- The Washington Times - Wednesday, December 13, 2000

The nation's foreign born are keeping the threat of tuberculosis alive in America, the Centers for Disease Control and Prevention reports.
In a study appearing in today's Journal of the American Medical Association, agency researchers state that while the overall incidence of the dreaded disease has steadily declined in the United States between 1993 and 1998, it has increased among immigrants.
Over the six-year period, the nation's U.S.-born population had 5.8 cases of TB per 100,000 persons. Foreign-born residents had 32.9. It's estimated that the foreign-born TB rate will escalate to 50 cases per 100,000 persons within two years.
"The figures tell us where the challenge is. The proportion of TB cases among the foreign born is five times higher than it is among native-born Americans," said Dr. Marisa Moore, one of the study's four authors.
She adds, "We need to mobilize the resources and political will to continue fighting the disease and tailor prevention and control efforts to meet the threat in at-risk foreign-born populations."
Dr. Lee B. Reichman, executive director of the National Tuberculosis Center in Newark, N.J., said:
"The study underscores the fact we're doing a good job in the United States of controlling TB. But we're now at the level that to control TB anywhere we have to control it everywhere. We're doing a great job with native-born Americans. We're not doing a good job in keeping down the incidence among persons coming into the country."
Dr. Reichman and other U.S. tuberculosis specialists have warned with increasing urgency in the last several years that the United States is not immune from what they call the "global TB crisis."
They have cautioned that travelers to this country can easily spread the airborne contagion. At worst, the scourge, which can devastate lungs and infect other body tissue, can spread on the breeze of a TB victim's cough.
Indeed, each year about 8 million people contract active TB and 2 million die. And it's known that a person with active TB typically infects 20 others. Of those, most harbor the disease in an inactive "latent" state that can become active later. The others quickly exhibit the debilitating signs of illness that take many months of expensive drug therapy to cure.
Most TB cases today occur in developing countries. It is from some of those countries that huge numbers of immigrants to the United States are coming.
"In each of the six years of observation, approximately two thirds of foreign-born persons with TB had come to the United States from one of seven countries: Mexico, the Philippines, Vietnam, China, India, Haiti and South Korea," the researchers report.
They note that in the six-year period covered, 10,814 U.S. residents from Mexico were victimized by the disease. That means Mexicans living in the United States had a comparatively low rate of 35.5 cases per 100,000.
Immigrants from Vietnam had 5,196 cases and a 137.7 infection rate. That was the highest. Then came Haitians, 1,896 victims and a 118.5 rate; Filipinos, 6,212 and 95.9; Indians, 2,402 and 75.1; Chinese, 2,332 and 62; South Koreans 1,567 and 38.8; and "others," 15,704 and 18.1.
The six states reporting most TB cases in the period were California, New York, Texas, Florida, New Jersey and Illinois. They accounted for 74.4 percent of the 130,218 cases reported.
As Dr. Reichman and his colleagues see it, the only reasonable way to halt the importing of TB is to "look for the people who have it and treat it."
He explains that people who come to the United States legally are required to have chest X-rays showing they have no active TB. If they do, they cannot be admitted.
However, he says X-rays aren't sufficient. Latent TB is difficult to observe on X-rays. But beyond that, it's well known that immigrants often buy the clear X-rays of others and present them as their own.
Then too, the hundreds of thousands of persons who enter the nation illegally "don't come with X-rays in hand," as Dr. Reichman puts it.
The National Academy of Sciences' Institute of Medicine has suggested that persons from counties with a high incidence of TB be given skin tests and treated if the tests reveal the presence of latent TB. That is a strategy many TB specialists support, because as Dr. Reichman contends, "It's good for the immigrant and for the Americans they might some day infect."



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