*This is an archive page. The links are no longer being updated. 
1991.01.25 :  Communicable Diseases and Foreign Visitors

Contact: Don Berreth (404) 639-3286
January 25, 1991

       The Department of Health and Human Services today proposed
that starting June 1 infectious tuberculosis would be the only
communicable disease which would exclude foreign visitors,
workers, refugees and immigrants.
       The Immigration Act of 1990 eliminated the category of
"dangerous contagious" diseases that have been listed as bars to
travel and immigration.  The act instructed the HHS secretary to
develop a new list of "communicable diseases of public health
significance" based on medical and scientific considerations
alone.      The medical experts consulted agreed that infectious
tuberculosis should be on the list but that the other seven
conditions -- leprosy and six sexually transmitted diseases,
including HIV infection -- should not be considered as medical
reasons for barring people under the new law.  A formal proposal
reflecting that view was published in the Jan. 23 Federal
Register for public comment. 
       A medical examination with chest X-ray would continue to
be required for adult immigrants.  Other requirements will remain
in effect to ensure that immigrants or foreign workers in the
United States have the financial resources or responsible
sponsors so they do not become medical or welfare dependents.

       Under the law, drug abusers and addicts and people who are
likely to cause harm because of a history of such behavior
associated with mental health conditions would be excluded. 
Regulations governing such aliens will be announced later.
       Under existing regulations, the list of dangerous
contagious diseases includes five sexually transmitted diseases -
- infectious syphilis, gonorrhea, granuloma inguinale,
lymphogranuloma venereum and chancroid.  HIV was added at the end
of 1987 by Congress.  Infectious leprosy and active tuberculosis
round out the current list of eight.  
       The Centers for Disease Control, an agency of the Public
Health Service within the Department of Health and Human
Services, reviewed diseases in consultation with non-federal
experts in infectious disease and public health and concluded
that, from a public health standpoint, sexually transmitted
diseases, including HIV infection, should not be on the list of
excludable conditions.  

       HHS Assistant Secretary for Health James O. Mason, M.D.,
who heads the Public Health Service, endorsed the CDC's
conclusions and forwarded them to HHS Secretary Louis W.
Sullivan, M.D., who concurred.  Dr. Sullivan said, "AIDS evokes
an emotional response from many--and that's understandable--but
we have been virtually the only major country to try to bar HIV-
infected travelers.  This policy will bring us in line with the
best medical thinking, here and abroad."

       In reaching their conclusions using the "communicable
disease" definition of the new law, the medical experts agreed:

--   Sexually transmitted diseases, including HIV infection, are
     not spread by casual contact, through the air, or from food,
     water or other objects, nor will an infected person in a
     common public setting place another individual inadvertently
     or unwillingly at risk.

--   HIV infection is transmitted among adults in this country
     almost exclusively by two routes:  sexual intercourse with
     an infected person, and sharing of contaminated injection
     equipment by injection drug users.  The risk of (or
     protection from) HIV infection comes not from the
     nationality of the infected person, but from the specific
     behaviors that are practiced.  The best defense against
     further spread of HIV infection, whether from a U.S. citizen
     or alien, is an educated population.  

--   Leprosy (Hansen's disease) is spread only through prolonged
     contact with an infected person.  Most imported cases occur
     in persons who do not manifest outward signs of the disease
     when they are medically screened abroad.  Effective drugs
     are now available for treating this disease and suppressing
     its infectiousness.  In recent years, management of patients
     with Hansen's disease has substantially changed from
     isolation from society to ambulatory treatment.  There is a
     nationwide system in the United States to provide
     comprehensive care and treatment to persons diagnosed with
     Hansen's disease.

--   Infectious tuberculosis is proposed for inclusion on the
     list because the disease can be transmitted through the air,
     and an infectious person places others at risk through
     casual contact.  The tuberculosis bacillus is carried in
     airborne particles that can be generated when persons with
     pulmonary or laryngeal tuberculosis sneeze, cough, speak or
     sing.  The disease can be spread by normal air currents in a
     room, building or airplane.

     The CDC and the non-federal experts were also asked if there
should be any other communicable diseases on a list of excludable
conditions, and they agreed that no other diseases should be
added.  However, the Public Health Service, through the World
Health Organization, maintains worldwide surveillance of
communicable diseases and will add diseases to the list when
necessary.

The comment period will close Feb. 22, *This is an archive page. The links are no longer being updated. 
1991. Comments should be
addressed to:  Director, Division of Quarantine, Center for
Prevention Services, Centers for Disease Control, Mail Stop E03,
Atlanta, Ga.  30333.

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