This week I received an announcement from the Office or Refugee Resettlement forwarding a grant announcement for some group or entity to apply to set up a surveillance system to track diseases coming in with refugees. No kidding! Apparently we have no way to track refugees with diseases at this time!
The full announcement at the Center for Disease Control is here (I couldn’t open the file), but here are some parts of the document from the e-mail.
The title is: Strengthening Surveillance for Diseases Among Newly-Arrived Immigrants and Refugees
Measurable outcomes of the program will be in alignment with one (or more) of the following performance goal(s) for the National Center for Emerging and Zoonotic Infectious Diseases: Protect Americans from Infectious Diseases
Here are some sections of the announcement (emphasis mine):
Every year, approximately 70,000 refugees and 400,000 immigrants resettle to the United States from overseas. Refugees are particularly vulnerable populations, marginalized from public-health surveillance, preventive treatment and health care in their home countries and countries of temporary asylum. They have complex health-care issues, such as low baseline vaccination rates and high rates of infectious diseases, including tuberculosis, malaria, and intestinal parasites.
[no wonder the cost of health care is sky rocketing!—ed]
One challenge to developing best practice health recommendations for refugees and immigrants is that there is no standardized national surveillance system for the identification of acute illnesses in newly arrived refugees and immigrants. Reporting of health conditions in refugees and immigrants that are identified after arrival is limited to the required reportable conditions as specified by state and federal requirements. However, refugee or immigrant status is not reported. Consequently, there is little data to evaluate the effectiveness and quality of the required overseas medical examination, the overseas presumptive treatment and other public health interventions, or to guide the establishment of evidence-based guidelines for the post-arrival medical examination. A better understanding of medical conditions in refugees and immigrants is essential for educating health care providers in the U.S. about those conditions, particularly tropical diseases, with which they may be largely unfamiliar, and for providing assistance to state and local refugee health programs so that they can better prepare for the arrival of these new Americans.
Since 2004, CDC has responded to over 50 domestic and international outbreaks of infectious diseases among U.S.-bound refugees, including measles, rubella, varicella, cholera, hepatitis A, O’nyong-nyong fever, and multi-drug-resistant tuberculosis.* These outbreaks, some of which were associated with the importation of infectious diseases to the United States and secondary domestic transmission within the United States, have taxed the resources of U.S. State and local health departments. These outbreaks also represent an obstacle to the U.S. Government’s plans for elimination of vaccine-preventable diseases, including measles and rubella, and constitute a risk for the importation of emerging infectious diseases. In addition to the public-health resources required for outbreak response, the outbreaks temporarily halted resettlement and cost the U.S. government hundreds of thousands of dollars in flight cancellations and other expenses. Early detection through pre-departure surveillance and appropriate, cost-effective public-health tools, such as routine vaccination, could have prevented these financial costs, and the mortality and the serious morbidity that occurred among U.S.-bound refugees.
Most recent outbreaks of communicable infectious diseases among refugees have occurred in refugee camps with a mixture of U.S.-bound and non-U.S.-bound refugees. While detecting, controlling and preventing outbreaks as early as possible in refugee camps is the most effective means to prevent the importation of communicable diseases into the United States, limited public health infrastructure and laboratory resources present challenges to disease surveillance in these settings. Conducting pre-departure surveillance in U.S.-bound immigrants is even more challenging since they are geographically dispersed and usually fully integrated into the local community. Until these complex and far-reaching limitations can be addressed, enhancing surveillance among refugees and immigrants after arrival in the United States will provide the most effective means of monitoring their health status, detecting outbreaks of communicable disease and evaluating the overseas health interventions designed to improve their health before resettlement.
The purpose of the program is to conduct surveillance to detect, prevent and control diseases and evaluate existing health programs to improve the health of refugees and/or immigrants that are newly arrived in the United States. The program will: 1) enhance existing surveillance networks for communicable and non-communicable diseases, including, but are not limited to: vaccine-preventable diseases, malaria, hepatitis, intestinal parasites, nutritional deficiencies and anemia; 2) evaluate the health status of refugees and/or immigrants for the purposes of informing and improving U.S. programs for overseas and the post-arrival health assessments and interventions, such as presumptive treatment for parasitic infections; and 3) improve the health of refugees and/or immigrants undergoing U.S. resettlement and protect the health of their receiving communities [your town!—ed] by controlling the spread of communicable diseases. This program addresses the “Healthy People 2020” focus area(s) of Global Health.
* I bet you have been told that no one gets into the US with drug-resistant TB! Think about this: a refugee or other immigrant gets into the US and can just disappear into the woodwork, so even if they have been identified with some communicable disease and possibly started treatment, there is no way of following them or to monitor their treatment as they simply move to another location in the US.
Endnote: If you are thinking about sending comments to the US State Department May 1st meeting, communicable disease is a good topic. More on refugee health problems can be found in our Health Issues category, here. We have 125 posts in that category and the first ones we posted in 2007 involved the Fort Wayne, IN (Allen County) health department’s crisis with too many TB cases to manage.