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Wednesday, 29 August 2007

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Another Illegal Immigrant Spreads Tuberculosis
August 28, 2007
Illustrating the serious health threat presented by illegal immigrants, a Mexican teenager has been forcibly detained with a highly contagious strand of tuberculosis (TB) just weeks after an outbreak of the fatal disease at a poultry plant in a different state.
This week’’s case involves an illegal immigrant teenager named Francisco Santos in an Atlanta suburb of about 750,000 residents. Gwinnett County health officials obtained a court order to detain the illegal alien because he refused treatment for active, contagious tuberculosis and instead offered to return to his native Mexico. Authorities refused because Santos is highly contagious and can spread the fatal disease, that primarily affects the lungs and can spread to the kidneys and spinal column, to anyone he comes in contact with.
Just weeks ago there was a tuberculosis outbreak (at least 131 tested positive) at a South Carolina poultry plant and health officials said the culprits were illegal immigrants infected in their home country before sneaking into the United States. The situation is becoming a crisis in the Carolinas because thousands of illegal immigrants go there annually to work in poultry, construction and other industries.
In fact, the U.S. Centers for Disease Control (CDC) reports that there are about 300 new TB cases a year in South Carolina alone. This is because, unlike legal immigrants who must first submit to a health test, those who enter the country illegally may carry a variety of contagious and fatal deceases that will go undetected until communities are seriously threatened.
A recent U.S. government report outlines the high incident of TB among new immigrants and reveals how the disease persists in those who are infected for many years after entering the country. A separate but equally alarming report published by the National Institutes of Health in 2002 attributed a TB epidemic in Delaware’’s poultry plants to the fact that most workers were from Mexico and Guatemala, countries where the disease is prevalent.
1,100 tuberculosis patients banned from flying
August 29, 2007 TAIPEI, CNA

Health authorities said they had notified some 1,100 tuberculosis patients in Taiwan that they are prohibited from traveling abroad by air.
The Center for Disease Control and Prevention disclosed that those placed under air travel restrictions comprise 188 multi-drug-resistant tuberculosis patients and over 900 other active infectious TB patients.
According to Chou Chih-hao, deputy director of the center, there are 399 multi drug-resistant TB patients in Taiwan, of whom 188 have not yet tested negative for the disease. He said that the more than 1,100 TB patients on the restricted list will not be allowed to leave Taiwan by air unless they can present documentary proof issued by their doctors within the past week declaring that they are no longer infectious.
According to center officials, the center originally planned to publicize related measures early next year to go with a ban on air travel for infectious TB patients, but decided to implement the measures from Sept. 1.
They said the measures need to be in place urgently after a southern Taiwan couple -- both multi drug-resistant TB patients -- traveled to China July 21, causing a public health alarm and prompting health officials on both sides of the Taiwan Strait to track them down.
Star-Gazette ( A pathologist full of life Retired Elmira physician, 90, spends time distance running and taking scientific expeditions. Not many people can say they've shared space with mountain gorillas. But Goryun Nigogosyan can say not only that, but also that he has survived tuberculosis, has felt the flippers of leatherback turtles and has performed thousands of autopsies. Nigogosyan of Elmira, is a retired pathologist and former chief of the department at St. Joseph's Hospital. " Nigogosyan was born in Istanbul, Turkey, of Armenian descent. His parents were teachers. For Nigogosyan, however, there was never a doubt in his mind that he would go into medicine. "I wanted to be (Louis) Pasteur," he says. Nigogosyan's father gave him biographies to read, and after reading about Pasteur's life story, he says his mind was made up. He also says his career options were limited. "Being an Armenian in Turkey was difficult ... there was such hatred between the Turks and the Armenians ... and the prejudice was terrible," Nigogosyan says. That's why Nigogosyan graduated from Istanbul Medical College -- with a great desire to leave his native country. Life in Switzerland. After spending three years in the Turkish army (from 1942 to 1945), Nigogosyan ended up in Switzerland, working as an attending physician at a world-renowned tuberculosis sanatorium in Davos. It was here, at Wald Sanatorium, where he met his future wife, Jeannine. She was a nurse from Belgium, and Nigogosyan says he vividly remembers the moment he met her. Numerous tuberculosis sanatoriums were in operation at the time, but Wald Sanatorium was perhaps the most prestigious. Only the wealthy could afford to stay there, 5,000 feet up a mountain, in the middle of the woods, and people traveled internationally for treatment. (One of Nigogosyan's patients was the daughter of the king of Nepal.) Goryun and Jeannine Nigogosyan contracted tuberculosis while working in Davos, and both became patients for a while. Physicians at the sanatorium prescribed programs for patients, depending on their specific condition, fever and X-ray results, explains Nigogosyan. People had to adhere to certain diets and exercise regimens. And all patients had their own chaise lounge on outdoor verandahs, on which they had to rest for certain periods of time in the morning and afternoon, with the "healing" air of the Alps to assist them. "This was the way tuberculosis was treated then," he says

