the control of TB worse.

  6. #6 M. Randolph Kruger
    November 2, 2007

    Jen-M…. With all due respect… Are you kidding me?. Employers following the law? The reason they are here now is because no one is following the law. They deliberately run multiple illegals under one legal SSN. You might not be aware of what happened in California under Gray Davis. The Dems registered 3 million illegals illegally to vote. They immediately voted as told and Clinton got elected for his second term and Gray D. to his first. Then armed with those voter cards and the illegal SSN cards they took over. First the schools, then the hospitals and because they were illegal never took part in the census or in the state/federal income taxes. They went to school and college on the taxpayer dime. They also partook heavily of the healthcare system because they were “below the poverty line”. Hell yeah they were because they have this no income income tax form out there. So the bills came due and the state went bankrupt in under two years and thats how Arnie did them. They all get a free ride. Put in UHC and they’ll come across that border like lemmings heading for the edge of the iceberg. Thats not a UHC slam Revere. If we are going to have it, then it better damned well be for Americans and not Cubans, Columbians, Nicaraguans, Salvadorans etc. We cant afford it now, much less by adding 20 million new recipients to the rolls that never pay a dime.

    Jen-TB is rampant in those countries I just read off. If you are in the states you could be infecting yourself and others by “intermingling” the two issues. They are one in the same. My record on helping them back down south is out there. I wouldnt deny them food, water, help or whatever. No vigilante in me. BUT, we all got here legally for the better part and they are just walking north like they are going to the Circle K.

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