(NOTE — Update at the End of the Column)
One of the things that changes you, when you become a parent, is the body of knowledge you acquire to protect your spouse and children including things like knowledge of infectious diseases in public schools. In my case that meant looking at the NY Times saying the following: “…the administration has begun to send the expected 240,000 migrants and 52,000 unaccompanied minors who have crossed the border illegally in recent months in the Rio Grande Valley to cities around the county.” And at headlines for the open border crisis like this by Todd Starnes titled “Immigration crisis: Tuberculosis spreading at camps” which caused me to immediately free associate them with a pair of “Tuberculosis in Public School”, headlines, one local to North Texas in 2011 and the other very recently in California. See this 2011 Consumer Health Daily article from Denton Texas “TB Outbreaks in Texas Schools Show Disease Still a Threat – At least 100 people have tested positive for the respiratory ailment” and this 1 July 2014 article from the Sacramento Bee “Four more students test positive for tuberculosis at Grant High.”
As a Texas parent, this idea of TB positive illegal alien children released to illegal immigrant parents scares the heck out of me from the point of view of epidemiology. In the 1920s TB was the eighth leading cause of death for children 1-to-4 years old. Since then American public health has been so effective in preventing it that the USA no longer has any “herd immunity” to TB.
This “catch and release” illegal alien policy is horrible from the infectious disease point of view in that phlegm or aerosolized sputum that are contaminated with Mycobacterium tuberculosis are active biohazards that have long latent infection periods. This makes “exposure” very easy. The clinical definition of TB Exposure — which I found in a University of Vanderbilt student medical file PDF — is the following:
“A person is considered to be exposed if there is shared breathing space with someone with infectious pulmonary or laryngeal tuberculosis at a time when the infectious person is not wearing a mask and the other person is not wearing an N95 respirator. Usually a person has to be in close contact with someone with infectious tuberculosis for a long period of time to become infected; however, some people do become infected after short periods, especially if the contact is in a closed or poorly ventilated space.”
The Federal Government Hazmat protocol for dealing with suspected active TB cases is as follows:
1. Administrative controls
• “Develop policies and protocols to ensure the rapid identification, isolation, diagnostic evaluation and treatment of persons likely to have TB.”
2. Engineering controls
• Isolation and
• Negative pressure room ventilation
3.Personal protective equipment controls
• N95 personal respirator protection
Questions people and reporters need to be asking their local, state and federal elected officials regards the so-called “unattended child immigration crisis” include:
1. How many Border Patrol Agents, health workers or other support staff at these immigration processing centers have worn N95 respirators in treating symptomatic TB sufferers?
2. How many TB sufferers were also wearing masks?
3. Have those Border Patrol Agents, health workers or other support staff followed a rigorous TB decontamination protocol?
Whether people ask those questions or not, we are going to find out the answers soon, and not just in Texas. Testable anti-bodies to TB infection appear in two to 12 weeks for skin and blood tests and the incubation period for full blown active TB is six months to two(+) years.
TB SCREENING, LTBI AND VACCINATION
While active TB can be found by chest X-rays, screening for latent TB infection (LTBI) can only be found by two tests that screen blood and skin. The problem for screening these illegal alien immigrants is, strangely enough, that they are from countries with wide scale TB vaccinations.
The TB vaccine is called BCG (Bacille Calmette-Guérin). It is considered controversial because it isn’t “very effective” in countries with a low incidence of TB, like the USA. However, that isn’t the biggest reason BCG isn’t usually given in the United States. Mass inoculation with BCG would remove both latent TB skin tests from the public health arsenal and increase the false positive rates from blood tests because those treated with BCG vaccinations all have the anti-bodies that current skin and blood tests look for. The public health system would lose most of its ability to track the spread of latent TB in the American population. The current public health paradigm of track, isolate and treat TB is about to come to a horrible end for the American public health system.
LTBI AND LETHAL DOSE 5% ISSUES
The real issue with TB positive illegal alien children is what the US Military epidemiologists called the “LD-5 population” back during the days of the Anthrax postal attack after 9/11/2001. In US Military speak “LD” is lethal dose. So a chemical or biological attack that is “LD50” kills 50% of the exposed.
What the 9/11/2001 Anthrax postal attacks proved via the death of one little old lady victim of a wrongly addressed mail — mail that went through a contaminated post office distribution center — was that there is a huge population of “immune impaired” in the USA who would be “LD5” for any infectious disease.
The Center for Disease Control (CDC) list of “special consideration” for the treatment of drug resistant TB reflects that “LD5” thought process. The list includes:
• Pregnant women
• Older people who have suppressed immunity from diabetes, open heart or other major cardiac surgeries
• HIV sufferers
• Or children under 4 years of age
There are ten FDA approved antibiotic drugs for treatment of TB with a core of four drugs listed by the CDC as the “preferred treatment regimes” which lasts 6-to-9 months. Those core treatment regimen drugs include:
• isoniazid (INH)
• rifampin (RIF)
• ethambutol (EMB)
• pyrazinamide (PZA)
The reason for so many different drugs is that TB is developing resistance to antibiotic treatment. According to the Texas Department of Health Services, TB is classified into three treatment groups — TB, multi-drug resistant (MDR) TB and extremely drug resistant (XDR) TB. The first responds to the ten standard antibiotic drugs, while the last two are less and less responsive to antibiotic treatments.
Multi-drug resistant TB is defined as INH and RIF resistant.
