Starbucks’ refugee applicants spark concern over high risk of TB

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In its efforts to hire 10,000 refugees over the next five years, Starbucks may be putting the American public at risk of contracting tuberculosis, according to a report published in Breitbart on Friday.

Recent arrivals from Somalia and other countries in sub-Saharan Africa were among the refugees interviewed for possible jobs by 30 Starbucks managers at a hiring event in El Cajon, California on Tuesday as part of the company’s commitment to employ more refugees.

The latent tuberculosis (TB) rate of 43 percent among refugees in San Diego County from sub-Saharan Africa is more than ten times greater than the latent TB rate of 4 percent found in the general population, according to a 2013 study from a research team led by Dr. Timothy Rodwell, an associate professor and physician in the Division of Global Health at UCSD [University of California at San Diego].

Rodwell’s study “analyzed data from LTBI [latent tuberculosis infection] screening results of 4,280 refugees resettled in San Diego County between January 2010 and October 2012,” and found that “[t]he prevalence of LTBI was highest among refugees from sub-Saharan Africa (43%) and was associated with current smoking and having a clinical comorbidity that increases the risk for active tuberculosis. Although refugees from sub-Saharan Africa had the highest prevalence of infection, they were significantly less likely to initiate treatment than refugees from the Middle East.”

On Tuesday, NBC 7 reported that “[d]ozens of people from Syria, Somalia and other countries throughout the middle east and Africa came out to interview [with the 30 local Starbucks managers] at the International Rescue Committee office on Main Street [in El Cajon].”

The International Rescue Committee is one of nine voluntary agencies (VOLAGs) paid more than $1 billion annually by the federal government to resettle refugees in the United States, and it’s the largest VOLAG in San Diego County.

“El Cajon is located in San Diego County, where more than 20,000 refugees have been resettled by the federal government in the past nine and a half years since the beginning of Fiscal Year 2008,” Breitbart News reported.

“Applicants needed to have work authorization and will go through the same review and background check as other potential employees, according to the company,” according to NBC 7.

Starbucks, however, does not include testing for latent tuberculosis infection (LTBI) as part of its “review and background check” of potential employees.

Like most states, California requires TB testing for health care workers. Restaurants, on the other hand, are not required by California law to test their employees for TB prior to hiring, which means that Somali refugees under consideration to become Starbucks baristas could pose a potential health risk to Starbucks employees and customers.

“Around 10 percent of those with LTBI will develop active TB at some point in their lives. The triggering mechanism to activate latent TB is not entirely understood, but high levels of stress, crowded living situations, poor public health practices, the presence of other diseases that lower the immune system, and behavioral conduct–such as smoking–appear to increase the chances of activation,” Breitbart reported.

Of the 1,263 refugees who have been resettled in San Diego County in the ten months and one week since FY 2017 began on October 1, 2016, 29 percent, or 364, are from sub-Saharan Africa, according to the Department of State’s interactive website: 177 from the Democratic Republic of Congo, 134 from Somalia, 20 from Eritrea, 14 from Ethiopia, 11 from Sudan, 5 from the Central African Republic, 2 from Kenya, and one from Cameroon.

There is no indication that latent TB testing and treatment requirements of refugees in San Diego County have changed since the 2013 study.

The 2013 Rodwell study found that, among refugees in San Diego, the incidence of active TB among refugees in San Diego County is 327 per 100,000. This is more than 100 times greater than the 2.9 per 100,000 incidence rate of active TB among the general population in the United States.

Not only is Starbucks apparently not testing these refugees it is considering hiring for TB — who apparently come from Somalia, Afghanistan, and Syria – many of them may not even have been tested by the federal government for TB in their initial domestic medical screenings.

“Most of the refugees we talked to here in El Cajon say they just got to the country in the last month,” NBC 7’s Danielle Radin reported from the Starbucks refugee hiring event.

An attorney familiar with the federal refugee resettlement program told Breitbart News, “The NBC report validates legitimate concerns that have been raised repeatedly by the very community stakeholders, ie, residents in receiving communities, that the ORR and VOLAGs for years, have deliberately kept out of the resettlement process.”

The attorney added, “With the documented increases of active TB and multi-drug resistant TB brought to communities by foreign nationals, ignoring the high latent TB rates demonstrates a reckless disregard for the public’s health and make state funded TB elimination programs a sad joke.”

The regulations of the federal government’s refugee resettlement program say that initial domestic medical screening reports must be conducted within 90 days of arrival, and must include testing for latent TB. Those initial domestic medical screenings, however, are not mandatory.

In California, it’s estimated that approximately 24 percent of arriving refugees never completed an initial domestic medical screening.

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