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Revision of Technical Instructions for Panel Physicians

The Division of Global Migration and Quarantine (DGMQ) has completed the revision of the Technical Instructions for panel physicians. Since 2005, DGMQ has been working with DTBE to review scientific literature on overseas pre-immigration medical screening and develop new algorithms. Input was also solicited from the U.S. tuberculosis community. The 2007 Technical Instructions for Tuberculosis Screening and Treatment (TB TIs) provide a modernized approach to TB screening overseas for U.S. immigration applicants. For the first time, mycobacterial cultures will be required for applicants suspected of having TB disease. Moreover, drug susceptibility testing (DST) on positive isolates and directly observed therapy (DOT) according to CDC / American Thoracic Society (ATS) / Infectious Diseases Society of America (IDSA) standards will be required for applicants with TB disease. It is expected that implementation of the 2007 TB TIs should help prevent importation of TB into the United States, improve U.S. domestic TB control, and increase TB infrastructure globally.

The 2007 TB TIs were first implemented in April 2007 for the screening of 14,000 Burmese refugees from Thailand who were to be resettled to the United States. The 2007 TB TIs have also been recently implemented for all applicants from Mexico and the Philippines. Global implementation will occur over the next several years, beginning in priority countries determined by immigration patterns, refugee resettlements, burden of TB, and U.S. domestic foreign-born TB case rates.

—Reported by Drew Posey, MD
Div of Global Migration and Quarantine


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