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By Joseph A. D’Agostino
© 2000 Human Events
As a drug-resistant strain of tuberculosis goes on a rampage in the
Third World, immigration and public health officials have begun to
scramble to prevent that epidemic from hitting the United States via
Once the leading cause of death in this country, better living
conditions and antibiotics have reduced the American infection rate to a
record low and raised TB’s cure rate to 90 percent. But new
drug-resistant strains increasingly prevalent in the Third World kill 60
percent of their victims, even with the best treatment.
Currently, the federal government screens those immigrants who wish
to remain here permanently for active TB, but does not screen the
millions of students and visitors who enter the country each year, even
though TB is easily communicated through coughing and sneezing. Nor
does it screen the tens of thousands a year who enter the country as
students or visitors but illegally remain here as permanent residents.
Of course, uncaught illegal immigrants are not screened.
Legal immigrants who have dormant TB are allowed in, although 5
percent of them develop active TB later in life, according to the
Centers for Disease Control.
Right now, the United States and European nations are almost the only
countries in the world without a serious TB problem. In 1998, the
American rate for the disease fell to 6.8 per 100,000 people, and
immigrants, who are a tenth of the population, made up 42 percent of the
18,361 tuberculosis cases. In California, 70 percent of TB cases were
immigrants. In New York, 53 percent of TB cases were in the
‘Totally Resistant Strains’
Though the press has reported on TB-infected immigrants for years
now, “the thing that’s changed is that the disease has developed totally
resistant strains,” said K.C. McAlpin, deputy director of the Federation
for American Immigration Reform.
“During 1986-1997, the number of tuberculosis (TB) cases among
foreign-born persons in the United States increased by 56 percent, from
4,925 cases (22 percent of the national total) to 7,702 cases (39
percent of the national total),” says a Centers for Disease control
report. “As the percentage of reported TB cases among foreign-born
persons continues to increase, the elimination of TB in the United
States will depend increasingly on the elimination of TB among
foreign-born persons.” The American Medical Association has issued a
report agreeing with the CDC’s conclusion on targeting the foreign-born.
According to a study released last year by Harvard Medical School,
eight countries, including China, now have large regions where the
percentage of the TB cases that are multiple drug resistant (MDR) is
over 5 percent, and growing.
Another CDC report called “Progress Toward the Elimination of
Tuberculosis — United States, 1998,” released in August 1999, says that
1.1 percent of TB cases in 1998 were MDR, a decrease from the 1993 rate
of 2.8 percent. But the proportion of these cases found among
foreign-born people rose from 31 percent to 61 percent, a reflection not
of an increase among immigrants but of a decrease among native-born
Americans. Therefore, the CDC concludes, MDR-TB has not gotten far in
the United States, but may yet, especially because the “incidence of
MDR-TB is increasing in eastern Europe, Asia, and Africa.”
It is impossible to quantify the threat to Americans from TB-infected
immigrants, but the CDC says that those with normal immune systems are
at little risk. Those with weak immune systems, such as young children,
the elderly, and the already sick — or who become sick years after
contracting dormant TB — are at risk of developing potentially fatal
Last year, officials first began to take action. In December,
President Clinton appointed eight experts to a panel that will oversee
efforts to improve health, including the combating of higher TB rates,
in communities along the border with Mexico. In response to a
front-page New York Times article the day before warning of the
potential for the return of a disease most Americans believed was
permanently defeated in this country decades ago, the Health Secretariat
of Mexico issued a statement on Jan. 4. “There is an understanding
between our two countries to strengthen control, supervision and
prevention efforts,” it said.
TB rates have declined here in the United States since 1952, when
streptomycin, the first antibiotic effective against TB, was
discovered. The ’90s saw a bubble increase in the rate as
immune-impaired AIDS patients developed and spread the disease,
prompting the CDC and state officials to take action. The CDC first
identified MDR-TB as a problem here in January 1992, and began a program
to prevent its further increase, a program that was successful. Between
1992 and 1996, federal and state officials spent $1 billion to prevent a
TB outbreak in New York City alone.
Now the recent rapid spread of MDR-TB in the Third World, combined
with unchecked immigration, threatens a much worse outbreak. The
proliferation of HIV in the Third World means those populations are more
at risk for TB. Some countries, such as Zimbabwe, have HIV infection
rates of 30 percent, according to the World Health Organization.
Immigration and Naturalization Service officials have installed
X-ray machines in detention centers in Texas to detect TB in foreigners
entering the country illegally and plans to do the same in California
and Florida. But still, visitors and students will not be tested.
A spokeswoman for the CDC said, “We need more funding to target
foreign-born subpopulations living in the United States. We need more
advertising to urge people to get themselves tested, and we need funds
to do the testing.” She added that it was the INS’s responsibility, not
the CDC’s, to screen immigrants before they enter the country.
The CDC wants $500 million for its TB-control program, but received $128
million this year.
A spokesman for the INS emphasized the new precautions the agency is
taking and said, “It is up to Congress to decide whether or not to
allocate the funds to test everyone coming into the country.” He
declined to put a dollar figure on the amount. TB infection can be
detected through an inexpensive skin test, but expensive chest X-rays
are needed to discover the progress of the disease in those who test
The treatment of TB takes from six months to a year, and if a patient
stops taking the drug too soon, he can develop MDR-TB. Treating MDR-TB
costs thousands of dollars per patient and takes up to two years, but
the usual result is death anyway.
Part of the problem lies in the long dormancy of the disease: A TB
infection can have no effect on a patient for years and then become a
disease when triggered by some sort of stress. In fact, only 5 percent
of those infected with the TB bacteria ever develop the disease. So
most immigrants, according to the CDC, contract the infection in their
home countries but then develop the disease here. Illegal immigrants in
particular, who may spend weeks traveling, eating poorly, and living in
cramped quarters, often develop the disease.
Mexico and Central America currently have bad TB epidemics. Mexican
immigrants have the highest number of TB cases in the country. Large
numbers of illegal Mexican immigrants go to the Port Isabel, Texas, INS
detention center, and in 1997, the detainees had an infection rate of
190 per 100,000. The United States had a rate of 7.2 per 100,000.