Spreading the Disease Americans won't.

--
Keith

http://washingtontimes.com/specialreport/20050212-112200-6485r.htm

Disease, unwanted import
By Joyce Howard Price
THE WASHINGTON TIMES
Published February 13, 2005

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Special Report
   
Contagious diseases are entering the United States because of
immigrants, illegal aliens, refugees and travelers, and World Health
Organization officials say the worst could be yet to come.
   
In addition to a list of imported diseases that includes tuberculosis,
sickle cell anemia, hepatitis B, measles and the potentially deadly
parasitic disease Chagas, officials fear what could happen if the
avian flu, which is flourishing among poultry in Southeast Asia,
mutates so that it is capable of human-to-human transmission through
casual contact.
   
The bird flu has killed at least eight Asians since early January.
Several of those deaths -- in Vietnam and Thailand -- were believed to
have been caused when the virus passed between people who had
sustained contact. If the avian flu mutates so that it can be
transmitted with only casual contact, WHO authorities predict at least
7 million and as many as 100 million would die in a worldwide
pandemic.
   
Another concern with Asian immigrants in this country is the link
between Asians and hepatitis B, said Jordan Su, program manager for
the Asian Liver Center at Stanford University. She said the link is
alarming enough to warrant action on its own.
   
Hepatitis B is a "very common epidemic in Asia" and more than half of
the 1.3 million cases in this country are among Asians, who make up
only 4 percent of the U.S. population, she said.
   
"We hope the government will pass a bill that requires every immigrant
to be tested for hepatitis B," Ms. Su said.
   
"People, in general, bring in diseases from their home countries. But
I don't want to say all immigrants are carrying diseases," said Dr.
Walter Tsou, president of the American Public Health Association.
   
Dr. Kenneth Castro, director of the Division of TB Elimination at the
Centers for Disease Control and Prevention in Atlanta, said the job of
preventing these diseases must extend beyond the United States.
   
"Many diseases know no borders, but all policies to prevent the
importation of disease need to be reasonable and implementable, and
our efforts to improve disease control cannot be restricted to our
borders," he said.
   
Concerns about imported disease prompted the State Department on Jan.
21 to temporarily suspend travel to this country by Hmong refugees
from the Wat Tham Krabok camp in Thailand. The order came after
federal health officials learned of at least 25 confirmed cases of TB
among refugees from that camp who had resettled in California,
Wisconsin and Minnesota.
   
Enhanced medical screening and treatment of the refugees are under way
both in Thailand and this country, and State Department officials say
it could be six months before the travel ban is lifted.
   
TB a growing threat
   
According to international health officials, about a third of the
world's population is infected with the bacteria that cause
tuberculosis. TB that is resistant to multiple drugs is rampant in
many parts of the world, including Peru, Russia, the Baltic nations,
Hunan province in China, the Dominican Republic and parts of South
Africa, according to Dr. Castro. Some of the cases of TB diagnosed
among Hmong refugees resettled in this country are drug-resistant,
which makes them far more difficult and costly to treat.
   
Personnel with the CDC's Division of TB Elimination have said in
various reports that "immigration is a major force that sustains the
incidence of tuberculosis" in the United States and other developed
countries.
   
"TB cases among foreign-born individuals remain disproportionately
high, at nearly nine times the rate of U.S.-born persons," researchers
said in a 2004 report in the CDC's Morbidity and Mortality Weekly
Report.
   
The report found that people from outside the United States accounted
for 53.3 percent of all new tuberculosis cases in this country in
2003. That was up from fewer than 30 percent in 1993. In 2003, nearly
26 percent of foreign-born TB patients in the United States were from
Mexico. Another third of the foreign-born cases were among those from
the Philippines, Vietnam, India and China, the CDC report said.
   
But Dr. Tsou says TB data are "misleading." He points out that an
immigrant might be in this country for years with "inactive"
tuberculosis. "But now, after being here for a long time, that
person's immunity wanes," and he or she develops active TB, which can
become contagious, he said.
   
The fear of imported disease has led to a push by Rep. Tom Tancredo,
Colorado Republican, for a moratorium on immigration.
   
In a recent statement, Mr. Tancredo, chairman of the House Immigration
Reform Caucus, cited the "serious consequences" associated with the
"smuggling" of illegals into the United States without proper medical
screening.
   
"Among them are the possibilities of the spread of diseases for which
we have few, if any, antidotes," he said.
   
