Disease Exposure

Communicable Disease

Communicable disease is defined as an infectious disease transmissible (as from person to person) by direct contact with an affected individual or the individual’s discharges or by indirect means [15]. Public health issues about immigration are to be considered. For example, studies have found that immigrants from continents where developing countries are prevalent (Africa or Latin America) have much higher incidence of communicable illnesses such as active tuberculosis, hepatitis C, hepatitis B, and HIV. Other common communicable diseases include Chagas disease and intestinal parasites [16]. Applicants who have communicable diseases of public health significance are inadmissible. The U.S. Department of Health and Human Services (HHS) has designated the following conditions as communicable diseases of public health significance that apply to immigration medical examinations conducted in the United States: Chancroid, Gonorrhea, Granuloma inguinale, infectious leprosy, Lymphogranuloma venereum, infectious stage of syphilis, and active tuberculosis (TB). As of January 4, 2010, HIV infection is no longer defined as a communicable disease of public health significance according to HHS regulations. Therefore, HIV infection does not make the applicant inadmissible on health- related grounds for any immigration benefit adjudicated on or after that date [17]. According to the CDC report on Health in the US, the number of new cases per

100,000 population of infection cases in 2012 were 3.19 for TB, 16.02 for Syphilis, and 107.46 for Gonorrhea [18]. The estimated percentage of HIV diagnosis among elderly was 2 %, whereas of all persons with HIV diagnosis, 28 % were White, 47 % were African American, 2 % were Asian, and 20 % were Hispanics [18].

Entering into the twenty-first century and confronting a microbial universe in which epidemic diseases such as tuberculosis and HIV are becoming more prevalent and drug resistant, we need to be aware of Americans’ propensity to blame outsiders for the spread of dangerous pathogens [19]. Markel and Stern [19] stated that despite the dramatic changes in demography, the meaning of citizenship, and the ability to treat and cure acute and chronic diseases, foreigners were consistently associated with germs and contagion. This mindset throughout the twentieth century affected immigration history and the health of foreigners in the United States.

By the second half of the twentieth century, immigrants coming to the United States were generally healthier people. After World War II, many countries built hospitals and rural clinics and spearheaded campaigns to combat endemic diseases, and many parts of the world benefited from reductions in childhood mortality and various infectious diseases as well as improved standards of nutrition as a result of hygiene and maternity programs. In addition, organizations like the United States Peace Corps and the United Nations World Health Organization brought modern sanitary techniques, public health administration, vaccines, and medical treatments to areas that had neither the financial or human resources to afford them. But these enhanced living conditions and lowered mortality rates had the ironic outcome of skyrocketing populations. People facing overcrowding and few opportunities now had powerful incentives to immigrate, especially to the United States. And they came, whether by jet, rickety boat, plane, or foot. In 1990, for example, more than 1.8 million legal and approximately 300,000 illegal newcomers entered the United States [19].

Despite that this period from 1965 to 2002 was characterized by family reunification laws that became the centerpiece of immigration policy and spawned the migration of millions of Asians and Latin Americans to this country. In 1986, the United States Public Health Service (USPHS) suggested adding AIDS to the list of infections that would automatically debar a prospective newcomer. Subsequently, in 1988, a bill was introduced that made AIDS an excludable disease for immigrants. Then on 1993, President Bill Clinton signed into law the National Institutes of Health Revitalization Act, which amended the Immigration and Nationality Act of 1988, adding HIV infection as a criterion to keep out immigrants. Another example is “Proposition 187”, this California state law required publicly funded health care facilities to refuse care to illegal immigrants and mandated that health care workers who suspected that one of their patients might be an illegal alien report him/her to the Immigration and Naturalization Service. Indeed, legal and illegal immigrants in California avoided health care providers during the months immediately after the passage of Proposition 187, a predicament that puts all U.S. citizens in jeopardy. Some recent studies of the public health risks of tuberculosis around the world recommend that instead of forcing undocumented immigrants to hide from physicians, the United States and other industrialized nations create user-friendly tuberculosis detection and treatment programs for the hundreds of millions of people who cross international boundaries each year. Especially novel is the creation of a confidential binational tuberculosis card that allows patients to obtain treatment in both the United States and Mexico without fearing deportation or long-term detention in one of the many TB screening centers along the border. This is the front line of global health [19]. Markel and Stern [19] concluded that maintaining and protecting the public health in our current era of globalization require an ecumenical, pragmatic, and historically informed approach to understanding the links between immigration and disease.

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