Tuberculosis among Foreign-born in United States

Tuberculosis, a deadly infectious disease that besides attacking the lungs can also infect the lymphatic, nervous, circulatory, genitourinary and gastrointestinal systems is spread through the air. The rate of infection is so high that it is argued that at least one individual gets infected every passing second. The United States has over the years been able to decrease the rate of infection amongst its citizens. Research reports show that the rate of tuberculosis though decreasing in the united states general population, the decline amongst the foreign born is not at tandem with that of the United states born.

Reports show that more than half of all tuberculosis cases are attributed to the foreign born United States residents. This situation which has become persistent has raised a lot of concerns in the health department as ways of curbing the problem are sought. The high prevalence of the disease amongst these individuals is attributed to many factors. It is worth to note that foreign birth is not the only risk factor for tuberculosis in the United States. Other factors include AIDS and lack of access to timely medical care.

Overcrowding in residential areas and lack of healthy diet are other tuberculosis risk factors. The high prevalence of tuberculosis amongst foreign born United States residents can be attributed to several factors. It is argued that one of the reasons could be that these individuals get infected in their countries of origin and suffer from the disease once they settle in the United States. Over the past years, epidemiological evidence has shown that there is a significant connection between tuberculosis and socio-economic status.

The diseases is said to be more prevalent amongst individuals who are not economically privileged. In the unite states, most foreign-born residents are not economically well off. For one, these individuals live in neighbourhoods that are overcrowded. This implies that that they are more prone to infection in the event there is an outbreak. One individual who is infected can also easily pass it to the other in such a setting. The high rates of tuberculosis amongst these individuals can also be attributed to the lack of access to health care due lack of medical cover.

In the United States, the foreign born residents account for the majority of all uninsured cases. This implies that medical care is expensive for them as they have to solely bear the responsibility of cost. These communities are hence characterized by hence lack of timely medical attention which delays diagnoses and increases the spread of he infection. Due to low increased poverty levels, these individuals have low standards of living that are characterized by poor diets. This in itself increases their vulnerability to TB infection.

This paper will discuss research articles that have carried out on this issue explaining why the problem is critical and plans that can be put in place to control it. Both governmental and private agencies that can get involved in dealing with the problem will also be discussed. According to Davidow et al. , (2003), the fact that the rate of decline in tuberculosis (TB) among the foreign-born United States residents is not at par with that one of united states-born residents has become a concern that is persistent.

This research shows that in spite of the Tb rate among the US falling by 40 percent between the years 1993 to 1998 (7. 4 cases out 100 000 in 1993 versus 4. 4 cases per 100 000 in 1998), the rate among the foreign-born fell by only 12 percent (34. 1 cases out of 100 000 versus 30. 1 cases per 10 000) in the same period . According to a census carried out in 1990, 8 percent of the total reported TB cases were US-born while an overwhelming 36 percent of the cases occurred amongst the foreign-born United States residents between the years1993 and 1998.

According to this study, foreign bone is amongst the risk factors for tuberculosis in the US. HIV/AIDS and drug use via injection are considered to be the other risk factors of the disease. The study further maintains that the epidemiological evidence that connects tuberculosis with socio-economic status remains long-standing and has extended up to the 20th century. According to studies done in the early 20th century, improved diet/nutrition and reduced overcrowding have contributed most to decline in tuberculosis both in the united states and in the united kingdom (Davidow et al.

, 2003). Most recent research evidence show that the continuing poverty has the greatest impact on tuberculosis rates, this is argument is based on a macro scale. Underfunding of programmes to control TB is considered to be another contributing factor to increase in tuberculosis rates that as experienced in the 1980’s (Davidow et al. , 2003). Studies on local scale show that neighbourhood crowding strongly influences TB rates. This factor is argued to persist even when AIDS prevalence is controlled (Davidow et al. , 2003).

According to this study, tuberculosis is closely connected to poverty and the TB complication may be due to the immigration patterns of the past years. The report explains that in spite of the fact that the foreign-born residents in New Jersey account for 13 percent of the total population in the state, they contributed to 47 percent of al the reported TB cases in New Jersey during 1994-1998 . New Jersey is listed fifth in states with largest population of foreign-born residents in the US. Most of these individuals are either born abroad or in Puerto Rico which is a country that is ranked second in countries that are heavily burdened by TB .