New Zealand Herald
Nurses check students after 17-year-old has TB
5:00AM Tuesday August 28, 2007 By Martin Johnston
Lynfield College students are being assessed for contact with tuberculosis after a 17-year-old was diagnosed with the disease and admitted to Auckland City Hospital.The student was confirmed last week as having tuberculosis in the lungs and is receiving treatment in a negative-air-pressure isolation room at the hospital designed for patients with infectious diseases. Medical officer of health Dr Greg Simmons, of the Auckland Regional Public Health Service, said yesterday nurses were at the Auckland school to identify students and teachers who had been in contact with the pupil.
Lynfield College has about 1800 students.
"Mantoux" skin tests would be done on school and home contacts of the 17-year-old, he said.
A positive test result indicates the person has been infected with the bacterium, but only 10 per cent of those infected develop active, infectious disease. The rest have latent TB infection - the bacteria become "walled off" by scar tissue. The disease can flare up at any time in these people when their immunity declines, more commonly in the elderly or those with other diseases like cancer or diabetes.
"If positive, those people would be offered treatment to stop them going on to develop tuberculosis disease," said Dr Simmons. "It's not a very nice disease, but it's one that develops slowly and certainly there are cures."
He said the 17-year-old was "not extremely sick. There are no major concerns in terms of the case".
The Government in 2004 extended TB screening requirements for migrants because of increasing numbers of foreign travellers coming to New Zealand. The Health Ministry says each TB case can infect 10 to 15 people in a year. More than half of New Zealand's 300-400 cases a year are in people born overseas.
* 10 per cent of those who catch the bacteria will develop "active" disease.
* Main symptoms: cough for more than three weeks, possibly blood in spit, weight loss, sweating, especially at night, fever, constant tiredness, breathlessness.
* Spread by coughing and even by singing.
* The bacteria can stay in the air for several hours but it usually takes many hours of close contact with an infectious person to catch the infection.
* 137 cases were reported nationally in the first half of this year.
* Treated with antibiotics.

