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Factsheet: CDC Global Tuberculosis Control Activities for U.S. Immigration

About Tuberculosis

Tuberculosis (TB) is a disease that usually affects the lungs, but can be found in any part of the body. TB bacteria can be spread through the air when someone with active TB coughs, speaks, sneezes, or sings. TB can lead to death if it is not treated.

To test for TB, patients have a chest x-ray and skin test and provide a sputum sample (i.e., a small amount of mucus from deep in the lungs). Each sputum sample is looked at by a lab to see if TB bacteria are present.

CDC’s Role in TB Control among Immigrant and Refugee Populations

CDC’s Division of Global Migration and Quarantine (DGMQ) sets guidelines for TB testing and treatment for those who seek permanent residence in the United States. DGMQ has the legal authority to set health screening standards for this group. These standards are known as Technical Instructions.

Changes in CDC Technical Instructions for TB

CDC issued 1991 TB Technical Instructions that called for a chest x-ray and three sputum samples from those who were thought to have TB.

In 2007 CDC updated the TB Technical Instructions by adding—

  • Cultures for those thought to have TB. This test attempts to grow any TB bacteria that may be in the sputum sample. Once colonies (or groups) of bacteria form, they can be checked for TB. The culture makes TB testing more accurate.
  • Drug susceptibility testing (DST) on positive TB cultures. This will show which drugs are likely to kill the type of TB bacteria found.
  • A new process for TB treatment before U.S. arrival:
    • TB drugs are given as directly observed therapy (DOT), in which medical staff give patients their TB drugs in person.

Reasons for Changing Technical Instructions

Use of the TB TIs using Cultures and Directly Observed Therapy (DOT)

  • Increases the number of TB cases found by two to three times
  • Reduces TB brought into the United States
  • Lowers the number of hard-to-treat (or drug-resistant) TB cases
  • Improves TB control in U.S. immigrant and refugee groups

Applying the TB TIs using Cultures and Directly Observed Therapy (DOT)
CDC is working to apply the TB TIs using Cultures and Directly Observed Therapy (DOT) globally. Countries are phased in based on—

  • The number of immigrants coming to the United States
  • The number of refugees resettling to the United States
  • The health care resources in the country.
  • Rates of TB in the country
  • The rate of TB in immigrant groups in the U.S.

Results of Changes to Technical Instructions

The TB TIs using Cultures and Directly Observed Therapy (DOT)now

  • Support the goals of the STOP TB Partnership and the World Health Organization (WHO)
  • Follow the Tuberculosis Coalition for Technical Assistance International Standards for Tuberculosis Care
  • Promote progress in developing nations—
    • Five new overseas labs have opened since April 2007; others offer more services
    • These labs can perform cultures and DST
    • Three of these labs are in countries cited by WHO as having a very high burden of TB—Kenya, Thailand, Vietnam

For More Information

Immigrant, Refugee, and Migrant Health Branch
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
1600 Clifton Road, NE, MS E-03
Atlanta, Georgia, USA 30333
Phone: 404-498-1600
Tuberculosis Technical Instructions using Cultures and Directly Observed Therapy (DOT)

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