Health Status of Haitian Migrants -- U.S. Naval Base, Guantanamo Bay, Cuba, November 1991-April 1992

In November 1991, following a military coup in Haiti, thousands of Haitians fled that country in small open boats. Most migrants were intercepted by U.S. Coast Guard cutters and taken to the U.S. Naval Base at Guantanamo Bay (GTMO), Cuba (Figure 1), where the U.S. Department of Defense (DOD) established a joint task force (JTF) migrant relief operation. * This report summarizes the results of health assessments of migrants conducted by the JTF.

JTF personnel provided all medical care and carried out the medical screening required for entry into the United States. For this report, medical data examined were obtained from medical screening on arrival at GTMO, outpatient clinic logs, inpatient hospital records, and results of chest radiographs and laboratory tests required for entry. Results of arrival screening, outpatient visits, and hospital admissions were reviewed weekly to calculate rates for the major categories of illness (e.g., "respiratory," "gastrointestinal," and "dermatologic"). Possible cases of highly contagious illnesses (e.g., varicella and measles) were reported to a designated JTF medical officer immediately.

During November 1991-April 1992, approximately 18,000 migrants received medical care from the JTF. During that period, the camp population fluctuated between approximately 3000 and 12,000. Overall, an estimated 75% of the migrants were male. Based on persons in the camp during the first month, 6% were 0-9 years of age; 19%, 10-19 years; 48%, 20-29 years; 20%, 30-39 years; and 7%, greater than or equal to 40 years.

Most persons had been at sea approximately 2-3 days when intercepted; on arrival at GTMO, none were considered to have been overtly malnourished. Acute medical problems encountered by Coast Guard shipboard health-care workers included minor injuries (e.g., abrasions), dehydration, and skin infections. Outpatient visits after arrival primarily were for acute minor illnesses; rates were highest for dermatologic complaints (9 cases per 1000 persons per week) and respiratory infections (6 per 1000 per week).

Approximately 2000 persons were treated at the main medical treatment facility, including many who were admitted to ensure compliance with medication schedules because language differences impeded recall and follow-up of patients. Of 1030 patients discharged from the facility from December 16, 1991, through April 4, 1992, fever/malaria (suspected, probable, and confirmed) was diagnosed in 360 (35%); otitis media, upper respiratory infection, or viral syndrome in 100 (10%); active tuberculosis (TB) in 88 (9%); measles in 58 (6%); pneumonia in 40 (4%); varicella in 40 (4%); cellulitis or abscess in 23 (2%); filariasis in 16 (2%); and "other" in 305 (30%). Two deaths occurred during hospitalization (one woman who had an ectopic pregnancy, and one stillborn infant), and 22 live infants were born.

Malaria was the most common discharge diagnosis for patients admitted with fever; monthly rates of smear-positive falciparum malaria in febrile patients varied from 18% to 48%. All 235 patients with laboratory-confirmed malaria responded well to oral chloroquine treatment.

Based on microscopic examination of peripheral blood smears, 29 cases of clinically suspected filariasis were confirmed. Of these, 25 patients were infected with Mansonella ozzardi, two with Wuchereria bancrofti, and two with both species. This disease commonly manifested as scrotal swelling. The one female patient had elephantiasis of the leg.

Two outbreaks of infectious disease (one each of varicella {during January 27-February 18} and measles {during February 4- March 13}) occurred at GTMO. The measles outbreak was controlled by use of a measles-mumps-rubella (MMR) vaccination program targeted first at children aged less than 5 years, then at all migrants in the camps. During the vaccination program, all persons received age-appropriate vaccines (i.e., diphtheria and tetanus toxoids and pertussis vaccine or diphtheria and tetanus toxoids, oral polio vaccine, MMR, and Haemophilus influenzae type b conjugate vaccine).

Syphilis, human immunodeficiency virus (HIV), and TB tests, as required by the Immigration Act of 1990, ** were performed for 7315 persons aged greater than or equal to 15 years. Of these, 366 (5%) had serologic evidence of past or present syphilis infection and 479 (7%) were positive for HIV. Of the approximately 7700 persons aged greater than or equal to 2 years who received chest radiographs, abnormalities suggested pulmonary TB in approximately 5%. Of those, approximately 30% had findings suggestive of active infection and were evaluated further with sputum smears and cultures. Antimicrobial sensitivity testing of the 29 Mycobacterium tuberculosis isolates identified six (21%) that were resistant to isoniazid.

Reported by: DS Herip, CDR, MC, DD Slaten, LCDR, MC, Epidemiology Dept, Navy Environmental and Preventive Medicine Unit No. 2, Norfolk, Virginia. Div of Quarantine, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The joint efforts of the DOD and the Public Health Service at GTMO addressed both the acute health and public health needs of this large group of Haitian migrants. Previous collaborative efforts have played a role in providing emergency health care in circumstances such as the Cuban migration of 1980 and the aftermath of Hurricane Andrew in August 1992 (1-3).

Specific needs in these circumstances include the treatment of acute conditions, provision of vaccinations, and controlling and preventing transmission of TB and other infectious diseases. In addition, information on the demographic characteristics and health status of migrant populations can be distributed to resettlement agencies and state and local health departments in advance of entry of migrants. This information may assist in planning for and addressing acute-care problems (e.g., intestinal parasites, TB, malaria, filariasis, and vaccination needs) during resettlement.

Additional information about the JTF is available from Commander Donald Herip or Lieutenant Commander Douglas Slaten, Epidemiology Department, Navy Environmental and Preventive Medicine Unit No. 2, Building X-336, Norfolk, VA 23511-6288; telephone (804) 444-7671; fax (804) 444-1191.

References

1. CDC. Health status of the Cuban refugees. MMWR 1980;29:217-8.

2. CDC. Follow-up on the health status of the Cuban refugees. MMWR 1980;29:255-6.

3. CDC. Rapid health needs assessment following Hurricane Andrew -- Florida and Louisiana, 1992. MMWR 1992;41:685-8.

• Consisting of DOD, the U.S. Department of Justice, the Public Health Service (including CDC), and other agencies. ** 8 U.S.C. 1101 et seq as amended.

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