Download Border Definition Who Lives there? Who Travels Across? Vector

Border Definition
• 3,141 km
• 1983 La Paz Agreement:
Who Lives there?
Who Travels Across?
• 14.94 million people
• According to the CDC, the United States-Mexico land
border is the busiest international land frontier in
the world
• 7.44 million in the U.S.
Defined it as the land within 100 km on either
side of the international boundary
• 15 pairs of sister cities
• Goal: to protect the environment and public
health in the U.S.-Mexico border region
• 7.50 million in Mexico
• Each year, tens of thousands of Mexican-born
immigrants come temporarily to the United States legally
to work 196,000 and 86,000 to study in 2009
• 2000-2010
• U.S. border population increased by 12%
• Mexican border population increased by about 18%
• 1.2 million daily border crossings into the U.S.
• Estimated by the Border Health Commission to double
by the year 2025.
• Mexico is the #1 country for U.S. citizens to enter
• Young population because of high fertility and a
continuous migratory flow
• About 30% of the Mexican border population and 24%
of the U.S. border population is under 15 years of age
Callie Davies, MSIII Class of 2015
Types of Infections
Vector Borne
Vector Diseases
One factor that increases the risk
• Strong market for used tires-millions of tires from the U.S. are
imported to Mexico for reuse
• Millions of scrap tires-46 known tire piles throughout the border
region
• Breeding grounds for mosquitoes, rodents, and other vectors of
disease
West Nile Virus
• First isolated from a blood sample in the West Nile province of
Uganda in 1937
• 1999 first outbreak in U.S.
• WNV detected south of border in Mexico in 2002
Transmission
Vaccine Preventable
• Childhood immunization
programs have been a success
in both countries and in the
border area itself
• 2009 coverage- U.S. border
states ranged from 57% to
87.9%
• 95% by age five because of
laws for school entry
• Coverage of fully immunized
kids 1-4 y/o in the 6 Mexican
border states in 2009 was
93.9-99.4%
• Mexico’s population has a
higher vaccination rate than
the U.S. because public health
nurse goes door to door
• Transmission due to mosquito bites, birds are amplifying hosts
Measles
• Ask patient if they have seen dead birds in their area especially
crows
• Measles virus from paramyxovirdae
• Spread through respiration
• Studies have shown that clusters of
dead birds predicted an increase risk
1-2 weeks prior to incidence of human
cases
• Symptoms include fever, cough, runny
nose, red eyes and a generalized,
maculopapular, erythematous skin
rash
Rates along the Border 2010
Mumps
• 1,021 cases: 38% from the 4 U.S.
border states
• Mumps virus
• Typically starts with a few days of
fever, headache, muscle aches,
tiredness, and loss of appetite, and
is followed by swelling of salivary
glands
• Arizona as the leading state with 167
cases and 15 deaths
• Almost half of the total deaths from
West Nile infections were from border
states
• According to BIDS most West Nile
Virus is north of the border in
Maricopa. Although there have been
a few cases in Pima County
Dengue Fever
• Human-mosquito-human
• Daytime feeder unnoticed
• Carries virus for lifespan once its infected
• Resides around human habitation
• Short flight distance and bounce from host to host infecting
multiple people in one day
Cases:
• Dengue virus transmission is seasonal, with peak activity in late
summer and fall
• In 2011, over 67,000 cases of dengue infection were reported
from Mexico, including 4000 cases of severe dengue and 36
deaths
• High risk on Mexican border states with over 18,000 reported in
2010 but these are located in the southern areas of the state- for
Sonora: Hermosillo and below
Rocky Mt Spotted Fever
• Spring and Early summer
• 2005: outbreak in Northern Arizona by the Brown Dog Tick
• First time this vector has been identified
Influenza (A/B/Pandemic/Avian)
• Mexico: Access to piped drinking
water 78-95%
• In 2009, along the U.S. side of the border, Arizona reported a
total of 676 (587 males and 89 females) newly reported cases
of HIV/AIDS
• Seasonal: influenza A or B
• Access to sewer services ranged
from 84-95%
• U.S. border cities: over 98% of the
households have access to piped
drinking water and treated wastewater services
• Colonias Texas
Education to treat well water appropriately and keep well water
stored at a cool temperature.
