[Rushtalk] 43 Percent Latent TB Rates Among Sub-Saharan Refugees in San Diego County Interviewed for Jobs at Starbucks

Carl Spitzer cwsiv at juno.com
Tue Nov 7 14:26:37 MST 2017

43 Percent Latent TB Rates Among Sub-Saharan Refugees in San Diego
County Interviewed for Jobs at Starbucks

by Michael Patrick Leahy

11 Aug 2017



Recent arrivals from Somalia and other countries in sub-Saharan Africa
were among the refugees interviewed for possible jobs by 30 Starbucks
managers at a hiring event in El Cajon, California on Tuesday as part of
the company’s commitment to hire 10,000 refugees over the next five

The latent tuberculosis (TB) rate of 43 percent among refugees in San
Diego County from sub-Saharan Africa is more than ten times greater than
the latent TB rate of 4 percent found in the general population,
according to a 2013 study from a research team led by Dr. Timothy
Rodwell, “an associate professor and physician in the Division of Global
Health at UCSD [University of California at San Diego].”

Rodwell’s study “analyzed data from LTBI [latent tuberculosis infection]
screening results of 4,280 refugees resettled in San Diego County
between January 2010 and October 2012,” and found that “[t]he prevalence
of LTBI was highest among refugees from sub-Saharan Africa (43%) and was
associated with current smoking and having a clinical comorbidity that
increases the risk for active tuberculosis. Although refugees from
sub-Saharan Africa had the highest prevalence of infection, they were
significantly less likely to initiate treatment than refugees from the
Middle East.”

NBC 7 reported that on Tuesday “[d]ozens of people from Syria, Somalia
and other countries throughout the middle east and Africa came out to
interview [with the 30 local Starbucks managers] at the International
Rescue Committee office on Main Street [in El Cajon].”

The International Rescue Committee is one of nine voluntary agencies
(VOLAGs) paid more than $1 billion annually by the federal government to
resettle refugees in the United States, and the largest VOLAG in San
Diego County.

“El Cajon is located in San Diego County, where more than 20,000
refugees have been resettled by the federal government in the past nine
and a half years since the beginning of Fiscal Year 2008,” as Breitbart
News reported earlier this week.

“Applicants needed to have work authorization and will go through the
same review and background check as other potential employees, according
to the company,” NBC 7 reported.

Starbucks apparently does not include testing for latent tuberculosis
infection (LTBI) as part of the “review and background check” of
potential employees.

“California, like most states, requires TB testing for health care
workers. Employees of restaurants are not required by California law to
be tested for TB prior to hiring,” Breitbart News reported.

Applying just this standard employee review practice to the Somali
refugees under consideration to become Starbucks baristas could pose a
potential health risk to Starbucks employees and customers.

“Around 10 percent of those with LTBI will develop active TB at some
point in their lives. The triggering mechanism to activate latent TB is
not entirely understood, but high levels of stress, crowded living
situations, poor public health practices, the presence of other diseases
that lower the immune system, and behavioral conduct–such as smoking–
appear to increase the chances of activation,” as Breitbart
News reported this week.

Of the 1,263 refugees who have been resettled in San Diego County in the
ten months and one week since FY 2017 began on October 1, 2016, 29
percent, or 364, are from sub-Saharan Africa, according to the
Department of State’s interactive website: 177 from the Democratic
Republic of Congo, 134 from Somalia, 20 from Eritrea, 14 from Ethiopia,
11 from Sudan, 5 from the Central African Republic, 2 from Kenya, and
one from Cameroon.

There is no indication that latent TB testing and treatment requirements
of refugees in San Diego County have changed since the 2013 study.

As Breitbart News reported this week, the 2013 Rodwell study found that,
among refugees in San Diego, the incidence of active TB among refugees
in San Diego County is 327 per 100,000, more than 100 times greater than
the 2.9 per 100,000 incidence rate of active TB among the general
population in the United States.

Not only is Starbucks apparently not testing these refugees it is
considering hiring for TB — who apparently come from Somalia,
Afghanistan, and Syria– many of them may not even have been tested by
the federal government for TB in their initial domestic medical

Breitbart News repeatedly asked Starbucks for comment on its TB testing
procedures for new hires, but received no response.

“Most of the refugees we talked to here in El Cajon say they just got to
the country in the last month,” NBC 7’s Danielle Radin reported from the
Starbucks refugee hiring event (beginning at the 26-second mark in this

“The NBC report validates legitimate concerns that have been raised
repeatedly by the very community stakeholders, ie, residents in
receiving communities, that the ORR and VOLAGs for years, have
deliberately kept out of the resettlement process,” an attorney familiar
with the federal refugee resettlement program tells Breitbart News.

“With the documented increases of active TB and multi-drug resistant TB
brought to communities by foreign nationals, ignoring the high latent TB
rates demonstrates a reckless disregard for the public’s health and make
state funded TB elimination programs a sad joke,” the attorney adds.

The regulations of the federal government’s refugee resettlement program
say that initial domestic medical screening reports must be conducted
within 90 days of arrival, and must include testing for latent TB. Those
initial domestic medical screenings, however, are not mandatory.

In California, about 24 percent of arriving refugees, asylees, parolees
(a term used for arrivals from Cuba), and special immigration visa
recipients (from Afghanistan and Iraq) never completed an initial
domestic medical screening.

According to the Report on Refugee Health in Calfornia for Federal
Fiscal Year 2015 published by the Office of Refugee Health in the
California Department of Health, about 76 percent, or 7,981, of the
refugees, asylees, parolees, and special immigration visa recipients
completed initial domestic medical screenings in the state that year,
out of a total of 10,520 arrivals in California in those immigration
categories. (A little over half of those arrivals, or 5,718, were
classified as refugees.)



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