Maine has had a slight increase this year in reported cases of several infectious diseases, including tuberculosis and hepatitis, compared with the past five years. But it’s not clear from publicly available health data whether Gov. Paul LePage was correct Wednesday when he said that immigrants are responsible for the rise.

At a town hall meeting Wednesday in Augusta, LePage renewed his claim that asylum seekers are bringing infectious diseases to the state.

“Because of HIPAA laws, I can’t tell you who they are,” the governor said, referring to the federal law that protects the confidentiality of personal medical information. “The fact of the matter is, there is an increase in disease.”

LePage made the comment in response to a remark by an audience member who was critical of his stance on asylum seekers. “We have them by data,” the governor went on to say, “but we don’t have them by name because we can’t.”

The Maine Center for Disease Control and Prevention publishes data online that shows varying increases in reported cases of tuberculosis, and hepatitis B and C. For example, there were seven cases of tuberculosis in the first quarter of 2016, compared with a median number of five cases for the same period during the previous five years. There were 12 cases of acute hepatitis B and 11 cases of acute hepatitis C in the quarter, compared with a median of four cases each in the same quarter the previous five years.

However, the published data does not indicate where in Maine the cases were reported or provide information about the ethnic or racial background or immigration status of reported cases.

John Martins, spokesman for the Maine CDC, and Samantha Edwards, spokeswoman for the Department of Health and Human Services, which oversees the CDC, did not respond Thursday to multiple phone calls and emails seeking to clarify what information the CDC receives about the individuals with reported cases of these diseases, and what information the agency may have shared with LePage that is not published online.

DRUG USE A FACTOR IN DISEASES

LePage repeatedly has said that asylum seekers – whom he has called “the biggest problem in our state” – are responsible for increases in cases of tuberculosis, HIV, hepatitis C and hepatitis B. In fall 2014, LePage said he had been “trying to get the president to pay attention to the illegals who are in the country. Because there is a spike in hepatitis C, tuberculosis, HIV, and it’s going on deaf ears.” Nineteen cases of HIV have been reported in the first quarter this year; the five-year median is 15.

During his 2015 State of the State address, LePage suggested that illegal immigrants and asylum seekers should be required to undergo medical examinations to avoid the spread of infectious diseases in Maine.

Many public health experts have attributed the increase in hepatitis to the epidemic of heroin abuse, with more addicts using the drug and sharing needles.

Most people become infected with hepatitis C by sharing needles or other equipment used to inject drugs, according to the federal CDC. Studies indicate that the greatest increases in hepatitis C are among young white people in suburban neighborhoods east of the Mississippi River who had abused prescription opioids in the past and had a recent history of intravenous drug use.

In a public health update sent out Thursday, the Maine CDC noted a “sharp increase” in the number of acute hepatitis B cases reported in 2016. There had been 15 confirmed cases this year as of May 16. No cases were reported during that period last year, while the five-year median for January through April is four cases.

“The primary risk factor for new cases of acute hepatitis B in Maine in 2016 is injection drug use,” the update said. The update did not mention immigrants.

The number of acute cases of hepatitis C tripled in 2014 to 31 cases, according to the Reportable Infectious Diseases in Maine annual report for 2014. The report said it was unclear whether the increase was due to more disease transmission or because of enhanced reporting through provider awareness and electronic laboratory reporting.

TUBERCULOSIS RISING IN FOREIGN-BORN

Tuberculosis cases in the United States are on the decline, according to the federal CDC. A total of 9,421 cases were reported in 2014, a 1.5 percent decrease from the previous year.

While the total number of tuberculosis cases is decreasing, the percentage of cases among foreign-born individuals has risen steadily since 1993, according to the federal CDC. The most common countries of origin for people with tuberculosis are Mexico, the Philippines, India, Vietnam and China.

“The sheer number of people who live, work and travel between the United States and Mexico has led to a sharing of culture and commerce, as well as the easy transportation of infectious diseases,” the federal CDC says on its website. “The large movement of people across the United States and Mexico border has led to an increase in health issues, particularly infectious diseases such as tuberculosis.”

To combat that risk, the federal CDC has launched several projects with the Mexican Secretariat of Health that aim to notify, detect and respond to communicable disease cases.

An overseas medical examination is mandatory for all immigrants and focuses on identifying people with inadmissible health-related conditions, including diseases such as cholera, plague and yellow fever. Medical screenings using guidelines developed by the CDC are recommended once refugees arrive in the U.S., but are not required.

Testing for HIV was removed from the requirements for U.S. admission in 2010, but the CDC highly encourages screening for all arriving immigrants and refugees.

 

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