Hepatitis A
• Spread via the fecal-oral route
• Is more prevalent in low socioeconomic areas
• lack of adequate sanitation
• poor hygienic practices
Cases:
• Acute hepatitis A incidence has declined by 92 percent between
1995 and 2007, from 12 to 1 case per 100,000 In 2007:
• Hep A incidence in U.S. border Arizona: 2.4/100,000
• Highest of all the border states
• Prevention: hand washing, heating foods appropriately, and
avoidance of water and foods from endemic areas.
• Hand washing is highly effective in preventing the transmission
of the virus since HAV may survive for up to four hours on the
fingertips.
• Last small outbreak was in 2009
according to the CDC
• What is it?
Rubella
• “Bathtub cheese”
• also known as German Measles or
3 day measles
• Can be eaten as long as it is pasteurized
• spread by contact, coughing, sneezing
• Street vendors
What infections?
Salmonella
Listeria
• In 2007, reported new cases of HIV in the Mexican border
states ranged from 5-91
How is HIV different along the border?
• Deportation: fear is a deterrent for undocumented individuals
from testing services and care
• Education: There is a perception that HIV happens only in
certain groups: homosexuals, unfaithful partners, or injection
drug users so many do not perceive themselves to be at risk
• Embarrassment: Religion is also prominent along border towns
many fear risk of being discovered and judgement by fellow
community members
• Transportation: Many HIV individuals along the border to not
have a way to get care in Tucson or Phoenix and do not want
to risk being seen by someone they know in a clinic along the
border.
• Clinic access on Mexico side: recently built new HIV clinics
along the border
Syphilis 2010
• Mexico: incidence rates of congenital syphilis among the highest
in the nation
Douglas, Agua Prieta
Nogales, AZ, Nogales, Sonora
Yuma, San Luis Rio Colorado
• Can cause miscarriage, premature birth or stillbirth, blood and
brain infections
Results:
• In Mexico, rubella vaccination was incorporated into the national
vaccination program in 1998; since then numbers have dropped
significantly
Brucellosis
• Abnormal Cytology
• highly contagious respiratory disease
• Caused by Bordatella pertussis
• Uncontrollable, violent coughing which often makes it hard to
breathe, followed by deep breathes resulting in a “whooping”
sound
• Pertussis most commonly affects infants and young children and
can be fatal, especially in babies less than 1 year of age
Tucson, Hermosillo
• Women on the Mexico side 11.2%
• More recent cases of Queso Fresco
• Women on U.S. side 6.9%
M Bovis
• The highest prevalence of abnormal Pap smears was 12.4% at
Agua Prieta/Cananea clinic site
• Resistant to front line therapy infections
• 2 x risk of death
What has Changed?
• In 2005 survey of Latina Women:
Drug Resistant TB
• Along Arizona’s border 19 providers are enrolled in the “National
Outpatient Influenza Like Illness Surveillance Network”
• On a weekly bases these sites report the total number of patients seen
with Influenza like illness
• ILI is defined as a fever of at least 100 degrees F plus a cough or sore
through in absence of a known cause other than influenza
Goals:
• Pandemic Influenza is rare, but are risks
• Avian Influenza H5N1, H7N9 in china, and corona virus in Middle
East causing severe respiratory syndrome
• Goal is to constantly monitor so we can be quick to respond and react
• Also to identify enough cases to subtype for vaccines
• Encourage all healthy people to become vaccinated
Rabies
• Since the beginning of 2014 rabid skunks have been a problem in
southern Arizona
• Treatments is only effective prior to invasion of neural tissue
• Disease prevention is entirely prophylactic and includes passive
antibody (immune globulin) and active immunization (rabies vaccine)
• 60% of all national cases in AZ
• U.S. had 124, according to the CDC
• Arizona has a low DRTB rate
• Treatment can require up to two years or more of
medication and potentially months of isolation
• Costs: according to a recent CDC study, treatment on
average in the U.S. was about $140,000 and ran as high
as $700,000
• 30% of patients in Mexico don’t complete their TB treatment
and there are lack of health workers to offer direct observed
therapy to every patient
How has control improved?
