We Need to Address the Health of Children at the Border

October 24, 2019

Migrant Kids, Infectious Diseases, and the Ongoing Border Crisis

Experts urge vaccination, better healthcare practices to curb infection-related deaths

MedpageToday
Seven migrant children have died in U.S. custody during the past year, and conditions in detention centers may be encouraging the unchecked spread of infectious diseases, a researcher argued.

Children have died from illnesses such as influenza with an associated bacterial infection, pneumonia, sepsis, and a misdiagnosed sinus infection, wrote Mark Travassos, MD, of the University of Maryland School of Medicine in Baltimore, in Clinical Infectious Diseases.

In the last 2 months alone, outbreaks of other infectious disease outbreaks, including flu, the mumps, and chicken pox have led to quarantines of migrants, he noted.

Lack of adequate healthcare for migrant children at the border has been widely reported. In a statement, heads of the Infectious Diseases Society of America (IDSA), the HIV Medicine Association, the Society for Healthcare Epidemiology of America, and the Pediatric Infectious Diseases Society (PIDS) expressed concern about the practice of care for migrants, including withholding medical immunizations and other critical and routine health services.

Indeed, IDSA Past President Cynthia Sears, MD, recently penned an editorial for MedPage Today, where she characterized withholding flu shots and other routine healthcare from migrants at the border as a "stark violation of law, ethics, and public trust, and a frightening violation of public healthcare principles."

An accompanying CID editorial by Betsy Herold, MD, and Kristina Bryant, MD, both of PIDS, provided a snapshot of the quarantines at detention centers: 5,200 adult immigrants quarantined due to vaccine-preventable diseases, nearly 900 confirmed and probable mumps cases reported by the CDC among adults and an additional 33 cases among facility staff from September 2018 to August 2019. They also noted 423 confirmed cases of influenza and 461 confirmed cases of chicken pox.

Children and others arriving from abroad may be incubating diseases to which they were exposed in their home countries. Immigrants may lack immunity to diseases considered vaccine-preventable, either from lack of access to vaccines or poor responses to receipt of improperly stored vaccines," Herold and Bryant wrote.

Indeed, Travassos discussed the detained children who died from infection-related causes, noting that "before September 2018, no child had died in United States Border Patrol Custody in a decade." The story of Felipe Gomez, who died of influenza in December 2018, is the most well-known.

"Transmission of infectious diseases such as influenza in these facilities suggests a lack of effective infection control procedures in place, perhaps even inadequate basic sanitation," Travassos wrote.

He detailed Gomez's autopsy report, indicating that the boy not only tested positive for influenza, but contracted sepsis from Staphylococcus aureus, a complication of the flu. Furthermore, Travassos stated that Carlos Hernandez Vásquez, age 16, died of influenza due to complications from pneumonia and sepsis, and Jakelin Caal Maquin, age 7, also died of sepsis.

In addition, 16-year-old Juan de Leon Gutierrez died from Pott's puffy tumor, an infection of the frontal portion of the skull, which Travassos said is "typically due to misdiagnosis or inappropriate treatment of a sinus infection." He added that these deaths "[raised] concerns about the ability of Border Patrol employees to recognize children in need of urgent medical attention."

Herold and Bryant argued that the U.S. government could learn from the everyday lessons of prior infectious disease outbreaks, specifically from military trainees. For example, handwashing at least five times a day among Navy recruits led to a 45% decrease in respiratory disease rates, they said, but adding that "hand hygiene is difficult when one is denied access to soap and facilities for basic personal hygiene."

"Overcrowding is known to contribute to disease outbreaks [and] military guidance emphasizes the importance of immunization in the prevention of respiratory disease outbreaks," the editorialists wrote.

Travassos also urged organizations like IDSA and the American Academy of Pediatrics to be included in "formulating effective policies for pediatric care and infection control policies ... [and] building on policies in place for child care centers and hospitals, including the training of workers to identify and manage illness in children."

"There is an urgent need for advocacy by clinicians and professional societies to resolve this crisis," he wrote