Academic journal article Revista Panamericana de Salud Publica

Transmision Transfronteriza De la Tuberculosis Entre Mexico Y Los Estados Unidos

Academic journal article Revista Panamericana de Salud Publica

Transmision Transfronteriza De la Tuberculosis Entre Mexico Y Los Estados Unidos

Article excerpt

Tuberculosis transmission across the United States--Mexico border

A REMARKABLE SETTING

The area encompassing the 2 000 mile border between the United States (U.S.) and Mexico is of mutual strategic importance to both countries and key to their security and economic prosperity. The U.S.-Mexico border area is also uniquely dynamic. According to the U.S. Department of Transportation and the U.S. Customs Service, nearly 200 million passenger-crossings were made by bus and personal vehicle in 2009 (1). Not only is the volume of documented and undocumented migration high, nonmigrants cross the border on a daily basis for employment, leisure, and to visit family. Furthermore, a significant portion of the U.S. population is of Mexican descent, as underscored by President Felipe Calderon of Mexico who said: "Mexico does not end at its border."

In a world characterized by globalization, policies concerning health security, communicable diseases, and health care are increasingly important. Infectious disease transmission along the U.S.-Mexico border is an area for particular concern. Although tuberculosis (TB) trends in the U.S. and in Mexico are encouraging, with prevalence levels currently at 9 500 and 24 000 respectively (2, 3), the advent of drug resistance and the complexities of border population dynamics may cause a considerable threat to the population on either side.

IMMIGRATION POLICY AND U.S.-MEXICO RELATIONS

Immigration is not new to the United States. On the contrary, over the course of this vast country's history, immigration has traditionally been a crucial source of population growth. In 1790, Congress began a process for enabling foreign-born individuals to become U.S. citizens (4). In 2008, nearly 190 000 individuals from Mexico obtained legal permission for permanent residency in the United States, and an additional 231 000 were naturalized (5). Non-immigrant admissions to the United States from Mexico reached over 7.2 million in 2008, by far the most from any single country, equivalent to 18.5% of the total. Mexico is also the source of the highest proportion of temporary and seasonal worker admissions, over 300 000 individuals in 2009 (5). Worth noting is that in 2009, according to the U.S. Office of Immigration Statistics, nearly 530 000 "deportable aliens" were identified as being Mexican nationals (5). Over 280 000 were removed from the United States, 34% with a criminal conviction. However, these figures are eclipsed by the estimated number of unauthorized immigrants in the United States: in 2009, 62% of the estimated 10.8 million illegal immigrants in the United States were thought to be from Mexico (6).

During 1994-2009, commercial ties between the United States and Mexico were cemented, and trade more than quadrupled (7). Indeed, the majority of foreign direct investment in Mexico originates from the United States. In 2008, 10% of U.S. merchandise imports came from Mexico, and 11% of U.S. merchandise exports were destined for Mexico; whereas 50% of Mexico imports originated in the United States, and 82% of Mexico exports headed to the United States (8). However, Mexico's border states (Baja California, Sonora, Chihuahua, Coahuila, Nuevo Leon, and Tamaulipas) and U.S. border states (Arizona, California, New Mexico, and Texas) are plagued by Mexico's devastating narcotics war. Violence, drug trafficking, and related security issues are straining relations and diverting limited resources like never before.

TB TRANSMISSION: A PUBLIC HEALTH CONCERN

TB has various mycobacterial strains, collectively termed the Mycobacterium tuberculosis complex, that cause disease via airborne droplet transmission. Predominantly, but not exclusively affecting the lungs, (9) TB is a leading cause of morbidity and mortality around the globe, with more than 9 million new cases and nearly 2 million deaths in 2007 (10). In terms of clinical manifestations, TB is commonly associated with cough, fever, night sweats, and weight loss. …

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