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No. 3, 2012

October 1, 2013, Deadline for 2007 TB TI implementation

On August 9, 2012, staff of the Medical Assessment and Policy (MAP) Team of CDC’s Division of Global Migration and Quarantine (DGMQ) held a webinar with U.S. Consular Sections around the world. In the webinar, DGMQ staff conveyed an important update regarding TB screening of immigrants and refugees: all U.S. panel physicians worldwide must begin screening for TB according to DGMQ’s 2007 Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy as soon as they are able, and no later than October 1, 2013. 

All persons applying to enter the United States as immigrants or refugees must undergo medical screening for various conditions, including TB, prior to departure. This screening is carried out by panel physicians, using TB Technical Instructions (TB TI) developed by DGMQ.

The original TB TI, issued in 1991, required a chest radiograph and, for anyone with an abnormal chest radiograph, three sputum samples. DGMQ updated the TB TI in 2007, requiring sputum culture in addition to sputum smears, drug-susceptibility testing for all positive cultures, and direct observation of therapy for treatment of TB. Implementation of the 2007 TB TI is being scaled up to additional countries each year, with implementation based on several factors such as a country’s rate of TB, the number of immigrants and refugees coming from that country to the U.S., and other pertinent factors.

Implementation of the updated TB TI has thus far resulted in a three-fold increase in the overseas detection of TB, and is positively affecting U.S. TB control efforts. DTBE and DGMQ have been collaborating in carrying out site visits to the various countries as they implement the updated TB TI. Both divisions are excited about the prospect of completing implementation of the 2007 TB TI. Completing this transition is expected to further reduce the burden of TB in foreign-born persons in the United States and to contribute to international TB control efforts.

The current TB Technical Instructions, as well as other information pertinent to them and the medical examination for applicants for U.S. immigration, can be found online at If you have any questions about these TB Technical Instructions, you may contact the Immigrant, Refugee, and Migrant Health Branch of DGMQ, CDC, at or 404-498-1600.

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

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