New Jersey has in the past years remained a destination for immigrants yet immigration during the same time is considered to be a risk factor for tuberculosis that results from Mycobacterium tuberculosis and active TB (undiagnosed) that is acquired from elsewhere (Davidow et al. , 2003). These populations usually are undeserved as they lack medical representation which results to inadequate access to health care services consequently resulting to delayed diagnoses and treatment hence increased rate of infection. One of the control plans is for the US government to re-examine TB’s socioeconomics.

This is attributed to the fact that some TB immigrant patients and other immigrants from regions which have high TB endemicity have settled and now are concentrated in areas that are socioeconomically advantaged making the traditional health department models that was designed for the disadvantaged areas inapplicable. Addressing these changes could help in controlling and completely eliminating tuberculosis from the United States (Davidow et al. , 2003). Research done on tuberculosis rate in North Carolina found that of all the patients diagnosed with TB, 21. 2 percent were foreign-born .

According to this research, the incidence of tuberculosis has been on the decline over the past years with the exception of the period between 1985 and 1992 in which there was a resurgence of the disease (Kipp, Stout, Hamilton, & Van Rie, 2008). The research reports that in 2006, TB cases hit 21 percent, the lowest percentage that has ever been reported in its history . Among the things the research sought to establish was the effect of foreign birth location on TB rates in North Carolina in the US. In the period between 1993 and 2006, 6,416 TB verified cases were reported in North Carolina of which 1,299 an overwhelming 21.

2 percent were among foreign-born individuals . There was an increase in this percentage from 6. 3 in 1993 to 37 percent in 2006 . More than 60 percent of these foreign born individuals had migrated from five countries which included Vietnam, Mexico, Phillips India and Honduras that are known to be heavily burdened by tuberculosis. Most of the individuals diagnosed were found to have Extrapulmonary Tuberculosis (EPTB), lacking the TB risk factors such as use of drugs and alcohol and homelessness (Kipp, Stout, Hamilton, & Van Rie, 2008).

These individuals were also found to be HIV negative and aged between 15 and 44 years (Kipp, Stout, Hamilton, & Van Rie, 2008). This study hence proved that even in the control of all the other tuberculosis risk factors, birth location had a great influence on TB rate. In order to control TB in the United States and eliminate it, immigrants need to be screened for EPTB and those found to be restrained from entering the United States unless they are treated.

This might however not entirely solve the problem as most of the cases are reported after the immigrants have been in the United States for some time. Mycobacterium tuberculosis genetic variations and other variations in the immune response of the host are other factors that account for the high TB rates among foreign-born US residents (Kipp, Stout, Hamilton, & Van Rie, 2008). Research on the 2005 TB outbreak among the Hmong refugees who lived or had immigrated in to the country in the recent past some camp in Thailand implied that the disease had been imported from Thailand (Oeltmann et al.

, 2008). Most of these resettled refugees were found to have the multidrug-resistant form of TB. This was attributed to the variations in Mycobacterium tuberculosis and genetic variations in the individuals’ immune system that made it become resistant to the drugs that are used to treat TB specifically rifampin and the isoniazid resulting to TB complications. The variation is attributed to changes in environment due to the migration (Oeltmann et al. , 2008).

According to research, current figures show that 56 percent of reported TB cases in the US occur among the foreign-born residents with the highest rates being recorded among the immigrants who migrated most recently . Refugee populations in the United States are the most vulnerable to TB infection. In order to control this situation in the developing countries as it affects even the developed countries due to immigration, effective control programs that involves availability of drugs that are more toxic and less potent than rifampin and isoniazid that are in use (Oeltmann et al.

, 2008). Since the screening technology currently in use has proved not to be effective as immigrants develop tuberculosis within a short time after arrival, screening of refuges and immigrants before being allowed to enter the united states should be done using a revised TB screening algorithm in which mycobacterial culture and susceptibility testing are included (Oeltmann et al. , 2008).

Multiple organizations that include government agencies, non-governmental organizations and multilateral agencies must all work together and provide TB diagnoses and treatment that is of high quality and meeting the international standards of care. This should apply to both the host and the recipient countries. The united stats as a low incidence country of TB should invest in global TB control as it is a cost effective long term strategy for reducing TB occurrence both domestically and internationally (Oeltmann et al. , 2008).

