A few weeks ago I came across a Morbidity and Mortality Weekly Report (MMWR) from the Center for Disease Control and Prevention (CDC) about tuberculosis and the United States – Mexico border.This week I want to discuss that report, "Preventing and Controlling Tuberculosis Along the U.S. – Mexico Border," which was released in January 2001.
Along the roughly 2,000 mile stretch of the border, the number of tuberculosis or “TB” cases, including drug-resistant strains, has increased, according to the report. Accordingly, the incidence of TB for border counties was higher than the national TB rate.
In 1999, 3/4 of the total number of Mexican-born individuals living in the U.S. with TB were from the four states that border Mexico; California, Texas, Arizona and New Mexico-- there were 67 cases in Arizona, according to the report.
In the report the CDC lists five factors that contribute to the prevalence of TB in the border states. These include; Mexico’s overall higher TB rate, low socioeconomic status and limited access to healthcare in Mexico, frequent border crossing, language and sociocultural differences and lack of coordinated care from both sides of the border.
It is chiefly the constant flow of people across the border, either legally or illegally, that is responsible for the transfer of TB from countries south of the border into the U.S.
“TB is brought into the United States from Mexico and Central America in three ways: a) persons with active TB disease move northward across the border; b) persons with latent TB infection experience active disease after arrival in the United States; or c) U.S. residents touring Mexico, including immigrants, acquire TB disease after returning to the United States,” according to the report.
Table courtesy of the Center for Disease Control, Morbidity and Mortality Weekly Report
The threat is amplified by the approximately 1 million people who cross the border cross the border daily and the 2.7 million individuals who illegally live in the U.S.
Many binational patients do not seek diagnosis, let alone continued care because they fear the potential repercussions of a TB diagnosis-- loss of housing, employment, income or even legal action for living in the country illegally. Not only that, but there are minimal resources for illegal immigrants in the U.S. healthcare system.
In order to combat the growing threat of TB, the CDC created the, TB Along the U.S. – Mexico Border Work Group. The report outlines the work group’s four focus areas; surveillance needs, case management and therapy completion, performance indicators and program evaluation, and research needs.
“Ultimately, lowering TB rates in the border area and reducing racial and ethnic disparities of TB disease depends on identifying and treating infected persons on both sides of the border until patients are cured. Therefore, TB prevention and control efforts along the U.S. – Mexico border require the cooperation of local, state, and national TB control programs in both countries […],” according to the report.
Surveillance includes communication and collaboration of U.S. and Mexican healthcare providers as well as establishing an electronic registry of binational TB cases. The CDC also notes the need for surveillance for immigrants with TB who are in Immigration and Naturalization Service (INS) custody. Medical staff and local health departments are not often notified when these individuals are released.
An increase in surveillance would greatly aid in the control of TB. Surveillance extends beyond simply recording the number of patients; it also includes monitoring the quality of their treatment and their progress.
Prompt diagnosis, careful observation of treatment, commitment to treatment and evaluation of healthcare contacts are all aspects of the case management and therapy completion focus area.
In order to accomplish all of these aspects, the CDC suggests screening populations that are at a higher risk for TB; including, HIV patients, medically underserved individuals, and immigrants that have lived in the U.S. for less than five years.
Performance indicators and program evaluation involves sharing laboratory and surveillance data between countries as well as healthcare providers increasing their own cultural awareness.
Discrepancies in coordinated care create confusion among both healthcare providers and patients and can negatively impact critical treatment.
The final focus area of the work group is research needs, which involves identifying strategies to eliminate TB at the border. This also includes researching all aspects of individual TB cases from diagnosis to treatment completion.
Combined, these four focus areas attempt to improve documentation, diagnosis and treatment of TB. They also illustrate the great need for coordination and collaboration between the U.S. and Mexico in both the clinical and human setting.
A key control of this work is funding. However, the report states that counties along the border are among the poorest economically in the U.S. and that about one third of border families live at or below the poverty line.
In an ideal world, the need would outweigh the costs and programs would be implemented to combat TB.
Likewise, the costs should not outweigh the risks. A lack of programs could lead to a lack of treatment and put the lives of U.S. citizens at risk.
Even though this data is somewhat dated, the disease has not been eliminated and thus the cases discussed in the report probably still exist today.
The air that is shared across the border is unavoidable but has become increasingly hazardous. Hopefully the alarming data presented in this report will encourage more aid in eliminating and controlling TB.
More Information:
CDC resources for tuberculosis
Read about the 2008 trends in tuberculosis
Read about the fight against drug-resistant tuberculosis
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