Mr. Tancredo's worries were prompted, in part, by the rising migration
of Hispanics to the United States and a potential increase in the
number of cases of Chagas disease, which is spread by insect bites in
South America and which can be spread through blood transfusions. It
is curable in its early stages, but kills about a third of the people
infected if it is not caught in time.
   
The American Red Cross estimates that nationally, the risk of a blood
donor having antibodies to Chagas or being infected with the disease
is 1 in 25,000. The risk is 1 in 5,400 in Los Angeles and 1 in 9,000
in Miami. The Red Cross says it will begin screening donors for
Chagas, once a suitable test is found.
   
Blood supply at risk
   
"An estimated 15 million South Americans [plus Mexicans and Central
Americans] are suffering from Chagas," said Dr. Arthur C. Aufderheide
of the University of Minnesota School of Medicine. "I'm amazed" that
only five cases have turned up in the U.S. blood supply since 1986.
   
Federal data suggest that as many as 10 percent of the approximately
1,000 Mexicans who emigrate to the United States daily probably are
infected with Chagas, said Dr. Louis V. Kirchhoff, a Chagas specialist
and a professor at the University of Iowa's medical school.
   
Other researchers say immigration is resulting in population shifts
that are contributing to a rise in sickle cell anemia.
   
While many incorrectly believe the disease is a condition that
afflicts only blacks or it has been eradicated, one in every 16
Hispanics -- the fastest-growing U.S. immigrant group -- also carry
the genetic trait that can cause the painful and incurable blood
disorder.
   
The number of Hispanic sickle cell cases in the United States has
risen rapidly, and one in every 900 Hispanic infants in this country
is born with the disease, said Gil Pena, outreach director for the
American Sickle Cell Anemia Association, based at the Cleveland
Clinic.
   
Dr. Samuel L. Katz, one of the world's foremost authorities on measles
and a professor of pediatrics at Duke University, says the childhood
illness is another contagious disease linked to immigration. In the
1960s, he was part of a team that developed an effective vaccine
against the disease.
   
"Instead of having millions of measles cases, as we did in the old
days, in the last 10 years, there have been less than 100 cases of
measles per year in this country," Dr. Katz said. "We're able to study
the genes of the virus to learn where it came from, and almost all of
the measles cases that have been found in the United States [in recent
years] were imported from a variety of different countries," he said.
   
The pediatrician noted that many of the imported measles cases have
come from Japan, Germany and Italy. Those developed nations "have not
been as aggressive about measles immunization" as some other
countries, he said.
   
While acknowledging that certain illnesses occur predominantly in
foreign-born people, Dr. Alfred DeMaria, director of the Bureau of
Communicable Disease Control of the Massachusetts Health Department,
said foreign travel, not immigration, is the real culprit.
   
Dr. DeMaria cited a case in his state last fall in which a
Haitian-born woman was diagnosed with diphtheria. The throat infection
is common in places such as Haiti and other countries in South and
Central America, Asia, Africa, the Middle East, Turkey and Albania,
but it is extremely rare in this country because of mass immunization.
   
Dr. DeMaria said it is believed the 60-year-old woman got diphtheria
from her husband, who recently had traveled to Haiti. Although he had
no symptoms, health officials found evidence of the infection in his
throat.
   
"If I vacationed in Tanzania, I could bring any number" of tropical
diseases back home to this country, as could a globe-trotting
businessman, he said. But "there's very limited risk of transmission
in this country," Dr. DeMaria said, concluding that "refugees and
immigrants don't account for major problems" in terms of public
health.
   
Despite the risks, the CDC's Dr. Castro said the "facility of
movement" between countries must be preserved.
   
"If everyone is required to have a chest X-ray before getting on a
plane, it's not going to work," he said.
   
But immigration opponents contend immigrants are carrying Third World
diseases -- some of which had been virtually eradicated here -- to the
United States.
   
"Mass immigration is a threat to our nation's health. Diseases nearly
eradicated are breaking out again," the U.S. Immigration Reform
Political Action Committee says at its Web site.
   
The cost of care
   
Immigrants, particularly illegals, also impose "huge costs" on the
U.S. health care system, especially in states bordering Mexico, says
Steven A. Camarota, research director for the Center for Immigration
Studies (CIS).
   
According to a survey by the American Hospital Association (AHA),
hospitals in 24 Southwest border counties in Arizona, California,
Texas and New Mexico reported uncompensated care totaling nearly $832
million in 2000.
   
A subsequent report prepared for the U.S.-Mexico Border Counties
Coalition determined that about 25 percent of those nonreimbursed
costs resulted from emergency medical treatment provided to
undocumented immigrants.
   