According to Glassroth (2005), in spite of most industrialised nations such as the united states having managed to control TB such that they now have low incidence of the disease, these countries face the challenges of having the disease imported through immigration from the countries that have identified as “high burden’ due to high incidence of the disease. Containing and completely eliminating this disease will therefore require creative strategies in both clinical, political and the scientific areas globally (Glassroth, 2005).

Globally, TB has been identified as the second infectious disease after HIV/AIDS that causes death. It is approximated that 8 to 9 million new cases of Tb are diagnosed annually and that over 2 million deaths are attributed to Tb annually . In most of the developed countries such as the United States, rates of TB have been on the decline over the past decade. In the US, over half of the TB cases occur in foreign-born immigrants within a few years of their arrival in the county. The rates in 2003 were approximated to be 2. 7 per 100 000 amongst the US born versus 23.

4 per 100 000 among foreign-born residents . This phenomenon is attributed to the fact that there are some parts of the world that are resistant to drugs hence difficulty in treating the disease. In the United States, the cases are attributed to activation of remotely acquired latent tuberculosis infections (LTBI) (Glassroth, 2005). According to Glassroth (2005), the best way the United States can control TB is to employ proper guidelines and technology during screening of the immigrants before they can be allowed to enter the United States.

Since most of the reported cases in the United States are among the foreign-born residents, the United States should take the responsibility as a developed country to assist the international community in monitoring and sea4rching for ways of controlling TB globally. According Page et al. , (2008), more than half of all the tuberculosis cases occur among the immigrants. One of the recommended means of controlling this incidence is screening and treating the immigrants for latent TB infection within at least five years of their arrival to the United States.

It is important to do this the earliest time possible as research has shown that those who are not referred for the therapy (LTBI) during the immigration proceedings are not likely to receive the therapy within the first five years of their arrival. There is need to therefore explore other frameworks and mechanisms that are beyond the immigration services for LTBI screening that is timely in order to control and possibly eliminate TB from the US. The rate of tuberculosis in the United States has been declining over the past decade.

Just like other industrialised countries, the US has been able to successfully reduce the incidence of the disease. The United States would have been successful in completely eliminating the deadly infectious disease were it not for the challenges posed by immigration. Researches done on the disease imply that one of the TB risk factors is location of birth. It has been proved that place of origin influences TB rates in the country as the highest incidents occur among the foreign-born residents especially those who migrated from countries that have been referred to as TB high burden such as Porto Rico.

It is argued that these individuals carry the disease with them as they migrate. Poverty which is characterized by poor nutrition and neighbourhood crowding that is common among these individuals has been identified as a contributing factor to the high TB rates. The fact that some of these individuals settle in areas that do not have programs that are designed to deal with cases of TB also contributes to the high TB rate among them. Lack of access to timely medical attention due to inadequate cover has a great impact on the high rates of TB occurrence among these individuals.

The persistence of this issue needs the government to take extra steps that are directed towards immigration procedures and also globally. Due to the fact that it is an immigrant hence global issue, the United States must make efforts towards ensuring that TB can be controlled and contained if not completely eliminated worldwide. It should do this by supporting the global efforts that are directed towards this goal especially through the WHO and other non-governmental organizations.

Screening procedures before immigrants can be allowed to come to the United States should involve procedures that can detect and treat latent tuberculosis infections LTBI and Mycobacterium tuberculosis. References Davidow et al. , (2003). Rethinking the socioeconomics and Geography of tuberculosis Among Foreign-Born residents of New Jersey, 1994-1999. American Journal of Public Health, 93(6) 1008-1012. Glassroth, J. (2005). Tuberculosis 2004: Challenges and Opportunities. Transaction of the American Clinical and Climatological association, 116 (1)293-310.

Kipp, M. A. , Stout, J. E. , Hamilton, C. , & Van Rie, A. , (2008). Extrapulmonary Tuberculosis, human Immunodeficiency Virus, and Foreifhn Birth in North Carolina, 1993-2006. BMC Public Health, 8 (107) pp. 1-10. Oeltmann et al. , (2008). Multidrug-Resistant Tuberculosis Outbreak among US-bound Hmoung Refugees, Thailand, 2005. Emerging Infectious Diseases, 14(11)1717-1721. Page et al. , (2008). Timing of Therapy for Latent Tuberculosis Infection among Immigrants Presenting to a U. S. Public Health Clinic: A Retrospective Study. BMC Public Health, 8(158)1-7.

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