February 18, 2015

Illegal Immigration and the Threat of Infectious Disease

There's a growing health concern over illegal immigrants bringing infectious diseases into the United States. Approximately 500,000 legal immigrants and 80,000 refugees come to the United States each year, and an additional 700,000 illegal immigrants enter annually, and three-quarters of these illegal immigrants come from Mexico, El Salvador, Guatemala, and Honduras.

Legal immigrants and refugees are required to have a medical examination for migration to the United States, while they are still overseas. This is the responsibility of the Centers for Disease Control and Prevention (CDC), which provide instructions to the Panel Physicians who conduct the medical exams. The procedure consists of a physical examination, an evaluation (skin test/chest x-ray examination) for tuberculosis (TB), and blood test for syphilis. Requirements for vaccination are based on recommendations from the Advisory Committee on Immunization Practices.

Individuals who fail the exam due to certain health-related conditions are not admitted to the United States. Such conditions include drug addiction or communicable diseases of public health significance such as TB, syphilis, gonorrhoea, leprosy, and a changing list of current threats such as polio, cholera, diphtheria, smallpox, or severe acute respiratory syndromes. Illegal immigrants crossing into the United States could bring any of these threats, however. Southern Texas Border Patrol agent Chris Cabrera warns: "What's coming over into the US could harm everyone. We are starting to see scabies, chicken pox, methicillin-resistant Staphylococcus aureus infections, and different viruses."

Illegal immigration may expose Americans to diseases that have been virtually eradicated, but are highly contagious, as in the case of TB. This disease rose by 20% globally from 1985 to 1991, and was declared a worldwide emergency by the World Health Organization (WHO) in 1995. Furthermore, TB frequently occurs in connection with the human immunodeficiency virus. Fortunately, more than 90% of Central Americans are vaccinated against TB, according to the WHO.

The federal government's Department of Homeland Security has public health controls in place to minimize any possible health risks, including medical units at the busiest border stations and measures to protect Customs and Border Protection including gloves, long-sleeve shirts, and frequent hand washing. In addition, the CDC’s Division of Global Migration and Quarantine has measures in place to protect the population from communicable diseases. The agency works through a variety of activities to prevent the introduction, transmission, and spread of communicable diseases in the United States. It operates Quarantine Stations at ports of entry; establishes standards for medical examination of persons headed legally for the United States; and administers interstate and foreign quarantine regulations governing the international and interstate movement of humans, animals, and cargo. The agency also alerts state authorities of newly arrived immigrants with certain health conditions.

The CDC's Epidemiology Team also monitors infectious diseases among immigrants and refugees with their disease surveillance systems, investigations of disease outbreaks, and their Migrant Serum Bank of anonymous immigrant and refugee blood samples available for research. Other branches of the CDC protect US health through ensuring the quality of overseas medical exams required of immigrants and refugees.

Concerns have been specifically raised about children, due to the risk of infections spreading in public schools. But the CDC currently believes that the children arriving at US borders "pose little risk of spreading infectious diseases to the general public." The CDC also confirms that vaccinations are provided to all children who do not have valid documentation. All children are initially screened for visible and obvious health issues (for example, lice, rashes, diarrhea, and cough) when they first arrive at Customs and Border Protection facilities.

References:

Details of the CDC's Immigrant, Refugee, and Migrant Health Branch:

www.cdc.gov/ncezid/dgmq/irmh-fact-sheet.html

Factsheet on Protecting America's Health at US Ports of Entry:

www.cdc.gov/ncezid/dgmq/pdf/quarantine-fact-sheet.pdf