Influenza is a respiratory disease caused by one of several influenza viruses. Between October and May of each year, the United States sees a rise and peak in the number of cases. According to the best estimates, the disease kills between 12,000 and 79,000 people in the United States, with hundreds of thousands of cases and hospitalizations.
The influenza vaccine is available in the United States in different formulations, and it is recommended to be given to anyone over the age of six months. Unfortunately, the vaccine has a track record of having varied efficacy. That is, the level of protection of the vaccine varies with the strain used for the vaccine, the formulation administered, the circulating strains in the population and the population getting the vaccine. For example, the vaccine may be most effective in preventing disease in children one year and in adults the next. Or it may be most effective against type A influenza one year and against influenza tube B the next.
Nevertheless, the vaccine is recommended because any protection against influenza is better than none. As more and more people in a population (e.g. a classroom, a school or a neighborhood) are immunized, community (herd) immunity kicks in and protects those for whom the vaccine was not very effective. O course, this requires most people to be immunized, something with which public health has been struggling for a while because of the perception that a vaccine that is not as effective as, say, the measles vaccine is not worth it.
Recently, the Trump Administration’s Customs and Border Protection agency announced that it will not provide the influenza vaccine to the thousands of detained immigrants at their facilities. Their reasoning was thus:
“The U.S. won’t be vaccinating migrant families in holding centers ahead of this year’s flu season, despite calls from doctors to boost efforts to fight the infection that’s killed at least three children at detention facilities in the past year.
“In general, due to the short-term nature of CBP holding and the complexities of operating vaccination programs, neither CBP nor its medical contractors administer vaccinations to those in our custody,” a Customs and Border Protection spokeswoman said in an emailed statement.”
From a public health perspective, this is troubling because people concentrated in high numbers — and in conditions reported to be lacking in sanitation and hygiene — represent the perfect situation for many communicable diseases to spread quite quickly. As it is, chickenpox outbreaks are being reported in facilities in Mexico where immigrant families are in a holding pattern while waiting for a decision on their applications for asylum into the United States. (Many Latin American countries do not use the chickenpox vaccine.) Other communicable diseases are soon to follow and enter the country with them.
Another problem with lack of prevention (and hygiene and sanitation) is that these facilities are not a closed system. Not only are detainees coming in and out, or being sent to other facilities, but the staff manning the facilities have direct interaction with the detainees and then go out into their respective communities and home to their families. This whole situation is begging for the detention centers to become major focal points for disease transmission, epicenters of outbreaks.
A proper infection prevention scheme for these facilities begins with proper hygiene and sanitation, so we hope that the deficiencies discovered recently are being addressed. Clean water and soap prevent all sorts of communicable diseases for which we don’t have vaccines licensed for use in the United States, like norovirus or cholera. Next, proper tracking of who is coming in and who is leaving a facility, along with a full medical examination will identify cases of disease who need to be distanced from the rest of the detainees. Tracking will also aid in following-up with people after their release so that, should they become ill, the facility where they came from can be contacted and followed-up for more cases.
While the situation at the border is a political and social problem with complex solutions that are being hotly debated in and out of government institutions. Vaccine-preventable diseases are not as complex to prevent. Clean water, hot food, soap and immunizations would go a long way to making sure that the detention facilities don’t become incubators for diseases that could make people sick far beyond their fences and gates. This is not hard to do, and it would have benefits for public health in general and the health of people seeking refuge in particular.