More than one-third of refugees in Vermont test positive for tuberculosis

This article by Bruce Parker originally published June 2, 2016, on

Data from the Vermont Department of Health show that more than one-third of refugees resettled in Vermont test positive for tuberculosis.

Since 2013, about 900 refugees admitted to the Green Mountain State have been tested for tuberculosis, a potentially fatal infectious disease affecting the lungs. Of that number, 318 refugees, or 35.4 percent, tested positive. obtained the health data on Wednesday following reporting by Stateline that the disease may be making a comeback in the United States.

Refugees brought to the United States undergo TB tests as part of comprehensive health screenings. State health departments track the data to monitor cases and protect against public health crises.

According to IGRA (Interferon-Gamma Release Assays) blood test results from 2013 to the present, the highest percentage of incoming refugees to Vermont infected with TB occurred in 2013. That year, 108 refugees out of 248 tested, or 43.6 percent, showed positive for TB.

Test results showed slight improvement in subsequent years, with 34 percent of incoming refugees having TB in 2014 and 32 percent showing positive in 2015. Children under age 5 are excluded from the results, as they undergo tuberculin skin tests, or TSTs.

While active TB is fatal in half of cases that go untreated, Ben Truman, health policy and web program coordinator at the Vermont Department of Health, said only a handful of TB cases each year in Vermont are “active.”

“The Vermont five-year average of active TB cases for 2011 to 2015 is 5.4 cases, with a range of two to eight cases per year,” Truman said.

Using Truman’s active TB averages, Vermont reported 27 active TB disease cases between 2011 and 2015. Truman would not say how many resettled refugees in Vermont have active TB disease, or if refugees are included in the Health Department’s five-year average of active TB cases.

The U.S. Centers for Disease Control and Prevention reports that tuberculosis is common worldwide, with one out of every three people carrying the bacterium Mycobacterium tuberculosis. In 2014, about 9.6 million people had active TB and 1.5 million people died from the disease. TB disease is rare in the United States, however, with just 9,421 active TB cases reported in 2014.

Unlike active TB disease, latent TB infection is not contagious, and people who have it experience no symptoms. Latent TB infection can advance to active TB disease, however, where symptoms typically include weight loss, fever, and chronic cough and phlegm, often including blood. About 10 percent of untreated latent infections advance to active TB disease, according to the CDC.

Last week Breitbart reported that most of Arizona’s 222 active TB cases among resettled refugees over the past two decades were caused by latent TB infections that advanced to active TB disease. A fact sheet from Arizona’s Department of Health states that the cases were “caused by latent tuberculosis infections that became active after years or even decades of lying dormant.” The department urges people with latent TB infection to “complete an entire course of medication” to prevent possible activation.

Truman said advancement from latent TB to active TB is not typical in Vermont cases.

“Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease,” he said. “The TB incidence in Vermont is low at 1.11 cases per 100,000 (2015), which is less than the national average of 3.0 cases per 100,000.”

Refugee resettlement is facing fresh scrutiny after President Obama pledged to admit 100,000 refugees to the United States, up from the prior cap of 70,000. As distinguished from immigrants, refugees are people who have fled their countries due to war or persecution.

State Refugee Coordinator Denise Lamoureux said Vermont plans to admit 350 refugees this year. One hundred refugees may be placed in Rutland, where Mayor Chris Louras is facing a backlash from residents for hiding the city’s resettlement plans from the public.

Refugees may be entitled to multiple years of taxpayer-funded medical, cash and social assistance. Assistance benefits range from Medicaid and Temporary Assistance for Needy Families to job preparation and placement. Funding for Vermont’s refugee resettlement program comes from federal grants distributed to the Vermont Agency of Human Services and the the U.S. Committee for Refugees and Immigrants.

Lamoureux said the current year funding is in line with the 2013-2014 funding grants, except that cash and medical assistance expenses dropped by about $350,000, due to lower refugee medical assistance costs following the Affordable Care Act and Medicaid expansion. She added that social services allocations are down to $195,737 for fiscal year 2016.

While Truman didn’t say how the Health Department was handling active TB cases among Vermont’s refugees, a single active TB case for a teacher at Charlotte Central School in 2015 led the department to test about 500 students and coworkers. Test results found that 19 children and two adults had become infected with latent TB.

Image courtesy of Public domain