What about tuberculosis?

At the September 19 public meeting in Hagerstown, a question was asked about the high rate of tuberculosis among refugees. Ann had just found this in the Fort Wayne Sentinel and posted it:

McMahan  said about 50 percent of refugees arrive with TB infection and must be tested, treated and tracked. The TB clinic is already seeing a surge in patients this year, and they are sicker, she said, adding more nurses are needed now, even without the additional refugees.

One of the speakers, Terry Rausch from the State Department, said in reply that many refugees test positive for TB because they’ve been exposed, but are not infected now. (It’s true that this commonly happens. My father, who grew up in a Philadelphia slum, tested positive for TB although he never had it that he knew of.) We were also told that all potential refugees go through a health screening before they come here, and are then checked once they are here.

The statement was intended to reassure us that there’s really no health danger in bringing in refugees. I’ve just been searching for some more facts.

A report from the CDC (the federal government’s Centers for Disease Control), “Multidrug-Resistant Tuberculosis in Hmong Refugees Resettling from Thailand into the United States, 2004–2005.” Apparently the screening procedures were deficient, and there were cases of multidrug-resistant TB getting through. They changed the procedures, and since then none of these TB cases have been found among Hmong refugees.

But the CDC then points out that the refugees could have latent TB and need to be monitored to make sure these cases don’t become active TB. The article also includes these observations:

The global incidence of TB disease is increasing, and an increasing percentage of TB cases in the United States are occurring among foreign-born persons.


 These investigations and responses have required and will continue to demand considerable public health resources. Per person, the estimated costs of detecting disease and treating patients with LTBI range from $208 to $11,125, and the direct medical costs associated with TB and MDR TB disease range from $3,800 to $137,000, depending on case complexity. These projections underestimate the costs for treating Hmong refugees because they exclude the additional expenses of providing culturally appropriate outreach, interpretation, and transportation services.


The annual number of immigrants to the United States continues to increase, and TB is the medical condition most frequently diagnosed among applicants for permanent residence.

They point out that the number would be even higher were it not for screening. But it is obvious that the screening isn’t perfect. It’s clear from skimming through some of the articles on the web that TB among refugees is a problem. TB hasn’t been a problem in this country for many years, but now it’s becoming one.