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October 24/31, 2007

Extensively Drug-Resistant Tuberculosis and Public Health—Reply

JAMA. 2007;298(16):1861-1862. doi:10.1001/jama.298.16.1861-b

In Reply: We disagree with Dr Brewer regarding his CDC classification of Andrew Speaker. The CDC has recently revised its tuberculosis screening protocols for immigrant visa applicants, emphasizing the importance of TB cultures in addition to acid-fast bacilli (AFB) smear microscopy. The Centers for Disease Control and Prevention's Division of Global Migration and Quarantine (DGMQ) and Division of Tuberculosis Elimination (DTE) have posted new TB technical instructions for overseas panel physicians performing screening examinations for individuals applying for permanent visas.1 These technical instructions have been revised over the past 2 years with the accretion of new scientific evidence documenting TB transmission from smear-negative, culture-positive patients and the continued emergence of drug-resistant TB (MDR and XDR).24

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