Border Lookout: Enhancing Tuberculosis Control on the United States–Mexico Border

Abstract

Abstract. We evaluated the use of federal public health intervention tools known as the Do Not Board and Border Lookout (BL) for detecting and referring infectious or potentially infectious land border travelers with tuberculosis (TB) back to treatment. We used data about the issuance of BL from April 2007 to September 2013 to examine demographics and TB laboratory results for persons on the list (N = 66) and time on the list before being located and achieving noninfectious status. The majority of case-patients were Hispanic and male, with a median age of 39 years. Most were citizens of the United States or Mexico, and 30.3% were undocumented migrants. One-fifth had multidrugresistant TB. Nearly two-thirds of case-patients were located and treated as a result of being placed on the list. However, 25.8% of case-patients, primarily undocumented migrants, remain lost to follow-up and remain on the list. For this highly mobile patient population, the use of this novel federal travel intervention tool facilitated the detection and treatment of infectious TB cases that were lost to follow-up.

Loss to Follow-Up (LTFU) during Tuberculosis Treatment

“…In contrast, among the Ugandan prison inmates, 43% were LTFU and the odds are greater among the transferred prisoners [64]. On the other hand, researchers from the USA found out that 25.8% of the cases in a public health intervention were LTFU, and they were mainly undocumented migrants [65]. In such countries, as discussed above, even a single case of LTFU can cause an outbreak of TB.…”

“…Another form of federal public health intervention is used in the USA to solve the problem of LTFU among the migrants [65]. These tools called the Do Not Board (DNB) and Border Lookout (BL) list are managed by the Department of Homeland Security (DHS) according to requests from the Centers for Disease Control and Prevention (CDC) Travel Restriction and Intervention expert workgroup.…”

“…(2) the person is unaware of his/her diagnosis, fails to adhere to public health recommendations, including treatment, or public health authorities are unable to locate the person; and (3) the person poses a risk to travel internationally or on a commercial flight" [65].…”

The Potential Impact of Border Security Upon Prevalence of Infectious Disease

“…69,74 Several studies on this issue report that these people may carry diseases of which they are unaware, indifferent to, or for which they cannot allocate diagnosis or treatment. 75,76 Therefore, when individuals migrate from one nation and enter another they may unintentionally share negative elements of their past, such as TB or other infectious diseases. 77 Evidence such as this indicates that undocumented immigration can unintentionally foster the spread of infectious disease.…”

“…77 Evidence such as this indicates that undocumented immigration can unintentionally foster the spread of infectious disease. 76,78,79 Diseases that were previously exempt from the United States can now be found in persons arriving as undocumented immigrants within the borders. 80 For instance, in 2007, a disproportionate incidence of HD (commonly known as leprosy) was reported in the state of California (CA).…”