Importing Disease

DDP Newsletter November 2014 Vol. XXXII, No. 6

There is a whole medical specialty of travel medicine for Americans who wish to visit exotic lands with exotic diseases. Travelers have additional vaccines and take malaria prophylaxis if appropriate. They may soak their clothing in permethrin if they expect to encounter mosquito-borne diseases. They learn about food and water precautions.

Because diseases follow human migration, immigrants have historically been required to undergo public health screening and periods of quarantine. Now, however, the Obama Administration and its supporters consider this to be a xenophobic policy. Instead, the plan seems to be to reduce “health disparities” by letting disease travel to the U.S.

Ebola is not in the news at present, although more than 1,400 persons were being actively monitored at the time of this writing (www.Sharylattkisson.com 12/1/14). Expect more. Obama is offering to convert any tourist visa from a hot zone country into a permanent residence visa, giving West Africans a once-in-a-lifetime opportunity to jump to the head of the U.S. citizenship line, providing extreme incentive for mass immigration from the Ebola hot zone, writes Alec Rawls. There is no cut-off date for eligibility.

Rawls notes that tracking, CDC director Thomas Frieden’s main defense mechanism, is easily overwhelmed. What if Dr. Craig Spencer, on his trek through the N.Y. subway system, had coughed on a homeless drug addict, who later left copious amounts of body fluid in public places, having no idea what was wrong with him?

The correct policy, Rawls suggests, is the one the Greeks used in coping with the Athenian plague described by Thucydides, which may have been Ebola. They left all the work of isolation and care to immune survivors. Africa is developing a corps of survivors—our aid efforts should be directed to training and funding them, he states. The combination of care and income could act as “negative pressure” to help contain the epidemic in Africa (http://tinyurl.com/q7jbcl6).

Another outbreak that has tapered off and dropped out of the news is the “mystery virus,” enterovirus D68 (EV-D68). CDC’s tracking has not determined (or informed the public) of the reason why U.S. cases exploded from 26 in 36 years (1970–2006) to nearly a thousand across the country just after school opened this year. The disease is not reportable, and the numbers are surely an underestimate. Also, it is not possible to simply order a test if the diagnosis is suspected. All testing is controlled by the CDC, and apparently only available for patients in intensive care.

The illness can cause severe respiratory distress, sometimes requiring positive-pressure ventilation or even extracorporeal membrane oxygenation. Emergency departments were overwhelmed, even before flu season. The death toll had reached 11 as of Nov 6. Additionally there have been 70 cases of polio-like paralysis, with lesions in the gray matter of the spinal cord (http://tinyurl.com/ly9n628). Breathing difficulties may persist, and paralysis may be permanent.

The multi-city, multi-strain pattern, rather than a geographic flow as occurred with H1-N1 influenza that emerged in Mexico in 2009, suggest that a population movement triggered the outbreak (http://tinyurl.com/oo9uvjt). It just happens that about 70,000 children recently entered illegally from Central American countries, and were sent to live in cities across the .U.S. As investigative reporter Sharyl Attkisson pointed out (IBD 10/17/14), human enteroviruses were found in a significant number of children suffering influenza-like illness in Central America (Virology Journal 2013;10:305, http://tinyurl.com/n7r2pr9).

“There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of those children testing positive for the virus,” stated M. Steve Oberste, chief of the polio and picornavirus laboratory branch at CDC. We do not know, however, the number of immigrant children tested. The “Bathtub Principle”—transfer carriers throughout the country to dilute the origin—could be operative. State-by-state statistics on infectious disease reports and known illegal immigrant activity are compiled at examiner.com (http://tinyurl.com/o8euh2r).

Measles is another illness occurring in higher numbers: 599 confirmed cases from Jan 1-Oct 11, with 18 outbreaks in 22 states. In 2013 and 2012, there were 187 and 55 cases, respectively (ibid.). While “parents who won’t vaccinate their children” are blamed for “reviving once-dead diseases” (WSJ 12/3/14), 97% of cases reported through May 2014 were associated with importations from at least 18 countries (MMWR 6/6/14).

Tuberculosis, perhaps the most dangerous infectious disease worldwide, has been well controlled in the U.S. According to 2012 CDC surveillance statistics, nearly 90% of multidrug-resistant tuberculosis (MDR-TB) was in foreign-born individuals. Providence Memorial Hospital in El Paso, Tex., a major port of entry for illegal aliens, recently reported that 700 newborns had been exposed to TB (examiner.com, op. cit.). Illegal aliens, even if apprehended, do not have chest xrays; doctors who work in hospitals must provide evidence that they do not have active TB.

Chagas disease, caused by the protozoan Trypanosoma cruzi, was rarely if ever transmitted within the U.S. in the past, though the kissing bug (triatome) vector is found across the lower half of the U.S. No longer a disease confined to Mexico and Central and South America, it probably infects far more than the 300,000 Americans estimated by the CDC, states Melissa Nolan Garcia of Baylor College of Medicine in Houston. Of 17 Texas blood donors who tested positive, a third had apparently acquired the disease locally, and 40% had cardiac abnormalities consistent with Chagas. (HealthDay 11/6/14, http://tinyurl.com/qj9loap). The disease is being called the new AIDS because of its sometimes asymptomatic beginning and fatal end. There may be initial signs of a skin lesion and a purplish swelling of eyelids on one side The CDC might make available two experimental drugs, nifurtimox and benznidazole, which do not help in late stage once heart damage has occurred (Mail Online 11/9/14, http://tinyurl.com/peuzg6d).

The fastest growing global health threat is dengue, which causes 20,000 deaths annually. It is called “breakbone fever” because it causes severe muscle and joint pains along with flu-like symptoms. Death may result from hemorrhage and organ failure. Locally transmitted cases are now being seen in the U.S. (http://tinyurl.com/kr9lvo2). It is transmitted by the Aedes aegypti mosquito, as is a clinically similar tropical viral disease chikungunya. Starting with a December 2013 outbreak in the Caribbean, more than 355,000 cases of chikungunya were reported in 20 countries in Latin America by July. Haiti is especially hard hit; missionaries are cancelling trips (http://tinyurl.com/nhjnw8c). The U.S. had at least 480 cases in returning travelers by August, and a few locally transmitted cases. Some mutated strains of both dengue and chikungunya can be spread by the Asian tiger mosquito (Aedes albopictus), which has a much wider range, being found in 32 states from Texas to New York (Nature 8/14/14).

The official U.S. response is to blame global warming for increasing the range of the mosquito (Ae. aegypti was spread worldwide by the slave trade 500 years ago), and to “keep our fingers crossed…that the Caribbean epidemic will decline and the virus will depart from the Western hemisphere” (David Morens and Anthony Fauci, NEJM 9/4/14).

Meanwhile Obama plans to allow 100,000 Haitians into the U.S. without visas, by executive order (American Thinker 10/18/14, http://tinyurl.com/khuyfjx).