A rise in diseases such as whooping cough, tuberculosis, malaria, measles and even leprosy are creating public health concerns and could hit hospitals and health care systems already financially burdened by indigent illegals flooding emergency rooms and urgent care centers.

The resurgence also is fueling conservative calls for tougher border security and could cause problems for Arizona industries that rely on migrant workers for jobs in food services, construction, tourism and agriculture.

The Maricopa County Health Department reported earlier this month a 100 percent increase in the number of cases of whooping cough (pertussis) over the past year.

TB concerns grow

Hospitals and health care professionals also are concerned about Mexican immigrants bringing tuberculosis with them to border states such as Arizona.

"I've been in practice in Arizona for 25 years," said Dr. Tim Kuberski, president of the Arizona Infectious Disease Society. "The one disease that is most often associated with undocumented aliens is tuberculosis because there is a resurgence in the number of cases of TB."

The federal government reports that while TB is on the decline nationally, Hispanics are the most-likely ethnic group to have the disease, and high TB rates in Mexican border areas are a big concern.

Recent federal reports found that Mexican border regions have high rates of infectious diseases and that half of U.S. TB cases are from immigrants.

TB rates in U.S. border regions, including Arizona, are "roughly double the national rate, according to the U.S. Department of Health and Human Services. The department reports the TB rate for Mexican border areas is greater than the Mexican national rate.

Greg Padilla, chief executive of Maryvale Hospital Medical Center, agreed.

"Typically, TB shows up in a lot of border cities," he said.

Limited health care access, lack of vaccinations, migratory population movements and poor living conditions all encourage the spread of TB and limit its treatment in border areas.

There were 14,500 TB cases in the U.S. last year. Mexico has 16,000 cases annually, with one quarter coming from border areas. The U.S. has a population of 296 million; Mexico 106 million persons.

Dr. Fritz Bredeek, an infectious disease specialist with El Rio Special Immunology Associates in Tucson, said tuberculosis is his biggest concern when it comes to people crossing the border illegally and bringing their diseases into the U.S.

"Tuberculosis is a contagious disease brought in from any poor country because TB is in countries with a poor health care structure, whether that is in Mexico or Eastern Europe or Asia or Africa," Bredeek said. "So that's certainly an infectious disease we do see."

Health care worries

Increased diseases are cause for obvious public health worries, but they also require hospitals and health care systems to dedicate more resources from an already strained system. Hospitals and the state and federal government often have to foot the bill for treating migrants, many of whom are indigent and have no health care coverage.

Worries about immigrants bringing infectious diseases into the country are prompting conservative calls to tighten up the U.S./Mexican border to stem the wave of migrants.

"Americans should be told that diseases long eradicated in this country -- tuberculosis, leprosy, polio, for example -- and other extremely contagious diseases have been linked directly to illegals," said Scottsdale Congressman J.D. Hayworth. "For example, in 40 years, only 900 persons were afflicted by leprosy in the U.S.; in the past three years, more than 7,000 cases have been presented."

There also are worries that illegal immigrants from Asia, particularly China, are bringing rare and infectious disease into the Western U.S.

Hayworth, a Republican, said the problem highlights the need for tougher border controls and immigration law enforcement.

"This emerging crisis exposes the upside-down thinking of federal immigration policy," he said. "While legal immigrants must undergo health screening prior to entering the U.S., illegal immigrants far more likely to be carrying contagious diseases are crawling under that safeguard and going undetected until they infect extraordinary numbers of American residents."

Rusty Childress, a Valley car dealer and a big backer of tougher immigration controls, worries about the spread of disease because of the prevalence of migrant labor in the food-service industry.

"This is one of the cheap thrills of cheap labor," said Childress. "As you may have noticed, many immigrants, legal or otherwise, are employed -- if they are at all -- as cooks, dishwashers, waiters and food handlers. And it's a fact that Hepatitis A, B, and C show up in fast food environments."

Steve Chucri, president of the Arizona Restaurant Association, said food-service companies and restaurants follow county health codes and some do brief health screenings for new hires to make sure they are not spreading some diseases when handling food.

Churci said restaurants do not usually require formal doctor's notes or physicals for prospective employees. He said state law prohibits employers from asking about medical conditions as a condition for employment, but some restaurants will ask employees after they are hired about health issues.

Vaccinations may help

Kathleen Howard, a registered nurse and infection-control specialist at St. Joseph's Hospital and Medical Center in Phoenix, said she is seeing a fair amount of disease, especially measles, coming in from other countries.

Howard and other health care professionals are concerned about the lack of vaccinations among immigrant populations.

"We see that from people who have come in and are not vaccinated," Howard said. "It puts our population at risk who also may not have been vaccinated."

A study that came out this week in the Archives of Pediatrics & Adolescent Medicine found that there is an increasing number of parents who choose not to vaccinate their school-age children because they believe the medicine will cause harm.

When people entering the U.S. bring diseases with them, American children who are not vaccinated are at a greater risk of getting diseases for which there are preventive measures available, Howard said.

"When you have children who have not been vaccinated, they can pass measles, mumps and rubella quickly," Howard said. "Even polio would be a risk for a child who was not vaccinated."

In the study, 69 percent of the parents of the 277 children with vaccination exemptions said they made that choice because of concerns that shots might cause harm.

Dr. Fred Scott, medical director of Maryvale Hospital in Phoenix, said the chances are overwhelming that a child could have very serious problems if the diseases are contracted because of a failure to immunize.

"If you're going to play the odds, the odds are in favor of surviving childhood with the immunizations as opposed to not getting immunizations," Scott said.

But he is not so sure the rise in TB can be attributed to Mexican nationals crossing the border illegally.

"It's related more to socioeconomic classes -- people who live in very close contact with one another," Scott said.

Tuberculosis spreads from coughing droplets onto another person. A persistent cough is accompanied by fever and chills.

"While there is no vaccine for TB, patients can be treated with anti-TB medications, said Dr. Ngozi Osondu, an infectious-disease specialist at Maryvale Hospital.

Kuberski, who also practices at John C. Lincoln Health Network, said there is a law in Arizona that prohibits hospitals from discharging a patient until that patient is free of infectious TB.

"What the fine politicians have done is shifted the burden of paying for these undocumented aliens to the hospitals," Kuberski said. "They get their two weeks of anti-TB therapy and they're discharged. My tax dollars are paying for them to take care of this illegal alien, and obviously the doctors don't get paid, either."

Kuberski said he takes care of lots of undocumented patients.

"It's just part of being a doctor in Phoenix," he said.

 The Business Journal of Phoenix -  From the May 16, 2005 print edition
       Angela Gonzales and Mike Sunnucks - The Business Journal

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