Experts Warn of Child Flu Outbreak in Detention Centers

While national attention has been focused on the 2019 novel coronavirus outbreak and efforts to stem person-to-person transmission, a more deadly, yet manageable, disease poses a particular hazard to children residing in Customs and Border Patrol (CBP) detention centers.

Infectious disease experts at the University of Maryland School of Medicine (UMSOM) recently warned of the urgent need for the administration of influenza vaccines among detainees at the southern border.

According to a press release issued by the university, “Over the past year, at least 7 children have died from diseases, including influenza, while being detained by the US Department of Homeland Security’s Customs and Border Protection agency.” Influenza accounted for 3 of the 7 deaths.

As of January 29, more than 8000 Americans have died from a flu infection during this flu season. This number is low compared with the yearly average of 12,000 and 61,000 deaths, NPR reports.

“A flu shot is your best way to protect yourself against getting the flu, and it's still not too late to be vaccinated this season,” the article reads.

However, this year, a viral strain of influenza B has taken a toll on children. The most recent data issued by the CDC show 68 pediatric deaths have occurred this flu season, 45 of which were associated with influenza B viruses. The American Journal of Managed Care^® reported a total of 32 pediatric deaths in mid-January.

Experts argue a mandatory influenza immunization policy for children in conjunction with an opt-out policy for adults should be implemented to prevent outbreaks and deaths in detention centers. They also contend it should be mandatory for employees at these centers to be immunized.

In a recently published article in the New England Journal of Medicine, UMSOM experts Mark Travassos, MD; Carlo Foppiana Palacios, MD; and John J. Openshaw, MD, highlight cases of detained children who did not receive adequate medical attention.

“One of these children, Felipe Alonzo Gómez, did not receive appropriate antiviral medication after being diagnosed with influenza,” they said. “A second child, Carlos Hernández Vásquez, who was also diagnosed with influenza, did not receive appropriate medical monitoring and died in quarantine at a detention facility.”

According to CBP policy, detainees should be transferred within 72 hours of arriving at a facility, but Vásquez was in his sixth day of custody when he died.

“Detention centers have become tinderboxes for infectious-disease outbreaks,” said Travassos, an assistant professor of pediatrics and a pediatric infectious disease specialist at the UMSOM Center for Vaccine Development and Global Health.

However, due to limited access to adequate hygienic care, overcrowding, and physical and emotional stressors compromising immune systems, detainees at detention centers are more susceptible to contracting diseases.

“Detainees are crammed into facilities that are sometimes stretched 5 times beyond their maximum capacity. Investigations suggest that most detainees lack facilities to wash their hands before eating or after using the toilet,” the authors said.

In November, the CDC recommended that migrants 6 months or older receive the flu vaccine, but CBP rejected the recommendation, saying Immigration and Customs Enforcement (ICE) and the Office of Refugee Resettlement (ORR) already offer vaccination services. They also cited logistical difficulties.

In response to these objections, the authors point out the influenza vaccine is simple to administer and has a low risk of adverse effects. In addition, if a detainee was previously immunized, a second administration will have no negative impact on the individual.

“There are some challenges involved in vaccinating the detainee population, including language barriers, poor health literacy, and mistrust of services, and the ethical complexities of obtaining consent when a guardian is absent,” the authors said. However, “None of these barriers is insurmountable or an excuse for leaving an at-risk child unvaccinated.”

A major factor hindering dependence on ICE and ORR for vaccinations is the fact that many migrants and refugees never fall under their care, the authors note. “Many migrants who arrive [at the border] are not being sent to the long-term detention facilities in the United States where the vaccinations are provided. Under the Trump administration’s new, more restrictive policies, thousands are being sent back to Mexico, where many wait in teeming, unhealthy border camps,” according to The New York Times.

ICE Health Service’s Corps’ policy already recommends administration of the measles-mumps-rubella vaccine, if it is determined a detainee has been exposed to the viruses. The authors say this sets a precedent for mandatory influenza vaccines. They believe protocols at detention centers should mirror those at health care facilities across the country.

“The CDC’s Advisory Committee on Immunization Practices recommends that all people who work in health care facilities receive annual influenza vaccines. Research has demonstrated that vaccination of employees of health care institutions can lead to reduced transmission of influenza and pneumonia,” they authors said. Vaccinating detainees will lead to lower costs associated with care of infected patients, and by refusing to vaccinate this population, the government undermines its own efforts to maximize influenza-immunization rates among US citizens, they argue.

The American Academy of Pediatrics (AAP) has been a leading voice in the debate over care received by immigrant children, previously stressing how stays in detention centers jeopardize children’s health.

In a statement issued in September, the AAP's President-Elect Sara H. Goza, MD, said, “No amount of time in detention is safe for a child...The conditions are prison-like, with metal fences, cold, concrete floors, no privacy, unpalatable food, and no access to pediatricians. Children detained in these facilities suffer physical and emotional stress, which increases their risk of serious short- and long-term health problems, developmental delays, anxiety, and depression.”

Some citizens have pushed back against the federal policy. Recently, the Los Angeles County Board of Supervisors voted to challenge CBP’s practices. Supervisor Hilda Solis said in a statement, “The U.S. Customs and Border Protection’s imprudent decision to deny migrant children the flu vaccine while they are detained at a border detention center is reprehensible and irresponsible. Flu outbreaks are common at CBP holding facilities. Unsanitary conditions, overcrowding, and poor nutrition increase the risk for infectious diseases to spread quickly.”

In December, around 20 medical professionals arrived at a detention center near San Diego, planning to immunize everyone within who consented, The New York Times reports. The group was made up physician and nurse members of a health-focused immigrant-rights organization, and it was ultimately denied entry.