The Trump administration continued its immigration crackdown this week with a new regulation that allows the government to detain migrants who cross the border illegally “indefinitely.” The announcement came on the heels of news that U.S. Customs and Border Protection (CBP) reportedly has “no plans” to provide influenza vaccinations to the families being held.
Lawmakers and activists immediately moved to condemn both decisions on Twitter, highlighting recent reports that at least three children have died of the flu in detention centers. But while the issue is inciting anger among politicians and the public, for doctors immersed in the field of treating sick kids, it’s uniquely troubling.
Yahoo Lifestyle spoke with two experts, a longtime pediatric researcher and an infectious disease specialist, about why the decision not to vaccinate migrant families poses many threats — especially to kids.
Close proximity increases likelihood of it spreading
William Schaffner, MD, professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine, suggests that the decision puts kids at great risk because of the close living conditions at detention centers. “These group settings...seem to be designed for the rapid spread of communicable diseases,” Schaffner tells Yahoo Lifestyle. “If an infectious agent such as flu is introduced into such a facility, you could get very, very rapid spread.”
According to the Centers for Disease Control and Prevention, while influenza can be transmitted year-round, it is most commonly spread during the fall and winter. The 2017-2018 flu season in the U.S. was classified as a “high severity,” with 48.8 million cases and more than 22.7 million medical visits.
Flu is only one of many communicable diseases
James D. Cherry, MD, a distinguished research professor at the David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital division of infectious diseases, says that influenza is just one of many diseases that children in detention centers are susceptible to. “You can be absolutely sure that there will be flu outbreaks, [but] there will likely be others, like measles, if they're not up on measles vaccines,” he says. “Particularly in a crowded circumstance.”
Schaffner agrees, saying that the danger is “not limited” to flu. “It could be measles, mumps, chicken pox — any number of infectious viruses could be introduced,” he says. “The environment in which these children are being [held] is an ideal environment for the transmission and spread of contagious infectious diseases.”
Overcrowding may cause more severe illnesses
Cherry, who has been researching vaccines and preventable diseases for over 50 years, explains that the illnesses children and families may be exposed to in holding centers will likely be more severe. “With influenza, the virus is spread from other people's respiratory secretions, but the amount in just a sporadic case is less than in a situation of close contact,” Cherry tells Yahoo Lifestyle. “There's actually a bigger dose — and more virus spread — which could lead to more serious illness.”
Schaffner calls this a “reasonable hypothesis.” He tells Yahoo Lifestyle, “You wouldn't just get one exposure, but you would be continually exposed to infected people in this environment. It's quite possible that...this would lead to more severe infections.”
Malnutrition and stress can exacerbate symptoms
One of Schaffner’s biggest concerns — which Cherry shares — is that the children entering detention centers are coming with already-weakened immune systems. “Influenza is likely to be more severe among a group of children who come from very stressful and less than optimal circumstances in terms of their nutrition and growth and development,” says Schaffner. “These are children who likely have more underlying medical problems than children born and raised in suburbia. Obviously, they have been through an extraordinarily stressful period of time coming to the border and their nutrition is very likely not to be optimal.”
Both doctors say that this can impact how well an individual can fight off the disease. “Illnesses are worse with varying degrees of malnutrition,” says Cherry. “Flu kills almost 80,000 people a year in the U.S., and the majority of those deaths are in young children and older adults. People who are not in good health are more likely to die from flu than otherwise robust people.”
Failing to vaccinate kids puts them in more danger
While the flu vaccine has limitations, according to research from the CDC, it has been successful in preventing an average of 5 million cases of influenza each year. The vaccine is particularly important for children. In a 2014 study from the Journal of Infectious Disease, researchers found that it may reduce the risk of flu-related pediatric intensive care visits by 74 percent. Another study, published in Pediatrics in 2017, found that the vaccine “significantly reduced” a child’s risk of dying from the flu.
While Schaffner notes the flu vaccine is “not perfect,” he suggests that not giving it to kids in detention centers is irresponsible. “Not vaccinating these children does not meet the standard of care for doctors...we need to think about prevention from the moment [these children] become the responsibility of the citizens of the United States,” he says. “CBP can't just say, ‘Gee, this isn't our major responsibility.’” On top of vaccines, Schaffner says doctors should be providing “comprehensive health screenings” to kids and families at the border to check for other illnesses as well.
Cherry agrees, arguing that ignoring prevention is both morally and medically wrong. “It's certainly not what we pediatricians believe is what's right,” he says. “A lot of dedicated pediatricians have been helping and they may see that immunizations get done. That’s what I would hope will happen.”
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