DGMQ Home > Medical Examinations of Aliens > Technical Instructions, Information, and Updates > Technical Instructions for Panel Physicians > Background: 2007 Instructions-Tuberculosis
Background on the 2007 Technical Instructions for Tuberculosis Screening and Treatment
The Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians, as part of requirements for immigration to the United States, have been revised. The previous screening algorithms were issued in 1991. To prevent applicants with smear-positive tuberculosis from traveling to the United States, the 1991 system relies on chest radiograph findings and sputum smears among overseas foreign national applicants 15 years of age or older. The 1991 system misses applicants with smear-negative but culture-positive tuberculosis, as well as tuberculosis in applicants <15 years of age. Moreover, the 1991 requirements do not provide guidance specifying the quality of treatment applicants with tuberculosis should receive prior to travel.
The Division of Global Migration and Quarantine (DGMQ), along with the CDC Division of Tuberculosis Elimination, has updated the Technical Instructions. Scientific literature was reviewed, including published recommendations from the U.S. tuberculosis community, and representatives of the U.S. tuberculosis community were invited to provide input.
Significant changes in the 2007 Technical Instructions for Tuberculosis Screening include requiring:
- Tuberculin skin tests (TST) for applicants <15 years of age in countries with a World Health Organization (WHO)-estimated tuberculosis incidence rate >20 per 100,000.
- All applicants <15 years of age with TST ≥5 mm will be required to have a chest radiograph.
- Mycobacterial cultures for applicants with chest radiographs suggestive of tuberculosis disease.
- Treatment under a directly observed therapy (DOT) program.
- Completion of treatment prior to immigrating to the United States, according to American Thoracic Society/CDC/Infectious Diseases Society of America guidelines.
- New TB classifications for all applicants with suspected latent Mycobacterium tuberculosis infection and for contacts for cases of tuberculosis disease.
Implementation of the 2007 Technical Instructions is expected to increase detection of tuberculosis overseas, decrease importation of tuberculosis, help prevent development of drug resistance overseas among persons applying for U.S. immigration, and contribute to global tuberculosis control efforts.
DGMQ is working with the CDC Division of Tuberculosis Elimination, the Department of State, the International Organization for Migration, panel physicians, and other organizations to implement these changes. The Technical Instructions are being implemented first in priority countries as determined by immigration patterns and tuberculosis burden. State and local health departments will be notified when the new instructions begin to be applied to specific populations.
As the instructions are phased in, the DGMQ website will provide information on countries where the instructions are being utilized.