Ray Borane, mayor of Douglas, Ariz., says he knows about those
financial burdens firsthand.
   
"The city of Douglas is the major crossing point for illegals ... and
there have been some people who have come over here specifically to
get dialysis or complicated eye surgery. They've established illegal
residency in this country in order to thrive off the health care
system," he said, adding, "Illegals and undocumented immigrants don't
have any health insurance. We've never been reimbursed for their care,
and the federal government has looked the other way, so they are not
held responsible."
   
However, Mr. Borane, a Democrat, said medical services available for
illegals have been "drastically" reduced since Arizona voters enacted
Proposition 200 last November, which requires proof of U.S.
citizenship for those seeking medical treatment or other public
services in that state.
   
For the most part, however, "hospitals treat first and bill later, and
they aren't required to ask about a person's citizenship before
providing treatment," said Tiffany Himmelreich, spokeswoman for the
Ohio Hospital Association.
   
She said hospitals in that state treat their share of immigrants,
particularly Somalis in Columbus and "many Latin farm workers in the
Cleveland and Toledo areas." She was unable to say how many lack
health insurance.
   
Under new federal Medicare rules that took effect Oct. 1, medical
workers are required to "make a good-faith effort to obtain
citizenship information" from patients who receive emergency care in
hospitals or doctors' offices. The rules were issued in July after
Congress established a $1 billion immigrant health program under the
2003 Medicare law to assist those who provide emergency care to
undocumented aliens.
   
Advocates for illegals fear the new rules will drive those without
papers underground, and they will not get the health services they
need. They are seeking legislation that would prohibit health care
providers from informing immigration officials about people who are in
this country illegally.
   
A report by CIS, using 2004 data, "found that 35 percent of [all]
immigrants don't have health insurance, and an estimated 65 percent of
illegals don't have it," Mr. Camarota said. In contrast, fewer than 13
percent of U.S. natives and their children lack health insurance, the
analysis showed. In 2002, he said, the federal government spent $2.5
billion to provide families of illegal immigrants with Medicaid and
another $2.2 billion to provide medical treatment for uninsured
illegals.
   
"State and local governments probably spent another $1.6 billion on
top of that providing health insurance for illegal aliens," said Mr.
Camarota, whose group analyzes Census Bureau data.
   
The health system of Los Angeles County, Calif., has been described as
the largest safety net for the uninsured in the nation.
   
"We have 2.5 million uninsured people in Los Angeles County out of a
population of 9.6 million," said Dr. Brian Johnston, a trustee of the
Los Angeles County Medical Association.
   California state law requires that counties provide medical care
for the uninsured. "But we have the lowest rates of reimbursement for
Medicaid of any program in the United States," he said.
   
Dr. Johnston said the situation has been bleak for health providers
and patients alike.
   
"In 2002, [emergency rooms] and trauma centers in California provided
$520 million worth of medical care for which they received no
reimbursement. About $150 million was lost in Los Angeles County
alone," he said. Those losses were 18 percent higher than in 2001, and
those in 2001 were 16 percent ahead of 2000. "So this puts the entire
system at risk," Dr. Johnston said.
   
He noted that Los Angeles County experienced the closings of seven
emergency rooms last year and 16 clinics the year before.
   
Although many of the uninsured people flooding emergency rooms and
clinics in Los Angeles are illegal immigrants, Dr. Johnston doesn't
think most are trying to rip off the system.
   
"Illegals come here to work, and they do work. But they can't get
health insurance," he said.
       
Screening at home
   
Some see stepped-up health screening in immigrants' home countries or
immigration bans as methods to attack imported health crises.
   
"I'm sympathetic to the plights of many states that are spending lots
of resources for services for immigrants. But to deny people health
care is counterproductive," Dr. Tsou said.
   
He says it's "necessary to detect these diseases early" in the
foreign-born. But this country's health care system makes that
difficult, "since Medicaid is denied to legal immigrants for five
years."
   
"Pregnant immigrant women are examples of how this health care system
is dysfunctional, since they are denied prenatal care. But their
babies do receive Medicaid. We should give people medical care,
regardless of their citizenship status," Dr. Tsou said.
   
   
   
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"Cosmic upheaval is not so moving as a little child pondering the death
of a sparrow in the corner of a barn." -Anouk Aimee, French Actor  
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"Death is better, a milder fate than tyranny", Aeschylus (525BC-456BC),
Agamemnon
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"I wear no Burka." - Mother Nature
   
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