Immigrants unlikely to spread disease, but may need medical care

The Dallas Morning NewsJuly 16, 2014 

— Despite concerns about the potential public health crisis posed by immigrant children crossing the Texas-Mexico border, medical experts say the likelihood of their spreading disease is low.

Still, experts in emergency preparedness are urging health care providers and Texas to get ready for many children who may need basic medical care.

"Four, five or a dozen children may not strain the system, but we're now talking about thousands and thousands of children" who have very unique physiological and psychological needs, said Michael Anderson, a Cleveland, Ohio, pediatrician and expert in pediatric disaster response.

More than 57,000 children have traveled alone from Central American countries and have been detained by U.S immigration authorities at South Texas holding facilities this year. That number could reach 90,000 by year's end.

Many are being transferred to other immigration centers, and 2,000 are expected to be housed in Dallas later this summer.

As of late last week, state health officials have reported three cases of tuberculosis, 23 cases of chicken pox and three cases of flu among children housed in detention centers in South Texas, said Carrie Williams, a spokeswoman for the Texas Department of State Health Services.

"We've had no reports of measles," she said. "Generally, the potential for a wider public health issue is there. But the biggest risk we are seeing for the people in the detention centers is because of the lack of hand-washing facilities."

Immigrant children typically pose little threat to public health, says the state's top pediatrician.

"The general public doesn't need to be concerned that there are going to be outbreaks of illness due to these immigrant children," says Dr. Mark Ward, president of the Texas Pediatric Society, which represents 2,800 pediatricians. "Most of these children will not have an illness that puts others at risk."

Recently, Gov. Rick Perry weighed in with his concerns about unsanitary conditions at the Texas facilities where the children are being housed. His June 20 letter to President Barack Obama asked for state inspections to ensure international and national sanitary standards are met.

"Officials who have visited such facilities indicate insufficient bathroom facilities, lack of adequate water supplies and other conditions that could result in epidemics of pertussis, tuberculosis and other diseases," Perry's letter said. Such diseases could threaten not only the children, but employees and communities where the detainees might end up, he warned.

Every immigrant child undergoes a medical screening by a paramedic or emergency medical technician, looking for rashes, fevers and coughing, said Jessica Maxwell, spokeswoman for the Department of Homeland Security's health affairs office.

Such symptoms would send a child for a second screening by a doctor, nurse or physician's assistant working for federal Health and Human Services.

"Any child who needs medical treatment is sent to a local emergency room, and if they are suspected to have a communicable disease, such as chicken pox or tuberculosis, they are quarantined, vaccinated and treated," she said. "It's a very small amount of children, compared to the general population."

The most common medical complaint among these new arrivals, Maxwell said, "relates to their journey: dehydration, exhaustion, foot and ankle injuries."

Providing prompt medical screening and treatment for ailments will save money in the long run, Ward said. "It makes sense to treat things now while they're minor instead of letting them become serious and more costly to treat," he said.

But many of the children remain in overcrowded conditions, sleeping side by side on the floor.

"Scabies and lice is primarily what we're seeing," said Shawn Moran, spokesman for the National Border Patrol Council, which represents 16,500 border agents. His group is calling for a more comprehensive medical response.

"You've got people in such close quarters," Moran said. "I'm hearing there's trouble getting cleaning supplies to kill off the infestations we're seeing."

Scabies is a contagious skin infection caused by mites, which usually results in a rash and relentless itching. Head lice, another parasite, infest the hair and neck and also cause itching. Both are easily treated.

"This facility is not intended for long-term detention, 72 hours at the most," said Moran, who is based in San Diego. He visited the overcrowded Rio Grande immigration facility in May.

Moran said most of the young immigrants appeared to be teenagers, although he declined to provide an exact percentage. He estimated that about 100 to 150 of them were under a year old, although the babies were accompanied by a relative, usually a teen.

Federal officials have been reluctant to discuss the children and their medical needs. They have not provided demographic information, including breakdown by age and gender.

"Some of them are illiterate," Moran said of the immigrants. "They are unable to tell us what town they are from, much less know their vaccination history."

Doctors on the border have a long history of treating immigrant children who accompany their parents across the border.

Dr. Martin Garza, a volunteer pediatrician at the Sacred Heart relief shelter in McAllen, sees the same health conditions in immigrant children as in his private patients at his Edinburg clinic.

"We haven't seen kids who have been significantly ill," he said. "In fact, we're seeing the opposite. I'm seeing kids that have been well taken care of in their country, that have vaccination records with them, that are not the poorest of the poor but a middle-class type person from their country."

The children who are being released from detention centers have common ailments - "everything from upper respiratory tract infections to abdominal pain from constipation or diarrhea," said Garza. "We're seeing some skin rashes, a few have been scabies but not very many. There's no rash epidemic or anything like that."

Dallas County Judge Clay Jenkins, who has led the effort to bring the children to Dallas, said he was not worried about them transporting serious diseases with them.

"The community need not be concerned about a mysterious disease," he said after a July 9 meeting with Obama. He also conferred with Dr. Kyle Janek, executive commissioner of the Texas Health and Human Services Commission, about TB testing for the children.

"The community needs to be concerned that these are children," Jenkins said. "And, in Texas, we stand up for children."

If any diseases should appear as a result of their transfer to Dallas, Jenkins said, "we have protocols in place that are exhaustive to quarantine children that are contagious."

Jenkins added that immigrant children had similar health profiles and higher vaccination rates than most American children.

"The diseases that the children may carry are, for the most part, diseases that go through every elementary school in (Dallas Independent School District) every year. And the more serious diseases are the diseases that we treat at Parkland every day."

Officials at Parkland Memorial Hospital, the county's lone public facility, say they are prepared to evaluate the medical needs of any incoming immigrants. The hospital would use its fleet of Homeless Outreach Medical Services, or HOMES, vans - mobile medical offices that carry medical supplies, medication and personnel.

Sharon Phillips, Parkland's chief of population health, said the county hospital's response would be similar to what was done when thousands of evacuees showed up in Dallas after Hurricanes Katrina and Rita in 2005. Most were sheltered at the Dallas Convention Center and the old Reunion Arena.

"Within three hours of their arrival, we had HOMES vans on site, assessing needs for medication and acute care," she recalled. "In this case, it would be a lot of children that need health care. The resources would have to be pediatric resources."

Parkland also has pediatricians it could dispatch to the immigration shelters, Phillips said. "We can be pretty agile and flexible, if we get notified that the children are coming here."

Health officials in Dallas County say they are prepared to respond to the medical needs of any immigrant children who arrive here.

"We have a great TB-testing and treatment program, if needed," said Zachary Thompson, director of Dallas County Health and Human Services. "We also have enough vaccine on hand, if that is what is needed. So far, nobody has asked us to provide anything."

(Dallas Morning News writer Matthew Watkins contributed to this report.)

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