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Best In Science

More Immigrants Being Screened for Tuberculosis

Ever wonder if CDC has the authority to prevent infectious diseases from entering the United States? It does. In fact, CDC has recently rewritten the rules on how countries should screen and treat people with tuberculosis before they arrive in this country. This will result in states saving an estimated $2 million in 2009 alone.

Medical screening for tuberculosis is legally required before applicants for US immigration (both immigrants and refugees) can receive a visa and enter the United States. Because of CDC’s authority, CDC is working on programs to decrease illness and death among immigrants and refugees and to prevent diseases from entering the United States. These efforts include building a Domestic Refugee Health Program, implementing the Electronic Disease Notification (EDN) system, publishing revised tuberculosis technical instructions, and developing a Refugee Health Initiative.

The Domestic Refugee Health Program assists refugees with the health aspects of resettlement and provides recommendations to physicians for post-arrival health assessments and preventive health interventions. This program also works with health departments to better understand the health problems that refugees face after arrival. The long-term goal of the Domestic Refugee Health Program is the standardization of medical services for refugees.

A long-term initiative now reaching maturity is EDN, an electronic, secure web-based system for notifying health departments of the arrival of immigrants and refugees. This system ensures that refugees receive a prompt post-arrival medical evaluation. As of October 1, 2008, the more cost-efficient EDN replaced the nationwide, slower, hard-copy notification system that depended on the mail service. All 50 states are receiving notifications through EDN.

In addition, CDC modernized the tuberculosis technical instructions used to screen overseas applicants for US immigration in 2007. The revised instructions identify additional tuberculosis cases by incorporating modern diagnostic testing and addressing appropriate treatment prior to arrival in the United States. By the end of Fiscal Year 2008, 28% of US-bound immigrants were screened for tuberculosis.

Implementing the revised instructions is anticipated to result in three times as many cases of tuberculosis being detected overseas and treated prior to arrival in the United States, allowing for diagnosis and treatment to occur prior to foreign-born persons entering the country. The decreased burden of diagnosis and treatment in the United States will lead to an estimated annual cost savings that will reach into the tens of millions, providing leadership in the global effort to control tuberculosis. This work supports CDC’s Health Protection Goal of People Prepared for Emerging Health Threats.

Additional information about the 2007 tuberculosis technical instructions and a listing of populations being screened can be found online at www.cdc.gov/ncidod/dq/panel_2007.htm.

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