At the end of 2003, the U.S. State Department agreed to allow 15,000 Hmong refugees to emigrate from Wat Tham Krabok Refugee Camp in Thailand. Of those, about 4,400 were bound for Minnesota.
But a few months into the relocation, the process ground to a halt when it was discovered that a few of the refugees had tuberculosis, including one who had come to Minnesota.
The State Department enacted a stricter screening process and treated the infected people. A few weeks later, with the infection under control, the path to the United States was reopened.
When it comes to TB, Americans are, by and large, lucky: The United States has experienced an overall decrease in the number of tuberculosis infections in recent years, with 13,767 cases reported in 2006, down 3.2 percent from 2005. That represents the lowest rate since 1953, when national reporting began.
In Minnesota, however, it's a different story. The rate of tuberculosis infection increased 9 percent between 2005 and 2006.
"We've gone from 199 cases last year, and this year we already have about 225, so it looks like it's probably going to be 235 or 240," says Deborah Sodt, Minnesota Department of Health TB program manager. "This will be the highest year we've had in recent memory."
Even more worrisome: About 15 percent of the TB diagnosed in Minnesota is resistant to at least one of the four drugs commonly used to treat the disease. There was also a recent case of multi-drug resistant tuberculosis—the same kind that triggered a nationwide panic earlier this year when patient Andrew Speaker flew on a commercial flight after being diagnosed.
The vast majority of TB cases in Hennepin County are diagnosed in people who recently emigrated from places where the disease is more common, including sub-Saharan Africa (specifically Somalia and Ethiopia) and southeast and south Asia (mostly Vietnam, India, and Laos). In 2005, for example, Minnesota received 2,233 immigrants from Somalia, where 1 in every 350 people has TB, and 1,303 from Ethiopia, where the infection rate is 1 in 183.
"Nationwide, about 50 percent of the TB in the U.S. is diagnosed in foreign-born people. In Minnesota, it's more like 82 to 85 percent," says Dr. Dean Tsukayama, medical director of the Tuberculosis Control Program for Hennepin County. "I think that explains why we have more cases per capita: We have more refugees."
This isn't the first time Minnesota has grappled with TB. In 1992, a homeless man spread the disease to at least 45 regulars at a bar he frequented, a case that garnered national attention from The New York Times.
Generally, however, TB isn't that easy to catch. It takes hours of exposure over days or weeks. "You're not going to get it standing behind someone at the Target checkout counter who's just coughing," says Sodt. And the chances of coming into contact with an infected patient remain relatively low despite the recent spike: The infection rate in Minnesota is still just 1 in 12,500.
Yet even a few cases can strain resources. Curing tuberculosis requires up to 12 pills a day for up to nine months, with side effects that include nausea, vomiting, and rash. To keep patients from quitting the regimen—which raises the risk of drug-resistant TB—the standard method of treatment is Directly Observed Therapy. "Basically, what it means is that there's someone who is with the client and observes the client swallow their medication," explains Carol Klitz, head nurse of TB control for Hennepin County.
Local doctors are reluctant to sound the alarm about the upswing in TB too loudly for fear of stirring up anti-immigrant backlash. That was the case in Emporia, Kansas, after a Somali man was found to have active TB. Some residents called for a mandatory yearlong quarantine for all immigrants, and one person called for local Somalis to be "sent back to Africa."
"There's stigma attached to it," Sodt says. "It becomes an anti-immigrant thing if you start talking about it, and we really don't want that to happen."
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