“Paul Ryan is to blame for importing TB to Wisconsin, which increased 40 percent in 2015,” his challenger Paul Nehlen tells Breitbart News.

Nehlen is running against Ryan in the Republican primary. It will be held on August 9 in Wisconsin’s First Congressional District, which “encompasses Kenosha and Racine counties and portions of Milwaukee, Rock, Walworth and Waukesha counties.”

“Paul has voted for every budget that has funded the federal refugee resettlement program, including the most recent ‘Cromnibus Budget’ he rammed through as Speaker,” Nehlen adds.

“Federal taxpayers are paying resettlement agencies, like Lutheran Social Services of Wisconsin, more than $1 billion per year to resettle refugees with high rates of active tuberculosis across the country, and Paul Ryan is responsible for that,” Nehlen adds.

“A vote for Paul Ryan is a vote to bring more TB to Wisconsin’s First Congressional District,” Nehlen tells Breitbart News.

A report from the Wisconsin Department of Health Services released in April confirms Nehlen’s claim that the number of active tuberculosis (TB) cases increased by 43 percent in one year, from 48 in 2014 to 69 in 2015.

Most of the increase in 21 active cases of TB is due to a spike in the number of foreign-born cases of TB, which increased from 33 in 2014 to 49 in 2015, an increase of 16 in foreign-born cases in one year, more than 70 percent of the total increase.

At least four of the 69 cases of TB in Wisconsin in 2015 were diagnosed and treated in the First Congressional District, which Paul Ryan represents: three cases were in Racine County and one was in Kenosha County. In addition, the First Congressional District contains part of Milwaukee County, where 23 cases of active TB were diagnosed, and part of Waukesha County, where two cases of active TB were diagnosed.

The increase in the number of active TB cases in Wisconsin and the number of foreign-born active TB cases in the state in 2015 comes in the same year that the number of refugees arriving in the state from Burma, a country with very high rates of active TB and one of the highest rates of multi-drug resistant (MDR) TB in the world increased by over 67 percent, from 557 in 2014 to 935 in 2015.

Overall, the number of refugees sent to Wisconsin by the federal government increased by 25 percent in one year, from 1,132 in 2014 to 1,415 in 2015.

The number of Burmese refugees sent to Wisconsin has been steadily rising each year since 2009, when 338 of the 536 refugees sent to Wisconsin (63 percent of that year’s total) came from Burma.

Burmese refugees as a percentage of total refugees increased from 49 percent (557 out of 1132) in 2014 to 66 percent (935 out of 1,415) in 2015.

In 2012, the percentage of all refugees sent to Wisconsin by the federal government who came from Burma was also 49 percent (387 out of 785).

It is not clear how many of the 49 cases of foreign-born TB in Wisconsin in 2015 were from recently arrived refugees, which the Department of Health Services defines as those who have lived in the United States for less than five years, and how many are from long-time refugees, legal immigrants, temporary immigrants, or illegal immigrants.

The TB rate for new refugees—those living in the United States for less than 5 years—in Wisconsin is 70 per 100,000, which is more than 200 times greater than the TB rate for American-born residents of Wisconsin, which is 0.33 per 100,000, according to the Wisconsin Department of Health Services.

The incidence of TB among Burmese refugees is very high—53.2 per 100,000. Likewise, Somali refugees have a high incidence of TB—60.8 per 100,000.

Between 2005 and 2014, the number of active TB cases reported in Wisconsin among foreign-born residents from the Hmong community (from Laos through Thailand) was 69. The number of active TB cases among foreign-born residents from Burma was 12.

Breitbart News asked the Wisconsin Department of Health Services to provide details on the increase in active TB cases in Wisconsin in 2015 but has not received a response.

As Breitbart News reported previously, the rise of MDR TB in Wisconsin has been a public health problem in the Badger State for a number of years.

In the eight years between 2005 and 2012, a total of twenty cases of MDR TB, all foreign-born, were diagnosed and treated in Wisconsin, at an estimated cost to the taxpayers of Wisconsin of $3 million.

Then, in 2013, a MDR TB outbreak among resettled refugees in Sheboygan, Wisconsin forced the Wisconsin State Legislature to appropriate an additional $5 million to deal with the public health crisis there.

Only one of the nine cases of active TB diagnosed as part of that outbreak turned out to be MDR.

Nonetheless, a TB outbreak of that magnitude stretched the ability of state and local resources to cope.

MDR TB in Wisconsin went from three cases in 2014 to four cases in 2015, according to the Wisconsin Department of Health Services, about double the national rate.

To put that number in perspective, Burma averages about 9,000 new cases of MDR TB each year.

“Not only is Paul Ryan importing TB and MDR TB to Wisconsin and the First Congressional District using federal tax dollars, he is forcing Wisconsin residents and his constituents to pay for the exorbitant health care costs associated with the treatment of these foreign-born cases of active TB to be paid for out of their state and local tax payments,” challenger Nehlen adds.

The primary in Wisconsin will be held on August 9.