title: Implementation of new TB screening requirements for U.S.-bound immigrants and refugees - 2007-2014.
abstract: For more than two decades, as the number of tuberculosis (TB) cases overall in the United States has declined, the proportion of cases among foreign-born persons has increased. In 2013, the percentage of TB cases among those born outside the country was 64.6%. To address this trend, CDC has developed strategies to identify and treat TB in U.S.-bound immigrants and refugees overseas. Each year, approximately 450,000 persons are admitted to the United States on an immigrant visa, and 50,000-70,000 are admitted as refugees. Applicants for either an immigrant visa or refugee status are required to undergo a medical examination overseas before being allowed to travel to the United States. CDC is the federal agency with regulatory oversight of the overseas medical examination, and panel physicians appointed by the U.S. Department of State perform the examinations in accordance with Technical Instructions (TI) provided by CDC's Division of Global Migration and Quarantine (DGMQ). Beginning in 1991, the algorithm for TB TI relied on chest radiographs for applicants aged ≥15 years, followed by sputum smears for those with findings suggestive of TB; no additional diagnostics were used. In 2007, CDC issued enhanced standards for TB diagnosis and treatment, including the addition of sputum cultures (which are more sensitive than smears) as a diagnostic tool and treatment delivered as directly observed therapy (DOT). This report summarizes worldwide implementation of the new screening requirements since 2007. In 2012, the year for which the most recent data are available, 60% of the TB cases diagnosed were in persons with smear-negative, but culture-positive, test results. The results demonstrate that rigorous diagnostic and treatment programs can be implemented in areas with high TB incidence overseas.
authors.forename: Drew L
authors.initials: DL
authors.lastname: Posey
authors.forename: Mary P
authors.initials: MP
authors.lastname: Naughton
authors.forename: Erika A
authors.initials: EA
authors.lastname: Willacy
authors.forename: Michelle
authors.initials: M
authors.lastname: Russell
authors.forename: Christine K
authors.initials: CK
authors.lastname: Olson
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Godwin
authors.forename: Pamela S
authors.initials: PS
authors.lastname: McSpadden
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: White
authors.forename: Terry W
authors.initials: TW
authors.lastname: Comans
authors.forename: Luis S
authors.initials: LS
authors.lastname: Ortega
authors.forename: Michael
authors.initials: M
authors.lastname: Guterbock
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Weinberg
authors.forename: Martin S
authors.initials: MS
authors.lastname: Cetron
mesh_terms: D000293:Adolescent; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence*; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D006801:Humans; D059425:Interferon-gamma Release Tests; D008403:Mass Screening / Q000331:legislation & jurisprudence* / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D017410:Practice Guidelines as Topic; D016730:Program Development; D012036:Refugees / Q000331:legislation & jurisprudence*; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology