Three Refugees Diagnosed with Active TB in California

Three refugees who arrived in California during 2014 were diagnosed with active tuberculosis (TB) at their initial domestic medical screening, according to the state’s Office of Refugee Health (ORH).

An additional 39 refugees were classified as “TB Class V” (TB suspected, pending final diagnosis), according to the ORH’s Report on Refugee Health in California, Federal Fiscal Year 2014.

The Diagnostic Standards and Classification of Tuberculosis in Adults and Children published by the Centers for Disease Control (CDC) defines “TB Class V” as:

Tuberculosis suspect (diagnosis pending)
Persons should be so classified when a diagnosis of tuberculosis is being considered, whether or not treatment has been started, until diagnostic procedures have been completed. Persons should not remain in this class for more than 3 mo.

When diagnostic procedures have been completed, the person should be placed in one of the preceding classes.

Breitbart News has contacted ORH to learn how many of the 39 Class V refugees suspected of having TB, based on their initial domestic medical screening, were subsequently diagnosed with active TB, but has not yet received a response.

California is now the fourteenth state in which Breitbart News has confirmed refugees diagnosed with active TB. The other thirteen states include Wisconsin (27), Nebraska (21), Louisiana (21), Michigan (19),  Vermont (17), Colorado (16), Florida (11), Ohio (11 in one county), Idaho (seven), Kentucky (nine in one county), North Dakota (four in one county), and Indiana (four), and Tennessee, where two refugees have been diagnosed with the very dangerous, multi-drug resistant (MDR) TB.

In other states that report this data, the number of refugees who are diagnosed with active TB within five years of arrival is significantly greater than the number of refugees who are diagnosed with TB at their initial domestic medical screening, which is usually conducted within 90 days of their arrival.

In Michigan, for instance, only five of the 19 cases of active TB were diagnosed among refugees at their initial domestic medical screening. In Nebraska, only two of the 21 cases of active TB were diagnosed among refugees at their initial domestic medical screening.

The report also notes that “12.1% [of arriving refugees] were classified as latent tuberculosis infection (TB II and TB IV).”

The latent tuberculosis (TB) infection rate among arriving refugees arriving in the state of California during 2014 is at the lower end of all reporting states. Florida has a similar rate (12 percent), and Texas (15 percent) is slightly higher. At the highest end are Vermont (35 percent) and Tennessee (27 percent).

Many states, however, fail to collect or report either latent TB infection rates or the number of active TB cases diagnosed among recently resettled refugees.

High latent TB infection rates among resettled refugees pose a public health risk of active TB in communities in which they live, according to a 2013 study from the University of California at San Diego.

The latent TB infection rate among the general population is about four percent.

California is just one of seven states that appear to be fully compliant with the refugee health reporting and monitoring standards specified by the Refugee Act of 1980. The other compliant states are Texas, Florida, Minnesota, Utah, Indiana, and Arizona.

A total of 5,125 refugee “Health assessments [were] completed by County Refugee Health Program for Federal Fiscal Year 2014,” according to ORH. This represents 84 percent of the 6,108 refugees who were resettled in California in FY 2014, according to the Department of State’s interactive web site.

An additional 4,500 asylees, special immigrant status cases, and Haitian and Cuban entrants arrived in the state and obtained initial domestic screenings, according to ORH.  All told, ORH reported 9,675 cases were medically screened in 2014. (Fifty cases appear to be in an unspecified category.)

In FY 2016, which ends on Friday,  7,766 refugees have been resettled in California, according to the State Department’s interactive web site, a 27 percent increase since FY 2014.

If the Obama administration’s plans for FY 2017 become effective, the number of refugees resettled in California is likely to increase significantly.

President Obama has proposed that the total number of refugees resettled in the United States be increased in FY 2017 by 29 percent, to 110, 000 up from 85,000 in FY 2016.

According to the ORH’s Report on Refugee Health in California for Federal Fiscal Year 2014, the state appears to take its statuory responsibility to report on and monitor refugee health seriously:

The Office of Refugee Health (ORH) data report provides an overview of the demographic characteristics and health conditions of the refugee population for FFY 2001-2014.

Methods of analysis include descriptive, trend, and ratios. Results of the data shows a gradual increase in the number of refugee for the past 3 years and significant health screening findings.

For FFY 2014, 64% of the refugees originated from the following top three countries: Iraq, Iran and Afghanistan.

With the number of arrivals projected to increase in the upcoming years, the ORH will continue to monitor health trends and report any significant findings. An annual data report will aid refugee stakeholders in the planning and assessment of policy development impacting placement, resettlement, and resource allocation.

With the data collected and analyzed, the ORH can better assess the health disparities and promote the long-term success and healthy quality of life among refugees arriving in California.

The report notes that “The Refugee Act of 1980 was passed by Congress in order to standardize resettlement services for all refugees admitted to the U.S.”

The Act also provides the legal basis for The Office of Refugee Resettlement (ORR) and for federal funding to provide services to refugees at state and local levels. With funding from ORR, the California Department of Public Health (CDPH), ORH was established in 1981 to provide statewide leadership in refugee health and to coordinate refugee health services in California. . .

Under the Refugee Health Assessment Program (RHAP), the CDPH/ORH allocates federal Refugee Medical Assistance funds from the ORR to refugee impacted local health jurisdictions (LHJs) statewide. . .

LHJs plan and coordinate with public and private health providers, mental health providers, social services agencies, community-based organizations, voluntary agencies, etc., to enhance access to health care for refugees.

The health and demographic information collected by LHJs provides early diagnosis, intervention, referral and health education for chronic and communicable diseases, intervention for immunizations for children and adults, continuity of care through medical record transfer, and statewide standardization of services provided.

The ORH also notes that, through the state’s Refugee Health Information System (RHEIS) it “collects pertinent health screening information that will help improve the health of the refugee population . . . [i]n order to maintain consistency with Center for Disease Control and Prevention (CDC) medical guidelines.”

“RHEIS serves as the tool that allows CDPH/ORH to improve and standardize the collection of quality, comprehensive data and to enhance processes for program planning and policy decisions and program management and oversight. RHEIS data also provides RHAP grantees data and reports to guide local planning efforts, ensure program performance and support local funding requests,” ORH says, adding, “ORH makes health screening recommendations based on CDC guideline updates.”

Despite limitations, demographic and health screening data provides an important means to monitor and evaluate health status for the refugee population. The data can facilitate development of policies, improve clinical practice, inform others about the health status of the California refugee population and assist in resource allocations at the local and state levels to reduce disparities and prioritize health equity.

California and Texas appear to be the two states in the country that have the most comprehensive data collection systems for the reporting and monitoring of refugee health.

***UPDATE***

The California Department of Public Health responded to Breitbart News’s inquiry about the ultimate disposition of the 39 “Class V” TB diagnoses in an emailed statement Monday afternoon.

“The cases were followed up by the local refugee health programs and TB active infection was ruled out,” the department says.

“None” of the cases were diagnosed with active TB, the department adds.