Tuberculosis and the Immigration Question
Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: Should we screen immigrants for tuberculosis?
Neil Schluger: Well, more than half of all people with active tuberculosis in the United States were born outside the U.S. Now very few of those people come in to the United States with active tuberculosis. Most of those persons come in with a latent form of tuberculosis that’s not contagious. They’re not sick. We can identify those people and we can treat them. So it’s a very treatable condition in my view. In no measure is it a reason to keep people from immigrating to the United States. Persons who are coming here should be screened for TB and treated if they have it and then it won’t be much of a problem so I don’t think it’s a reason to keep people out. It’s a very easy mallet to beat people over the head with to try to prevent immigration. Immigrants are bad people who bring diseases. We have seen that before in the United States and certainly in the current climate there is the potential for that again, but most persons who come in to the U.S. just have latent TB infection, as I said not contagious. We can identify them, we can treat them, and they’ll never get TB so from my point of view it would be really a tragedy if that were used to drum up prejudice and discrimination against people coming in for perfectly legitimate reasons, and we’ve always depended on these people in the United States.
Question: What about actively contagious immigrants?
Neil Schluger: Right. So people coming to the United States with active TB, as I said it’s relatively uncommon. Most of those persons don’t come legally. If you try to legally immigrate to the United States for example you actually have to be screened for tuberculosis in your home country so if you’re coming here on a residence Visa or something like that you have to have an x-ray in your home country and it’s got to show that you don’t have contagious TB before you can come in. Now some people are exempt from that. Tourists for example don’t get that kind of screening and students often don’t get that kind of screening but people who are coming here to live at least do, and we don’t think there’s too many people who actually come in to the United States with active TB. Now in some parts of the United States that is more of an issue and that’s particularly out west, California and the Southwest, where people go back and forth across the border all the time. And that’s not really the case in New York because we’re separated by an ocean from most other borders but California, Arizona, places like that, it’s more of a problem there because people go back and forth all the time. And there I think the solution is in sort of cross- border cross government cooperation for TB treatment.
Recorded on: 04/25/2008
Tuberculosis should not be a reason to keep people from immigrating to the United States, Schluger says.