Where TB's Danger Lies
It's easy to be riveted by the 31-year-old groom who slipped the filmy nets of federal agents last month to find his own way home with his new bride. Andrew Speaker, who touched down in five countries while carrying a deadly strain of tuberculosis, is not the typical TB patient from a vulnerable population, often sick or homeless. Smart and educated, Speaker is a professional who volunteers for humanitarian missions yet finds himself in forcible detention because he went on the lam. It's the new face of TB; get used to it. In a world in which one third of the population is infected, the occasional traveler who goes to places steeped in TB brings it home. And in a country dependent upon the talent and energy of people migrating from high-TB areas, the microbe has become a regular import. Moreover, the tubercle bacillus, a survivor that mutates around the drugs designed to wipe it out, is a formidable foe for a public-health system that has just shown itself to be inconsistent, disconnected, and underfunded.
The fuss over Speaker is that he was traveling with a dangerous and contagious disease. But was he contagious? The irony is that, by the Centers for Disease Control and Prevention's own criteria for immigrants entering the country, he would have been given a green light. Current health requirements for those seeking permanent residence do call for a chest X-ray to screen for active TB and, if that's abnormal, sputum tests. If three sputum exams show no sign of the microbe under the microscope, the patient is deemed noncontagious and safe for travel. But a good number of immigrants traveling to their new home on long-distance flights are bound to have infectious TB anyway, since the pathogen may be present and show up only in a more sensitive test, a lab culture—as it did for Speaker. The pretravel screen for immigrants does not require a culture. At last week's hearing held by the House Committee on Homeland Security, Rep. Al Green of Texas said we should not think of Speaker's case as an aberration. Green pointed out that we have no way of knowing how many people are traveling with infectious TB. He's right.
More than half the TB cases in the United States are in foreign-born individuals, who have nearly 10 times the chance of having TB as native-born Americans, and the number is growing. Over 80 percent of drug-resistant TB is found in the foreign born. While immigrants are inadequately screened, those who come here for long stays on work or student visas aren't screened at all, even when they are from countries where half the population has TB. Meanwhile, we don't know the TB status of the estimated 12 million illegal immigrants. That points to a glaring hole in the new immigration bill, which stalled in the Senate last week: Under the measure, illegal aliens will apply for a Z visa, which, if granted, makes them legal and enables them to get in line for immigration papers. That takes at least eight years, and only then will they have to undergo the usual immigration health check. Since the Z visa requires no medical screen, that makes for one long and unhealthy waiting line.
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