Two hundred and ninety-six refugees were diagnosed with active tuberculosis (TB) between 2010 and 2014 in Minnesota, according to the Minnesota Department of Health.

Seventy-one were diagnosed within one year of their arrival, while 225 were diagnosed after the first year.

The number of active TB cases reported among refugees arriving in Minnesota is ten times higher than reported in any of the fourteen other states that have released refugee TB data to the public, or made it available to Breitbart News.

The previous high among the other reporting states was Wisconsin, which reported 27 cases of active TB among refugees arriving in the state between 2014 and 2015.

The other thirteen states, and the number of diagnosed cases of active TB among refugees are:

With 296 cases of active TB diagnosed among refugees over five years, Minnesota reported more cases than all fourteen other states where that data has been made available — a combined total of 172 cases.

The total number of active TB cases diagnosed among refugees resettled in the United States in recent years now stands at 468, but 36 states have yet to report their number. Data reported in several of the fourteen states in which there is some data (Ohio, North Dakota, Kentucky, and Tennessee) is only partial, and in other states (California, and Indiana) covers only the most recent year, rather than the five most recent years.

The Minnesota Department of Health provided Breitbart News with this statement when asked why Minnesota has reported ten times more active TB cases among refugees than any of these fourteen other states:

The data you are referring to, showing 50% of the 593 foreign born residents of Minnesota diagnosed with TB arrived as refugees, represents years 2010 – 2014. The majority of those refugees actually developed TB disease after being in Minnesota at least five years, and many had been in the US at least 10 years, so these are not new arrivals to the US. The presence of other medical conditions is the chief risk factor for the activation of TB disease in a person with latent infection (and remember, a third of the world has latent TB infection). These conditions include diabetes, cancers, immune suppressing medications, and renal disease. These are conditions common with the American diet and lifestyle, and new risk factors for these refugee populations. Tuberculosis can be treated with antibiotics. Often times the reason that Minnesota reports TB and other infectious diseases at higher rates than other states is because we have a stellar system of surveillance and screening. From 2010 – 2014, in addition to their overseas screening, 99% of our primary refugee arrivals completed an additional health screening within 90-days of their arrival in the US. If you look at national surveillance data in 2014, states with a lower percentage of foreign-born cases arriving as refugees often have a higher percentage of unknown or missing data.

During the five years between 2010 and 2014, 732 cases of active TB were diagnosed in Minnesota. Of these, 81 percent, or 593, were foreign-born. Of foreign-born cases, 50 percent, or 296, were refugees, according to “The Epidemiology of Tuberculosis in Minnesota, 2010-2014,” a report published by the Minnesota Department of Health.

Minnesota’s 81 percent of TB cases diagnosed among foreign-born residents is significantly higher than the 66 percent of TB cases in the entire country that were diagnosed among foreign-born residents in 2015.

As Breitbart News reported previously, one major factor in the sudden increase in the number of reported cases of TB in the United States in 2015 (the first time in 23 years the number of TB cases has increased) is the increase in the foreign-born population as a percentage of the total population during this period of time.

Twenty-nine percent of the 593 foreign-born cases of active TB diagnosed in Minnesota, or 161, were attributed to Somali born migrants. Almost all Somali migrants to the United States have arrived under the federal refugee resettlement program.

The state of Minnesota’s population is 5.5 million. Fox News reports the population of the Somali community in the state of Minnesota is 40,000, according to census data. The Star Tribune, citing “community leaders,” reports the Somali population in the state may be as high as 70,000, or about one percent of the state’s total population.

During the five years between 2010, and 2014, 22 percent of Minnesota’s active TB cases (161 out of 732) were diagnosed among the one percent of the state’s residents born in Somalia.

The remaining 99 percent of the state’s population accounted for 78 percent of Minnesota’s active TB cases (471 out of 732).

At an average cost of $17,000 for each case of successfully treated active TB, taxpayers of Minnesota paid an estimated $5 million to treat the 296 cases of active TB diagnosed among refugees between 2010 and 2014–$3 million for the 161 Somali refugees diagnosed with active TB, and an additional $2 million to treat the 132 refugees diagnosed with active TB who were not born in Somalia.

During these five years, 10,128 refugees were resettled in Minnesota, according to the Department of State’s interactive website. Of these, 4,163 listed Burma as their country of origin and 3,458 listed Somalia as their country of origin.

Dahir Adan, who attacked ten Americans in a mall in St. Cloud, Minnesota on September 17 before he was shot and killed by an armed off-duty police officer, was a Somali refugee who arrived in North Dakota in the 1990s and subsequently moved to Minnesota, where he was a resident at the time of his death.

One particular note of concern from a health perspective is the number of refugees allowed to arrive in Minnesota with a pre-existing TB health classification who developed active TB after arriving in the United States.

Refugees diagnosed with active infectious TB receive a Class A TB risk health classification and are not allowed to enter the country unless they receive a waiver from the Department of Homeland Security. Some refugees with a Class A TB diagnosis apparently have received such a waiver, but the Department of Homeland Security has not made public the number of such waivers it has granted.

Refugees who receive Class B1, B2, and B3 TB risk classifications in their overseas medical screenings are allowed to enter the United States.

The Centers for Disease Control defines Class B1 TB risk classifications for refugees with “chest radiograph findings that are consistent with tuberculosis infection without positive sputum smear or culture results for tuberculosis,” and Class B2 TB risk classifications for refugees with “latent tuberculosis infection.”

Of the 71 refugees/immigrants “diagnosed with TB within one year after arrival to U.S., Minnesota, 2010-2014,” 17 percent, or 12, arrived with Class B1 TB health risk classifications, and nine percent, or six, arrived with Class B2 TB health risk classifications.

Most of the 296 refugees were diagnosed with active TB during Hillary Clinton’s tenure as Secretary of State, from January 2009 to February 2013.

Placement of refugees in specific states is determined by the Assistant Secretary of State for Population, Refugees, and Migrants, in consultation with the director of the Office of Refugee Resettlement, which is part of the Department of Health and Human Services.

Though the Refugee Act of 1980 requires that the federal government “consult with” state, local, and county governments prior to the placement of refugees in those jurisdictions, that requirement has been largely ignored by the federal government.

Breitbart News previously reported that 22 percent of refugees arriving in Minnesota tested positive for latent TB infection at the time of their initial domestic medical screening.