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2007 Technical Instructions for Tuberculosis Screening and Treatment
Addendum: Instructions for Applicants 10 Years of Age or Younger
September 28, 2009
This document corrects typographical errors in the Addendum posted September 18, 2009; the requirements are unchanged.
CDC has developed the following addendum instructions for travel clearances for applicants 10 years of age or younger. The criteria described in these addendum Technical Instructions are based on physiologic aspects of childhood tuberculosis disease and children’s ability to transmit tuberculosis disease. These criteria do not apply to adults or children with tuberculosis disease associated with higher levels of transmissibility.
Applicants 10 years of age or younger who require sputum cultures, regardless of HIV infection status, may travel to the United States immediately after sputum smear analysis (while culture results are pending) if none of the following conditions exist:
- Sputum smears are positive for acid-fast bacilli (AFB). If the applicant could not provide sputum specimens and gastric aspirates were obtained, positive gastric aspirates for AFB do not prevent travel while culture results are pending.
- Chest radiograph findings include―
- One or more cavities
- Extensive disease (e.g., particularly if involving both upper lobes)
- Respiratory symptoms include forceful and productive cough
- Known contact with a person with multidrug-resistant tuberculosis (MDR TB) who was infectious at the time of contact
For applicants 10 years of age or younger who travel to the United States while results of cultures are pending, panel physicians should―
- Give the applicant a Class B1 TB, Pulmonary classification
- Document that culture results are pending on the Chest X-Ray Worksheet (DS 3024 [until September 30, 2009] or DS 3030 [beginning October 1, 2009]
- Forward culture results to DGMQ “Quality Assessment Program” via fax at 404-639-4441 so that DGMQ can forward the culture results to the receiving health departments
Panel physicians should provide the DS Forms based on the date of intended travel. If an applicant 10 years of age or younger will not travel until after culture results are to be reported (assuming they are negative), the panel physicians should wait until that time before completing the DS Forms. If the applicant 10 years of age or younger will travel while results of cultures are pending, the panel physician should provide DS Forms while cultures are pending.
Panel physicians should not delay treatment of applicants 10 years of age or younger for whom there is high suspicion of tuberculosis disease and who would benefit from therapy being started prior to departure to the United States. Consistent with other applicants started on tuberculosis treatment prior to travel, if therapy is started for an applicant 10 years of age or younger, the applicant is Class A for tuberculosis. A Class A waiver petition can be filed so that the waiver petition could be reviewed and the applicant can travel to the United States before completion of therapy. CDC supports the filing of waiver requests for young children with tuberculosis disease so that the waiver application may be reviewed and adjudicated in a timely manner.