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Border Patrol Stance on Flu Vaccines Mobilizes ID Community

AUG 23, 2019 | CONTAGION&R EDITORIAL STAFF
The US Customs and Border Protection (CBP) stance on not administering influenza vaccines to migrants in custody has rallied the infectious disease community and sparked a larger conversation about the conditions at border detention facilities.

According to a letter sent by several health care professionals to 2 Democratic members of Congress earlier this month, at least 3 children have died in CBP custody since December 2018, in part as a result of influenza.

“With so many lives at risk, these issues are worthy of Congressional investigation,” the letter, compiled by 6 public health experts, reads. “Another influenza season is around the corner, and there are other types of infectious diseases that pose a threat to detained populations. Timely action is critical.”

Influenza deaths are rare in the United States, with approximately 1 reported death per 600,000 children, according to US Centers for Disease Control and Prevention statistics. But migrant populations, a majority of which are not vaccinated, are at an increased risk of illness for a few different reasons, according to Paul Spiegel, MD, director of the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health and one of the authors of the letter.

“They have crossed an internationally recognized border after walking long distances with limited food and water in insecure conditions,” he told Contagion®. “Many are seeking asylum due to insecurity in the country that they are leaving.”

Spiegel and his co-authors have been in contact with congressional staffers since the letter was sent August 1, and they are hoping to also engage with the Department of Homeland Security.

“We certainly are trying to advocate for an investigation to see which standards are being met at the various facilities (CBP, ICE [Immigration and Customs Enforcement], and ORR [Office of Refugee Resettlement]),” he said. “We are also advocating via the media so that the public can be well-informed. We are trying to make this a nonpartisan issue and using only evidence-based recommendations to ensure that appropriate health services are provided to all persons in US government detention.”

CBP’s policy is not to administer influenza vaccines to individuals in its custody, a department spokesperson told Contagion® via email.

“In general, due to the short-term nature of CBP holding, the time the vaccine takes to begin working, and the complexities of operating vaccination programs, neither CBP nor its medical contractors administer vaccinations to those in our custody,” the spokesperson said. “Persons in our custody who require vaccination are referred to the local health system and may receive vaccinations by medical personnel at a local medical facility, if determined necessary by the medical professional during their assessment. In circumstances with public health considerations regarding vaccination, CBP coordinates with local health authorities and CDC for support as appropriate.”

An unvaccinated population in close quarters creates an environment for opportunistic infections to take hold, according to Josiah “Jody” Rich, MD, MPH, professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights.

“What’s going on in the detention facilities…it’s fairly easy to speculate that, No. 1, you have a large unvaccinated population that is getting detained and, No. 2, that they are being put into concentrated environments just like college dormitories or military barracks,” Rich, an infectious disease and correctional health expert, told Contagion® in a previous interview earlier this year. “You are taking a susceptible population with some level of disease that normally might not spread and you’re creating the environment to facilitate the spread.”

CBP’s non-vaccination policy, coupled with news of the 3 deaths attributable to influenza, has mobilized the infectious disease community to speak out this week. A group of ID organizations issued a joint statement Wednesday calling the non-vaccination rule “a violation of the most basic principles of public health and human rights.”

“In conditions of overcrowding poor sanitation and emotional stress involving vulnerable populations such as pregnant women and young children, choosing not to follow the CDC recommendations is particularly egregious,” the statement read.

“The Infectious Diseases Society of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, and the American Society of Tropical Medicine and Hygiene call for the immediate articulation and implementation of a plan to administer vaccinations against seasonal influenza and to ensure the delivery of all other routine medical immunizations in facilities under the oversight of US Customs and Border Patrol.”

According to CBP, individuals with the flu are handled as appropriate depending on the specific circumstances. Those migrants with the flu may be diagnosed and treated on site by CBP medical personnel or may be referred as appropriate to the local health system for diagnosis and treatment. 
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