Positive TB tests for Island cabbies
Cheryl Chan, The Province
Published: Monday, August 27, 2007
The Vancouver Island Health Authority is trying to quell fears a tuberculosis outbreak in Port Alberni may have spread to the general population after six cab drivers tested positive in skin tests for TB.
"None of them have the disease," said medical health officer Dr. Sharmaine Enns. "Don't be afraid of taking a cab or walking down the streets of Port Alberni."
There have been 30 confirmed cases of active tuberculosis in Port Alberni since May 2006.
Three people have died, but for reasons "completely unrelated to TB," said Enns. A third has completed treatment and is considered cured. The rest are on antibiotic treatment. None is contagious.
Health authorities have screened more than 2,000 people and identified 58 patients who are infected with the bacteria. They have been put on preventive treatment to ensure the infection does not develop into the full-blown disease.
"We've been looking hard for the infection," said Enns. "We cast our nets very far for contact follow-up."
One of the contact follow-ups led to United Cabs in Port Alberni after a driver was exposed to a person who has active TB.
The company's 30 cab drivers were screened earlier this month. Six tested positive for the infection.
"All it means is that they have been exposed to TB some time in their past," said Enns. "They are now part of [the] one-third of the world [population] who has TB infection."
The 30 people who were diagnosed with active tuberculosis are linked to each other, said Enns. "They're not random cases." Most are native.
Last year, there were 331 cases of tuberculosis reported in B.C., mostly in Vancouver and Richmond. The central island, which includes Port Alberni, Nanaimo and Parksville, averages about five new cases of active TB a year.
Enns believes the outbreak has peaked. "In the last two or three months, we have only received one new active case."
But she estimates the task of notifying and testing people who may have come in close contact with the patients with active tuberculosis will take a year or two more.
Port Alberni Coun. Cindy Solda, in charge of the health portfolio, said the outbreak has put a spotlight on a disease people don't really think about.
But while she is not concerned about tuberculosis on a personal level, she said the city will ask a health- authority representative to attend the next council meeting in September to talk to townspeople.
"The rumours are all over town . . . We need to know more."
- TB is transmitted when a person with infectious TB coughs or sneezes and the airborne germs are inhaled by someone nearby.
-There are two types of TB. Latent TB infection occurs when a person inhales TB germs but their immune system suppresses the bacteria. The patient will not exhibit symptoms and is not contagious. TB disease occurs when the germs activate and causes damage to organs.
-Tuberculosis is curable and treatment is free of charge in B.C

DANBURY, Conn. -- Before going to school, dozens of students and staff at Danbury High School are being asked to be tested for tuberculosis after a student tested positive for the disease earlier this month.
That student was diagnosed with tuberculosis over the summer, but was sick with a fever during classes last winter.
To be safe, school officials said they invited students and staff who were in contact with that person to be screened.
Catherine Richard, the Principal, said, "I think the goal is to be as cautious as we can be. We don't expect to find any other students or staff infected but we want to be as cautious and careful as we can with our students and our staff."
All of the students and staff tested will have to come back in two to three days so nurses can see if there's any reaction on their skin.
Those results will be just in time for the start of the school year on Friday.

Sunday, 26 August 2007

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Homeless tuberculosis patient jailed for refusing treatment
1:30 p.m. August 24, 2007
LODI – Police arrested a homeless man infected with tuberculosis they fear may have exposed others when he refused to follow proper treatment procedures for the contagious disease.
Bobby Presley, 48, was booked into an isolation cell Thursday at the San Joaquin County Jail, where he will be treated until public health officials clear him for release, according to an arrest warrant.
He was being held in lieu of $252,000 bail on suspicion of violating his treatment orders and several drug charges.
Test results will determine whether Presley has a drug-resistant strain of the lung disease, officials said.
Presley was screened for tuberculosis in April as a condition for staying in a Sacramento shelter. In May, tests confirmed he was positive, but shelter managers couldn't find him.
Presley was taken to Lodi Memorial Hospital on Aug. 10 after police served him with isolation orders. While at the hospital, Presley left his room several times and had to be forced to take his medications, hospital staff said.

