needed list of academic researchers

[Guest guest]

We are trying to pull together a list of academically based researchers

who have written or studied the recent migrant laborer flow to and

within the Deep South (North and South Carolina, Georgia, Alabama,

Kentucky, Mississippi and Louisiana). If any one can be of help in this

regard please e-mail or call me.

Dennis deLeon

President

Latino Commission on AIDS

212-584-9300

917-697-8040 (cell)

212-202-3620 (fax)

ddeleon@...

www.latinoaids.org

-----Original Message-----

From:

[mailto: ] On Behalf Of Ed

Zuroweste

Sent: Wednesday, February 08, 2006 6:53 PM

Subject: Re: [ ] Re: TB testing singles out

migrant workers' Kids

Unfortunately, this series of articles and quotes are filled with

inaccurate information about TB. Alayne is correct in her statement that

most state TB programs screen " all recent immigrants from countries with

high prevalence of TB " . It is a fact that since 2002 over 50% of all

active

TB cases in the US occur from reactivation of TB infection that the

individual obtained in their country of birth. The only way to prevent

this

reactivation is to screen all recent immigrants (including children) and

offer treatment prophylactically with TB medication (currently now 9

months

of INH or 4 months of Rifampin) to reduce their risk from approximately

10%

lifetime conversion to active TB to less than 1%.

It is inaccurate to state that individuals who have received a BCG

vaccination in their childhood have a positive PPD. In the past several

years, experts in Tuberculosis have come to a consensus to ignore the

history of BCG vaccination when reading a PPD because the incidence of a

positive PPD (greater than 10mm in a foreign born individual from high

risk

country) in these individuals is extremely small. Therefore a positive

PPD

in these individuals should be considered evidence of " infection with

tuberculosis " .

However, not all " migrant children " need to be tested for TB. Only

those children who are recent immigrants from high risk countries who

have

not already tested positive should be tested.

It is true that once you have a positive PPD, you are obligated to rule

out

active pulmonary TB usually by history/physical exam/Chest X-ray before

a

student returns to the classroom (if the child is totally asymptomatic

they

can usually return to the classroom very quickly-within 24-48 hours).

A new screening tool is now available that will eliminate a lot of

the

inaccuracies of the PPD (which celebrated it's 100th birthday last year

without any improvement in it's accuracy). Quanti-Feron -TB Gold was

approved by the FDA in May, 2005 and the CDC released a MMWR Guideline

Dec.

2005 (Dec. 16, 2005/Vol. 54/No. RR-15). This is a blood test that

completely

eliminates the " potential cross positive reaction with BCG and other

Mycobacterium " .

I do agree that it is discriminatory to single out " migrant

children "

for TB testing. It is however just good public health to screen all

children

who are recent immigrants from high risk countries for tuberculosis and

if

they test positive, offer them appropriate antibiotics for prophylaxis

to

prevent conversion to active tuberculosis disease.

When children are not offered this protection we run the risk of what

happened to us in Pennsylvania last year when a recent immigrant child

from

Russia presented to the ER with a 3 day history of severe headache and

died

within the week from TB meningitis.

I would be happy to discuss more details with anyone who has more

questions or more answers.

Ed

Ed Zuroweste MD

Chair National Coalition to Eliminate Tuberculosis

Assistant Professor of Medicine

s Hopkins School of Medicine

Medical Director

Migrant Clinician Network

878 North Street

State College, PA 16803

814-238-6566 (office/fax)

814-571-7395 (cell)

kugelzur@...

----- Original Message -----

From: " Alayne Unterberger " <alayne@...>

< >

Sent: Wednesday, February 08, 2006 2:54 PM

Subject: Re: [ ] Re: TB testing singles out

migrant

workers' Kids

> This is not a new policy. I know this is an issue we documented as a

> barrier for the West Palm Beach School District back in the 1990s,

where

> advocates felt that migrants were being unfairly singled out. In fact,

I

> found out that it is part of almost every state's TB program and

because

> migratory farmworkers and their children have been found to test

> positive for TB (sometimes because they received a TB vaccination in

> Mexico, making them look TB positive), this is a priority population.

> Not everyone has the same relative risk of TB, due to medical and

> migration history, so they don't test everyone equally.

>

> I don't know how the rest of you feel about this. I'm just sharing our

> experience.

> A

>

>

> Hilda Ochoa Bogue wrote:

>

>> <http://www.spokesmanreview.com/>

>>

>>

>>

>>

>> Wednesday, February 8, 2006

>>

>>

>> *Brewster school district TB testing singles out migrant workers'

>> kids *

>>

>>

>> *Action taken without state, county consultation*

>>

>> Graman

>>

<http://www.spokesmanreview.com/news/bylines.asp?bylinename=%20Gram

an>

>> Staff writer

>> February 8, 2006

>>

>> The school district in Brewster, Wash. - already named in a federal

>> civil rights lawsuit brought by the parents of Latino students - now

>> has singled out the children of migrant workers for tuberculosis

>> testing as a condition of enrollment, without consulting state or

>> county health officials, according to those officials.

