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Border Report: Diseases Don't Stop at the Border

U.S. residents who’ve contracted infections at a Tijuana hospital drive home the extent to which preventing diseases and infections requires cross-border collaboration.

A view of Tijuana and the U.S.-Mexico border fence / Photo by Sam Hodgson

Some U.S. residents who have had non-emergency surgeries in Tijuana have returned with drug-resistant bacterial infections.

The outbreak prompted the Centers for Disease Control and Prevention to issue a warning in January, the Washington Post reported. It urged travelers to avoid surgery at Grand View Hospital in Tijuana, linked to eight of the infections at the time, until Mexican authorities could confirm its safety.

To date, there have been 32 reported cases in 16 different states, 20 of which are confirmed and 12 suspected, said Dr. Ian Kracalik, a CDC epidemic intelligence officer. The first cases were reported to the CDC in September 2018.

Dr. Eric McDonald, medical director of the San Diego County public health department’s epidemiology and immunization services branch, said his office became aware of two local cases, one in October and one in January, after issuing a preliminary notice to doctors on Jan. 16. Neither of those cases, he said, involved a San Diego County resident — one lived elsewhere in California and another lived out of state.

He said two other patients, both of whom live in San Diego County but who had weight-loss surgeries at Tijuana hospitals other than Grand View, were admitted to area hospitals with infections that are also under investigation.

McDonald said they hadn’t seen cases in California or San Diego until the CDC’s national alert, which let members of the medical community know they must report such infections to local health authorities.

Infections and disease crossing the border isn’t new. Public health was one of the reasons San Diego County got involved in efforts to provide shelter and care to asylum-seeking families crossing the border.

San Diego County, the state of California and the CDC all have binational offices that communicate frequently with their Mexican counterparts. In 2013, a series of meningococcal cases spread through the Tijuana and San Diego regions.

“We have a very interdependent and interconnected community,” said Justine Kozo, the chief of the county’s Office of Border Health. “Having a physical border does nothing to stop diseases. If we give public health information on this side of the border that is different than what’s given on the other side, then we’re giving the same community different information.”

Health officials from both sides of the border are in constant communication, and meet regularly to discuss health issues impacting both sides.

“Many people go across the border for their health care,” McDonald said. “Many San Diegans use the health care system in Mexico and it’s a different system than ours. We are a true binational community in which we have these regular means of communication on these issues. Hospital-acquired infections and outbreaks that involve patients traveling between jurisdictions give a little extra complexity, but it is something that we have processes to handle.”

Dr. Maroya Walters, a CDC epidemiologist, said the goal is to improve infection control so patients are no longer at risk and the infections are no longer happening.

“Our surveillance is better than it’s been before, but it’s still only moderately good in terms of knowing what’s happening, so we know we miss cases,” Walters said. For the latest outbreak, the CDC received names of individuals who were exposed at the Grand View hospital in 2019 through a travel agency and is reaching out to them to see if they’ve developed infections.

“We don’t have a great understanding of what’s exactly happening in this facility,” Walters said. Some evidence suggests the infection is coming from a point source, like a medical device that was continually contaminated. “But we don’t have the epidemiological data of the environmental sampling to help confirm that hypothesis,” she said.

Court Temporarily Allows Policy Requiring Asylum-Seekers to Wait in Mexico

On Friday, the 9th U.S. Circuit Court of Appeals temporarily allowed a policy forcing migrants to stay in Mexico while their asylum claims are processed to continue, Buzzfeed News reports. The decision came after a federal judge in San Francisco temporarily blocked the policy.

As of last week, more than 700 people had been returned to Tijuana and almost 200 more to Mexicali, the Union-Tribune reports.

The Latest on Cross-Border Water Issues

VOSD’s Ry Rivard wrote about Mexico’s role in helping solve California and Arizona’s water problems.

Assemblyman Todd Gloria and other officials met with Baja California officials to discuss future collaboration and potential California funding to address Tijuana’s lack of wastewater infrastructure. (Union-Tribune)

More Border News

  • U.S. Customs and Border Protection officials have temporarily reassigned 51 officers in California to help process, transport and care for migrants crossing the border illegally. The shift is resulting in lengthy border waits, lane closures and reduced hours of operations at ports of entry. (KQED)
  • The number of Mexicans repatriated from the United States has decreased by 17 percent. (24 Horas)
  • Baja California leaders have contracted more debt – more than 90 billion pesos – to refinance existing debt and other infrastructure projects, like the Rosarito desalination plan. (Zeta)
  • The Los Angeles Times and ProPublica took a comprehensive look at deadly high-speed Border Patrol chases.
  • Researchers from El Colegio de la Frontera Norte released another report about November 2018’s caravan as they continue to follow the circumstances and outcomes of the thousands of Central Americans who came to Tijuana last year.
  • The Netflix series “Tijuana,” which tells the story of a group of Mexican journalists who investigate the assassination of a gubernatorial candidate, debuted earlier this month. The reporters and their publication in the series were inspired by the Tijuana-based news organization Zeta. (Sin Embargo)
  • A $40 million mixed-used development project in Tijuana trying to attract foreign investors who need office space in the city will break ground soon. (Union-Tribune)
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