Information from: Lodi News-Sentinel,
Teen jailed for TB denied having disease, officials sayBy CRAIG SCHNEIDERThe Atlanta Journal-ConstitutionPublished on: 08/25/07
When doctors told Francisco Santos he had tuberculosis Friday, health officials said the Gwinnett County 17-year-old refused to believe it.
Then the wiry, dark-haired youth refused to submit to any treatment. Worse, he said he was walking out of the Gwinnett Medical Center in Lawrenceville and heading back to his home country of Mexico, officials said.
Francisco Santos lives in Norcross with at least one parent and several younger siblings, records show.
"I think he was scared," said David Will, attorney for the Gwinnett County Board of Health.
Gwinnett health officials found themselves in a bind. They had a person with a case of active, contagious tuberculosis, refusing treatment and threatening to carry the disease to a foreign country.
They also were aware of the recent incident involving Atlanta lawyer Andrew Speaker, who also has tuberculosis. After Speaker left for his wedding in Greece, a national news conference set off an international health scare.
In this case, the Gwinnett officials acted decisively: They put Santos in jail Friday evening, in a rare act of a government agency confining a sick person. Santos is the only inmate in a special medical isolation cell designed for inmates with contagious conditions. The cell, which measures about 15 feet by 20 feet, has a special ventilation system that keeps the air from reaching other inmates.
The 5-foot-5 teenager has a toilet, sink, bed and a mirror made of polished metal. Two deputies guard him and the other medical inmates.
Will, the county health attorney, said Santos was detained because he is a public health threat.
"He has active, contagious TB," Will said Saturday. "He is at risk of communicating that with anybody he comes in contact with."
Will said Santos is being held under a court order for confinement. He'll stay in that cell until either he starts cooperating and accepting treatment, or a judge makes some other decision at a Sept. 5 hearing. At that commitment hearing, the judge could decide to place him in a hospital with security.
Looking for recent contactsMeanwhile, Gwinnett health officials have started tracking down those people Santos may have come in contact with, such as family members. Will said Santos, who lists his address in jail records as Norcross, lives with at least one parent and several younger siblings. His jail records also indicate he is unemployed.
Santos listed his birth place as Mexico. Will said he did not know the status of Santos' citizenship. The Gwinnett jail has two federal immigration agents who screen foreign-born inmates to determine whether to investigate their status and potentially place a hold on them for deportation.
As early as Monday, Gwinnett health officials expect to speak publicly about the extent of Santos' disease and his treatment.
Right now, it remains unclear how long his confinement may go on. If he starts cooperating and obtaining treatment, he could be moved to a hospital and, when he is no longer contagious, sent home for further treatment. But if he continues his denials, the judge may commit him to a hospital with security for treatment, Will said.
Speaker case drew attentionHis case arrives only about a month after Speaker, the Atlanta attorney, was released from hospital isolation in Denver. When the Atlanta-based Centers for Disease Control and Prevention interrupted his honeymoon in Greece, Speaker and his bride raced back to the United States to avoid detention in Italy.
Once back in the U.S., Speaker spent time under armed guard at Grady Memorial Hospital — the first person placed under a federal isolation order in more than 40 years. Speaker's case drew heightened concern because he was diagnosed with a particularly drug-resistant form of tuberculosis.
Will he did not know the extent of Santos' disease.
Speaker, commenting on the Santos case, said that if indeed the testing was accurate on Santos being contagious, then the Gwinnett officials acted appropriately.
"It's in the public's interest that he be forced to seek treatment," Speaker said Saturday.
At the same time, Speaker stressed that his case was different. When he left the country, Speaker said Fulton County health officials had said he was not contagious and not a threat to anyone. Fulton County health officials, however, have contended they clearly "advised" Speaker not to travel, and they have since been criticized for failing to sequester Speaker before he departed the country.
In the Santos case, custody was sought by the Gwinnett County health department through a petition for commitment. Such petitions are "extremely rare," Will said. "I personally have not been involved in one in more than a decade," he said.
In his isolation cell, Santos is alert and walking around, officials said. He does not have the appearance of a sickly person and has not been a problem for jail officials, apart from his unwillingness to accept treatment, officials said.
The Gwinnett officials hope his family members talk some sense into the headstrong youth.
"Everybody's hoping he will undergo the treatment," Will said
Samuel Fisk, President Colorado State Medical Society:
we should never forget that a phthisical invalid is a human being...who values his independence as we all do...who chafes under discipline of any sort and who detests being treated as a schoolchild or herded together with other invalids like a flock of sheep