• “Meet and Greet”- 6 years headed by BIDS
• If a patient with TB is deported or simply moving back to
Mexico the local hospital will be notified and a nurse and
doctor will come to the port of entry and meet the patient
• Project CURE-TB which helps with refer all for treatment
when traveling across the border
Out of 5,000 cases in 2007, 500 were interviewed:
• It also delegates on both sides and helps contact the family
in contact with infected patient to ensure they are not
infected as well
• 1/3 did not know how it was transmitted
• For the U.S. border states, in 2009, California reported the highest
incidence rate in the region (6.7 cases per 100,000 population),
while Arizona was 3.9
• Study also found that people who did know know what valley fever
was had an average of 3.5 rounds of antibiotic before getting
serology test for cocci
• BIDS has been working with Mexico and help create systematic
testing in labs along endemic areas like the border states
• California had the highest incidence rate and the highest number of
cases (2,470) in the nation
• The six Mexican border states reported TB incidence rates higher than
the national average of 13.5 cases per 100,000 population in 2007
Who to contact with any infection questions:
Office of Border Health, BIDS
Orion McCotter:
[email protected]
Phone (520) 770-3110
(520) 770-3307
• All Mexican study sites had the higher prevalence rates of
abnormal paps than the sister cities
• In 2,270 women, C. trachomatis prevalence overall was 8.2%
References
• Numbers have been decreasing as education and awareness
have increased since this study
CDC, United States-Mexico Public Health, http://www.cdc.gov/USMexicoHealth/
The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance, Emerging Infectious Disease Journal, CDC,
http://wwwnc.cdc.gov/eid/article/9/1/02-0047_article.htm
Cases:
• Educational pamphlets- what is “safe” cheese
• 2010: 1,682 cases of RMSP
were reported in U.S.
• Limited the quantity of cheese able to be brought across the
border.
• AZ had 41 all on tribal lands
and from the brown dog tick
Design and results of the USA-Mexico border human papillomavirus (HPV), cervical dysplasia, and Chlamydia trachomatis study.
http://www.ncbi.nlm.nih.gov/pubmed/11349353
• Queso Fresco infection outbreak is now not a current concern;
however important to maintain education so it stays that way
• Cases throughout AZ, but there have been widespread prevention
efforts to treat home and dogs.
• 1/5 of Arizonans have never heard of VF
• Mexico City only public health lab
Chlamydial infection in women along the US-Mexico border.
http://www.ncbi.nlm.nih.gov/pubmed/15601488
• The Mexicali outbreak was
also linked to transmission by
Rhipicephalussanguineus, and
spread through infected ticks
by stray and free–roaming
dogs
• Arizona Department of Health services recommends patients with
community acquired pneumonia from endemic areas be tested for
cocci since valley fever mimics CAP
• Patients in the U.S. who refuse treatment can be jailed, but
Mexico by law can’t compel patients to take their drugs
• Bad: wildlife tick vs brown dog tick which is in human habitat
• 2009–2010, over 1,000 cases
of RMSF were reported in
Mexicali, Mexico
• Sonora, Coahuila, Nuevo León, and Baja California considered to be
most affected
• Mexico rate of TB infection is up to 10 times higher- the
resistant strains begin to breed and the same drug regimens
are given over and over with little supervision to complete
treatment before being cured
• 99% received prenatal care for most recent pregnancy- only 1%
of them reported that they were told not to eat queso fresco
• 1/3 never recall recent tick bite
• Endemic to southwest and Mexican border states
The Worry
• 83% eat queso fresco
• 82% didn’t know if the queso fresco they ate was from pasteurized or unpasteurized milk
• Grows in the soil
• A total of 2,437 women were recruited
• highest rates in hispanics
• Can cause TB consumption vs respiration
How do they keep track?
• In continental U.S. rabies among dogs is reported most commonly
along the U.S.-Mexico border (vs bats for most of the nation)
• Women 15 years and older living in the following pairs of
Arizona/Mexico communities:
• After STDs 2nd Most common infection
• Almost half of the U.S. cases came from California and
Texas
• Congenital syphilis in 2010 according to CDC
• OBH created a study to investigate the prevalence of
C. trachomatis, HPV, and cervical dysplasia among women
along the Arizona, U.S.-Sonora, Mexico border
Coccidiomycosis
Above baseline, but never went above the epidemic threshold of
3.72% for Arizona
• Rabies virus is most commonly transmitted via saliva introduced by a
bite or other exposure to an infected host. (open wound too)
• Not many studies done
Environmental
• In 2011: WHO- Mexico had 467 MDR-TB cases
• U.S. Border: congenital syphilis ranged from 0.0-25.3 cases per
100,000 live births compared to 8.7 for the nation
Chlamydia
Respiratory
Transmitted
Total of 1,142 cases of influenza were reported from the border
region
• Clinical rabies is almost always fatal, so prevention of the disease is
priority!