>>

>> Selectively testing one population is not standard practice,

>> especially when no one shows symptoms of tuberculosis, said Dr. Kim

>> Thorburn, Spokane County health officer.

>>

>> " If you are insistent (on testing), it should be all students, "

>> Thorburn said. " There are all these policy considerations that should

>> have been worked out. It's just not the way we do TB control. "

>>

>> Concerned about October news reports of a case of tuberculosis at

>> Coeur d'Alene High School, Brewster school Superintendent Jim

>> kept at least four students who tested positive for tuberculosis out

>> of school " until a doctor can assure us in writing that they do not

>> actually have TB, " according to a Jan. 17 e-mail sent to Kim

>> Field, tuberculosis program manager for the Washington Department of

>> Health.

>>

>> wrote Field that " 13 of my migrant students " were tested, and

>> seven tested positive. Of those, three students had transferred to

>> another school district, leaving four in the Brewster district. It's

>> unclear whether more than the 13 have since been tested.

>>

>> " I assume we will get letters from doctors indicating it is safe for

>> these students to return to school, " wrote. " If so, we may not

>> have a problem. If not, what steps should we be taking in order to

>> protect the rest of our students? Notification of parents? Testing of

>> all students? "

>>

>> The testing, apparently done by a local health care provider,

occurred

>> without consulting either the Department of Health or the Okanogan

>> County Health District, Field said. Only migrant students were

tested.

>>

>> was out of town on Tuesday and unavailable for comment.

Brewster

>> school board member Dina Divas declined to comment other than to say,

>> " We are testing. "

>>

>> According to 's e-mail to the Department of Health, 80 percent

of

>> the Brewster School District's student body is Hispanic and 40

percent

>> are the children of migrant workers.

>>

>> Mexico has a higher tuberculosis rate than the United States. For

this

>> reason, Mexican children often are inoculated with the Bacillus

>> Calmette-Guerin, or BCG vaccine, which can cause skin tests to read

>> positive. According to the Spokane Regional Health District, there

are

>> other reasons for false positives, and a positive test does not mean

>> an individual has active tuberculosis or can infect others.

>>

>> More than 30 students, faculty and staff of Coeur d'Alene High School

>> showed positive reactions to tests after a student was hospitalized

>> with an active case of tuberculosis believed to have been contracted

>> outside the country, The Spokesman-Review has reported. None of those

>> has shown symptoms of the bacterial disease, and none was kept out of

>> school.

>>

>> In a follow-up telephone conversation with Field, spoke of

steps

>> the Brewster School District took to protect its students against

>> tuberculosis. Field summarized the conversation in a Jan. 19 e-mail

to

>> other public health officials including Thorburn:

>>

>> " Community members raised the issue of concern for TB when they heard

>> about the Idaho student. "

>>

>> " The school decided to screen all migrants (from Mexico). "

>>

>> " This individual () excluded all the students from school

>> initially - and said they had to be released back to school. "

>>

>> " The individual went to our DOH Web site to 'learn' about TB and

>> discovered the difference between infection and disease. "

>>

>> " He stated he has allowed the children to return to school unless

they

>> 'have symptoms.' "

>>

>> " He stated that as a school district they will continue to screen all

>> migrant children for school entry. "

>>

>> Field said that she thought called to say he had reversed his

>> decision to continue screening, but that was not the case.

>>

>> " I referred him to the local health officer and local health

>> department, " said Field, adding that still had not notified the

>> Okanogan County Health District.

>>

>> " I was a little upset that we weren't notified, " said Lauri ,

>> public health nurse for the health district.

>>

>> said she knew of no other school district in Okanogan County

>> testing students, but that Brewster has the largest Latino population

>> in the county.

>>

>> Field, who has been with the state's tuberculosis program since 1993,

>> also said such testing is not standard practice in Washington state.

>> Because positive tests for TB are not required to be reported under

>> state law, the Department of Health has no record of who was tested

or

>> who did the testing.

>>

>> None of the district's three clinics contacted by The

Spokesman-Review

>> provided the tests, according to their spokespersons.

>>

>> The Brewster School District, and high school Principal Randy

>> were named as defendants in a civil rights lawsuit filed in

>> U.S. District Court in Spokane in October. Eight Latino parents

allege

>> the district discriminated against their children by singling them

out

>> for disciplinary action not imposed on non-Latino students.

>>

>>

>>

>> © League of United Latin American Citizens.

>> Please see our web site at www.LULAC.org for more information.

>>

>>

>>

>>

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