Immigration helps diseases spread in Valley

High rate of tuberculosis hard to control along border

By Sara Ins Caldern

The Brownsville Herald

November 21, 2005 - Undocumented immigrants crossing through the Rio Grande Valley could be introducing or helping spread communicable diseases in South Texas, such as resistant strains of tuberculosis and even the avian flu, according to health officials.

The illegal immigrants dont necessarily help the situation, said Herb Tolentino, director of nurses for the Cameron County Department of Health and Human Services (DHHS).

In the 2005 fiscal year, the U.S. Border Patrol detained 137,083 undocumented immigrants in the Valley, and 15,321 people have been detained in fiscal year 2006, since Oct. 1.

Especially if they are coming from Central America, and they come through Mexico, if they have TB (tuberculosis) or dengue, they might bring that with them to the border and then transmit it, Tolentino said.

Communicable diseases are those considered transmittable from human to human through either direct or indirect contact, such as coughing, sneezing or coming into contact with body fluids.

It is tuberculosis, however, that is the primary health concern due to illegal immigration in the Valley, said Miguel Escobedo of the Centers for Disease Control in El Paso.

People who have active tuberculosis are usually very thin and have a very noticeable cough, said Brian Smith, the director for the Department of State Health Services in Region 11, which includes the Valley.

With other communicable diseases people are usually so sick that they are not able to travel, he said.

Tuberculosis, along with cholera, smallpox, yellow fever, hemorrhagic fevers, SARS, and influenza with potential for pandemic are diseases the federal government deems quarantinable.

In Cameron County officials closely monitor the diseases, plus dengue, chickenpox, AIDS/HIV, hepatitis and measles for sudden outbreaks.

TUBERCULOSIS

The Valley has more cases of tuberculosis per 100,000 people than the national average, Tolentino said, and that has always been the case.

But rather than blame illegal immigration, Tolentino said the demands of border life and the frequent crossing of borders that accompanies it is at fault.

Our society is becoming so mobile that it is hard for us to contain or to control tuberculosis, he said, That back-and-forth stuff is hard on the medical providers who take care of the patients.

Treatment for tuberculosis must be strictly adhered to in order to prevent creating drug-resistant strains of the bacteria. Both Mexican and U.S. health authorities work together to ensure that those with tuberculosis follow their treatment, Tolentino said.

There is no Border Patrol for mosquitoes, said Lorenzo Pelly, a Brownsville physician who has been practicing in the Valley for 23 years.

There is an increasing number of tuberculosis patients from south of the border that come into the U.S., some of them with resistant strains of TB, Pelly said.

Federal agencies in the Valley, such as the Border Patrol and Immigration and Customs Enforcement (ICE), which runs the Port Isabel Detention Center, have some policies in place to deal with communicable disease.

Pelly, who has contracted with the government to provide care for immigrants, said the Port Isabel centers measures are adequate to prevent the spread of tuberculosis, but the Border Patrol does not have the process to deal with the disease.

Every detainee at the Port Isabel center has their chest x-rayed upon arrival to screen for tuberculosis. Detainees at the center are usually awaiting a final decision on their immigration status, and many reside in the center for several months.

In addition, all Port Isabel detainees pass a mental and physical screening. Those who are confirmed tuberculosis cases are separated in the Tuberculosis Isolation Facility, completely segregated from the rest of the population, until the completion of their treatment.

The Border Patrol counts some formal and periodic training for agents dealing with air and blood pathogens, the use of surgical masks and gloves for detainees, daily staff meetings, standard operating procedures dealing with contagious diseases and a partnership with the CDC as its preparation to deal with communicable diseases.

The agents really are our eyes and ears in the community, and they are the ones that help us detect and respond and whenever there is a condition that is of interest, Escobedo said.

The CDC provides information and assistance in the case of severe cases of communicable diseases in immigrants, he said.

Every sector is different, said Salvador Zamora, a spokesman for the Border Patrol in Washington, D.C.

Most sectors have contracts with medical facilities to monitor the health of detainees, he said, most of whom are not housed by the Patrol for extended periods of time.

There have been cases of agents and their families contracting tuberculosis, he said.

The risk of being a Border Patrol agent are high even without communicable disease, Zamora said, When they come into contact with an individual, that risk increases because we add the element of the unknown, which is where these people came from.

As long as there is a border, there is no way to eliminate the potential for transmission of tuberculosis, Pelly said.

For every detainee, there are probably many more that are in this country the potential impact is that there can be potentially a significant number of people who acquire tuberculosis.

And where prevention is not possible, quarantine may be an option.

Almost all of the cases where quarantine has been enforced in the last decade have been for TB, said Allison Abell, an epidemiologist with the Department of State Health Services.

Nowadays in Texas almost every time quarantine is imposed, it is going to be for TB.

AVIAN FLU

As of Nov. 17, the World Health Organization reported 67 avian flu-related deaths worldwide and a total of 130 laboratory-confirmed reported cases. No cases of the avian flu have been reported in the Valley, according to DHHS.

Currently China has two confirmed cases of the avian flu, with a probable third, the Associated Press recently reported. The country has been working to prevent an outbreak, killing and immunizing billions of domestic poultry and stockpiling 60 million units of the bird vaccine, AP reported.

More than half of all undocumented Chinese immigrants detained by the Border Patrol were detained in the Valley, officials said.

The Valley has potential to be a hotspot for the disease, Tolentino said, but an outbreak of avian flu would threaten everyone on the planet.

If the disease starts to spread from human-to-human, it wont be long before its everywhere because of how people travel, Tolentino said.

The avian flu, however, has yet to mutate into a human-to-human form, according to health officials.

The mortality rate of this disease is quite high and half the people who contract the disease are likely to die, he said. This is partially due to the fact that the virus is adapted to birds immune systems, so the human immune system is totally unprepared to fight it.

Quarantine measures against this flu might be imposed if it were detected in the Valley, said Abell.

It could mutate where it is transmittable human-to-human and then its going to get really serious, Tolentino said of an avian flu outbreak, The Valley would just be another place in the world.

ASSESSING THE RISK

Better and amplified screenings for tuberculosis and other diseases, as well as making sure those affected finish their treatments completely are the best ways to deal with TB, said Smith.

The CDC, in partnership with federal agencies, works with other health agencies to prepare and understand communicable diseases, Escobedo said.

We are concerned about the introduction of communicable diseases, Escobedo said, For those reasons we look for ways to do research to better understand the patterns of the disease transmission and address diseases from a binational perspective.

sicalderon@brownsvilleherald.com