CDC Domestic Refugee Health Program
Frequently Asked Questions
The Domestic Refugee Health Program was established to facilitate collaboration between the Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, and its domestic partners, to improve the healthcare of refugees after their arrival in the United States, initiate surveillance activities to monitor medical conditions identified post-arrival, work together to ensure adequate follow-up of refugees with medical conditions identified overseas, and strengthen the resources available for post-arrival health assessments and follow-up activities.
Definitions and Entities
- any individual granted parole status by the Department of Homeland Security as a Cuban/Haitian entrant ; and
- any other national of Cuba or Haiti who:
- was paroled into the United States and has not acquired any other status under the INA;
- is the subject of exclusion or deportation proceedings under the INA; or
- has an application for asylum pending with the Immigration and Naturalization Service; and with respect to whom a final, nonappealable, and legally enforceable order of deportation or exclusion has not been entered (45 CFR § 401.2External).
Although it stands alone as a body of law, the Act is also contained in the United States Code. The code is a collection of all the laws of the United States, arranged in 50 subject titles by general alphabetic order. Title 8 of the U.S. Code, one of the 50 titles, deals with “Aliens and Nationality.”
The CDC’s DGMQ has been delegated certain responsibilities under this act. These responsibilities include:
- providing for the identification of refugees who have been determined to have medical conditions affecting the public health and requiring treatment;
- assuring that State and/or local health officials at the resettlement destination of each refugee are promptly notified of the refugee’s arrival and provided with all applicable medical records;
- providing for such monitoring of refugees identified with medical conditions affecting public health and requiring treatment, ensuring that they receive appropriate and timely treatment; and developing and implementing methods for monitoring and assessing the quality of medical screening and related health services provided to refugees awaiting resettlement to the United States.
Information regarding immigration laws and regulations can be found on the U.S. Citizenship and Immigration Services (USCIS) websiteExternal. Additional information regarding CDC and DGMQ legal authority can be found on the CDC Immigrant, Refugee and Migrant Health website.
Medical Examination: General Information
Medical examinations are valid for 6 months for individuals with the following conditions:
- No Class (i.e., No Apparent Defect, Disease, or Disability)
- Class A Other than TB
- Class B2 Latent TB Infection (LTBI)
- Class B3 TB (Contact Evaluation)
- Class B, all except TB, including specific Class B conditions
- Class B Other conditions
Medical examinations are valid for 3 months for individuals with the following conditions:
- Class A TB with Waiver
- Class B1 TB, Pulmonary
- Blass B1 TB, Extrapulmonary
- HIV infection
However, the validity period for overseas medical examinations may vary depending on the refugee population being referred for resettlement.
Medical Examination: Technical Instructions
Class A conditions include diseases that may pose a threat to public health or may require an individual to be quarantined. Class A conditions include:
- active tuberculosis;
- untreated syphilis;
- untreated gonorrhea;
- Hansen’s disease, which is also known as leprosy;
- pandemic flu;
- severe acute respiratory syndrome (SARS);
- viral hemorrhagic fevers such as Marburg and Ebola;
- smallpox; and
- yellow fever.
The list of diseases that are considered Class A conditions can change. New diseases may be added to the list in the event of a public health emergency, and the President of the United States can issue an Executive Order to make updates to the list of Class A conditions. The World Health Organization may also identify a global public health emergency that requires CDC to update or change the list of Class A conditions.
Other Class A conditions are:
- Physical or mental disorders with current associated harmful behavior or history of associated harmful behavior that is likely to recur; and
- Substance-related disorders
Class B conditions are health-related conditions that may require extensive medical treatment or follow-up. Class B conditions include:
- inactive or noninfectious tuberculosis;
- treated syphilis and other sexually transmitted diseases;
- Hansen’s disease (leprosy), which has been treated or meets certain criteria;
- certain substance-related disorders that are in remission; and
- certain physical or mental disorders that don’t have associated harmful behaviors or behaviors that are likely to recur.
Class B conditions will not prevent a person from being admitted into the United States. However, Class B conditions are significant enough to interfere with a person’s ability to care for themselves or their ability to attend work or school. Class B conditions often require extensive medical treatment or institutionalization.
For additional information, please see the Technical Instructions for Panel Physicians.
Medical Examination: Tuberculosis Evaluation and Testing
Medical Examination: Sexually Transmitted Diseases (STDs)
Medical Examination: Vaccinations
The U.S. Immigration and Naturalization Service – now Department of Homeland Security, United States Citizenship and Immigrant Service – determined that the vaccination requirements do not apply to refugees and nonimmigrants at the time of their initial admission to the United States. However, refugees and V (spouses or children of permanent residents) and K (fiancé(e) of permanent resident) visa holders in the United States must comply with the vaccination requirements when they apply for adjustment of status to Legal Permanent Resident; for refugees, this application occurs 1 year after arrival in the United States.
Additional information about overseas vaccination programs for U.S.-bound refugees is available on the CDC Immigrant and Refugee Health website.
Medical Screening: Domestic Guidelines and Recommendations
Current domestic medical screening guidelines for newly arrived refugees are available on CDC’s Immigrant and Refugee Health website.
Screening should be performed on all refugees unless they decline (opt out). When a refugee declines an HIV test, this decision should be documented in the medical record. Refugees should be clearly informed orally or in writing that HIV testing will be performed. Oral or written information should include an explanation of HIV infection and the meanings of positive and negative test results, and the patient should be offered an opportunity to ask questions. Appropriate referral for care, treatment, and preventive services should be made for all individuals confirmed to be HIV infected.
Notifications and the Electronic Disease Notification (EDN) System
DS forms include the U.S. Department of State Medical Examination for Immigrant or Refugee Applicant (DS-2054) and the associated worksheets:
- DS-3030 (Tuberculosis Worksheet)
- DS-3025 (Vaccination Documentation Worksheet)
- DS-3026 (Medical History and Physical Examination Worksheet)