Sunday, October 01, 2006

Immigration and diseases such as tuberculosis

The closest I've ever been to tuberculosis was when the disease took out one of my family members in the old Oregon Trail computer game. But as the US sheds its 'parochial' WASP culture, it is being enriched by the abundance offered up by other cultures:

State health officials say tuberculosis is under control in Arizona despite growing national concern over imported drug-resistant strains of a disease that hasn't flourished in the United States since the mid-1900s. ...

"It's just an airplane ride away," said Dr. Karen Lewis, tuberculosis-control officer for the Arizona Department of Health Services.

Do we even have that much cushion? More like it's a border-hop away:

Arizona reported 281 active tuberculosis infections. A total of 172 infected people were foreign-born, 68 percent from Mexico, where the tuberculosis incidence rate is 10 times higher than in Arizona.
In absolute terms the number of infections are quite small. Although tuberculosis is contagious, most people can cohabitat with a person who is infected and not contract the disease themselves.

But it's certainly worth noting that a disease we eradicated a century ago is now proving itself atavistic as over a million new arrivals inundate the US, coming primarily from a country where the rate of tuberculosis is ten times as high as it is stateside. And the media went into a hissy-fit over a single spinach fatality. About one in 300 E Coli sufferers die from the virulent infection. In contrast, without chemotherapy, a person who contracts tuberculosis has a 50/50 shot. Even with celerity of treatment, one-in-five die. I'm not sure what percentage of the population regularly consumes spinach (ascertain it here) or what percentage comes into daily contact with foreign-born Hispanics, but it appears that being around immigrants is worse for your health than eating raw spinach was during the height of the E coli scare.

The article linked to previously reads:

The majority of drug-resistant infections are brought to the U.S. by legal visitors, many of them unaware that they carry the deadliest strains.
I'd like to know how the doctor reached that conclusion. She's speaking in absolute terms (there are some 50 million visitors to the US each year, so this wouldn't be surprising), presumably, but I bet the rate of TB is higher among illegal vistors than legal ones. The former are obviously much harder to track, while the latter are more likely to have the means to insulate themselves from the disease and also treat it when it is contracted.

Relative to other regions of the world, TB isn't much of a problem in Europe, but in the Western Hemisphere, only one country, Canada, has a lower TB prevelancy than the US does. Haiti's rate is a full 90 times greater than the US' (and virtually all African and SE Asian countries are at least an order of magnitude worse than the US in terms of TB prevelancy). In Peru, it's over 60 times greater.

TB is as diverse as America:

Nationwide, there has been a spike in milder but lethal "multidrug-resistant" tuberculosis, which responds to more treatments but can cost up to $250,000 and
take several years to cure.
So mild it will kill you, but not before ringing you dry! Who's going to come up with the money to treat the 'undocumented' who carry the disease? This strain is more nefarious than the original, in my opinion. In any case, tuberculosis is clearly a consequence of foreigners arriving in the US, legal and illegal. It is an almost purely external threat:
In 2005, the most important risk factor associated with tuberculosis in Arizona and nationwide was birth outside the U.S., according to the state's Tuberculosis Surveillance Report, released last week.
Don't be afraid to bring up health in discussions you have with others over the topic of immigration. It's not just tuberculosis--other putatively historical diseases of the Oregon Trail era are making a comeback in North America: Syphilis, gonorrhea, and hepatitis (mostly from Asia) are all coming home to roost.

Our government is supposed to protect us from this kind of stuff. A merit immigration system would fancifully include health screenings (and part of the total score that determines whether or not an applicant can be a US resident would be derived from these screenings) as a way of shoring up our government's dereliction of duty.

(Immigration2)

9 comments:

mping said...

At least if you die you get a free t-shirt.

I think TB is bad in Russia. I have heard of drug resistant versions that have sprung up in their jails.

JSBolton said...

In South Africa, there has already appeared a a fast-killing TB which is highly resistant to all the drugs currently used.
Once drugs no longer get used differentially against the more virulent, faster-killing TB germs, the natural selection constraint against such strains is gone!
The impetus then is all towards the more virulent, which transmit themselves more efficiently, by making active cases faster, thus gaining transmission opportunity over the slower ones.
In the 19th century it was not so rare for TB to kill in 6 months, ergo the genetic capacity for that is not impossible.
What has controlled this in the past, has been that the strain which causes active cases faster draws drugs to itself, thus favoring the slower-moving types.
Diversity of virulence of TB strains circulating in a country, should not be considered something to value, especially not when there could be a huge plague starting up in fatalistic Africa.
Sometimes one runs into those who say one has compared immigrants to germs, when one makes bold to mention that infectious disease has exploded through immigration.
An immigrant carrying the seeds of an epidemic, is an evil to us in the same way, as his infectious agents are.
Concern for morality would have us wish him less mobile, and to be made to stay where he can't spread it.
Such innuendoes are attempted smears, as if to say that anyone who warns of the danger of spread of disease from the tropics, wants to use lethal drugs on such immigrant carriers, in the same way as with what they're carrying.
Rather than be apologetic to such smearing slippery slope promoters, it is better to go on the offensive.
Our officials are guilty of depraved lassitude of immigration law enforcement, to the point of allowing a great many lethal or highly damaging infectious agents to cross unhindered.

JSBolton said...

Since ad hominem is used by knowledgeable advocates for disease-carrying immigrants, this indicates that rational arguments for allowing the free spread of such infectious agents between countries, are likely unavailable.
Even on the face of it, it should be clear that such spread is not desirable; and the foreigners' freedom to spread such infections here is not known to be a reasonable value for us.

Anonymous said...

On a more mundane and not as life threatening (but still gross and irritating) is the spread of bedbugs in NYC because of all the diverse people that are now living there. Goddamn bedbugs! Wonderful. I'm sure Bloomberg thinks that the bedbugs are just fine because without them the exterminating industry would collapse, or something.

crush41 said...

Heh, mping. I know what I'll tell mom to get me for my birthday this year!

"Even on the face of it, it should be clear that such spread is not desirable."

Indeed. And so it is mostly glossed over, or subject to great diminution while an outbreak of E Coli that kills one fills the headlines for days.

Here's an article on just that, anon. The infestation seems almost impossible to eradicate. I feel sorry for those in the Northeast having to suffer the bedbugs.

JSBolton said...

The NYT article on 'XDR', i.e. extremely drug-resistant TB in Africa is on p.A4 8-18th-06.

green card visa said...

"The majority of drug-resistant infections are brought to the U.S. by legal visitors" Really? I was under the impression that the drug-resistant strains were more of a product of the effects of vaccination and medicines, with the strains evolving in response.

Audacious Epigone said...

Greencard,

In the case of recidivistic tuberculosis, yes, that apparently is the case.

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Disease.com