Extreme Drug Resistant TB is MDR plus resistant to any of the following:
• Any fluoroquinolone; plus one of three following injectable second line drugs
The six-to-nine month long TB antibiotic treatment regimes must be followed rigorously, and completed, or the LTBI and the active TB infected will breed more MDR and XDR TB strains.
COUNTING THE COST
A LTBI individual represents a 5% risk of developing active TB in the first 2 years of infection and is at a cumulative 10% risk of active TB over his or her lifetime. The US Army medical community estimates 1/3 of the world population has LTBI, with World Health Organization (WHO) data showing 9.2 million active TB cases and 1.7 million deaths annually.
By way of contrast, the 2010 estimate for the US LTBI population was at 4.2% (11 million people).
That 1/3 LTBI infection number for foreigners means that adding one million new illegal aliens results in 300,000(+) new people with LTBI, or a 3% increase in America’s pool of LTBI people over that 2010 estimate. Some 30,000 of these people will have an active TB in their lifetime, and if we are talking recently infected children, up to 15,000 of that may happen in the next 2-years.
Given the current Federal Judiciary enforced defacto Open Borders policy of “All illegal aliens have the rights of citizens,” it is impossible to enforce, for reasons of Public Health, long term detention for a full directly observed therapy (DOT) course for the TB positive that are harbored in that the 12-to-20 million and growing illegal immigrant community.
The willingness of American citizens to follow TB medical protocols can be shown by the fact that even with LTBI positive US servicemen — who are getting mandatory treatment under color of authority — only 50% complete a full drug therapy course for LTBI. Thus we are certain to see more and more antibiotic resistant strains of TB everywhere.
A collapse of the current non-vaccination based public health standards on TB (See the 1996 article “The Role of BCG Vaccine in the Prevention and Control of Tuberculosis in the United States” in the notes below on the ‘track, isolate and treat’ standard model TB public health thinking) with the illegal alien community will be a huge budget issue for the Border Patrol, healthcare workers, emergency 1st responders, prisons…and increasingly Public Schools serving illegals.
The coming TB epidemic in the illegal population will force the public health system to require complete mandatory vaccination of children, all women planning to have children, healthcare workers, emergency 1st responders and prison populations nationwide for TB as the latent periods for TB will see all prisons and hospitals pretty much contaminated all the time.
The actuarial cost hit on public budget medical care coverage of families of Federal Border Patrol agents and Prison Guards infected with extremely resistant TB from Agent/Guard work related exposure will be mind boggling.
Knowing all the above, you can see why I am terrified.
THINGS TO LOOK FOR
Forewarned is forearmed, so here are a list of “The TB Epidemic is here markers” to put in your social media and RSS feeds in terms of near future events –
• Mass orders of N95 masks by State, Federal or Military health systems.
• Mass orders of BCG vaccine by State, Federal or Military health systems.
• Shortages/price spike of the list of 10 standard TB antibiotics
• “Cone of silence” media reporting of TB in public hospitals or school stories that exclude the mention of illegal alien TB sufferers.
• Border Patrol Agent or health worker families becoming infected with TB from immigrant processing centers
Given the numbers of illegal immigrant children already released by the Obama Administration — and the further numbers it wants to release before President Obama leaves office — the only thing you can say for certain about the coming TB epidemic is that it is inevitable.
UPDATE 12:30pm –
I have been watching some of the comments over on the American Thinker article quoting my column regards the Center for Disease Control and why it isn’t acting more swiftly regards the TB threat.
I am going to point everyone to this book by Thomas S. Kuhn so you can understand their inaction —
The Structure of Scientific Revolutions: 50th Anniversary Edition
Kuhn’s key point is that the only way that scientific paradigm change happens is over the dead bodies of those that hold the obsolete paradigm, while those that replace them hold the new scientific paradigm.
The CDC is made up of scientists just like the ones Kuhn described, scientists who have fought TB one way their entire careers and cannot think outside that paradigm.
They are so hugely locked into the existing “track, isolate and treat standard TB public health model” that they cannot acknowledge the reality that President Obama’s mass importation of unscreened for TB illegal alien children has already destroyed their life’s work.
My intent in writing the column was to provide “The Hand Book for the Coming TB Epidemic” for parents and public employee union shop stewards in the Border Patrol, Public Schools, and other State/Local Health Care/emergency 1st responder communities to give them all a template to push the transition from the “made obsolete as a result of stupid public policy” — See Obama’s DACA executive orders — “track, isolate and treat” public health model to a mass vaccination model.
Public employee unions have a huge dog in the fight against this coming TB epidemic and the Open Border policy that is creating it. Telling them how to avoid watching their children suffer a tortured agonizing death from TB is serving the general public’s interest as well as the unions.
I owe my 6-year old, 2 year old and 2-month old children that much and more.
Official TB Sources For Column:
The Big Picture
Tuberculosis (TB) Treatment
Treatment for TB Disease
Treatment of Drug-Resistant Tuberculosis
LTC Jamie Mancuso MD, MPH, “Tuberculosis in the US Military” Sept 15, 2010, Program Director, Preventive Medicine Residency Walter Reed Army Institute of Research
“The Role of BCG Vaccine in the Prevention and Control of Tuberculosis in the United States” A Joint Statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices, Morbidity and Mortality Weekly Report, April 26, 1996 / Vol. 45 / No. RR-4
Tuberculosis Among Nonimmigrant Visitors to U.S. Military Installations
Tuberculosis, Tuberculin Skin Test, and BCG Vaccine, Military Vaccine Agency, 1 March 2007