• Higher rates in hispanic infants
• AKA “whooping cough”
• Arizona Border 2011-2012 Influenza Season Summary Records:
• Rates were the highest in Baja California 30 per 100,000 under
1 y/o and 21 for Sonora compared to 0.03 for the nation
• Birth defects if acquired by a pregnant woman: deafness,
cataracts, heart defects, mental retardation, and liver and spleen
damage
Pertussis
Zoonotic
HIV/AIDS
Queso Fresco
• acute, causes fever and rash
Sexually Transmitted
Drinking Water 2010
• Rare due to vaccination
• Rubella virus
• Aedes aegypti mosquito
Food Borne
Women Along the U.S.-Mexico Border Are at Higher Risk of Chlamydial Infection
The body complete HIV/AIDS resource, CDC http://www.thebody.com/content/art24848.html
Epidemiology and pathogenesis of West Nile virus infection, UpToDate,
http://www.uptodate.com.ezproxy2.library.arizona.edu/contents/epidemiology-and-pathogenesis-of-west-nile-virus-infection?detectedLanguage=en&source=search_result&search=US+Mexico+border+wnv&selectedTitle=1~150&provider=noProvider
Epidemiology of dengue virus infections
http://www.uptodate.com.ezproxy2.library.arizona.edu/contents/epidemiology-of-dengue-virus-infections?detectedLanguage=en&source=search_result&search=US+Mexico+border+dengue&selectedTitle=1~150&provider=noProvider
Clinical manifestations and diagnosis of Rocky Mountain spotted fever
http://www.uptodate.com.ezproxy2.library.arizona.edu/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?detectedLanguage=en&source=search_result&search=US+Mexico+border+rocky+mountain+spotted+fever&selectedTitle=2~150&provider=noProvider
Risk of Deadly TB Exposure Grows Along U.S.-Mexico Border
http://online.wsj.com/article/SB10001424127887323293704578336283658347240.html
US/ mexico border and TB
http://www.nmsu.edu/~bec/tbontheborder.pdf
Overview of Hep A virus infection
http://www.uptodate.com.ezproxy2.library.arizona.edu/contents/overview-of-hepatitis-a-virus-infection-in-adults?detectedLanguage=en&source=search_result&search=US+Mexico+border+Hepatitis+A&selectedTitle=1~150&provider=noProvider
Understanding Knowledge, Attitudes, and Behaviors Related to Influenza and the Influenza Vaccine in US-Mexico Border Communities.
http://www.ncbi.nlm.nih.gov/pubmed/22684884
United states- Mexico Border Office, H1N1
http://www.paho.org/fep/index.php?option=com_content&task=blogcategory&id=741&Itemid=333
Rabies, Clinical Key
https://www.clinicalkey.com/topics/infectious-disease/rabies.html
What is Border 2012, La Paz Agreement
http://www.epa.gov/Border2012/framework/background.html
US Mexico Border Health Commission
http://www.borderhealth.org/
Acute Viral Hepatitis in the US mexico border region: data from the BIDS Project, 2009
http://www.ncbi.nlm.nih.gov/pubmed/22447176
Revocery of Salmonella, Listeria monocytogenes and M.Bovis from Cheese Enterin the US through Noncommercial Land
Port of Entry.
http://naldc.nal.usda.gov/download/21281/PDF
Arizona Border 2011-2012 Influenza Season Summary
http://www.azdhs.gov/diro/borderhealth/bids/documents/influenza/11-12summary-influenza-report-week40-20.
pdf
Understanding Knowledge, attitudes, and behaviors related to influenza and the influenza vaccine in US mexico Border
Communities
http://www.ncbi.nlm.nih.gov/pubmed/22684884
AIDS education and Training Center
http://aidsetc.org/aidsetc?page=home-00-00
Office of Border Health, HPV, Chlamydia, and Cerival dysplasia Prevalence Along the Arizona-Sonora Border
http://www.azdhs.gov/diro/borderhealth/studies/chlamydia.htm