Threat of deportation 'increases spread of TB'
The UAE's policy of automatic deportation for anyone suffering from pulmonary tuberculosis may unwittingly be contributing to the alarming spread of the disease in Abu Dhabi and Dubai, a world authority on TB warned yesterday.
Cases of pulmonary TB - the most infectious - more than doubled in the capital from 193 in 2009 to 450 last year, and 143 were reported in the first three months of this year alone, according to new figures from the Health Authority Abu Dhabi (HAAD).
The number of all reported TB cases rose from 272 in 2009 to 625 last year.
In Dubai, according to figures released this year, 122 cases of all TB were detected in 2008, 159 in 2009 and 722 in 2010.
The Ministry of Health decreed last year that anyone with any scar or other abnormality in lung tissue - whether old, new or active - would be considered unfit for residency. Dr Ibrahim Al Qadi, director of preventive medicine at the ministry, said any expatriate workers found to have a history of pulmonary tuberculosis would be sent back to their home countries.
That policy, according to Dr Jonathan E. Golub, a specialist in TB research at Johns Hopkins Bloomberg School of Public Health in Baltimore in the United States, may be part of the problem.
Based on a study he conducted in the US, Dr Golub says fear of deportation discourages patients with symptoms of the disease from coming forward, thus allowing the infection to spread.
His study found that expatriate patients waited longest from when they developed symptoms to seeking treatment. The most common reason for the delay was the fear of being reported to immigration authorities, as many were illegal immigrants.
"Thus, I certainly think that in a country where a TB diagnosis gets you deported, then people are very likely to not come forward, or at least delay coming forward until they are very, very sick," he said. "During their prolonged delay they are likely to be transmitting TB to others."
One of the most important components of any TB control programme is to detect the infection as early as possible so treatment can begin and transmission can be minimised, Dr Golub said.
"To do this, the disease must be de-stigmatised as much as possible so that people are willing to come forward."
In the UAE, patients in whom extra-pulmonary TB (where the bacterial infection is outside the lungs) is diagnosed are treated, and not deported. Nor are they banned permanently from entering the UAE, provided they have received treatment and are cured of the infection.
However, those with pulmonary TB (where the infection is in the lungs) are deported because this form of the disease is highly infectious, Dr Al Qadi said.
"This is because even though they receive treatment, they are not completely cured. A patch remains in the lungs indicating that the person has old TB," he said. "This means the person could get the disease again."
Not all experts agree. "Studies do show that people with a history of tuberculosis can relapse with another infection later in life, but this is only in about 5 per cent of cases," said Dr Golub.
"And the reason for it is not exactly known. It could be the individual's surroundings or environment that could be causing the reoccurrence."
International experts have said that once patients are given the six-month treatment for pulmonary TB, a culture test is taken to determine if the patient is cured.
Dr Golub said once individuals are cured of pulmonary TB they are no longer infectious, regardless of whether there is a visible abnormality in the lungs.
Although studies show that individuals with a history of TB are more likely to develop the infection again, the reason is not necessarily biological, Dr Golub said.
Health officials in the UAE insist that a rigorous tuberculosis prevention programme is necessary to prevent the disease from spreading.
"Tuberculosis control is a public health challenge worldwide, and as is well known, the UAE has a high influx of expatriate workers coming from countries with high incidence of TB," said Dr Farida Al Hosani, the section head of communicable diseases at HAAD.
"Therefore, tuberculosis control in the UAE must be implemented effectively in order to prevent the transmission of it."
In addition, under a new GCC Health Programme, anyone testing positive for the infection when applying for a visa to the UAE will be permanently denied entry.
The programme for expatriate workers was implemented at the beginning of this month for workers coming from Indonesia and Sri Lanka, with long-term plans to extend the programme to eight additional East Asian and African countries.
Countries outside the GCC, including Australia and the UK, neither deport nor ban individuals with pulmonary TB, provided they have received treatment and are free from active TB.
Christine Pearson, from the National Center for Emerging and Zoonotic Infectious Diseases at the US Centres for Disease Control and Prevention, said a history of tuberculosis alone would not prevent someone from coming to the US.
"In general, immigrants who have active TB can come to the US only after they have begun treatment," she said. "In certain rare cases, the immigrant may apply for a waiver from the US Department of Homeland Security."